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Objetivo: Avaliar alterações no perfil de biomarcadores (proteína C reativa, fator de necrose tumoral, interleucina 6 e creatinina) em pacientes com pneumonia, durante o período de internação segundo a sobrevivência ou óbito, relacionando a gravidade do quadro de pneumonia ou indicativo de desenvolvimento de doença renal aguda em pacientes com pneumonia. Método: Foi realizado um estudo prospectivo com 47 pacientes que foram internados com pneumonia, no município de Cajazeiras, PB. Foram realizadas análises laboratoriais para quantificação sérica de creatinina, proteína C reativa, IL-6 e TNF- α. Resultados: Foram analisados segundo o teste de Mann-Whitney e o teste de correlação de Spearman. Foram consideradas diferenças significativas quando p0,05. Observou-se que os níveis de creatinina, proteína C reativa, IL-6 e TNF-α estavam mais elevados no grupo dos pacientes com pneumonia que vieram a óbito. Os pacientes com pneumonia e doença renal aguda, do grupo que foram a óbito apresentaram maiores níveis de creatinina e IL-6. Para esse o grupo, os níveis de creatinina, TNF-α e IL-6 apresentaram correlação diretamente proporcionais ao escore da escala de CURB-65. Conclusão: Sugere-se que biomarcadores inflamatórios podem ser utilizados no monitoramento de agravo no quadro clínico da doença.Palavras-chave: Creatinina. Fator de Necrose Tumoral Alfa. Interleucina-6. Pneumonia. Proteína C-reativa. Abstract: The aim of this study was to evaluate changes in the profile of biomarkers (C-reactive protein, tumor necrosis factor, interleukin 6 and creatinine) in patients with pneumonia, during the hospitalization period, according to survival or death, relating the severity of pneumonia or indicative of development of acute kidney disease in patients with pneumonia. A prospective study was carried out with 47 patients who were hospitalized with pneumonia in the city of Cajazeiras, Paraíba. Laboratory analyzes were performed to quantify serum creatinine, C-reactive protein, IL-6 and TNF-α. Results were analyzed using the Mann-Whitney test and the Spearman correlation test. Significant differences were considered when p0.05. It was observed that the levels of creatinine, C-reactive protein, IL-6 and TNF-α were higher in the group of patients with pneumonia who died. Patients with pneumonia and acute kidney disease from the group who died had higher levels of creatinine and IL-6. For this group, creatinine, TNF-α and IL-6 levels correlated directly proportional to the CURB-65 scale score. It is suggested that inflammatory biomarkers can be used to monitor the disease's clinical condition. Keywords: Creatinine. Tumor Necrosis Factor Alpha. Interleukin-6. Pneumonia. C-reactive protein.

We assessed the associations of social distancing and mask use with symptomatic, laboratory-confi rmed severe acute respiratory syndrome coronavirus 2 infection in Porto Alegre, Brazil. We conducted a population-based casecontrol study during April–June 2020. Municipal authorities furnished case-patients, and controls were taken from representative household surveys. In adjusted logistic regression analyses of 271 case-patients and 1,396 controls, those reporting moderate to greatest adherence to social distancing had 59% (odds ratio [OR] 0.41, 95% CI 0.24– 0.70) to 75% (OR 0.25, 95% CI 0.15–0.42) lower odds of infection. Lesser out-of-household exposure (vs. going out every day all day) reduced odds from 52% (OR 0.48, 95% CI 0.29–0.77) to 75% (OR 0.25, 95% CI 0.18–0.36). Mask use reduced odds of infection by 87% (OR 0.13, 95% CI 0.04–0.36). In conclusion, social distancing and mask use while outside the house provided major protection against symptomatic infection.

OBJECTIVE To describe the clinical characteristics of cutaneous adverse reactions and cross-sensitivity induced by antiseizure medications and compare the pattern of use of antiseizure medications in patients with epilepsy according to skin rash history. METHODS We analysed patients with a history of skin rash presenting for up to 12 weeks after initiating antiseizure medication. The history of skin rash was verified by medical charts, interviews, and identification of skin lesions by patients based on illustrative images. The minimum follow-up period was eight months. The control group comprised epilepsy patients with regular antiseizure medication use for at least 12 weeks without skin rash. We included 109 cases and 99 controls. RESULTS The median (interquartile range) period from the index rash was six years (2-11). Carbamazepine was the trigger medication in 48% of cases and induced skin rashes in all patients with cross-sensitivity and carbamazepine exposure. Stevens-Johnson syndrome, toxic epidermal necrolysis, or drug reactions with eosinophilia and systemic symptoms affected 36% of cases. Carbamazepine- or oxcarbazepine-induced maculopapular exanthema occurred earlier (median: one week) than that induced by other antiseizure medications (median: three weeks) (p=0.006). Cross-sensitivity was more common in patients with at least one episode of Stevens-Johnson syndrome (29%) and Stevens-Johnson/toxic epidermal necrolysis overlap (50%) than in patients with maculopapular exanthema (8%) (p=0.01). Although most cases were mild, the pattern of antiseizure medication use differed from that of controls, with a lower proportion of antiseizure medication typically associated with severe cutaneous adverse reactions (carbamazepine, phenytoin, phenobarbital, primidone, oxcarbazepine, and lamotrigine) (p

