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Objectives. To assess cannabis and alcohol involvement among motor vehicle crash (MVC) fatalities in the United States. Methods. In this repeated cross-sectional analysis, we used data from the Fatality Analysis Reporting System from 2000 to 2018. Fatalities were cannabis-involved if an involved driver tested positive for a cannabinoid and alcohol-involved based on the highest blood alcohol concentration (BAC) of an involved driver. Multinomial mixed-effects logistic regression models assessed cannabis as a risk factor for alcohol by BAC level. Results. While trends in fatalities involving alcohol have remained stable, the percentage of fatalities involving cannabis and cannabis and alcohol increased from 9.0% in 2000 to 21.5% in 2018, and 4.8% in 2000 to 10.3% in 2018, respectively. In adjusted analyses, fatalities involving cannabis had 1.56 (95% confidence interval [CI] = 1.48, 1.65), 1.62 (95% CI = 1.52, 1.72), and 1.46 (95% CI = 1.42, 1.50) times the odds of involving BACs of 0.01% to 0.049%, 0.05% to 0.079%, and 0.08% or higher, respectively. Conclusions. The percentage of fatalities involving cannabis and coinvolving cannabis and alcohol doubled from 2000 to 2018, and cannabis was associated with alcohol coinvolvement. Further research is warranted to understand cannabis- and alcohol-involved MVC fatalities. (Am J Public Health. 2021;111(11):1976–1985. https://doi.org/10.2105/AJPH.2021.306466 )

10 figures, 1 table, Various types of fluorescent carbon nanoparticles, often called carbon dots (CDs), are synthesized by different polycondensation methods: microwave irradiation, hydrothermal conditions or solution chemistry at ambient temperature with subsequent chemical functionalization. The CDs are deposited on TiO2 films to be probed as electron transport layers in perovskite photovoltaics and the anode for photoelectrochemical water splitting. Nitrogen CDs, which do not contain oxygen, lead to an increase of around 50 mV in the open circuit voltage of perovskite solar cells. All the CD types produce an improved photocurrent in water splitting, particularly CDs that are functionalized with thiol groups and butyl chains. It is demonstrated that the modified electrode is stable under continuous operation. Other electrochemical characteristics of the electrode, such as the voltammogram shape, onset potentials and open circuit potentials, remain nearly unchanged upon the deposition of CDs. Only the incident photon to current conversion efficiency improves clearly, extending the absorption range by around 20 nm towards longer wavelengths. This study provides new data about mechanisms and electrode arrangements for improving the performance of n-type semiconductors in photovoltaic cells and photoelectrochemical hydrogen production., This work has been funded by the Spanish MINEICO under the project ENE2016-79282-C5-1-R (AEI/FEDER, UE), the Government of Aragón (Grupo reconocido T03-17R) and associated EU Regional Development Funds (DGA/FEDER, UE).

Introduction Laryngeal squamous cell carcinoma is the second most prevalent malignancy among head and neck tumors, and the treatment of patients with stage I or II disease can be performed with surgery or radiation therapy. National population studies describing therapeutic results comparing these modalities are unusual, but they can be very important to direct treatment guidelines. Objective To evaluate the survival results of patients with laryngeal squamous cell carcinoma at clinical stages I or II, according to the main therapeutic modalities used. Methods Cross-sectional, population-based study using the database of Fundação Oncocentro de São Paulo from January 2000 to March 2019. Inclusion criteria were patients with laryngeal squamous cell carcinoma in clinical stages cT1-2N0. To compensate for the non-random allocation of patients and the imbalance between confounding variables between groups, we used the propensity score methodology. Results A total of 3786 patients met the inclusion criteria. Regarding the cT stage, there were 2171 patients (57.3%) with cT1 tumors. Patients in the public health system had a longer time between diagnosis and treatment (p< 0.001). The analysis by propensity score showed that patients treated with surgery had a tendency towards better disease-specific survival (p = 0.012). Comparing radiotherapy alone versus its combination with radiochemotherapy, radiotherapy alone showed a tendency towards a better survival rate (p< 0.001). Conclusion Analysis by propensity score identified better results for disease-specific survival in patients with laryngeal squamous cell carcinoma at clinical stages I and II treated by surgery when compared to radiotherapy. Resumo Introdução O carcinoma epidermoide de laringe é o segundo mais prevalente entre os tumores de cabeça e pescoço e o tratamento dos pacientes com doença em estádio I ou II pode ser feito com cirurgia ou radioterapia. Estudos populacionais nacionais que descrevem os resultados terapêuticos e compararam essas modalidades são poucos frequentes, mas podem ser muito importantes para orientar diretrizes de tratamento. Objetivo Avaliar os resultados de sobrevida dos pacientes com carcinoma epidermoide de laringe em estádios clínicos I ou II de acordo com as principais modalidades terapêuticas usadas. Método Estudo transversal de base populacional com a base de dados da Fundação Oncocentro de São Paulo de janeiro de 2000 a março de 2019. Os critérios de inclusão foram pacientes com carcinoma epidermoide de laringe em estádios clínicos cT1-2N0. Para compensar pela alocação não randômica dos pacientes e pelo desequilíbrio entre variáveis confundidoras entre os grupos, usamos a metodologia do escore de propensão. Resultados Preencheram os critérios de inclusão 3.786 pacientes. Em relação ao estádio cT, houve 2.171 pacientes (57,3%) com tumores cT1. Os pacientes do sistema único de saúde (SUS) apresentaram um maior tempo entre o diagnóstico e o tratamento (p < 0,001). A análise por escore de propensão mostrou que os pacientes submetidos a cirurgia apresentaram uma tendência de melhor sobrevida doença específica (p = 0,012). Comparando-se radioterapia isolada versus combinação com radioquimioterapia, o tratamento isolado demonstrou tendência a melhor taxa de sobrevida (p< 0,001). Conclusão A análise por escore de propensão identificou melhores resultados de sobrevida doença específica em pacientes com carcinoma epidermoide de laringe estádios clínicos I e II tratados por cirurgia quando comparados a radioterapia.

Aim: To determine the prevalence of non-carious cervical lesions in children in the primary dentition and possible associated etiological factors. Method: After approval by the Ethics Committee - CEP / UESPI (3,289,732) – this cross-sectional study was carried out on 360 children, from 2 to 6 years of age, from public and private schools, divided into two groups: G1 (with cervical lesions) and G2 (without cervical lesions). A questionnaire was applied to the parents, followed by the children’s clinical examination. Lesions detected by touch and visually were considered. Evaluations of means and standard deviations were performed for quantitative variables. Percentages and frequencies were obtained, analyzing the association between qualitative variables based on the chi-square test and comparing the average age using the t test (p < 0.05). Results: Only abfraction-type lesions were found in the sample (5%), and white individuals presented a higher prevalence in relation to the others (55.5%). There was a statistically significant difference (p < 0.001), and these lesions were found only in private schools. As for sex, in G1, there was a statistically significant difference (p = 0.01) with a higher prevalence in males (66.7%). The most affected teeth in decreasing order were the canines and upper central incisors, followed by the canines and lower central incisors. Conclusion: The prevalence of non-carious cervical lesions of the abfraction type in children from 2 to 6 years of age was 5%, which was only found in private schools, with a predominance in males. An association was found between the abfraction and the type of brush used in toothbrushing, with a higher frequency of lesions when hard brushes were used and strong brushing was performed. Uniterms: Tooth wear. Tooth erosion. Tooth abrasion. Dentistry, operative.

