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Objetivo: Conhecer as características dos pacientes internados nas clínicas II-A e II-B usando sonda de nutrição enteral (SNE) no Hospital Universitário Walter Cantídio (HUWC), bem como os medicamentos prescritos e utilizados via SNE. Metodologia: Trata-se de um estudo observacional e descritivo. Foram investigados todos os prontuários de pacientes que estiveram internados nas clínicas II-A e II-B, no período de junho a outubro de 2009, e que atenderam os critérios de inclusão. O tamanho da amostra foi calculado com o auxílio do programa Statcalc do software EPI-INFO versão 6.0. Resultados: Foram analisadas 65 prescrições. A maioria dos pacientes era do sexo feminino (61,5%), com idade entre 41-60 anos (48%). Foram prescritos de 3-15 medicamentos no total e uma média de quatro medicamentos por SNE por paciente. Os fármacos mais prescritos por sonda foram captopril, lactulose e omeprazol. Para a maioria dos medicamentos foram prescritas formas farmacêuticas sólidas. As formas líquidas tiveram uma baixa prevalência de uso. Dos 48 medicamentos encontrados, 17 (33%) possuíam dados na literatura sobre suas possíveis interações com a nutrição. Vinte e oito (58%) medicamentos possuíam informações sobre a sua viabilização de administração por SNE. Dos 65 pacientes estudados, 62 apresentaram interações potenciais (95,4%). Conclusão: A alta incidência do uso de formas farmacêuticas sólidas e o número de medicamentos prescritos mostram que, apesar da literatura disponível, a prática clínica está sendo realizada de modo incoerente, acarretando, assim, dificuldades para o tratamento dos pacientes.

Introduction: Rheumatic heart disease (RHD) is underdiagnosed globally resulting in missed treatment opportunities and adverse clinical outcomes. We describe the protocol for a study which aims to co-design, implement and conduct an evaluation of a task-sharing approach to echocardiographic active case finding for early detection and management of RHD in high-risk settings in Australia and Timor-Leste., Methods and Analysis: Echocardiograms will be obtained by trained local staff using hand-held echocardiographic devices employing the 'Single Parasternal Long Axis view with a Sweep of the Heart' (SPLASH) technique and interpreted by experts remote from the site of acquisition. Approximately 1500 children and pregnant women will be screened across high-risk communities in Australia and Timor-Leste over an 18-month period. The study will use a type II effectiveness-implementation hybrid design. A tailored package of implementation strategies will be co-designed with communities and health services and mapped onto a Theory of Change framework. The clinical effectiveness will be assessed as the change in the proportion of the target population that are prescribed secondary prophylaxis for RHD by the end of the study compared with baseline. The implementation will be assessed as the adoption, penetration, sustainability, fidelity and cost of the programme with a mixed-methods theory-based and economic evaluation. Data will include numbers of normal, abnormal and uninterpretable SPLASH echocardiograms obtained, numbers of participants progressing through the cascade of care, interviews with staff and programme costs., Ethics and Dissemination: Ethical approval has been obtained from the Human Research Ethics Committee of the NT Department of Health and Menzies School of Health Research, Darwin (HREC-2022-4479), the Western Australian Aboriginal Health Ethics Committee (HREC-1237) and the Instituto Nasional Saude Publika Timor-Leste Ethics and Technical Committee (03-UEPD/INSP-TL/V/2023). Informed consent is required to be enrolled. Study findings will be disseminated in the communities involved and submitted for publication., Trial Registration Number: NCT06002243., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: DLEUs are a major cause of morbidity. Appropriate treatment is essential, and newer methods to achieve ulcer healing have been described, including application of PG., Objective: This study evaluated the effectiveness and safety of homologous PG in patients with chronic noninfected DLEU refractory to standard treatment as well as possible correlations between patient comorbidities and response to treatment., Materials and Methods: Data from patients with chronic refractory DLEU managed with homologous PG between January 2014 and October 2022 were evaluated (comorbidities, wound characteristics, number and time of treatment, outcome). Outcome was classified as complete response (complete ulcer healing with reepithelialization), partial response (≥50% reduction in area and/or improvement of pain), or absence of response. The chi-square test was used to compare groups, with alpha level set at less than .05., Results: A total of 81 patients (63 male, 18 female; median age, 65 years; median HbA1c, 7.6%; median ulcer area, 2.9 cm2) were proposed for PG application. A total of 62 patients had 3 or more comorbidities. Outcome was evaluated in 69 patients, with response observed in 49% (complete, 32%; partial, 17%). Worse outcomes occurred in patients with polyneuropathy (chi-square statistic: 4.183; P = .041)., Conclusion: Homologous PG is a safe and possibly effective therapeutic alternative for DLEU that is unresponsive to standard therapies.

