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Abstract Inflammation may play a significant role in Keratoconus (KC), but the relationship between inflammatory markers and choroidal thickness (CT) is unknown. The purpose of this study was to evaluate serum inflammatory markers and correlate them with the choroidal profile of KC patients and control subjects. Forty patients with KC and 26 age-matched control subjects were enrolled in a cross-sectional case–control study. Choroidal profile was studied with a Spectralis Heidelberg apparatus and venous blood samples were collected. Neutrophil/lymphocyte ratio (NLR), monocyte/HDL ratio (MHR), platelet/lymphocyte ratio (PLR) and systemic immune inflammation index (SII) were calculated. Serum inflammatory biomarkers IL-1, IL-6 and TNF-alfa were also analyzed. KC group presented thicker choroids in each evaluated point when compared to the control group (subfoveal CT 417.38 ± 79.79 vs 299.61 ± 76.13, p

Abstract Fungal strains used in the biocontrol of animal gastrointestinal parasites have been mainly isolated from pasture soil, decaying organic matter, and feces from herbivores and carnivores. However, their isolation from birds and assessment of predatory activity against avian GI parasites has been scarce thus far. This research aimed to isolate filamentous fungi from avian fecal samples and evaluate their predatory activity against coccidia. A pool of 58 fecal samples from chickens, laying hens, and peacocks, previously collected between July 2020-April 2021, were used for isolation of filamentous fungi and assessment of their in vitro predatory activity against coccidian oocysts, using Water-Agar medium and coprocultures. The Willis-flotation technique was also performed to obtain concentrated suspensions of oocysts. A total of seven Mucor isolates was obtained, being the only fungal taxa identified, and all presented lytic activity against coccidia. Isolates FR3, QP2 and SJ1 had significant coccidiostatic efficacies (inhibition of sporulation) higher than 70%, while isolates FR1, QP2 and QP1 had coccidicidal efficacies (destruction of the oocysts) of 22%, 14% and 8%, respectively, after 14 days of incubation, being a gradual and time-dependent process. To our knowledge, this is the first report regarding the isolation of native predatory fungi from avian feces and demonstration of their lytic activity against coccidia.

ABSTRACT Bisphosphonates (BPs) are medications widely used in clinical practice to treat osteoporosis and reduce fragility fractures. Its beneficial effects on bone tissue have been consolidated in the literature for the last decades. They have a high affinity for bone hydroxyapatite crystals, and most bisphosphonates remain on the bone surface for a long period of time. Benefits of long-term use of BPs: Large and important trials (Fracture Intervention Trial Long-term Extension and Health Outcomes and Reduced Incidence with Zoledronic acid Once Yearly-Pivotal Fracture Trial) with extended use of alendronate (up to 10 years) and zoledronate (up to 6 years) evidenced significant gain of bone mineral density (BMD) and vertebral fracture risk reduction. Risks of long-term use of BPs: The extended use of antiresorptive therapy has drawn attention to two extremely rare, although severe, adverse events. That is, atypical femoral fracture and medication-related osteonecrosis of the jaw are more common in patients with high cumulative doses and longer duration of therapy. BPs have demonstrated safety and effectiveness throughout the years and evidenced increased BMD and reduced fracture risks, resulting in reduced morbimortality, and improved quality of life. These benefits overweight the risks of rare adverse events.

Abstract The prescription of psychotropic drugs has been rising in Europe over the last decade. This study provides a comprehensive profile of prepandemic consumption patterns of antidepressant, antipsychotic, and anxiolytic drugs in Portugal considering full nationwide psychotropic drug prescription and dispensing records (2016–2019) against several criteria, including active ingredient, sociodemographics, medical specialty, and incurred costs. An increase of 29.6% and 34.7% in the consumption of antipsychotics and antidepressants between 2016 and 2019 is highlighted, accompanied by an increase of 37M Eur in total expenditure (> 20M Eur in public copay) for these classes of drugs. Disparities in sociodemographic and geographical incidence are identified. Amongst other pivotal results, 64% of psychotropic drug prescriptions are undertaken by general practitioners, while only 21% undertaken by neurological and psychiatric specialties. Nationwide patterns of psychotropic drug prescription further reveal notable trends and determinants, establishing a reference point for cross-regional studies and being currently assessed at a national level to establish psychosocial initiatives and guidelines for medical practice and training.

Abstract Sjögren's Syndrome (SjS) is a chronic systemic immune-mediated inflammatory disease characterized by lymphocytic infiltration and consequent lesion of exocrine glands. SjS diagnosis and classification remains a challenge, especially at SjS onset, when patients may have milder phenotypes of the disease or uncommon presentations. New biomarkers are needed for the classification of SjS, thus, we aimed to evaluate the added-value of lymphocyte subpopulations in discriminating SjS and non-Sjögren Sicca patients. Lymphocyte subsets from 62 SjS and 63 Sicca patients were characterized by flow cytometry. The 2002 AECG and the 2016 ACR/EULAR SjS classification criteria were compared with clinical diagnosis. The added discriminative ability of joining lymphocytic populations to classification criteria was assessed by the area under the Receiver-Operating-Characteristic Curve (AUC). Considering clinical diagnosis as the gold-standard, we obtained an AUC = 0.952 (95% CI: 0.916–0.989) for AECG and an AUC = 0.921 (95% CI: 0.875–0.966) for ACR/EULAR criteria. Adding Tfh and Bm1 subsets to AECG criteria, performance increased, attaining an AUC = 0.985 (95% CI: 0.968–1.000) (p = 0.021). Th1/Breg-like CD24hiCD27+ and switched-memory B-cells maximized the AUC of ACR/EULAR criteria to 0.953 (95% CI: 0.916–0.990) (p = 0.043). Our exploratory study supports the potential use of lymphocyte subpopulations, such as unswitched memory B cells, to improve the performance of classification criteria, since their discriminative ability increases when specific subsets are added to the criteria.

Abstract This work proposes a new class of explainable prognostic models for longitudinal data classification using triclusters. A new temporally constrained triclustering algorithm, termed TCtriCluster, is proposed to comprehensively find informative temporal patterns common to a subset of patients in a subset of features (triclusters), and use them as discriminative features within a state-of-the-art classifier with guarantees of interpretability. The proposed approach further enhances prediction with the potentialities of model explainability by revealing clinically relevant disease progression patterns underlying prognostics, describing features used for classification. The proposed methodology is used in the Amyotrophic Lateral Sclerosis (ALS) Portuguese cohort (N = 1321), providing the first comprehensive assessment of the prognostic limits of five notable clinical endpoints: need for non-invasive ventilation (NIV); need for an auxiliary communication device; need for percutaneous endoscopic gastrostomy (PEG); need for a caregiver; and need for a wheelchair. Triclustering-based predictors outperform state-of-the-art alternatives, being able to predict the need for auxiliary communication device (within 180 days) and the need for PEG (within 90 days) with an AUC above 90%. The approach was validated in clinical practice, supporting healthcare professionals in understanding the link between the highly heterogeneous patterns of ALS disease progression and the prognosis.

