Uso do brinquedo no hospital: o que os enfermeiros brasileirosestão estudando?

O cuidado às necessidades emocionais de crianças hospitalizadas vem merecendo atenção dos profissionais de enfermagem em nosso país, embora ainda não de modo generalizado. A possibilidade de brincar sabidamente atenua o sofrimento, especialmente na infância, justificando-se a importância deste tema. Assim, este trabalho teve como objetivo analisar a produção acadêmica dos enfermeiros brasileiros sobre o uso do brinquedo na atenção à criança em cuidado hospitalar, nos programas de pós-graduação stricto sensu. O levantamento foi feito no Portal CAPES, CEPEn, IBICT e consulta às referências dos trabalhos. Das quinze teses/dissertações encontradas na literatura pode-se encontrar catorze, que foram analisadas e constituem o corpus do presente estudo. O brinquedo foi mais utilizado no pré e pós-operatório, por enfermeiros docentes, com crianças pré-escolares e escolares, pais e enfermeiros. Os trabalhos analisados reforçam os resultados positivos desta prática. Recomendamos que as enfermeiras pediatras utilizem o brinquedo em todas as instituições onde a criança necessite de cuidado.

Minocycline Promotes Remyelination in an In Vitro Model of Demyelination

Brain inflammation plays a central role in numerous brain pathologies, including multiple sclerosis (MS). Microglial cells and astrocytes are the effector cells of neuroinflammation. They can be activated by agents such as interferon-g (IFN-g) and lipopolysaccharide (LPS). Aggregating brain cultures exposed to a repeated treatment (3 fold) with IFN-g (50 U/ml) and LPS (5 ug/ml) were used as an in vitro model of demyelination. Demyelination could be due to either the direct effect of IFN-g and LPS on oligodendrocytes or the IFN-g and LPS-induced inflammatory response. We investigated the involvement of microglial reactivity in demylination and remyelination by using minocycline, an antibiotic known to block microglial reactivity. Changes in myelination were examined by measuring the expression of myelin basic protein (MBP) and myelin oligodendrocyte glycoprotein (MOG) at the mRNA level by quantitative RT-PCR and at the protein level by Western blotting and immunohistochemistry. To evaluate brain inflammatory reactions, microglia were stained with isolectin B4 (IB4), quantitative RT-PCR was used to determine the expression of tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6), and inducible NO synthase (iNOS). The repeated treatment with IFN-g and LPS caused demyelination, as indicated by a decrease in MBP and MOG expression. It also activated microglial cells, and up-regulated TNF-a, IL-6, and iNOS expression. Although minocycline did not affect the IFN-g- and LPS-induced upregulation of TNF-a, IL-6, it decreased the number of IB4-labeled microglial cells. Furthermore, minocycline did not prevent demyelination, whereas it strongly increased MBP expression one week after the end of the demyelinating treatment. In conclusion, the present results show that minocycline promoted remyelination after IFN-g- and LPS-induced demyelination, presumably due to its effects on microglial cells.

Nexos entre Enfermagem, Nutrição e Serviço Social, profissões femininas pioneiras na área da Saúde

Estudo histórico-social sobre a emergência das profissões de nutricionista e de assistente social, entre os anos 30 e meados do século 20. O trabalho trata das circunstâncias do surgimento dos cursos de nutrição e de serviço social no interior da Escola Anna Nery/UFRJ, e compara as funções desempenhadas por enfermeiras, nutricionistas e assistentes sociais à época. As fontes primárias de pesquisa encontram-se no Centro de Documentação da Escola de Enfermagem Anna Nery/UFRJ e incluem documentos escritos e depoimento oral. As fontes secundárias foram artigos, livros e teses. A análise de textos e documentos evidenciou que a Escola teve papel decisivo na emergência dessas novas profissões, que vieram contribuir para uma melhor organização e funcionamento dos serviços de saúde e para a prestação de uma assistência mais completa à clientela. Ao mesmo tempo, sua característica feminina veio, ainda, favorecer a inserção de mulheres no mercado de trabalho qualificado na área da saúde.

Conflitos e sentimentos de mulheres portadoras de HIV/AIDS: um estudo bibliográfico

Pesquisa bibliográfica que buscou identificar como os conflitos e sentimentos das mulheres portadoras de HIV/Aids são abordados na literatura nacional e os caminhos propostos para uma abordagem de cuidado integral. Os dados foram coletados em novembro de 2006, na base de dados LILACS, utilizando as palavras-chave: mulheres, sentimentos, HIV, Aids, sofrimento, depressão e medo e como critério de inclusão o fato de os estudos terem sido divulgados nos últimos cinco anos. A amostra ficou constituída de catorze pesquisas (quatro teses, duas dissertações e oito artigos). O método de análise de conteúdo permitiu identificar três categorias temáticas: o olhar do pesquisador, o que seu olhar identifica e o seu olhar para além do corpo físico - as quais revelam a necessidade de abordar as mulheres considerando todo o seu contexto enquanto ser humano, incluindo questões de vulnerabili-dade, ideologia social de gênero, promoção da auto-estima e exercício da cidadania.