Background The effect of exercise training and its mechanisms on the functional capacity improvement in Fontan patients (FP) are virtually unknown. This trial evaluated four-month aerobic exercise training and inspiratory muscle training on functional capacity, pulmonary function, and autonomic control in patients after Fontan operation. Methods A randomized controlled clinical trial with 42 FP aged 12 to 30 years and, at least, five years of Fontan completion. Twenty-seven were referred to a four-months supervised and personalized aerobic exercise training (AET) or an inspiratory muscle training (IMT). A group of non-exercise (NET) was used as control. The effects of the exercise training in peak VO2; pulmonary volumes and capacities, maximal inspiratory pressure (MIP); muscle sympathetic nerve activity (MSNA); forearm blood flow (FBF); handgrip strength and cross-sectional area of the thigh were analyzed. Results The AET decreased MSNA (p = 0.042), increased FBF (p = 0.012) and handgrip strength (p = 0.017). No significant changes in autonomic control were found in IMT and NET groups. Both AET and IMT increased peak VO2, but the increase was higher in the AET group compared to IMT (23% vs. 9%). No difference was found in the NET group. IMT group showed a 58% increase in MIP (p = 0.008) in forced vital capacity (p = 0.011) and forced expiratory volume in the first second (p = 0.011). No difference in pulmonary function was found in the AET group. Conclusions Both aerobic exercise and inspiratory muscle training improved functional capacity. The AET group developed autonomic control, and handgrip strength, and the IMT increased inspiratory muscle strength and spirometry. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02283255

This analytical, cross-sectional, observational study aimed to evaluate the perception of dentists working at the public system of the state of Rio Grande do Sul, southern Brazil, regarding academic training to treat oral lesions, adoption of preventive measures for oral cancer, and attitude toward the need to perform oral biopsies. The sample consisted of questionnaires filled out by 192 dentists (153 women and 39 men) working in primary health care who participated in training activities on oral cancer diagnosis in July 2016. To enroll in the training activities, the professionals completed an online questionnaire to evaluate their perceptions regarding oral cancer issues. With respect to preventive measures, 96.88% of dentists reported performing full mouth examination, 87.50% reported providing tobacco cessation counseling, and 51.04% reported giving advice on excessive alcohol consumption. In addition, 72.40% and 44.79% of dentists considered, respectively, clinical training and theory instruction in oral medicine to be insufficient during undergraduate school. Only 8.33% reported performing biopsies in daily clinical routine, and almost 90% reported referring the patient to a specialist from the public system or universities. Lack of experience was the main reason not to perform a biopsy. The dentists in our sample recognize the importance of preventive measures for oral cancer, but few of them perform biopsies regularly. Therefore, there is a need for continuing education actions including practical training.

Introduction: Abdominal surgery in patients with Crohn’s disease (CD) is challenging, especially in the biologic era. The aim of this study was to evaluate factors associated with increased risk for postoperative complications in CD. Methods: A retrospective study was conducted with consecutive patients who underwent abdominal surgery for CD from January 2012 to January 2018. Results: Of 103 patients, 32% had postoperative complications. Gender, age, disease location and phenotype, hemoglobin and albumin levels, previous abdominal surgery, and preoperative optimization did not differ between the groups with or without complications. Thirty-five percent of the patients were under anti-TNF therapy, and this medication was not associated with increased risk for postoperative complications. Time since the onset of the disease was significantly higher in patients with complications (12.9 vs. 9.4, p = 0.04). In multivariate analysis, creation of ostomy and urgent surgery were the only variables independently associated with increased risk for complications (OR 3.2, 95% CI 1.12–9.46 and OR 2.94, 95% CI 0.98–9.09, respectively). Conclusion: Urgent surgery for CD should preferably be performed in specialized centers, and creation of stoma is not necessarily associated with lower rate of postoperative complications but rather less severe complications.