Abstract This study aimed to evaluate, in vitro, the use of leaf extracts of Azadirachta indica (A. indica) and Melia azedarach (M. azedarach) as antivirals against caprine lentivirus (CLV) in colostrum and milk of goat nannies. These were collected from eight individuals and infected with the standard strain of CLV. Samples were then subdivided into aliquots and treated with 150 µg/mL of crude extract, and with ethyl acetate and methanol fractions for 30, 60, and 90 min. Next, somatic cells from colostrum and milk were co-cultured with cells from the ovine third eyelid. After this step, viral titers of the supernatants collected from treatments with greater efficacy in co-culture were assessed. The organic ethyl acetate fractions of both plants at 90 min possibly inhibited the viral activity of CLV by up to a thousandfold in colostrum. In milk, this inhibition was up to 800 times for the respective Meliaceae. In conclusion, the ethanolic fraction of ethyl acetate from both plants demonstrated efficacy against CLV in samples from colostrum and milk when subjected to treatment, which was more effective in colostrum.

O objetivo deste estudo é analisar a morbimortalidade materna de mulheres atendidas em hospitais do Sistema Único de Saúde (SUS) no Município do Rio de Janeiro, Brasil, no período de 2014 a 2016. Foi realizado estudo ecológico, por meio da coleta de dados do Sistema de Informações sobre Nascidos Vivos (SINASC), Sistema de Informação sobre Mortalidade (SIM) e Sistema de Informações Hospitalares (SIH/SUS). Para analisar a razão de mortalidade materna (RMM), foram utilizados dados do SIM. Para investigar a morbidade materna, adotaram-se critérios da Organização Mundial da Saúde para estimar as razões de near miss materno e de condições potencialmente ameaçadoras à vida. Dados do SINASC foram usados para número de nascidos vivos e caracterização demográfica, social e de acesso a serviço de pré-natal. Para avaliar a associação espacial entre os indicadores RMM, razões de near miss materno e condições potencialmente ameaçadoras à vida e os indicadores demográficos, sociais, obstétricos e de acesso obtidos no SINASC, foi calculado o índice de Moran bivariado com nível de 0,05 de significância, por meio do programa GeoDa. No período analisado, a RMM no Município do Rio de Janeiro foi de 94,16/100 mil nascidos vivos, a razão de near miss materno de 28,21/1.000 nascidos vivos e a razão de condições potencialmente ameaçadoras à vida de 34,31/1.000 nascidos vivos. Casos de condições potencialmente ameaçadoras à vida foram utilizados pela primeira vez neste estudo e apresentaram diagnósticos de internação e procedimentos realizados mais condizentes com o perfil de mortalidade materna no Município do Rio de Janeiro. Houve associação significativa entre RMM e percentual de nascidos vivos no SUS, razão de condições potencialmente ameaçadoras à vida e percentual de nascidos vivos no SUS e razão de condições potencialmente ameaçadoras à vida e ser solteira.

Resumo: Estudo transversal, de base hospitalar, nacional, com entrevista de 23.894 puérperas, em 2011-2012, com os objetivos de estimar a prevalência de consumo de álcool na gestação e identificar grupos mais vulneráveis. O uso de álcool na gestação foi identificado por meio da escala TWEAK, sendo classificadas como “diagnóstico presumível de uso inadequado de álcool” mulheres com pontuação ≥ 2. Calculou-se a prevalência nacional de uso de álcool e em subgrupos de acordo com características maternas, com respectivos intervalos de 95% de confiança (IC95%). Foram encontradas, de forma gráfica, coexistência de tabagismo, inadequação de consultas pré-natais e ingestão de bebidas alcoólicas na gestação. A prevalência de uso de álcool foi de 14% (IC95%: 13,3-14,7), com 10% (IC95%: 9,3-10,6) das mulheres apresentando diagnóstico presumível de uso inadequado de álcool na gestação. Maiores prevalências de uso de álcool e de diagnóstico presumível de uso inadequado foram observadas em mulheres pretas, com 12-19 anos de idade, com menor índice de escolaridade, de classe econômica mais baixa, sem companheiro, sem trabalho remunerado, com mais de três partos anteriores, que não queriam engravidar, com assistência pré-natal inadequada, com parto em serviços públicos e que referiram tabagismo na gestação. Estima-se que 1,2% das mulheres entrevistadas apresentavam concomitância dos três fatores de risco para desfechos perinatais negativos: fumo, álcool e assistência pré-natal inadequada. Os resultados demonstraram alta prevalência de uso de álcool na gestação e de diagnóstico presumível de uso inadequado, principalmente por mulheres em situação de vulnerabilidade social. São relevantes a elaboração de políticas públicas que contemplem ações de prevenção do uso de bebidas alcoólicas e a prestação de serviços de apoio para cessação do uso de álcool na gravidez.

Abstract The aim of this research was to analyze pregnancy incidence and associated factors in a cohort of 753 women living with HIV/AIDS (WLWHA) in Rio de Janeiro, Brazil, from 1996 to 2016. Women aged 18-49 years who were not on menopause (surgical or natural) and did not have a tubal ligation were eligible for the study. Data were collected by medical professionals during initial and follow-up visits. Person-time pregnancy incidence rates were calculated throughout the follow-up period. Pregnancy incidence-associated factors were investigated by univariate and multiple analyzes, using an extension of the Cox survival model. Follow-up visits recorded 194 pregnancies, with an incidence rate of 4.01/100 person-years (95% CI: 3.47; 4.60). A higher pregnancy incidence was associated with CD4 nadir ≥ 350 cells/mm³, use of an antiretroviral regimen not containing Efavirenz, and prior teenage pregnancy. In turn, women with a viral load ≥ 50 copies/mL, age ≥ 35 years old, with two or more children and using a highly effective contraceptive method showed a lower incidence. Results showed a significant reduction in pregnancy incidence after 2006, a significant reduction in female sterilization from 1996 to 2016, and a high rate of cesarean sections. The association found between pregnancy incidence and the use of contraceptive methods and virological control markers suggests a good integration between HIV/AIDS and reproductive health services. The high rate of cesarean section delivery indicates the need to improve childbirth care.

Enquadramento: A infeção pelo Vírus da Imunodeficiência Humana (VIH) constitui um problema de saúde pública. O Enfermeiro de Família desempenha um papel significativo na Prevenção e Controlo da Infeção (PCI). Objetivo: Analisar a auto perceção dos enfermeiros face às competências que detêm na PCI por VIH e a sua relação com a formação na área. Metodologia: Estudo quantitativo e descritivo-correlacional. Amostra selecionada a partir dos enfermeiros de família da Administração Regional de Saúde do Norte que aceitaram participar no estudo. Utilizou-se um formulário que integrou a ECAPC-VIH_CSP. Recorreu-se à estatística descritiva e inferencial através do IBM SPSS Statistics, versão 25.0. Resultados: Os enfermeiros apresentaram um nível medio (M = 4,44 ± 1,24) de auto perceção de competências na PCI por VIH. Os enfermeiros com formação específica apresentam maior perceção da competência. Conclusão: Os resultados evidenciam um nível medio de competências na PCI por VIH auto percebidas pelos enfermeiros. Conclui-se da necessidade da formação dos enfermeiros para o desenvolvimento das competências para a qualidade e segurança na PCI por VIH.

