INTRODUÇÃO: A atenção primária à saúde (APS) possibilita a melhor cobertura populacional de cuidados à saúde e também o atendimento às pessoas com epilepsia (PCE). OBJETIVOS: Apresentar aspectos evolutivo-conceituais da APS, suas implicações na educação médica, e uso da telemedicina com repercussões no atendimento de PCE. METODOLOGIA: Revisão narrativa com os objetivos apresentados. RESULTADOS: Pessoas habitualmente cuidadas pelo médico de família são mais saudáveis, principalmente devido à abordagem holística; maior ênfase em prevenção e redução de custos por procurar a atenção dos especialistas apenas quando necessária. A educação médica e o mercado de trabalho estão se adaptando a esse perfil de atenção à saúde. Ao mesmo tempo em que médicos de família admitem estar despreparados para o atendimento de PCE, verificou-se não haver neurologistas suficientes para avaliação e condução dessa clientela. A telemedicina apresenta potencial para ensino, consultoria e qualificação da equipe de saúde à distância colaborando com a redução dos óbices mencionados. CONCLUSÃO: Proposições para o atendimento de PCE no Sistema de Saúde: treinamento formal dos profissionais da equipe da APS, criação de médicos especialistas intermediários e enfermeiras treinadas, com aumento dos recursos da telemedicina o que pode garantir a qualidade da APS e integração melhor do sistema de saúde.
Objective: To elaborate a clinical evaluation sheet (CES) of the lower limbs (LL) for diabetic foot (DF) prevention. Methods: Based on literature review, a four-phased CES has been elaborated: phases 1 and 2 contemplate clinical evaluation (anamnesis and physical evaluation, respectively) with emphasis on feet evaluation and search for soreness risk factors; phase 3 evaluates feet care and phase 4 describes the main guidelines for this care. Results: With the completion of phases 1 and 2, a feet soreness risk rating follows. Phase 3 evaluates feet care with ten questions and phase 4 presents ten educational guidelines for DF prevention. Conclusion: The proposed CES enables the detection and early intervention on foot soreness risk. Descriptors RESUMENObjetivo: Desarrollar formulario de evaluación clínica (FEC) de los miembros inferiores (MIs) para la prevención del pie diabético (PD). Métodos: A partir de la revisión de la literatura, fue preparada una FEC con 4 fases: fases 1 y 2 incluyen examen clínico (anamnesis y la exploración física, respectivamente), con énfasis en la evaluación de los pies y los factores de riesgo para buscar úlceras; fase 3 se evalúa el autocuidado con sus pies y la fase 4 se describen las pautas principales para este tipo de atención. Resultados: Después de la terminación de las fases 1 y 2 sigue la clasificación de riesgo de la ulceración de los pies. Fase 3 evalúa con diez preguntas del cuidado de los pies y la fase 4 presenta diez directrices educativas para prevenir el PD. Conclusión: La propuesta FEC permite detectar e intervenir temprano en riesgo de ulceración de los pies.
Introduction: The importance of epigenetic in the onset and progression of breast cancer has led many researchers to incorporate this new and exciting theme in the development of anti-cancer drugs. Breast cancer is the most common cancer among women. Human chorionic gonadotropin (hCG) has been correlated to antitumoral actions in the breast epithelium. It has anti-proliferative, pro-apoptotic and differentiative effects on this tissue. In contrast, estradiol (E2) is correlated to tumor development and progression. This steroid hormone increases cell proliferation, invasion and metastasis, as well as it inhibits anti-apoptotic and dedifferentiation processes. Objective: To obtain an expression profile of chromatin remodeling-related genes, such as histone deacetylase, histone acetylases and nuclear receptors in the breast tumor cell line (SK-BR3) after treatment with the glycoprotein hormone, hCG, and the steroid hormone, E2. Experimental Procedures: Her-2 overexpressing breast tumor cells SK-BR3 were divided into three groups: control (no treatment), hCG and E2. Cells were treated for 11 days. After each treatment, these cells had their mRNA extracted, purified, analyzed and then used to quantify the expression of chromatin remodeling-related genes — histone acetylases (KAT5, NCOA1, NCOA3 and KAT2B), histone deacetylases (HDACs 1 to 7) and other chromatin modifiers (ESR1, HMGA1, NCOA6 and PPARGC1B) by quantitative PCR (qPCR). Results: hCG and E2 treatments downregulated histone deacetylases 5 and 6 (HDAC5, and HDAC6) and nuclear receptor coactivator 3 (NCOA3) when compared to control. However hCG caused a more potent inhibitory effect than E2 on HDCA5, HDAC6 and NCOA3 expressions, hCG (-5.3, -3.3 and -3.3 fold respectively, p <0.0001) and E2 (-1.9 - 1.2, and -2.4 fold respectively, p <0.001). Furthermore, both treatments slightly upregulated KAT2B expression, hCG by 2.0 fold (p <0.01) and E2 by 1.3 fold (p <0.001). Conclusions: Our results show that hCG has a more potent effect on the expression control of chromatin remodeling-related-genes of the highly undifferentiated and estrogen receptor-negative cell line, SK-BR3 than E2 has. Both hormones hCG and E2, inhibited NCOA3 (AIB1) expression, suggesting that this nuclear factor, overexpressed in breast tumors, interacts with steroid and nonsteroid intracellular activated pathways. Treatments also downregulated two out of seven deacetylase-related genes (HDACs 5 and 6). None was upregulated. and hCG upregulated one out of three assessed acetylase-related genes (KAT2A). hCG inhibits deacetylation and stimulates acetylation of histone tails in SK-BR3, therefore positively regulating gene transcription. It is known that HDACs have an important role in mammary tumor cell growth control. Its differential expression, mainly induced by hCG, might contribute to breast cancer malignancy attenuation induced by the hormone. (De) Acetylation mechanisms of specific histone tail-amino acid residues, as well as cytoskeletal microtubule assembling control exerted by HDAC6 that alters cell motility might also contribute. Financial support: FAPESP Citation Format: Isidoro Binda-Neto, Silvana Aparecida Alves Correa-Noronha, Jorge Kede, Maria del Carmen GM Wolgien, Ismael DCG Silva, Samuel Marcos Ribeiro de Noronha. Epigenetic mechanisms of human chorionic gonadotropin (hCG) intracellular pathways activation in mammary tumor cells SKBR3. [abstract]. In: Proceedings of the AACR Special Conference on Chromatin and Epigenetics in Cancer; Jun 19-22, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2013;73(13 Suppl):Abstract nr A53.
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