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The objective of the study was to evaluate the effect of photobiomodulation (PBM) with laser on the inflammatory process in an experimental in vitro model of ACO. The groups were: (1) human bronchial epithelial cells (BEAS-2B); (2) BEAS-2B cells treated with dexamethasone; (3) BEAS-2B cells irradiated with laser; (4) BEAS-2B cells stimulated with cigarette smoke extract (CSE) + House Dust Mite (HDM); (5) BEAS-2B cells stimulated with CSE + HDM and treated with dexamethasone; (6) BEAS-2B cells incubated with CSE + HDM and irradiated with laser. After 24 h, cytokines were quantified. There was a reduction in TNF-α, IL-1ß, IL-6, IL-4, IL-5, IL-13, IL-17, IL-21, IL-23, and an increase in IL-10 and IFN-γ in cells from the laser-irradiated ACO group compared to only ACO group. With these results, we can suggest that photobiomodulation acts in the modulation of inflammation observed in ACO, and may be a treatment option.

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INTRODUCTION: Long COVID occurs when numerous symptoms begin 3 weeks after acute infection and last for 12 months or more. High-definition transcranial direct current stimulation (HD-tDCS) has been tested in patients with COVID-19; however, previous studies did not investigate the HD-tDCS use combined with inspiratory muscle training (IMT) for respiratory sequelae of long COVID. CASE PRESENTATION: Six individuals (four women and two men) aged between 29 and 71 years and presenting with respiratory sequelae of long COVID were included. They were submitted to an intervention that comprised HD-tDCS combined with IMT twice a week for 5 weeks. Lung function and respiratory muscle assessments were performed at baseline and after 5 weeks of intervention. IMPLICATIONS ON PHYSIOTHERAPY PRACTICE: HD-tDCS may enhance the IMT effects by increasing respiratory muscle strength, efficiency, and lung function of individuals with long COVID.

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Introduction: Pathogenesis of cutaneous leishmaniases involves parasite growth, persistent inflammation, and likely participation of lipoproteins (LP). The cholesteryl ester transfer protein (CETP), involved in LP remodeling, has been shown to participate in the inflammatory response and the evolution of infectious conditions. Methods: We evaluated the impact of the presence of CETP on infection by Leishmania (L.) amazonensis in an experimental model of cutaneous leishmaniasis using C57BL6/J mice transgenic for human CETP (CETP), having as control their littermates that do not express the protein, wild-type (WT) mice. The progression of the lesion after infection in the footpad was monitored for 12 weeks. Two groups of animals were formed to collect the plantar pad in the 4th and 12th week post-infection. Results: The lesion increased from the 3rd week onwards, in both groups, with a gradual decrease from the 10th week onwards in the CETP group compared to the WT group, showing a reduction in parasitism and an improvement in the healing process, a reduction in CD68+ cells, and an increase in CD163+ and CD206, characterizing a population of M2 macrophages. A reduction in ARG1+ cells and an increase in INOS+ cells were observed. During infection, the LP profile showed an increase in triglycerides in the VLDL fraction in the CETP group at 12 weeks. Gene expression revealed a decrease in the CD36 receptor in the CETP group at 12 weeks, correlating with healing and parasite reduction. In vitro, macrophages derived from bone marrow cells from CETP mice showed lower parasite load at 48 h and, a reduction in arginase activity at 4 h accompanied by increased NO production at 4 and 24 h compared to WT macrophages, corroborating the in vivo findings. Discussion: The data indicate that the presence of CETP plays an important role in resolving Leishmania (L.) amazonensis infection, reducing parasitism, and modulating the inflammatory response in controlling infection and tissue repair.

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Advanced glycation end products (AGEs) prime macrophages for lipopolysaccharide (LPS)-induced inflammation. We investigated the persistence of cellular AGE-sensitization to LPS, considering the nuclear content of p50 and p65 nuclear factor kappa B (NFKB) subunits and the expression of inflammatory genes. Macrophages treated with control (C) or AGE-albumin were rested for varying intervals in medium alone before being incubated with LPS. Comparisons were made using one-way ANOVA or Student t-test (n = 6). AGE-albumin primed macrophages for increased responsiveness to LPS, resulting in elevated levels of TNF, IL-6, and IL-1beta (1.5%, 9.4%, and 5.6%, respectively), compared to C-albumin. TNF, IL-6, and IL-1 beta secretion persisted for up to 24 h even after the removal of AGE-albumin (area under the curve greater by 1.6, 16, and 5.2 times, respectively). The expressions of Il6 and RelA were higher 8 h after albumin removal, and Il6 and Abca1 were higher 24 h after albumin removal. The nuclear content of p50 remained similar, but p65 showed a sustained increase (2.9 times) for up to 24 h in AGE-albumin-treated cells. The prolonged activation of the p65 subunit of NFKB contributes to the persistent effect of AGEs on macrophage inflammatory priming, which could be targeted for therapies to prevent complications based on the AGE-RAGE-NFKB axis.