A síndrome pós-trombótica (SPT) é uma complicação tardia da trombose venosa profunda (TVP) que surge em 20%- 50% dos doentes. A sua sintomatologia é causa de grande morbilidade e compromete a qualidade de vida dos doen- tes. Assim, a prevenção da SPT após um episódio de TVP é fundamental. Várias guidelines têm recomendado o uso de meias elásticas compressivas diariamente como forma de prevenção da SPT. Contudo, o ensaio SOX veio alterar este paradigma ao concluir que não existiu benefício no uso de meias compressivas. Desde então, vários estudos têm sido feitos nesta área, uma vez que o seu uso apresenta também algumas desvantagens como o preço e o desconforto. O objetivo desta revisão consiste em determinar a eficácia da utilização de meias elásticas compressivas na prevenção da SPT. Dos 16 artigos obtidos a partir das diferentes bases de dados, 8 foram incluídos na revisão narrativa. Fo- ram também incluídas guidelines internacionais sobre este tema, nomeadamente as European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Vários estudos apontam para a não redução da incidência de SPT com a utilização de terapêutica compressiva, enquanto outros continuam a sugerir benefícios com o seu uso. Os estudos analisados apresentam evidência muito contraditória, sendo controver- sa a recomendação do uso de meias compressivas na profilaxia do SPT. Uma limitação da presente revisão deve-se à heterogeneidade dos estudos. Assim, são necessários estudos de melhor qualidade, com amostras populacionais maiores e metodologias mais homogéneas, para que se possa concluir de forma inequívoca se existe ou não benefício na utilização das meias compressivas.

A síndrome pós-trombótica (SPT) é uma complicação tardia da trombose venosa profunda (TVP) que surge em 20%- 50% dos doentes. A sua sintomatologia é causa de grande morbilidade e compromete a qualidade de vida dos doen- tes. Assim, a prevenção da SPT após um episódio de TVP é fundamental. Várias guidelines têm recomendado o uso de meias elásticas compressivas diariamente como forma de prevenção da SPT. Contudo, o ensaio SOX veio alterar este paradigma ao concluir que não existiu benefício no uso de meias compressivas. Desde então, vários estudos têm sido feitos nesta área, uma vez que o seu uso apresenta também algumas desvantagens como o preço e o desconforto. O objetivo desta revisão consiste em determinar a eficácia da utilização de meias elásticas compressivas na prevenção da SPT. Dos 16 artigos obtidos a partir das diferentes bases de dados, 8 foram incluídos na revisão narrativa. Fo- ram também incluídas guidelines internacionais sobre este tema, nomeadamente as European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Vários estudos apontam para a não redução da incidência de SPT com a utilização de terapêutica compressiva, enquanto outros continuam a sugerir benefícios com o seu uso. Os estudos analisados apresentam evidência muito contraditória, sendo controver- sa a recomendação do uso de meias compressivas na profilaxia do SPT. Uma limitação da presente revisão deve-se à heterogeneidade dos estudos. Assim, são necessários estudos de melhor qualidade, com amostras populacionais maiores e metodologias mais homogéneas, para que se possa concluir de forma inequívoca se existe ou não benefício na utilização das meias compressivas.

A síndrome pós-trombótica (SPT) é uma complicação tardia da trombose venosa profunda (TVP) que surge em 20%- 50% dos doentes. A sua sintomatologia é causa de grande morbilidade e compromete a qualidade de vida dos doen- tes. Assim, a prevenção da SPT após um episódio de TVP é fundamental. Várias guidelines têm recomendado o uso de meias elásticas compressivas diariamente como forma de prevenção da SPT. Contudo, o ensaio SOX veio alterar este paradigma ao concluir que não existiu benefício no uso de meias compressivas. Desde então, vários estudos têm sido feitos nesta área, uma vez que o seu uso apresenta também algumas desvantagens como o preço e o desconforto. O objetivo desta revisão consiste em determinar a eficácia da utilização de meias elásticas compressivas na prevenção da SPT. Dos 16 artigos obtidos a partir das diferentes bases de dados, 8 foram incluídos na revisão narrativa. Fo- ram também incluídas guidelines internacionais sobre este tema, nomeadamente as European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Vários estudos apontam para a não redução da incidência de SPT com a utilização de terapêutica compressiva, enquanto outros continuam a sugerir benefícios com o seu uso. Os estudos analisados apresentam evidência muito contraditória, sendo controver- sa a recomendação do uso de meias compressivas na profilaxia do SPT. Uma limitação da presente revisão deve-se à heterogeneidade dos estudos. Assim, são necessários estudos de melhor qualidade, com amostras populacionais maiores e metodologias mais homogéneas, para que se possa concluir de forma inequívoca se existe ou não benefício na utilização das meias compressivas.

Objetivo: estudo objetivou descrever as representações sociais de pacientes católicos e analisar as implicações do seu imaginário para o processo saúde-doença. Método: estudo descritivo, com abordagem qualitativa. Realizado em um hospital oncológico, tendo como participantes pessoas autodeclaradas católicas. Utilizou-se entrevista semiestruturada e técnica de livre associação de palavras para coleta de dados. Resultados: emergiram três unidades temáticas: A representação da doença para cristões católicos; A religião católica como alicerce no processo de adoecimento; Representação da doença para católicos: enfermidades adquiridas por infringirmos as leis de Deus. Considerações finais: a religiosidade é parte significativa no cotidiano das pessoas e deve ser respeitada independente da crença do profissional.

Abstract Background and Aims Hepatitis C (HCV) programs face challenges, especially linked to key populations to achieve World Health Organization (WHO) goals of eliminating hepatitis. Médecins Sans Frontières and Mozambique's Ministry of Health first implemented HCV treatment in Maputo, in 2016 and harm reduction activities in 2017. Methods We retrospectively analyzed routine data of patients enrolled between December 2016 and July 2021. Genotyping was systematically requested up to 2018 and subsequently in cases of treatment failure. Sustainable virological response was assessed 12 weeks after the end of treatment by sofosbuvir‐daclatasvir or sofosbuvir‐velpatasvir. Results Two hundred and two patients were enrolled, with 159 (78.71%) males (median age: 41 years [interquartile range (IQR): 37.10, 47.00]). Risk factors included drug use (142/202; 70.29%). One hundred and eleven genotyping results indicated genotype 1 predominant (87/111; 78.37%). Sixteen patients presented genotype 4, with various subtypes. The people who used drugs and HIV coinfected patients were found more likely to present a genotype 1. Intention‐to‐treat analysis showed 68.99% (89/129) cure rate among the patients initiated and per‐protocol analysis, 88.12% (89/101) cure rate. Nineteen patients received treatment integrated with opioid substitution therapy, with a 100% cure rate versus 59.37% (38/64) for initiated ones without substitution therapy (p

N/a.

