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Coeliac disease is a common condition for which the only current treatment is a gluten-free diet. Adherence to this diet is not always easy and is associated with a reduction in quality of life for the patient and their family. Non-adherence is associated with complications of varying severity. The lack of control at the outpatient care level in a high percentage of these patients evinces the need to improve follow-up protocols and the approach to care delivery with coordination of paediatric gastroenterology units (PGU) and primary care paediatricians. With this aim in mind, the present document was developed by consensus to offer a set of recommendations adapted to our region, based on the recent recommendations published by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), and with participation of the pertinent scientific societies, including those concerning the adult population, for the management and follow-up of adolescents and the transition to adult care. Resumen: La enfermedad celíaca es una patología frecuente y cuyo único tratamiento en el momento actual es la dieta sin gluten. El seguimiento de esta dieta no siempre es fácil e implica limitaciones en la calidad de vida del paciente y su familia. La no adherencia se asociaría a complicaciones de distinta gravedad. La falta de control de estos pacientes en consultas en un alto porcentaje de casos plantea la necesidad de mejorar los protocolos de seguimiento y de abordarlos de forma coordinada entre las Unidades de Gastroenterología Pediátrica (UGP) y los pediatras de Atención Primaria. Con ese objetivo se han consensuado en este documento, basándose en las recomendaciones recientemente publicadas por la Sociedad Europea de Gastroenterología, Hepatología y Nutrición Pediátrica (ESPGHAN), un conjunto de recomendaciones adaptadas a nuestro entorno y contando con la participación de las Sociedades Científicas implicadas, incluyendo a las Sociedades de adultos para el abordaje del seguimiento del adolescente y de la transición de cuidados a los profesionales de adultos.

Objective: The aim of the study was to describe how physical exercise affects metabolic control, insulin requirements and carbohydrate intake in children who use hybrid closed-loop systems. Methods: Cross-sectional study design. The sample included 21 children and adolescents diagnosed with type 1 diabetes. During the study, participants were monitored for a period of 7 days to gather comprehensive data on these factors. Results: Nine participants (42.9%) had switched to exercise mode to raise the target glucose temporarily to 150 mg/dL. The HbA1c values ranged from 5.5% to 7.9% (median, 6.5%; IQR, 0.75). The percentage of time within the target range of 70−180 mg/dL was similar; however, there was an increased duration of hyperglycaemia and more autocorrections on exercise days. The time spent in severe hyperglycaemia (>250 mg/dL) increased by 2.7% in exercise compared to non-exercise days (P = .02). It is worth noting that hypoglycaemic episodes did not increase during the exercise days compared with non-exercise days. Conclusion: The hybrid closed-loop system was effective and safe in children and adolescents with type 1 diabetes during the performance of competitive sports in real life. Resumen: Objetivo: El objetivo de este estudio es describir cómo el ejercicio físico afecta el control metabólico, las necesidades de insulina y el consumo de carbohidratos en niños usuarios de un sistema híbrido de circuito cerrado. Métodos: Diseño de estudio transversal. Se reclutaron veintiún niños y adolescentes diagnosticados con diabetes tipo 1. Durante el estudio, los participantes fueron monitoreados durante un período de 7 días para recopilar datos completos sobre estos factores. Resultados: Nueve participantes (42,9%) habían activado el modo de ejercicio, para elevar temporalmente la glucosa objetivo a 150 mg/dL. La HbA1c osciló entre 5,5% y 7,9% (mediana 6,5%, IQR 0,75). El porcentaje de tiempo dentro del rango de 70−180 mg/dL fue similar; sin embargo, hubo una mayor duración de la hiperglucemia y más autocorrecciones en los días en que se realizó ejercicio. El porcentaje de tiempo en hiperglucemia grave (>250 mg/dL) fue 2,7 mayor durante el ejercicio versus los días sin ejercicio (p = 0,02). En particular, los episodios de hipoglucemia no aumentaron durante los días de práctica de ejercicio, en comparación con los días sin ejercicio. Conclusiones: El sistema híbrido de circuito cerrado fue efectivo y seguro en niños y adolescentes diagnosticados con diabetes tipo 1 durante ejercicios físicos competitivos en la vida real.

The group of companies formed by Meta, Apple, Microsoft, Amazon and Alphabet have become a successful investment alternative in the U.S. stock market. In this context, the aim of this research is to provide investment strategies based on these companies to the challenge of how individual investors should allocate their funds in a portfolio and outperform benchmarks such as the SPY ETF or a naïve portfolio. To this end, we developed a total of 20 asset allocation models and constructed portfolios with different rebalancing periods between April 2014 and June 2022. Our overall results reveal that a combination of a short window length for estimating the parameters of the asset allocation models and a procedure that takes downside risk into account, more precisely the Lower Partial Moment approach, significantly outperforms the alternative of investing in the SPY ETF and also the naïve portfolio.

Resumen: Los dispositivos intravasculares son esenciales para el abordaje diagnóstico y terapéutico de múltiples enfermedades en pediatría, siendo especialmente importantes los catéteres venosos centrales (CVC). Una de las complicaciones más frecuentes es la infección de estos dispositivos, lo cual conlleva una elevada morbimortalidad. Estas infecciones presentan una gran complejidad, precisando de un elevado consumo de recursos, tanto para su diagnóstico como para su tratamiento, afectando de manera más frecuente a pacientes pediátricos vulnerables ingresados en unidades de alta complejidad. La evidencia para su abordaje en pediatría es menor que en adultos, y no hay documentos de consenso realizados en nuestro medio. El objetivo de este documento, realizado entre la Sociedad Española de Enfermedades Infecciosas Pediátricas (SEIP) y la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), es dar recomendaciones de consenso basadas en la mayor evidencia disponible para optimizar el diagnóstico y tratamiento de las bacteriemias y fungemias relacionadas con el catéter. Este documento se centrará en pacientes pediátricos no neonatales, sin entrar en discusión sobre la prevención de estas infecciones. Abstract: Intravascular devices are essential for the diagnostic and therapeutic approach to multiple diseases in paediatrics, and central venous catheters (CVCs) are especially important. One of the most frequent complications of these devices is the infection, which is associated with a high morbidity and mortality. These infections are highly complex, requiring the use of substantial resources, both for their diagnosis and treatment, and affect vulnerable paediatric patients admitted to high-complexity units more frequently vulnerable. There is less evidence on their management in paediatric patients compared to adults, and no consensus documents on the subject have been published in Spain. The objective of this document, developed jointly by the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Intensive Care (SECIP), is to provide consensus recommendations based on the greatest degree of evidence available to optimize the diagnosis and treatment of catheter-related bloodstream infections (CRBSIs). This document focuses on non-neonatal paediatric patients with CRBSIs and does not address the prevention of these infections.

Temporary rivers, which support a dry phase, are abundant and expected to increase worldwide in the face of global change. The European Water Frame Directive still overlooks these ecosystems since information about a proper ecological assessment is scarce, especially during the complete absence of water. As a result, rivers that mostly run dry cannot be assessed yet. We aimed to examine the potential use of physico-chemical elements as suitable indicators during the dry phase of temporary rivers. We monitored 41 Mediterranean rivers (dry channel sediments and co-occurring riparian soils) previously categorized according to their level of anthropogenic impact by using both qualitative attributes at local scale (Mediterranean Reference Criteria) and by land use coverage at catchment scale. We examined common physico-chemical parameters used in monitoring programs (nutrients, electrical conductivity, pH), as well as organic matter and carbon, albeit measured in sediments and soils, to test whether they significantly changed across the monitored sites as impact level increased. Results from both approaches showed that leaching nitrate (NO3–) from dry-channel sediments and riparian zones increased significantly with the level of exposure of stressors in the study sites. High NO3– content, especially within sediments, seemed to respond to agriculture presence, which supports this parameter as a suitable indicator. However, natural variability linked to climate and geology of the study area hinders the reliability of the rest of parameters as robust indicators of the dry phase. We encourage more research across different regions to refine the physico-chemistry of dry phase to advance in properly assessing the ecological quality of temporary rivers.

Background & Aims: Liver stiffness measurement (LSM) has been shown to adequately predict outcomes in patients with liver disease. However, the value of LSM as a predictor of disease progression in autoimmune hepatitis (AIH) remains to be determined. This study aimed to evaluate the role of LSM as a predictor of disease progression and decompensation of cirrhosis in patients with AIH. Methods: This multicentre cohort study included 439 patients with histologically confirmed AIH and at least one LSM during follow-up. The association between the first LSM performed at least 6 months after treatment initiation (baseline LSM [BLSM]) and cirrhosis development and poor outcomes (decompensation, liver transplantation, and/or liver-related death) was assessed using Cox regression and its discriminating capacity with a receiver-operating characteristic curve. Results: Most patients were female (n = 301, 70%), with a median age of 52 years. BLSM performed after a median of 2.18 (1.19-4.68) years had a median value of 6 kPa (4.5-8.5). At the time of BLSM, 332 (76%) patients had achieved a biochemical response and 57 (13%) had cirrhosis. During follow-up, eight patients (2%) presented with poor outcomes and 26 (7%) developed cirrhosis. BLSM was higher among patients with poor outcomes (13.5 kPa vs. 6 kPa; p

Summary: The blood enzyme glutamate-oxaloacetate transaminase (GOT) has been postulated as an effective therapeutic to protect the brain during stroke. To demonstrate its potential clinical utility, a new human recombinant form of GOT (rGOT) was produced for medical use.We tested the pharmacokinetics and evaluated the protective efficacy of rGOT in rodent and non-human primate models that reflected clinical stroke conditions.We found that continuous intravenous administration of rGOT within the first 8 h after ischemic onset significantly reduced the infarct size in both severe (30%) and mild lesions (48%). Cerebrospinal fluid and proteomics analysis, in combination with positron emission tomography imaging, indicated that rGOT can reach the brain and induce cytoprotective autophagy and induce local protection by alleviating neuronal apoptosis.Our results suggest that rGOT can be safely used immediately in patients suspected of having a stroke. This study requires further validation in clinical stroke populations.