Background: One of the risk factors for suicide includes the presence of depressive disorder and symptoms, which may be related to the reduction of 25-hydroxyvitamin D serum levels. In this scenario, evidence shows vitamin D deficiency as an important aspect directly related to depressive disorder chronicity. Objective: To assess the association between Vitamin D serum levels and the intensity of depressive symptoms and suicidal behavior in a clinical sample of depressed patients. Methods: A cross-sectional study with 146 patients aged between 18 and 59, seen in two psychiatry ambulatories. Data collection involved measurement of serum 25-hydroxyvitamin D levels and assessment of the intensity of depressive symptoms and suicide risk. Results: In the sample, 35% presented low Vitamin D serum levels and, in these individuals, the incidence of family history of Depressive Disorder (95.2%) and chronicity of severe depressive symptoms (47.8%) was higher. As to suicidal behavior, both groups presented high active suicide risk, with higher rates in the group with hypovitaminosis D. Only suicidal ideation was linked to lower Vitamin D levels (67.4% p= 0,005). Conclusion: In this study, hypovitaminosis D was associated with negative mental health outcomes, such as more severe chronicity of depressive symptoms and suicidal behavior, characterized by active suicidal ideation.

Background : Lymphomas are considered uncommon in goats, being the multicentric form with the highest number of cases for the species. Primary intranasal lymphomas are often diagnosed in dogs, cats, and humans. In the literature, there is only a description of a multicentric case involving the frontal sinuses and mucosa of the nasal cavity in a goat; therefore, it is important to describe unusual cases of this disease for the inclusion of new clinical and pathological characteristics in the ruminant clinic medicine. The objective of this work is to describe a case of T-cell lymphoma in the nasal cavity of a young goat. Case : The animal had dyspnea and respiratory noise for 15 days. Clinical examination showed nodulation in the right nasal cavity associated with serosanguinous secretion. Tracheostomy was performed; however, after 30 days the animal was euthanized. A sagittal plane of the head showed a pinkish-gray mass in the right and left nasal cavity, with a smooth, multilobulated surface, smooth adhering to the rostral portion of the dorsal concha and occluding the dorsal nasal meatus. Submandibular lymph nodes were slightly enlarged. Histopathological examination of the nasal cavity revealed a non-encapsulated, poorly delimited and ulcerated tumor composed of round cells arranged in a mantle supported by a discrete fibrovascular stroma extending the mucosa and lamina propria. Cells were round with sparse, eosinophilic and poorly delimited cytoplasm. Nuclei varied from round to elongated with condensed chromatin and evident nucleoli. Occasionally, aberrant nuclei, reniform shape and multinucleated cells were seen. Pleomorphism was moderate characterized by anisocytosis and anisocariosis. Typical and atypical mitosis were frequent (0-4 per field of highest magnification [400x]). Amidst the neoplasm, there were multifocal areas of necrosis and hemorrhage associated with a mild lymphocytic inflammatory infiltrate. Immunohistochemistry showed positive immunostaining for Vimentin antibodies and CD3, and negative for pan CK and CD20. Discussion : The lymphomas immunophenotyping is little used when it comes to farm animals, and there are few studies that use this technique for the definitive diagnosis of these neoplasms for small ruminants. The use of this technique must be considered in each case, in order to determine the pathogenesis, the accurate diagnosis and the origin of the neoplastic lymphocytes. In goats, T-cell lymphomas are the most diagnosed, although cases of multicentric B-cell lymphomas with ocular involvement have been diagnosed. In view of the clinical picture of the case described, infectious rhinitis already described in goats, such as aspergillosis and protothecosis, should be included as differential diagnoses. However, the anatomopathological findings facilitate the direction of the diagnosis, since infectious rhinitis presents as nodules / ulcerated masses or focal areas of necrosis associated with purulent secretion and in the histopathological examination it is possible to observe the intralesional etiological agents. In addition, the enzootic ethmoidal tumor must be included, as it has similar clinical signs and affects young animals, but they are adenomas/adenocarcinomas that affect the ethmoidal nasal shells induced by a retrovirus. Lymphomas in the caprine species are rare in the Northeastern semi-arid, but that in the present diagnostic routine occasionally occurs, being important the first description of its nasal shape for its inclusion in the differential diagnoses of diseases that present with clinical obstruction and dyspnea for the species. Keywords: hematopoietic neoplasia, immunophenotyping, lymphocytes, dyspnea. Descritores: neoplasia hematopoietica, imunofenotipagem, linfocitos, dispneia. Titulo: Linfoma de celulas T na cavidade nasal de caprino.

Resumen: El término colestasis se refiere a la retención de ácidos biliares ya sea dentro del hepatocito o en los ductos biliares de cualquier calibre. Por laboratorio, se define por la elevación de fosfatasa alcalina arriba de 1.67 veces su valor normal. Las enfermedades colestásicas pueden asociarse a un proceso inflamatorio de la glándula hepática que provoca destrucción de los hepatocitos (hepatitis), a ictericia (coloración amarillenta de piel y mucosas asociada a elevación en niveles séricos de bilirrubinas) o ambas, aunque estos tres conceptos no deben considerarse sinónimos. Los padecimientos colestásicos pueden clasificarse como intra o extrahepáticos dependiendo de su etiología, y esto es importante para elegir los estudios diagnósticos adecuados y la terapéutica indicada en cada uno de los casos. Una historia clínica completa, aunada a exploración física exhaustiva y estudios iniciales básicos como el ultrasonido hepático y las pruebas de funcionamiento del hígado, pueden ayudar al clínico a decidir el camino a seguir al enfrentarse al paciente con colestasis. La Asociación Mexicana de Hepatología, la Asociación Mexicana de Gastroenterología y la Asociación Mexicana de Endoscopia Gastrointestinal decidieron trabajar en el primer posicionamiento científico mexicano sobre este tema. Abstract: The term cholestasis refers to bile acid retention, whether within the hepatocyte or in the bile ducts of any caliber. Biochemically, it is defined by a level of alkaline phosphatase that is 1.67-times higher than the upper limit of normal. Cholestatic diseases can be associated with an inflammatory process of the liver that destroys hepatocytes (hepatitis), with jaundice (yellowing of the skin and mucus membranes, associated with elevated serum bilirubin levels), or with both, albeit the three concepts should not be considered synonymous. Cholestatic diseases can be classified as intrahepatic or extrahepatic, depending on their etiology. Knowing the cause of the condition is important for choosing the adequate diagnostic studies and appropriate treatment in each case. A complete medical history, together with a thorough physical examination and basic initial studies, such as liver ultrasound and liver function tests, aid the clinician in deciding which path to follow, when managing the patient with cholestasis. In a joint effort, the Asociación Mexicana de Hepatología (AMH), the Asociación Mexicana de Gastroenterología (AMG) and the Asociación Mexicana de Endoscopia Gastrointestinal (AMEG) developed the first Mexican scientific position statement on said theme.

Considering the context of Computer Science, chatbots are computer programs that use Artificial Intelligence techniques to simulate human behavior in dialogues. The use of chatbots applied to the health area has been growing, especially in scenarios for dealing with pandemics, such as COVID-19, as they help to avoid the burden of face-to-face care. Thus, this article proposes a systematic review of the work carried out in this line of research. After the review, it was found which technologies, strategies and frameworks are most used in recent times, as well as which specific areas of health are having more focus on the use of chatbots.

Perovskite solar cells (PSCs) are one of the most prominent photovoltaic technologies. However, PSCs still encounter great challenges of scaling up from laboratorial cells to industrial modules without serious performance loss while maintaining excellent long-term stability, owing to the resistive losses and extra instability factors that scale quadratically with the device area. Here, we manifest a concept of multifunctional interface modulation for highly efficient and stable perovskite solar modules (PSMs). The advisably designed multifunctional interface modulator GO/QD crosslinks the CsPbBr3 perovskite quantum dots (QDs) on the conductive graphene oxide (GO) surfaces, which significantly improve charge transport and energy band alignment at the perovskite/hole transporting layer interface to reduce the charge transport resistance while passivating the surface defects of the perovskite to inhibit carrier recombination resistive losses. Moreover, the GO/QD interlayer acts as a robust permeation barrier that modulates the undesirable interfacial ion and moisture diffusion. Consequently, we adopt a scalable vacuum flash-assisted solution processing (VASP) method to achieve a certified stabilized power output efficiency of 17.85% (lab-measured champion efficiency of 18.55%) for the mini-modules. The encapsulated PSMs achieve over 90% of their initial efficiency after continuous operation under 1 sun illumination and the damp heat test at 85 °C, respectively. This journal is, The authors acknowledge financial from the National Natural Science Foundation of China (21875081, 91733301, and 51972251), the Chinese National 1000-Talent-Plan program, the Foundation of State Key Laboratory of Coal Conversion (Grant No. J18-19-913), and the Frontier Project of the Application Foundation of Wuhan Science and Technology Plan Project (2020010601012202).

