Medical School Students’ Knowledge of Pain and Palliative Care: An Observational Study

Background: Pain and palliative care are a reality in daily routines of medical treatment. However, the theoretical-practical curricula of traditional medical school course still unsatisfactorily contemplate pain management, as well as the palliative care approach. Objective: To assess the knowledge of medical students about pain and palliative care, as well as to identify their perception of teaching these topics during hospitalization. Methods: A cross-sectional observational study, with a descriptive and exploratory approach, data collection for which was carried out between August and November 2020. The target population was medical students, who responded to an online survey of a quantitative, anonymous and follow-up nature. The survey study variables concerned knowledge about pain management and palliative care. Results: An expressive majority of academics showed difficulty in understanding the pathophysiology of pain related to prescribing drugs for pain management purposes, and all of them believe that it is necessary to acquire more knowledge about pain treatment. In parallel, only 9.3% report having received sufficient information regarding palliative care during medical school. Conclusion: The results suggest a certain lack of knowledge and insecurity among medical school students with respect to pain management and care for patients receiving palliative care. The didactical approach to this theme is still deficient in the medical curriculum and requires immediate improvement and new proposals that address the training of these professionals in a more specific and effective way.

Microstructure features and mechanical/electrochemical behavior of directionally solidified Al−6wt.%Cu−5wt.%Ni alloy

The effects of the addition of 5.0 wt.%Ni to an Al−6wt.%Cu alloy on the solidification cooling rate(T),growth rate(V_(L)),length scale of the representative phase of the microstructure,morphology/distribution of intermetallic compounds(IMCs)and on the resulting properties were investigated.Corrosion and tensile properties were determined on samples solidified under a wide range of T along the length of a directionally solidified Al−6wt.%Cu−5.0wt.%Ni alloy casting.Experimental growth laws were derived relating the evolution of primary(λ_(1))and secondary(λ_(2))dendritic spacings with T and V_(L).The elongation to fracture(δ)and the ultimate tensile strength(σ_(U))were correlated with the inverse of the square root of λ_(1) along the length of the casting by Hall−Petch type experimental equations.The reinforcing effect provided by the addition of Ni in the alloy composition is shown to surpass that provided by the refinement of the dendritic microstructure.The highest corrosion resistance is associated with a microstructure formed by thin IMCs evenly distributed in the interdendritic regions,typical of samples that are solidified under higher T.

MGMT and MLH1 methylation in Helicobacter pylori-infected children and adults

AIM:To evaluate the association between Helicobacter pylori(H.pylori) infection and MLH1 and MGMT methylation and its relationship with microsatellite instability(MSI).METHODS:The methylation status of the MLH1 and MGMT promoter region was analysed by methylation specific methylation-polymerase chain reaction(MSPPCR) in gastric biopsy samples from uninfected or H.pylori-infected children(n = 50),from adults with chronic gastritis(n = 97) and from adults with gastric cancer(n = 92).MLH1 and MGMT mRNA expression were measured by real-time PCR and normalised to a constitutive gene(β actin).MSI analysis was performed by screening MSI markers at 4 loci(Bat-25,Bat-26,D17S250 and D2S123) with PCR;PCR products were analysed by single strand conformation polymorphism followed by silver staining.Statistical analyses were performed with either the χ 2 test with Yates continuity correction or Fisher's exact test,and statistical significance for expression analysis was assessed using an unpaired Student's t-test.RESULTS:Methylation was not detected in the promoter regions of MLH1 and MGMT in gastric biopsy samples from children,regardless of H.pylori infection status.The MGMT promoter was methylated in 51% of chronic gastritis adult patients and was associated with H.pylori infection(P < 0.05);this region was methylated in 66% of gastric cancer patients,and the difference in the percentage of methylated samples between these patients and those from H.pylori-infected chronic gastritis patients was statistically significant(P < 0.05).MLH1 methylation frequencies among H.pylori-infected and non-infected chronic gastritis adult patients were 13% and 7%,respectively.We observed methylation of the MLH1 promoter(39%) and increased MSI levels(68%) in samples from gastric cancer patients in comparison to samples from H.pylori-infected adult chronic gastritis patients(P < 0.001 and P < 0.01,respectively).The frequency of promoter methylation for both genes was higher in gastric cancer samples than in H.pylori-positive chronic gastritis samples(P < 0.05).The levels of MLH1 and MGMT mRNA were significantly reduced in chronic gastritis samples that were also hypermethylated(P < 0.01).CONCLUSION:In summary,MGMT and MLH1 methylation did not occur in earlier-stage H.pylori infections and thus might depend on the duration of infection.

