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Considerando o cenário vivenciado pela pandemia do novo coronavírus (SARS-CoV-2), verificou-se que a Mobile Learning (aprendizagem móvel) se tornou ainda mais presente auxiliando na manutenção das atividades de ensino e nas interações. Desta forma, compreende-se como relevante a identificação da atual relação dos alunos com os DM, visando suas possibilidades de uso nas dinâmicas e práticas pedagógicas dentro e fora da sala de aula. O artigo tem como objetivo identificar o sujeito mobile através de uma análise do perfil dos alunos de graduação e pós-graduação de uma universidade pública do sul do país. O estudo foi de natureza descritiva, utilizando uma abordagem quali-quanti, através de três etapas, sendo elas: revisão sistemática do tema, desenvolvimento e aplicação de um questionário do tipo survey e análise dos dados. Dentre os principais resultados, percebeu-se que o smartphone é o principal DM utilizado tanto para atividades pessoais quanto para fins educacionais. Por fim, considera-se que a identificação deste sujeito contribui para o desenvolvimento de estratégias pedagógicas personalizadas com foco no aluno, a fim de qualificar o processo de aprendizagem do referido público.

Background Prostate adenocarcinoma is the most frequent cancer type among men, followed by skin cancer. Patients with prostate cancer usually present lower urinary tract symptoms due to tumor involvement. Bone marrow invasion is associated with prostate cancer metastasis and is common if blastic lesions in bones are present but is very rare without a large bone involvement and uncommon as initial presentation. Case presentation We present a case of an 86-year-old Caucasian man with bone marrow invasion of prostate cancer without urological or bone-related symptoms and without prostate nodules. His findings were dyspnea, fatigue, and tachycardia. We detail the complete investigation of the case until we found the accurate diagnosis. The patient started treatment, but he had no response and so the oncology team started palliative care. Conclusion Bone marrow invasion as an initial manifestation of prostate cancer is not common, especially if no prostatic lesions are found. This report is important to provide additional information about prostate cancer management.

BACKGROUND Natalizumab is an anti-integrin monoclonal antibody used as an alternative treatment regimen for patients with autoimmune disorders, especially multiple sclerosis and Crohn's disease. Natalizumab-induced liver injury has been rarely reported and may follow the first dose (with increases in liver enzymes usually after 6 or more days), or after multiple doses. In general, it is non-severe acute hepatitis (with a hepatocellular pattern) and autoantibodies can be positive, mainly anti-nuclear and anti-smooth muscle antibodies. CASE REPORT We are reporting the case of a 60-year-old woman diagnosed with multiple sclerosis previously treated with interferon-beta, dimethyl fumarate, and fingolimod, who presented jaundice 1 day after the first infusion of natalizumab. She had an early-onset acute hepatitis with aminotransferases levels higher than 1000 IU/L and total bilirubin almost 41 mg/dL. Anti-nuclear and anti-smooth muscle antibodies were positive and the histopathological analysis of the liver showed intrahepatic cholestasis associated with moderate necroinflammatory activity (subacute cholestatic hepatitis) and mild diffuse perisinusoidal fibrosis, which could be compatible with the hypothesis of drug-induced liver injury. The scenario of an autoimmune-like hepatitis led the medical team to start oral prednisone and she progressively improved in clinical and laboratory features. Serum levels of liver enzymes and bilirubin were normal within 3 months and there was no further increase after discontinuation of corticosteroid therapy. CONCLUSIONS Physicians should be aware of the risk of early-onset acute hepatitis in patients starting natalizumab, especially women with multiple sclerosis. Treatment with corticosteroid for a few months may be beneficial.