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RESUMO Objetivo: analisar os indicadores de gestão em saúde relacionados ao serviço de atendimento móvel de urgências do Ceará. Método: trata-se de um estudo documental, retrospectivo, de abordagem quantitativa, realizado no sítio eletrônico IntegraSUS do governo do estado do Ceará - Brasil, no período de julho de 2021, para análise dos indicadores "total de chamadas" e "tempo médio de resposta". Resultados: verificou-se um perfil de chamadas prevalentes para homens (52,66%), com idade avançada >70 anos (22,06%), ocorrências de atendimento Covid-19 para a Central Juazeiro (7,62%) e acidentes por motocicleta para a Central Eusébio (7,94%). O serviço obteve chamados para 177 municípios cearenses (96,19%) com tempo médio de resposta maior para Covid-19. Conclusão: a análise sinaliza a necessidade de ajuste das estratégias para melhorar o desempenho do tempo-resposta do serviço, com revisão do sistema organizacional, inclusive, da publicização dos dados pela plataforma digital.

ABSTRACT Objective: To analyze the health management indicators related to the mobile emergency care service in Ceará. Method: This is a documentary, retrospective, quantitative study, carried out on the IntegraSUS website of the Ceará state government - Brazil, during the period July 2021, to analyze the indicators "total calls" and "average response time". Results: It was verified a profile of prevalent calls for men (52.66%), with advanced age >70 years (22.06%), Covid-19 service occurrences for the Juazeiro central station (7.62%) and motorcycle accidents for the Eusébio central station (7.94%). The service got calls for 177 cities in Ceará (96.19%) with a longer average response time for Covid-19. Conclusion: The analysis signals the need to adjust strategies to improve the performance of the service response time, with a review of the organizational system, including the publication of data by the digital platform.

RESUMEN Objetivo: analizar los indicadores de gestión de salud relacionados con el servicio móvil de atención de urgencias en el Estado de Ceará. Método: se trata de un estudio documental, retrospectivo, de abordaje cuantitativo, realizado en el sitio IntegraSUS del gobierno del estado de Ceará - Brasil, en el período de julio de 2021, para el análisis de los indicadores "total de llamadas" y "tiempo medio de respuesta". Resultados: se verificó un perfil de prevalencia de llamadas para hombres (52,66%), con edad avanzada >70 años (22,06%), ocurrencias de asistencia del Covid-19 para la Central Juazeiro (7,62%) y accidentes de motocicleta para la Central Eusébio (7,94%). El servicio obtuvo llamadas para 177 municipios de Ceará (96,19%) con un tiempo medio de respuesta mayor para Covid-19. Conclusión: el análisis señala la necesidad de ajustar las estrategias para mejorar el rendimiento del tiempo de respuesta del servicio, con una revisión del sistema organizativo, incluida la publicación de datos por la plataforma digital.

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BACKGROUND: and purpose: Fatigue is among the most common persistent symptoms following post-acute sequelae of Sars-COV-2 infection (PASC). The current study investigated the potential therapeutic effects of High-Definition transcranial Direct Current Stimulation (HD-tDCS) associated with rehabilitation program for the management of PASC-related fatigue. METHODS: Seventy patients with PASC-related fatigue were randomized to receive 3 mA or sham HD-tDCS targeting the left primary motor cortex (M1) for 30 min paired with a rehabilitation program. Each patient underwent 10 sessions (2 sessions/week) over five weeks. Fatigue was measured as the primary outcome before and after the intervention using the Modified Fatigue Impact Scale (MFIS). Pain level, anxiety severity and quality of life were secondary outcomes assessed, respectively, through the McGill Questionnaire, Hamilton Anxiety Rating Scale (HAM-A) and WHOQOL. RESULTS: Active HD-tDCS resulted in significantly greater reduction in fatigue compared to sham HD-tDCS (mean group MFIS reduction of 22.11 points vs 10.34 points). Distinct effects of HD-tDCS were observed in fatigue domains with greater effect on cognitive (mean group difference 8.29 points; effect size 1.1; 95% CI 3.56-13.01; P < .0001) and psychosocial domains (mean group difference 2.37 points; effect size 1.2; 95% CI 1.34-3.40; P < .0001), with no significant difference between the groups in the physical subscale (mean group difference 0.71 points; effect size 0.1; 95% CI 4.47-5.90; P = .09). Compared to sham, the active HD-tDCS group also had a significant reduction in anxiety (mean group difference 4.88; effect size 0.9; 95% CI 1.93-7.84; P < .0001) and improvement in quality of life (mean group difference 14.80; effect size 0.7; 95% CI 7.87-21.73; P < .0001). There was no significant difference in pain (mean group difference -0.74; no effect size; 95% CI 3.66-5.14; P = .09). CONCLUSION: An intervention with M1 targeted HD-tDCS paired with a rehabilitation program was effective in reducing fatigue and anxiety, while improving quality of life in people with PASC.