This study aims to analyze the improvement of the operational performance of Indonesia’s Soekarno-Hatta Airport train through service quality which is mediated by train passenger loyalty and passenger satisfaction. The main problems in this study are the use of the same railway for long-distance train, airport train, and commuter Line train, the limited use of airport railway with four schedules, the headway which becomes 30 minutes since the number of travels becomes 82 trips, and the tariff being applied now is considered as burdening the passengers. The research method uses a quantitative analysis approach with the technique of Structural Equation Modeling-Lisrel. Data collection is done through observation and questionnaire distribution. The respondents are 306 passengers of trains heading for Soekarno-Hatta Airport. The benefit of this study for the domestic railway company is that by improving service quality, passenger loyalty and satisfaction, it will improve the operational performance of airport trains. The result of this research indicates the significant influence of service quality variable on passenger loyalty through passenger satisfaction, the significant influence of service quality variable on operational performance through passenger satisfaction and passenger loyalty as well as the significant influence of passenger satisfaction variable on operational performance through passenger loyalty.

The adoption of IoT for smart health applications is a relevant tool for distributed and intelligent automatic diagnostic systems. This work proposes the development of an integrated solution to monitor maternal and fetal signals for high-risk pregnancies based on IoT sensors, feature extraction based on data analytics, and an intelligent diagnostic aid system based on a 1-D convolutional neural network (CNN) classifier. The fetal heart rate and a group of maternal clinical indicators, such as the uterine tonus activity, blood pressure, heart rate, temperature, and oxygen saturation are monitored. Multiple data sources generate a significant amount of data in different formats and rates. An emergency diagnostic subsystem is proposed based on a fog computing layer and the best accuracy was 92.59% for both maternal and fetal emergency. A smart health analytics system is proposed for multiple feature extraction and the calculation of linear and nonlinear measures. Finally, a classification technique is proposed as a prediction system for maternal, fetal, and simultaneous health status classification, considering six possible outputs. Different classifiers are evaluated and a proposed CNN presented the best results, with the F1-score ranging from 0.74 to 0.91. The results are validated based on the diagnosis provided by two specialists. The results show that the proposed system is a viable solution for maternal and fetal ambulatory monitoring based on IoT.

Background The rotator cuff surgery (RCS) incidence is rising rapidly in North America, Europe, Asia, and Australia. Despite this, multiple factors limit patients’ access to surgery. In Latin America, barriers to orthopedic surgery have been largely ignored. The purpose of this study was to calculate the rate of RCS in Chile between 2008 and 2018, investigating possible associated factors to access such as age, sex, and the health insurance. Methods An ecological study was carried out with nationwide data obtained from the Database of Hospital Discharges of the Department of Statistics. All Chilean inhabitants aged 25 years or more were included. We used the ICD-10 codes M751, M754, and S460. The annual incidence rate of surgeries and the incidence rate for the period studied per 100,000 inhabitants were calculated. Data were analyzed stratified by age, sex, year of study, and the health insurance. Negative binomial regression was used to compare rates. Statistical analyzes were performed with Stata v.14 software. Results 39,366 RCSs were performed, with a total rate for the period of 32.36 per 100,000 inhabitants. The annual rate of surgeries from 2008 to 2018 increased from 24.55 to 49.11 per 100,000/year. When adjusting for year, an annual increase in surgery rates of 8.19% (95% CI 6.7–9.6) and 101% growth between 2008 and 2018 (95% CI 90–109%, p < 0.001) was observed. When comparing the global rates according to the health insurance, the public system corresponds to 21.3 per 100,000 and the private system to 72 per 100,000, the latter being 3.4-times higher (95% CI 2.7–4.4; p < 0.001). Conclusion RCS rates are increasing in Chile concordantly with previous reports of other western countries. The most important factor associated with RCS rate found was the patients’ health insurance, with higher rates observed for the private sector.

Data on the prevalence and mortality of paediatric sepsis in resource-poor settings are scarce. We aimed to assess the prevalence and in-hospital mortality of severe sepsis and septic shock treated in paediatric intensive care units (PICUs) in Brazil, and risk factors for mortality.We performed a nationwide, 1-day, prospective point prevalence study with follow-up of patients with severe sepsis and septic shock, using a stratified random sample of all PICUs in Brazil. Patients were enrolled at each participating PICU on a single day between March 25 and 29, 2019. All patients occupying a bed at the PICU on the study day (either admitted previously or on that day) were included if they were aged 28 days to 18 years and met the criteria for severe sepsis or septic shock at any time during hospitalisation. Patients were followed up until hospital discharge or death, censored at 60 days. Risk factors for mortality were assessed using a Poisson regression model. We used prevalence to generate national estimates.Of 241 PICUs invited to participate, 144 PICUs (capacity of 1242 beds) included patients in the study. On the day of the study, 1122 children were admitted to the participating PICUs, of whom 280 met the criteria for severe sepsis or septic shock during hospitalisation, resulting in a prevalence of 25·0% (95% CI 21·6-28·8), with a mortality rate of 19·8% (15·4-25·2; 50 of 252 patients with complete clinical data). Increased risk of mortality was associated with higher Pediatric Sequential Organ Failure Assessment score (relative risk per point increase 1·21, 95% CI 1·14-1·29, p0·0001), unknown vaccination status (2·57, 1·26-5·24; p=0·011), incomplete vaccination status (2·16, 1·19-3·92; p=0·012), health care-associated infection (2·12, 1·23-3·64, p=0·0073), and compliance with antibiotics (2·38, 1·46-3·86, p=0·0007). The estimated incidence of PICU-treated sepsis was 74·6 cases per 100 000 paediatric population (95% CI 61·5-90·5), which translates to 42 374 cases per year (34 940-51 443) in Brazil, with an estimated mortality of 8305 (6848-10 083).In this representative sample of PICUs in a middle-income country, the prevalences of severe sepsis or septic shock and in-hospital mortality were high. Modifiable factors, such as incomplete vaccination and health care-associated infections, were associated with greater risk of in-hospital mortality.Fundação de Amparo à Pesquisa do Estado de São Paulo and Conselho Nacional de Desenvolvimento Científico e Tecnológico.For the Portuguese translation of the abstract see Supplementary Materials section.

Stable isotopes are an important tool to assess livestock diet in binary mixtures of C3-C4 forages. However, the use of stable isotopes to trace livestock diet using tropical arboreal legumes has been limited. The objective of this study was to evaluate the use of 13C stable isotopes to identify the proportions of grass (C4) and legume in sheep diet, when consuming various inclusion levels. We evaluated models correlating faecal δ13C to diet δ13C and inferred which model can better predict the different proportions of grass or legume consumed by sheep. Thirty male lambs (17 ± 1.3 kg) were used, and the experiment was set up in a randomised complete block design with body weight being the criteria for blocking. Treatments included various inclusion levels of Sabiá (Mimosa caesalpiniifolia Benth) in signalgrass (Urochloa decumbens Stapf) hay (100:0, 75:25, 50:50, 25:75 e 0:100%). Total faecal production and in vivo digestibility were calculated, as well as δ13C of diet and faecal samples. Sabia diet (100%) showed the greatest overall intake, and the lowest faecal production was observed when forages were fed alone, both for signalgrass or sabia hays, with 234 and 245 g dry matter animal−1 d−1. The models used within this study estimated with high accuracy the grass-legume proportions within the diets of sheep (R2=0.97). Our results indicate that using additional coefficients (digestibility, discrimination) did not increase the accuracy of the models, since using only isotopes from faeces was sufficient to predict the contribution of C3 or C4 species in the diet.Highlights Stable isotopes are an efficient tool to trace back dietary sources in binary mixtures of C3-C4 forages. Faecal samples are accurate to use to trace back dietary changes using stable isotopes. Addition of digestibility and isotope discrimination coefficients did not improve prediction models.

