ABSTRACT Objectives: to analyze the perception of nursing professionals in an intensive care unit in Angola about humanized care and identify resources necessary for its implementation. Methods: a qualitative, descriptive study conducted with 15 professionals in June-October/2020 in intensive care unit in Angola. The data were collected through semi-structured interviews; analysis based on the collective subject discourse technique. Results: five central ideas emerged: three related to the perception of humanized care (“From integral vision and empathy to a set of actions in all phases of care”, “Humanizing is extending care to family members and companions”, “Humanized care requires the establishment of a bond of trust and guarantee of individualized care”); and two on the resources necessary for this care (“Need for infrastructure - human and material resources”, “Professional training and humanized care are interconnected”). Final Considerations: humanized care involves objectivity and subjectivity; it includes family members. An adequate infrastructure can provide it.

RESUMEN Objetivos: analizar percepción de enfermeros de una Unidad de Cuidados Intensivos en Angola sobre atenciones humanizadas e identificar recursos necesarios para su implementación. Métodos: estudio cualitativo, descriptivo, realizado con 15 profesionales en junio-octubre/2020, en una Unidad de Cuidados Intensivos de Angola. Los datos fueron recolectados mediante entrevista semiestructurada; análisis basado en técnica del Discurso del Sujeto Colectivo. Resultados: emergieron cinco ideas centrales: tres referentes a la percepción de la atención humanizada (“De la visión integral y empatía a un conjunto de acciones en todos los momentos de la atención”, “Humanizar es extender atención a familiares y acompañantes”, “Atención humanizada implica establecimiento de vínculo de confianza, garantía de atención individualizada”); y dos sobre los recursos necesarios para esa atención (“Necesidad de infraestructura - recursos humanos y materiales”, “Capacitación profesional y atención humanizada están interconectados”). Consideraciones Finales: la atención humanizada involucra objetividad y subjetividad; incluye familiares. Hay necesidad de infraestructura adecuada para proporcionarlo.

RESUMO Objetivos: analisar a percepção dos profissionais de enfermagem de uma Unidade de Terapia Intensiva em Angola sobre cuidados humanizados e identificar recursos necessários para sua implementação. Métodos: estudo qualitativo, descritivo, realizado com 15 profissionais em junho outubro/2020, em Unidade de Terapia Intensiva de Angola. Os dados foram coletados mediante entrevista semiestruturada; análise baseada na técnica do Discurso do Sujeito Coletivo. Resultados: emergiram cinco ideias centrais: três referentes à percepção do cuidado humanizado (“Da visão integral e empatia a um conjunto de ações em todos os momentos do cuidado”, “Humanizar é estender cuidado aos familiares e acompanhantes”, “Assistência humanizada requer estabelecimento de vínculo de confiança e garantia de cuidado individualizado”); e duas sobre os recursos necessários para esse cuidado (“Necessidade de infraestrutura - recursos humanos e materiais”, “Capacitação profissional e cuidado humanizado estão interligados”). Considerações Finais: o cuidado humanizado envolve objetividade e subjetividade; inclui os familiares. Há necessidade de infraestrutura adequada para proporcioná-lo.

ABSTRACT Visceral leishmaniasis (VL) is a chronic vector-borne zoonotic disease caused by trypanosomatids, considered endemic in 98 countries, mainly associated with poverty. About 50,000–90,000 cases of VL occur annually worldwide, and Brazil has the second largest number of cases in the world. The clinical picture of VL is fever, hepatosplenomegaly, and pancytopenia, progressing to death in 90% of cases due to secondary infections and multi-organ failure, if left untreated. We describe the case of a 25-year-old female who lived in the metropolitan area of Sao Paulo, who had recently taken touristic trips to several rural areas in Southeastern Brazil and was diagnosed post-mortem. During the hospitalization in a hospital reference for the treatment of COVID-19, the patient developed acute respiratory failure, with chest radiographic changes, and died due to refractory shock. The ultrasound-guided minimally invasive autopsy diagnosed VL (macrophages containing amastigote forms of Leishmania in the spleen, liver and bone marrow), as well as pneumonia and bloodstream infection by gram-negative bacilli.