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Primary hyperlipidaemia in Schnauzer is characterized by increased plasma triglycerides (TG) and/or total cholesterol (TC) concentration and is associated with an increased risk of developing pancreatitis, insulin resistance and seizures. In humans, omega-3 fatty acids in addition to a low-fat diet can be used to reduce TG and TC. This study evaluated the therapeutic efficacy of omega-3 fatty acids associated to a diet management with two different fat content in Schnauzer with primary hyperlipidaemia. Eighteen dogs with primary hyperlipidaemia were divided into two groups: group 1, n = 10, 8 females, 2 males, age (mean ± standard deviation) of 7.13 ± 2.70 years and body weight (BW) (mean ± standard deviation) of 7.25 ± 1.22 kg were treated with fish oil (approximately 730 mg/day of omega-3) associated with a low-fat and low-calorie diet (approximately 24g of fat/1000 kcal) for 90 days (T90); and group 2, n = 8 dogs, 6 females, 2 males, with 7.0 ± 1.77 years old and average BW of 8.36 ± 1.51 kg, treated with fish oil (approximately 730 mg/day of omega-3) and maintenance diet with moderate amount of fat (approximately 33g of fat/1000 kcal) for 90 days. Plasma TG and TC concentrations and lipoprotein (LP) profile (VLDL, LDL, HDL) were evaluated before and after treatment. TG and TC serum concentrations, expressed in mg/dL (mean ± standard deviation), before and after treatment in group 1 were: TG = 391.30 ± 487.86 (T0) and 118.7 ± 135.21 (T90); TC = 308.2 ± 63.06 (T0) and 139 ± 36.91 (T90). As for group 2, TG = 391.63 ± 336.89 (T0) and 250.75 ± 211.56 (T90); TC = 257.25 ± 92.88 (T0) and 207.25 ± 63.79 (T90). A reduction (p<0.05) of TG and TC was observed in both groups. The distribution of TG and TC among LP was not different between the pre (T0) and post treatment (T90) periods. After 90 days of treatment, the administration of omega-3 fatty acids, associated with a low-fat or maintenance diet reduced triglyceridemia and cholesterolemia without altering LP profile. The current investigation shows that both therapies were effective in reducing plasma TC and TG concentrations without altering LP profile.

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Cholesterol-ester transfer protein (CETP) plays a role in atherosclerosis, the inflammatory response to endotoxemia and in experimental and human sepsis. Functional alterations in lipoprotein (LP) metabolism and immune cell populations, including macrophages, occur during sepsis and may be related to comorbidities such as chronic obstructive pulmonary disease (COPD). Macrophages are significantly associated with pulmonary emphysema, and depending on the microenvironment, might exhibit an M1 or M2 phenotype. Macrophages derived from the peritoneum and bone marrow reveal CETP that contributes to its plasma concentration. Here, we evaluated the role of CETP in macrophage polarization and elastase-induced pulmonary emphysema (ELA) in human CETP-expressing transgenic (huCETP) (line 5203, C57BL6/J background) male mice and compared it to their wild type littermates. We showed that bone marrow-derived macrophages from huCETP mice reduce polarization toward the M1 phenotype, but with increased IL-10. Compared to WT, huCETP mice exposed to elastase showed worsened lung function with an increased mean linear intercept (Lm), reflecting airspace enlargement resulting from parenchymal destruction with increased expression of arginase-1 and IL-10, which are M2 markers. The cytokine profile revealed increased IL-6 in plasma and TNF, and IL-10 in bronchoalveolar lavage (BAL), corroborating with the lung immunohistochemistry in the huCETP-ELA group compared to WT-ELA. Elastase treatment in the huCETP group increased VLDL-C and reduced HDL-C. Elastase-induced pulmonary emphysema in huCETP mice promotes lung M2-like phenotype with a deleterious effect in experimental COPD, corroborating the in vitro result in which CETP promoted M2 macrophage polarization. Our results suggest that CETP is associated with inflammatory response and influences the role of macrophages in COPD.