Contact tracing of individual exposed to any infectious measles case deserves special attention when in the country the disease is mostly imported. We present the coordinated public health actions triggered after reporting a suspected measles case in an aircraft. Spanish public health authorities and airlines responded promptly to allow a rapid contact tracing. Even one secondary measles case was reported no further transmission was identified, revealing that giving PEP and appropriate information help to avoid transmission and to maintain measles elimination in Spain.

Although Alzheimer’s disease (AD) cause is still unknown, there are several known risk factors, such as dyslipidemia. Statins are the most prescribed lipid-modifying therapies. Recent research has suggested a relationship between statins and AD, nevertheless, their ability to prevent AD is still unclear. Therefore, this cross-sectional study aimed to examine the relationship between statin use and anti-AD drug prescription. For that purpose, a database containing information on medications prescribed to patients aged 50 years or older (n = 233183) between 2018 and 2020 was used. Defined daily doses (DDDs) were calculated according to the ATC/DDD index 2023. Statistical analyses, with logistic regression and cumulative incidence, were carried out to assess statins and anti-AD drug consumption. As a result, a total of 47852 patients aged more than 70 years who were prescribed at least one antihypertensive, antidiabetic or lipid-modifying agent were included in the study. Of these, 45345 patients were classified within the cardiovascular risk group and 2483 were classified as patients with only hyperlipidemia. Patients using low-potency or hydrophilic statins had lower odds of anti-AD usage when compared to high-potency or lipophilic statins, respectively. Similarly, rosuvastatin and pitavastatin had lower odds of anti-AD medication intake when compared to atorvastatin. Finally, pitavastatin DDDs were prone to lower the odds of anti-AD medication usage when compared to rosuvastatin. In conclusion, a potential association between statins and the intake of AD medication has been observed. Specifically, low-potency (pitavastatin) and hydrophilic (rosuvastatin) statins were associated with less use of anti-AD medication.

Background: Exposure to Δ9-tetrahydrocannabinol (THC) is an established risk factor for later-life neuropsychiatric vulnerability, including mood- and anxiety-related symptoms. The psychotropic effects of THC on affect and anxiogenic behavioral phenomena are known to target the striatal network, particularly the nucleus accumbens, a neural region linked to mood and anxiety disorder pathophysiology. THC may increase neuroinflammatory responses via the redox system and dysregulate inhibitory and excitatory neural balance in various brain circuits, including the striatum. Thus, interventions that can induce antioxidant effects may counteract the neurodevelopmental impacts of THC exposure. Methods: In the current study, we used an established preclinical adolescent rat model to examine the impacts of adolescent THC exposure on various behavioral, molecular, and neuronal biomarkers associated with increased mood and anxiety disorder vulnerability. Moreover, we investigated the protective properties of the antioxidant N-acetylcysteine against THC-related pathology. Results: We demonstrated that adolescent THC exposure induced long-lasting anxiety- and depressive-like phenotypes concomitant with differential neuronal and molecular abnormalities in the two subregions of the nucleus accumbens, the shell and the core. In addition, we report for the first time that N-acetylcysteine can prevent THC-induced accumbal pathophysiology and associated behavioral abnormalities. Conclusions: The preventive effects of this antioxidant intervention highlight the critical role of redox mechanisms underlying cannabinoid-induced neurodevelopmental pathology and identify a potential intervention strategy for the prevention and/or reversal of these pathophysiological sequelae.

Introdução: As metodologias de simulação são ferramentas de ensino e aprendizagem importantes na formação dos estudantes do curso de medicina que ajudam a desenvolver competências educacionais em um ambiente controlado, seguro e com possibilidade de adaptação as necessidades do momento, assim o uso dessas estratégias visa aprimorar nos futuros médicos atitudes e competências ativas e permitir a integração de conteúdos teóricos e práticos e a construção do conhecimento em vez de somente recebê-los. A dengue é uma doença endêmica no Brasil e com o objetivo de melhorar a assistência ao paciente com dengue o Brasil adotou em 2014 a atual classificação de casos da Organização Mundial de Saúde, pois é mais simples de ser aplicada, auxilia nas decisões médicas a respeito de onde tratar o paciente e como dimensionar o tratamento, dispondo de uma ferramenta importante para lidar com essa doença desde a atenção primária até as unidades de maior complexidade. Objetivo: Destacar a importância no uso do laboratório de habilidades e simulação no desenvolvimento de competências nos estudantes de medicina do terceiro ano da Faculdade Metropolitana de Manaus. Método: É um relato que descreve a experiência do uso do laboratório de habilidades e simulação na abordagem diagnóstica e terapêutica da dengue. Resultados: Previamente lido o manual de diagnóstico e manejo clínico da dengue do Ministério da Saúde os estudantes do terceiro ano são colocados diante de casos simulados que englobam situações menos complexas e de manejo na atenção primária a saúde como diagnóstico e manejo clínico da dengue em pacientes classificados nos grupos A e B, aqui os acadêmicos interagem com atores treinados dentro das situações clínicas correspondentes e os estudantes devem realizar avaliação clínica, estratégia diagnóstica e terapêutica e intervenção comunitária de educação em saúde, em seguida propomos casos classificados nos grupos C e D em simuladores clínicos e digitais onde é solicitado avaliação clínica, diagnóstica, terapêutica e de tomada de decisões rápidas baseadas na literatura vigente com interação com equipe multidisciplinar e onde podem ocorrer os mais diversos desfechos clínicos. Conclusão: A utilização da simulação no processo de ensino e aprendizagem, pois é uma potente estratégia que integra conhecimentos e competências, ajudando a desenvolver habilidades profissionais nos futuros profissionais.

Introdução: A dengue é uma das arboviroses mais incidentes no mundo. No Brasil, é considerada uma doença endêmica de caráter sazonal e de importância epidemiológica. No estado do Amazonas, devido ao prolongado período pluviométrico, a Dengue incide durante todo ano. OBJETIVO: Categorização epidemiológica dos casos de dengue no município de Manaus entre janeiro de 2023 a maio de 2024. Método: Estudo descritivo e retrospectivo a partir da extração de dados secundários do Sistema de Informação de Agravos e Notificação (SINAN). Foram utilizadas as seguintes variáveis: sexo, faixa etária, meios de diagnóstico e evolução dos pacientes que tiveram diagnóstico de Dengue no período de 2023 a maio de 2024. Resultados: Entre janeiro de 2023 e maio de 2024 foram notificados 4.269 casos de dengue. Em 2023 foram relatados 1.170 (27,40%) casos, dos quais 1.096 sorotipos não identificados, 49 casos DEN1, 24 casos DEN2, 1 caso DEN3. Em 2024 foram relatados 3.099 (72,59%) casos, nos quais, 2.977 sorotipos não identificados, 11 casos DEN1, 110 casos DEN2, 1 caso DEN4. Em 2023 foram 604 (51,62%) homens afetados e 560 (47,86%) mulheres afetadas, a faixa etária mais acometida foi adultos (20-39 anos) com 398 (34,01%) casos notificados. Para fins diagnósticos, em 2023, 474 (40,51%) pessoas tiveram diagnóstico confirmado por exame laboratorial e 309 (26,41%) tiveram diagnóstico clínico-epidemiológico. A incidência em 2023 foi de 50 casos por 100.000 habitantes. As hospitalizações foram 115 (9,82%) pacientes com 3 (0,25%) registros de óbitos. Em 2024 foram acometidos 1549 (49,98%) homens e 1538 (49,62%) mulheres, a faixa etária com mais notificações foi adultos (20-39 anos) com 1.316 (42,46%) casos. Para fins diagnósticos, 466 (15,03%) tiveram diagnóstico confirmado com exames laboratoriais e 1.468 (47,37%) de diagnóstico clínico-epidemiológico e 197 (6,35%) aparecem em investigação. A incidência em 2024 foi de 150 casos por 100.000 habitantes. As hospitalizações foram 100 (3,22%) com 1 (0,03%) óbito registrado. Conclusão: Observou-se, desse modo, um aumento de 164,85% do número de casos notificados de dengue de janeiro a maio de 2024 comparado ao ano de 2023, mantendo-se quase estática a proporção entre homens e mulheres. Ocorreu também, um aumento da incidência de subtipos do vírus da dengue que antes tinham taxas de contágio pouco expressivas no município. A incidência foi 3 vezes maior em 2024 e ainda com a crescente de casos nesse mesmo ano, se notou menores taxas de hospitalizações e óbitos.

