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This work reports the effect of 1–5 wt% epoxidized soybean oil (ESO) addition on the thermal, mechanical, and morphological properties of polybutylene succinate (PBS). ESO acts as a chain extender as well as a mild plasticizer of PBS. N-methylimidazole (NMI) is used as a catalyst to promote the reaction between PBS and ESO, and thermal, rheological, and spectroscopic analyses demonstrate increased viscoelastic properties, compatibility, crystallinity and thermal stability of the melt reacted formulations. In the presence of NMI, storage modulus (G’) values two orders of magnitude higher than that of pure PBS are achieved, confirming the completion of the chain extension reaction. A drastic refinement of the biphasic structure of the blend is observed, with the formation of a homogenous structure where ESO is well incorporated into the matrix. Finally, tensile tests reveal enhanced mechanical performance in the blends reacted in the presence of NMI. These findings pave the way for the development of a versatile family of materials which could find potential application in sustainable biodegradable packaging.

A significant additional benefit of incorporating organic forms of selenium into poultry diets is the substantial improvement in the nutritional quality of the meat. This study aimed to investigate gradual inclusions of Zinc-L-Selenomethionine in the diet of broiler chickens from one to 42 days of age, reared under cyclic heat stress conditions, and its effects on carcass traits, breast myopathies, quality, and composition. A total of 1,000 one-day-old male Cobb 500® broiler chicks were randomly assigned to five treatments: 0, 0.15, 0.23, 0.47, and 1.30 mg of Zn-L-SeMet per kg of feed, with each group consisting of ten replicates of 20 birds. The carcass traits were unaffected (p ≥ 0.102). All scores of breast myopathy incidence (from 0 to 3) were affected by the treatments (p < 0.05). For wooden breast, the inclusion of 1.30 mg provided breasts with a lower incidence. Breasts from the 0.15 mg treatment had a lower incidence within the severe and extreme White striping scores. The treatments had no significant effects on the breast meat quality (p ≥ 0.180), lipid peroxidation (p ≥ 0.172), or composition (p ≥ 0.383). Including 1.30 mg of Zn-L-SeMet for broiler chickens results in better scores of 0 for wooden breast. For white striping, supplementation from 0.15 mg of Zn-L-SeMet reduces the incidence of score 3.

RESUMO Uma ‘boa’ relação médico-paciente é fundamental para uma prática clínica efetiva no Sistema Único de Saúde. São comuns, na prática clínica, os problemas de comunicação, o autoritarismo e certa desconsideração da situação existencial e da agenda dos usuários. Paulo Freire tratou de temas similares na educação, sendo menos aproveitado para ensino e prática da condução dos atendimentos médicos. O objetivo deste ensaio foi sintetizar contribuições das ideias freirianas para construção/melhoria da relação médico-paciente em contexto clínico ambulatorial. Metodologicamente, foi realizada uma análise de literatura articulando aspectos da relação médico-paciente e ideias de Freire. A análise consistiu em leitura e síntese livre de obras selecionadas sobre a relação clínica e das ideias contidas nos principais livros de Freire, consideradas pertinentes a essa temática (primeiro e segundo tópicos do artigo). Seguiuse uma síntese das contribuições freirianas, organizadas em cinco temas: reforço ao desafio de desviar da objetificação do usuário; concepção emancipadora, crítica e participativa da relação médico-paciente e dos seus aspectos educativos; importância do mundo da vida dos usuários; importância de abrir e manter o diálogo; ‘bem’ manejar as dinâmicas de poder. As ideias de Freire continuam muito relevantes e contribuem para o ensino e a melhoria da prática clínica ambulatorial.

Abstract Archival resources, a photogrammetric survey, analysis of materials and techniques, and evaluation of the state of conservation were interconnected phases in the interdisciplinary research on the perspective scenery of the Teatro Olimpico in Vicenza. To fill existing gaps related to the history of this unique artefact and to the undocumented retouching of paint layers on the scenery during post-war reconstruction work, a broad analytical approach (optical microscopy, XRPD, SEM–EDX, μFTIR and μRaman) was applied to micro-samples, the selection of which was guided by consolidated geometrical and archival data. The aims were to obtain a characterisation of the pigments and binders and to evaluate the microstratigraphic sequence, the state of conservation of the scenery flats, and the deterioration processes involved. The findings unveiled a discernible variability in the production techniques of the finishes, frequently lacking the classic microstratigraphic sequence associated with the traditional method for painting on wooden panels from the sixteenth century. Moreover, by identifying many pigments that could be used as temporal markers we were able unequivocally to establish, for the first time, that a significant part of the scenery designed by the architect Vincenzo Scamozzi was heavily repainted in the post-WWII period. These analytical results and all the data collected on the artefacts over time were related through an HBIM model, enabling the historical and technical-analytical information to be linked to the geometrical survey and thus to provide guidance for actions based on current and future knowledge for the maintenance and monitoring of the Teatro Olimpico.