In December of 2019, there was an outbreak of a severe acute respiratory syndrome caused by the coronavirus 2 (SARS-CoV-2 or COVID-19) in China. The virus rapidly spread into the whole world causing an unprecedented pandemic and forcing governments to impose a global quarantine, entering an extreme unknown situation. The organizational consequences of quarantine/isolation are absence of organized training and competition, lack of communication among athletes and coaches, inability to move freely, lack of adequate sunlight exposure, and inappropriate training conditions. The reduction of mobility imposed to contain the advance of the SARS-Cov-2 pandemic can negatively affect the physical condition and health of individuals leading to muscle atrophy, progressive loss of muscle strength, and reductions in neuromuscular and mechanical capacities. Resistance training (RT) might be an effective tool to counteract these adverse consequences. RT is considered an essential part of an exercise program due to its numerous health and athletic benefits. However, in the face of the SARS-Cov-2 outbreak, many people might be concerned with safety issues regarding its practice, especially in indoor exercise facilities, such as gyms and fitness centers. These concerns might be associated with RT impact in the immune system, respiratory changes, and contamination due to equipment sharing and agglomeration. In this current opinion article, we provide insights to address these issues to facilitate the return of RT practices under the new logistical and health challenges. We understand that RT can be adapted to allow its performance with measures adopted to control coronavirus outbreak such that the benefits would largely overcome the potential risks. The article provides some practical information to help on its implementation.

Background Targeted therapy with BRAF and MEK inhibitors has improved the survival of patients with BRAF-mutated metastatic melanoma, but most patients relapse upon the onset of drug resistance induced by mechanisms including genetic and epigenetic events. Among the epigenetic alterations, microRNA perturbation is associated with the development of kinase inhibitor resistance. Here, we identified and studied the role of miR-146a-5p dysregulation in melanoma drug resistance. Methods The miR-146a-5p-regulated NFkB signaling network was identified in drug-resistant cell lines and melanoma tumor samples by expression profiling and knock-in and knock-out studies. A bioinformatic data analysis identified COX2 as a central gene regulated by miR-146a-5p and NFkB. The effects of miR-146a-5p/COX2 manipulation were studied in vitro in cell lines and with 3D cultures of treatment-resistant tumor explants from patients progressing during therapy. Results miR-146a-5p expression was inversely correlated with drug sensitivity and COX2 expression and was reduced in BRAF and MEK inhibitor-resistant melanoma cells and tissues. Forced miR-146a-5p expression reduced COX2 activity and significantly increased drug sensitivity by hampering prosurvival NFkB signaling, leading to reduced proliferation and enhanced apoptosis. Similar effects were obtained by inhibiting COX2 by celecoxib, a clinically approved COX2 inhibitor. Conclusions Deregulation of the miR-146a-5p/COX2 axis occurs in the development of melanoma resistance to targeted drugs in melanoma patients. This finding reveals novel targets for more effective combination treatment. Graphical Abstract

BackgroundSteroid use for coronavirus disease 2019 (COVID-19) is based on the possible role of these drugs in mitigating the inflammatory response, mainly in the lungs, triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to evaluate the efficacy of methylprednisolone (MP) among hospitalized patients with suspected COVID-19.MethodsA parallel, double-blind, placebo-controlled, randomized, Phase IIb clinical trial was performed with hospitalized patients aged ≥18 years with clinical, epidemiological, and/or radiological suspected COVID-19 at a tertiary care facility in Manaus, Brazil. Patients were randomly allocated (1:1 ratio) to receive either intravenous MP (0.5 mg/kg) or placebo (saline solution) twice daily for 5 days. A modified intention-to-treat (mITT) analysis was conducted. The primary outcome was 28-day mortality.ResultsFrom 18 April to 16 June 2020, 647 patients were screened, 416 were randomized, and 393 were analyzed as mITT, with 194 individuals assigned to MP and 199 to placebo. SARS-CoV-2 infection was confirmed by reverse transcriptase polymerase chain reaction in 81.3%. The mortality rates at Day 28 were not different between groups. A subgroup analysis showed that patients over 60 years old in the MP group had a lower mortality rate at Day 28. Patients in the MP arm tended to need more insulin therapy, and no difference was seen in virus clearance in respiratory secretion until Day 7.ConclusionsThe findings of this study suggest that a short course of MP in hospitalized patients with COVID-19 did not reduce mortality in the overall population.Clinical Trials RegistrationNCT04343729.

Resumen Objetivo Los objetivos principales son describir la practica de la ventilacion mecanica en un periodo de 18 anos en Mexico y estimar los cambios en la mortalidad de los pacientes criticos con ventilacion mecanica invasiva (VMI). Diseno Subanalisis retrospectivo de un estudio prospectivo y observacional en 1998, 2004, 2010 y 2016. Ambito Unidades de Cuidados Intensivos (UCI) de Mexico. Participantes Pacientes adultos que ingresaron consecutivamente en la UCI, durante un mes y que recibieron VMI durante mas de 12 h o ventilacion mecanica no invasiva durante mas de una hora. El seguimiento se realizo hasta 28 dias despues de la inclusion. Intervenciones Ninguna. Variables de interes Edad, sexo, gravedad al ingreso estimada por el SAPS II, parametros de la gasometria arterial diaria, variables de tratamiento y complicaciones, fecha y estado al alta de la UCI y del hospital. Resultados Se incluyo a 959 pacientes en 81 UCI. El volumen corriente (VC) ha disminuido significativamente tanto en pacientes con criterios de SDRA (de 8,5 ml/kg de peso estimado en 1998 a 6 ml/kg en 2016; p Conclusiones La practica clinica de la VMI en las UCI de Mexico se ha modificado a lo largo de un periodo de 18 anos. El cambio mas significativo es la estrategia ventilatoria basada en VC bajos. Estos cambios no se han asociado a cambios significativos en la mortalidad.

Objective The main study objectives were to describe the practice of mechanical ventilation over an 18-year period in Mexico, and estimate changes in mortality among critical patients subjected to invasive mechanical ventilation (IMV). Design A retrospective subanalysis of a prospective observational study conducted in 1998, 2004, 2010 and 2016 was carried out. Setting Intensive Care Units (ICUs) in Mexico. Participants Adult patients consecutively enrolled in the ICU during one month and who underwent IMV for more than 12 h or noninvasive mechanical ventilation for more than one hour. Follow-up was performed up to a maximum of 28 days after inclusion. Interventions None. Principal variables of interest Age, sex, severity upon admission as estimated by SAPS II, parameters of daily arterial blood gases, treatment and complication variables, date and status at discharge from the ICU and from hospital. Results A total of 959 patients were included in 81 ICUs. Tidal volume (vt) decreased significantly both in patients with acute respiratory distress syndrome (ARDS) criteria (estimated 8.5 mL/kg b.w. in 1998 to 6 mL/kg in 2016; P Conclusions The clinical practice of IMV in Mexican ICUs has been modified over a period of 18 years. The most significant change is the ventilatory strategy based on low vt. These changes have not been associated with significant changes in mortality.