Purpose: Simultaneous pancreas-kidney transplantation (SPKT) remains the best treatment option in patients with type 1 diabetes and chronic kidney failure. There are only a few studies addressing the potential ischemic deterioration of peripheral arterial disease (PAD) due to blood diverting from the iliac artery to the kidney graft. We aimed to evaluate diabetic foot lesions and PAD evolution in SPKT recipients and investigate if they are more frequent in ipsilateral lower limb of kidney graft., Methods: We developed a retrospective cohort, including patients submitted to SPKT in our tertiary center, between 2000 and 2017. Diabetic foot lesions and PAD frequencies were compared in the period before and after transplantation., Results: Two hundred and eleven patients were included, 50.2% (n = 106) female, with a median age at transplantation of 35 years (IQR 9). After a median follow-up period of 10 years (IQR 7), patient, kidney, and pancreatic graft survival were 90.5% (n = 191), 83.4% (n = 176), and 74.9% (n = 158), respectively. Before transplant, 2.8% (n = 6) had PAD and 5.3% (n = 11) had history of foot lesions. In post-transplant period, 17.1% (n = 36) patients presented PAD and 25.6% (n = 54) developed diabetic foot ulcers, 47.6% (n = 35) of which in the ipsilateral and 53.3% (n = 40) in the contralateral lower limb of the kidney graft (p = 0.48). Nine patients (4.3%) underwent major lower limb amputation, 3 (30%) ipsilateral and 7 (70%) contralateral to the kidney graft (p = 0.29)., Conclusions: Diabetic foot lesions were not more frequent in the ipsilateral lower limb of the kidney graft, therefore downgrading the 'steal syndrome' role in these patients., (© 2023. The Author(s), under exclusive licence to Italian Society of Endocrinology (SIE).)

AmpC is a type of β-lactamase enzyme produced by bacteria; these enzymes are classified in Class C and Group 1, and these confer resistance to cephamycin. Enterobacterales producing AmpC are reported worldwide and have great clinical importance due to therapeutic restriction and epidemiological importance once the easy dissemination by plasmidic genes to other bacteria is a real threat. These genes are naturally found in some enterobacteria as Enterobacter cloacae, Morganella morganii, and Citrobacter freundii, but other species have demonstrated similar resistance phenotype of AmpC production. Genes carried in plasmids have been described in these species conferring resistance to cefoxitin and causing therapeutic failure in some bacterial infections. This work detected and described five clinical strains of Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae that presented plasmid ampC (pAmpC) isolated from the north of Portugal collected in 2009. AmpC production was confirmed by inhibition of the enzyme by cloxacillin and boronic acid in agar diffusion tests. Also, PCR (polymerase chain reaction) was performed for the detection of gene universal to AmpC, bla ampC , and others to AmpC group: bla ACC , bla CIT , bla CMY , bla DHA , and bla EBC . The conjugation in liquid medium for 24 h was realized to determine if gene is localized in chromosome or plasmid. The isolates and their conjugants showed phenotypic characteristics and bla CMY and bla CIT were detected by PCR corroborating the AmpC characteristics observed in these bacteria. Confirmation of transfer of plasmid containing genes encoding AmpC is of high epidemiological relevance to the hospital studied and demonstrated the importance of AmpC surveillance and studies in hospital and community environments in order to choose the appropriate therapy for bacterial infections.

The operating temperature plays a key role in the performance and lifetime of photonic integrated circuits (PICs). Miniaturization and increasing heat dissipation promote thermal crosstalk effects and pose additional challenges to the PIC designer. The European Photonics Industry Consortium recommends thermal modeling during design phase. However, a fully numerical optimization of a particular layout requires an unrealistically large number of simulations. Here, we propose a compromise approach: a set of carefully chosen simulations are performed with a multi-physics software. The obtained results are used to derive a linearized equivalent thermal circuit that can be used to maximize the power levels and to minimize the distance between the chosen components while guaranteeing the absence of a thermal crosstalk. For simplification, this model is derived considering a PIC with only two active components. Other parameters are varied, such as the material of the holder (silicon or diamond) and the layer of epoxy that is used to attach the PIC to the holder. The obtained circuit is used to determine the maximum dissipated power or the minimum distance between the components while keeping some predetermined specifications. The model can be extended to contain more elements or to include transient analysis of the temperature distribution.