Objective Evaluate patient‐reported outcomes after 6 months of on‐label guselkumab use in patients with rheumatologist‐diagnosed active psoriatic arthritis (PsA) enrolled in the CorEvitas PsA/Spondyloarthritis Registry. Methods This analysis includes registry participants who initiated and persisted with on‐label guselkumab (after US Food and Drug Administration approval for PsA; 100 mg at weeks 0, 4, and every 8 weeks) at their 6‐month follow‐up visit (On‐Label Persisters). Among patients not meeting response criteria at baseline, responses at 6 months were determined for patient‐reported outcomes, including patient‐reported pain (0–100 mm visual analog scale), patient global assessment of arthritis + psoriasis (PtGA; 0–100 visual analog scale), and Health Assessment Questionnaire‐Disability Index (HAQ‐DI; 0‐3). Unadjusted, nominal P values were calculated via single‐proportion, one‐sided test (H0 = 0%; α = 0.05). Results Of 90 On‐Label Persisters, most had treatment‐resistant PsA (92.2% and 73.3% previously received ≥1 and ≥2 biologic/targeted synthetic disease‐modifying antirheumatic drugs, respectively), with mean (SD) baseline patient‐reported pain, PtGA, and HAQ‐DI scores of 57.0 (24.6), 50.3 (24.4), and 0.9 (0.6), respectively. Among those with patient‐reported pain and PtGA scores of at least 15 at baseline, 40.2% (33/82) and 46.8% (36/77), respectively, achieved at least 15‐mm reductions at 6 months; among those with HAQ‐DI scores of at least 0.35 and more than 0.5 at baseline, respectively, 30.4% (21/69) achieved improvements of at least 0.35 and 10.3% (6/58) achieved scores of 0.5 or lower at 6 months (all nominal P

A sexualidade humana é um tema complexo, sendo acompanhado também por fatores biológicos, psicológicos e, sobretudo, sociais. O artigo objetiva apresentar a construção de um instrumento para a avaliação do conhecimento clínico sobre saúde LGBTI+ entre estudantes de Enfermagem, Medicina e Odontologia. A partir de revisão de literatura, foi desenvolvido um questionário com 76 itens, que passou pelas seguintes etapas: (1) análise de linguagem e adequação de conteúdo por meio de seis grupos focais com 21 estudantes heterossexuais e vinte LGBTI+ dos três cursos; e (2) Técnica Delphi, com 16 experts em educação superior nas três formações; e em gênero e diversidade sexual. Os dados do processo apontam que o instrumento, em sua versão final de quarenta itens, está adequado para a avaliação da formação dos estudantes para a assistência à saúde de pessoas LGBTI+.

Background: Urinary tract infections (UTIs) are the most common bacterial infections in children. The high variability in pathogen susceptibility rates leads to the lack of clear guidelines for empiric and targeted therapies. In this view, local microbiological surveillance and locally adapted stewardship interventions need to be implemented. Objective: The study aims to describe the results of a pediatric antimicrobial stewardship program on antibiotic prescriptions for UTIs over 8 years in a pediatric general ward of a tertiary center. Design: This quasi-experimental study was conducted between 2015 and 2022, with two different implementations, one in 2018 and one in 2021. Methods: Demographic, clinical, microbiological, and therapeutic data were retrieved from the electronic clinical records of included patients. The primary outcomes were adherence to local guidelines for empiric therapies and the adequacy of targeted therapy. Secondary outcomes were evaluating antibiotic prescription patterns stratified by antibiotics during hospital stay and at discharge, and assessing the microbiological characteristics of UTI episodes. Results: During the study period, 7038 patients were admitted to the pediatric acute care unit (PACU), and 264 (3.7%) were included in this study. Adherence to local guidelines was highest immediately after the interventions, and it slightly decreased thereafter. Use of cephalosporins remained high throughout the 8 years but the changing microbiological scenario observed led to changing recommendations within the study period. An increase in E. coli strains resistant to co-amoxiclav was observed in the last years. Oral second-line agent consumption remained high but was adequate considering the prevalence of resistant bacteria. Conclusion: The variability of antimicrobial consumption reflects the changing resistance patterns for UTIs pathogens, underlying the importance of locally adapted, persevering antimicrobial stewardship interventions.

