Search

Abstract Background The analytical rubric serves as a permanent reference for guidelines on clinical performance for undergraduate dental students. This study aims to assess the rubric system used to evaluate clinical class II composite restorations performed by undergraduate dental students and to explore the impact of gender on overall student performance across two academic years. Additionally, we investigated the relationship between cumulative grade point averages (CGPAs) and students’ clinical performance. Methods An analytical rubric for the assessment of clinical class II composite restoration in the academic years of 2022/2023 and 2023/2024 was used by two evaluators. These two evaluators were trained to use the rubric before doing the evaluations. The scores were based on a 4-point scale for the evaluation of five major parameters for pre-operative procedures (10 points), cavity preparation (20 points), restoration procedures (20 points), and time management (4 points). At the same time, chairside oral exam parameter was 15 points based on a 5-point scale. Descriptive statistics were calculated for the different analytical rubric parameters, and the independent t-test was used to compare the scores between the student groups and the evaluators. Other tests, such as the Kappa test and Pearson’s correlation coefficient, were used to measure the association among CGPA, evaluators, and gender participants. Results The overall score out of 69 slightly increased for females/males (61.28/59.42) and (61.18/59.49) in the 2022/2023 and 2023/2024 academic years, respectively, but the differences were not statistically significant. In the 2022/2023 academic year, female students scored significantly higher than male students in pre-operative procedures, as evaluated by both evaluators (p = 0.001), and in time management, as assessed by both evaluators (p = 0.031). The Kappa test demonstrated a moderate to substantial level of agreement between the two evaluators in both academic years. Strong and significant correlations were noted between students’ CGPA and some tested parameters (p = 0.000). Conclusion The overall performance was very good and high among both genders, but it was marginally higher among females than among males. This study found some differences in performance between male and female students and variability in the evaluations by the two raters ranging from moderate to substantial agreement and similar performances for students with different CGPA.

Background/Objectives: Limited research has been performed to assess the strength of resin-bonded 3D-printed restorations. Based on that, this study investigates the impact of different manufacturing methods on the fracture load of indirect composite restorations (ICRs) following an aging process. Methods: Three manufacturing techniques—conventional (CRC), milled (MRC), and printed (PRC)—were evaluated using 60 specimens, each with a diameter of 10 mm and a thickness of 1.0 mm. Sandblasting with Al2O3 particles was employed to optimize the bonding process, significantly influencing surface roughness parameters (Ra, Rz, RSm). All specimens were bonded to the dentin analog using composite resin cement and subjected to either 10,000 thermocycles (TC) or storage (ST) at 37 °C in distilled water. Fracture load assessments were performed using a universal testing machine. A finite element analysis was conducted to assess stress distribution. Results: Two-way ANOVA results indicated that the manufacturing method significantly affected mean fracture load values (p < 0.001), with PRC showing the highest mean fracture load (4185 ± 914 N), followed by MRC (2495 ± 941 N) and CRC (599 ± 292 N). The aging protocol did not have a significant impact on fracture load. Conclusions: This study revealed that 3D-printed resin composite exhibited comparable strength to milled resin composite when adhesively cemented, suggesting it is a promising option for indirect composite restorations based on its mechanical performance. However, further research is needed to evaluate its bond strength and optimal surface treatment methods to prevent early debonding.

Abstract Background Surgical site infection (SSI) is an important cause of disease burden and healthcare costs. Fully manual surveillance is time-consuming and prone to subjectivity and inter-individual variability, which can be partly overcome by semi-automated surveillance. Algorithms used in orthopaedic SSI semi-automated surveillance have reported high sensitivity and important workload reduction. This study aimed to design and validate different algorithms to identify patients at high risk of SSI after hip or knee arthroplasty. Methods Retrospective data from manual SSI surveillance between May 2015 and December 2017 were used as gold standard for validation. Knee and hip arthroplasty were included, patients were followed up for 90 days and European Centre for Disease Prevention and Control SSI classification was applied. Electronic health records data was used to generate different algorithms, considering combinations of the following variables: ≥1 positive culture, ≥ 3 microbiological requests, antimicrobial therapy ≥ 7 days, length of hospital stay ≥ 14 days, orthopaedics readmission, orthopaedics surgery and emergency department attendance. Sensitivity, specificity, negative and predictive value, and workload reduction were calculated. Results In total 1631 surgical procedures were included, of which 67.5% (n = 1101) in women; patients’ median age was 69 years (IQR 62 to 77) and median Charlson index 2 (IQR 1 to 3). Most surgeries were elective (92.5%; n = 1508) and half were hip arthroplasty (52.8%; n = 861). SSI incidence was 3.8% (n = 62), of which 64.5% were deep or organ/space infections. Positive culture was the single variable with highest sensitivity (64.5%), followed by orthopaedic reintervention (59.7%). Twenty-four algorithms presented 90.3% sensitivity for all SSI types and 100% for deep and organ/space SSI. Workload reduction ranged from 59.7 to 67.7%. The algorithm including ≥ 3 microbiological requests, length of hospital stay ≥ 14 days and emergency department attendance, was one of the best options in terms of sensitivity, workload reduction and feasibility for implementation. Conclusions Different algorithms with high sensitivity to detect all types of SSI can be used in real life, tailored to clinical practice and data availability. Emergency department attendance can be an important variable to identify superficial SSI in semi-automated surveillance.

Background The present in vitro study aimed to evaluate the fatigue behavior of teeth filled with a calcium silicate-based sealer (Bio-C Sealer, BC) or an epoxy resin-based sealer (AH Plus, AH), in bulk or associated with gutta-percha as main core material. Methods Seventy-two sound human maxillary anterior teeth were initially selected. Sixty of them, were randomly chosen, and had their root canals prepared using nickel-titanium reciprocating instruments, being again randomly assigned to five experimental groups (n = 12): C+ (control + prepared but not filled); BC-B (BC in bulk); BC-GP (BC+ gutta-percha); AP-B (AH in bulk); AP-GP (AH+ gutta-percha). An additional negative control group (C−) was considered (n = 12), consisting only on sound teeth, without preparation and filling. The specimens were submitted to a survival analysis after the cyclic fatigue test. Results Sound teeth (C−) presented the best fatigue performance (P < 0.05), being similar only to the AP-GP group (P > 0.05). Despite that, all experimental groups showed similar fatigue behavior (P > 0.05) to C+ (BC-B = BC-GP = AP-B = AP-GP = C+). Based on that, it can be seen that the use of gutta-percha, as a main core material, associated with the AH Plus sealer, reestablished the mechanical fatigue performance of endodontically treated teeth comparable to sound teeth, still consisting on the most promising approach to rehabilitate such scenario. Teeth filled in bulk, had discreetly higher risk of premature failures and inferior fatigue performance.