Markers for Rapid Evaluation of Virus Resistance for TYLCV in Tomato, ZYMV and PRSV-W in Zucchini and LMV in Lettuce and Hybrid Seeds in Pumpkin

Screening for the source of virus resistance in horticultural plants or specific characterization as hybridization, through symptoms, requires time and depends on the weather and knowledge of plant characteristics. So, it is important to develop specific gene markers to allow rapid diagnosis by PCR. Markers were developed based on sequences homology comparison of susceptible and resistant plants provided by HORTEC SEEDS in tomato for Tomato yellow leaf curl virus (TYLCV) by the resistance gene Ty-1, in zucchini for Zucchini yellow mosaic virus (ZYMV) and Papaya ringspot virus estirpe watermelon (PRSV-W), and in lettuce for Lettuce mosaic virus (LMV). Fragments of 249 bp were amplified only by resistant plants to TYLCV as the hybrids 2648 and Aguamiel, and not for varieties as Santa Cruz or Carina. It were observed for ZYMV the amplification of 791 bp by the resistant hybrid Px7051 and not for the susceptible cultivar La Belle;for PRSV-W using the same zucchini plants the amplification of 650 bp for susceptible and 750 bp for resistant;for LMV the 421 bp amplification only for the resistant cultivar Brasil 303 and not for susceptible Babá de Ver&atilde;o. Finally, it was observed that primers PK47F/R were able to check the Cabotiá seed hybrids of pumpkin Jabras.

Downregulation of TNFR2 decreases survival gene expression,promotes apoptosis and affects the cell cycle of gastric cancer cells

BACKGROUND Chronic inflammation due to Helicobacter pylori(H.pylori)infection promotes gastric carcinogenesis.Tumour necrosis factor-α(TNF-α),a key mediator of inflammation,induces cell survival or apoptosis by binding to two receptors(TNFR1 and TNFR2).TNFR1 can induce both survival and apoptosis,while TNFR2 results only in cell survival.The dysregulation of these processes may contribute to carcinogenesis.AIM To evaluate the effects of TNFR1 and TNFR2 downregulation in AGS cells treated with H.pylori extract on the TNF-αpathway.METHODS AGS cell lines containing TNFR1 and TNFR2 receptors downregulated by specific shRNAs and nonsilenced AGS cells were treated with H.pylori extract for 6 h.Subsequently,quantitative polymerase chain reaction with TaqMan®assays was used for the relative quantification of the mRNAs(TNFA,TNFR1,TNFR2,TRADD,TRAF2,CFLIP,NFKB1,NFKB2,CASP8,CASP3)and miRNAs(miR-19a,miR-34a,miR-103a,miR-130a,miR-181c)related to the TNF-αsignalling pathway.Flow cytometry was employed for cell cycle analysis and apoptosis assays.RESULTS In nonsilenced AGS cells,H.pylori extract treatment increased the expression of genes involved in cell survival and inhibited both apoptosis(NFKB1,NFKB2 and CFLIP)and the TNFR1 receptor.TNFR1 downregulation significantly decreased the expression of the TRADD and CFLIP genes,although no change was observed in the cellular process or miRNA expression.In contrast,TNFR2 downregulation decreased the expression of the TRADD and TRAF2 genes,which are both important downstream mediators of the TNFR1-mediated pathway,as well as that of the NFKB1 and CFLIP genes,while upregulating the expression of miR-19a and miR-34a.Consequently,a reduction in the number of cells in the G0/G1 phase and an increase in the number of cells in the S phase were observed,as well as the promotion of early apoptosis.CONCLUSION Our findings mainly highlight the important role of TNFR2 in the TNF-αpathway in gastric cancer,indicating that silencing it can reduce the expression of survival and anti-apoptotic genes.

