Modificação do fenótipo linfocitário e aumento da sobrevida do enxerto de pele após a terapia com FTY720 + FK506

The development of new drugs to be associated with calcineurin inhibitors and promote additional immunosuppression with fewer side effects is the goal in transplantation. FTY720 is a new synthetic compound which presents immunomodulatory properties which are not fully understood. It has been reported that the main mechanism of action of FTY720 is to reduce the peripheral lymphocyte count by redirecting these cells toward secondary lymphoid organs. Skin allograft transplantation in a fully mismatched strain combination was used to investigate the potential of FTY720 alone or in combination with a calcineurin inhibitor - FK506 - in preventing rejection. The number and phenotype of immune system cells was also evaluated. FTY720 alone or in combination with FK506 provided significant skin allograft survival. FTY720+FK506 therapy was associated with decreases of total lymphocyte numbers in spleen and blood, and increases in apoptosis levels in splenocytes. In FTY720 isolated treatment, a significant decrease in the CD4 expression and significantly lower expressions of MHC II and ICAM-1 molecules were observed in spleen lymphocytes. Despite of allograft survival being the same in both FTY720 and FTY720+FK506 treated groups, the association of drugs was associated with the absence of macroscopic skin necrosis for a longer period than the other treatments (FTY720, FK506) and histology showed less cell infiltration. Our results suggest that a decrease of effector T cells due to elevated levels of apoptosis and impairment in the appearance of antigens were events associated with FTY720+FK506 administration.O objetivo na área dos transplantes é o desenvolvimento de novas drogas que possam ser associadas a inibidores da calcineurina para evitar o processo de rejeição e causar menos efeitos colaterais. FTY720 é um novo composto sintético que apresenta propriedades imunomoduladoras não completamente elucidadas. Foi relatado que o principal mecanismo de ação do FTY720 é a redução do número de linfócitos periféricos através do redirecionamento dessas células para órgãos linfóides secundários. O alotransplante de pele entre linhagens de camundongos completamente incompatíveis quanto ao MHC foi usado para investigar o potencial de FTY720 isolado ou em combinação com um inibidor da calcineurina - FK506 - na prevenção da rejeição. Também foram avaliados o número e fenótipo das células do sistema imune. A administração de FTY720 como monoterapia ou FTY720+FK506 associou-se a uma diminuição do número total de linfócitos no baço e no sangue e aumento dos níveis de apoptose nos esplenócitos. No grupo tratado somente com FTY720, foi observada uma diminuição mais importante da expressão de CD4 e expressão significativamente menor de moléculas de MHC II e ICAM-1. Apesar de a sobrevida do aloenxerto ter sido igual para os grupos tratados com FTY720 ou FTY720 +FK506, a associação das drogas promoveu ausência de necrose macroscópica da pele por um período maior do que os outros tratamentos (FTY720, FK506) e os achados histológicos mostraram menor infiltrado celular. Nossos resultados sugerem que uma diminuição do número de células T efetoras devido a elevados níveis de apoptose e o prejuízo da apresentação de antígenos foram os eventos associados à administração de FTY720+FK506.Faculdade de Medicina de São José do Rio PretoUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

HUMAN MILK BANK: THE BREASTFEEDING COUNSELING AND THE DURATION OF EXCLUSIVE BREASTFEEDING

Objective: To identify which sociodemographic factors are associated with early weaning and compare the duration of exclusive breast feeding between mothers which received counseling about maternal feeding and mothers which was not guided for these practices. Methods: A cross-sectional study with 25 mothers that received counseling about the benefits of maternal feeding in the human milk bank and 25 from a university hospital that were not counseled. Data were collected using a structured questionnaire addressing mother-related data, the infant and the breastfeeding in the first semester. Comparison and odds ratio were the statistical analyses adopted. Results: There was not a significant difference of the duration of exclusive breast-feeding between the two groups (p = 0,524). Among mothers in the human milk bank group that discontinued early exclusive breast-feeding, fewer children (p=0,034) and a higher frequency of maternal work (p = 0,022) were observed. Wile, in the university hospital group low education (p < 0.001) and lower income (p = 0.009) were prevalent. In the totality of the sample, the interruption of exclusive breast-feeding was associated with <1 children (OR = 0.21, p = 0.030), the presence of a partner (OR = 0.046, p = 0.001) and the use of bottles or pacifiers (OR = 87.5, p <0.001). In both groups, the most cited motivation for exclusive breast-feeding discontinuation was the medical assistance. It was observed the absence of a specific standard guideline provided in the Human Milk Bank, and less than the recommended number of consultations in the literature. Conclusions: Socioeconomic factors and inadequate incentives negatively influence the duration of exclusive breast feeding. It was verified the need to provide standardized and more frequent counseling for effective reduction of early weaning