Abstract Background Infections increase mortality and morbidity and often limit immunosuppressive treatment in rheumatoid arthritis patients. Objective To analyze the occurrence of serious infections and the associated factors in a cohort of rheumatoid arthritis patients under real-life conditions. Methods We analyzed data from the REAL, a prospective observational study, that evaluated Brazilian RA patients, with clinical and laboratory data collected over a year. Univariate and multivariate analyses were performed from the adjustment of the logistic regression model Generalized Estimating Equations (GEE), with the primary outcome being the occurrence of serious infection, defined as need for hospitalization or use of intravenous antibiotics for its treatment. Results 841 patients were included with an average follow-up time of 11.2 months (SD 2.4). Eighty-nine serious infections occurred, corresponding to 13 infections per 100 patient-years. Pulmonary fibrosis, chronic kidney disease (CKD) and central nervous system disease increased the chances of serious infection by 3.2 times (95% CI: 1.5–6.9), 3.6 times (95% CI: 1.2–10.4) and 2.4 times (95% CI: 1.2–5.0), respectively. The use of corticosteroids in moderate doses increased the chances by 5.4 times (95% CI: 2.3–12.4), and for each increase of 1 unit in the health assessment questionnaire (HAQ), the chance increased 60% (95% CI: 20–120%). Conclusion The use of corticosteroids at moderate doses increased the risk of serious infection in RA patients. Reduced functionality assessed by the HAQ and comorbidities were other important factors associated with serious infection in this cohort.

Toll-like receptors (TLRs) play a key role in the response of innate and adaptive immune system to microbial and endogenous ligands. Inflammation is a common feature in end-stage renal disease (ESRD) patients; however, the mechanisms/factors triggering the inflammatory process are still poorly clarified. Our aim was to analyze the impact of the c.-1486T>C and c.896A>G polymorphisms in TLR9 and TLR4 genes, respectively, on the inflammatory response of ESRD patients. Clinical and laboratory evaluation was carried out on 184 ESRD patients. Polymerase chain reaction followed by restriction fragmens length polymorphisms (PCR-RFLP) was employed for genotyping of TLR-4 c.896A>G and TLR-9 c.-1486T>C polymorphisms. The prevalence of AA and AG of TLR4 c.896A>G polymorphism in ESRD patients was 97.8% and 2.2%, respectively. None of the individuals showed a homozygous TLR4 polymorphism. Concerning the TLR9 c.-1486T>C polymorphism, we found that ESRD patients showed a prevalence of TC and CC genotypes of 57.1% and 20.6%, respectively. We found that the heterozygous patients for the TLR4 c.896A>G polymorphism presented an increased level in lymphocyte count, a decrease in neutrophil/lymphocyte ratio and in serum levels of hepcidin. Regarding the TLR9 c.-1486T>C polymorphism, we found that it is associated with decreased white blood cell and neutrophil counts, ferritin and CRP serum levels, and with an increase in serum levels of creatinine. Our data suggest that the presence of the studied polymorphisms is associated with a decreased inflammatory response in ESRD patients under hemodialysis, and, thus its presence might have beneficial effects in ESRD patients. Moreover, our data provide new insights in the role of TLR polymorphisms in renal disease, which might have impact in the near future for the development of innovative therapies.

A pandemia da Covid-19 impôs restrições das mais variadas à humanidade, incluindo a suspensão de visitas e acompanhantes aos pacientes hospitalizados. Frente a isso, muitos hospitais implantaram as chamadas visitas virtuais. Esta pesquisa teve como objetivo analisar as percepções de familiares de pacientes internados sobre as visitas virtuais (VV) realizadas em ambiente hospitalar durante a pandemia da Covid-19. De natureza qualitativa, procedeu-se à entrevista de nove familiares de pacientes que ficaram internados durante a pandemia. Os dados foram submetidos à análise lexical por meio do software IRAMUTEQ, resultando em cinco classes. Na percepção dos participantes, a suspensão das visitas e da presença de acompanhantes intensificava o sofrimento de pacientes e familiares. Apesar do reconhecimento por parte dos participantes da importância do isolamento como forma de se mitigar o contágio e avanço da pandemia, o preço afetivo e emocional advindos disto foi alto para todos os envolvidos. Os resultados indicam que as visitas virtuais foram um importante fator de promoção de alívio emocional para familiares e pacientes por favorecer a comunicação e contato direto, possibilitando a emergência de sentimentos positivos e a redução do sofrimento mental e estresse. Considera-se que seus impactos podem diminuir as chances de luto complicado. Conclui-se que as VV se apresentam como uma modalidade de cuidado psicológico eficiente na medida em que promovem a emergência de sentimentos positivos como esperança, gratidão e calma. Tais sentimentos sinalizam a redução do sofrimento mental e estresse, alcançando um dos principais objetivos da psicologia hospitalar.

Organogels are semi-solid pharmaceutical forms whose dispersing phase is an organic liquid, for example, an oil, such as acai oil, immobilized by a three-dimensional network formed by the gelling agent. Organogels are being highlighted as innovative release systems for cosmetic active ingredients such as hyaluronic acid for topical applications. Acai oil was evaluated for its physicochemical parameters, fatty acid composition, lipid quality index, spectroscopic pattern (Attenuated total reflectance Fourier Transform Infrared Spectroscopy), thermal behavior, total phenolic, total flavonoids, and total carotenoids and β-carotene content. The effectiveness of the organogel incorporated with hyaluronic acid (OG + HA) was evaluated through ex vivo permeation and skin retention tests, in vitro tests by Attenuated total reflectance Fourier Transform Infrared Spectroscopy and Differential Scanning Calorimetry. The physicochemical analyses highlighted that the acai oil exhibited quality standards in agreement with the regulatory bodies. Acai oil also showed high antioxidant capacity, which was correlated with the identified bioactive compounds. The cytotoxicity tests demonstrated that the formulation OG + HA does not release toxic substances into the biological environment that could impede cell growth, adhesion, and efficacy. In vitro and ex vivo analyses demonstrated that after 6 h of application, OG + HA presented a high level of hydration, thermal protection and release of HA. Thus, it can be concluded that the OG + HA formulation has the potential for physical–chemical applications, antioxidant quality, and potentially promising efficacy for application in the cosmetic areas.

ABSTRACT Objective: The current study aimed to translate the Hammersmith Infant Neurological Examination (HINE) into Brazilian Portuguese and analyze the reliability of the translated version for a population of Brazilian infants. Methods: This was a methodological study, approved by the Ethics Committee, carried out between June 2020 and May 2021. HINE is a standardized clinical neurological examination used for the early detection of cerebral palsy. The quantitative section, “neurological examination”, contains 26 items scored from 0 to 3 points, divided into five categories: cranial nerve function, posture, movements, muscle tone and reflexes, and reactions. The HINE translation followed four steps: translation, synthesis, back-translation, and evaluation by an expert committee. To verify the reliability of the HINE-Br (Portuguese-Brazil version) two independent examiners evaluated 43 infants, between 3 and 22 months of age. Internal consistency was verified by Cronbach’s Alpha coefficient and interrater reliability by the intraclass correlation coefficient (ICC). Results: The translated version was similar to the original version and a few semantic and idiomatic adjustments were necessary. Appropriate internal consistency (Alpha=0.91) was found for the 26 items of the HINE-Br, as well as strong interrater reliability for the total score (ICC2.1=0.95), and also for the five categories (ICC2.1=0.83–0.95). Conclusions: The HINE-Br presents adequate rates of internal consistency and interrater reliability, and can be used for the evaluation of children at risk for cerebral palsy, between 3 and 24 months of age, by pediatricians and pediatric physical therapists.