B-ALL is heterogeneous disease and its classification can be defined by recurrent genetic abnormalities as WHO 5th. Recent gene expression studies have identified genetic drivers that confer distinct prognostic impact, as B-ALL ZNF384-r. We report a case of TAF15::ZNF384 B-ALL recurring 6 years after the 1st diagnosis. 3-year-old boy admitted in 2014 with fever and petechiae. CBC HB 7.9 g/dL WBC 2.9 × 109/L Platelets 30 × 109/L. BMA showed 87% blasts and by flow cytometry (FC) with B-ALL. Cytogenetic analyses (CA):46,XY,t(17;17)(p12;q11)[3]/46,XY[17]. RT-PCR negative for BCR::ABL1 p190 and ETV6::RUNX1. It's collected biospecimens from BMA for further analysis. He's treated as HR-ALL according to “Brazilian Childhood Acute Lymphoblastic Leukemia Treatment Group 2009” protocol and achieved remission by the end of induction. He's out of therapy for 6 years when he presented with 2 weeks of fever. CBC HB 14.9 g/dL WBC 5440 × 109/L Platelet 335 × 109/L with 22% blasts. BMA was performed and through FC was confirmed B-cell ALL and CA was 47,XY,t(17;17)(p12;q11),+21[15]/46,XY[5]. The same translocation from the 1st diagnosis. FISH reveal (ETV6 × 2, RUNX1 × 3)[112/200], (3’IGH × 2, 5’IGH x 1) [109/200], without other changes. He received ALL-REZ BFM 2002 reinduction and as he failure the 1st therapy, he underwent to 2nd reinduction with Mini-CVAD and Blinatumomab as bridge for HSCT. By the end of the 1st cycle MRD was up to 5%. Due to the refractory of the disease, we run NGS using the Oncomine Childhood Cancer Research Assay Panel. He's submitted to a 3rd salvage plan with bortezomib plus chemotherapy. By the end of the 1st cycle MRD was 1%. NGS result showed TAF15::ZNF384 in the biospecimens from the diagnosis and relapse. With this information and in attempt to improve response to reach HSCT, it's proposed hybrid therapeutic with cytarabine, azacytidine and venetoclax. After 1st cycle, BMA demonstrated MRD of 0,02%, achieving better response as he could got to undergo to HSCT. WHO 5th recognizes the importance of genetic information in the evaluation of lymphoid neoplasia, and this harbored spot to incorporate new entities whose recognition is increasing as molecular diagnostic become more available. TAF15::ZNF384 occurs in early common progenitor which may discern into myeloid or lymphoid. Considering the ZNF384-r lineaging plasticity and the highly chemorefractory in our case, it's proposed hybrid treatment associating myeloid scheme as salvage regimen.

ABSTRACT: The study investigated guanidinoacetic acid (GAA) supplementation with varying dietary digestible arginine (Arg) and glycine+serine (Gly+Ser) concentrations in the starter phase, exploring respective carry-over effects on growth performance, blood chemistry, incidence of pectoral myopathies and proximate composition in broilers. A total of 2,800 one-day-old male broiler chicks were distributed in a central composite design with 2 factors and double experimental mesh, represented by supplementation or omission of 0.6 g per kg of GAA, with a central point represented by 107% of Arg and 147% of Gly+Ser, 4 factorial points (combinations of Arg/Gly+Ser concentrations: 96.4/132.5%; 117.6/132.5%; 96.4/161.5%, and 117.6/132.5%), and 4 axial points (combinations of axial points estimated for Arg and Gly+Ser, with the central points of 92/147%; 122/147%; 107/126.5, and 107/167.5%), totaling 18 treatments, 4 repetitions to factorial and axial points, 24 replicates to the central point, and 25 birds per pen. Feed conversion ratio (FCR) from d 1 to 10 had a linear response (P = 0.009) for the decreasing Arg content and a quadratic response (P = 0.047) for Gly+Ser concentrations. Broilers supplemented GAA had lower FCR compared with nonsupplemented groups from d 1 to 10 (P = 0.048) and d 1 to 42 (P = 0.026). Aspartate aminotransferase (AST) exhibited increasing and decreasing linear effects as a function of Arg (P = 0.008) and Gly+Ser (P = 0.020) concentrations, respectively. Guanidinoacetic acid decreased serum AST (P = 0.028). Guanidinoacetic acid reduced moderate + severe (P = 0.039) and mild (P = 0.015) Wooden Breast scores. The occurrence of normal White Striping increased (P = 0.002), while severe score was reduced (P = 0.029) with GAA supplementation. In conclusion, increased digestible Arg:Lys and 14% and 6% above the recommendations (107% and 147%), respectively, provided improved FCR during the starter phase. Dietary GAA supplementation (0.6 g per kg) improved FCR, reduced severity of breast myopathies and appears to have reduced muscle damage in broilers fed plant-based diets.