Introduction: Children with neuromotor changes are challenged daily, and such challenges may be faced with the help of a caregiver. Thus, the functional dependence of these children lead to the daily demands, causing physical and emotional distress, which affect the quality of life of their caregiver. Objective: Analyze the sociodemographic indicators that interfere with the level of life quality of the caregivers of children with neuromotor changes. Method: 50 caregivers of children with neuromotor changes were interviewed at the Association of Parents and Friends of the Exceptional (APAE) of Paraiba, on the city of João Pessoa. To evaluate the quality of life, the questionnaire SF-36 was used, in addition to collecting demographic data (sex, age, degree of kinship, marital status, number of children, school level and religion). For the data analysis, a descriptive study was developed, the normality test of Shapiro-Wilk was realized, followed by the inferential analysis with non-parametric correlation of Spearman, considering the significant value α = 0.05. Results: There was a predominance of the female sex (96%) with medium age of ≥ 39 years old. Correlating the sociodemographic indicators with the level of life quality of the SF-36 of the caregivers, only the vitality domain presented significance with the variables: number of children (p=0.012), benefits (p=0.044), and how the transfer of the child is done (p=0.044). There was no significant difference relating the sociodemographic indicators on the other domains. Conclusion: The knowledge of sociodemographic indicators that interfere with the quality of life shows the importance of preventive measures, such as guidance and, if needed, treatment for improvement of possible grievances.

Purpose: Skeletal muscle mass (SMM) depletion and sarcopenia as predictors of postoperative complications and poorer overall survival (OS) have been validated in many surgical fields through cross-sectional imaging (CT, MRI), with potential limitations. We evaluated it in a stage III–IV head and neck squamous cell carcinoma (HNSCC) surgical cohort through ultrasound (US) of rectus femoris muscle (RF), a quick, cheap, repeatable alternative. Methods: Patients submitted to surgical treatment with curative purpose were recruited and prospectively evaluated through clinical, biometric, biochemical, surgical, pathological and functional prognosticators and with preoperative US of RF with regards to 30-day complications and OS. Results: Forty-seven patients completed the study. RF cross-sectional area (RF-CSA) was used to identify patients with low SMM (CSA ≤ 0.97cm2: 18/47, 38.3%). RF-CSA was lower in complicated cases (0.95 ± 0.48 vs 1.41 ± 0.49cm2; p = 0.003), remaining the only independent predictor of postoperative complications at multivariate analysis, with a model including ASA score and modified Frailty index (OR 9.84; p = 0.004). SMM depletion significantly impaired OS (13.6 ± 2.9 vs 26.3 ± 2.1months; p = 0.017), being its only independent prognosticator at multivariate Cox regression analysis (OR 4.42; p = 0.033). Conclusion: RF-CSA, evaluated with US, seems a reliable method for identification of patients with low SMM in a stage III–IV HNSCC cohort, defining a subset at high-risk of 30-day complications and poorer OS.

Jogos tornam o ensino-aprendizado mais dinâmico e poucos trabalhos sobre o ensino de bioquímica na educação superior com auxílio de jogos são publicados. Neste trabalho objetivou-se conhecer a perspectiva docente sobre jogos no ensino-aprendizagem em bioquímica. A metodologia seguiu viés qualitativo com entrevista a oito professores de bioquímica nos cursos Ciências da Saúde, Ciências Biológicas e Ciências Agrárias de Instituições de Ensino Superior reconhecidas pelo Ministério da Educação. Quatro professores entrevistados não conheciam jogos como ferramenta didática. Contudo, os que utilizaram os jogos relataram melhora na compreensão dos estudantes e maior participação tornando o processo prazeroso. Portanto, são necessários investimentos em produtos e métodos facilitem o ensino-aprendizagem. Jogos são importantes para viabilizar experiências prazerosas e enriquecedoras no ensino de bioquímica.

The aim of this study was to compare two different maximal intensity exercise modality training protocols of similar durations on muscle strength, cardiorespiratory fitness, and lower limb composition in recreationally trained men. Twenty-five trained men (28.9 ± 5.6 years) were randomly divided into Cycle ergometer (4 sets of 30 seconds sprints) and Leg press (4 sets of 10-12 repetitions to momentary failure). Both groups trained three times a week for 5 weeks. Before and after the training period, the participants performed a 10-repetition maximum (10RM) test for knee extension, an incremental exercise test on a treadmill for time to exhaustion (TTE) and peak oxygen consumption (V˙O2peak) and underwent dual energy X-ray absorptiometry to assess lower limb composition. Knee extension 10RM and TTE increased in both groups with no statistically significant between group (p = 0.614 and p = 0.210). Only cycle ergometer group increased V˙O2peak (p= 0,012). For all lower limb composition outcomes, changes were minimal. The results suggest that 5 weeks of effort and duration matched exercise protocols using cycle ergometer training or leg press may produce similar strength adaptations.

Introdução: A COVID-19 é uma afecção de alta transmissibilidade e, a cada dia, é notório o aumento de infecções bacterianas secundárias, bem como a presença de microrganismos que apresentam fenótipos críticos de resistência aos antimicrobianos em pacientes acometidos por essa doença. Objetivo: Analisar a prevalência de fenótipos críticos de resistência antimicrobiana em pacientes acometidos pela COVID-19 em uma unidade hospitalar situada em Aracaju/SE. Metodologia: Trata-se de um estudo epidemiológico, retrospectivo, com delineamento transversal, referente à prevalência de microorganismos e à ocorrência de fenótipos bacterianos críticos isolados a partir de culturas de vigilância de swabs retais em pacientes acometidos pela COVID-19. Resultados: Das 1140 amostras de swab retal destinadas à pesquisa de fenótipos críticos de resistência (FCR) apresentaram-se positivas 328 (28,8%). Quanto à distribuição de positividade, 40% dos pacientes eram positivos para COVID-19 e 27,3% negativos. Conclusão: Evidenciou-se que houve um aumento na frequência de swabs retais destinados à cultura de vigilância positiva para microrganismos com fenótipos críticos de resistência após o início da pandemia por COVID-19. Quanto ao microrganismo predominante, a Escherichia coli foi a prevalente, sobretudo a produtora do fenótipo de resistência ESBL. Os resultados obtidos no presente trabalho sugerem que possivelmente a terapia antimicrobiana empírica aplicada em paciente acometidos pela COVID-19 tenha contribuído para uma seletividade de microrganismos e aumento de FCR.

This article addresses cooperativism in the context of family farming, based on the experience of the Cooperativa Mista de Agricultores Familiares do Vale do Ipanema (COOPANEMA) based in the municipality of Águas Belas, Pernambuco, Brazil. This is a reflection on the importance of COOPANEMA for local social and economic development. We used qualitative and descriptive methodology supported by case studies, interviews, and documentary and bibliographic surveys. The cooperative maintains a participative management, with good administrative quality, thanks to its specialized accounting, technical and legal assistance. We conclude that COOPANEMA is a socially consolidated institution, regarded as a reference in cooperative management, acting in the execution of actions and occupying seats in forums, municipal and regional public policy councils, thus contributing to local development.

Lesbian women experience situations of discrimination and prejudice that require them to constantly negotiate the disclosure of their sexual orientation. The quality of this negotiation can post either a positive or negative effect on their mental health. The present study aimed to characterize outness profiles in lesbian women. Profile differences were verified according to sociodemographic as well as health care access data. An anonymous self-applicable instrument was used to perform an online study in the year of 2019 with 1146 women who self-identified as lesbian and that lived in Brazil in the year before data collection. Participants responded instruments concerning sociodemographic and health care access data, internalized homophobia, general outness, and distress levels. Through cluster analytic method, four outness profiles were identified: Functional Outness (n = 328; 28,62%), Functional Concealment (n = 273; 23,83%), Dysfunctional Outness (n = 385; 33,60%), and Dysfunctional Concealment (n = 160, 13,96%). Functionality was determined by low levels of distress. Differences were observed among cluster groups with regard to their socio-demographic and health care access data. It is argued that the differences (sociodemographic as well as health care access data) observed among the four cluster groups interfere in the way lesbian women negotiate disclosure which, in turn, alters the effect of outness and internalized homophobia in their mental health. Brazilian studies involving outness especially in lesbian women are incipient. Health professionals need to be aware of the influence of outness in the health care of lesbian women. This awareness should be introduced in academic formation and endorsed through professional updating.