Introduction: Recently, simulation as an educational method has gained increasing importance in Medicine. However, medical education has favored the acquisition of individual knowledge and skills, while overlooking the development of teamwork skills. Since most errors in clinical practice are due to human factors, i.e., non-technical skills, the aim of this study was to assess the impact that training in a simulation environment has on teamwork in an undergraduate setting. Material and Methods: This study took place in a simulation center, with a study population of 23 participants, fifth year undergraduate students, randomly divided into teams of four elements. Twenty simulated scenarios of teamwork in the initial assessment and resuscitation of critically ill trauma patients were recorded. Video recordings were made at three distinct learning moments (before training, end of the semester, and six months after the last training), and a blinded evaluation was performed by two independent observers, who applied the Trauma Team Performance Observation Tool (TPOT). Additionally, the Team STEPPS Teamwork Attitudes Questionnaire (T-TAQ) was applied to the study population before and after the training to assess any change in individual attitudes towards non-technical skills. A 5% (or 0.05) significance level was considered for statistical analysis. Results: With a moderate level of inter-observer agreement (Kappa = 0.52, p = 0.002), there was a statistically significant improvement in the team's overall approach, evidenced by the TPOT scores (median of 4.23, 4.35 and 4.50, in the three time-points assessed, respectively, p = 0.003). In the T-TAQ, there was an improvement in non-technical skills, that was statistically significant for "Mutual Support” (median from 2.50 to 3.00, p = 0.010). Conclusion: In this study, incorporating non-technical skills education and training in undergraduate medical education was associated with sustained improvement in team performance in the approach to the simulated trauma patient. Consideration should be given to introducing non-technical skills training and teamwork in the emergency setting during undergraduate training.

BackgroundFood aesthetics influences affective dimensions (valence and arousal) and subsequent emotional and behavioural responses in images presented in more traditional form, almost rustic in some cases, to the signature dishes of haute cuisine. However, the visual impact of images of haute cuisine dishes on consumers' affective and emotional responses compared to traditional dishes is still understudied.MethodsWe recorded electrodermal activity, ocular movements and self-report affect of 35 volunteers while they performed a picture viewing paradigm using images of haute cuisine food, traditional food, and non-food. Additionally, the moderating role of age was examined.ResultsOur results showed that subjects had higher feelings of pleasure and arousal toward images of food (haute cuisine and traditional dishes) compared to non-food images. However, no difference in self-report affect, physiological and behavioural responses was found between haute cuisine and traditional dishes. Interestingly, a moderating effect of age was revealed, reporting that younger participants had greater feelings of pleasure and shorter eye-to-screen distance towards traditional food than haute cuisine.ConclusionsAs a whole, our findings suggest that food aesthetics could at least partially affect consumers' affective and emotional responses. Interestingly, physiological responses to food pictures seemed to be relatively independent of approach/avoidance motivational states, supporting the assumption that traditional visual restaurant menus with attractive images might be insufficient for eliciting intense positive emotions. This study also contributes to advancing the understanding of the role that age plays in emotional impact when images of haute cuisine dishes are presented to consumers.

Objetivo: caracterizar custo de curativo a vácuo como nova tecnologia em tratamentos de feridas em um hospital na região sul de Santa Catarina. Método: estudo de natureza quali-quantitativa, descritiva, composta por 12 prontuário eletrônico de paciente (PEP) do ano de 2020, realizada no mês de setembro de 2021. Resultados: nos PEP, foram encontrados 06 homens (50%) e 6 mulheres (50%) com idade que varia de 36 a 95 anos, sendo 08 deles(70%) idosos. Sendo que 09 destes apresentaram feridas em membros inferiores e 03 em outras regiões do corpo. O tempo de tratamento dos pacientes, variou de 6 a 28 dias. Discussões: o curativo a vácuo é efetivo diante feridas complexas, reduz o tempo de hospitalização do paciente, reduz o custo hospitalar para a instituição. Considerações finais: o paciente terá muitos benefícios com a utilização do curativo a vácuo, visto que diante desta pesquisa foram encontrados resultados positivos quando comparados o custo com seus benefícios.

ABSTRACT Several drugs are available for the treatment of osteoporosis in postmenopausal women. Over the last decades, most patients requiring pharmacological intervention were offered antiresorptive drugs as first-line therapy, while anabolic agents were considered a last resource for those with therapeutic failure. However, recent randomized trials in patients with severe osteoporosis have shown that anabolic agents reduce fractures to a greater extent than antiresorptive medications. Additionally, evidence indicates that increases in bone mineral density (BMD) are maximized when patients are treated with anabolic agents first, followed by antiresorptive therapy. This evidence is key, considering that greater increases in BMD during osteoporosis treatment are associated with a more pronounced reduction in fracture risk. Thus, international guidelines have recently proposed an individualized approach to osteoporosis treatment based on fracture risk stratification, in which the stratification risk has been refined to include a category of patients at very high risk of fracture who should be managed with anabolic agents as first-line therapy. In this document, the Brazilian Society of Endocrinology and Metabolism and the Brazilian Association of Bone Assessment and Metabolism propose the definition of very high risk of osteoporotic fracture in postmenopausal women, for whom anabolic agents should be considered as first-line therapy. This document also reviews the factors associated with increased fracture risk, trials comparing anabolic versus antiresorptive agents, efficacy of anabolic agents in patients who are treatment naïve versus those previously treated with antiresorptive agents, and safety of anabolic agents.

Background The order and orientation of genes encoded by animal mitogenomes are typically conserved, although there is increasing evidence of multiple rearrangements among mollusks. The mitogenome from a Brazilian brown mussel (hereafter named B1) classified as Perna perna Linnaeus, 1758 and assembled from Illumina short-length reads revealed an unusual gene order very different from other congeneric species. Previous mitogenomic analyses based on the Brazilian specimen and other Mytilidae suggested the polyphyly of the genus Perna. Methods To confirm the proposed gene rearrangements, we sequenced a second Brazilian P. perna specimen using the “primer-walking” method and performed the assembly using as reference Perna canaliculus. This time-consuming sequencing method is highly effective when assessing gene order because it relies on sequentially-determined, overlapping fragments. We also sequenced the mitogenomes of eastern and southwestern South African P. perna lineages to analyze the existence of putative intraspecific gene order changes as the two lineages show overlapping distributions but do not exhibit a sister relationship. Results The three P. perna mitogenomes sequenced in this study exhibit the same gene order as the reference. CREx, a software that heuristically determines rearrangement scenarios, identified numerous gene order changes between B1 and our P. perna mitogenomes, rejecting the previously proposed gene order for the species. Our results validate the monophyly of the genus Perna and indicate a misidentification of B1.

