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Aims: To analyse nutrition-related knowledge and its determinants in middle-aged and older patients with T2D.Methods: In a cross sectional study, a total of 116 participants with T2D, aged 50-80 years, were recruited in primary health care. Data was collected by a self-reported questionnaire - the modified version of General Nutrition Knowledge Questionnaire (0-56 points). Sociodemographic data was also collected: gender, age, personal monthly income, living situation, education level, and marital status. One-way analysis of variance (ANOVA) was performed to assess differences in nutrition-related knowledge score among the different levels of sociodemographic characteristics.Results: Questions on general dietary recommendations, dietary behaviors to reduce cardiovascular disease and cancer are the items with higher proportion of correct answers. On the other hand, health problems related with lower intake of fruit, vegetables and fiber and knowledge about antioxidants vitamins presented the lower proportion of correct answers. Higher scores were found among those with lower age, higher personal monthly income, and higher education.Conclusions: Middle-aged and older patients with T2D showed alarming deficits on nutrition-related knowledge. Age, personal monthly income, and education level were observed as major determinants of nutrition-related knowledge.Trial Registration: NCT02631902. [ABSTRACT FROM AUTHOR]

Violence against women is a profound global injustice. It is a major obstacle to fulfilling the human rights of women and their children. Confined to their aggressors, women exposed to this violence have even greater difficulty in accessing support networks and care services. Furthermore, the economic impact of the pandemic, which disproportionately affected women, created additional barriers. In reality, however, femicide is forgotten, underestimated, and poorly prosecuted throughout the world. In this context, more than 100 children witnessed a murder or were at home when it took place. This form of indirect violence is vicarious , in which children are left out, anonymous, and invisible. The trauma generated potentiates mentalization difficulties, emotional dependence, and instability in future relationships, caused by pain and psychological suffering. • Femicide is forgotten, underestimated, and poorly prosecuted around the world. • 80% of mothers in domestic homicides were killed by a current or previous partner. • In at least 19 cases, femicide was followed by suicide, leaving the child/children orphan(s). • Femicide is avicarious, in which children are left out, anonymous, and invisible. [ABSTRACT FROM AUTHOR]

More than 2.3 million children under the age of five in Yemen suffer from acute malnutrition. Approximately 450,000 are expected to suffer from severe acute malnutrition and may die if they do not receive urgent treatment. In this context, without security, stability, and better access for farmers to have the means to resume growing food, children and their families continue to sink deeper and deeper into hunger and malnutrition. As a result, malnourished children are more vulnerable to illnesses, including diarrhea, respiratory infections, and malaria, which are a major concern in Yemen. This situation is a vicious and often deadly cycle. • Around 370,000 children in Yemen suffer from severe malnutrition in Yemen. • 9.9 million children need some form of nutritional assistance in Yemen's 22 provinces are on the brink of hunger. • Chronic malnutrition rates (short stature and underweight) are more prevalent in the mountainous regions of the country. [ABSTRACT FROM AUTHOR]

More than 2.3 million children under the age of five in Yemen suffer from acute malnutrition. Approximately 450,000 are expected to suffer from severe acute malnutrition and may die if they do not receive urgent treatment. In this context, without security, stability, and better access for farmers to have the means to resume growing food, children and their families continue to sink deeper and deeper into hunger and malnutrition. • Around 370,000 children in Yemen suffer from severe malnutrition in Yemen. • 9.9 million children need some form of nutritional assistance in Yemen's 22 provinces are on the brink of hunger. • Chronic malnutrition rates (short stature and underweight) are more prevalent in the mountainous regions of the country. [ABSTRACT FROM AUTHOR]