Introdução: A esporotricose humana constitui a micose subcutânea mais comum da américa latina, é causada pelo fungo Sporothrix schenckii. A transmissão acontece com a contaminação de ferimentos ou através da inoculação do fungo na pele a partir de um trauma. Quanto a apresentação clínica temos a esporotricose cutânea, a linfocutânea sendo esta a apresentação mais frequente da doença e a forma disseminada. O diagnóstico é feito através da correlação entre os dado clínicos, epidemiológicos e laboratoriais, a confirmação diagnóstico acontece com isolamento do fungo obtido através de biopsia ou aspirado de amostras de lesões sugestivas da infecção. Desde fevereiro de 2021 a esporotricose passou a ser doença de notificação compulsória no estado do Amazonas. Objetivo: Descrever a distribuição geográfica e o perfil epidemiológico da esporotricose humana no Amazonas no período de janeiro a outubro de 2023. Método: Estudo descritivo e quantitativo a partir da extração de dados do boletim epidemiológico da Secretária de Estado de Saúde do Amazonas. Resultados: No período compreendido entre 01 de janeiro e 20 de outubro de 2023 tivemos 403 casos foram confirmados de esporotricose humana, comparados com o mesmo período do ano de 2022 houve um aumento de 89% e entre os meses de abril a agosto foi o de maior ocorrência com 281 casos confirmados. Os casos estão distribuídos em 5 municipios do estado onde 96,8% estão concentrados na capital Manaus, Presidente Figueiredo 1,7%, Iranduba 0,7%, Barcelos 0,5% e Urucurituba 0,2% e observa-se 99% dos casos ocorreram em zona urbana e 73% o ambiente de infecção foi domiciliar. O município com maior taxa de incidência da doença foi Presidente Figueiredo com 18,4, com menor taxa de incidência foi Urucurituba com 4,1, a capital do estado ficou com a segunda maior incidência no ano de 2023 com 17,3 casos/100 mil habitantes. O sexo feminino foi o mais acometido pela infecção com 61,5% e a faixa etária mais afetada é a de 20 a 59 anos de idade com 66%. Nos antecedentes epidemiológicos 72,7% relataram contato com animal doente, sendo o gato o principal animal deste contato correspondendo a 96,6%. Viu-se ainda que 94,3% são autóctones, 90,3% não estão relacionados ao trabalho, a infecção no ambiente domiciliar ocorrendo em 73% dos casos e finalmente em relação aos critérios de confirmação 61,3% foram por critérios laboratoriais e 38,7% clínico-epidemiológicos. Conclusão: A esporotricose é um zoonose emergente no Amazonas no último ano e observa-se aumento dos casos na zona urbana do estado.

Entrepreneurial ecosystems (EEs) are a growing focus for policymakers and academics seeking to foster innovation and economic growth. While existing literature has analysed various aspects of EEs, limited research has examined how public policies can contribute to their development. Through a single-case study, this study addresses this gap by analysing the role of a regional government in overcoming the challenges of building an EE. We explore the creation and development of the Biscay Startup Bay (BSB) EE in Bilbao City (Bizkaia, Basque Country, Spain). We describe the unique framework that they crafted and implemented, highlighting the key attributes that generate value for all stakeholders. This single-case study of the BSB EE in Spain offers valuable insights for policymakers seeking to design and implement successful Open Innovation-driven approaches to creating and developing regional EEs.

Objetivo: Apresentar reflexõesacerca da relação entre os setores de Hemoterapia e Hematologia do Hemorio, a partir do índice de comparecimentos de doadores em 2023. Material e método: O material do estudo é composto de pesquisa documental e levantamento de dados quantitativos coletados no Sistema de Administração ao Ciclo do Sangue (SACS) referentes ao comparecimento de doadores e números de doações em 2023. Resultados: O Hemorio possui a doação personalizada, conhecida em outros hemocentros como fenotipada. Para esse tipo de doação é realizada a fenotipagem sanguínea pelo setor de imunohematologia. Após esta etapa, ocorre a convocação destes doadores. De forma geral, a fenotipagem não influencia na terapia transfusional, mas para pacientes que recebem transfusões ao longo da vida, ela torna-se imprescindível, diminuindo ou evitando reações advindas desse processo. Em 2023, o Hemorio teve 105.001 candidatos à doação de sangue, resultando na coleta de 87.323 (86,16%) bolsas. No mesmo período, ocorreram 479 comparecimentos para doações personalizadas e 462 (96,45%) bolsas coletadas (Hemorio, 2023). Essas bolsas vão diretamente para pacientes internados no hospital e que precisam de transfusões que são realizadas no setor de hematologia e representam o fim do ciclo do sangue, efetivando a relação entre as áreas da hemoterapia e hematologia no instituto. As etapas do ciclo do sangue, anteriormente mencionado, são constituídas pela captação de doadores, cadastro, triagem clínica, hidratação, doação (coleta do sangue), lanche pós doação e transfusão. Discussão: O Hemorio é o Hemocentro Coordenador do Estado do Rio de Janeiro e desempenha papel central nos serviços de hemoterapia. É um hospital especializado no tratamento de doenças hematológicas, servindo a usuários do Sistema Único de Saúde (SUS), além de ser uma instituição de ensino e pesquisa. O setor de Hematologia atende aproximadamente 10.000 pacientes diagnosticados com doenças hematológicas, que frequentemente requerem transfusões de sangue e hemoderivados. Na área de Hemoterapia, o salão de doadores tem capacidade para atender 500 pessoas por dia, embora a média diária em 2023 tenha sido de 288 candidatos, resultando em média 240 bolsas de sangue por dia (Hemorio, 2023). Esses números evidenciam a correlação entre os setores de Hemoterapia e Hematologia, apesar de possuírem estruturas organizacionais, equipes e chefias distintas. Conclusão: Observa-se que as equipes de Hematologia e Hemoterapia, apesar de realizarem intervenções no ciclo do sangue, poderiam ter um melhor diálogo entre si. No Hemorio, o principal elo entre as áreas de hematologia e hemoterapia é o sangue, onde é possível a efetivação de todas as etapas do ciclo, desde a captação de doadores até a transfusão. Destacamos a relevância do Hemorio ser uma instituição onde é possível a realização de todas as etapas do sangue. O Programa de Residência Multiprofissional é um elemento importante que pode efetivar o diálogo entre as duas áreas, visto que os residentes perpassam por ambos os setores, tendo a possibilidade de interlocução entre as equipes, com uma visão crítica das atividades desempenhadas e a possibilidade de propor melhorias na qualidade dos serviços prestados. O diálogo entre as equipes pode possibilitar a integralidade do cuidado, princípio do SUS, superando a fragmentação que se expressa nos serviços e tende a separar as ações de promoção/proteção e recuperação da saúde.

Introdução e objetivo: A hemofilia é uma doença hereditária que afeta a coagulação sanguínea, sobrevém quando uma pessoa nasce com deficiência do fator VIII que designa a Hemofilia A ou do fator IX que caracteriza a Hemofilia B (ABRAPHEM, 2024). Sendo uma doença crônica, é necessário o tratamento contínuo e em alguns casos precisam realizar reposição de fator deficiente. Uma das ações do Hemorio para a avaliação é oacompanhamento multiprofissional, sendo a equipe composta por Médicos Hematologistas e Fisiatras, Enfermeiros, Educador Físico, Fisioterapeuta, Psicólogo e Assistente Social. Entre as demandas atendidas predominam as orientações sobre o acesso ao transporte, aos benefícios de transferência de renda e o acesso a rede de apoio socioassistencial. Dessemodo, o presente trabalho tem como objetivo apresentar a relevância profissional do Serviço Social no atendimento aos pacientes com Hemofilia na perspectiva de possibilitar sua aderência ao tratamento, bem como o acesso aos direitos sociais. Material e métodos: Trata-se de um levantamento de dados referente aos atendimentos realizados aos pacientes com Hemofilia pela equipe do Serviço Social no ambulatório no período de primeiro semestre de 2023 ao primeiro semestre de 2024. A metodologia será baseada por meio de revisão bibliográfica, através de artigos, legislações referente ao tema, assim como, dados da atuação profissional. Amparando-se nos conceitos de Minayo (2015) e Gil (2002), que buscam compreender os fenômenos presentes nas relações sociais e a prática exercida na abordagem da realidade. Será utilizada a perspectiva quanti-quali.Resultados: Entre o primeiro semestre de 2023 ao primeiro semestre de 2024, foram realizados 959 diagnósticos de hemofílicos, desse total, foram atendidos pelo Serviço Social com demandas específicas 132 atendimentos. Desses atendimentos, 65% são referentes a crianças e adolescentes. Entretanto, no desenvolvimento do atendimento, as principais demandas estão voltadas para o acesso ao transporte, sendo elas 44%. Além disso, os benefícios de transferência de renda ocupam 25% dessas demandas. Discussão: A Lei 8.080, que rege o Sistema Único de Saúde, traz o conceito ampliado de saúde, que não se limita à ausência de doença, mas apresenta como diretriz a identificação e divulgação dos fatores condicionantes e determinantes da saúde, entendendo que esta é resultante de diversos fatores, como condições de alimentação, habitação, renda, acesso a serviços de saúde. Nessa direção, o Serviço Social enfatiza as determinações sociais e culturais, preservando sua identidade profissional. Não se trata de negar que as ações no trato com os usuários e familiares produzam impactos subjetivos, o que se põe em questão é o fato do assistente social tomar por objeto a subjetividade, o que não significa abster-se do campoda saúde, pois nos cabe diversas ações desafiantes frente às diversas requisições tanto notrabalho com as famílias, na geração de renda, no controle social, na garantia de acesso aos benefícios, dentre outras. Conclusão: De acordo com os dados apresentados, infere-se a importância do trabalho do serviço social para a adesão ao tratamento do paciente hemofílico, tendo em vista que o acesso ao transporte e aos programas de transferência de renda são fatores determinantes para que ocorra a sua continuidade.