Introduction The WHO End-TB Strategy calls for the development of novel diagnostics to detect tuberculosis (TB) earlier and more accurately. Better diagnostics, together with tools to predict disease progression, are critical for achieving WHO End-TB targets. The Early Risk Assessment in TB Contacts by new diagnoStic tEsts (ERASE-TB) study aims to evaluate novel diagnostics and testing algorithms for early TB diagnosis and accurate prediction of disease progression among household contacts (HHCs) exposed to confirmed index cases in Mozambique, Tanzania and Zimbabwe.Methods and analysis A total of 2100 HHCs (aged ≥10 years) of adults with microbiologically-confirmed pulmonary TB will be recruited and followed up at 6-month intervals for 18–24 months. At each time point, a WHO symptom screen and digital chest radiograph (dCXR) will be performed, and blood and urine samples will be collected. Individuals screening positive (WHO symptom screen or dCXR) will be requested to provide sputum for Xpert MTB/Rif Ultra. At baseline, HHCs will also be screened for HIV, diabetes (HbA1c), chronic lung disease (spirometry), hypertension and anaemia. Study outcomes will be coprevalent TB (diagnosed at enrolment), incident TB (diagnosed during follow-up) or no TB at completion of follow-up. Novel diagnostics will be validated using fresh and biobanked samples with a nested case–control design. Cases are defined as HHCs diagnosed with TB (for early diagnosis) or with incident TB (for prediction of progression) and will be matched by age, sex and country to HHCs who remain healthy (controls). Statistical analyses will include assessment of diagnostic accuracy by constructing receiver operating curves and calculation of sensitivity and specificity.Ethics and dissemination ERASE-TB has been approved by regulatory and ethical committees in each African country and by each partner organisation. Consent, with additional assent for participants

Purpose: This study aimed to reflect on the challenges of Health Information Systems in Portugal at a time when technologies enable the creation of new approaches and models for care provision, as well as to identify scenarios that may characterize this practice in the future. Design/methodology/approach: A guiding research model was created based on an empirical study that was conducted using a qualitative method that integrated content analysis of strategic documents and semi-structured interviews with a sample of fourteen key actors in the health sector. Findings: Results pointed to the existence of emerging technologies that may promote the development of Health Information Systems oriented to “health and well-being” in a preventive model logic and reinforce the social and management implications. Originality/value: The originality of this work resided in the empirical study carried out, which allowed us to analyze how the various actors look at the present and the future of Health Information Systems. There is also a lack of studies addressing this subject. Research limitations/implications: The main limitations resulted from a low, although representative, number of interviews and the fact that the interviews took place before the pandemic, so the digital transformation that was promoted was not reflected. Managerial implications and social implications: The study highlighted the need for greater commitment from decision makers, managers, healthcare providers, and citizens toward achieving improved digital literacy and health. Decision makers and managers must also agree on strategies to accelerate existing strategic plans and avoid their implementation at different paces.

Toxoplasma gondii and Neospora caninum are apicomplexan protozoa of major concern in livestock and T. gondii is also considered one of the major threats and a public health concern. These protozoa have a wide range of intermediate hosts, including birds. The present work aimed to assess the prevalence of these cyst-forming parasites in migratory and sedentary birds of prey. The skeletal muscle and myocardium of 159 birds of prey from Central Italy, belonging to 19 species and recovered across 6 Wildlife Recovery Centers/Care structures along the Italian migratory route, were collected specifically for molecular (PCR) and for histopathological analysis to detect T. gondii and N. caninum. For the molecular analysis, genomic DNA was extracted. The DNA was tested by sequence typing, targeting GRA6, 529 bp repeated element, B1, PK1, BTUB, SAG2, alt.SAG2, and APICO genes for T. gondii and to end-point PCR targeting NC5 gene for N. caninum. Thirty-seven out of the one hundred and fifty-nine analyzed samples tested positive for T. gondii with a prevalence of 23.27% and nine for N. caninum, with a prevalence of 5.66%. Thirty-two sequences were obtained from the thirty-seven isolates of T. gondii. Among these, 26 presented alleles compatible with type I strain in 1 or more loci, 4 with type II strain and 2 consisted of atypical strains. Toxoplasma gondii genetic variability in birds of prey confirms previous findings of wildlife as reservoirs of atypical strains. Results from the histology showed few protozoal tissue cysts in skeletal muscle (n. 4) and hearts (n. 2).

Enquadramento: O Modelo Dinâmico de Avaliação e Intervenção Familiar é mobilizado no processo de ensino aprendizagem dos estudantes da licenciatura em enfermagem, como orientador no processo de cuidados às famílias na comunidade. Objetivo: Analisar as dimensões valorizadas pelos estudantes do curso de licenciatura em enfermagem, no desenvolvimento de competências na avaliação e intervenção familiar. Metodologia: Estudo exploratório-descritivo com 350 estudantes da licenciatura em Enfermagem. Uso de formulário para identificar aspetos valorizados na utilização do modelo referencial teórico e operativo em ensino clínico. Análise de conteúdo com categorização a priori e a posteriori. Cumpridos os pressupostos éticos. Resultados: Identificam-se cinco dimensões: Clareza (mais valorizada); Simplicidade; Generalidade; Consequências deriváveis (frequência de nomeação intermédia) e Precisão empírica (menos valorizada). Emerge interligação entre etapas do processo de cuidados e modelo como instrumento de mudança e referencial na tomada de decisão no contexto clínico. Conclusão: As dimensões confirmam a importância atribuída pelos estudantes à estrutura e sentido na aprendizagem dos cuidados à família sendo preditivas da aprendizagem integrada, entre teoria e prática em enfermagem.

Objective: The objective of this work was to quantify the number of scientific publications on technical nursing education over 20 years (1996-2016) and discuss them in light of the ecosystem paradigm. Methods: This integrative literature review with a descriptive-exploratory approach was performed using the following online databases: Biblioteca Virtual em Saúde (BVS) [Virtual Health Library], Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) [Latin American and Caribbean Health Sciences Literature], MEDLINE, and Índice Bibliográfico Espanhol de Ciências da Saúde (IBECS) [Health Sciences Spanish Bibliographical Index]. The sample consisted of five articles that were selected after applying inclusion and exclusion criteria. Descriptive statistical analysis was used to describe the selected articles. Collected data was subject to thematic content analysis. Results: The following category was elaborated: “The influence of the Cartesian model on technical nursing education”. Conclusion: There is an emerging need to rethink old paradigms and insert new conceptual perspectives on technical and vocational education to support the training of nurse technicians.

Objetivo: identificar o perfil dos pacientes acometidos com traumatismo cranioencefálico atendidas em um hospital público de Teresina. Método: Estudo descritivo, exploratório, retrospectivo, documental de abordagem quantitativa realizado em um hospital público de Teresina-PI. Os dados foram coletados no período set/out/ de 2016 e janeiro de 2017 por meio de pesquisa nos prontuários através do formulário elaborado pelas pesquisadoras. Resultados: Registraram-se 1603 internações com o diagnóstico de traumatismo cranioencefálico destes, 5,67% tiveram traumatismo cranioencefálico leve, 92,67% moderado e 1,67% grave. Houve predomínio da faixa etária de 18 a 29 anos, sexo masculino, solteiro e o ensino fundamental. Nesta busca, 19,33% dos pacientes foram a óbito. Conclusão: Conclui-se que o perfil do paciente acometido por trauma cranioencefálico, no hospital estudado, é caracterizado por um predomínio do sexo masculino com uma faixa etária de 19 a 29 anos, solteiros e com escolaridade de até o ensino fundamental.