A prevenção é consensualmente defendida, especialmente para as doenças crônicas não transmissíveis. Porém, dada a proliferação de tecnologias preventivas, não parece defensável estimular genericamente condutas e exames preventivos em profissionais de saúde e usuários. Neste ensaio, apresentamos uma articulação de conceitos, ideias e critérios para a consideração de medidas preventivas, como um roteiro mínimo a ser manejado pelos profissionais (especialmente os da atenção primária à saúde) e gestores. São articulados os conceitos de: prevenção primária, secundária e quaternária; prevenção redutiva e aditiva, estratégias preventivas de alto risco e populacional; medicina baseada em evidências e sua crise contemporânea; princípio da precaução; promoção da saúde, abordagem ampliada e centrada na pessoa e decisão compartilhada. Tal articulação foi concebida visando melhorar a competência na avaliação de medidas preventivas, tornando as decisões clínicas e sanitárias mais criteriosas e menos iatrogênicas quanto à prevenção primária e secundária.

ABSTRACT: Necrotic enteritis (NE) is a disease of worldwide distribution, which affects young broilers and causes economic losses on a scale of 6 billion dollars per year. For decades, NE was controlled in poultry flocks by dietary administration of low doses of antimicrobial growth promoters (AGPs). However, an increase in NE incidence was noted after the AGP ban. This study aimed to compare the effect of an antibiotic (Enramycin) diet to a combination of sodium butyrate, hydrolyzed yeast, and zinc proteinate (ViligenTM) on broiler diets regarding performance, blood parameters, intestinal permeability, morphology and lesions, and carcass yield of broilers challenged with Eimeria spp. and Clostridium perfringens to simulate subclinical necrotic enteritis. A total of 1,150 one-day-old male broiler chickens with an initial average weight of 43.9 ± 0.65 g were allocated to 50 experimental pens. Animals were divided into 5 groups: Negative control (NC) without additives; Positive control (PC) with 0.12 g/ton of Enramycin (8%); V500, V1000, and V1500 with the addition of 500, 1.000, and 1.500 g/ton of Viligen, respectively. All animals were challenged by Eimeria spp. at 7 d of age and by C. perfringens at 17, 18, and 19 d for induction of subclinical NE. The broilers fed with all concentrations of Viligen showed similar performance, blood parameters, intestinal permeability, and carcass yield compared to PC broilers. However, NC broilers showed higher FCR compared to PC broilers from 1 to 33 d (1.42 vs. 1.39) (P = 0.048) and from 1 to 42 d (1.51 vs. 1.49) (P < 0.001). V1500 broilers had fewer intestinal lesions at 28 d when compared to the PC treatment (P < 0.05) and showed that higher Viligen inclusion resulted in lower intestinal damage. At 21 d, the V500 group showed higher intestinal morphology characteristics (VH:VD 4.9 vs. 3.5) compared to the PC treatment (P < 0.001). Thus, in this study, the dietary addition of Viligen to broilers challenged by an experimental model of subclinical NE resulted in lower intestinal damage and similar performance to that obtained by the addition of Enramycin.