Background Knowledge of the real-world effectiveness and safety of tofacitinib for ulcerative colitis (UC) is relevant to confirm the benefit observed in clinical trials. Methods This systematic review and meta-analysis evaluated the real-world effectiveness of tofacitinib for moderate to severely active UC. The primary outcome was clinical remission evaluated at week 8, weeks 12 to 16, and month 6. Secondary outcomes were response, corticosteroid-free remission, mucosal healing, colectomy, and safety. Results Seventeen studies with a total of 1162 patients with UC were included. Remission (11 studies) was achieved in 34.7% of patients at week 8 (95% confidence interval [CI], 24.4%-45.1%), 47% at weeks 12 to 16 (95% CI, 40.3%-53.6%), and 38.3% at month 6 (95% CI, 29.2%-47.5%) at month 6 duplicated. Response was achieved in 62.1%, 64.2%, 50.8%, and 41.8% of patients at week 8, weeks 12 to 16, month 6, and month 12, respectively. Corticosteroid-free remission (5 studies) was achieved in 38.4%, 44.3%, 33.6%, and 31% of patients at week 8, weeks 12 to 16, month 6, and month 12, respectively. Mucosal healing was achieved in 48.3% and 45.3% of patients at week 8 and weeks 12 to 16, respectively. Patients who were biologic-naïve (11.6%) had a significantly higher rate of response at week 8 (1.38; 95% CI, 1.03-1.84). The incidence rates of serious adverse events and herpes zoster was 8.9 and 6.9 per 100 patient-years, respectively. Conclusions This meta-analysis of real-world studies confirms the effectiveness of tofacitinib in a highly refractory population of patients with moderate to severely active UC. Tofacitinib showed an acceptable safety profile. These findings were consistent with clinical trials and further support the use of tofacitinib in UC.

BACKGROUND: Optimal thresholds for golimumab concentrations during maintenance for important outcomes are lacking. AIM: The aim of the study was to investigate the association of golimumab trough concentrations during maintenance with key outcomes, including endoscopic and histologic remission, and long-term event-free persistence with golimumab, in patients with UC. METHODS: This multicentre, cross-sectional study included UC patients on golimumab maintenance recruited either in remission or during a flare. Colonoscopy was scheduled, and study-specific rectocolonic biopsies were taken for blind central histologic reading. Samples for golimumab trough concentrations were collected close to colonoscopy. RESULTS: Fifty-two patients were included. Median golimumab trough concentrations (µg/ml) were significantly higher in patients who had clinical remission (2.01 vs. 0.72, p = 0.047), combined clinical-biochemical remission (PMS =2 + faecal calprotectin

Mechanical allodynia (pain to normally innocuous tactile stimuli) is a widespread symptom of inflammatory and neuropathic pain. Spinal or medullary dorsal horn (SDH or MDH) circuits mediating tactile sensation and pain need to interact in order to evoke mechanical allodynia. PKCγ-expressing (PKCγ

Background Adalimumab (ADA) dose escalation from 40 mg SC every other week (EOW) to 40 mg weekly is approved for IBD patients with loss of response. A recently registered device containing 80 mg of ADA will allow an alternative dose escalation regimen with SC doses of 80 mg EOW. The ADASCAL study aimed to evaluate the preferences and satisfaction of patients with modifying the ADA regimen from 40 mg weekly to 80 mg EOW. Methods This multicentre cross-sectional study included patients with IBD in whom the ADA regimen was changed from 40 mg weekly to 80 mg EOW according to clinical practice. Patients who have received at least 4 doses of 80 mg EOW completed a 4-item self-questionnaire (a Likert-like 5-point scale for preferences, 2 closed questions for convenience, and a 100-point visual analogue scale [VAS] to evaluate patient’s preference for weekly or EOW ADA) (Figure 1); and the 14-item Treatment Satisfaction Questionnaire for medication (TSQM 1.4) that covers 4 domains: effectiveness, side effects, convenience, and overall satisfaction. Results Seventy-seven patients (64 CD, 13 UC; 67.5% men; mean age 48 years, SD 14.1) were included. The overall mean duration of exposure to ADA was 66 months (SD 34), with mean exposure to ADA 40 mg weekly of 40 months (SD 25), and mean exposure to ADA 80 mg EOW of 12 months (SD 5). At the time of the survey, 87.1% of CD patients and all UC patients were in clinical remission (Harvey-Bradshaw index ≤4 for CD, Partial Mayo score ≤1 for UC). According to the results of the questionnaires, 74% of the patients preferred the 80 mg EOW ADA regimen (59.7% had a strong preference and 14.3% had a slight preference) (Figure 1). Patients referred that ADA EOW regimen interferes less with daily activity and with travel plans. Most patients wanted to continue with ADA 80 mg EOW, as reflected by a mean VAS score of 84.7 (SD 24.1), where 0 indicated a choice for weekly ADA, 100 for ADA EOW, and 50 indifferent. Overall, 77% of patients preferred to continue with ADA EOW, 4% with ADA weekly, and 17% were indifferent. Attending physicians also reported a greater preference for the EOW ADA regimen (mean VAS score 93, SD 7.8). The mean global satisfaction according to the TSQM was 84.3% (SD 13.5), where 0 indicated extremely dissatisfied and 100 extremely satisfied. Patients reported very high TSQM scores for individual components: effectiveness 77.6% (SD 16.9), convenience 83.7% (SD 14.5), and side effects 86.1% (SD 23.4). Conclusion IBD patients in whom the ADA regimen was changed from 40 mg weekly to 80 mg EOW reported a higher preference for the EOW regimen. TSQM results indicated that patients had a high level of satisfaction with the current EOW regimen. Therefore, most patients wanted to continue with ADA 80 mg EOW.