Objectives Intracranial aneurysm consists of localized dilatation of the vascular wall. Its importance includes the fearsome event of rupture and subarachnoid hemorrhage, which presents high morbimortality rates. The present study aimed to analyze the profile and clinical outcome of patients submitted to the microsurgical approach of cerebral aneurysm in the city of Criciúma, state of Santa Catarina, Brazil, from 2015 to 2018. Methods A retrospective observational study was performed, with secondary data collection and a quantitative approach of 47 charts. Results A predominance of females (74.5%) and a mean age of 53 years old (53.53 ± 9.64) was observed. The middle cerebral artery was the most affected vessel (36.2%), with the highest percentage of aneurysms being between 2.1 mm and 7.0 mm (65.9%). There was a correlation between consciousness level and classification on the Hunt-Hess (HH) scale. Patients with Glasgow Coma Scale (GCS) > 7 points had a better prognostic score in the HH scale, and those with GCS ≤ 7 points had a worse prognostic score in the HH scale. Conclusions The present study observed the presence of important risk factors for cerebral aneurysm formation, such as gender, age, smoking, and systemic arterial hypertension. The present study can measure a correlation of the level of consciousness with the HH classification.

For the first time, the pharmacokinetic (PK) profile of tryptophanol-derived isoindolinones, previously reported as p53 activators, was investigated. From the metabolites’ identification, performed by liquid chromatography coupled to high resolution tandem mass spectrometry (LC-HRMS/MS), followed by their preparation and structural elucidation, it was possible to identify that the indole C2 and C3 are the main target of the cytochrome P450 (CYP)-promoted oxidative metabolism in the tryptophanol-derived isoindolinone scaffold. Based on these findings, to search for novel p53 activators a series of 16 enantiopure tryptophanol-derived isoindolinones substituted with a bromine in indole C2 was prepared, in yields of 62–89%, and their antiproliferative activity evaluated in human colon adenocarcinoma HCT116 cell lines with and without p53. Structural optimization led to the identification of two (S)-tryptophanol-derived isoindolinones 3.9-fold and 1.9-fold more active than hit SLMP53-1, respectively. Compounds’ metabolic stability evaluation revealed that this substitution led to a metabolic switch, with the impact of Phase I oxidative metabolism being minimized. Through differential scanning fluorimetry (DSF) experiments, the most active compound of the series in cell assays led to an increase in the protein melting temperature (Tm) of 10.39 °C, suggesting an effective binding to wild-type p53 core domain.

Infections caused by gastrointestinal parasites have been described worldwide as one of the most important issues impacting small ruminant production. The systematic administration of anthelmintic (AH) drugs without following good practice principles has led to an increase in anthelmintic resistance (AR). There is scarce information regarding AH efficacy in small ruminants in Portugal. This study aimed to characterize by in vivo methods the presence and level of AR in four farms in the region of Lisbon and Tagus Valley. All four farms kept small herds in extensive management systems and used different deworming protocols. The active substances used were fenbendazole and a combination of mebendazole plus closantel in a dosage according to the manufacturers’ instructions. On day 0 (T0), fecal samples were collected from all study animals, and animals in the treatment group (n = 40) were dewormed with the AH previously chosen by the assistant veterinarian. Animals in the control group (n = 30) did not receive any AH drug. The fecal sample collection was repeated on day 15 (T15), and the control group was treated. Egg counts were performed using the McMaster method for the eggs per gram (EPG), and AR was evaluated by the fecal egg count reduction test (FECRT) with a 95% confidence level (CL). The results from this experiment indicated that the four farms presented AR with two farms to fenbendazole (FECRT of 48% and 85%) and two farms to mebendazole plus closantel (FECRT of 66% and 79%). These results indicate that the gastrointestinal parasites of the four studied Portuguese farms are resistant to benzimidazoles, which suggests an increase in AR regarding nematodes in small ruminant production systems in Portugal.

Dogs and cats are potential sources of infection for some zoonotic diseases such as Q fever, caused by Coxiella burnetii, a multiple host pathogen. Q fever outbreaks in dogs and cats have been related with parturition and abortion events, and ticks have a potential role in the transmission of this pathogen. This study aimed to screen for C. burnetii in dogs and cats, and in ticks collected from infested animals. An observational descriptive study was conducted in Portugal at two time points nine years apart, 2012 and 2021. Sera obtained from dogs and cats (total n = 294) were tested for C. burnetii antibodies using a commercial ELISA adapted for multi-species detection. C. burnetii DNA was screened by qPCR assay targeting IS1111 in uterine samples and in ticks. A decrease in the exposure to C. burnetii was observed in cats from 17.2% (95% CI: 5.8–35.8%) in 2012 to 0.0% in 2021, and in dogs from 12.6% (95% CI: 7.7–19.0%) in 2012 to 1.7% (95% CI: 0.3–9.1%) in 2021 (p < 0.05). Overall, and despite differences in the samples, rural habitat seems to favour the exposure to C. burnetii. The DNA of C. burnetii was not detected in ticks. The low seropositivity observed in 2021 and the absence of C. burnetii DNA in the tested samples, suggest that dogs and cats from Portugal are not often exposed to the pathogen. Nevertheless, the monitoring of C. burnetii infection in companion animals is an important tool to prevent human outbreaks, considering the zoonotic potential for owners and veterinarians contacting infected animals, mainly dogs and cats from rural areas which often come into contact with livestock.

Under laboratory conditions, Triatoma rosai and T. sordida are able to cross and produce hybrids. In the face of climate and environmental changes, the study of hybrids of triatomines has evolutionary and epidemiological implications. Therefore, we performed morphological, cytological and molecular studies and characterized the feeding and defecation pattern of hybrids from crosses between T. sordida and T. rosai. The morphological characterization of the female genitalia of the hybrids showed that characteristics of both parental species segregated in the hybrids. Cytogenetic analyzes of hybrids showed regular metaphases. According to molecular studies, the mitochondrial marker Cytochrome B (CytB) related the hybrids with T. sordida and the nuclear marker Internal Transcribed Spacer 1 (ITS-1) related the hybrids with T. rosai. Both parents and hybrids defecated during the blood meal. Thus, the hybrids resulting from the cross between T. sordida and T. rosai presented segregation of phenotypic characters of both parental species, 100% homeology between homeologous chromosomes, phylogenetic relationship with T sordida and with T. rosai (with CytB and ITS-1, respectively), and, finally, feeding and defecation patterns similar to the parents.

New world cutaneous leishmaniasis (NWCL) is an anthropozoonosis caused by different species of the protozoan Leishmania. Colorimetric in situ hybridization (CISH) was shown to satisfactorily detect amastigote forms of Leishmania spp. in animal tissues, yet it was not tested for the diagnosis of human NWCL. The aim of this study was to compare CISH, histopathology (HP), and immunohistochemistry (IHC) techniques to diagnose NWCL in human cutaneous lesions. The sample comprised fifty formalin-fixed, paraffin-embedded skin biopsy specimens from patients with NWCL caused by L. (V.) braziliensis. These specimens were analyzed by CISH, using a generic probe for Leishmania, IHC, and HP to assess the sensitivity of these methods by using a parasitological culture as a standard reference. Additional specimens from three patients diagnosed with cutaneous mycoses were also included to evaluate cross-reactions between CISH and IHC. The sensitivities of IHC, CISH, and HP for detecting amastigotes was 66%, 54%, and 50%, respectively. IHC, unlike CISH, cross-reacted with different species of fungi. Together, these results demonstrate that CISH may be a complementary assay for the detection of amastigote in the laboratorial diagnosis routine of human NWCL caused by L. (V.) braziliensis.