Objetivo: Explorar e compreender a eficácia e segurança de terapias inovadoras no tratamento de Leucemia Mieloide Aguda (LMA), identificando novas abordagens que possam melhorar os desfechos clínicos e a qualidade de vida dos pacientes. Material e métodos: Por meio de pesquisas em artigos científicos, utilizando como base de dados de estudo o Google Acadêmico, PubMed Central e SciElo, com as seguintes palavras chaves: Atuação fisioterapêutica; Leucemia; Qualidade de vida, alguns artigos nacionais e também artigos internacionais. Os critérios de inclusão dos estudos consistiram em: publicação em português ou inglês, e artigos publicados entre 2017 e 2024. Foram excluídos artigos não apresentados sob a forma de revisão sistemática e ensaio clínico, que não atendiam aos critérios propostos da temática. Inicialmente foram selecionados 15 artigos sobre o tema, porém 7 artigos foram excluídos por não apresentarem relevância ao estudo proposto. Resultados: O diagnóstico de LMA é confirmado pela presença de pelo menos 20% de células imaturas e anormais (blastos mieloides) na medula óssea. O tratamento tradicional para LMA envolvia quimioterapia combinada com terapias-alvo, como inibidores de tirosina quinase (TKIs). Foi demostrado por Abreu et al. (2012) que dos 30 pacientes submetidos a TCTH, 39% sobreviveram ao primeiro ano pós-transplante. Esse procedimento destaca-se pelo potencial de substituir o sistema hematopoiético do paciente e eliminar células leucêmicas residuais, prevenindo recaídas e proporcionando uma possível cura. O procedimento consiste na infusão de um concentrado com o objetivo de tratar doenças hematológicas, onco-hematológicas e imunodeficiências, principalmente recidivantes e refratárias a outras terapêuticas. Vergas et al. (2019) demonstrou que o TCTH é uma terapia pós-remissão eficaz, sendo frequentemente considerada curativa. As terapias-alvo focam em mutações genéticas específicas, como FLT3, IDH1 e IDH2, inibindo vias de sinalização anormais que promovem o crescimento das células cancerosas. Discussão: Na indicação do TCTH é fundamental considerar diversos fatores tanto relacionados ao receptor quanto ao doador. No que diz respeito aos doadores, a compatibilidade dos antígenos leucocitários humanos é um aspecto crucial, pois é o principal fator genético que influencia o sucesso do transplante. Para o receptor, é essencial analisar o tipo e o estágio da doença, a viabilidade do doador, a idade do paciente e seu estado geral de saúde, entre outros aspectos. É recomendável que o acompanhamento pós-TCTH seja mantido até o D+100, período em que o paciente deve ser monitorado frequentemente pela equipe multiprofissional para prevenir a doença do enxerto contra o hospedeiro. Nesta condição, as células do doador atacam as células do receptor. Essa compreensão abrangente é crucial para avaliar adequadamente as opções de tratamento disponíveis e oferecer abordagens mais eficazes e personalizadas para o manejo da doença. Conclusão: As terapias inovadoras no tratamento da Leucemia Mieloide Aguda (LMA) representam um avanço significativo na abordagem desta condição complexa e desafiadora.

Objetivos: Este trabalho visa explorar a importância dos biomarcadores no prognóstico de doenças hematológicas, como leucemias, linfomas e mielomas múltiplos. Métodos: Foi realizada uma revisão sistemática da literatura nas bases de dados PubMed, SciELO e Web of Science, abrangendo publicações dos últimos cinco anos. Foram incluídos estudos que avaliaram biomarcadores em doenças hematológicas e forneceram dados sobre seu impacto prognóstico. Resultados: Diversos biomarcadores com relevância prognóstica em doenças hematológicas foram identificados. Na leucemia mieloide aguda (LMA), a mutação FLT3-ITD está associada a um prognóstico desfavorável, maior risco de recidiva e menor sobrevida global. Em contraste, a mutação NPM1 está associada a um melhor prognóstico, desde que ocorra na ausência de mutações FLT3-ITD. No linfoma de Hodgkin, a expressão elevada de CD30 correlaciona-se com uma resposta favorável ao tratamento com anticorpos monoclonais, enquanto a presença do vírus Epstein-Barr (EBV) está associada a um pior prognóstico em adultos, uma vez que promove a transformação maligna de células. No mieloma múltiplo, níveis elevados de beta-2 microglobulina indicam uma maior carga tumoral e pior prognóstico. Por outro lado, a elevação da enzima lactato desidrogenase (LDH) está associada a um comportamento mais agressivo da doença. Discussão: Os resultados confirmam a importância dos biomarcadores na estratificação de risco e prognóstico de doenças hematológicas. Na leucemia mieloide aguda, a presença da mutação FLT3-ITD direciona para terapias-alvo específicas, enquanto a mutação NPM1 indica melhores respostas à quimioterapia. No linfoma de Hodgkin, a expressão de CD30 é crucial para a seleção de pacientes para tratamento com brentuximab vedotin, um anticorpo monoclonal anti-CD30. A detecção do vírus Epstein-Barr em células tumorais sugere a necessidade de estratégias terapêuticas mais agressivas. No mieloma múltiplo, a beta-2 microglobulina e a LDH são fundamentais para a classificação de risco, sendo biomarcadores essenciais para o planejamento terapêutico. Esses achados destacam a necessidade de integrar a avaliação de biomarcadores na prática clínica para melhorar a precisão do prognóstico e otimizar estratégias terapêuticas, garantindo ao paciente um tratamento adequado as particularidades do seu organismo. Conclusão: Os biomarcadores desempenham um papel essencial no prognóstico das doenças hematológicas, permitindo uma abordagem mais personalizado e eficaz no tratamento dessas condições. A identificação de mutações genéticas, níveis de proteínas séricas e marcadores virais oferece uma ferramenta valiosa para a classificação de risco e o planejamento terapêutico, contribuindo para melhorar a sobrevida e a qualidade de vida dos pacientes. Futuros estudos devem continuar a explorar os novos biomarcadores e validar os existentes, ampliando as opções terapêuticas e aprimorando o manejo clínico das doenças hematológicas.

Objetivo: Compreender o perfil clínico dos pacientes pediátricos diagnosticados com leucemia linfocítica aguda, bem como caracterizar quanto ao prognóstico desses pacientes, identificando abordagens importantes que mudem o desfecho clínico e qualidade de vida dos pacientes. Material e métodos: Estudo qualitativo utilizando artigos do Pubmed, Lilacs e Scielo. Palavras-chave: leucemia, pediatria, perfil clínico, diagnóstico, prognóstico. Incluídos artigos em português ou inglês dos últimos cinco anos. Excluídos artigos sem revisão sistemática ou ensaio clínico. Selecionados 12 artigos, 8 excluídos por falta de relevância. Resultados: Estudos mostraram que a idade do paciente é considerada como fator de importância prognóstica importante em crianças com LLA. Assim, pacientes com idade menor que 9 anos, apresentam um melhor prognóstico do que aquelas com mais de 9 anos. Nos pacientes com idade superior a 10 anos, a sobrevida global em oito anos foi de apenas 49%. Quanto aos sinais e sintomas das crianças no momento do diagnóstico, um estudo realizado por Barbosa com 61 crianças portadoras de leucemia aguda, mostrou que 62% apresentaram manifestações do sistema músculoesquelético. Foi visto que às queixas relacionadas a esse sistema se destacam e estão manifestadas na forma de artrite, artralgias e outras dores ósseas, o que são sintomas comuns a várias outras doenças, tornando mais difícil assim chegar ao diagnóstico de leucemia. Devido a gama de doenças com tais manifestações de sintomas, esses pacientes recebem diagnóstico inicial de calazar, lúpus eritematoso sistêmico, artrite reumatóide juvenil ou púrpura trombocitopênica imune e alguns ainda recebem corticoterapia antes do diagnóstico definitivo. Vale ressaltar que o uso de corticosteróides pode aliviar os sintomas da leucemia, mascarando a doença, além de alterar a citologia e a histologia medular, retardando ainda mais o diagnóstico. Discussão: A idade do paciente deve guiar o diagnóstico e tratamento da LLA. Sintomas musculoesqueléticos comuns exigem atenção para diagnóstico diferencial de leucemia, evitando atrasos e diagnósticos errôneos. A confusão diagnóstica leva a corticoterapia inadequada, destacando a necessidade de educação contínua entre os profissionais de saúde. Conclusão: Diante disso, o estudo destaca a complexidade que é diagnóstico de leucemia linfoide aguda em pacientes pediátricos, tanto pela abrangência dos sintomas que frequentemente levam a diagnósticos iniciais errôneos, como pelo início de terapias que muitas vezes mascaram o diagnóstico da LLA. Isso reforça a necessidade de que a LLA seja considerada um diagnóstico diferencial de crianças apresentando sintomas musculoesqueléticos. Ademais, avanços nos métodos diagnósticos e a promoção de uma formação em educação entre os profissionais de saúde podem melhorar significativamente a detecção da LLA, aumentando as chances dos pacientes pediátricos terem uma maior taxa de sobrevivência e melhor qualidade de vida.