Influence Of Substratum Position And Acquired Pellicle On Candida Albicans Biofilm.

The purpose of this study was to evaluate the influence of the substratum position and the saliva acquired pellicle (AP) on Candida albicans biofilm development. Poly(methylmethacrylate) (PMMA) disks were fabricated and randomly allocated to experimental groups: HNP (disks placed in a horizontal position and uncoated by pellicle), VNP (disks placed in a vertical position and uncoated by pellicle), HCP (disks placed in a horizontal position and coated by pellicle), and VCP (disks placed in a vertical position and coated by pellicle). Disks were placed in a 24-well plate and a suspension of 107 cells/mL of Candida albicans was added to each well for biofilm development. The plates were aerobically incubated at 35°C. The biofilms were evaluated at 1.5 (adhesion time point), 24, 48, 72, and 96 hours. The number of viable cells was quantified in terms of the colony-forming units per milliliter (CFU/mL). Metabolic activity was measured by the XTT assay. The biofilm structure was analyzed by scanning electron microscopy. The data were analyzed by three-way ANOVA followed by Tukey's test, with significance set at 5%. The vertical groups showed less biofilm formation and lower metabolic activity than the horizontal groups (p0.05). It can be concluded that the substratum position influenced biofilm development.27369-7

Tecnologias da Informação e Comunicação para a educação em saúde e educação permanente em oncologia: protocolo de busca sistematizada

The aim is to outline a systematic review protocol on the evidence about the use of information and communication technology for health education in oncology aimed at patients, families and the education of health professionals. This exploratory study describes a six-step integrative review protocol integrated with two other systematic search phases and a final knowledge synthesis phase. We propose: 1) a search in PubMed, CINAHL, SCOPUS, LILACS and Web of Science with Medical Subject Headings (MeSH), CINAHL subjects and Health Science Descriptors (DeCS), in addition to alternative terms. The PRISMA 2020 guidelines will be used to check the integrative review report; 2) search for mobile apps on Google Play Store; 3) search for patent registrations at the National Institute of Industrial Property (INPI Brasil) and at PatentScope. Each step will have separate collection and descriptive analysis. The discussion and presentation will be mediated by the emergence and systematization of common themes and taking into account health education for the patient-caregiver binomial and continuing education for professionals. The results are expected to summarize the profile and functions of the technologies developed for patients, family members and for the education of health professionals.Objetiva-se delinear protocolo de revisão sistematizada sobre as evidências acerca da utilização de tecnologia da informação e comunicação para a educação em saúde em oncologia voltada para a pacientes, familiares e para a educação de profissionais de saúde. Este estudo exploratório descreve um protocolo de revisão integrativa de seis etapas integrado a outras duas fases de busca sistematizada e uma fase final de síntese do conhecimento. Propõem-se: 1) uma busca nas bases PubMed, CINAHL, SCOPUS, LILACS e Web of Science com Medical Subject Headings (MeSH), assuntos CINAHL e Descritores em Ciências da Saúde (DeCS), além de termos alternativos. As diretrizes PRISMA 2020 serão usadas para checagem do relato da revisão integrativa; 2) busca de aplicativos móveis na Google Play Store; 3) busca de registros de patentes no Instituto Nacional da Propriedade Industrial (INPI Brasil) e no PatentScope. Cada etapa possuirá coleta e análise descritiva separadas. A discussão e apresentação serão mediadas pela emersão e sistematização de temas em comum e levando em conta educação em saúde para binômio paciente-cuidador e educação permanente para profissionais. Esperam-se como resultados a síntese do perfil e funções das tecnologias desenvolvidas destinadas a pacientes, familiares e para a educação de profissionais de saúde