BackgroundDried plasma spot specimens may be a viable alternative to traditional liquid plasma in field settings, but the diagnostic accuracy is not well understood.MethodsStandard databases (PubMed and Medline), conferences, and gray literature were searched until January 2019. The quality of evidence was evaluated using the Standards for Reporting Studies of Diagnostic Accuracy and Quality Assessment of Diagnostic Accuracy Studies-2 criteria. We used univariate and bivariate random effects models to determine misclassification, sensitivity, and specificity across multiple thresholds, overall and for each viral load technology, and to account for between-study variation.ResultsWe identified 23 studies for inclusion in the systematic review that compared the diagnostic accuracy of dried plasma spots with that of plasma. Primary data from 16 of the 23 studies were shared and included in the meta-analysis, representing 18 countries, totaling 1847 paired dried plasma spot:plasma data points. The mean bias of dried plasma spot specimens compared with that of plasma was 0.28 log10 copies/mL, whereas the difference in median viral load was 2.25 log10 copies/mL. More dried plasma spot values were undetectable compared with plasma values (43.6% vs. 29.8%). Analyzing all technologies together, the sensitivity and specificity of dried plasma spot specimens were >92% across all treatment failure thresholds compared and total misclassification

El síndrome respiratorio agudo severo por coronavirus (SARS-CoV-2) ha generado una pandemia que ha requerido ajustes significativos en los sistemas de salud mundiales, tanto a nivel hospitalario como ambulatorio. Para patologías crónicas no transmisibles, como las oncológicas, esta pandemia ha tenido repercusiones importantes especialmente a nivel primario de atención. Se ha afectado el manejo oncológico integral, desde la detección precoz, el tratamiento, los exámenes de control y el seguimiento de los pacientes. Entre ellos destaca la disminución, a nivel mundial, del número de procedimientos diagnósticos digestivos, de imágenes, citológicos, quirúrgicos, de tratamiento sistémico, consultas e interconsultas oncológicas. Diversas organizaciones han recopilado cifras de ello y han proyectado cifras de como la disminución de diagnóstico oportuno o el retraso y/o interrupción del tratamiento repercutirán en un aumento de la morbimortalidad. Por ello, han elaborado guías de recomendaciones para minimizar el riesgo de contagio por coronavirus, para retomar a la brevedad el nivel de atención. Esta revisión ejemplifica el impacto de la pandemia de COVID-19 en el manejo habitual de los pacientes con patologías oncológicas, lo que permitirá dimensionar su efecto, así como delinear un plan multidisciplinario de recuperación y puesta al día en el manejo integral de los pacientes oncológicos.

BACKGROUND There are concerns that Asian patients respond differently to some medications. This study evaluated the efficacy and safety of evolocumab among Asian vs. other subjects in the FOURIER trial, which randomized stable atherosclerosis patients to receive either evolocumab or placebo.Methods and Results:Effects of adding evolocumab vs. placebo to background statin therapy on low-density lipoprotein cholesterol (LDL-C) reductions, cardiovascular outcomes, and adverse events were compared among 27,564 participants with atherosclerotic disease, according to self-reported Asian (n=2,723) vs. other (n=24,841) races followed for a median of 2.2 years in the FOURIER trial. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. At randomization, Asians had slightly lower LDL-C (median 89 [IQR 78-104] mg/dL vs. 92 [80-109] mg/dL; P

O estudo tem como objetivo evidenciar a necessidade de construção de propostas educativas que discutam o lugar do negro na sociedade brasileira e sua relação intrínseca com as determinações sociais de saúde, no contexto da pandemia da Covid-19. Trata-se de um relato de experiência da primeira turma do Curso de Atualização em Cuidado à Saúde da População Negra, desenvolvido pela Escola de Saúde Pública da Bahia Professor Jorge Novis (ESPBA), em parceria com a Diretoria de Gestão do Cuidado (DGC). O referido curso nasceu da necessidade de investir na implementação da política voltada para esse segmento social. No processo de estruturação do curso, foram realizadas reuniões com atores sociais relevantes, potenciais docentes, escolhidos pela aproximação com a temática e experiência com movimentos e causas sociais. No âmbito do SUS, as Escolas de Governo são responsáveis pelos processos formativos dos trabalhadores da saúde, sob a perspectiva da educação permanente. A inserção da temática da saúde da população negra nos currículos trabalhados se tornou imagem-objetivo a ser alcançada pela instituição, não apenas a partir dos cursos desenvolvidos, mas também com a realização de um estudo piloto para enfrentamento da Covid-19 em comunidades quilombolas do estado. Reconhecendo o racismo como um dos determinantes sociais do processo de adoecimento e morte, defende-se que gestores e profissionais de saúde tenham acesso a ações educativas que oportunizem a reflexão sobre os processos sócio-históricos de construção da nossa sociedade, ampliem o conhecimento sobre a saúde da população negra e a importância do preenchimento do quesito raça/cor em todos os protocolos da rede SUS.

Introducao: O transtorno de estresse pos-traumatico (TEPT) e caracterizado por um conjunto de reacoes associadas a uma memoria do evento traumatico. Ser admitido em uma UTI pode gerar experiencias emocionais estressantes e traumaticas, por ser algo inesperado e pela vivencia de ameaca de morte. Objetivo: Caracterizar o TEPT derivado de internacao em UTI, mostrando que a doenca e realmente prevalente, associando a possiveis causas e fatores de risco, e se confirmada, o que fazer para mudar este quadro. Metodo: Realizou-se uma revisao de literatura integrativa nas bases de dados digitais do LILACS, Medline e o SciELO. Os termos escolhidos foram: "posttraumatic stress disorder" e "intensive care" juntamente com o operador booleano "AND". Assim, foram selecionados 17 artigos que se enquadraram nos criterios de inclusao estabelecidos e apresentaram uma tematica pertinente. Resultados: Dos estudos analisados, os indices de prevalencia foram bastante variaveis. Ao analisar a amostra de todas as pesquisas e separar a quantidade de pacientes que estiveram internados em UTI por pelo menos 2 dias e que teriam preenchidos os criterios propostos na metodologia, os estudos apontam que 23,13% dos pacientes apresentaram sintomas e um possivel diagnostico de TEPT. Alguns fatores presentes nos estudos estiveram associados a maior incidencia de TEPT na populacao estudada, incluindo pacientes com idade avancada, sexo feminino, solteiros, desempregados e com a presenca comorbidades. Alem disso, o tempo de internacao maior que sete dias, tempo de ventilacao mecânica maior que dois dias, uso de opioides para sedacao, agitacao psicologica na UTI, interrupcao do uso de benzodiazepinicos durante a hospitalizacao, choque septico e hipoxia tambem foram citados. Conclusao: Mesmo com um indice elevado de prevalencia na populacao, o TEPT, em geral, ainda se encontra subdiagnosticado e banalizado pelas equipes de saude. Quando se fala em TEPT e UTI e que se pode perceber essa negligencia e falta de informacao, pois nao ha muitas pesquisas nem algum tipo de guia ou protocolo que fornecam informacoes aos profissionais de saude.

