Abstract Palliative care is the holistic care of individuais with serious health-related suffering due to severe illness. The improving survival in malignant and non-malignant diseases results in an ageing population who tive with advanced chronic diseases that commonly present to acute care settings. With our improved ability to relief symptoms and treat intercurrent complications, imaging can be an important aspect of modem palliative care. Point-of-care ultrasound (POCUS) is ultrasound used at the bedside to answer directed clinical questions and guide clinical care. The goals of our review are to provide greater understanding about utility and appropriateness of the use of POCUS in palliative care. The use of POCUS in the clinical setting has increased substantially in recent years, and its characteristics make it an attractive diagnostic and therapeutic adjunct in palliative care, namely in home-based care.

Resumo Os cuidados paliativas são cuidados holísticos prestados a indivíduos com sofrimento intenso decorrente de doença grave. A melhoria da sobrevida nas doenças malignas e não malignas levou ao envelhecimento da população, que vive com doenças crónicas avançadas e frequentemente recorre aos serviços de saúde. Os métodos imagiológicos não invasivos podem ter um papel importante nos cuidados paliativas modernos, no controlo sintomático e na abordagem de intercorrências agudas. A ecografiapoint-of-care (POCUS) trata-se da ecografia realizada à cabeceira do doente, para responder a questões clínicas dirigidas, com o objetivo de orientar a abordagem clínica. O objetivo da nossa revisão é contribuir para uma maior compreensão acerca da utilidade e adequação de POCUS em cuidados paliativas. A utilização do POCUS na prática clínica tem vindo a aumentar nos últimos anos e as suas características tornam-no uma ferramenta útil no diagnóstico e terapêutica em cuidados paliativas, nomeadamente em equipas de apoio comunitário.

RESUMO: Procedimentos dolorosos podem afetar a função das células imunes inatas como neutrófilos e macrófagos, aumentando o risco de ocorrer doenças infeciosas. Desta maneira, o presente trabalho pretendeu verificar se os analgésicos flunixin meglumine ou cetoprofeno conseguem atenuar a dor/desconforto de cordeiros neonatos submetidos a caudectomia por elastração, evitando assim o comprometimento da função dos granulócitos sanguíneos. Para tanto 21 cordeiras foram aleatoriamente divididas em três tratamentos: grupo controle (n=7) não submetido a caudectomia, grupo flunixin (n=7) submetido a caudectomia precedida por anestesia local e duas doses de flunixin meglumine, e cetoprofeno (n=7) submetido a caudectomia precedida por anestesia local e duas doses de cetoprofeno. Mensurou-se os indicadores de dor/desconforto após caudectomia por observações de escore de postura de dor (EP), número de vocalizações (V), frequência de movimentar as orelhas (FO) e frequência respiratória (FR), observados em vídeos de 10 minutos nos momentos -15 min e 6, 48 e 144h. Nos mesmos momentos, avaliou-se a as funções de produção de espécies reativas de oxigênio (ERO) e de fagocitose por granulócitos sanguineos em citometria de fluxo. Notou-se aumento dos indicadores de dor (FR, de V e de EP), da porcentagem dos granulócitos sanguíneos e redução da eficiência de fagocitose em ambos os grupos as 6h. As 48h, os animais do grupo cetoprofeno ainda apresentava mais tempo em postura de dor que os demais grupos e as 144h, apresentou redução da produção ERO por granulócitos. Tais achados permitem concluir que tanto o flunexin meglumine como o cetoprofeno não preveniram dor/desconforto agudo promovido pela elastração, pois os dois grupos manifestaram comportamento de dor e redução da resposta imune inata. Ainda, o analgésico flunixin meglumine foi efetivo em controlar a dor mais tardia e seus efeitos na função de granulócitos sanguíneos em comparação ao cetoprofeno.

ABSTRACT: Painful procedures can affect the function of innate immune cells, such as neutrophils and macrophages, increasing the risk of infectious diseases. The present work aimed to verify if the analgesics flunixin meglumine or ketoprofen can attenuate the pain/discomfort of newborn lambs submitted by elastration tail docking and thereby avoid the impairment of blood granulocytes function. Twenty-one neonate lambs were divided into three treatments: the control group (n=7), not subjected to caudectomy; the flunixin group (n=7), subjected to caudectomy under local anesthesia and analgesia with two doses of flunixin meglumine; and the ketoprofen group (n=7), subjected to caudectomy under local anesthesia and two doses of ketoprofen. Pain indicators were observed by pain posture score (PS), the number of vocalizations (V), frequency of the movement of the ears (EF), and respiratory rates (RR), observed by a 10 minutes videos for each time points: -15min, 6h, 48h, and 144h. At the same time points, the reactive oxygen species (ROS) production and phagocytosis of blood granulocytes were measured by flow cytometry. At 6h after caudectomy, there was a pain indicator increase (RR, V, and PS), a blood granulocyte percentage increase, and a granulocytes phagocytosis reduction for both groups. At 48h, the ketoprofen group spend more time in pain posture and, at 144h, they exhibited a ROS production granulocyte reduction without signs of pain. We conclude the flunixin meglumine and ketoprofen did not prevent the acute pain/discomfort caused by caudectomy, because the groups showed a pain behavior and impaired of the innate immune response however, the flunixin meglumine was effective in controlling the chronic pain and their effects on blood granulocytes function in compare ketoprofen.