SUMMARY: The objective of this study was to determine the appropriate number of replicates to identify significant differences in carcass and cut yields in broiler chickens. At 42 d of age, a total of 480 broiler chickens were selected, weighed, and processed to obtain the hot carcass yield. Subsequently, after cooling, the cold carcass yield was determined. The cold carcass was dismembered into boneless and skinless breast, tenders, legs, and whole wings, which were individually weighed to obtain the cuts yield. The collected data underwent normality analysis and subsequent determination of descriptive statistics, as well as analysis of variance, in both cases to determine mean values, standard deviation, and coefficient of variation (CV). The required number of replicates to detect differences between means for different magnitudes was determined. The CVs obtained were stable, with the highest CV observed for tenders’ yield (11.34%) and the lowest for the hot carcass (2.35%). To achieve significant differences in both, cold and hot carcass, a minimum of 8 replicates is needed for 5% differences in 97% of experiments. For breast fillet characteristics, 10 replicates are required to detect a 10% difference in 99% of experiments. Due to higher variation, tenders yield necessitates at least 10 replicates to detect a 20% difference in 90% of cases. For wing yield, 8 replicates suffice for 94% accuracy when differences exceed 15%. Lastly, 10 replicates enable detection of 7.5% differences in leg variables in 95% of experiments. Effective experimental planning, based on the statistical power of the test, is essential for determining the requisite number of replicates. Researchers must prioritize the specific carcass characteristic relevant to their study and design the number of replicates, accordingly, ensuring more reliable and realistic results.

Resumo O dissenso interno às ciências é importante para mudanças e correções de rumo no desenvolvimento sociotécnico do cuidado à saúde-doença. Este trabalho discute a recomendação do rastreamento do câncer de mama como um caso de dissenso interno à biomedicina e à saúde pública, o qual merece aplicação de prevenção quaternária (P4), ou seja, a ação de proteger pessoas de danos iatrogênicos e da medicalização desnecessária. A partir de uma revisão crítica-narrativa dos principais aspectos envolvidos na polêmica científica sobre esse rastreamento, argumentamos que há evidências crescentes tornando no mínimo duvidoso - senão negativo - o seu balanço benefícios-danos, devido à dimensão dos maiores danos (sobrediagnósticos e sobretratamentos) e à redução dos benefícios estimados até sua nulidade. Tal dissenso tem sido ofuscado por recomendações oficiais, informes tendenciosos, interesses econômicos e corporativos, crenças ilusórias, expectativas fictícias e pelo paradoxo da popularidade. Argumentamos que a P4 nesse caso significa suspender ou inverter a recomendação positiva da mamografia periódica. Isso constitui um grande desafio institucional, social e político no contexto atual de preventivismo e de apelos morais/emocionais associados. Este tema é um exemplo da necessidade de exploração do dissenso interno às ciências, como via de melhoria crítica de práticas biomédicas preventivas disseminadas e redução de iniquidades em saúde.

RESUMO Introdução: A implementação da Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais, Travestis e Transexuais (PNSI-LGBTT) em 2011 e de outros marcos legais destaca a importância da inclusão da identidade de gênero e da orientação sexual na formação em saúde. Objetivo: Nesse contexto, o presente estudo tem como objetivo apresentar a presença da diversidade sexual e de gênero nas Diretrizes Curriculares Nacionais (DCN) dos cursos de graduação em saúde. Método: A coleta de dados foi realizada por meio de documentos de acesso público disponíveis no site do MEC. Examinaram-se 22 DCN estabelecidas nas últimas duas décadas, com foco nos registros de direitos humanos, identidade de gênero e orientação sexual. Resultado: Houve um aumento progressivo na inclusão das minorias sexuais nas DCN ao longo das duas últimas décadas, sobretudo nos últimos dez anos. Destaca-se um notável crescimento nos registros de direitos humanos, identidade de gênero e orientação sexual, refletindo uma mudança significativa no panorama das DCN. Conclusão: Os resultados evidenciam uma tendência positiva de inclusão de temas relacionados à diversidade sexual e de gênero nas DCN da área da saúde. Esse avanço sugere maior conscientização e reconhecimento da importância de uma formação inclusiva para profissionais de saúde, promovendo a equidade e a justiça social.