Objetivo: analisar a literatura sobre intervenções para prevenção do comportamento suicida em universitários. Método: revisão integrativa realizada nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Web of Science, Medical Literature Analysis and Retrieval Sistem Online, Cummulative Index to Nursing and Allied Health Literature e SCOPUS, entre maio a julho de 2018, utilizando-se os descritores: ‘’estudantes’’, ‘’suicídio’’ e ‘’promoção da saúde’’. Resultados: seis artigos compuseram amostra, os quais 50% abordaram intervenções usando softwares ou links da internet, 16,6% metodologia tradicional e 33,3% intervenções tradicionais associadas às tecnológicas. Conclusão: intervenções para a prevenção do suicídio em universitários devem capacitar os sujeitos de modo acessível, consentâneas ao contexto onde universitários estão inseridos.

Objetivo: analisar a literatura sobre intervenções para prevenção do comportamento suicida em universitários. Método: revisão integrativa realizada nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Web of Science, Medical Literature Analysis and Retrieval Sistem Online, Cummulative Index to Nursing and Allied Health Literature e SCOPUS, entre maio a julho de 2018, utilizando-se os descritores: ‘’estudantes’’, ‘’suicídio’’ e ‘’promoção da saúde’’. Resultados: seis artigos compuseram amostra, os quais 50% abordaram intervenções usando softwares ou links da internet, 16,6% metodologia tradicional e 33,3% intervenções tradicionais associadas às tecnológicas. Conclusão: intervenções para a prevenção do suicídio em universitários devem capacitar os sujeitos de modo acessível, consentâneas ao contexto onde universitários estão inseridos.

Objetivo: identificar o perfil dos pacientes acometidos com traumatismo cranioencefálico atendidas em um hospital público de Teresina. Método: Estudo descritivo, exploratório, retrospectivo, documental de abordagem quantitativa realizado em um hospital público de Teresina-PI. Os dados foram coletados no período set/out/ de 2016 e janeiro de 2017 por meio de pesquisa nos prontuários através do formulário elaborado pelas pesquisadoras. Resultados: Registraram-se 1603 internações com o diagnóstico de traumatismo cranioencefálico destes, 5,67% tiveram traumatismo cranioencefálico leve, 92,67% moderado e 1,67% grave. Houve predomínio da faixa etária de 18 a 29 anos, sexo masculino, solteiro e o ensino fundamental. Nesta busca, 19,33% dos pacientes foram a óbito. Conclusão: Conclui-se que o perfil do paciente acometido por trauma cranioencefálico, no hospital estudado, é caracterizado por um predomínio do sexo masculino com uma faixa etária de 19 a 29 anos, solteiros e com escolaridade de até o ensino fundamental.

Objetivo: identificar o perfil dos pacientes acometidos com traumatismo cranioencefálico atendidas em um hospital público de Teresina. Método: Estudo descritivo, exploratório, retrospectivo, documental de abordagem quantitativa realizado em um hospital público de Teresina-PI. Os dados foram coletados no período set/out/ de 2016 e janeiro de 2017 por meio de pesquisa nos prontuários através do formulário elaborado pelas pesquisadoras. Resultados: Registraram-se 1603 internações com o diagnóstico de traumatismo cranioencefálico destes, 5,67% tiveram traumatismo cranioencefálico leve, 92,67% moderado e 1,67% grave. Houve predomínio da faixa etária de 18 a 29 anos, sexo masculino, solteiro e o ensino fundamental. Nesta busca, 19,33% dos pacientes foram a óbito. Conclusão: Conclui-se que o perfil do paciente acometido por trauma cranioencefálico, no hospital estudado, é caracterizado por um predomínio do sexo masculino com uma faixa etária de 19 a 29 anos, solteiros e com escolaridade de até o ensino fundamental.

Objetivo: identificar o perfil dos pacientes acometidos com traumatismo cranioencefálico atendidas em um hospital público de Teresina. Método: Estudo descritivo, exploratório, retrospectivo, documental de abordagem quantitativa realizado em um hospital público de Teresina-PI. Os dados foram coletados no período set/out/ de 2016 e janeiro de 2017 por meio de pesquisa nos prontuários através do formulário elaborado pelas pesquisadoras. Resultados: Registraram-se 1603 internações com o diagnóstico de traumatismo cranioencefálico destes, 5,67% tiveram traumatismo cranioencefálico leve, 92,67% moderado e 1,67% grave. Houve predomínio da faixa etária de 18 a 29 anos, sexo masculino, solteiro e o ensino fundamental. Nesta busca, 19,33% dos pacientes foram a óbito. Conclusão: Conclui-se que o perfil do paciente acometido por trauma cranioencefálico, no hospital estudado, é caracterizado por um predomínio do sexo masculino com uma faixa etária de 19 a 29 anos, solteiros e com escolaridade de até o ensino fundamental.

Ruthenium complexes are emerging as one of the most promising classes of complexes for cancer therapy. However, their limited aqueous solubility may be the major limitation to their potential clinical application. In view and to contribute to the progress of this field, eight new water-soluble Ru(II) organometallic complexes of general formula [RuCp(mTPPMS)n(L)] [CF3SO3], where mTPPMS = diphenylphosphane-benzene-3-sulfonate, for n = 2, L is an imidazole-based ligand (imidazole, 1-benzylimidazole, 1-butylimidazole, (1-(3-aminopropyl)imidazole), and (1-(4-methoxyphenyl)imidazole)), and for n = 1, L is a bidentate heteroaromatic ligand (2-benzoylpyridine, (di(2-pyridyl)ketone), and (1,2-(2-pyridyl)benzo-[b]thiophene)) were synthesized and characterized. The new complexes were fully characterized by NMR, FT-IR, UV–vis., ESI-HRMS, and cyclic voltammetry, which confirmed all the proposed molecular structures. The antiproliferative potential of the new Ru(II) complexes was evaluated on MDAMB231 breast adenocarcinoma, A2780 ovarian carcinoma, and HT29 colorectal adenocarcinoma cell lines, showing micromolar (MDAMB231 and HT29) and submicromolar (A2780) IC50 values. The interaction of complex 6 with human serum albumin (HSA) and fatty-acid-free human serum albumin (HSAfaf) was evaluated by fluorescence spectroscopy techniques, and the results revealed that the ruthenium complex strongly quenches the intrinsic fluorescence of albumin in both cases.