Intravaginal and subcutaneous immunization induced vaccine specific CD8 T cells and tumor regression in the bladder.

PURPOSE: Vaccines targeting tumor associated antigens are in development for bladder cancer. Most of these cancers are nonmuscle invasive at diagnosis and confined in the mucosa and submucosa. However, to our knowledge how vaccination may induce the regression of tumors at such mucosal sites has not been examined previously. We compared different immunization routes for the ability to induce vaccine specific antitumor CD8 T cells in the bladder and bladder tumor regression in mice. MATERIALS AND METHODS: In the absence of a murine bladder tumor model expressing a tumor antigen relevant for human use we established an orthotopic model expressing the HPV-16 tumor antigen E7 as a model. We used an adjuvant E7 polypeptide to induce CD8 T cell mediated tumor regression. RESULTS: Subcutaneous and intravaginal but not intranasal vaccination induced a high number of TetE7(+)CD8(+) T cells in the bladder as well as bladder tumor regression. The entry of vaccine specific T cells in the bladder was not the only key since persistent regression of established bladder tumors by intravaginal or subcutaneous immunization was associated with tumor infiltration of total CD4 and CD8 T cells. This resulted in an increase in TetE7(+)CD8(+) T cells and a decrease in T regulatory cells, leading to an increased number of effector interferon-γ secreting vaccine specific CD8 T cells in the regressing bladder tumor. CONCLUSIONS: These data show that immunization routes should be tailored to each mucosal tumor site. Subcutaneous or intravaginal vaccination may be of additional value to treat patients with bladder cancer.

Low dose endoluminal photodynamic therapy improves murine T cell-mediated colitis.

BACKGROUND AND STUDY AIMS: Low dose photodynamic therapy (LDPDT) may modify the mucosal immune response and may thus provide a therapy for Crohn's disease. We evaluated the efficacy and safety of this technique in a murine T cell-mediated colitis model. METHODS: The safety of LDPDT was first tested in BALB/c mice. Naïve T cells were used to induce colitis in mice with severe combined immunodeficiency, which were followed up endoscopically, and a murine endoscopic index of colitis (MEIC) was developed. The efficacy of LDPDT (10 J/cm (2); delta-aminolevulinic acid, 15 mg/kg bodyweight) was then tested on mice with moderate colitis, while a disease control group received no treatment. The MEIC, weight, length, and histology of the colon, cytokine expression indices, number of mucosal CD4 (+) T cells, percentage of apoptotic CD4 (+) T cells, body weight, and systemic side effects were evaluated. RESULTS: LDPDT improved the MEIC ( P = 0.011) and the histological score ( P = 0.025), diminished the expression indices of the proinflammatory cytokines, interleukin-6 ( P = 0.042), interleukin-17 ( P = 0.029), and interferon-gamma ( P = 0.014), decreased the number of mucosal CD4 (+) T cells, and increased the percentage of apoptotic CD4 (+) T cells compared with the disease control group. No local or systemic side effects occurred. CONCLUSION: LDPDT improves murine T cell-mediated colitis, decreases the proinflammatory cytokines interleukin-6, interleukin-17, and interferon-gamma, and decreases the number of CD4 (+) T cells. No adverse events were observed. Therefore, this technique is now being evaluated in patients with inflammatory bowel disease.

Induction of innate immune responses through Nalp3 inflammasome sensing of asbestos and silica

The inhalation of airborne pollutants such as asbestos or silica is linked to inflammation of the lung, fibrosis and lung cancer. How the presence of pathogenic dust is recognised, and how chronic inflammatory diseases are triggered are poorly understood. We will se show that asbestos and silica are sensed by the Nalp3 inflammasome, whose subsequent activation leads to IL-1b secretion. Inflammasome activation is triggered by reactive oxygen species, which are generated by a NADPH oxidase upon particle phagocytosis. In a model of asbestos inhalation, Nalp3_/_ mice showed diminished recruitment of inflammatory cells to the lungs, paralleled by lower cytokine production. Our findings implicate the Nalp3 inflammasome in particulate matter-related pulmonary diseases and support its role as a major proinflammatory ''danger" receptor.

Plasmacytoid dendritic cells sense skin injury and promote wound healing through type I interferons.