COVID-19; Immunosuppression; Inflammatory bowel disease COVID-19; Immunosupressió; Malaltia inflamatòria intestinal COVID-19; Inmunosupresión; Enfermedad inflamatoria intestinal (1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case−control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March−July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p < 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p < 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3−5.9), occupational risk (OR: 2.9; 95%CI: 1.8−4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2−2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09−0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution.

The goal of the present article is to present the mapping, creation and application of pedagogical strategies (PS) focused on Distance Education (DE) in different contexts. For that, extension courses were used in different areas, which dealt with socio-affective aspects of distance education, m-learning and digital inclusion of the elderly. The need of this investigation arises from the fact that the concept of pedagogical strategies is usually broad and often inaccurate. Although some studies do use the term, few authors discuss its meaning and application. Based on these, this article presents a definition of pedagogical strategies, as well as implementation situations in distance education. In this approach, PS can be considered as a set of actions put into practice by the teacher to achieve an education-aimed goal. The methodology used to carry out this research was a multiple case study of the qualitative type. Data collection was based on the development, application and evaluation of pedagogical strategies used in extension courses. From the analysis of the data, it was possible to map different strategies and verify the pertinence in their adequacy, according to the context and profile of each audience. Based on the studies we carried out, we can conclude that the pedagogical strategies need to be constantly evaluated, mainly due to the transformations that can occur with the inclusion of new digital technologies in the virtual context, in addition to the heterogeneous profile of the students., El artículo tiene como objetivo presentar el mapeo, la construcción y la aplicación de estrategias pedagógicas (EP) centradas en la educación a distancia (ED) en diferentes contextos. Para ello, se utilizaron cursos de extensión en diferentes áreas, que trataron aspectos socio-afectivos de la educación a distancia, el aprendizaje virtual y la inclusión digital de las personas mayores. Se demostró que la investigación era necesaria en vista del hecho de que la comprensión del concepto de estrategias pedagógicas suele ser amplia y, a menudo, imprecisa. Este artículo presenta una definición de estrategias pedagógicas, así como situaciones de implementación en educación a distancia. La educación física se puede considerar como un conjunto de acciones puestas en práctica por el profesor para lograr un objetivo dirigido a la educación. La metodología utilizada para llevar a cabo esta investigación fue el tipo cualitativo de estudio de caso múltiple. La recolección de datos se basó en el desarrollo, aplicación y evaluación de estrategias pedagógicas en cursos de extensión. A partir del análisis de los datos, fue posible mapear diferentes estrategias y verificar la pertinencia de su adecuación, de acuerdo con el contexto y el perfil de cada audiencia. La educación física debe ser evaluada constantemente, principalmente debido a las transformaciones que pueden ocurrir con la inclusión de nuevas tecnologías digitales en el contexto virtual, además del perfil heterogéneo de los estudiantes involucrados en el proceso educativo., O artigo tem como objetivo apresentar o mapeamento, construção e aplicação de estratégias pedagógicas (EP) voltadas para a Educação a Distância (EaD) em diferentes contextos. Para isso, foram utilizados cursos de extensão em áreas distintas, que versaram sobre aspetos socioafetivos da EaD, m-learning e inclusão digital de idosos. A realização da investigação mostrou-se necessária, tendo em vista que o entendimento sobre o conceito de estratégias pedagógicas costuma ser amplo e, muitas vezes, impreciso. Este artigo apresenta uma definição de estratégias pedagógicas, bem como situações de implementação na EaD. As EP podem ser consideradas como um conjunto de ações colocadas em prática pelo professor para alcançar uma finalidade voltada à educação. A metodologia empregada para a realização desta pesquisa foi a qualitativa do tipo estudo de casos múltiplos. A coleta de dados teve como base o desenvolvimento, aplicação e avaliação de estratégias pedagógicas em cursos de extensão. A partir da análise dos dados, foi possível mapear diferentes estratégias e verificar a pertinência da sua adequação, de acordo com o contexto e perfil de cada público. As EP necessitam ser constantemente avaliadas, principalmente em função das transformações que podem ocorrer com a inclusão de novas tecnologias digitais no contexto virtual, além do perfil heterogéneo dos alunos envolvidos no processo educativo.