Tecnologias da Informação e Comunicação para a educação em saúde e educação permanente em oncologia: protocolo de busca sistematizada

The aim is to outline a systematic review protocol on the evidence about the use of information and communication technology for health education in oncology aimed at patients, families and the education of health professionals. This exploratory study describes a six-step integrative review protocol integrated with two other systematic search phases and a final knowledge synthesis phase. We propose: 1) a search in PubMed, CINAHL, SCOPUS, LILACS and Web of Science with Medical Subject Headings (MeSH), CINAHL subjects and Health Science Descriptors (DeCS), in addition to alternative terms. The PRISMA 2020 guidelines will be used to check the integrative review report; 2) search for mobile apps on Google Play Store; 3) search for patent registrations at the National Institute of Industrial Property (INPI Brasil) and at PatentScope. Each step will have separate collection and descriptive analysis. The discussion and presentation will be mediated by the emergence and systematization of common themes and taking into account health education for the patient-caregiver binomial and continuing education for professionals. The results are expected to summarize the profile and functions of the technologies developed for patients, family members and for the education of health professionals.Objetiva-se delinear protocolo de revisão sistematizada sobre as evidências acerca da utilização de tecnologia da informação e comunicação para a educação em saúde em oncologia voltada para a pacientes, familiares e para a educação de profissionais de saúde. Este estudo exploratório descreve um protocolo de revisão integrativa de seis etapas integrado a outras duas fases de busca sistematizada e uma fase final de síntese do conhecimento. Propõem-se: 1) uma busca nas bases PubMed, CINAHL, SCOPUS, LILACS e Web of Science com Medical Subject Headings (MeSH), assuntos CINAHL e Descritores em Ciências da Saúde (DeCS), além de termos alternativos. As diretrizes PRISMA 2020 serão usadas para checagem do relato da revisão integrativa; 2) busca de aplicativos móveis na Google Play Store; 3) busca de registros de patentes no Instituto Nacional da Propriedade Industrial (INPI Brasil) e no PatentScope. Cada etapa possuirá coleta e análise descritiva separadas. A discussão e apresentação serão mediadas pela emersão e sistematização de temas em comum e levando em conta educação em saúde para binômio paciente-cuidador e educação permanente para profissionais. Esperam-se como resultados a síntese do perfil e funções das tecnologias desenvolvidas destinadas a pacientes, familiares e para a educação de profissionais de saúde

Avaliação psicológica dos estudantes de ciências biológicas da Universidade Estadual de Ponta Grossa

No período universitário, uma série de fatores estressores como o excesso de tarefas acadêmicas, a falta de motivação com a profissão escolhida, os conflitos com professores, entre outros, podem levar ao desenvolvimento de transtornos mentais como a depressão e ansiedade. Neste contexto, o presente estudo avaliou a correlação dos dados de depressão e ansiedade nos acadêmicos dos cursos de Ciências Biológicas (licenciatura e bacharelado) da Universidade Estadual de Ponta Grossa. Comparou-se a prevalência de sintomas e fatores associados. Os estudantes investigados apresentaram elevadas taxas de ansiedade e depressão, verificados por meio de aplicação de questionários paramétricos amplamente conhecidos e validados

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Quality of perioperative care in a public hospital: the patient\'s perspective