Abstract Introduction Although Rheumatoid Arthritis (RA) extra-articular manifestations (ExtRA) occurrence has been decreasing over time, they are still a major mortality risk factor for patients. Objective To determine the prevalence of ExtRA in a large cohort, and its association with demographic and clinical variables. Method Cross-sectional and observational study, based on a multi-centric database from a prospective cohort, in which 11 public rheumatology centres enrolled RA patients (1987 ARA or 2010 ACR-EULAR). Data collection began in 08-2015, using a single online electronic medical record. Continuous variables were compared using Mann–Whitney U-test, and Fisher’s exact test or chi-square test, as appropriate, were used for categorical variables. The level of significance was set at 5% (p

Despite the advancements in indirect monolithic restorations, technical complications may occur during function. To overcome this issues, intraoral repair using resin composite is a practical and low-cost procedure, being able to increase the restoration’s longevity. This review aimed to evaluate the need for repair and suggest a standardized repair protocol to the main indirect restorative materials. For this, studies were surveyed from PubMed with no language or date restriction, to investigate the scientific evidence of indirect monolithic restoration repair with direct resin composite. A classification to guide clinical decisions was made based on the FDI World Dental Federation criteria about defective indirect restorations considering esthetic and functional standards, along with the patient’s view, to decide when polishing, repairing or replacing a defective restoration. Based on 38 surveyed studies, different resin composite intraoral repair protocols, that included mechanical and chemical aspects, were defined depending on the substrate considering resin-based, glass-ceramic or zirconia restorations. The presented criteria and protocols were developed to guide the clinician’s decision-making process regarding defective indirect monolithic restorations, prolonging longevity and increasing clinical success.

Objective: To evaluate the effect of different surface treatments on the morphology, shear bond, and flexural fatigue strength of a repaired translucent zirconia. Methods: Monolithic disc-shaped specimens of translucent zirconia were prepared and ground to simulate repair areas. Four groups underwent different treatments: Air-MDP (air-abrasion with alumina particles and 10-MDP primer), Si-Sil (silica-coated alumina particles with MDP-containing silane), Si-MDP (silica coating with 10-MDP primer), and Uni adhe (universal adhesive). After roughness measurements and treatments, repairs were done using resin composite. Shear bond and flexural (n = 15) fatigue tests were performed. Surface topography, interfacial analysis, fractographic, and finite element analysis were conducted. Results: The zirconia roughness was similar between the groups, however, the surface topography was modified according to the surface treatments. Si-Sil generated higher and more stable bond strength values (20.69 MPa) between translucent zirconia and resin composite when compared to Uni adhe (15.75 MPa) considering the fatigue bond strength scenario, while it was similar to Si-MDP (17.70 MPa) and Air-MDP (18.97 MPa). Regarding the mechanical behavior, Si-Sil (680.83 MPa) also showed higher and significantly different fatigue strength when compared to Uni adhe (584.55 MPa), while both were similar to Si-MDP (634.22 MPa) and Air-MDP (641.86 MPa). Conclusion: The association of mechanical and chemical approaches is essential for long-term bond strength and optimized mechanical behavior, being air-abrasion protocols and the use of silane and/or MDP-based primers suitable for zirconia repair protocols. It was found that relying solely on a universal adhesive was not as effective as other options available. Clinical significance: The surface treatment of repair protocols affects translucent zirconia's morphology. To enhance fatigue behavior in repaired monolithic zirconia, air abrasion is crucial. Exclusive use of a universal adhesive is less effective than other choices. A primer containing silane/MDP holds the potential for stable bond strength and optimized mechanical performance.

A automedicação é um problema recorrente de saúde pública devido ao uso indiscriminado de medicamentos. Este estudo analisou o perfil de automedicação por acadêmicos de uma Instituição de Ensino Superior na pandemia da Covid-19 com base em um questionário aplicado on-line. A maioria dos participantes era do gênero feminino, cursando Farmácia, no 10° semestre e já atuando como profissional de saúde. Destes, 36,9% foram diagnosticados com a doença pelo médico a partir de exames laboratoriais, e os principais sintomas relatados foram dor de cabeça (16%) e febre (13,7%). Os medicamentos mais utilizados, prescritos ou não por médicos, foram analgésicos e antitérmicos. A indicação de medicamentos foi realizada por outros profissionais de saúde, como o farmacêutico. Conclui-se que a automedicação se agravou durante a pandemia devido à procura por medicação para atenuar os sintomas da Covid-19 ou a falta de fármacos eficazes para o tratamento do novo coronavírus.

RESUMO O advento da pandemia da Covid-19 restringiu o acesso à prevenção e aos serviços de HIV/AIDS, ocasionando efeitos nas condições de vida e saúde dos indivíduos. O objetivo foi analisar o acesso de Homens que fazem Sexo com Homens (HSH) e mulheres trans/travestis às tecnologias de prevenção do HIV, suas práticas sexuais, de sociabilidade e de trabalho no contexto da Covid-19 em Curitiba/PR. Foram realizadas entrevistas semiestruturadas virtuais, e utilizado o referencial conceitual da vulnerabilidade. A análise foi viabilizada pelo software MaxQDA. Os resultados apontaram que muitos HSH conseguiram se isolar socialmente, restringindo as parcerias sexuais, alguns perderam o emprego, e a diminuição da renda girou entre os autônomos ou profissionais liberais. As mulheres trans/travestis profissionais do sexo tiveram que interromper o isolamento social para retornarem ao trabalho sexual, expondo-se ao novo coronavírus. A Profilaxia Pré-Exposição (PrEP) foi utilizada entre aqueles(as) que já estavam em uso. A oferta da PrEP e da Profilaxia Pós-Exposição (PEP) foram mantidas, mas sofreram mudanças. Os serviços especializados adequaram o atendimento, mas geraram exposição dos(as) usuários(as) e revelação do status sorológico. Como conclusão, destaca-se a necessidade de serviços de HIV contínuos em emergências de saúde pública, entendidos como um direito que deve ser garantido pelo Estado.

We aimed to study the impact of polymorphisms in the genes encoding interleukin-6 (IL6) and tumor necrosis factor receptor-2 (TNFR2), reported to be mortality risk predictors, in patients with end-stage kidney disease (ESKD) undergoing dialysis. TNFRSF1B (rs3397, rs1061624, and rs1061622) and IL6 (rs1800796, rs1800797, and rs1554606) polymorphisms were studied in patients with ESKD and controls; the genotype and allele frequencies and the associations with inflammatory and erythropoiesis markers were determined; deaths were recorded throughout the following two years. The genotype and allele frequencies for the TNFRSF1B rs3397 polymorphism were different in these patients compared to those in the controls and the global and European populations, and patients with the C allele were less common. Patients with the CC genotype for TNFRSF1B rs3397 presented higher hemoglobin and erythrocyte counts and lower TNF-α levels, suggesting a more favorable inflammatory response that seems to be associated with erythropoiesis improvement. Patients with the GG genotype for TNFRSF1B rs1061622 showed lower serum ferritin levels. None of the TNFRSF1B (rs3397, rs1061624, and rs1061622) or IL6 (rs1800796, rs1800797, and rs1554606) polymorphisms had a significant impact on the all-cause mortality rate of Portuguese patients with ESKD.