Background: A recently registered device containing 80 mg of adalimumab (ADA) allows an alternative dose escalation regimen with ADA 80 mg every other week (EOW) given as a single subcutaneous injection instead of 40 mg every week. The ADASCAL study evaluated the preferences and satisfaction of inflammatory bowel disease (IBD) patients after switching their ADA regimen from 40 mg weekly to 80 mg EOW given with a single-dose pen. Methods: In this multicentre cross-sectional study, patients in whom the ADA regimen was changed from 40 mg weekly to 80 mg EOW completed the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4), a four-item questionnaire [a Likert-type 5-point scale for preferences, two closed questions for convenience and a 100-point visual analogue scale (VAS) to assess which escalated ADA regimen patients would prefer to continue] and two Health-Related Quality of Life (HRQoL) questionnaires: the generic European Quality of Life–5 Dimensions (EQ-5D) and disease-specific Spanish version of the Inflammatory Bowel Disease Questionnaire (SIBDQ-9). Results: In total, 77 patients (64 Crohn’s disease and 13 ulcerative colitis) were included. The TSQM score showed a notably high global satisfaction [83.4, standard deviation (SD) = 14.1] of patients with ADA 80 mg EOW given with a single-dose pen, with high TSQM scores for individual components: effectiveness (77.6, SD = 16.9), convenience (83.7, SD = 14.5) and side effects (86.1, SD = 23.4). Most of the patients (74%) preferred the ADA EOW regimen (59.7% had strong preference, 14.3% slight preference). ADA EOW interferes less with daily activity (59.7%) and with travel plans (81.8%). Most patients (77%) would prefer to continue with ADA EOW (mean VAS score of 84.7, SD = 24.1, where 100 indicates a preference for ADA EOW). Patients reported high HRQoL scores on both the EQ-5D (72.3, SD = 20.1) and SIBDQ-9 (75.1, SD = 14.7). Conclusion: IBD patients in whom the ADA regimen was changed from 40 mg weekly to 80 mg EOW reported a higher preference for the EOW regimen and therefore most decided to continue with a single self-injection EOW.

Orientador: Mario Jose Abdalla Saad Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: A insulina estimula a capacidade quinase de seu receptor, que se autofosforila e estimula a fosforilação de substratos citoplasmáticos, IRS-I e IRS-2. Estes, por sua vez, associam-se e ativam a enzima fosfatidilinositol 3-quinase (pI 3-quinase), que é importante no transporte de glicose. Animais alimentados com dietas ricas em lípides apresentam resistência à ação insulínica, ainda que os mecanismos moleculares dessa alteração não estejam esclarecidos. Esse estudo avaliou as etapas iniciais da ação insulínica em figado e músculo de ratos alimentados durante 4 semanas com uma dieta hiperlipídica, contendo 59% de lípides saturados. Utilizou-se extração de tecidos hepático e muscular após estimulação com insulina e imunoprecipitação seguida de "immunoblotting" com anticorpos anti receptor de insulina anti-IRS-l, antifosfotirosina e anti-PI 3-quinase. Os resultados mostraram que tanto a concentração como a autofosforilação do receptor de insulina estimulada pela insulina em tecidos hepático e muscular, permaneceram inalteradas nos dois grupos, alimentados com a dieta hiperlipídica e com ração convencional. Em figado, a concentração do IRS-I aumentou 51:t17% (p