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OBJECTIVE: To recognize the domains of competencies in promoting health in the environmental education practices performed by community health agents. METHOD: A mixed study, which adopted the Developing Competencies and Professional Standards for Health Promotion Capacity Building in Europe (CompHP) as a theoretical framework, conducted in Crato, Ceará, with 16 community health agents, based on semi-structured interviews and data organization through the ALCESTE software. RESULTS: The following domains of competencies in health promotion were evidenced: partnership, possibility of changes, and diagnosis. We recognize evidence signaling other domains, although with less statistical significance, such as: communication, planning and implementation, with a view to developing environmental education activities. FINAL CONSIDERATIONS: There is a mobilization of a limited number of health promotion competences in the environmental education practices developed by community health agents, which requires the wholeness of these elements to implement health promotion practices and, thus, positive transformations on the environment and health.

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RESUMO Objetivo: Analisar as evidências científicas sobre estudos de elaboração e/ou validação de tecnologias educacionais para o ensino de primeiros socorros a pais e educadores. Método: Estudo de revisão integrativa, com questão de pesquisa elaborada pela estratégia PICo - População, Interesse, Contexto, selecionando-se os descritores "Parents", "SchoolTeachers", "First Aids", "Teaching Material", "Educational Techonology', "Validation Study". Realizou-se a busca em seis fontes de literatura científica, no período de junho de 2021. Aplicaram-se os critérios de inclusão e exclusão, em seguida, os dados foram extraídos por formulário próprio, avaliados por nível de evidência, analisados e interpretados pelo método de redução dos dados. Resultados: A amostra final quantificou seis estudos, com níveis de evidência científica baixo a moderado, que se destacam pela diversidade entre as tecnologias educacionais do tipo cartilha, calendário, folheto, pôster e história em quadrinhos para pais e educadores que tratam do ensino de primeiros socorros. Conclusão: Observou-se escassez de estudos de elaboração e validação de tecnologias educativas em primeiros socorros para pais e educadores. Recomenda-se investir em tecnologias educativas validadas de fácil acesso e leitura e, ainda, que permitam o uso em recursos informatizados, de modo a ampliar o acesso da população e abranger acidentes e incidentes vivenciados nos ambientes doméstico e escolar.

RESUMEN Objetivo: analizar las evidencias científicas sobre estudios de elaboración y/o validación de tecnologías educativas para la enseñanza de primeros auxilios a padres y educadores. Método: estudio de revisión integradora, con cuestión de investigación elaborada por la estrategia PICo - Población, Interés, Contexto, seleccionándose los descriptores "Parents", "School Teachers", "First Aids", "Teaching Material", "Educational Techonology', "Validation Study". Se realizó la búsqueda en seis fuentes de literatura científica, en el período de junio de 2021. Se aplicaron los criterios de inclusión y exclusión, luego, los datos fueron extraídos por formulario propio, evaluados por nivel de evidencia, analizados e interpretados por el método de reducción de los datos. Resultados: la muestra final cuantificó seis estudios, con niveles de evidencia científica bajo a moderado, que se destacan por la diversidad entre las tecnologías educativas del tipo cartilla, calendario, folleto, póster y cómic dirigidos a padres y educadores que se ocupan de la enseñanza de primeros auxilios. Conclusión: se observó escasez de estudios de elaboración y validación de tecnologías educativas en primeros auxilios para padres y educadores. Se recomienda invertir en tecnologías educativas validadas de fácil acceso y lectura y, además, que permitan el uso de recursos informatizados, a fin de ampliar el acceso a la población e incluir accidentes e incidentes vividos en los ambientes doméstico y escolar.

ABSTRACT Objective: To analyze the scientific evidence on studies on the development and/or validation of educational technologies for teaching first aid to parents and educators. Method: Integrative review study, with research question elaborated by the PICo strategy - Population, Interest, Context, selecting the descriptors "Parents", "School Teachers", "First Aids", "Teaching Material", "Educational Technology", "Validation Study". A search was carried out in six sources of scientific literature, in the period of June 2021. The inclusion and exclusion criteria were applied, then the data were extracted using a specific form, evaluated by level of evidence, analyzed and interpreted by the data reduction method. Results: The final sample quantified six studies, with low to moderate levels of scientific evidence, which stand out for the diversity between educational technologies such as a booklet, calendar, leaflet, poster and comic book for parents and educators who deal with the teaching of first aid. Conclusion: There was a scarcity of studies on the development and validation of educational technologies onfirst aid for parents and educators. It is recommended to invest in validated educational technologies that are easy to access and read and also allow the use of computerized resources in order to expand the population's access and also to cover accidents and incidents experienced in the home and school environments.

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