Current therapies against malignant melanoma generally fail to increase survival in most patients, and immunotherapy is a promising approach as it could reduce the dosage of toxic therapeutic drugs. In the present study, we show that an immunotherapeutic approach based on the use of the Toll-like receptor (TLR)-5 ligand flagellin (Salmonella Typhimurium FliCi) combined with the major histocompatibility complex class II-restricted P10 peptide, derived from the Paracoccidioides brasiliensis gp43 major surface protein, reduced the number of lung metastasis in a murine melanoma model. Compounds were administered intranasally into C57Bl/6 mice intravenously challenged with syngeneic B16F10-Nex2 melanoma cells, aiming at the local (pulmonary) immune response modulation. Along with a marked reduction in the number of lung nodules, a significant increase in survival was observed. The immunization regimen induced both local and systemic proinflammatory responses. Lung macrophages were polarized towards a M1 phenotype, lymph node cells, and splenocytes secreted higher interleukin-12p40 and interferon (IFN)-γ levels when re-stimulated with tumor antigens. The protective effect of the FliCi+P10 formulation required TLR-5, myeloid differentiation primary response gene 88 and IFN-γ expression, but caspase-1 knockout mice were only partially protected, suggesting that intracellular flagellin receptors are not involved with the anti-tumor effect. The immune therapy resulted in the activation of tumor-specific CD4 + T lymphocytes, which conferred protection to metastatic melanoma growth after adoptive transfer. Taken together, our results report a new immunotherapeutic approach based on TLR-5 activation and IFN-γ production capable to control the metastatic growth of B16F10-Nex2 melanoma, being a promising alternative to be associated with chemotherapeutic drugs for an effective anti-tumor responses.

Objective: Perform a transcultural adaptation of the current risk assessment scale for pressure injuries in intensive care (Escala de Valoración Actual del riesgo de desarrollar Úlceras por presión en Cuidados Intensivos -EVARUCI) to Brazilian Portuguese and analyze its reliability among intensive care unit (ICU) patients. Methods: Methodological study for transcultural adaptation and reliability analysis of the EVARUCI. Internal consistency was verifi ed using Cronbach's alpha coeffi cient. Inter-rater agreement was verifi ed using the simultaneous application of the fi nal version of the EVARUCI by 3 nurses and analyzed by the intraclass correlation coeffi cient (ICC). Results: In the translation and back-translation processes, disagreements were related to the use of synonyms and writing style. In the evaluation of the expert committee, the terms 'conscious,' 'supine decubitus,' and 'shift' did not reach a 90.0% agreement. The internal consistency of the EVARUCI was acceptable (α=0.782). Inter-rater agreement was excellent (ICC=0.980). Conclusion: The transcultural adaptation of the EVARUCI to Brazilian Portuguese was satisfactory in terms of internal consistency and inter-rater agreement, indicating that it is a specifi c instrument for ICUs that can be easily and quickly used in the evaluation of risk for pressure injuries in critically ill patients. ResumoObjetivo: Realizar a a daptação transcultural da Escala de Valoración Actual del riesgo de desarrollar Úlceras por presión en Cuidados Intensivos (EVARUCI) para a língua portuguesa do Brasil e analisar sua confi abilidade em pacientes de Unidade de Terapia Intensiva (UTI). Métodos: Pesquisa metodológica para adaptação transcultural e análise da confi abilidade da EVARUCI. A consistência interna foi verifi cada utilizando-se o Coefi ciente Alfa de Cronbach. A concordância interobservadores foi verifi cada pela aplicação simultânea da versão fi nal da EVARUCI por 3 enfermeiros e analisada pelo Coefi ciente de Correlação Intraclasse (CCI). Resultados: Na tradução e retrotradução, as discordâncias relacionaram-se ao uso de sinônimos e estilo de redação. Na avaliação do comitê de especialistas os termos, consciente, decúbito supino e turno não alcançaram a concordância de 90,0%. A consistência interna da EVARUCI mostrou-se aceitável (α=0,782). A concordância interobservadores foi excelente entre os avaliadores (CCI=0,980). Conclusão: A adaptação transcultural da EVARUCI para o português do Brasil foi satisfatória quanto à consistência interna e à concordância interobservadores, indicando ser um instrumento específi co para UTI, de fácil e rápida aplicação para avaliação de risco para lesão por pressão em pacientes críticos. ResumenObjetivo: Realizar la adaptación transcultural de la Escala de Valoración Actual del Riesgo de Desarrollar Úlceras por Presión en Cuidados Intensivos (EVARUCI) al portugués brasileño y analizar su confi abilidad en pacientes de Unidad de Terapia Intensiva (UTI). Métodos: Investigación metodológica para adaptación transcultural y análi...