INTRODUCTION Collection efficiency (CE1) of cells refers to the number of cells that are collected from the total number of cells processed by the apheresis device. Limited data are available about the CE1 of cells when performing leukocytapheresis in nonmobilized donors for cellular therapy purposes. The aim of our study was to evaluate donor- and procedure-related characteristics that might influence the CE1 of cells. MATERIAL AND METHODS Variables that predicted the CE1 of cells were analyzed by longitudinal linear regression in a series of 1071 leukocytapheresis procedures on 249 nonmobilized donors. Donor-related characteristics considered were gender, age, total blood volume, and complete blood count (CBC) data. Procedure-related characteristics considered were vascular access and device used. RESULTS Older donor age was associated with a decrease in the CE1 of leukocytes, lymphocytes, monocytes, and mononuclear cells (MNCs; sum of leukocytes and monocytes) and with an increase in the CE1 of platelets (P

Essential thrombocytosis (ET) is a chronic myeloproliferative neoplasm characterized by the presence of thrombocytosis and it can be complicated by thrombotic and/or hemorrhagic events. Treatment options include low-dose aspirin and cytoreductive agents such as hydroxyurea. In cases of extreme thrombocytosis, therapeutic thrombocytapheresis can be a useful procedure. We present a case of a 61-year-old-man previously diagnosed with CALR-mutated ET, who develop acute myeloid leukemia. When recovering after induction chemotherapy, he developed an extreme thrombocytosis up to 2337 × 109 /L regardless hydroxyurea was started. Two therapeutic trombocytapheresis were performed and anagrelide was added to cytoreductive regimen. Platelet count stabilized around 570 × 109 /L. Both procedures were performed with the Spectra Optia Apheresis System version 11.3 (Terumo BCT) and we decided to use a higher collection preference and lower collection speed than manufacturer's recommendations. Platelet count decreased from 2380 × 109 /L to 1035 × 109 /L in the first procedure and from 1813 × 109 /L to 768 × 109 in the second procedure. Platelet collection efficiency was calculated to be 110.3% and 86.1% in the first and second thrombocytapheresis, respectively. Therapeutic thrombocytapheresis with Spectra Optia is a safe and efficient therapy to treat patients with primary thrombocytosis while effect of cytoreductive agents is attained. Platelet collection efficiency was calculated to be higher than previously reported. We suggest that changes in technical parameters such as a deeper aspiration point and/or lower collection speed may increase procedure's efficiency.

"Análisis del proceso que siguen las mujeres en el ámbito rural para reducir la pobreza patrimonial y, con ella, la violencia que enfrentan cuando se integran como socias a proyecto s productivos. Se estudian las tres dimensiones culturales –familiar, generacional y local– que las mujeres requieren c ambiar para integrarse plenamente a pro­ yec tos productivos en el México rural, a través de las ex­ periencias de dos organizaciones: Mujeres de Cacaloapan, criadoras de conejos en el estado de Hidalgo, y Mujeres Envasadoras de Nopal de Ayoquezco, una unidad de pro ­ ducción agroindustrial en el estado de Oaxaca."

International audience; The noradrenergic locus coeruleus nucleus is an important station in both the ascending and descending pain regulatory pathways. These neurons discharge in tonic and phasic modes in response to sensory stimuli. However, few studies have set out to characterize the electrophysiological response of the locus coeruleus to noxious stimuli in conditions of neuropathic pain. Thus, the effects of mechanical nociceptive stimulation of the sciatic nerve area on spontaneous (tonic) and sensory-evoked (phasic) locus coeruleus discharge were studied by extracellular recording in anesthetized rats seven, fourteen and twenty-eight days after chronic constriction injury. Minor significant electrophysiological changes were found seven and fourteen days after nerve injury. However, alterations to the spontaneous activity in both the ipsilateral and contralateral locus coeruleus were found twenty-eight days after nerve constriction, as witnessed by an increase of burst firing incidence and irregular firing patterns. Furthermore, noxious-evoked responses were exacerbated in the contralateral and ipsilateral nucleus at twenty-eight days after injury, as were the responses evoked when stimulating the uninjured paw. In addition, mechanical stimulation of the hindpaw produced a significant sensitization of neuronal tonic activity after 28 days of neuropathy. In summary, long-term nerve injury led to higher spontaneous activity and exacerbated noxious-evoked responses in the locus coeruleus to stimulation of nerve-injured and even uninjured hindpaws, coinciding temporally with the development of depressive and anxiogenic-like behavior.