Considering the promising antitumor effects of compounds with dual anti-inflammatory and antiproliferative activities, thus benzophenones analogs (2-7) were evaluated on in vivo anti-inflammatory assay and molecular docking analysis. Those with the best molecular docking results were in vitro evaluated on cyclooxygenase (COX) enzymes and tested regarding antiproliferative activity. All derivatives displayed in vivo anti-inflammatory activity. Among them, the substances 2’-hydroxy-4’-benzoylphenyl-β-D-glucopyranoside (4), 4-hydroxy-4’-methoxybenzophenone (5) and 4’-(4’’-methoxybenzoyl)phenyl-β-D-glucopyranoside (7) showed the best values of Glide Score in COX-2 docking evaluation and 4 and 5 selectively inhibited COX-2 and COX-1 in vitro enzymatic assay, respectively. Thus, 4 and 5 were tested against breast cancer (MCF-7, MDA MB-231, Hs578T) and non-small-cell-lung cancer (A549) cell lines. The estrogen-positive MCF-7 cell line was more responsive compared to other tested cell lines. They induced cell cycle arrest at G1/S transition in MCF-7 cell line once there was an increase in G0/G1 population with concomitant reduction of S population. The antiproliferative activity of these substances on MCF-7 was associated with their ability to inhibit cyclin E expression, a critical regulator of G1/S transition. Taken together, the data indicate that 4 and 5 have dual anti-inflammatory and antiproliferative activities and support further studies to evaluate their antitumor potential.

Resumo A disfagia tem impactos negativos multidimensionais na vida do paciente disfágico e pode gerar conflitos decisórios relacionados à alimentação. O objetivo deste artigo é revisar a literatura sobre fonoaudiologia, conflitos na tomada de decisão e agentes envolvidos nas deliberações sobre a nutrição desse tipo de paciente. Trata-se de estudo exploratório-descritivo, de revisão integrativa, com análise de conteúdo conforme proposta por Bardin. As bases de dados utilizadas foram: PubMed, Scopus, Web of Science, Cochrane, Embase e Biblioteca Virtual em Saúde. Identificaram-se conflitos envolvendo o fonoaudiólogo, o paciente, a família e a equipe multidisciplinar. Nos artigos selecionados não foi possível identificar uma teoria ou método que fundamentasse a mediação desses conflitos. Não foram encontradas publicações brasileiras que respondessem à pergunta norteadora da revisão.

Abstract Dysphagia presents multidimensional negative impacts on the life of dysphagic patients and may generate decision conflicts related to their diet. This is a review of the literature on speech-language therapy, decision conflicts and the agents involved in the decision making process for deliberations related to the nutrition of this type of patient. This is an exploratory and descriptive study, with content analysis as proposed by Bardin. The databases used were PubMed, Scopus, Web of Science, Cochrane, Embase and Virtual Health Library. Conflicts involving the speech-language therapist, the patient, the family and the multidisciplinary team were identified. In the selected articles, no theory or method was identified to support the mediation of these conflicts. No Brazilian publications that answered the guiding question were found.

Resumen La disfagia tiene impactos negativos multidimensionales en la vida del paciente disfágico y puede generar conflictos de decisión relacionados con su alimentación. El objetivo de este artículo fue revisar la literatura sobre fonoaudiología, los conflictos de decisión y los agentes involucrados en el proceso de toma de decisiones para las deliberaciones relacionadas con la nutrición de este tipo de pacientes. Se trata de un estudio exploratorio y descriptivo, donde se realizó una revisión integradora con análisis de contenido y categorización por Bardin. Las bases de datos utilizadas fueron: PubMed, Scopus, Web of Science, Cochrane, Embase y Biblioteca Virtual en Salud. Se identificaron los conflictos entre fonoaudiólogo, paciente, familia y equipo multidisciplinario. En los artículos seleccionados no se identificó ninguna teoría o método que sustente la mediación de estos conflictos. No hay publicaciones nacionales que respondan a la pregunta orientadora.

RESUMO. O Plano de Atenção Gerontológica é idealizado por meio da gestão de casos que engloba em sua vertente, engajamento da pessoa idosa, autocuidado e aquisição e manutenção de comportamentos de promoção de saúde. Objetivo: Avaliar a importância de um plano de atenção gerontológica em um serviço de geriatria de um hospital de referência na cidade de São Paulo. Métodos: Foram entrevistados 15 pacientes idosos, sendo aplicado o Plano de Atenção Gerontológica (PAGe). Resultados: Em sua maioria, os entrevistados foram classificados como independentes para as atividades instrumentais de vida diária, sendo que 42% deles residem sozinhos. Dados de 277 folhas amarelas foram analisados, ou seja, Fichas de Encaminhamento, nos quais foi possível verificar que as áreas mais acionadas foram o serviço social e a psicologia. Para assistência social, as solicitações mais recorrentes foram a verificação da rede de suporte social, falta de acompanhante e de cuidador, com 53%, problemas familiares, com 20%, falta de adesão ao tratamento, 12%, e problemas relacionados a medicamentos, 10%. Na área da psicologia, 82% dos encaminhamentos foram feitos por necessidade de acompanhamento psicológico/psicoterapia, problemas com família, depressão e luto. Conclusões: Elaborou-se uma proposta de Gestão Gerontológica dentro dos Serviços de Geriatria do Hospital das Clínicas. O plano de gestão teve o intuito de integrar as ações realizadas pela equipe interprofissional, por meio da criação de uma Ficha Integradora que permitiu ao profissional gerontólogo propor, executar e implementar um plano de atenção, acompanhamento e monitoramento dos casos, incluindo o contexto extra-hospitalar.