Despite the global importance of the zoonotic parasite Toxoplasma gondii, little is known regarding its infection in the Democratic Republic of São Tomé and Príncipe (DRSTP). This is the first report of antibodies to T. gondii in cattle, sheep, goats and pigs from the DRSTP. Antibodies were assessed by the modified agglutination test (MAT), with a cut-off titer of 100 for cattle and 20 for sheep, goats and pigs. The present study revealed an overall seroprevalence of 55.8%; 27.1% in 48 cattle, 68.4% in 98 sheep, 70.1% in 97 goats and 43.7% in 103 pigs. The south geographical area for cattle, the central area for sheep, and adult age and living in the central region for goats were found to be risk factors for seropositivity to T. gondii. These results support the scenario of a considerable presence of sporulated oocysts as well as of infected intermediate hosts in the local environment. Consumption of raw or undercooked meat should be considered as an important potential source of infection for animals and humans in the DRSTP.

The thermal management of photonic integrated circuits (PICs) poses a few challenges at the packaging level. The integration of a PIC with a proper holder provides mechanical support and electrical interconnection, as well as spreading of the heat generated during PIC operation. This study proposes and evaluates the thermal behavior of silicon and diamond holders and estimates the impact of integrating them with PICs as a packaged system; to this end, the thermal profile of a PIC with distributed feedback lasers mounted on silicon or diamond holders was simulated for different power levels using ANSYS Mechanical software. The impact of the epoxy resin used to mount the PIC on the holder and the thermal crosstalk between the active components were also evaluated. Based on steady-state thermal analysis, when the PIC is assembled via wire bonding, the replacement of the silicon holder with a diamond holder brings only a marginal advantage. The choice of epoxy has a larger impact on the maximum PIC temperature and the thermal crosstalk between active components. Choosing a large-thermal-conductivity-value epoxy is thus a mandatory requirement in order to guarantee the proper thermal management of PICs and their corresponding holders.

In this observational study performed during 45 months we evaluated patients with chronic and recalcitrant diabetic ulcers who were treated with homologous platelet gel., Methods: platelet gels were obtained from homologous platelet concentrates that were aliquoted and freezed, being then activated with calcium gluconate and applied in the ulcer after cleaning and debridement. We evaluated patient's comorbidities, wound characteristics (size, tissue, inflammatory signs, pain), number and time of treatment as well as outcome (classified as complete epithelialization; partial improvement- 50% reduction in wound size or pain relief; no evolution)., Results: Fifty-two patients (42 males, 10 females), with a median age of 65 years (range 43-85) were proposed for platelet gel. The following associated comorbidities were observed: hypertension (n = 41), dyslipidemia (n = 29), polyneuropathy (n = 30), peripheral arteriopathy (n = 32), retinopathy (n = 21), nephropathy (n = 15), cardiac ischemic disease (n = 14), obesity (n = 9). Thirty-eight patients presented with 3 or more associated comorbidities. The more frequent ulcer locations were sole of the foot (n = 13) and heel (n = 10). The median number of applications was 16, during 8.5 weeks. Nineteen patients (44%) achieved complete healing, 3 patients (7%) had a partial response and 21 (49%) had no progression. We did not observe a statistically significant relationship between patient age and response nor between number of comorbidities and response. We observed a more favorable evolution in patients with good compliance and good glycemic control., Conclusion: Platelet gel is an effective therapeutic alternative, provided compliance and effective metabolic control are ensured., (Copyright © 2018 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Objective: Restoration of the sensitivity to sensory stimuli in complete brachial plexus injury is very important. The objective of our study was to evaluate sensory recovery in brachial plexus surgery using the intercostobrachial nerve (ICBN) as the donor., Methods: Eleven patients underwent sensory reconstruction using the ICBN as a donor to the lateral cord contribution to the median nerve, with a mean follow-up period of 41 months. A protocol evaluation was performed., Results: Four patients perceived the 1-green filament. The 2-blue, 3-purple and 4-red filaments were perceptible in one, two and three patients, respectively. According to Highet's scale, sensation recovered to S3 in two patients, to S2+ in two patients, to S2 in six patients, and S0 in one patient., Conclusion: The procedure using the ICBN as a sensory donor restores good intensity of sensation and shows good results in location of perception in patients with complete brachial plexus avulsion.