Objetivo: Descrever o perfil clínico-epidemiológico dos casos diagnosticados com Linfoma não-Hodgkin difuso na população do estado do Ceará no período de 2019 a 2023. Material e estudo: Trata-se de um estudo epidemiológico de abordagem quantitativa, nos quais os dados sobre o diagnóstico e tratamentos do Linfoma não-Hodgkin difuso entre 2019 a 2023 no estado do Ceará. Os dados foram alcançados através da plataforma DATASUS, seção Painel Oncologia. As variáveis analisadas foram: sexo, faixa etária e modalidade terapêutica. Resultados: Entre 2019 e 2023, foram documentados cerca de 1069 casos diagnosticados como Linfoma não-Hodgkin difuso no estado do Ceará. Dos quais, os casos por sexo dessa patologia equivale a um total de 573 (53,6%) casos do sexo masculino e 496 (46,4%) do sexo feminino. Quanto à faixa etária 0 a 19 anos foram um total de 84 casos (7,8%), 20 a 29 anos um total de 72 casos (6,7%), 30 a 39 anos um total de 98 casos (9,2%), 40 a 49 anos um total de 130 anos (12,2%), 50 a 59 anos um total de 222 casos (20,8%), 60 a 69 anos um total de 227 casos (21,2%), 70 a 79 anos um total de 168 casos (15,7%) e 80 anos e mais foram um total de 68 casos (6,4%). Quanto às modalidades terapêuticas aplicadas no estado do ceará para os casos diagnosticados com Linfoma não-Hodgkin difuso, a cirurgia como o tratamento de escolha foi relatada em 4 casos (0,4%), a radioterapia em 46 casos (4,3%), quimioterapia em 909 casos (85%) e 110 casos (10,3%) não se obteve informações do tratamento escolhido. Discussão: O Linfoma Não-Hodgkin Difuso é heterogêneo e agressivo, de grande relevância clínica, sendo relevante o estudo sobre o seu perfil clínico e epidemiológico. Entre os anos 2019 e 2023, no Ceará, foram relatados 1069 casos diagnosticados, possuindo um predomínio discreto no sexo masculino de 53,6%. Quanto à faixa etária, a maior quantidade de casos diagnosticados se encontram entre 60 a 69 anos de idade com cerca de 21,2%, principalmente quando comparados a faixa etária de 0 a 19 anos com 7,8% dos casos. E quanto ao tratamento, preconiza-se a quimioterapia como a modalidade terapêutica mais utilizada na região do Ceará, correspondendo a mais de 80% dos casos ao comparar com a cirurgia e radioterapia. Com isso, achados clínicos são relevantes para o resultado do tratamento, dentre eles destacam-se a idade do paciente, a condição de desempenho, o estágio. Conclusões: Portanto, vale ressaltar a importância de compreender a epidemiologia do Linfoma não-Hodgkin difuso para auxiliar no diagnóstico e possíveis tratamentos dos casos e permitir a análise dessa doença na população da região. Desse modo, pode-se perceber que no estado do Ceará entre os anos de 2019 e 2023, esse tipo de linfoma foi prevalente em homens e em idade avançada que varia principalmente de 40 a 70 anos. O tratamento quimioterápico é visto como principal, mas deve ser guiado pelos fatores diagnósticos, clínica do paciente e estadiamento. Assim, destaca-se que a população idosa merece uma atenção maior na investigação a fim de diagnosticar mais precocemente e instituir um tratamento eficaz.

Objetivo: Conhecer o número de crianças hospitalizadas por anemia por deficiência de ferro, no Brasil, durante os anos de 2019 a 2023, agrupadas em intervalos etários e por regiões brasileiras. Material e métodos: Trata-se de um trabalho descritivo e retrospectivo o qual utilizou dados do Departamento de Informática do Sistema Único de Saúde (DATASUS) referentes à morbidade hospitalar por anemia por deficiência de ferro, no Brasil, em crianças de 0 a 9 anos, durante os últimos 4 anos. Resultados: De acordo com os dados obtidos, 3.895 crianças, entre 0 e 9 anos, foram internadas devido à anemia por deficiência de ferro durante o período de tempo referido. Na divisão por faixa etária, os seguintes resultados foram alcançados: 1.469 menores de 1 ano; 1.914 entre 1 a 4 anos; 512 entre 5 a 9 anos. Desses números, 2.283 são do sexo masculino e 1.612 são do sexo feminino. Discussão: A anemia ferropriva em crianças no Brasil revela uma situação preocupante, evidenciada pelo elevado número de hospitalizações relacionadas a essa condição. A prevalência mais alta em idades tão jovens pode estar relacionada a fatores como a introdução tardia ou inadequada de alimentos ricos em ferro e a falta de suplementação adequada. Além disso, a divisão por sexo mostra uma ligeira predominância de casos em meninos (2.283) em comparação com meninas (1.612). Esses dados sublinham a necessidade urgente de intervenções voltadas à educação nutricional dos pais e cuidadores, políticas de saúde que assegurem a suplementação de ferro a partir dos 6 meses de idade, e estratégias de prevenção eficazes para reduzir a morbidade associada à anemia ferropriva em crianças no Brasil. Conclusão: Por meio do estudo do quadro epidemiológico obtido, conclui-se que a anemia por deficiência de ferro é um problema de saúde pública responsável por altos números de internação de crianças entre 0 e 9 anos no Brasil. Além disso, observa-se que a faixa etária menor de 5 anos é a mais afetada. Dessa forma, evidencia-se a necessidade de promoção de saúde sobre a importância de uma alimentação adequada para as crianças e da suplementação de ferro a partir dos 6 meses de vida.

Objective: The aim was to examine the association between social frailty and diet quality in adults over 65 years of age, and whether results differed by sex. Design: Population-based cross-sectional study using data from the Spanish National Health Survey. Participants: 5,071 community-dwelling people ≥65 years from Spain. Measurements: Social frailty was deemed to exist when the person both lived alone and had low social support, measured with the Duke-UNC scale. Diet was assessed with the Spanish Healthy Eating Index (S-HEI), ranging from 0 to 100 points (highest diet quality). Means and 95% confidence intervals of the S-HEI score for each social frailty group were calculated using linear regressions, with socially robust people as reference. Analyses were adjusted for main confounders, including sociodemographic, lifestyle and morbidity variables. Results: There were no differences in the S-HEI adjusted mean of socially frail (74.3 points, 95%CI: 73.4−75.2) compared to socially robust older adults (75.4 points; 95%CI: 75.1−75.7). In sex-stratified analyses, the S-HEI adjusted mean of socially frail men (71.9 points; 95%CI: 70.6−73.2) was lower than robust men (74.8 points; 95%CI: 74.4−75.3). Specifically, social frailty was associated with lower consumption of vegetables, fruits, dairy and lower diet variety in men. Differences were not observed according to social frailty among older women. Conclusions: Social frailty was associated with poor diet quality in community-dwelling older men, but not in women in Spain. Gender differences in self-care could partly explain this association. Sex-specific interventions are required to minimize the impact of social frailty on diet quality.