ABSTRACT. The Gerontological Care Plan is idealized through case management that includes in its aspect engaging the elderly, self-care and the acquisition and maintenance of health-promoting behaviors. Objective: To evaluate the importance of a gerontological care plan, in a geriatric service of a referral hospital in the city of São Paulo. Methods: Fifteen older adult patients were interviewed and the Gerontological Care Plan (PAGe) was applied. Results: Most respondents were classified as independent for instrumental activities of daily living, 42% of whom lived alone. Data from 277 yellow sheets were analyzed, that is, referral forms, in which it was found that the most affected areas were: social work and psychology. For the social worker, the most recurring requests were: verification of the social support network, namely lack of companion and caregiver, with 53%; family problems, with 20%; lack of adherence to treatment, 12%, and problems related to medication, 10%. In the area of psychology, 82% of referrals were due to the need for psychological support, psychotherapy, and help with family problems, depression and grief. Conclusions: A gerontological management proposal was developed within the Geriatric Services of Hospital das Clínicas. The management plan was intended to integrate the actions carried out by the interprofessional team, through the creation of an Integrating Form that allowed the gerontologist to propose, execute and implement a plan of care, follow-up, and monitoring of cases, including the extra context-hospital.

Abstract COVID-19 comprises clinical outcomes of SARS-CoV-2 infection and is highly heterogeneous, ranging from asymptomatic individuals to deceased young adults without comorbidities. There is growing evidence that host genetics play an important role in COVID-19 severity, including inborn errors of immunity, age-related inflammation and immunosenescence. Here we present a brief review on the known order of events from infection to severe system-wide disturbance due to COVID-19 and summarize potential candidate genes and pathways. Finally, we propose a strategy of subject’s ascertainment based on phenotypic extremes to take part in genomic studies and elucidate intrinsic risk factors involved in COVID-19 severe outcomes.

OBJECTIVES: Ultrasound-guided minimally invasive autopsies (MIA-US) are an alternative to conventional autopsies and have been used in our institution to investigate the pathophysiology of COVID-19 since the beginning of the pandemic. Owing to the limitations of post-mortem biopsies for evaluating cardiopulmonary events involving large vessels, we continuously improved the technique during this period. Objectives: To demonstrate the usefulness of an extended MIA-US technique (EMIA-US) for the study of thoracic involvement in COVID-19. METHOD: US-guided percutaneous tissue sampling was combined with a small thoracic incision (≤5 cm), allowing for the sampling of larger tissue samples or even the entire organ (lungs and heart). RESULTS: EMIA-US was performed for eight patients who died of COVID-19 in 2021. We demonstrate cardiopulmonary events, mainly thromboembolism and myocardial infarction, that could be evaluated using EMIA-US. CONCLUSIONS: Minimally invasive image-guided post-mortem tissue sampling is a flexible and practical method to conduct post-mortem studies of human diseases, mainly in areas that do not have autopsy facilities or, alternatively, when autopsy is not possible owing to financial constraints, cultural and religious values, or for safety reasons, such as in the case of highly contagious infectious diseases. We present evidence that EMIA-US is feasible and can be used as an alternative to increase the accuracy of MIA-US in detecting cardiopulmonary events involving large vessels, which may not be assessed through post-mortem biopsies.

Abstract Demand for iron ore worldwide has been steadily increasing, thus implying an increase in the volume of mining resulting in the extraction of ores with higher levels of silicon, phosphorus and sulfur impurities. An extensively used alternative is to perform a pre-treatment of the particles in order to reach the acceptable phosphorus limit in iron ore before its use in steel production. This study aims at the evaluation of the heating process and decrease of the phosphorus content of the particles using microwave energy in iron ore samples percolated by sulfuric acid followed by the leaching technique as a feasible route for the remotion of the phosphorus content in iron ore particles. Using the scanning electron microscopy (SEM) and statistical analysis techniques, it was possible to observe the characteristics of the iron ore particles after treatment with microwave energy. The results indicated that the developed process is feasible. The results of the kinetic simulation contribute to a better understanding of the phenomena of heating using microwave energy and also to the development of new cleaner technologies aiming to improve the efficiency of the acid baking - leaching technique for the reduction of the phosphorus content in iron ore particles.