In this study, biopolymer-based pH-sensitive hydrogels have been successfully prepared using alginate, κ-carrageenan and pectin aimed at the encapsulation of pancreatin (hydrolytic enzymes like α-amylase, lipase and protease) so as to preserve enzymatic activities. Hydrogels have been characterized by Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), scanning electron microscopy (SEM), swelling degree and swelling profile. Encapsulation efficiency and in vitro studies on delayed release have also been evaluated. All hydrogels presented low swelling degree and enzyme release in a gastric medium. On the other hand, high swelling degree and enzyme release were observed in an intestinal medium. Alginate hydrogel achieved optimal results concerning encapsulation efficiency (18, 68 and 53% for α-amylase, lipase and protease, respectively) and delayed release (363, 7,673 and 17,497 U for α-amylase, lipase and protease, respectively) which has been afterwards compared to a commercial pancreatin formulation (CreonTM 10,000). Thus, it presented better performance than its commercial formulation, mainly in respect of lipase.

Abstract INTRODUCTION: Pulmonary arterial hypertension (PAH) is a serious pulmonary circulation disease caused by several etiologies, including schistosomiasis. The present study retrospectively evaluated the clinical and hemodynamic characteristics of patients with schistosomal PAH (PAH-Sch) compared to those of non-Sch PAH patients (non-Sch PAH). METHODS: Patients treated at the Pronto-Socorro Cardiológico de Pernambuco and diagnosed by right cardiac catheterization were divided into PAH-Sch and non-Sch PAH groups. Their socio-demographic and clinical characteristics, N-terminal-pro B-type natriuretic peptide (NT-proBNP), and echocardiography and hemodynamic parameters were retrospectively reviewed. RESULTS: Among the included 98 patients (mean age, 45 ± 14 years; 68 women [69.4%]), we found 56 PAH-Sch and 42 non-Sch PAH. The age distribution was heterogeneous in the PAH-Sch group, with patients predominantly ranging from 50-59 (p <0.004). Dyspnea was the most common symptom, reported by 92 patients (93.8%), and commonly present for over two years prior to diagnosis. Clinical symptoms were similar in both groups, with no differences in functional class, pulmonary artery systolic pressure (p = 0.102), 6-minute walk test score (p = 0.234), NT-proBNP serum levels (p = 0.081), or hemodynamic parameters. CONCLUSIONS: Patients with PAH-Sch present clinical, laboratory, and hemodynamic profiles similar to those with PAH resulting from other etiologies of poor prognosis. PAH is an important manifestation of schistosomiasis in endemic regions that is often diagnosed late.

RESUMO: A identificação de dor em bovinos e seu alivio, são essenciais para o bem estar animal, todavia ainda não há um teste ideal para esta avaliação. Alguns pesquisadores têm utilizados cortisol sérico e frequências cardíaca e respiratória para esta avaliação, enquanto outros utilizam escalas baseadas em comportamento ou expressões faciais, não existindo uma escala que leve em consideração a união destes identificadores para bovinos. Além disso, a maioria dos pesquisadores manipulam os animais para identificar a dor, o que poderia mascarar os resultados. Desta maneira o presente trabalho propôs elaborar e validar uma escala análogo visual para identificação de dor em bovinos submetidos à orquiectomia. Para tanto 8 bovinos holandeses de 200 dias de vida e 250 kg de peso vivo foram submetidos a orquiectomia com previa anestesia local e uso de analgésicos. A identificação de dor foi baseada em analises fisiológica (cortisol sérico e frequência respiratória), comportamental, de expressão facial e análogo visual nos momentos -30 (30 minutos antes do procedimento) e 1, 3, 6 12, 24, 72 e 420 horas após o procedimento; e com a exceção do cortisol, todas as analises foram realizadas sem a interferência do avaliador com o animal, por meio de filmagens de vídeos. Notou-se que todas as metodologias propostas foram capazes de identificar dor pós orquiectomia em bovinos, no entanto a graduação de maior dor foi em momentos pós-cirúrgicos distintos conforme o parâmetro avaliado. Assim houve fraca correlação entre os modelos propostos, pois se encontrou limitações para a maioria das metodologias avaliadas, concluindo-se que a associação entre os vários parâmetros de dor, tal qual o utilizado na escala análogo visual, aumenta a acurácia em identificar a dor após orquiectomia em bovinos.