Pressure ulcer (PU) can be classified according to tissue impairment, etiology, healing time and tissue characteristics. Currently, it is the third type of adverse event most reported by the patient safety centers of health services in the country, according to the National Report of Incidents Related to Health Care. The classification and the identification of risk factors are essential for implementation of preventive and therapeutic actions in susceptible patients. Nutritional status is a fundamental piece for the prevention and development of PU, making it essential to integrate the interdisciplinary team in the prevention and treatment of PU, with a focus on quality, safety and patient experience. In this sense, the objective of this campaign is to disseminate knowledge, providing technical support for patient care and reducing PU rates. A mnemonic was developed with the word “CICATRIZATION”, in which each letter proposes steps that help in the identification of risk, assessment, treatment and monitoring of PU. Thus, the sequence of 12 steps established in this campaign is suggested as a measure to assist health professionals in this management

Introducción: Las limitaciones de la percepción sensorial, la inmovilidad, la sedación, la ventilación mecánica, la hipoperfusión tisular, el edema y la humedad se consideran factores que predisponen la aparición de úlceras por presión en pacientes en estado crítico. Objetivo: Caracterizar las úlceras por presión en pacientes críticos, determinar la asociación con variables demográficas, la hospitalización y las condiciones clínicas, e identificar los factores de riesgo para la aparición de úlceras por presión. Materiales y Métodos: Se realizó un estudio transversal mediante una muestra de pacientes > 18 años que no presentaban úlceras por presión al ingreso y habían estado hospitalizados >24 horas en la Unidad de Cuidados Intensivos. La asociación de las úlceras por presión con las variables se verificó a través de la prueba U de Mann-Whitney, prueba de chi-cuadrado, razón de verosimilitud y el test exacto de Fisher. Los factores de riesgo se identificaron mediante regresión logística múltiple. Resultados: De 324 pacientes, 46 (14.2%) desarrollaron úlceras por presión con mayor frecuencia en las regiones sacra y calcánea. Los factores de riesgo para la aparición de úlceras por presión fueron la edad, la duración de la hospitalización y la estancia hospitalaria antes de ingresar a la Unidad de Cuidados Intensivos. Discusión: La alta incidencia, la localización y el estadio de las úlceras por lesión observadas revelan la vulnerabilidad del paciente de la unidad de cuidados intensivos a este tipo de lesiones. Entre los riesgos de las úlceras por presión se encuentran factores relacionados con el paciente, la hospitalización y la gravedad de la enfermedad, y su combinación debe valorarse en la evaluación diaria del paciente crítico. Conclusión: La aparición de úlceras por presión en pacientes críticos es un fenómeno multifactorial, para la que el reconocimiento de factores de riesgo puede contribuir a una rápida adopción de medidas para su prevención Como citar este artículo: Campos, Michelle Mayumi Yoshimura de; Souza, Mariana Fernandes Cremasco de;  Whitaker, Iveth Yamaguchi.  Risco para lesão por pressão em pacientes de unidade de terapia intensiva. Revista Cuidarte. 2021;12(2):e1196. http://dx.doi.org/10.15649/cuidarte.1196

Objective: To compare the predictive capacity of the current risk assessment scale for pressure ulcers in intensive care (EVARUCI), translated into Brazilian Portuguese, using the Braden scale. Method: This cross-sectional study collected prospective data from adult patients in three intensive care units. The receiver operating characteristic (ROC) and precision-recall curve (PR curve) were used to analyse the predictive capacity for pressure injury (PI) using both predictive values and odds ratios (ORs). Results: The incidence of PIs in the study sample of 324 patients was 14.2%. The area under the ROC curve was 0.807 for EVARUCI and 0.798 for the Braden scale. At a cutoff point of 10 on the EVARUCI scale, sensitivity was 69.6%; specificity 78.4%; positive predictive value 34.8%; and OR 8.3. At a cutoff point of 11 on the Braden scale, sensitivity was 76.1%; specificity 75.9%; positive predictive value 34.3%; and OR 10. The area under the PR curve was 0.396 for the EVARUCI scale and 0.348 for the Braden scale, reflecting a smaller area for both. The F1 score value was 0.476 with 37.5% precision and 65.2% recall for the EVARUCI scale, and 0.473 with 34.3% precision and 76.1% recall for the Braden scale. Conclusion: The EVARUCI scale predictive capacity was similar to that of the Braden scale. However, the precision of both scales was low for the accurate prediction of patients at risk of developing PIs.