Effects of Dexamethasone, Clonidine, Tramadol and Nalbuphine on Fentanyl-Induced Hyperalgesia in Rats

Opioids are drugs used to alleviate pain. However, studies have demonstrated that these drugs can cause an increase in pain sensitivity, which is called opioid-induced hyperalgesia. The objective of this study was to describe the effects of dexamethasone, clonidine, tramadol and nalbuphine on fentanyl-induced hyperalgesia in rats. After obtaining approval from the Committee for the Ethical Use of Animals (CEUA), 36 male Wistar rats were divided into 6 groups: Group 1 (GCSSL) wherein the rats received 1 ml 0.9% saline solution in two injections;Group 2 (GFTSL), received fentanyl at a dose of 100 ug·kg-1 followed by 1 ml 0.9% saline solution via intraperitoneal;the remaining groups (3, 4, 5, 6) received fentanyl at a dose of 100 ug·kg-1 following doses via intraperitoneal: Group 3 (GFTDX), dexamethasone at a dose of 1.0 mg·kg-1;Group 4 (GFTCL), clonidine at a dose of 20 mg·kg-1;Group 5 (GFTTR), tramadol at a dose of 50 mg·kg-1, and Group 6 (GFTNB), nalbuphine at a dose of 5 mg·kg-1. Under general anestesia using isoflurane, the animals were submitted to a surgical incision. Hyperalgesia was evaluated by applying Von Frey filaments at 2 hours after the incision and on the 1st, 3rd and 5th days afterward. At 2 hours after the surgical procedure, there was lower intensity of pain in the fentanyl group (GFTSL) compared to the other groups, and on the fifth day there were no significant differences for pain intensity between groups. The results suggest the presence of fentanyl-induced hyperalgesia and efficacy in its reduction by dexamethasone, clonidine, tramadol and nalbuphine.

Adenosine A1 receptor activation inhibits histamine release in gastric enterochromaffin-like cells

Adenosine acts as a gastroprotective factor decreasing inflammation and reducing gastric acid secretion. Quantitative RT-PCR was used to determine the expression of the adenosine receptor genes (A1AR, A2AAR, A2BAR and A3AR) and that of the gastrin receptor B gene (CCKBR) in isolated, short-term cultured enterochromaffin-like (ECL) cells. Both the A1AR and the CCKBR genes were expressed at a level high-er than the other genes. Also, the effect of 2-chloroadenosine, a stable agonist of A1 and A2A receptors, was explored on ECL cells, with a resulting inhibition of both basal and gastrin-stimulated histamine release. Also, dipropylcyclopentylxanthine (DPCPX), a selective A1 antagonist, prevented the inhibitory effects of 2-chloro-adenosine, suggesting the effect of 2-chloroadenosine is mediated by A1 receptors. It is concluded that isolated, short-term cultured ECL cells are a suitable model for studies relating gene expression and function, and that the gastroprotective actions of adenosine are at least partly mediated through A1 receptors.

Effects of Ketoprofen, Ketamine, Lidocaine and Propofol on Fentanyl-Induced Hyperalgesia in Rats