ABSTRACT: The identification of pain in cattle and your relief, are essential for animal welfare, however there is still no ideal test for this evaluation. Some researchers have used serum cortisol, heart and respiratory rates for this assessment, while others use scales based on behavior or facial expressions. However, doesn’t exist but a scale that takes into account the union of these identifiers for cattle. Furthermore, most researchers manipulate the animals to identify pain, which could mask the result. In this way, this paper proposed design and validate a visual analog scale for pain identification in cattle undergoing orchiectomy. For this, 8 Holstein calves with 200 days old and 250kg live weight were submitted to orchiectomy with local anesthesia and analgesics. The identification of pain was based on physiological analysis (serum cortisol and respiratory rate), behavioral, and facial expression in the visual-analogue -30 (30 minutes before surgery) and 1, 3, 6, 12, 24, 72 and 420 hours after the procedure; and with the exception of cortisol, all analyzes were performed without the interference of the appraiser with the animal, by videos. It was noted that all the methods proposed were able to identify post orchiectomy pain in cattle, however the degree of pain were higher in different post-surgical times. There was poor correlation between the proposed models, because it was found limitations for most assessed methodologies. We concluded an association between various parameters of pain, as visual analogue scale, can increase the accuracy to identify pain orchiectomy in bulls.

Resumo Opções ambientalmente corretas de destinação de resíduos e a necessidade de ampliação e diversificação da matriz energética nacional e internacional são assuntos pertinentes na atualidade. Uma das técnicas capaz de atender estas premissas é a biodigestão anaeróbica, que gera energia limpa a partir de biomassa. Desta forma, o objetivo deste trabalho foi realizar uma avaliação quanti e qualitativa sobre o tema biodigestão, entendendo o comportamento científico das publicações sobre esta técnica, fundamental para a sustentabilidade ambiental e econômica. Foram avaliados 99 artigos da publicação científica nacional, indexados na Scientific Eletronic Library Online, entre os anos de 1980 a 2015. Os resultados mostraram um aumento expressivo nas publicações científicas a partir de 2000, que abordavam, além da gestão de resíduos ambientalmente correta, a questão energética, com o uso do biogás. Este aumento nas publicações coincide com a maior conscientização acerca dos cuidados com os recursos naturais e a preocupação com a gestão energética mundial. A maioria dos artigos discutiu sobre a avaliação geral do processo, empregando dejetos animais, principalmente de suínos, enfatizando a biodigestão como gestão de resíduos, visto que a suinocultura gera um grande volume de dejetos e ocasiona elevado impacto ambiental.

Abstract Environmentally friendly options for waste disposal and the need for expansion and diversification of the national and international energy matrix are relevant issues today. One technique that supports these goals is anaerobic biodigestion, which generates clean energy from biomass. Accordingly, our goal was to perform a quantitative and qualitative assessment of scientific publications on biodigestion in order to understand the evolution of the technique, which is essential for environmental and economic sustainability. Ninety-nine articles indexed in the Scientific Electronic Library Online between 1980 and 2015 were evaluated. The results showed a significant increase in scientific publications since 2000 which addressed, in addition to environmentally friendly waste management, the energy issue, with the use of biogas. This increase in the number of publications coincides with increased awareness on natural resource management and concern about global energy management. Most of the articles involved a general evaluation of the process, using mainly animal waste from pigs, and emphasizing biodigestion as waste management, since pig farming produces a large volume of waste and has a high environmental impact.

Lipase from Thermomyces lanuginosus was covalently immobilized on activated poly-hydroxybutyrate, sugarcane bagasse and the chemically modified hybrid hydrogel chitosan-alginate prepared by different strategies. Among the tested supports, chitosan-alginate chemically modified with 2,4,6-trinitrobenzenesulfonic acid rendered derivatives with the highest hydrolytic activity and thermal-stability, 45-fold more stable than soluble lipase and was then selected for further studies. The pH of maximum activity was similar for both immobilized and free lipase (pH 8.0) while optimum temperature was 5 - 10 ºC higher for the immobilized lipase. Higher yields in the butyl butyrate synthesis were found for the derivatives prepared by activation with glycidol and epichlorohydrin.