In this study, the oils of açaí, passion fruit, pequi, and guava were submitted to physicochemical analysis to investigate their potential application in the food industry. Gas chromatography associated with mass spectroscopy showed that oleic and linoleic acids are mainly responsible for the nutritional quality of açaí, passion fruit, pequi, and guava oils, which exhibited 46.71%, 38.11%, 43.78%, and 35.69% of the former fatty acid, and 18.93%, 47.64%, 20.90%, and 44.72% of the latter, respectively. The atherogenicity index of the oils varied from 0.11 to 0.65, while the thrombogenicity index was 0.93 for açaí, 0.35 for guava, and 0.3 for passion fruit oils, but 1.39 for pequi oil, suggesting that the use of the first three oils may lead to a low incidence of coronary heart disease. Thermogravimetry showed that all tested oils were thermally stable above 180 °C; therefore, they can be considered resistant to cooking and frying temperatures. In general, the results of this study highlight possible applications of these oils in the food industry, either in natura or in typical food production processes.

Hydrogels consist of a network of highly porous polymeric chains with the potential for use as a wound dressing. Propolis is a natural product with several biological properties including anti-inflammatory, antibacterial and antioxidant activities. This study was aimed at synthesizing and characterizing a polyacrylamide/methylcellulose hydrogel containing propolis as an active ingredient, to serve as a wound dressing alternative, for the treatment of skin lesions. The hydrogels were prepared using free radical polymerization, and were characterized using scanning electron microscopy, infrared spectroscopy, thermogravimetry, differential scanning calorimetry, swelling capacity, mechanical and rheological properties, UV-Vis spectroscopy, antioxidant activity by the DPPH, ABTS and FRAP assays and biocompatibility determined in Vero cells and J774 macrophages by the MTT assay. Hydrogels showed a porous and foliaceous structure with a well-defined network, a good ability to absorb water and aqueous solutions simulating body fluids as well as desirable mechanical properties and pseudoplastic behavior. In hydrogels containing 1.0 and 2.5% propolis, the contents of total polyphenols were 24.74 ± 1.71 mg GAE/g and 32.10 ± 1.01 mg GAE/g and those of total flavonoids 8.01 ± 0.99 mg QE/g and 13.81 ± 0.71 mg QE/g, respectively, in addition to good antioxidant activity determined with all three methods used. Therefore, hydrogels containing propolis extract, may serve as a promising alternative wound dressing for the treatment of skin lesions, due to their anti-oxidant properties, low cost and availability.

ABSTRACT Aedes aegypti mosquitoes can transmit several arboviruses, including chikungunya virus (CHIKV), dengue virus (DENV), and Zika virus (ZIKV). When blood-feeding on a virus-infected human, the mosquito ingests the virus into the midgut (stomach), where it replicates and must overcome the midgut barrier to disseminate to other organs and ultimately be transmitted via the saliva. Current tools to study mosquito-borne viruses (MBVs) include 2D-cell culture systems and in vivo mosquito infection models, which offer great advantages, yet have some limitations. Here, we describe a long-term ex vivo culture of Ae. aegypti guts. Cultured guts were metabolically active for 7 d in a 96-well plate at 28°C and were permissive to ZIKV, DENV, Ross River virus, and CHIKV. Ex vivo guts from Culex pipiens mosquitoes were found to be permissive to Usutu virus. Immunofluorescence staining confirmed viral protein synthesis in CHIKV-infected guts of Ae. aegypti. Furthermore, fluorescence microscopy revealed replication and spread of a reporter DENV in specific regions of the midgut. In addition, two known antiviral molecules, β-d-N4-hydroxycytidine and 7-deaza-2′-C-methyladenosine, were able to inhibit CHIKV and ZIKV replication, respectively, in the ex vivo model. Together, our results show that ex vivo guts can be efficiently infected with mosquito-borne alpha- and flaviviruses and employed to evaluate antiviral drugs. Furthermore, the setup can be extended to other mosquito species. Ex vivo gut cultures could thus be a new model to study MBVs, offering the advantage of reduced biosafety measures compared to infecting living mosquitoes. IMPORTANCE Mosquito-borne viruses (MBVs) are a significant global health threat since they can cause severe diseases in humans, such as hemorrhagic fever, encephalitis, and chronic arthritis. MBVs rely on the mosquito vector to infect new hosts and perpetuate virus transmission. No therapeutics are currently available. The study of arbovirus infection in the mosquito vector can greatly contribute to elucidating strategies for controlling arbovirus transmission. This work investigated the infection of guts from Aedes aegypti mosquitoes in an ex vivo platform. We found several MBVs capable of replicating in the gut tissue, including viruses of major health importance, such as dengue, chikungunya, and Zika viruses. In addition, antiviral compounds reduced arbovirus infection in the cultured gut tissue. Overall, the gut model emerges as a useful tool for diverse applications such as studying tissue-specific responses to virus infection and screening potential anti-arboviral molecules.

Abstract This study aimed to investigate the physical characteristics of pequiá fruits in the Cerrado areas of Nova Xavantina-MT, and to determine the influence of native vegetation on fruit biometry and productivity. The research question was whether proximity to fragments of native vegetation increases the productivity of pequiá fruit. In 2017 and 2018, 40 ripe fruits that had fallen to the ground were collected from three locations, two of which were close to native vegetation and one of which was close to crops and pastures. The highest values were observed in fruits collected in 2018, when there was more rainfall, and in fruits from the locations close to native vegetation, indicating that the presence of native vegetation can provide ecosystem services that promote the productivity of pequiá fruits. These findings have important implications for the conservation and management of Cerrado ecosystems.

O artigo traça um percurso de definição do conceito de micropolítica em uma visada singular da Semiótica Crítica. Busca suplementos nas teorizações de Deleuze e Guattari para pensá-la enquanto força subjacente a alianças que produzem zonas de devir. Em relação às proposições de Rolnik e Guattari, projeta a compreensão da micropolítica enquanto processo de cooperação dissonante entre sujeitos posicionados em subjetividades distintas, processo que faz esses modelos existenciais desterritorializarem-se. Já considerando as características fenomênicas desse processo, recorre ao pensamento de James e de Lapoujade para compreender que a micropolítica é produzida e intensificada a partir do que esses filósofos chamaram de experiência pura.

O artigo apresenta premissas para o projeto As configurações da comunicação,idealizado por Alexandre Rocha da Silva e desenvolvido coletivamente por integrantes do GPESC. A comunicação é pensada desde a Semiótica Crítica como indissociável das três ordens faneroscópicas que a configuram ad hoc (primeiridade, secundidade e terceiridade), mas também das três ordens metafísicas que configuram o processo do conhecimento e da vida. Na primeira seção, vemos como o acaso distribui qualidades em operações estéticas que configuram iconicamente o sensível; na segunda, pensamos a existência e o encontro à luz de uma ética comunicacional; na terceira, a mediação como fundamento para a fixação da crença e a mudança de hábitos. Uma última seção formula os termos de um conceito de comunicação sinequista como uma continuidade entre os três distintos horizontes comunicacionais. Procura-se, com isso, problematizar politicamente a comunicação ao concebê-la pela atualização ética de potenciais estéticos.