Background & Aims: Senescence has been reported to have differential functions in cholangiocytes and hepatic stellate cells (HSCs) during human and murine cholestatic disease, being detrimental in biliary cells and anti-fibrotic in HSCs. Cholestatic liver disease is associated with loss of intestinal barrier function and changes in the microbiome, the mechanistic cause of which is undetermined. Methods: Intestinal samples were analysed from controls and patients with primary sclerosing cholangitis, as well as wild-type (WT) and p16-3MR transgenic mice. Cholestatic liver disease was induced by bile duct ligation (BDL) and DDC diet feeding. Fexaramine was used as an intestinal-restricted FXR agonist and antibiotics were given to eliminate the intestinal microbiome. Senescent cells were eliminated in p16-3MR mice with ganciclovir and in WT mice with the senolytic drug ABT-263. In vitro studies were done in intestinal CaCo-2 cells and organoids were generated from intestinal crypts isolated from mice. Results: Herein, we show increased senescence in intestinal epithelial cells (IECs) in patients with primary sclerosing cholangitis and in mice after BDL and DDC diet feeding. Intestinal senescence was increased in response to reduced exposure to bile acids and increased presence of lipopolysaccharide in vitro and in vivo during cholestatic liver disease. Senescence of IECs was associated with lower proliferation but increased intestinal stem cell activation, as supported by increased organoid growth from intestinal stem cells. Elimination of senescent cells with genetic and pharmacological approaches exacerbated liver injury and fibrosis during cholestatic liver disease, which was associated with increased IEC apoptosis and permeability. Conclusions: Senescence occurs in IECs during cholestatic disease and the elimination of senescent cells has a detrimental impact on the gut-liver axis. Our results point to cell-specific rather than systemic targeting of senescence as a therapeutic approach to treat cholestatic liver disease. Impact and implications:: Cholestatic liver disease associates with the dysregulation of intestinal barrier function, while the mechanisms mediating the disruption of the gut-liver axis remain largely undefined. Here, we demonstrate that senescence, a cellular response to stress, is activated in intestinal cells during cholestatic liver disease in humans and mice. Mechanistically, we demonstrate that the reduction of bile acids and the increased presence of bacterial products mediate the activation of intestinal senescence during cholestatic liver disease. Importantly, the elimination of these senescent cells promotes further damage to the intestine that aggravates liver disease, with increased tissue damage and fibrosis. Our results provide evidence that therapeutic strategies to treat cholestatic liver disease by eliminating senescent cells may have unwanted effects in the intestine and support the need to develop cell/organ-specific approaches.

Objectives: Contacts of patients with infectious tuberculosis (TB) testing positive on interferon-gamma release assay (IGRA) are followed up to exclude active disease. However, identifying factors that predispose IGRA-negative contacts to TB could improve screening and follow-up strategies in a medium TB burden country such as Singapore. Methods: We conducted a retrospective study of IGRA-negative contacts aged ≥2 years identified during contact investigation between January 2014 and December 2022. We examined the risk factors associated with developing active TB among contacts previously testing IGRA-negative, using univariate and multivariable logistic regression and odds ratios with 95% confidence intervals. Results: Of 60,377 IGRA-negative contacts, 150 developed TB disease, and half were notified within 23 months of index patient diagnosis. IGRA-negative contacts of a smear-positive index patient were more likely to develop TB. Independent risk factors for TB were age >50 years, Malay ethnicity, having diabetes or end-stage renal failure, a “family” relationship with the index patient, or exposure in a dormitory or nursing home. Conclusions: Identifying risk factors could help optimise follow-up strategies and preventive treatment in IGRA-negative individuals. The incidence rate of TB in this group was 150 per 100,000 population, substantially higher than in the community, with a median 92 weeks to develop disease. Findings suggest that follow-up should be extended to 24 months for contacts with these risk factors.

Over millennia, mammals have coexisted with humans across the forest-savannah mosaics characterising part of West Africa. While some savannahs have long been used for rice cultivation in Guinea-Bissau, savannas and forests are now being rapidly converted into cashew monocultures. To understand how species cope with such land-use changes, we investigated how mammals make use of forest patches, cashew orchards and rice paddies over two contrasting periods: early and late rainy season. Using camera-trapping, we examined mammal diversity and trophic guild activity across seven landscapes, each with one sampling site per habitat type in Northern Guinea-Bissau. Based on 937 records from 21 species, species richness and activity were similar across habitat types, but generally higher in the late-rainy season. In this season, species composition differed between the cashew orchards and rice paddies. At the guild-level, carnivore activity was lower in the rice paddies than in forests, while herbivore activity was lower in the cashew orchards in comparison to that in forests in the early-rainy season. The relatively similar assemblage-wide diversity across habitat types seems to be enabled by the high habitat heterogeneity, but likely offset by previous extinctions from the area. Yet, guild-level habitat use highlighted the fundamental role of forests to sustain functionally healthy mammal assemblages. Maintaining habitat heterogeneity, including patches of native forests, seems to be key in optimizing the long-term conservation of mammal diversity in rural West Africa.

Summary: Post-coronavirus disease condition (PCC) continues to affect many people globally, yet there remains a lack of diagnostic biomarkers to distinguish PCC from those recovered from acute COVID-19. This study compared biomarkers between two age- and gender-matched groups: PCC individuals and those recovered within three months of acute COVID-19 in 2020 (n = 85 each). Biomarkers were assessed 12–24 months after initial diagnosis, examining biochemical profiles, blood cell counts, coagulation status, antibody serology, lymphocyte populations, and cytokine levels. PCC individuals exhibited significant alterations in 49 of 167 markers, including K+ levels, αGAD antibodies, antithrombin III, insulin-like growth factor-binding protein 3 (IGFBP3), and interleukin-10 (IL-10). A panel of αGAD, IL-10, potassium levels, and CD16brightCD56− cell presence distinguished PCC individuals from recovered patients with >88% accuracy and

Pervaporation emerges as a promising technique for brine treatment. In this investigation, we employed a PVDF substrate layer and applied various coating solutions using a simple spray technique to produce a composite pervaporation membrane. The composite membrane's chemical structure, morphology, hydrophilicity, swelling property, surface roughness, and crosslinking conditions were thoroughly investigated. Notably, the PVDF/PEI/P(SS-MA) composite membrane exhibited outstanding desalination performance, demonstrating high salt rejection and flux of 308.7 ± 13.8 kg m−2 h−1 when subjected to a 3.5 wt% sodium chloride solution. Even at an elevated brine concentration of 20 wt%, the membrane maintained a commendable flux of 88.76 ± 5.4 kg m−2 h−1 at 72 °C. These findings underscore the efficacy of the developed composite membrane for brine desalination applications.

Background and objectives: Fibrosis contributes to 45% of deaths in industrialized nations and is characterized by an abnormal accumulation of extracellular matrix (ECM). There are no specific anti-fibrotic treatments for liver fibrosis, and previous unsuccessful attempts at drug development have focused on preventing ECM deposition. Because liver fibrosis is largely acknowledged to be reversible, regulating fibrosis resolution could offer novel therapeutical options. However, little is known about the mechanisms controlling ECM remodeling during resolution. Changes in proteolytic activity are essential for ECM homeostasis and macrophages are an important source of proteases. Herein, in this study we evaluate the role of macrophage-derived cathepsin D (CtsD) during liver fibrosis. Methods: CtsD expression and associated pathways were characterized in single-cell RNA sequencing and transcriptomic datasets in human cirrhosis. Liver fibrosis progression, reversion and functional characterization were assessed in novel myeloid-CtsD and hepatocyte-CtsD knock-out mice. Results: Analysis of single-cell RNA sequencing datasets demonstrated CtsD was expressed in macrophages and hepatocytes in human cirrhosis. Liver fibrosis progression, reversion and functional characterization were assessed in novel myeloid-CtsD (CtsDΔMyel) and hepatocyte-CtsD knock-out mice. CtsD deletion in macrophages, but not in hepatocytes, resulted in enhanced liver fibrosis. Both inflammatory and matrisome proteomic signatures were enriched in fibrotic CtsDΔMyel livers. Besides, CtsDΔMyel liver macrophages displayed functional, phenotypical and secretomic changes, which resulted in a degradomic phenotypical shift, responsible for the defective proteolytic processing of collagen I in vitro and impaired collagen remodeling during fibrosis resolution in vivo. Finally, CtsD-expressing mononuclear phagocytes of cirrhotic human livers were enriched in lysosomal and ECM degradative signaling pathways. Conclusions: Our work describes for the first-time CtsD-driven lysosomal activity as a central hub for restorative macrophage function during fibrosis resolution and opens new avenues to explore their degradome landscape to inform drug development.

Acute hepatic porphyrias (AHPs) are a family of rare, autosomal, dominantly inherited conditions characterized by abnormalities in the production of heme. Advances in molecular engineering have provided new therapeutic possibilities for modifying the heme synthetic pathway in patients with porphyria. In particular, the RNA interference therapeutic givosiran was approved for the treatment of adults and adolescents with AHP aged >12 years based on the positive results of the phase III trial ENVISION. Despite the extended characterization of the activity of givosiran in clinical trials, reports on the long-term effects and effectiveness of the treatment in clinical practice are still scant. To fill this gap, this case series describes a monocentric Italian cohort of AHP patients treated with givosiran. Overall, our real-life experience supports the clinical evidence that long-term treatment with givosiran is well tolerated and able to provide sustained and continuous benefit to patients with acute intermittent porphyria, as reflected by the reduction in the frequency of attacks. In our series, givosiran treatment was also associated with improvement in assessments of quality of life, pain and fatigue.

Scientific literature for mineral soil nitrogen content (ammonium and nitrate) measurements usually differs regarding the chosen soil sample conservation method (fresh, frozen or air-dry) before soil extraction and analysis. In addition, most of the commonly used methodologies focus on the definition of the analysis processes, regardless of the previous sample conservation methodology. With the aim to fill this gap, we performed an analysis of the conservation method effect on the nitrate, and ammonium content in frozen or air-dried samples, comparing the results with direct fresh extraction. Moreover, the effects of additional soil parameters, such as soil texture, organic matter content or mineral nitrogen content range were also studied. The results showed that both, frozen and air drying soil samples, were capable of reliably preserving the N content of soil samples in most cases. However, some ammonium losses may occur in frozen samples when a high N content (>30 mg kg−1) is present. It was also observed that air-dried soil samples can reduce the soil nitrate and increase ammonium content in samples with a high N content. It was also observed that significant amounts of organic matter in soil can alter the mineral N measured depending on the conservation method chosen. On the other hand, the soil texture presented small effects on the mineral N measurements. In any case, a broader range of soils conditions (including i.e. pH or different natural organic matter content) should be further tested to confirm our findings.