Abstract: Conditions that facilitate epilepsy, such as sleep deprivation or the cholinergic muscarinic agonist pilocarpine (PILO), have been experimentally studied, as they are relevant for brain excitability control and could help in understanding the development of epilepsy in humans. In this work, following to 72h deprivation (D) of sleep by the water tank technique, adult Wistar rats were anesthetized with a 1g/kg urethane+40mg/kg chloralose mixture and cortical spreading depression (CSD) was recorded for a 1–2h period in the parietal surface. CSD propagation velocity was calculated based on the time spent for a CSD-wave to pass the interelectrode distance. After this “baseline” recording, D-animals were divided in three groups and respectively injected with 45, 95 and 190mg/kg of PILO, i.p., and the CSD recording continued for two more hours. Three groups of non-deprived (ND) rats were also injected with the three doses of PILO and studied regarding CSD features. D-animals presented higher baseline CSD velocities than the corresponding ND-controls, confirming previous observations that D-condition facilitates CSD propagation. After PILO, the ECoG amplitudes were markedly and lastingly reduced in all animals, at the three doses used. In the groups treated with 95 and 190mg/kg PILO, the CSD velocity of propagation significantly (P <0.05) decreased, and the incidence of PILO-associated CSD-propagation failure increased in the D rats, but not in the ND rats, as compared with the pre-drug values. The data suggest the existence of one or more cholinergic, muscarinic-mediated antagonistic processes influencing CSD, which are dose-dependent and are modulated by sleep-deprivation. [Copyright &y& Elsevier]

Abstract: Refractory disease (RD) definition has different meanings but it is dynamic, according to knowledge and the availability of new drugs. It should be differentiated from severe disease and damage definitions and it must take into account duration of adequate therapy and compliance of the patient. It can be related to inadequate or inefficacious treatment or to pathogenesis. RD definition has multiple implications to clinical guidelines and to the use of off-label drugs. It should not be regarded as lost cases and prospective studies, registries and clinical trials should be planned. [Copyright &y& Elsevier]

Systemic sclerosis (SSc) is a chronic multi-system autoimmune disease associated with disability and reduced quality of life. There is no effective treatment or cure to SSc, so it is important improve global health of these patients and reduce morbidity and mortality associated with SSc. It was made a literature review about quality of life in patients with SSc, regarding the several factors that should be considered and evaluated when attending to SSc patients. It was also considered the validated scales and questionnaires used to measure outcomes in patients with SSc. We concluded that it is important to have an interdisciplinary approach to SSc patients considering the patient's cognitive representations of the disease and what they value most like mobility and hand function, pain, fatigue, sleep, depression and body image. [ABSTRACT FROM AUTHOR]

Abstract: There is no definition or guidelines for refractory disease (RD) in Systemic Lupus Erythematosus (SLE). However, new therapies have been tested mainly in refractory patients. The concept, like the disease, is complex and implies deeper knowledge on the disease pathogenesis and patients'' subsets. RD is not included in current activity indices of the disease, what raises the question of how are we monitoring its response to new drugs. In this paper, we analyse some concepts considered important for the global definition of RD in SLE and in some specific organ involvements, excluding lupus nephritis. Management issues will be addressed also. Finally, we review therapeutic options in particular subsets of the disease, namely, cutaneous, articular, haematological and neuropsychiatric lupus. Crucial to the management of a patient suspected to be refractory is an accurate diagnosis, assuring that the persistent clinical manifestations are derived primarily from SLE and not from a concomitant or alternative process. Likewise, certainty about the patient compliance with the therapy prescribed is a frequent unrecognized problem that erroneously might lead to a classification of RD. Therapy of RD for SLE, in general and in most particular involvements, is currently based mainly on the clinician''s own experience and judgement, with few randomized trials effectively addressing the issue. In such a heterogeneous disease, consideration of approval of drugs for single-organ indications may pave the way for new therapies. Better biomarkers are needed to add accuracy to the currently used activity indices in order to monitor RD and consolidate its definition. Prospective studies directed to RD in the main SLE involvements are needed to improve our understanding on the management of the disease and foster the development of targeted new drugs. [Copyright &y& Elsevier]