O objetivo desse estudo foi de conhecer e analisar a experiência dos empresários, donos de pequenos negócios sergipanos no processo de registro de marca. O estudo é baseado na relação entre o registro de marca e o porte da empresa e utiliza diversos estudos (Mamede, Fernandes, Godinho, 2011; Singh, 2018; Dinlersoz et al., 2018; Pinto et a.l, 2018) que comprovam que as pequenas empresas registram menos as suas marcas que as grandes empresas. Foi realizada uma pesquisa qualitativa com 45 donos de pequenos com ênfase nas suas motivações e nas dificuldades encontradas para realizarem o registro de suas marcas negócios formalizados de diferentes portes (MEI, ME e EPP) e setores econômicos (indústria, comércio e serviço). Para a coleta dos dados, foram realizadas entrevistas, e seguiu-se um roteiro semiestruturado. Os resultados apontam que 100% das empresas não possuem o registro de suas marcas, a maior parte dos empresários (91%) desconhece o processo de registro de marca, 98% dos empresários querem fazer o registro para se proteger dos concorrentes, e a principal dificuldade apontada por 87% dos empresários é não conhecer o processo de como solicitar o registro de marca. O estudo contribui para a discussão sobre quais são as ações que podem ser desenvolvidas e implementadas com a finalidade de aumentar a quantidade de pequenos negócios com a proteção de suas marcas, por meio do registro no Sistema Marcário.

This study evaluated the mechanical behavior and risk of failure of three CAD-CAM crowns repaired with different resin composites through a three-dimensional (3D) finite element analysis. Three-dimensional models of different cusp-repaired (conventional nanohybrid, bulk-fill, and flowable resin composites) crowns made of zirconia, lithium disilicate, and CAD-CAM resin composite were designed, fixed at the cervical level, and loaded in 100 N at the working cusps, including the repaired one. The models were analyzed to determine the Maximum Principal and Maximum Shear stresses (MPa). Complementary, an in vitro shear bond strength test (n = 10) was performed to calculate the risk of failure for each experimental group. The stress distribution among the models was similar when considering the same restorative material. The crown material affected the stress concentration, which was higher for the ceramic models (±9 MPa for shear stress; ±3 MPa for tensile stress) than for the CAD-CAM composite (±7 MPa for shear stress; ±2 MPa for tensile stress). The shear bond strength was higher for the repaired CAD-CAM resin composite (±17 MPa) when compared to the ceramics (below 12 MPa for all groups), while the repair materials showed similar behavior for each substrate. The stress distribution is more homogenous for repaired resin composite crowns, and a flowable direct resin composite seems suitable to repair ceramic crowns with less risk of failure.

ABSTRACT Objective: To describe the clinical characteristics of cases of COVID-19 severe acute respiratory syndrome (SARS) in Brazilian newborns (NBs) in 2020 and 2021, recorded in the Influenza Epidemiological Surveillance Information System (Sistema de Informação da Vigilância Epidemiológica da Gripe — SIVEP-Gripe). Methods: The variables analyzed were gender, race/skin color, hospitalization, intensive care unit (ICU) admission, use of ventilatory support, signs and symptoms (fever, cough, O2 saturation

O presente trabalho analisa a relação entre o conceito de emancipação e a formação do chamado novo constitucionalismo latino-americano, com ênfase no caso boliviano. O referido fenômeno político possibilita um processo emancipatório, haja vista que esse novo modelo de constitucionalismo é fruto de reinvindicações sociais de grupos historicamente excluídos do jogo do poder, como os indígenas? A Constituição boliviana de 2009 trouxe uma ruptura do constitucionalismo tradicional de matriz europeia, propondo a construção de um Estado plurinacional que reconhece e respeita as diferenças. Sua elaboração segue o materialismo histórico que possibilita compreender os fenômenos sociais e sua evolução ao longo da história e considera aspectos econômicos, sociais, jurídicos do objeto investigado. Nas considerações finais indica-se que o novo constitucionalismo latino-americano possui diretrizes legais fundamentadas na emancipação humana, assim como é permeado por limites estruturais de ordem econômica, social, política e cultural.

Abstract A phytochemical study of Tecoma genus (Bignoniaceae) was accomplished by antitumor activity of ethanolic extracts. Species of this genus are composed of small shrubs often used as ornamental plants. The Tecoma stans species is used in folk medicine for different purposes. Recent work shows in vitro anticancer activity against human breast cancer. The ethanolic extracts from leaves and trunks of Tecoma casneifolia, T. garrocha, T. stans var. angustata and T. stans var. stans were tested in vitro. The assays used were against line tumor cells by the MTT method and the most active extracts were further studied. In this way, the ethanolic extract from T. stans var. stans trunks presented the higher cytotoxicity against the tumor cell lines studied (CC50 0.02 to 0.55 µg/ml) when compared to the other extracts tested (CC50 0.08 to 200.0 µg/ml). Accordingly, this extract was selected for chromatographic fractionation from which five known lignans were isolated. Further, paulownin, paulownin acetate, sesamin, olivil and cycloolivil were identified using 13C and 1H NMR, IR, UV and spectroscopy and spectrometric MS techniques. These isolated compounds were tested and exhibited CC50 ranging from 13.01 to100.0 µg/ml which is superior to the ethanolic extract of trunk of T. stans.

Abstract Background Stratifying patients with sepsis was the basis of the predisposition, infection, response and organ dysfunction (PIRO) concept, an attempt to resolve the heterogeneity in treatment response. The purpose of this study is to perform an independent validation of the PIRO staging system in an international cohort and explore its utility in the identification of patients in whom time to antibiotic treatment is particularly important. Methods Prospective international cohort study, conducted over a 6-month period in five Portuguese hospitals and one Australian institution. All consecutive adult patients admitted to selected wards or the intensive care, with infections that met the CDC criteria for lower respiratory tract, urinary, intra-abdominal and bloodstream infections were included. Results There were 1638 patients included in the study. Patients who died in hospital presented with a higher PIRO score (10 ± 3 vs 8 ± 4, p