Aims: To evaluate the mandibular bone cortical of patients with mucopolysaccharidosis on panoramic radiograph, through radiomorfometric indices. Study Design: Case-control study. Place and Duration of Study: Sample: Department of Diagnostic Imaging of the Universidade Estadual da Paraíba, Campus VIII, in the city of Araruna, PB, between January and December of 2015. Methodology: Panoramic radiographs of sixteen patients with mucopolysaccharidosis and 32 controls, organized by gender and age, composed the sample. The mandibular panoramic index, gonial index, antegonial index and mental index were evaluated. Pearson's Chi-square test, Fisher's exact test and Mann-Whitney test were used to statistical analysis with a level of significance of 5.0%. Results: Mucopolysaccharidosis patients were mostly female (62.5%), with a mean age of 12.31 + 7.16 years, MPS VI (50.0%) being the most prevalent. Patients with mucopolysaccharidosis had higher values in the gonial (1.86+0.48), the antegonical (4.36+1.24) and the mental (5.24+1.21). However, only the antegoniac index presented a significant difference (P=0.047). Conclusion: The antegoniac index was higher in patients with mucopolysaccharidosis and the other radiomorphometric measures were similar to those observed in the control group. Apparently, mucopolysaccharidosis is not related to decreased bone to mandibular quality.

BACKGROUND: The current environmental issue that concerns us all is the use of peatland for oil palm plantations. This damages the peatland ecosystem, even though peatland are very important in the hydrological system of the downstream area of a watershed. One of the impacts of the destruction of the peat ecosystem is the occurrence of flooding in the downstream watershed. In addition, if forest and peatland fires occur, it will cause CO2 emissions, thereby disrupting public health. AIM: The purpose of this research is to develop the concept of environmental health. The focus of this research is improving environmental health in communities on peatlands. METHODS: The research method used was qualitative where data collection was done through interviews, observation, and documentation. RESULTS: The findings of this study are that the research location is dominated by oil palm plantations which have a negative impact on public health. CONCLUSION: Based on these findings, the development of the concept of environmental health is the interaction between the environment, economy, society, and society to improve the quality of life.

Background: Fluoxetine (FLX) represents the antidepressant of choice for the management of pediatric mood-related illnesses. Accumulating preclinical evidence suggests that ontogenic FLX exposure leads to deregulated affect-related phenotypes in adulthood. Mood-related symptomatology constitutes a risk-factor for various neurological disorders, including Alzheimer’s disease (AD), making it possible for juvenile FLX history to exacerbate the development of neurodegenerative diseases. Objective: Because AD is characterized by the pathological accumulation of hyperphosphorylated tau, which can result from impaired function of protein degradation pathways, such as autophagy and the ubiquitin-proteasome system (UPS), we evaluated the long-term effects of adolescent FLX exposure on these pathways, using mice as a model system. Methods: We subjected C57BL/6 adolescent male mice to FLX (20 mg/kg/day) from postnatal day (PD) 35 to PD49. Twenty-one days after the last FLX injection (i.e., adulthood; PD70), mice were euthanized and, using immunoblotting analysis, we evaluated protein markers of autophagy (Beclin-1, LC3-II, p62) and the UPS (K48-pUb), as well as AD-associated forms of phosphorylated tau, within the hippocampus and prefrontal cortex. Results: Juvenile FLX pre-exposure mediated long-term changes in the expression of protein markers (increased LC3-II and decreased p62) that is consistent with autophagy activation, particularly in the prefrontal cortex. Furthermore, FLX history induced persistent accumulation of AD-associated variants of tau in both the hippocampus and prefrontal cortex Conclusion: Adolescent FLX treatment may have enduring effects in the neuronal protein degradation machinery, which could adversely influence clearance of abnormal proteins, potentially predisposing individuals to developing AD in later life.

The results of evaluating the effectiveness of the use of kumis treatment in 64 patients who have had pneumonia associated with the novel coronavirus infection COVID-19 are presented. It was found that the use of kumis treatment in addition to the basic complex in 32 patients of the main group has led to an increase in exercise tolerance by 13.6 % (p < 0,05), a decrease in the severity of shortness of breath by 36.3 % (p < 0.05), and contributed to the improvement of the parameters of the function of external respiration with an increase in the vital capacity of the lungs by 14,4 % (p < 0,05), the volume of forced expiration — by 24,5 % (p < 0,05). Against the background of kumis treatment, the patients of the main group showed a significant decrease in the severity of depression and anxiety — by 62.5 % (p < 0.05) and by 62.3 % (p < 0,05), respectively, an improvement in the parameters of «well-being» by 62,2 % (p < 0.05), «activity» — by 37,6 % (p < 0,05), «mood» — by 35,5 % (p < 0,05), compared to the initial values. The dynamics of parameters in the patients of the control group against the background of the basic complex turned out to be less significant in comparison with the main group.

Prematurity of birth can interfere in the mother's relationship with her baby, with risks of establishing psychic failures. So, this research sought to analyze how the maternal function can be affected by the conditions of premature birth of the baby and by the therapeutic itinerary in a neonatal referral unit for the Kangaroo Method. 06 mothers of preterm babies participated. Open interviews were conducted, using the conceptual operators of the protocol axes of the Research on Clinical Risk Indicators for Child Development (IRDI) as guides.The study was submitted to the Ethics Committee in resolution 466/12. In content analysis, the following thematic categories emerged: “Repercussions of premature birth in the mother's subjectivity” and “About time and support networks”. It was understood that the waiting time for the hospitalization of the preterm child can work for the mother as a time for psychic re-elaboration. The support networks and transfer attenuared the obstacles established in the mother-infant relationship, thus protecting maternal-infant mental health.

Introduction: The prognosis of chronic heart failure (CHF) is determined by the complex relationship of neurohormonal, mechanical and polyorgan pathological changes emerging in the course and progression of the disease. Objective: To assess the risk and rate of rehospitalisation due to decompensation of chronic heart failure (CHF) in relation to certain biologic, clinical and instrumental characteristics. Material and Methods: This study conducted in the Department of Cardiology, Community Based Medical College & Hospital, Bangladesh. Prospective study on 228 consecutive CHF patients. The follow-up period was 12 to 24 months. The primary endpoint was rehospitalization due to HF decompensation. The risk values were calculated using the Cox regression models. Results: Median survival time was 8 months. The total number of rehospitalizations was 86 (37.7%). Rehospitalization risk values were insignificantly lower in women (HR 0.7, 95% CI 0.4-1.1, р >0.05) and higher in older age groups (HR 1.4 95% CI 0.8-2.2, р>0.05). Univariate regression analysis showed a higher rehospitalization risk in patients with survived myocardial infarction, clinical signs of CHF, high functional class and pulmonary pressure. Multivariate regression analyses revealed the leading role of functional class on rehospitalization risk. Conclusion: rehospitalization rates due to decompensation of CHF are high. Age and gender are insignificant predictors for rehospitalization in our study. Functional class is the prognostic factor with an independent effect on rehospitalization risk over the defined follow-up period among the examined group of patients.

Summary Introduction Sarcopenia is a muscle disease that is associated with a decline in muscle strength and function. When this condition coexists with sarcopenia, it is characterized as sarcopenic obesity (OS), and is associated with worse outcomes of physical functions. The aim of this study was to investigate sarcopenia in obesity and its relationship with body composition in young adults with grade II and grade III obesity. Methods Analytical, cross-sectional study. Volunteers of both sexes were selected, aged between 20 and 59 years, and who had a BMI ≥35 kg/m2 with the presence of comorbidities or BMI> 40 kg/m2. Body composition was measured by dual-energy X ray absorptiometry (DEXA). The following parameters of sarcopenia included handgrip strength (HGS), chair stand, appendicular skeletal muscle mass (ASM), ASM adjusted by weight and ASM adjusted by BMI; HGS adjusted by ASM and gait speed. Results 108 volunteers, of both sexes, with a mean age of 43, ±11.7 years, were evaluated. 2% had dinapenia and 33% low leg muscle strength. The prevalence of sarcopenia varied between 11.1% and 13.9%, corresponding to the confirmatory criteria of low muscle quantity and low muscle quality, respectively, particularly affecting middle-aged women. We found a reduction in HGS by ASM with an increase in BMI and fat mass (kg) in both age groups, being significant among middle-aged adults (40–59 years). Conclusion Even with young adults, we observed changes in all parameters with a negative impact on strength, mass and muscle function. Muscle quality can be considered an important risk factor for functional disability and should be considered in the assessment of sarcopenia. The results show the need to standardize criteria for the assessment of sarcopenia in young adults with severe obesity, since the prevalence differed widely.