Opioid-induced hyperalgesia negatively affects physiological pain management and presents a complex causal mechanism, involving, pharmacodynamic and pharmacokinetic factors of interactions with receptors, opioid-independent ascending systems and with pro-nociceptive systems. After approval by the CEUA, 42 male Wistar rats were divided into 7 groups: In group 1 (GCSSL) the animals received 1 ml of 0.9% saline solution intraperitoneally (IP);in group 2 (GFTSL), they received fentanyl at a dose of 100 ug·kg-1 IP;in the remaining groups (3, 4, 5, 6 and 7) the animals received IP, fentanyl at a dose of 100 ug·kg-1 followed also by IP route of: group 3 (GFTKP) ketoprofen at a dose of 5 mg·kg-1;group 4 GFTKT), ketamine up to a dose of 10.0 mg·kg-1;group 5 (GFTLI), incisional lidocaine up to a dose of 10 mg·kg-1;group 6 (GFTLP), intraperitoneal lidocaine up to a dose of 10 mg·kg-1 and group 7 (GFTPP), propofol up to a dose of 60 mg·kg-1. Under general anesthesia, all animals with a plantar surgical incision. Hyperalgesia was evaluated by applying Von Frey filaments on the 2nd, 1st, 3rd and 5th days after treatment. In the 2nd hour and on the 5th day after the procedure, there was no hyperalgesia associated with the use of fentanyl, however, on the 1st and 3rd postoperative days there was hyperalgesia that was attenuated by ketoprofen, ketamine, lidocaine infiltrated in the incision and intraperitoneally, an effect not observed with the use of propofol. The results suggest fentanyl-induced hyperalgesia and the efficacy of ketoprofen, ketamine, incisional lidocaine and intraperitoneal lidocaine in reducing this effect.

Approach to Pain in Endometriosis Patients: Systematic Literature Review

Background: Endometriosis is a gynecological, multifactorial condition that affects women’s life quality, especially due to the pain inherent to it. Pain is caused by physical and psychological aspects;therefore, several factors must be analyzed, aiming to treat the whole. Conventional, drug or surgical treatments are the most used;however, the search for alternative therapeutic methods is growing. Objective: To analyze the approach to pain in women with endometriosis, seeking a better understanding of the pathophysiological mechanisms of this disease, its impact on life quality, as well as the means of treatments in use and innovations in this field. Methods: Systematic literature review, conducted in the Virtual Health Library databases between 2010 and 2021, restricted to articles in English and Portuguese with the descriptors: Endometriosis, Pain, and Treatment. After reading the abstracts, 197 articles were found, and, after reading them, 59 articles were selected. Results: This review analyzed 59 scientific studies that rigorously met the previously established characteristics in the sample selection. The synthesis included the following aspects: author/year of publication, article title, objective, type of study and database. Related factors such as acute or chronic pain, late diagnosis, discrediting symptomatic complaints and trivialization by health professionals have a profound impact on the physical and mental health of women with endometriosis. On the other hand, there are several classes of drugs, surgical procedures, and alternative therapies available for pain management. Conclusion: Given the context addressed, a certain need is suggested for health professionals to better understand the disease and adopt new behaviors or improve existing ones, such as reception, active listening, early diagnosis and comprehensive and individualized treatment. In addition, further studies are needed regarding alternative therapies, seeking to expand the scientific evidence of their benefits.

Tracheal Intubation Difficulties: Systematic Literature Review

Background: Tracheal intubation is a common procedure in medical practice, being performed mainly in surgical centers and emergencies in trauma patients. Objective: This systematic literature review aims to understand the main difficulties and complications related to tracheal intubation. Methods: Systematic literature review, conducted in the Virtual Health Library databases between 2016 and 2021, restricted to articles in English and Portuguese with the descriptors: Airway, Difficult intubation, and Complications. After reading the abstracts, 34 articles were found, and, after reading them, 9 articles were selected. Results: This review analyzed 9 scientific studies that rigorously met the previously established characteristics in the sample selection. The synthesis included the following aspects (author/year of publication, article title, objective, type of study, and database. Discussion: Several factors that influence the success of intubation were identified, such as technical, professional, and patient issues. In addition, measures to minimize the risks involving the procedure were highlighted. Conclusion: Tracheal intubation is a common procedure in surgical centers and emergencies. However, its risks, while low, should not be ignored. Unsuccessful procedures can occur and have consequences for the patient, such as trauma to the upper airway.