ABSTRACT Human norovirus (HuNoV) is the major agent for viral gastroenteritis, causing >700 million infections yearly. Fucose-containing carbohydrates named histo-blood group antigens (HBGAs) are known (co)receptors for HuNoV. Moreover, bacteria of the gut microbiota expressing HBGA-like structures have shown an enhancing effect on HuNoV replication in an in vitro model. Here, we studied the role of HBGAs and the host microbiota during HuNoV infection in zebrafish larvae. Using whole-mount immunohistochemistry, we visualized the fucose expression in the zebrafish gut for the HBGA Lewis X [LeX, α(1,3)-fucose] and core fucose [α(1,6)-fucose]. Costaining of HuNoV-infected larvae proved colocalization of LeX and to a lower extent core fucose with the viral capsid protein VP1, indicating the presence of fucose residues on infected cells. Upon blocking of fucose expression by a fluorinated fucose analogue, HuNoV replication was strongly reduced. Furthermore, by comparing HuNoV replication in conventional and germfree zebrafish larvae, we found that the natural zebrafish microbiome does not have an effect on HuNoV replication, contrary to earlier reports about the human gut microbiome. Interestingly, monoassociation with the HBGA-expressing Enterobacter cloacae resulted in a minor decrease in HuNoV replication, which was not triggered by a stronger innate immune response. Overall, we show here that fucose has an essential role for HuNoV infection in zebrafish larvae, as in the human host, but their natural gut microbiome does not affect viral replication. IMPORTANCE Despite causing over 700 million infections yearly, many gaps remain in the knowledge of human norovirus (HuNoV) biology due to an historical lack of efficient cultivation systems. Fucose-containing carbohydrate structures, named histo-blood group antigens, are known to be important (co)receptors for viral entry in humans, while the natural gut microbiota is suggested to enhance viral replication. This study shows a conserved mechanism of entry for HuNoV in the novel zebrafish infection model, highlighting the pivotal opportunity this model represents to study entry mechanisms and identify the cellular receptor of HuNoV. Our results shed light on the interaction of HuNoV with the zebrafish microbiota, contributing to the understanding of the interplay between gut microbiota and enteric viruses. The ease of generating germfree animals that can be colonized with human gut bacteria is an additional advantage of using zebrafish larvae in virology. This small animal model constitutes an innovative alternative to high-severity animal models.

Abstract The chord length is an essential geometric property that must be defined in the analysis of isolated joints composed of hollow steel sections, as well as the boundary conditions of the test. The analysis of these parameters’ effect on the behavior of joints has been addressed by other studies, mostly with joints between circular hollow sections with compact or semi-compact cross-sections. Recent research about tubular joints has addressed cases with slender sections, where the design of joints containing these sections is still in development. In this context, this study aimed to evaluate the effect of the chord length in the behavior of T-joints between circular hollow section braces and slender rectangular hollow section chords through experimental tests and a numerical study considering the application of axial compression at the braces. The joint behavior was examined through the load-strain and load-deformation curves and the von Mises stress distribution, which allowed the failure mode's determination and the joint resistance value. Chord face failure was observed in the prototypes. It was concluded that a minimum chord length of 0.6m would be the adequate value for the study of the T-joints containing the geometric properties used in this study, which would be equivalent to a chord length five times higher than the width of the cross-section (5b0).

Abstract The flavonoids and xanthones present in the ethanol extracts of leaves and stems of Fridericia samydoides showed that anti-dengue activities in vitro were investigated qualitatively by liquid chromatography-ultraviolet-mass spectrometry in series. Nineteen flavones and fifteen xanthones were detected and characterized on the basis of their fragmentation pattern in the positive and negative ion mode tandem mass spectrometry spectra and ultraviolet bands. Acacetin, chrysin, vitexin, isovitexin, orientin, isoorientin, mangiferin, 2’-O-trans-caffeoylmangiferin, 2’-O-trans-coumaroylmangiferin and 2’-O-trans-cinnamoylmangiferin were identified by comparison with authentic samples. The other compounds detected were tentatively assigned by analysis of the spectral data and by comparison with literature reports. In addition, it performed the fractionation of the leaves extract leading to the isolation of mangiferin, isovitexin and isoorientin. All extracts and isolated compounds inhibited the Dengue virus replication cycle with EC50 less than 25.0 µg/mL for extracts and 272.5, 85.6 and 79.3 µg/mL for mangiferin, isovitexin and isoorientin, respectively.

O caso do tombamento da Igreja da Ordem Terceira do Carmo, em São Paulo, em 1996, apresenta os meandros do processo de identificação do patrimônio cultural brasileiro, evidenciando os embates entre narrativas de seleção que ora ampliam as possibilidades de compreensão do bem cultural, ora reiteram as práticas já consolidadas de reconhecimento do patrimônio edificado. A discussão perdurou por 38 anos e culminou na seleção de partes da edificação – frontaria, nave, capela-mor, sacristia e compartimentos em estrutura de taipa – caracterizadas enquanto bem tombado e na delimitação das demais fachadas e elementos integrantes da edificação como área de entorno.

This study aimed to evaluate the effects of different sowing depths and light intensities on the emergence and development of the monocot weed species, Urochloa decumbens and Cenchrus echinatus, under field conditions. Each species constituted an experiment, and the experimental design was completely randomized with four replicates. The treatments were arranged in a 6 x 4 factorial scheme, with six sowing depths (0.5, 1.0, 2.0, 4.0, 8.0, and 12.0 cm) associated with four solar radiation intensities (100%, 70%, 50%, and 30%) obtained through the use of shading screens. Seedling emergence capacity was evaluated daily to obtain the emergence percentage and speed index. Plant height, floral induction time, and plant dry matter at flowering were measured. Even when subjected to different solar radiation intensities, U. decumbens and C. echinatus seedlings emerged at all the sowing depths. Sowing between 2.0- and 4.0-cm depths favored the emergence of seedlings of U. decumbens and C. echinatus. However, sowing at 12-cm depth reduced the emergence of both species regardless of the solar radiation intensity. Urichloa decumbens plants grown under conditions of greater shading showed the lowest values of height and dry matter accumulation during flowering. High levels of shading facilitated only the etiolation of C. echinatus plants. Increased shading flowering time in both species compared to full sunlight.

Abstract Chronic inflammation plays an important role in the progression and outcome of chronic kidney disease (CKD). The circulating levels of the inflammatory biomarkers interleukin 6 (IL6) and pentraxin 3 (PTX3) are enhanced in CKD patients, and are associated with the progression of the disease and with higher risk for cardiovascular events, the major cause of death in CKD patients. Our aim was to study how specific polymorphisms of IL6 and PTX3 encoding genes affect the inflammatory response and outcome of end-stage renal disease (ESRD) patients on dialysis. Methodology included the analysis of two single nucleotide polymorphisms (SNP), namely the IL6 (rs1800795) polymorphism in the promoter region (-174G > C), and the PTX3 (rs2305619) polymorphism in the intron 1 (+ 281A > G), which were analyzed in ESRD patients on dialysis and in a group of heathy individuals. The allelic frequencies, genotype distribution and their association with circulating levels of the inflammatory markers C-reactive protein (CRP), IL6, growth differentiation factor 15 (GDF15) and PTX3, were determined in ESRD patients. Events of death were recorded along one year, to assess the association of the studied SNPs with all-cause mortality and the inflammatory biomarkers, in ESRD patients. Results showed that the allelic frequencies and genotype distribution for IL6 and PTX3 SNPs in the control group and ESRD patients were similar and in agreement with other European reports. For the IL6 polymorphism, we found a trend towards higher levels of high-sensitivity (hs) CRP, IL6 and PTX3 in the homozygous genotypes; the CC genotype also showed the highest levels of GDF15. The mortality rate after the 1-year follow-up was 10.4%. The CC genotype (IL6 SNP) was associated to a higher risk of mortality and deceased patients carrying this genotype also showed the highest levels of hsCRP. Regarding the studied PTX3 SNP, the AA genotype was linked to an enhanced inflammatory response, showing the highest values of hsCRP and IL6. Nevertheless, this genotype had no significant impact on the mortality rate. In conclusion, both studied SNPs seem to modulate the inflammatory response in ESRD and may, therefore, be determinant on disease progression and patients’ outcome. Our data also highlights the importance of research on genetic variants that, although less frequent, may have significant biological value.