Abstract Objectives The aim of the present study was to analyze the prognostic impact of intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). Methods An observational, retrospective and quantitative study was performed. The sample consisted of 246 patients diagnosed with severe TBI, from January 2009 to August 2017. Results Out of the total sample, 43.56% of the patients were submitted to ICP monitoring. The mean time of use of the catheter was 1.7 days. In both groups, males were the most affected, and the majority of the patients were 30 days were related to meningitis, especially in those who used the catheter. Conclusion Patients who used a catheter for ICP monitoring had a significant improvement in survival.

AbstractIntroduction Worldwide there is serious concern about food and consumer safety [1], namely with seafood products. Consequently, there is a major concern regarding food spoilage which make them unsuitable for human consumption. When deteriorating, seafood products suffers a complex series of events that begins when the organism die [1,2]. Therefore, there is a strong need for developing reliable seafood quality analysis. In the present study we surveyed histamine and spermidine in several seafood products (fresh fish and clams), purchased in a Portuguese traditional market.Materials and methods Fresh seafood (Sardina pilchardus, Trachurus trachurus, Sparus aurata and Ruditapes decussata) were purchased in a market and taken to the laboratory in refrigerated containers. A total of 10 specimens were sampled from each species. Then samples were processed for analysis by homogenising in a phosphate buffer saline solution, centrifuged (10,000×g at 4 °C) for 15 min) and then stored at –80 °C until analysis. Seafood samples were assessed for the presence and content of histamine and spermidine using an indirect Enzyme Linked Immunosorbent assay (ELISA) [3]. The statistical analysis was performed using the Mann–Whitney U-test to determine differences between biogenic amine levels in seafood samples. Statistics was performed with a significance level of 5%, using the software Statistica 8.0 (Statsoft, Tulsa, OK, USA).Results The results show variable results between species (from

BackgroundTwin pregnancies account for 0.5-2.0% of all gestations worldwide. They have a negative impact on perinatal health indicators, mainly owing to the increased risk for preterm birth. However, population-based data from low/middle income countries are limited. The current paper aims to understand the health risks of twins, compared to singletons, amongst late preterms and early terms.MethodsData is from "Birth in Brazil", a national inquiry into childbirth care conducted in 2011/2012 in 266 maternity hospitals. We included women with a live birth or a stillborn, and excluded births of triplets or more, totalling 23,746 singletons and 554 twins. We used multiple logistic regressions and adjusted for potential confounders.ResultsTwins accounted for 1.2% of gestations and 2.3% of newborns. They had higher prevalence of low birth weight and intrauterine growth restriction, when compared to singletons, in all gestational age groups, except in the very premature ones (ConclusionAlthough strongly mediated by gestational age, an independent risk remains for twins for most neonatal morbidities, when compared to singletons. These disadvantages seem to be more prominent in early-term newborns than in the late preterm ones.

Delirium is the most common postsurgical neurological complication and has a variable incidence rate. Laparoscopic surgery, when associated with the Trendelenburg position, can cause innumerable physiological changes and increase the risk of neurocognitive changes. The association of general anesthesia with a spinal block allows the use of lower doses of anesthetic agents for anesthesia maintenance and facilitates better control over postoperative pain. Our primary outcome was to assess whether a spinal block influences the incidence of delirium in oncologic patients following laparoscopic surgery in the Trendelenburg position. Our secondary outcome was to analyze whether there were other associated factors. A total of 150 oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position were included in this randomized controlled trial. The patients were randomized into 2 groups: the general anesthesia group and the general anesthesia plus spinal block group. Patients were immediately evaluated during the postoperative period and monitored until they were discharged, to rule out the presence of delirium. Delirium occurred in 29 patients in total (22.3%) (general anesthesia group: 30.8%; general anesthesia plus spinal block: 13.8% p = 0.035). Patients who received general anesthesia had a higher risk of delirium than patients who received general anesthesia associated with a spinal block (odds ratio = 3.4; 95% confidence interval: 1.2-9.6; p = 0.020). Spinal block was associated with reduced delirium incidence in oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position.

Triatomines are hematophagous insects of great epidemiological importance, since they are vectors of the protozoan Trypanosoma cruzi, the etiological agent of Chagas disease. Triatoma brasiliensis complex is a monophyletic group formed by two subspecies and six species: T. b. brasiliensis, T. b. macromelasoma, T. bahiensis, T. juazeirensis, T. lenti, T. melanica, T. petrocchiae and T. sherlocki. The specific status of several species grouped in the T. brasiliensis complex was confirmed from experimental crossing and analysis of reproductive barriers. Thus, we perform interspecific experimental crosses between T. lenti and other species and subspecies of the T. brasiliensis complex and perform morphological analysis of the gonads and cytogenetic analysis in the homeologous chromosomes of the hybrids of first generation (F1). Besides that, we rescue all the literature data associated with the study of reproductive barriers in this monophyletic complex of species and subspecies. For all crosses performed between T. b. brasiliensis, T. b. macromelasoma, T. juazeirensis and T. melanica with T. lenti, interspecific copulas occurred (showing absence of mechanical isolation), hybrids were obtained, none of the male hybrids presented the phenomenon of gonadal dysgenesis and 100% pairing between the chromosomes homeologous of the hybrids was observed. Thus, we demonstrate that there are no pre-zygotic reproductive barriers installed between T. lenti and the species and subspecies of the T. brasiliensis complex. In addition, we demonstrate that the hybrids obtained between these crosses have high genomic compatibility and the absence of gonadal dysgenesis. These results point to reproductive compatibility between T. lenti and species and subspecies of the T. brasiliensis complex (confirming its inclusion in the complex) and lead us to suggest a possible recent diversification of the taxa of this monophyletic group.

Objective: The objective of this work was to quantify the number of scientific publications on technical nursing education over 20 years (1996-2016) and discuss them in light of the ecosystem paradigm. Methods: This integrative literature review with a descriptive-exploratory approach was performed using the following online databases: Biblioteca Virtual em Saúde (BVS) [Virtual Health Library], Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) [Latin American and Caribbean Health Sciences Literature], MEDLINE, and Índice Bibliográfico Espanhol de Ciências da Saúde (IBECS) [Health Sciences Spanish Bibliographical Index]. The sample consisted of five articles that were selected after applying inclusion and exclusion criteria. Descriptive statistical analysis was used to describe the selected articles. Collected data was subject to thematic content analysis. Results: The following category was elaborated: “The influence of the Cartesian model on technical nursing education”. Conclusion: There is an emerging need to rethink old paradigms and insert new conceptual perspectives on technical and vocational education to support the training of nurse technicians.

Objectives To compare definitions of high disease activity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in selecting patients for treatment with biologic disease-modifying antirheumatic drugs (bDMARDs).Methods Patients from Rheumatic Diseases Portuguese Register (Reuma.pt) with a clinical diagnosis of axial spondyloarthritis (axSpA) were included. Four subgroups (cross-tabulation between ASDAS (≥2.1) and BASDAI (≥4) definitions of high disease activity) were compared regarding baseline characteristics and response to bDMARDs at 3 and 6 months estimated in multivariable regression models.Results Of the 594 patients included, the majority (82%) had both BASDAI≥4 and ASDAS ≥2.1. The frequency of ASDAS ≥2.1, if BASDAI