ABSTRACT Geopropolis is produced by some stingless bee species such as Melipona fasciculata and consists of a mixture of plant resins, salivary secretions of the bee, wax, and soil. This study evaluated the antileishmanial activity in vitro, cytotoxicity and chemical composition of geopropolis produced by M. fasciculata in the savannah region of Maranhão, Brazil. The geopropolis extract was obtained through maceration using in 70% ethanol. The hydroalcoholic extract of geopropolis after liquid–liquid partition yielded the hexane, chloroformic, ethyl acetate and hydroalcoholic fractions. Antileishmanial activity was evaluated against promastigote and intracellular amastigote of Leishmania amazonensis. Cytotoxic was realized in BALB/c mice peritoneal macrophages. Chemical analysis was performed by gas chromatography–mass spectrometry and high performance liquid chromatography coupled to an ultraviolet–visible detector. The geopropolis inhibited the L. amazonensis promastigotes growth and was effective in reducing the infection of murine macrophages since the number of internalized amastigotes were smaller in cells treated with the geopropolis extract in relation to the untreated group. The ethyl acetate fraction was the most active and showed the highest index of selectivity as antileishmanial product. The geopropolis from M. fasciculata had an antileishmanial effect, mainly after the obtention of the ethyl acetate fraction that improved the activity without increasing the cytotoxicity against murine macrophages. Analysis for gas chromatography-mass spectrometer identified as main compounds the gallic and ellagic phenolic acids, either in the extract or in the active fraction. The results obtained by high performance liquid chromatography it was possible to confirm the presence and quantify the concentration gallic and ellagic acid either in the extract or in the active fraction. These results suggest that the antileishmanial activity of geopropolis is related to the presence of derivatives of these phenolic acids, mainly gallic and ellagic acids.

Unlike the available mineral resources, the steelmaking processes have demanded raw material with lower phosphorus content to decrease the costs, energy use, and the residue generated within the steel plant. One alternative is to develop pretreatment of the iron ore concentrates producing raw materials with lower phosphorus. Depending on the mineral structure, a heat treatment combined with leaching could be an efficient way to achieve concentrates with low phosphorus (less than 0.01%), suitable for steelmaking processes. A fast and efficient way of applying energy to iron ore particles is the use of microwave to heat the particles. Thus, we propose a treatment using microwave heating while mixing with a dilute aqueous solution of sulfuric acid, followed by quenching during leaching with water, as a feasible route for the phosphorus removal from iron ore particles. We performed a design of experiment (DOE) to investigate the optimal conditions of heating and leaching, which maximize the rate of phosphorus removal. The structure of the iron ore particles after their treatment with microwave energy was observed by scanning electron microscopy (SEM). Thus, we analyze the optimal conditions for heating and leaching, the structure of the iron ore particles and which mechanism and rate equations are controlling the phosphorus removal. The results indicated that the average heating time is 10 min, the size of the crack of the order of 20µm and a leaching time of 8 min are adequate to achieve less than 0.01% of phosphorus. We demonstrated that under the most favorable combination of conditions for heating followed by leaching proposed in this study, the removal of the phosphorus content in the iron ore samples could reach 100%.

Uma das prioridades para a sustentabilidade da agricultura é a redução da aplicação de pesticidas para o controlo de pragas e doenças. Atualmente é utilizada a aplicação preventiva repetida de fungicidas durante a época de cultivo para controlo do míldio da videira. A identificação dos mecanismos de resistência ou de moléculas com atividade biofungicida é de extrema importância para a definição de novas estratégias de controlo da doença. Utilizando uma abordagem de biologia de sistemas baseada em “Ómicas” (transcritómica, proteómica e metabolómica) foi possível identificar proteases de tipo subtilisina e eventos de sinalização associados a lipídios como mecanismos chave na resposta de resistência da videira ao míldio (Plasmopara viticola). Uma caracterização mais aprofundada destes mecanismos é essencial para a definição de medidas de controlo de doenças em prol de uma viticultura sustentável.

The reduction of pesticide use to control pests and diseases is one of modern agriculture’s demands. In the grapevine-Plasmopara viticola pathosystem, repeated preventive applications of fungicides occur during the vegetative period. The identification of specific mechanisms or molecules with bioactive fungicide properties may lead to new disease control strategies. Following an omics-based system biology approach we were able to identify both subtilisin-like proteases and lipid associated signalling events as key players on grapevine resistance mechanisms. Efforts are being conducted to characterize their role aiming at the definition of alternative control measures towards a sustainable viticulture.