Abstract: Ethnopharmacological relevance: Cassia occidentalis L. (syn. Senna occidentalis; Leguminosae) has been used as natural medicine in rainforests and tropical regions as laxative, analgesic, febrifuge, diuretic, hepatoprotective, vermifuge and colagogo. Herein, we performed a pre-clinical safety evaluation of hydroalcoholic extract of Cassia occidentalis stem and leaf in male and female Wistar rats. Materials and methods: In acute toxicity tests, four groups of rats (n =5/group/sex) were orally treated with doses of 0.625, 1.25, 2.5 and 5.0g/kg and general behavior, adverse effects and mortality were recorded for up to 14 days. In subacute toxicity assays, animals received Cassia occidentalis by gavage at the doses of 0.10, 0.50 or 2.5g/kg/day (n =10/group/sex) for 30 days and biochemical, hematological and morphological parameters were determined. Results: Cassia occidentalis did not produce any hazardous symptoms or death in the acute toxicity test, showing a LD50 higher than 5g/kg. Subacute treatment with Cassia occidentalis failed to change body weight gain, food and water consumption and hematological and biochemical profiles. In addition, no changes in macroscopical and microscopical aspect of organs were observed in the animals. Conclusions: Our results showed that acute or subacute administration of Cassia occidentalis is not toxic in male and female Wistar rats, suggesting a safety use by humans. [Copyright &y& Elsevier]

This study aimed to test the effects of an IVM SPOM adaptation (SPOM-adapted IVM) on the production, total number of cells (TNC), apoptosis, and cryotolerance (post-warming survival and cytoskeleton actin integrity) of bovine IVP embryos. Two experiments were conducted with two experimental groups based on IVM treatment: A control group (TCM 199 without FCS) and an SPOM-adapted group (TCM 199 with forskolin and IBMX in pre-IVM and IVM with cilostamide). The first experiment evaluated embryo in vitro production, TNC, and apoptosis rate on D9 of development. In the second experiment, embryos were vitrified/warmed at D7 (control fresh and vitrified; SPOM-adapted fresh and vitrified) and assessed regarding post-warming survival rates and cytoskeleton actin integrity. Statistical analysis was performed using GraphPad INSTAT software at a significance level of 5%. An increase (p < 0.05) in blastocyst production was observed in the SPOM-adapted group comparing to the control group. There was no difference (p > 0.05) in the TNC or apoptosis rate between the groups. Regarding cryopreservation, no differences were found (p > 0.05) in actin integrity or post-warming survival rates between the vitrified groups. In both vitrified groups, we observed a significantly lower uninjured pattern of actin integrity compared to the fresh groups (p < 0.05). We conclude that the SPOM-adapted IVM system is beneficial for blastocyst production and does not affect the quality and cryotolerance of the produced embryos. • We reduced the IVM SPOM system's duration from 28 to 24 h (SPOM-adapted). • The SPOM-adapted improves embryo production. • The SPOM-adapted does not influence embryo quality parameters. • The SPOM-adapted does not affect embryo cryotolerance parameters. [ABSTRACT FROM AUTHOR]

• Exposure to heat stress reduces rumination time in dry dairy cows • Peak rumination time reduced more drastically by heat stress in the afternoon • Heat stress impaired ruminal degradability of silage, concentrate and diet The objective of this study was to evaluate the effects of heat stress (HS) on: i) time and daily pattern of rumination and ii) in situ degradability in Holstein-Gyr crossbred dry cows. Nine cows, weighing 556.2 ± 97.1 kg were housed in a climate chamber (average THI=83.1) or a freestall barn (average THI=66.5) randomly assigned to treatments in a crossover design. Cows were fed corn silage ad libitum and 1 kg of concentrate as a maintenance diet. To measure rumination, we used a sensor attached to a collar. The in situ ruminal degradability was evaluated by incubation of concentrate, silage, and diet samples into the rumen of a fistulated cow for 6, 24, 48 and 96 h. The RT was affected by HS (P<0.001) and time of the day (P<0.001). The rumination pattern for control and HS cows had a first peak at approximately 04:00h and the magnitude of this peak in HS was 22.9% less than controls. The second RT peak occurred in the evening (~20:00h), when RT in HS was 27.8% less compared with controls. We observed a reduction in dry matter digestibility (DMD) of concentrate (85.1% vs 77.8%, control and HS, respectively; P<0,05) and also in the slow-degradable fraction of concentrate (93.9% vs 85.1%, respectively; P<0,05). Finally, DMD of the diet reduced from 73% to 70% for animals exposed to HS compared to controls. In conclusion, HS negatively affected e rumination time and in situ ruminal degradability in dry dairy cows. [ABSTRACT FROM AUTHOR]