Este artigo tem o escopo de refletir acerca da obsolescência de mercadorias como um processo atrelado ao desenvolvimento das forças produtivas. Nesse sentido, busca-se compreendê-la à luz dos desdobramentos históricos da subordinação das necessidades humanas à reprodução do valor-de-troca. Apresenta ainda a obsolescência planejada no século XX, caracterizada pela redução da vida útil dos produtos de forma deliberada no âmbito da produção como um expediente resultante desse processo histórico que, em tempos de crise estrutural, emerge como artifício do capital para deslocar a contradição entre produção e consumo.

Evidence of sylvatic yellow fever was first reported in Atlantic Forest areas in Espírito Santo, Brazil, during a yellow fever virus (YFV) outbreak in 1931. An entomological survey was conducted in six forest sites during and after an outbreak reported ~80 years after the last case in the area. Among 10,658 mosquitoes of 78 species, Haemagogus leucocelaenus, and Hg. janthinomys/capricornii were considered the main vectors as they had a relatively high abundance, co-occurred in essentially all areas, and showed high YFV infection rates. Sabethes chloropterus, Sa. soperi, Sa. identicus, Aedes aureolineatus, and Shannoniana fluviatilis may have a secondary role in transmission. This is the first report of Sa. identicus, Ae. aureolineatus, and Sh. fluviatilis infected with YFV. Our study emphasizes the importance of entomological monitoring and maintenance of high vaccination coverage in receptive areas to YFV transmission.

Enteroviruses are a leading cause of upper respiratory tract, gastrointestinal, and neurological infections. Management of enterovirus-related diseases has been hindered by the lack of specific antiviral treatment. The pre-clinical and clinical development of such antivirals has been challenging, calling for novel model systems and strategies to identify suitable pre-clinical candidates. Organoids represent a new and outstanding opportunity to test antiviral agents in a more physiologically relevant system. However, dedicated studies addressing the validation and direct comparison of organoids versus commonly used cell lines are lacking. Here, we described the use of human small intestinal organoids (HIOs) as a model to study antiviral treatment against human enterovirus 71 (EV-A71) infection and compared this model to EV-A71-infected RD cells. We used reference antiviral compounds such as enviroxime, rupintrivir, and 2′-C-methylcytidine (2′CMC) to assess their effects on cell viability, virus-induced cytopathic effect, and viral RNA yield in EV-A71-infected HIOs and cell line. The results indicated a difference in the activity of the tested compounds between the two models, with HIOs being more sensitive to infection and drug treatment. In conclusion, the outcome reveals the value added by using the organoid model in virus and antiviral studies.

Left ventricular hypertrophy (LVH) is a common cardiovascular complication in end-stage kidney disease (ESKD) patients. We aimed at studying the association of LVH with adiponectin and leptin levels, cardiovascular stress/injury biomarkers and nutritional status in these patients. We evaluated the LV mass (LVM) and calculated the LVM index (LVMI) in 196 ESKD patients on dialysis; the levels of hemoglobin, calcium, phosphorus, parathyroid hormone, albumin, adiponectin, leptin, N-terminal pro B-type natriuretic peptide (NT-proBNP) and growth differentiation factor (GDF)-15 were analyzed. ESKD patients with LVH (n = 131) presented higher NT-proBNP and GDF-15, lower hemoglobin and, after adjustment for gender, lower leptin levels compared with non-LVH patients. LVH females also showed lower leptin than the non-LVH female group. In the LVH group, LVMI presented a negative correlation with leptin and a positive correlation with NT-proBNP. Leptin emerged as an independent determinant of LVMI in both groups, and NT-proBNP in the LVH group. Low hemoglobin and leptin and increased calcium, NT-proBNP and dialysis vintage are associated with an increased risk of developing LVH. In ESKD patients on dialysis, LVH is associated with lower leptin values (especially in women), which are negatively correlated with LVMI, and with higher levels of biomarkers of myocardial stress/injury. Leptin and NT-proBNP appear as independent determinants of LVMI; dialysis vintage, hemoglobin, calcium, NT-proBNP and leptin emerged as predicting markers for LVH development. Further studies are needed to better understand the role of leptin in LVH in ESKD patients.

Objetivo: evidenciar a aplicação de scaffolds para promover a reabilitação periodontal dos tecidos de suporte do dente. Materiais e Métodos: trata-se de uma revisão da literatura através da base de dados PubMed, utilizado o Boleano and e os descritores ''3D printing'' e ''periodontal regeneration''. Os critérios de inclusão foram: artigos completos e disponíveis na íntegra. Foram encontrados 35 artigos, sendo analisados títulos e resumos e excluídos 10 artigos. Após a leitura dos artigos selecionados na íntegra restaram 13 artigos que foram incluídos nesta revisão de literatura. Resultados: o periodonto se refere aos tecidos que sustentam e circundam os dentes, como o cemento, ligamento periodontal, e osso alveolar. A destruição desses tecidos pode ser causada pela periodontite, levando a perda dental. O tratamento dessa condição tem como objetivo principal evitar a progressão da doença e aliviar os sintomas. Apesar da existência de vários tratamentos nenhum é capaz de permitir a regeneração do periodonto. Para suprir tal necessidade à engenharia tecidual desenvolveu andaimes que são constituídos de metais, cerâmicas e polímeros, o que permite seu desenvolvimento funcional e mecânico quando inseridos na cavidade oral. Os scaffolds são projetados baseados em imagens colhidas e processadas com reconstrução tridimensional e modelagem CAD, depois da impressão a fabricação de modelos personalizados é realizada, criando um ambiente ideal para o crescimento celular e angiogênese. O objetivo dos andaimes está em promover a osteogênese, a formação do ligamento periodontal e cemento além de proporcionar a integração entre eles. Conclusão: diante do que foi encontrado nesta revisão é possível inferir que o scaffold apresenta impacto positivo na reconstrução do periodonto, podendo ser usado como modalidade de tratamento.

Select herbicides with different mechanism of action is a satisfactory option for resistant weed control. Then, the present work aimed to study the efficiency of different herbicides and their mixtures on Bidens pilosa (blackjack) and Euphorbia heterophylla (wild poinsettia) biotypes, resistant to ALS herbicides in two development stages. The trials we arranged in a completely randomized design with four replications. The treatments tested were (g a.i/a.e ha-1): imazethapyr at 70 and 140 (WG formulation) + 1.0% Assist; imazethapyr at 57.6 and 72 (SL formulation) + 1.0% Assist; imazapic + imazethapyr at 56 and 70 + 1.0% Assist; glyphosate + imazethapyr (596); saflufenacil + glyphosate at 35 + 720 + 0.5% Dash in tank mix, glyphosate at 720 and, a control without herbicide application. Control efficiency was evaluated, as well as dry matter accumulation at the end of the studies. Plants of both species were more susceptible to herbicides at the early stage of development (2 to 4 leaves). The treatments with saflufenacil + glyphosate, (imazethapyr + glyphosate) and glyphosate promoted the best controls, regardless of the species studied and the application stage. The mixture with saflufenacil provided the highest control speed, and the mixture (imazethapyr + glyphosate) was less efficient among three excellent treatments when applied to plants in the 4-6 leaf stage. The treatments (imazethapyr, in both formulations) and (imazethapyr + imazapic) were ineffective in controlling the studied biotypes, regardless of dose and developmental stage studied.