Purpose This case report aimed to investigate the effects of supervised home-based resistance training (RT) on functional capacity and mental health on a man with idiopathic peripheral polyneuropathy (PP). Method A 50-year-old man diagnosed with PP with no previous experience in RT performed 24 session of home-based RT for 12 weeks. Resistance training consisted of 3 exercises performed with 3 sets and lasted approximately 30 min per session. Exercises were performed with minimal implements (e.g., elastic tubes and light dumbbells). The Patient was evaluated for muscle performance, functionality, anxiety levels, and depressive symptoms before and after intervention period. Muscle performance was evaluated though 30-s push up test (PU30), functional capacity was evaluated through functional tests [sit to stand test (SST), arm curl (AC), and 2-min step test (2-MST)] and anxiety levels and depressive symptoms were evaluated through the State-Trait Anxiety Inventory (STAI) and Beck's depression inventory (BDI), respectively. Results After 12 weeks, the performance on PU30 increased 40% (from 8 to 11 repetitions), while the performance on SST, AC and 2-MST increased 100% (from 4 to 8 repetitions), 44% (from 16 to 23 repetitions) and 157% (from 47 to 121 repetitions), respectively. Anxiety state and trait levels have been reduced 24% (from 42 to 32 scores) and 4% (from 47 to 45 scores), respectively. There was no change for BDI. Conclusion Supervised home-based RT using low cost and affordable equipment was a feasible strategy to provide functional capacity and mental health benefits in a patient with PP.

In 2018, 22,000,000 Brazilian women experienced some type of violence (either physical or psychological), and 42% of these episodes occurred in the domestic environment. Therefore, government strategies have been developed to solve this problem. This study aimed to (a) carry out a survey of Brazilian government strategies for the protection of women after the creation of the Maria da Penha Law (Law No. 11.340, 2006) and (b) discuss these strategies from the concept of cultural design. Sixteen laws, five decrees, and two ordinances were found and analyzed. In a general way, the analysis suggests that they are not effective cultural plans because most do not show long-term results, and some of the laws that typify crimes and those that relate to the aggressor’s behavior do not specify the target behaviors, so there is no explicit contingency. Despite this, such strategies are relevant, as they end up providing the protective context for women from a social, legal, and political point of view. Finally, it is expected that the discussions raised in the present work can help prepare interventions that favor socially beneficial cultural practices.

Information production is key to the efficiency of financial markets. Does selling information separately improve its production? We investigate this question using MiFID II, a European regulation that unbundles research from transactions. We show that unbundling causes fewer research analysts to cover a firm. This decrease does not come from small- or mid-cap firms but is concentrated in large firms. Surprisingly, the reduction in analyst coverage is accompanied by a decrease in forecast error. Further analyses suggest that analyst competition enhancement could drive the results: inaccurate analysts drop out, and analysts who stay produce more accurate research.

Background The aim was to verify the prevalence of vaccination coverage, tendency and factors of the third dose of the vaccine against diphtheria, tetanus and pertussis-DTP3 in surveys over the period of 25 years in a state of the Northeast of Brazil. Methods Cross-sectional and temporal series, utilizing ad hoc database, were extracted from the Health and Nutrition State Research 1991, 1997, 2006 and 2015/2016. Children from 12 to 23 months of age with proof in the vaccination card were included. The vaccination coverage (outcome) of each year was calculated, the tendency throughout the period was analyzed and the associations through Pearson chi-squared were tested. The results of the first and last survey were compared with a significance level of 5%. The reasons of the crude prevalence and confidence intervals of 95% were estimated. Results The vaccination coverage in 1991, 1997, 2006 and 2015/2016 was 77.6%, 82.7%, 89.7% and 72.9%, respectively, with an increasing tendency from 1991 to 2006 (p

Most cases of thyroid carcinoma are classified as low risk. These lesions have been treated with open surgery, remote access thyroidectomy, active surveillance, and percutaneous ablation. However, there is lack of consensus and clear indications for a specific treatment selection. The objective of this study is to review the literature regarding the indications for management selection for low-risk carcinomas. Systematic review exploring inclusion and exclusion criteria used to select patients with low-risk carcinomas for treatment approaches. The search found 69 studies. The inclusion criteria most reported were nodule diameter and histopathological confirmation of the tumor type. The most common exclusions were lymph node metastasis and extra-thyroidal extension. There was significant heterogeneity among inclusion and exclusion criteria according to the analyzed therapeutic approach. Alternative therapeutic approaches in low-risk carcinomas can be cautiously considered. Open thyroidectomy remains the standard treatment against which all other approaches must be compared.

Objetivo: analisar o conhecimento da equipe de saúde da Unidade de Terapia Intensiva de adulto sobre protocolo de morte encefálica e manutenção do potencial doador de órgãos e tecidos para transplantes. Método: estudo transversal, observacional, analítico desenvolvido na unidade de terapia intensiva adulto, de um hospital de alta complexidade do Nordeste brasileiro, no período de julho a setembro de 2019. A amostra foi de conveniência, formada por 22 profissionais, enfermeiros, médicos e fisioterapeutas. Resultados: a maioria apresentou conhecimento adequado sobre os procedimentos necessários para abertura do protocolo de morte encefálica, entretanto, não sabe quais profissionais têm competência para abertura do protocolo, desconhece quando deve ser iniciado o processo de manutenção do potencial doador de órgãos, apresentaram déficit de conhecimentos sobre suas atribuições. Conclusão: identificamos a necessidade de capacitação da equipe de saúde sobre o protocolo de morte encefálica, doação de órgãos e tecidos, com foco na manutenção do potencial doador.

The purpose was to analyze the learning processes in virtual education in students of a university in Huacho, 2020, where two categories have been considered: virtual education and skills in the context of this health emergency. From the qualitative approach, the population made up of university students was studied and the effectiveness of virtual education was obtained as a result, considered as a means of interaction between students and teachers despite the limitations: internet access, saturation of the university platform and greater teacher training in the use of technological tools. The category of competencies shows the ignorance of students about generic competences and specific competences, for which it is necessary to reinforce virtual education in the accompaniment and training of teachers and students.

Con el objetivo de describir cómo es la gestión por procesos en el marco de la Modernización de la Gestión Pública, se eligió a la Defensoría del Pueblo para realizar un estudio de caso. A través de entrevistas aplicadas a expertos en el modelo normativo vigente, se abordaron una serie de preguntas para poder analizar los objetivos específicos relacionados a los conocimientos especializados que debe de reunir un especialista, a la metodología aplicada según la Norma Técnica N° 001-2018-SGP/PCM, a los elementos relevantes para el diseño de los procesos, a las actividades de control aplicadas para el seguimiento y evaluación, a los mecanismos aplicados para la mejora y finalmente, a los medios utilizados para la difusión de los procesos. Se concluyó que, el modelo es laborioso y eficaz pero las entidades públicas no lo aplican de acuerdo a la normativa vigente, dejando un vacío en la gestión. La gestión por procesos se da manera paulatina y su aplicación en el estado se encuentra en un proceso de conocimiento y madurez; y que, con la necesidad de modernizar la gestión pública, los procesos toman mayor relevancia para implementar nuevos sistemas de mejora que impacten en la calidad de los servicios públicos.