This study examines the intercorrelation of measures reflecting beliefs about and attitudes toward people with mental illness in a sample of health professionals (N = 902) from five countries: Brazil, China, Ghana, Nigeria, and the United States, and, more specifically, the association of beliefs in supernatural as contrasted with biopsychosocial causes of mental illness. Factor analysis of a 43-item questionnaire identified four factors favoring a) socializing with people with mental illness; b) normalizing their roles in society; c) belief in supernatural causes of mental illness (e.g., witchcraft, curses); and d) belief in biopsychosocial causes of mental illness. Unexpectedly, a hypothesized negative association between belief in supernatural and biopsychosocial causation of mental illness was not found. Belief in the biopsychosocial causation was weakly associated with less stigmatized attitudes towards socializing and normalized roles.

Plant organogenesis requires control over division planes and anisotropic cell wall growth, which each require spatial patterning of cells. Polyhedral plant cells can display complex patterning in which individual faces are established as biochemically distinct domains by endomembrane trafficking. We now show that, during organogenesis, the Arabidopsis endomembrane system specifies an important additional cellular spatial domain: the geometric edges. Previously unidentified membrane vesicles lying immediately beneath the plasma membrane at cell edges were revealed through localization of RAB-A5c, a plant GTPase of the Rab family of membrane-trafficking regulators. Specific inhibition of RAB-A5c activity grossly perturbed cell geometry in developing lateral organs by interfering independently with growth anisotropy and cytokinesis without disrupting default membrane trafficking. The initial loss of normal cell geometry can be explained by a failure to maintain wall stiffness specifically at geometric edges. RAB-A5c thus meets a requirement to specify this cellular spatial domain during organogenesis., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

Recently it was shown that both recycling endosome and endosomal sorting complex required for transport (ESCRT) components are required for cytokinesis, in which they are believed to act in a sequential manner to bring about secondary ingression and abscission, respectively. However, it is not clear how either of these complexes is targeted to the midbody and whether their delivery is coordinated. The trafficking of membrane vesicles between different intracellular organelles involves the formation of soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) complexes. Although membrane traffic is known to play an important role in cytokinesis, the contribution and identity of intracellular SNAREs to cytokinesis remain unclear. Here we demonstrate that syntaxin 16 is a key regulator of cytokinesis, as it is required for recruitment of both recycling endosome-associated Exocyst and ESCRT machinery during late telophase, and therefore that these two distinct facets of cytokinesis are inextricably linked.

The Exocyst is an octameric protein complex comprised of Sec3, Sec5, Sec6, Sec8, Sec10, Sec15, Exo70, and Exo84 subunits.(1, 2) This complex was first identified in budding yeast where it acts to target vesicles to the bud tip and the cleavage furrow.(3) Here, we show that all Exocyst subunits are required for cytokinesis in mammalian cells. We further show that a subset of Exocyst proteins are differentially regulated by Rab11, consistent with recent studies implicating Rab11 vesicles in Exocyst protein trafficking.

To identify potentially novel and essential components of plant membrane trafficking mechanisms we performed a GFP-based forward genetic screen for seedling-lethal biosynthetic membrane trafficking mutants in Arabidopsis thaliana. Amongst these mutants, four recessive alleles of GSH2, which encodes glutathione synthase (GSH2), were recovered. Each allele was characterized by loss of the typical polygonal endoplasmic reticulum (ER) network and the accumulation of swollen ER-derived bodies which accumulated a soluble secretory marker. Since GSH2 is responsible for converting γ-glutamylcysteine (γ-EC) to glutathione (GSH) in the glutathione biosynthesis pathway, gsh2 mutants exhibited γ-EC hyperaccumulation and GSH deficiency. Redox-sensitive GFP revealed that gsh2 seedlings maintained redox poise in the cytoplasm but were more sensitive to oxidative challenge. Genetic and pharmacological evidence indicated that γ-EC accumulation rather than GSH deficiency was responsible for the perturbation of ER morphology. Use of soluble and membrane-bound ER markers suggested that the swollen ER bodies were derived from ER fusiform bodies. Despite the gross perturbation of ER morphology, gsh2 seedlings did not suffer from constitutive oxidative ER stress or lack of an unfolded protein response, and homozygotes for the weakest allele could be propagated. The link between glutathione biosynthesis and ER morphology and function is discussed., (© 2012 The Authors. The Plant Journal © 2012 Blackwell Publishing Ltd.)