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P

Glomalin-related soil protein (GRSP) is a potential byproduct of arbuscular mycorrhizal fungi (AMF) and a major contributor to the passive soil organic carbon (SOC) pool. Despite its crucial role in SOC storage, we know little about the response of GRSP to anthropogenic global change factors (GCFs). Here, using 530 observations from 107 primary studies, we conducted a global meta-analysis to unravel the effects of multiple GCFs (climate change, plant invasion (PI), wildfire, urbanization, land-use change (LUC), and nutrient addition (nitrogen; N, phosphorus; P, and potassium; K) on two functional GRSP fractions (easily extractable- (EE-) and total- (T-) GRSPs) in terrestrial ecosystems. We found that elevated carbon-dioxide increased T-GRSP by 28%, combined NP addition by 39.9%, and NPK addition by 29.5%. Climate warming and alone N addition increased EE-GRSP solely by 2.4% and 13.6%, respectively, but did not influence T-GRSP. However, urbanization and drought decreased T-GRSP by 26% and 15%, respectively. The LUC from natural ecosystems to cropland decreased T-GRSP by 40%, while afforestation in croplands increased it by 32%. Other GCFs (PI, wildfire, and P) had non-significant effects on GRSP probably because of (i) minor changes in AMF activity and (ii) the counterbalancing of effects by opposite processes. GCF impacts were robust when applied at higher intensities for medium-to-long durations (3–10＋ years) in humid conditions and clay-rich soils. The sandy soils experienced greater T-GRSP losses during LUC. Increases in T-GRSP were positively correlated with AMF-root colonization, soil mean-weight diameter, and SOC content. Further, our structure equation model confirmed that GCFs directly influence SOC by altering AMF-GRSP production and indirectly affecting soil aggregate formation and protection, suggesting that optimizing GRSP production can enhance SOC sequestration.

Background: Stroke survivors experience a wide range of physical, cognitive, and emotional challenges. In the MindFit Project, a randomized clinical trial, 141 chronic stroke patients were divided into three groups: mindfulness-based stress reduction (MBSR) with computerized cognitive training (CCT), physical exercise (PE) with CCT, and CCT alone. The interventions were conducted remotely over 12 weeks, including online group and individual sessions. Objective: This exploratory nested qualitative study aimed to investigate chronic stroke survivors’ experiences, opinions, and perceived changes due to the interventions within the MindFit Project. The secondary objective was to describe the broader experience of their recovery journey. Methods: Twenty-seven participants were recruited through purposive sampling and engaged in semi-structured one-on-one interviews. Twelve received MBSR+CCT, nine received PE+CCT, and six received CCT-only. The interviews were recorded, transcribed, and analyzed using thematic analysis. Results: Participants shared insights into their lives after stroke, including emotional and physical challenges, coping mechanisms, and the impact of societal perceptions. The interventions were generally positively valued, with MBSR aiding in emotional regulation, PE enhancing physical capabilities, and CCT improving cognition. The group setting provided valuable peer support and motivation, although some participants noted challenges owing to the heterogeneity. The telematic format was also appreciated for its accessibility, although it posed challenges to personal interaction and intervention supervision. Conclusions: Our study emphasizes the complexity of stroke recovery and the importance of holistic, patient-centered rehabilitation approaches. It also highlights the value of combining physical and non-physical interventions in a group setting, along with the potential of remote platforms to enhance the accessibility of rehabilitation programs. These findings generate hypotheses for future randomized clinical trials aimed at improving post-stroke recovery.

This study addresses a comparative comprehensive metabolic profiling of two Egyptian cultivars of fenugreek (Trigonella foenum-graecum L.) seeds ‘Giza 2’ and ‘Giza 30’ via RP-HPLC-DAD-QTOF-MS and MS/MS. Briefly, 126 metabolites were detected in the samples under investigation, being classified into hydroxybenzoic acids (8), hydroxycinnamic acids (7), flavonoids (49 with a predominancy of flavones in particular apigenin derivatives), coumarins (1), furostanol saponins (17), alkaloids (2), amino acids (11), peptides (2), jasmonates (6), nucleosides (30), organic acids (16), terpenoids (1), and sugars (3). In addition, the total phenolic content and antioxidant activity were determined and compared with other geographically related seeds (chickpea Giza-1, sesame Giza-32, and linseed, Giza-10), showing slight differences among them but higher values than the other geographically related seeds that were segregated from them upon chemometric analysis. This is the first comprehensive metabolic profiling of these cultivars, presenting an initial account of some metabolites found in Fabaceae, such as apigenin di C pentoside, with a significant occurrence of biologically active furostanol saponins. It gives a prospect of fenugreeks richness of bioactive metabolites as an essential functional food that could add value to the food and nutraceutical industries' sustainability.

The Ecosystem Services Approach (ESA) is an effective tool for evaluating humans-nature relationships, but publications on the use of ES to assess groundwater ecosystem services (GWES) are scarce. This work presents a practical example of how to apply the ESA to support groundwater dependent ecosystems (GDE) and aquifer management, using groundwater numerical modelling as assessment tool. It was performed in the NAIAD Horizon 2020 project to assess current status and potential future evolution of two GWES of the Medina del Campo Groundwater Body (Spain): the Provisioning Service Groundwater Used for Non-Drinking Purposes (APS_GUNDP), focusing on irrigation water supply, and the Regulating and Maintaining Service Regulation of Baseline Flows and Extreme Events (ARMS_RBFEE), focusing on GDE.The numerical modeling was done with MODFLOW 2005 and ModelMuse. The present-day status of APS-GUNDP was evaluated analyzing the piezometric trends from 1950 to 2018, while the ARMS_RBFEE was assessed comparing GDE areas in 2018 to those in 1956. The future evolution of both GWES until 2350 was predicted as piezometric level changes and flooded land surface under different precipitation and groundwater management scenarios.Intensive groundwater exploitation in the past led to drying GDE and boost different groundwater management measures. But natural conditions are not restored any scenario by year 2350, due to ongoing adjustment of the aquifer water balance. This work demonstrates how to use ESA to assess management actions to recover GWES.

This study delves into the evolutionary path of food and agricultural research and development organizations, aligning with the ambitious climate-change objectives outlined in the Paris Agreement. Our exploration revolves around advancing the triple goals of creating sustainable, low-emission food systems, enhancing nutrition, and ensuring food security. A pivotal consideration emerges from the recent United Nations Framework Convention on Climate Change's Conference of the Parties, where civil society advocacy gained momentum, emphasizing the need to seamlessly integrate food and nutrition security within climate-change mitigation initiatives. The objective of this study is therefore to examine how agriculture and food research organizations incorporate climate-change mitigation to address food security, health, and environmental sustainability challenges. In light of this, we undertook an examination of CGIAR's published articles, existing research initiatives, and a curated selection of innovations, with a focus on regional climate-change priorities. Our analysis not only underscores CGIAR's commitment to climate-change research, but also evaluates its contribution to reducing greenhouse gas emissions within food systems. Noteworthy is the discernible shift in CGIAR's research portfolio, reflecting a response to the escalating demand for environmental sustainability and an increased awareness of the interconnected nature of malnutrition and food security. While CGIAR has made significant strides in climate-change adaptation efforts, our analysis indicates an incomplete integration of food-systems perspectives for mitigating climate change. Our proposed approach advocates a comprehensive strategy that harmonizes adaptation and mitigation research, encourages cross-CGIAR collaboration through institutional changes, and underscores the importance of scaling innovations. This holistic endeavor highlights the type of research CGIAR is developing, seamlessly integrating the food-systems approach into the broader climate-change research agenda.

The convergence of Artificial Intelligence (AI) and mobile learning (mLearning) has revolutionized digital education, heralding a transformative paradigm shift in learning methodologies. AI-powered mLearning holds promise but requires deep understanding of pedagogical principles. Concerns over smartphone overuse have heightened discussions about mLearning integration. In this context, with the rising penetration of AI in various educational settings, it is crucial that research delves into the pedagogically sound integration of AI into mLearning environments. A systematic literature review of forty-two articles has yielded a framework summarizing mLearning attributes, functionalities, and their impact on transversal learning principles highlighting the profound impact of AI.