Introduction The association of myasthenia gravis (MG) and inflammatory myopathy is rare and often only one of the diseases is diagnosed. Thymus pathology may be in the origin of such disease association. Methods We described four patients with both MG and inflammatory myopathy. Results These cases correspond to 2.3% of our MG cohort. Case 1: MG, polymyositis and thymolipoma; case 2: MG and necrotizing myopathy without thymic pathology on a background of scleroderma, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia (CREST); case 3: MG and dermatomyositis without thymic pathology; case 4: MG and dermatomyositis with type C thymoma. Discussion The recognition of these neuromuscular co-morbidities contributes to (i) understanding their pathogenic mechanisms, (ii) developing better management approaches and (iii) further improving disease outcomes. [ABSTRACT FROM AUTHOR]

Infections are considered an environmental trigger for exacerbations of immune-mediated diseases. We aimed to establish if common viral infections could be identified as a precipitant of Behçet disease (BD) with or without neurological involvement and to assess the variability of the immune response to common viruses. We also investigated whether cytokines and chemokines could be markers of neurological involvement. Finally, we explored if anti-basal ganglia antibodies (ABGAs) would be associated with neurological involvement in BD. Our study included 14 individuals with BD with neurological involvement (neuroBehçet syndrome — NBS), 16 individuals with BD without neurological involvement and 18 healthy controls (HC). Overall we found a tendency for increased levels of anti-viral IgG antibody levels in BD, more evident in NBS patients versus HC. Epstein–Barr viral-capsid antigen IgG titres were increased in NBS patients versus other BD patients (p = 0.032). Anti-measles antibody titres induced by vaccination were similarly elevated. ABGAs were not detected in the serum of our cohort. Raised levels of serum IL-8 in some BD patients did not reflect clinical activity or severity. In conclusion, there was evidence for a polyclonal immune activation rather than a specific virus effect in the sera of individuals with BD or NBS. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disorder that affects women at childbearing age. During pregnancy, maternal immune system is challenged to tolerate a semi-allogenic fetus and a shift toward a tolerogenic profile is essential. Failure to develop this tolerogenic profile seems to be associated with the development of adverse obstetric outcomes. We conducted a prospective longitudinal observational study where peripheral blood lymphocyte subsets were analyzed during pregnancy in a group of SLE patients and compared with healthy gestations. We observed a reduction in peripheric Treg cell count throughout all pregnancy in control patients, which was not observed in SLE patients. In contrast, the Th17 cell count remained stable in both groups. In the control group, the Treg/Th17 ratio decreased throughout pregnancy to the postpartum, which was not observed in the study group. These changes may be justified by the migration of the immunotolerant Treg cells to the maternal decidua and may lead to the establishment of a pro-inflammatory profile by the end of pregnancy in healthy pregnancies, which was not observed in the SLE pregnant patients. This pro-inflammatory state at the end of a healthy pregnancy may be necessary for the spontaneous beginning of labor and help to explain why systemic syndromes like preeclampsia develop during the second half of pregnancy. The lack of these findings in SLE patients may express a pro-inflammatory state from the beginning of pregnancy, the influence of immunomodulatory medication or an intrinsic deregulation of immune function, which is a characteristic of these patients. • First study evaluating Treg cells and Th17 cells during gestation in lupus patients. • Circulating Treg cells decreases steadily during pregnancy in healthy pregnancies. • In lupus patients these findings were not observed. • The Th17 cells count did not differ between groups during gestation. • The Treg/Th17 ratio decreases in the healthy pregnant group. • The Treg/Th17 ratio increases in the group of lupus patients. [ABSTRACT FROM AUTHOR]