The terminal stage of cytokinesis - a process termed abscission - is the severing of the thin intercellular bridge that connects the two daughter cells. Recent work provides new insight into the mechanism by which this microtubule-dense membrane bridge is resolved, and highlights important roles for multi-protein assemblies in different facets of abscission. These include the endosomal sorting complex required for transport (ESCRT), which appears to have a decisive role in the final scission event, and vesicle tethering complexes, which potentially act at an earlier stage, and might serve to prepare the abscission site. Here, we review recent studies of the structure, function and regulation of these complexes as related to abscission. We focus largely on studies of cytokinesis in mammalian cells. However, cell division in other systems, such as plants and Archae, is also considered, reflecting the mechanistic conservation of membrane-scission processes during cell division., (© 2011. Published by The Company of Biologists Ltd)

All cells complete cell division by the process of cytokinesis. At the end of mitosis, eukaryotic cells accurately mark the site of division between the replicated genetic material and assemble a contractile ring comprised of myosin II, actin filaments and other proteins, which is attached to the plasma membrane. The myosin-actin interaction drives constriction of the contractile ring, forming a cleavage furrow (the so-called 'purse-string' model of cytokinesis). After furrowing is completed, the cells remain attached by a thin cytoplasmic bridge, filled with two anti-parallel arrays of microtubules with their plus-ends interdigitating in the midbody region. The cell then assembles the abscission machinery required for cleavage of the intercellular bridge, and so forms two genetically identical daughter cells. We now know much of the molecular detail of cytokinesis, including a list of potential genes/proteins involved, analysis of the function of some of these proteins, and the temporal order of their arrival at the cleavage site. Such studies reveal that membrane trafficking and/or remodelling appears to play crucial roles in both furrowing and abscission. In the present review, we assess studies of vesicular trafficking during cytokinesis, discuss the role of the lipid components of the plasma membrane and endosomes and their role in cytokinesis, and describe some novel molecules implicated in cytokinesis. The present review covers experiments performed mainly on tissue culture cells. We will end by considering how this mechanistic insight may be related to cytokinesis in other systems, and how other forms of cytokinesis may utilize similar aspects of the same machinery.

One of the first signs of peripheral neuropathy is the loss of perspiration of the feet. Untill now, the Semmes-Weinstein monofilament test has been considered the gold test to detect early peripheral neuropathy. Recently, the Neuropad test has become available: it is a cobalt salt plaster designed to change colour from blue to pink in contact with liquids, namely sweating. The objective of this study was to find if the Neuropad test could be considered as a test for detecting peripheral autonomic neuropathy and to compare its sensitivity and specificity to the Semmes-Weinstein monofilament test. Forty diabetic patients were studied, 22 of them presented with peripheral neuropathy. The criteria used for the definition of neuropathy was based on the Neuropathy Disability Score (NDS). Under Semmes-Weinstein monofilament test, we found a sensitivity and specificity of 82% and 94%, respectively, and with the Neuropad test, a specificity of 44%, but a sensitivity of 100%. Ten patients presented a sudomotor dysfunction of the feet in the absence of peripheral neuropathy (based on the NDS criteria), and were considered as false positives. We concluded that the Neuropad test is a simple, sensitive test to screen for diabetic neuropathy. Based on the false positive results, we may consider it as a reliable test detecting neuropathy in a earlier phase.

The Ypt3/Rab11/Rab25 subfamily of Rab GTPases has expanded greatly in Arabidopsis thaliana, comprising 26 members in six provisional subclasses, Rab-A1 to Rab-A6. We show that the Rab-A2 and Rab-A3 subclasses define a novel post-Golgi membrane domain in Arabidopsis root tips. The Rab-A2/A3 compartment was distinct from but often close to Golgi stacks and prevacuolar compartments and partly overlapped the VHA-a1 trans-Golgi compartment. It was also sensitive to brefeldin A and accumulated FM4-64 before prevacuolar compartments did. Mutations in RAB-A2a that were predicted to stabilize the GDP- or GTP-bound state shifted the location of the protein to the Golgi or plasma membrane, respectively. In mitosis, KNOLLE accumulated principally in the Rab-A2/A3 compartment. During cytokinesis, Rab-A2 and Rab-A3 proteins localized precisely to the growing margins of the cell plate, but VHA-a1, GNOM, and prevacuolar markers were excluded. Inducible expression of dominant-inhibitory mutants of RAB-A2a resulted in enlarged, polynucleate, meristematic cells with cell wall stubs. The Rab-A2/A3 compartment, therefore, is a trans-Golgi compartment that communicates with the plasma membrane and early endosomal system and contributes substantially to the cell plate. Despite the unique features of plant cytokinesis, membrane traffic to the division plane exhibits surprising molecular similarity across eukaryotic kingdoms in its reliance on Ypt3/Rab11/Rab-A GTPases.