A satisfação do paciente com a assistência perioperatória pode contribuir na avaliação da qualidade dos serviços de saúde, por meio da identificação de lacunas, subsidiando o planejamento e políticas públicas em saúde. Este estudo teve como objetivo geral avaliar a qualidade da assistência perioperatória, na perspectiva dos pacientes, em um hospital do Sistema Único de Saúde (SUS) e como objetivos específicos analisar o perfil sociodemográfico, clínico e terapêutico de pacientes submetidos ao tratamento cirúrgico em um hospital público; analisar as expectativas e as percepções do paciente em relação à assistência perioperatória, neste hospital; e analisar as lacunas entre as percepções e as expectativas do paciente sobre a qualidade da assistência perioperatória neste hospital. Trata-se de um estudo descritivo, transversal, prospectivo quantitativo, em um hospital filantrópico terciário, que atende pacientes pelo SUS, com uma população de 600 pacientes, que foram submetidos ao tratamento cirúrgico eletivo, em um hospital filantrópico terciário, no período de junho a setembro de 2022 (CAAE 91356218.0.0000.5393). Foram utilizados dois instrumentos para a coleta de dados, um de caracterização sociodemográfica e clínica e o instrumento SERVQUAL, estruturado em 22 afirmativas para mensurar as cinco dimensões da qualidade de serviços: Tangibilidade (Itens 1 a 4); Confiabilidade (Itens de 5 a 9); Responsabilidade (Itens 10 a 13); Segurança (Itens 14 a 17); e Empatia (Itens 18 a 22); além da além da afirmativa 23, com cinco proposições em relação às dimensões do SERVQUAL, sendo que o participante foi solicitado para distribuir 100 pontos, entre estas. No que se refere à qualidade da assistência perioperatória, os participantes indicaram lacunas em todos os quesitos, com identificação de possíveis melhorias. Em relação às características do atendimento recebido, a afirmativa melhor pontuada relacionou-se à infraestrutura e a execução dos serviços pelo hospital. Quanto à caraterização sociodemográfica e clínica da população do estudo, verificou-se idade entre 18 e 99 anos; escolaridade entre zero e 18 anos; predomínio de participantes sem companheiro; com, pelo menos, uma comorbidade; tempo médio de internação de 4,14 dias; 55,8% submetida às cirurgias ortopédicas e gastrointestinais; e a dor foi a principal intercorrência no pós-operatório mediato para 46,2%. Estes resultados podem subsidiar o planejamento da assistência perioperatória, assim como no processo de melhorias da qualidade dos serviços em saúde no SUS e a utilização do questionário SERVQUAL pode ser uma nova possibilidade de análise de resultados, no contexto perioperatório, incluindo-se as pessoas que recebem o atendimento ofertado.Patient satisfaction with perioperative care can contribute to assessing the quality of health services, by identifying gaps, supporting planning of public health policies. The general objective of this study was to evaluate the quality of perioperative care, from the perspective of patients, in a hospital of the Brazilian Unified Health System (SUS) and as specific objectives: to analyze the sociodemographic, clinical and therapeutic profile of patients undergoing surgical treatment in a public hospital; to analyze the patient\'s expectations and perceptions regarding perioperative care in this hospital; and to analyze gaps between patient perceptions and expectations about the quality of perioperative care in this hospital. This is a descriptive, cross-sectional, prospective quantitative study, in a tertiary philanthropic hospital, which serves patients through the SUS, with a population of 600 patients, who underwent elective surgical treatment, in a tertiary philanthropic hospital, in the period of June to September 2022 (research ethics commitee number 91356218.0.0000.5393). Two instruments were used for data collection, one of sociodemographic and clinical characterization and the SERVQUAL instrument, structured in 22 statements to measure the five dimensions of service quality: Tangibility (Items 1 to 4); Reliability (Items 5 to 9); Responsibility (Items 10 to 13); Security (Items 14 to 17); and Empathy (Items 18 to 22); in addition to affirmative 23, with five propositions in relation to the dimensions of SERVQUAL, and the participant was asked to distribute 100 points among these dimensions. With regard to the quality of perioperative care, the participants indicated gaps in all questions, identifying possible improvements. Regarding the characteristics of the care received, the best scored statement was related to the infrastructure and the execution of services by the hospital. In the sociodemographic and clinical characterization of the study population, it was verified: age between 18 and 99 years; schooling between zero and 18 years; predominance of participants without a partner; with at least one comorbidity; mean length of stay of 4.14 days; 55.8% underwent orthopedic and gastrointestinal surgeries; and pain was the main intercurrence in the mediate postoperative period for 46.2%. These results can support the planning of perioperative care, as well as in the process of improving the quality of health services in the SUS, and the use of the SERVQUAL questionnaire can be a new possibility for analyzing results, in the perioperative context, including the people who receive the service provided