The aim of this work was to verify the ability of enzymatic crude extract from dormant castor bean seeds to yield concentrated fatty acids by hydrolysis of polyunsaturated vegetable oils such as corn and sunflower. The enzymatic extract exhibited higher activity towards corn oil, which was selected for further studies to determine optimum hydrolysis conditions by factorial design. Maximum hydrolysis percentage (≈84%) was reached at 60% wt. oil:buffer acetate 100 mM pH 4.5, 33 ºC and 5.0% wt. of crude extract after 70 min of reaction. These results suggest that the use of low-cost lipase from castor bean seeds has potential for oil hydrolysis.

FUNDAMENTO: A taxa de vasorreatividade pulmonar da Hipertensão Arterial Pulmonar Esquistossomótica (HAPE) não é conhecida. Dados hemodinâmicos obtidos pelo cateterismo cardíaco associam-se aos critérios clínicos de gravidade mais utilizados. OBJETIVO: Estimar o percentual de vasorreatividade positiva ao óxido nítrico em hipertensão arterial pulmonar esquistossomótica; verificar nesses pacientes a associação de parâmetros hemodinâmicos com a classificação funcional da OMS e teste de caminhada de seis minutos. MÉTODOS: Foram selecionados 84 pacientes portadores de hipertensão pulmonar de etiologia esquistossomótica de um banco de dados, submetidos ao cateterismo cardíaco direito e esquerdo com realização do teste de vasorreatividade pulmonar com óxido nítrico. Foram coletados os dados da classificação funcional da OMS e do teste de caminhada de seis minutos para fim de comparação com os dados invasivos. RESULTADOS: Dos 84 pacientes portadores de HAPE, três (3,5%) apresentaram os critérios para vasorreatividade pulmonar positivo. O aumento da resistência vascular pulmonar esteve associado significativamente à menor capacidade de esforço aferida pelo teste de caminhada de seis minutos (p = 0,045) e maiores sintomas de gravidade por meio de maiores classificações funcionais da OMS (classes III/IV) (p = 0,013). A diminuição da saturação de oxigênio na artéria pulmonar esteve associada significativamente a maiores classificações funcionais (p = 0,041). CONCLUSÃO: A taxa de resposta pulmonar ao teste de vasodilatação dos pacientes esquistossomóticos encontra-se abaixo dos valores encontrados para hipertensão pulmonar de etiologia idiopática. A resistência vascular pulmonar e a saturação de oxigênio na artéria pulmonar são dados hemodinâmicos que podem ser utilizados como marcadores de gravidade na hipertensão pulmonar esquistossomótica.

BACKGROUND: The pulmonary vasoreactivity rate of Schistosomal Pulmonary Artery Hypertension (SPAH) is not known. Hemodynamic data obtained by cardiac catheterization are associated with the most commonly used clinical criteria of severity. OBJECTIVE: To estimate the percentage of positive vasoreactivity to nitric oxide in schistosomal pulmonary arterial hypertension and verify the association of hemodynamic parameters with WHO functional classification and the six-minute walk test in these patients. METHODS: A total of 84 patients with schistosomal pulmonary hypertension were selected from a database, who had been submitted to the right and left cardiac catheterization and pulmonary vasoreactivity test with nitric oxide. Data on WHO functional classification and six-minute walk test were collected for comparison with invasive data. RESULTS: Of the 84 patients with SPAH, 3 (3.5%) had positive criteria for pulmonary vasoreactivity. The increase in pulmonary vascular resistance was significantly associated with lower exercise capacity measured by the six-minute walk test (p = 0.045) and greater symptom severity by higher functional classifications (WHO class III/IV) (p = 0.013). The decrease in oxygen saturation in the pulmonary artery was significantly associated with higher functional classifications (p = 0.041). CONCLUSION: The pulmonary response rate to the vasodilation test of schistosomiasis patients is below the values found for idiopathic pulmonary hypertension. Pulmonary vascular resistance and oxygen saturation in the pulmonary artery are hemodynamic data that can be used as markers of severity in schistosomal pulmonary hypertension.

Lipase from Candida rugosa was immobilized by covalent attachment on hybrid SiO2-chitosan obtained by sol-gel technique. A comparative study between free and immobilized lipase was provided in terms of pH, temperature, kinetic parameters and thermal stability on the olive oil hydrolysis. The pH and temperature for maximum activity shifted from 7.0 and 45 ºC for the free lipase to 7.5 and wide range of temperature (40-50 ºC) after immobilization. Kinetics parameters were found to obey Michaelis-Menten equation and K M values indicated that immobilization process reduced the affinity of enzyme-substrate; however Kd values revealed an increase of thermal stability of lipase.