Robo advising is an emerging business model that aims to popularize investment advisory services by automating all the activities involved. The robo-advisor (RA) stream of research is relatively new, yet it has started to attract the attention of numerous scholars. This manuscript aims to analyze the academic literature on RA based on its impact on the different phases that make up the investment advice process. Our aim is to investigate which phases of the investment advice service prove of most interest to scholars. Since selecting relevant and precise keywords increases the visibility, accessibility, and indexing of a research paper, we explore the RA research landscape using keyword relational analysis. We analyze metadata from 195 identified papers combining the Scopus and Web of Science databases until May 2022. The analysis unfolds in two parts. First, we examine the relationships and associations of keywords in titles, abstracts, and author keywords to extract knowledge patterns from said associations. As a novelty, a specific dictionary of RA-synonyms formed by 19 disjoint families of concepts is obtained. The second part presents the RA's conceptual and relational structure. For this, five clusters are determined to identify and organize those studies dealing with similar topics. The results of our study suggest that research is more interested in aspects related to the human factor, namely, those with phases requiring more direct contact with the client or investor. The most relevant research interests include the automation of client profiling functions and client response to the latter automation.

Background: Severe cutaneous adverse reactions (SCAR) are a group of delayed presumed T-cell mediated hypersensitivities associated with significant morbidity and mortality. Despite their shared global healthcare burden and impact, the clinical phenotypes, genomic predisposition, drug causality, and treatment outcomes may vary. We describe the establishment and results from the first Australasian registry for SCAR (AUS-SCAR), that via a collaborative network advances strategies for the prevention, diagnosis and treatment of SCAR. Methods: Prospective multi-center registry of SCAR in Australian adult and adolescents, with planned regional expansion. The registry collects externally verified phenotypic data drug causality, therapeutics and long-term patient outcomes. In addition, biorepository specimens and DNA are collected at participating sites. Results: we report on the first 100 patients enrolled in the AUS-SCAR database. DRESS (50%) is the most predominant phenotype followed by SJS/TEN (39%) and AGEP (10%), with median age of 52 years old (IQR 37.5, 66) with 1:1 male-to-female ratio. The median latency for all implicated drugs is highly variable but similar for DRESS (median 15 days IQR 5,25) and SJS/TEN (median 21 days, IQR 7,27), while lowest for AGEP (median 2.5 days, IQR 1,8). Antibiotics (54.5%) are more commonly listed as primary implicated drug compare with non-antibiotics agent (45.5%). Mortality rate at 90 days was highest in SJS/TEN at 23.1%, followed by DRESS (4%) and AGEP (0%). Conclusion: In the first prospective national phenotypic and biorepository of SCAR in the southern hemisphere we demonstrate notable differences to other reported registries; including DRESS-predominant phenotype, varied antibiotic causality and low overall mortality rate. This study also highlights the lack of standardised preventative pharmacogenomic measures and in vitro/in vivo diagnostic strategies to ascertain drug causality. Trial registration: ANZCTR ACTRN12619000241134. Registered 19 February 2019.

In this work, we extend the Fourier transform Jones (FTJ) matrix approach to handle input scalar fields with spatially variant transverse profiles. Additionally, we integrate the FTJ matrix with the beam coherence-polarization (BCP) matrix, suitable for describing partially coherent and partially polarized light. This approach is particularly effective when the polarization diffractive optical element is illuminated with a quasi-monochromatic paraxial scalar field with transverse spatial coherence, but with any degree of polarization and transverse profile. We apply the method to a meaningful example: a rectangular aperture with orthogonal polarizers on each half, illuminated with uniform randomly polarized light. We provide experimental validation using a randomly polarized He-Ne laser and a specially fabricated double polarizer mask. Furthermore, by placing a polarizer behind the polarization diffractive optical element, we generate a scalar beam with spatial incoherence across two distinct zones, suggesting the potential use of randomly polarized lasers with binary patterned polarizers to encode arbitrary binary coherence functions.

The lack of effective treatments for dementia has led to explore the potential of antidiabetic agents as a possible approach. This cross-sectional and population-based study aimed to investigate the relationship between each antidiabetic drug and their defined daily doses (DDDs) and the use of anti-Alzheimer’s disease (AD) drugs in order to establish new possible hypotheses about the role of antidiabetic drugs in AD.For that purpose, a database containing information on medications prescribed to 233183 patients aged 50 years or older between 2018 and 2020 was used. DDDs were calculated according to the ATC/DDD index 2023. Statistical analyses, with logistic regression, were carried out to assess antidiabetic and anti-AD drugs consumption.A total of 91836 patients who were prescribed at least one antihypertensive, antidiabetic, or lipid-modifying agent were included in the study; specifically, 29260 patients were prescribed antidiabetic medication. Among the antidiabetic agents, glucagon–like peptide–1 analogs (GLP–1) DDDs were likely to have a positive association with anti-AD drugs in people aged between 70 and 80 years. Additionally, sodium–glucose cotransporter 2 inhibitors (SGLT2i) were prone to have a positive association with anti-AD drug usage across almost every age. However, insulin usage was associated with an increased usage of anti-AD agents.In conclusion, there is evidence suggesting a correlation between certain antidiabetic agents and dementia. Specifically, GLP-1 and SGLT2i might be associated with lower odds of anti-AD drugs usage, while insulins might be linked to higher odds of using anti-AD drugs.

Innovations in precision agriculture enhance complex tasks, reduce environmental impact, and increase food production and cost efficiency. One of the main challenges is ensuring rapid information availability for autonomous vehicles and standardizing processes across platforms to maximize interoperability. The lack of drone technology standardisation, communication barriers, high costs, and post-processing requirements sometimes hinder their widespread use in agriculture. This research introduces a standardized data fusion framework for creating real-time spatial variability maps using images from different Unmanned Aerial Vehicles (UAVs) for Site-Specific Crop Management (SSM). Two spatial interpolation methods were used (Inverse Distance Weight, IDW, and Triangulated Irregular Networks, TIN), selected for their computational efficiency and input flexibility. The proposed framework can use different UAV image sources and offers versatility, speed, and efficiency, consuming up to 98 % less time, energy, and computing requirements than standard photogrammetry techniques, providing rapid field information, allowing edge computing incorporation into the UAV data acquisition phase. Experiments conducted in Spain, Serbia, and Finland in 2022 under the H2020 FlexiGroBots project demonstrated a strong correlation between results from this method and those from standard photogrammetry techniques (up to r = 0.93). In addition, the correlation with Sentinel 2 satellite images was as strong as that obtained with photogrammetry-based orthomosaics (up to r = 0.8). The proposed approach could support irrigation leak detection, soil parameter estimation, weed management, and satellite integration for agriculture.

Background: Aging triggers intricate physiological changes, particularly in whole-body fat-free mass (FFM) and handgrip strength, affecting overall health and independence. Despite existing research, the broader significance of how muscle health is affected by the intricate interplay of lifestyle factors simultaneously during aging needs more exploration. This study aims to examine how nutrition, physical activity, and sleep impact on FFM and handgrip strength in middle-aged men and women, facilitating future personalized recommendations for preserving muscle health. Methods: The cross-sectional analysis of the UK Biobank involved 45,984 individuals (54 % women) aged 40–70 years with a complete dataset. Multiple linear regression explored determinants of FFM and handgrip strength, considering traditional, socio-demographics, medication use and smoking as covariates, with sex and age (younger and older than 55 years) stratifications. Results: In older men and women, higher physical activity beneficially affect both FFM (respectively Β = 3.36 × 10−3, p-value = 1.66 × 10−3; Β = 2.52 × 10−3, p-value = 3.57 × 10−4) and handgrip strength (Β = 6.05 × 10−3, p-value = 7.99 × 10−5, Β = 8.98 × 10−3, p-value = 2.95 × 10−15). Similar results were found in fiber intake for FFM in older men and women (respectively B = 3.00 × 10−2, p-value = 2.76 × 10−5; B = 2.68 × 10−2, p-value = 1.78 × 10−9) and handgrip strength (Β = 3.27 × 10−2, p-value = 1.40 × 10−3; Β = 3.12 × 10−2, p-value = 1.34 × 10−5). Other lifestyle factors influence FFM and handgrip strength differently. Key determinants influencing handgrip strength included higher protein intake, lower water intake, higher alcohol intake, and extended sleep duration whereas mainly higher water intake is associated with higher FFM. Conclusions: In both men and women, the main factors associated with FFM and handgrip strength are physical activity and fiber intake, which may underlie a connection between gut and muscle health. Given the observed complexity of muscle health in the age and sex strata, further longitudinal research is needed to provide personalized lifestyle recommendations.

Academic English is discipline-specific and requires a high level of linguistic knowledge as well as expertise in respective fields. Therefore, doctoral students with limited exposure to academic English tend to face challenges in dealing with its demands, especially when they come from non-native English-speaking (NNES) backgrounds. At the doctoral level, research students are expected to work independently. Therefore, the ability to critically engage with academic materials written in English and the ability to write a dissertation in English at an expected standard play essential roles in successful PhD completion for students studying in international PhD programs where everything is conducted in English. This study investigates the relationship between English academic reading (EAR) and English academic writing (EAW) abilities among NNES doctoral students. We conducted a survey by employing a 1–6 Likert scale, following Dörnyei and Dewaele (2022), in the 2021–2022 academic year. A total of 255 international doctoral students studying in 65 PhD programs across Hungary voluntarily participated in the study. The students came from 49 countries and represented 48 mother tongues. The analysis revealed that students were positive about their abilities in both EAR and EAW, even though there was a significant gender difference at the p