Plasmacytoid dendritic cells (pDCs) are specialized type I interferon (IFN-α/β)-producing cells that express intracellular toll-like receptor (TLR) 7 and TLR9 and recognize viral nucleic acids in the context of infections. We show that pDCs also have the ability to sense host-derived nucleic acids released in common skin wounds. pDCs were found to rapidly infiltrate both murine and human skin wounds and to transiently produce type I IFNs via TLR7- and TLR9-dependent recognition of nucleic acids. This process was critical for the induction of early inflammatory responses and reepithelization of injured skin. Cathelicidin peptides, which facilitate immune recognition of released nucleic acids by promoting their access to intracellular TLR compartments, were rapidly induced in skin wounds and were sufficient but not necessary to stimulate pDC activation and type I IFN production. These data uncover a new role of pDCs in sensing tissue damage and promoting wound repair at skin surfaces.

Le point sur le traitement de l'hépatite C chronique [An update on the management of chronic hepatitis C]

Treatment of chronic hepatitis C with pegylated interferon-a and ribavirin is now adapted individually based on the virological response on treatment. This approach should improve the tolerability while maintaining or even improving in some patients the efficacy of antiviral therapy. Several new antiviral drugs are currently being evaluated in advanced clinical trials, with very promising results. These new drugs should greatly broaden treatment options for chronic hepatitis C in the near future.

A saúde neonatal na perspectiva de atenção contínua à saúde da mulher e da criança

O estudo é uma revisão narrativa de teses e dissertações concluídas no período de 2000 a 2009 produzidas pelo Grupo de Pesquisa Enfermagem Obstétrica e Neonatal e pelo Núcleo de Estudos e Pesquisa em Aleitamento Materno da Escola de Enfermagem da Universidade de São Paulo que focalizaram os fatores maternos e perinatais que repercutem na saúde neonatal. A produção científica evidencia alinhamento com as diretrizes estabelecidas pelos órgãos de saúde nacionais e internacionais para a promoção da saúde neonatal e infantil.

Produção de conhecimento sobre o cuidado ao recém-nascido em UTI Neonatal: contribuição da enfermagem brasileira

Esta pesquisa documental teve como objetivo refletir sobre o estado da arte na Enfermagem brasileira acerca do cuidado ao recém-nascido em UTI neonatal. A fonte de pesquisa foi o Banco de Teses e Dissertações da Associação Brasileira de Enfermagem. Foram identificados 81 estudos. A análise dos dados foi feita em duas etapas: primeiro realizamos a caracterização dos trabalhos; após, organizamos o material a partir de dados evidentes nos estudos, dando lugar às categorias temáticas: cuidado centrado nos aspectos fisiológicos do recém-nascido; a família que acompanha os cuidados ao recém-nascido em UTI neonatal; e a equipe de saúde que atua no cuidado ao recém-nascido em UTI neonatal. Constatamos que a pesquisa em enfermagem busca novas formas de cuidar, e proporciona uma aproximação entre a teoria e a prática, garantindo sua sustentação enquanto profissão, e contribuindo na produção de conhecimento em neonatologia.

Impact of genetic SLC28 transporter and ITPA variants on ribavirin serum level, hemoglobin drop and therapeutic response in patients with HCV infection.

BACKGROUND & AIMS: In the last decade, pegylated interferon-α (PegIFN-α) plus ribavirin (RBV) was the standard treatment of chronic hepatitis C for genotype 1, and it remains the standard for genotypes 2 and 3. Recent studies reported associations between RBV-induced anemia and genetic polymorphisms of concentrative nucleoside transporters such as CNT3 (encoded by SLC28A3) and inosine triphosphatase (encoded by ITPA). We aimed at studying genetic determinants of RBV kinetics, efficacy and treatment-associated anemia. METHODS: We included 216 patients from two Swiss study cohorts (61% HCV genotype 1, 39% genotypes 2 or 3). Patients were analyzed for SLC28A2 single nucleotide polymorphism (SNP) rs11854484, SLC28A3 rs56350726, and SLC28A3 rs10868138 as well as ITPA SNPs rs1127354 and rs7270101, and followed for treatment-associated hemoglobin changes and sustained virological response (SVR). In 67 patients, RBV serum levels were additionally measured during treatment. RESULTS: Patients with SLC28A2 rs11854484 genotype TT had higher dosage- and body weight-adjusted RBV levels than those with genotypes TC or CC (p=0.02 and p=0.06 at weeks 4 and 8, respectively). ITPA SNP rs1127354 was associated with hemoglobin drop ≥3 g/dl during treatment, in genotype (relative risk (RR)=2.1, 95% CI 1.3-3.5) as well as allelic analyses (RR=2.0, 95%CI 1.2-3.4). SLC28A3 rs56350726 was associated with SVR in genotype (RR=2.2; 95% CI 1.1-4.3) as well as allelic analyses (RR=2.0, 95% CI 1.1-3.4). CONCLUSIONS: The newly identified association between RBV serum levels and SLC28A2 rs11854484 genotype, as well as the replicated association of ITPA and SLC28A3 genetic polymorphisms with RBV-induced anemia and treatment response, may support individualized treatment of chronic hepatitis C and warrant further investigation in larger studies.