RESUMO Objetivo: As infecções respiratórias constituem a principal causa de morbidade e mortalidade em transplantados de órgãos sólidos. A incidência de tuberculose pulmonar é alta entre esses pacientes. Em exames de imagem, a tuberculose tem diferentes apresentações. Uma maior compreensão dessas apresentações poderia reduzir o impacto da doença ao facilitar o diagnóstico precoce. Portanto, buscamos descrever os padrões de tuberculose pulmonar na TCAR em transplantados de pulmão. Métodos: De dois hospitais no sul do Brasil, foram coletados os seguintes dados sobre transplantados de pulmão que desenvolveram tuberculose pulmonar: sexo; idade; sintomas; doença pulmonar que levou ao transplante; padrão na TCAR; distribuição dos achados; tempo entre transplante e tuberculose pulmonar; e taxa de mortalidade. Os achados na TCAR foram classificados como nódulos miliares; cavitação e nódulos centrolobulares com padrão de árvore em brotamento; atenuação em vidro fosco com consolidação; linfonodomegalia mediastinal; ou derrame pleural. Resultados: Foram avaliados 402 transplantados de pulmão, dos quais 19 desenvolveram tuberculose pulmonar após o transplante. Entre esses 19 pacientes, os padrões mais comuns na TCAR foram atenuação em vidro fosco com consolidação (em 42%); cavitação e nódulos centrolobulares com padrão de árvore em brotamento (em 31,5%); e linfonodomegalia mediastinal (em 15,7%). Entre os pacientes com cavitação e nódulos centrolobulares com padrão de árvore em brotamento, esses achados se distribuíam nos lobos superiores em 66,6%. Não se observou derrame pleural. Apesar do tratamento, a mortalidade em um ano foi de 47,3%. Conclusões: O padrão predominante na TCAR foi atenuação em vidro fosco com consolidação, seguido por cavitação e nódulos centrolobulares com padrão de árvore em brotamento. Esses achados são semelhantes aos relatados para pacientes imunocompetentes com tuberculose pulmonar e consideravelmente diferentes dos relatados para portadores de AIDS com a mesma doença.

ABSTRACT Objective: Respiratory infections constitute a major cause of morbidity and mortality in solid organ transplant recipients. The incidence of pulmonary tuberculosis is high among such patients. On imaging, tuberculosis has various presentations. Greater understanding of those presentations could reduce the impact of the disease by facilitating early diagnosis. Therefore, we attempted to describe the HRCT patterns of pulmonary tuberculosis in lung transplant recipients. Methods: From two hospitals in southern Brazil, we collected the following data on lung transplant recipients who developed pulmonary tuberculosis: gender; age; symptoms; the lung disease that led to transplantation; HRCT pattern; distribution of findings; time from transplantation to pulmonary tuberculosis; and mortality rate. The HRCT findings were classified as miliary nodules; cavitation and centrilobular nodules with a tree-in-bud pattern; ground-glass attenuation with consolidation; mediastinal lymph node enlargement; or pleural effusion. Results: We evaluated 402 lung transplant recipients, 19 of whom developed pulmonary tuberculosis after transplantation. Among those 19 patients, the most common HRCT patterns were ground-glass attenuation with consolidation (in 42%); cavitation and centrilobular nodules with a tree-in-bud pattern (in 31.5%); and mediastinal lymph node enlargement (in 15.7%). Among the patients with cavitation and centrilobular nodules with a tree-in-bud pattern, the distribution was within the upper lobes in 66.6%. No pleural effusion was observed. Despite treatment, one-year mortality was 47.3%. Conclusions: The predominant HRCT pattern was ground-glass attenuation with consolidation, followed by cavitation and centrilobular nodules with a tree-in-bud pattern. These findings are similar to those reported for immunocompetent patients with pulmonary tuberculosis and considerably different from those reported for AIDS patients with the same disease.

ABSTRACT The dichloromethane extract of Plectranthus ornatus Codd., a tradicional medicinal plant, showed antibiotic activity with minimum inhibitory concentration (MIC) values of 0.4 mg.mL-1 and 100 percent of biofilm inhibition against Staphylococcus aureus strains isolated from animals with mastitis infections. Based on these antibacterial activities, in addition to ethnopharmacological reports from healing men and farmers in Brazil, an herbal soap was produced from this active extract and was tested both in vitro and in vivo. In vivo assays conducted on these herbal soaps led to results similar to those previously conducted with the active extract. These results indicated the great potential of this plant for use as an excipient by preparing herbal antibacterial soaps as an alternative veterinary medicine aimed at controlling bovine mastitis infections on small Brazilian farms.