Chitosan, poly[β-(1-4)-linked-2-amino-2-deoxy-D-glucose], is the N-deacetylated product of chitin which is a major component of arthropod and crustacean shells such as lobsters, crabs, shrimps, and cuttlefishes. In addition, chitosan has many significant biological and chemical properties such as biodegradability, biocompatibility and bioactivity as well as polycationic properties. Thus, it has been widely used in many industrial and biomedical applications including wastewater treatment, chromatographic support, carriers for controlled drug delivery and enzyme immobilization. This review is an insight into the exploitation of utilization of chitosan based-supports in different geometrical configurations on the immobilization of enzymes by different protocols for further application in biotransformation reactions.

O presente trabalho teve como objetivo o pré-tratamento de efluente da indústria de laticínios na hidrólise de lipídeos, empregando lipase de fonte de células animais de baixo custo disponível comercialmente (pâncreas de porco) na formação de gás metano por biodegradabilidade anaeróbia empregando diferentes concentrações de lipase (0,05 e 0,5 % w.v-1). A utilização de lipase no pré-tratamento do efluente acelerou a hidrólise de lipídeos e, conseqüentemente, auxiliou o tratamento biológico resultando na redução da matéria orgânica em termos de Demanda Química de Oxigênio (DQO), cor e sólidos em suspensão como lipídeos. Os melhores resultados em termos de remoção de DQO e cor foram obtidos quando a hidrólise e biodigestão foram realizadas simultaneamente, independente da concentração de lipase empregada. Estes resultados mostram que a hidrólise e biodigestão podem ser realizadas simultaneamente empregando baixa concentração de lipase (0,05% w.v-1), contribuindo para a redução de custo e tempo no processo de biodegradação aneróbia.

Lipids-rich wastewater was partial hydrolyzed with porcine pancreas lipase and the efficiency of the enzymatic pretreatment was verified by the comparative biodegradability tests (crude and treated wastewater). Alternatively, simultaneous run was carried out in which hydrolysis and digestion was performed in the same reactor. Wastewater from dairy industries and low cost lipase preparation at two concentrations (0.05 and 0.5% w.v-1) were used. All the samples pretreated with enzyme showed a positive effect on organic matter removal (Chemical Oxygen Demand-COD) and formation of methane. The best results were obtained when hydrolysis and biodegradation were performed simultaneously, attaining high COD and color removal independent of the lipase concentration. The enzymatic treatment considerably improved the anaerobic operational conditions and the effluent quality (lower content of suspended solids and less turbidity). Thus, the use of enzymes such as lipase seemed to be a very promising alternative for treating the wastewaters having high fat and grease contents, such as those from the dairy industry.

A hipertensão arterial pulmonar frequentemente está associada a dor torácica com características anginosas e sua etiologia é desconhecida. A compressão extrínseca do tronco de artéria coronária esquerda pela artéria pulmonar é uma causa tratável e deve ser considerada. É apresentado o caso de uma paciente com hipertensão arterial pulmonar de etiologia esquistossomótica, com angina do peito decorrente de compressão do tronco de artéria coronária esquerda, que foi tratada com stent intracoronário. Os sinais e sintomas isquêmicos foram completamente resolvidos e a ultrassonografia intracoronária, realizada na evolução tardia, mostrou a consolidação do resultado angiográfico.

Pulmonary hypertension is frequently associated to chest pain with anginous characteristics and its etiology is uncertain. Extrinsic compression of the left main coronary artery by the pulmonary artery is a treatable cause and should be taken into consideration. We present the case of a patient with pulmonary hypertension of schistosomotic etiology presenting angina due to compression of the left main coronary artery, who was treated with an intracoronary stent. Signs and symptoms of ischemia were completely resolved and a late follow-up intravascular ultrasound confirmed the vessel patency.

Diversas doenças cardiorespiratórias podem complicar a síndrome da imunodeficiência adquirida. A hipertensão pulmonar é uma rara doença com um pobre prognóstico. Nós descrevemos esta síndrome em cinco pacientes com infecção pelo vírus da imunodeficiência adquirida em nosso serviço com revisão da literatura.

Several cardiorespiratory diseases may complicate the acquired immunodeficiency syndrome. Pulmonary hypertension is a rare clinical disorder with a poor prognosis. We describe this syndrome in five patients seen at our service who presented infection with the acquired immunodeficiency virus, and we review the literature.