Abstract Background Thyroglossal Duct Cyst (TDC) is a common lesion of the midline neck, originating from an incomplete involution of the thyroglossal duct. It is typically observed in pre-scholar patients and surgery is the treatment of choice to prevent infections. Here reported a case of incidental diagnosis in a newborn patient. Case presentation a 3-week-old male baby was admitted to our hospital for weight loss and projectile vomits after breastfeeding. After a diagnosis of hypertrophic pyloric stenosis, the baby underwent pyloromyotomy. During the endotracheal tube placement, the anesthetist noticed the presence of a midline neck mass. The suspect of TDC was confirmed by an intraoperative ultrasound, so, despite the age of the patient, we proceeded with the excision of the lesion according to Sistrunk’s procedure to avoid future complications and anesthesia. Conclusions even if TDC is a common lesion of pediatric patients, anecdotical neonatal cases were described in the literature, all of them symptomatic. An accurate physical examination and ultrasound are essential diagnostic tools to distinguish TDC from other middle neck lesions, particularly ectopic thyroidal tissue. Sistrunk’s procedure is the most effective surgical approach. When diagnosis is made in a newborn, we suggest postponing surgery, unless the baby requires general anesthesia for other surgical procedures, such as in our case.

Infliximab and golimumab are intravenously (IV) administered tumor necrosis factor inhibitors approved to treat moderate-to-severe rheumatoid arthritis (RA) with concomitant methotrexate. Owing to differences in biologic construct, patients with IV-infliximab treatment failure may benefit from switching to IV-golimumab. Utilizing the ACR's Rheumatology Informatics System for Effectiveness (RISE), a large electronic health records registry based in the USA, we assessed RA disease activity in patients switching from IV-infliximab to IV-golimumab. This retrospective, longitudinal, single-arm study included adults (≥ 18 years) with ≥ 1 RA diagnosis code between 2014 and 2018 and ≥ 1 IV-infliximab prescription within 6 months of a new IV-golimumab order (index date). Longitudinal assessments of disease activity using the Clinical Disease Activity Index (CDAI) were calculated in patients continuing IV-golimumab for 6-9- and 9-12-months post-switch. Paired t-tests evaluated significance of mean improvements during the follow-up periods. Most RA patients with disease activity assessments during the 6-month follow-up (N = 100; mean age: 65.3 years; 81% female; 74% white) demonstrated moderate-to-high disease activity (CDAI: 73% [38/52]) at enrollment. On average, patients showed significant improvement in disease activity within 6-9 months of switching; mean CDAI scores improved from 21.3 to 14.1 (p

O objetivo do trabalho foi avaliar o uso de aditivos alternativos em dietas para frangos de corte desafiados com Eimeria vacinal e Clostridium perfringens. Ao todo 600 pintos de corte, distribuídos em delineamento inteiramente casualizado, com cinco tratamentos, seis repetições e 20 aves por unidade experimental. Os tratamentos foram constituídos por: controle negativo, ração basal sem promotor de crescimento; controle positivo, ração basal com inclusão de 50 g ton-1 de avilamicina 20%, ração A, ração basal mais inclusão de 100 g ton-1 de um produto a base de extrato de Macleaya cordata, ração B, ração basal mais inclusão de 1000 g ton-1 de um produto a base de castanha vermelha (Castanea sativa) e quebracho colorado (Schinopsis lorentzii) e ração C, ração basal mais inclusão de 100 g ton-1 de um produto a base de prebióticos de levedura de pichia, glutamina e aluminosilicato. Todas as aves foram desafiadas individualmente aos quatro dias de idade com 0,6 ml da vacina para Eimeira spp., e aos sete e 10 dias de idade com 0,5 ml de Clostridium perfringens. Foram avaliados os parâmetros de desempenho, saúde intestinal, parâmetros sanguíneos, qualidade de cama e rendimento de carcaça e cortes. O uso de prebióticos (produto C) melhorou o ganho de peso (P0,05) nas aves do tratamento recebendo aditivo B e menores no grupo de aves alimentadas com o produto A. O uso do produto B e C, podem atuar como substituto ao antibiótico em aves desafiadas com Eimeria vacinal e Clostridium perfringens.

The production of cementitious formulations involves the addition of chemical additives essential for the optimization of many properties. Superplasticizers are considered additives of great interest but when mixed with concrete they lead to an undesirable increase of air content, with the consequent development of foam. This can adversely affect both mechanical properties and workability, therefore, the use of an antifoam agent is also necessary which should be able to prevent or destroy the foam. This work aims to synthesize esters derived from the reaction of glycine betaine with saturated and unsaturated fatty alcohols of different chain lengths. The reaction products were analyzed by 1H NMR analysis, and the stability of antifoam agents in a superplasticizer solution was studied through foaming tests according to the Ross-Miles method. At the same time, their effectiveness in the cementitious systems was evaluated through flow Table tests. Finally, the effectiveness of the antifoam agents was quantified through an image analysis software, Image J, which allowed the investigation of the contents of the bubble in concrete samples. All synthesized antifoams showed properties superior to the commercial product, especially defoamers containing saturated fatty alcohols. It has been found that alcohols with too small or too long carbon chains were not effective. In particular, it was verified the optimal range of carbon atoms number contained in the antifoam chain which included between 12 and 14.