SARS-CoV-2 infection can result in severe lung inflammation and pathology, but host response remains incompletely understood. Here the authors show in Syrian hamsters that STAT2 signaling restricts systemic virus dissemination but also drives severe lung injury, playing a dual role in SARS-CoV-2 infection.

Objectives: To assess whether electronic records data could improve the efficiency, exhaustiveness, and representativeness of SSI surveillance by selecting a group of high-risk patients for manual review. Methods: Colorectal surgeries (2016–2018) and cholecystectomies (2017–2018) were selected. Post-surgical antibiotic use, positive culture, C-reactive protein (CRP) values, body temperature, leukocyte count, surgical re-intervention, admission to the emergency room, and hospital readmission were retrieved. For representativeness, procedures registered in HAI-Net were compared with non-included procedures, and the validity of each variable (or combination) was tested considering the presence of SSI as the gold standard. The proportion of procedures flagged for manual review by each criterion was estimated. Results: Little more than 50% of procedures were included in HAI-Net (SSI risk: 10.6% for colorectal and 2.9% for cholecystectomies). Non-included procedures showed higher proportions of infection markers. Antibiotic use and CRP >100 mg/dl presented the highest sensitivity for both surgical groups, while antibiotic use achieved the highest positive predictive value in both groups (22% and 21%, respectively) and flagged fewer colorectal procedures (47.7%). Conclusions: Current SSI surveillance has major limitations. Thus, the reported incidence seems unreliable and underestimated. Antibiotic use appears to be the best criterion to select a sub-sample of procedures for manual review, improving the exhaustiveness and efficiency of the system.

There is an urgent need for drugs, therapies and vaccines to be available to protect the human population against COVID-19. One of the first approaches taken in the COVID-19 global response was to consider repurposing licensed drugs. This commentary highlights an extraordinary international collaborative effort of independent researchers who have recently all come to the same conclusion—that chloroquine or hydroxchloroquine are unlikely to provide clinical benefit against COVID-19.

Abstract This article analyzes sleeve connections between circular hollow sections. This type of connection is composed of two tubes connected by bolts to an inner tube with a smaller diameter, and explores the efficiency, aesthetics and resistance of hollow sections subjected to tension and compression. In previous researches, sleeve connections with aligned and crossed bolt dispositions and under axial tension were studied. Herein, the behavior of sleeve connections with aligned bolts and under compression was analyzed. A model to represent the connection using the finite element method was developed, which allowed a numerical analysis with geometric property variations. In the numerical/parametric results, bearing failure was observed in all cases, either in the outer or inner tube. Limiting the number of bolts to 6 and considering that connections have a lower outer thickness than the inner tube, a formulation was proposed to determine the ultimate bearing capacity of sleeve connections under compression and with bearing failure.

Abstract: Introduction: Population aging, longer life expectancy and the increase in the prevalence of chronic diseases have brought new health demands, among them, palliative care (PC). Although present in the clinical routine, this topic has not yet been included in most medical schools in Brazil. Objective: To know the teaching-learning process in PC according to the perception of medical students from schools that have this subject. Method: Qualitative method through interviews with 35 medical students from 14 medical schools located in the Northeast, Southeast and South regions of the country. Results: The reports were classified into three categories: conception of PC, changes perceived after exposure to PC teaching, challenges and successful strategies identified in PC teaching. Students recognize the value of teaching in PC and have a greater understanding of PC approach and its early indication for people with complex chronic conditions. The inclusion of the topic contributed to the overcoming of fears and taboos related to death, providing greater comfort to deal with human suffering, adding emotional skills. The formal education in PC allowed understanding the person in their biopsychosocial and spiritual dimension. They stressed the importance of communication skills to communicate difficult news, symptom management, teamwork and an individualized approach to the person and their family. Although they identify little theoretical-practical integration in the teaching-learning scenario in PC, they report an interest in the topic, and indicated successive experiences as strategies throughout the training, in a humanist axis. Conclusion: PC teaching brings contributions to medical training that go beyond the learning of the subject and reinforces the development of empathy and compassion, recognized as essential in this profession, as well as the relevance of assertiveness in the management of suffering and the comprehensive care of people with advanced diseases.

Brain abscess is a very rare condition but has a significant mortality rate. The three main routes of inoculation are trauma, contiguous focus, and the hematogenous route. The odontogenic focus is infrequent and is usually a diagnosis of exclusion. This paper presents a brain abscess case proven to be of dental origin, caused by Actinomyces meyeri and Fusobacterium nucleatum. This case highlights the risk underlying untreated dental disease and why oral infectious foci removal and good oral health are essential in primary care.

Introdução: As meningites relacionadas às neurocirurgias causadas por bactérias Gram-negativas (BGN), especialmente resistentes aos carbapenêmicos, são complicações com alta letalidade. O tratamento dessas infecções é complexo devido ao aumento da resistência aos antimicrobianos, associada à limitação de drogas que atinjam concentração adequada em sistema nervoso central. Objetivo: Descrever os aspectos epidemiológicos e avaliar a segurança do uso empírico do meropenem para o tratamento das meningites pós neurocirúrgicas causadas por bactérias Gram negativas e descrever a letalidade dessas infecções. Material e métodos: Este é um estudo prospectivo, realizado entre dezembro de 2013 a agosto de 2021, em um hospital especializado em neurocirurgia, com 37 leitos para pacientes adultos. Para o diagnóstico de meningites relacionadas às neurocirurgias foram utilizados os critérios da ANVISA. Resultados: Foram detectados 25 casos de meningite por BGN. A mediana de idade dos pacientes foi de 55 anos (22-75 anos), com ligeiro predomínio do sexo feminino (14/25). A principal patologia relacionada a esta complicação foi hemorragia subaracnóidea, ocorrida em 52% dos casos (13/25). Em 15 pacientes (60,0%) a meningite foi relacionada a um dispositivo ventricular. A terapêutica empírica inicial foi meropenem associado a vancomicina em 24 casos. Em 15 pacientes (62,5%) o espectro de ação deste tratamento foi adequado e neste grupo ocorreram quatro óbitos (26,6%). Em seis casos (25%) a terapêutica inicial foi inadequada e neste grupo houve quatro óbitos (66,7%). Conclusão: A literatura recomenda para o tratamento empírico das meningites relacionadas a neurocirurgia o uso de uma cefalosporina com ação anti pseudomonas ou meropenem associados com vancomicina. No entanto a emergência da resistência aos carbapênemicos torna o tratamento destas infecções desafiador. Na nossa casuística esse esquema foi inadequado em 37,5% dos casos (6/24) e neste grupo houve quatro óbitos . É necessário o desenvolvimento de novas opções terapêuticas com boa penetração em sistema nervoso central para o tratamento de infecções por Gram negativos.