Abstract: The 'Task Force on Catastrophic Antiphospholipid Syndrome (CAPS)' was developed on the occasion of the 14th International Congress on Antiphospholipid Antibodies. The objectives of this Task Force were to assess the current knowledge on pathogenesis, clinical and laboratory features, diagnosis and classification, precipitating factors and treatment of this condition in order to address recommendations for future research. This article summarizes the studies analyzed by the Task Force, its recommendations and the future research agenda. [Copyright &y& Elsevier]

Abstract: Systemic sclerosis or scleroderma (SSc) is an heterogeneous disease involving the connective tissue and the microvasculature with fibrosis and vascular occlusion. It is difficult to define refractory SSc once it is itself a paradigm of a refractory condition: there is no evidence of when to act to stop the progression to fibrosis and irreversible microvascular damage. There is no definition of refractory disease in SSc and to propose a definition we used mainly the Medsger severity index and the EULAR 2009 treatment recommendations from the skin to the heart through peripheral vascular, musculoskeletal, gastrointestinal, renal, pulmonary hypertension and interstitial lung disease. We used some clinical setting reflecting the different reasoning when there is probable refractory disease and finally we briefly pointed out some available treatment options to refractory disease. With this reflection, we would like to open paths to a broader discussion. [Copyright &y& Elsevier]

Abstract: The objective was to characterize vaginal bacteria in ewes with vaginitis. Intravaginal sponges impregnated with medroxyprogesterone were used to synchronize estrus in 22 multiparous Santa Inês ewes. At sponge removal (6 days later), all ewes had clinical signs of vaginitis. Purulent vaginal secretions were subjected to standard bacteriological procedures, including determining whether isolates were susceptible to trimethoprim-sulfamethoxazole, gentamicin, cefalotin, tetracycline, ciprofloxacin, nitrofurantoin, ampicillin, penicillin G, and amoxicillin. The majority of the isolates were coliforms (72.7% Escherichia coli and 18.2% Klebsiella pneumoniae), whereas the remainder were Staphylococcus aureus. Antimicrobial resistance was common, with all isolates resistant to at least one compound. Ciprofloxacin and trimethoprim-sulfamethoxazole were the most effective (100% susceptibility), whereas penicillins (including broad-spectrum penicillins), were the least effective (80–100% resistance). In conclusion, pathogenic bacteria, mainly coliforms, were present in association with vaginitis in ewes given intravaginal sponges; all isolates were susceptibile to at least some antimicrobials. [Copyright &y& Elsevier]

Abstract: The impact on fetal outcome in women with autoimmune diseases is a result of a several conditions. Fetal success depends on early immunological changes in the mother, which rely in modifications of the innate and adaptative immune system, inducing tolerance to the semi-allogenic fetus. Others crucial factors are maternal disease activity, severity of organ damage, circulating antibodies, and drug treatment. Although fetal outcome is becoming better still it has a worse prognosis in comparison with healthy women. Diseases like antiphospholipid syndrome, systemic lupus erythematosus and vasculitis have the higher risk while rheumatoid arthritis and spondiloarthopaties the least. In the majority of the diseases the risk of poor fetal outcome directly correlates with the activity of disease. While there are no pathognomonic autoantibodies for fetal outcome, antiphospholipid and anti-thyroid antibodies have been implicated in unsuccessful pregnancies and anti-Ro and, to a lesser extent, anti-La antibodies may result in neonatal lupus syndrome congenital heart block. There is increasingly the hope that fetal outcome will be good if the disease is well controlled prior to pregnancy, and with a specialized interdisciplinary support. [Copyright &y& Elsevier]