Abstract Background H Syndrome is a rare genetic condition caused by biallelic pathogenic variants in the SLC29A3 gene. It is characterized by a wide range of clinical manifestations, many of which are related to the immune-rheumatological field. These include scleroderma-like skin changes, deforming arthritis, and enlarged lymph nodes. The condition also features cardiac and endocrine defects, as well as hearing loss, for which the immune pathogenesis appears less clear. Immunomodulatory medications have been shown to improve many symptoms in recent experiences. Case presentation A 21-year-old girl was referred to our institute after being diagnosed with H syndrome. Her medical history was characterized by the development of finger and toe deformities, which developed since the first years of life and progressively worsened with clinodactyly. At 6 years of age, she was diagnosed with diabetes mellitus without typical autoantibodies and with bilateral sensorineural hearing loss. She also complained of frequent episodes of lymphadenopathy, sometimes with colliquation and growth retardation due to pancreatic insufficiency. It wasn’t until the genetic diagnosis of H syndrome that the continual increase in acute phase reactants was noticed, suggesting that an immunological pathogenesis may be the source of her problems. During her visit to our institute, she reported serious pain in both feet and hands and difficulty walking due to knee arthritis and muscle contractures. Conventional therapy with steroid injection in affected joints and methotrexate only led to partial improvement. After a thorough assessment of her inflammatory profile showing a high interferon score, the girl received treatment with baricitinib. Furthermore, based on recent data showing that SLC29A3 deficiency results in interferon production because of Toll-like Receptor 7 activation in lysosomes, hydroxychloroquine was also added. The combination of the two drugs resulted for the first time in a rapid and persistent normalization of inflammatory markers, paralleled by a dramatic improvement in symptoms. Conclusions We describe the results of inhibiting IFN inflammation in H syndrome and discuss how JAK inhibitors and antimalarials might represent a mechanistically based treatment for this orphan drug disorder.

Abstract Background This study sought to evaluate the efficacy and safety of tofacitinib in patients with rheumatoid arthritis with distinct treatment histories. Methods Pooled phase II/III trial data from patients who received tofacitinib 5 or 10 mg twice daily or placebo, as monotherapy or with conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs), were analyzed post hoc. Separate evaluations were conducted for populations with a prior inadequate response (IR) to: 1) non-methotrexate (MTX) csDMARDs only (non-MTX csDMARD-IR; n = 537); 2) MTX (MTX-IR; n = 3113); and 3) biologic (b)DMARDs (bDMARD-IR; n = 782). Efficacy outcomes included rates of response (American College of Rheumatology 20/50/70% response criteria) and remission (Disease Activity Score in 28 joints derived from 4 measures, erythrocyte sedimentation rate [DAS28-4(ESR)]

RESUMO Os Problemas de Saúde Mental (SM) e o uso indiscriminado de psicofármacos são problemas de grande relevância para a Atenção Primária à Saúde (APS) e a saúde pública. O objetivo deste ensaio é apresentar uma fundamentação atualizada da tese de Robert Whitaker, desenvolvida no livro ‘Anatomia de uma epidemia: pílulas mágicas, drogas psiquiátricas e o aumento assombroso da doença mental’. É apresentada uma síntese do livro, acrescida de comentários sobre determinados temas, visando à melhor ancoragem científica dos argumentos. A tese defendida é que se deve evitar prescrever o uso de psicofármacos; e, caso seja iniciado o uso, que seja como sintomático agudo pelo menor tempo possível. Os argumentos giram em torno de que há evidências favoráveis apenas para redução de sintomas, para algumas dessas drogas e para curtos períodos de uso. Com seu uso crônico, há piora em longo prazo quanto à estabilidade, autonomia e funcionalidade social, com problemas graves de abstinência. Especialmente na APS (e também nos serviços especializados em SM), os profissionais deveriam ter uma abordagem mais crítica dos psicotrópicos e investir em outras abordagens terapêuticas, para fazerem algo melhor, menos iatrogênico e tão ou mais eficaz para os pacientes com problemas de SM no longo prazo.