Background Brazil experienced a disproportionately higher rate of microcephaly cases in November 2015 with evidence of a causal link with Zika virus (ZIKV) infections during pregnancy. Epilepsy is a major neurological feature seen as part of congenital Zika virus syndrome (CZVS). Different seizure types and electroencephalographic (EEG) abnormalities have been described in association with this syndrome. However, clinical and neurophysiological features of epilepsy seen in children with CZVS are not fully understood. Methods We evaluated children with CZVS showing an EEG pattern of electrical status epilepticus during slow-wave sleep (ESES). Information on gender, age of onset of seizures, head circumference at birth, gross motor function at the time of diagnosis, of clinical and EEG aspects of seizures, EEG features and response to drug treatment was assessed. Results Our case series included four patients. They were diagnosed with epilepsy between one month to 18 months of age and showed an ESES pattern at the age of three. They presented with a wide range of epileptic symptoms, but all experienced tonic seizures. Multiple drug treatment was the management approach for three patients; however, they showed poor response to treatment with conventional drugs used in the treatment of ESES. Conclusions Children with CZVS may develop an EEG pattern of ESES. Clinicians and neurologists should be aware of this neurological presentation to improve the management of these patients.

ResumoA estenose degenerativa do canal vertebral lombar é a causa mais frequente de dor lombar e/ou ciática no paciente idoso; sua epidemiologia, fisiopatogenia, manifestações e testes clínicos são revistos em ampla investigação bibliográfica atual. A importância da relação entre a clínica e o estudo por imagens, principalmente a ressonância magnética (RM), é ressaltada. Antes da indicação do tratamento, é necessário identificar a localização precisa da dor, bem como o diagnóstico diferencial entre a claudicação neurogênica e a vascular. O tratamento conservador associando medicações com as diversas técnicas fisioterápicas resolve o problema na maioria dos casos, já o teste terapêutico com os bloqueios, seja epidural, foraminal ou facetário, é realizado quando as dores não cedem com o tratamento conservador e antes da indicação da cirurgia. Os bloqueios costumam dar melhores resultados no alívio dos sintomas de ciatalgia e menos no quadro de claudicação neurogênica. A descompressão da cauda equina e/ou radicular associada ou não à artrodese é o padrão ouro quando a intervenção cirúrgica é necessária. A artrodese após a descompressão é necessária nos casos com instabilidade segmentar, como na espondilolistese degenerativa. Quando a estenose de canal acontece em múltiplos níveis e vem acompanhada de desvio de eixo, seja coronal e/ou sagital, deve ser realizada, além das descompressões e artrodese, a correção dos desvios de eixo, principalmente o eixo sagital, quando a correção da lordose lombar se impõe com técnicas que corrigem a lordose retificada para valores próximos à incidência pélvica.

Aims We studied the association between android (A) to gynoid (G) fat ratio and functional capacity (peak VO2) in male patients with heart failure with reduced ejection fraction (HFrEF). Methods and results We enrolled 118 male patients with HFrEF with left ventricular ejection fraction (LVEF) 25 kg/m2 with FNIH index < 0.789). The median A/G ratio was 0.55. A/G ratio > 0.55 was detected in 60 patients. Relative peak VO2 was lower in patients with A/G ratio > 0.55 than in patients with A/G ratio 0.55 to be independently associated with reduced peak VO2 adjusted for age, body mass index, LVEF, presence of sarcopenia, anabolic hormones, and haemoglobin (odds ratio 3.895, 95% confidence interval 1.030–14.730, P = 0.045). Conclusions Body fat distribution, particularly android and gynoid fat composition, together with other cofactors, might have an important adverse role on functional capacity in male patients with HFrEF. Future studies are needed to address possible mechanisms involved in this relationship.

IntroductionDiabetic nephropathy (DN) is a disease that progresses with the slow and progressive decline of the glomerular filtration rate (GFR); the installation of this pathology is silent and one of the major causes of death in patients with diabetes.AimsTo identify new molecular biomarkers for early identification of the onset of DN in patients with type II diabetes mellitus (DM2). We studied the expression profile of the genes; suppressor of mothers against decapentaplegic type 1 (SMAD1), neutrophil gelatinase-associated lipocalin (NGAL) and type IV collagen (COLIV1A) in peripheral blood and urine sediment samples.MethodsNinety volunteers, 51 with DM2 and 39 healthy, were recruited from the Faculdade de Medicina do ABC outpatient clinic. We conducted an interview and collected anthropometric data, as well as blood and urine samples for biochemical evaluation and real-time PCR amplification of the genes of interest.ResultsGene expression data: peripheral blood NGAL (DM2 0.09758±0.1914 vs CTL 0.02293±0.04578), SMAD1 (blood: DM2 0.01102±0.04059* vs CTL 0.0001317±0.0003609; urine: DM2 0.7195±2.344* vs CTL 0.09812±0.4755), there was no significant expression of COLIV1A. These genes demonstrated good sensitivity and specificity in the receiving operating characteristic curve evaluation.ConclusionOur data suggest the potential use of NGAL and SMAD1 gene expression in peripheral blood and urine samples as early biomarkers of DN.

Introduction:Hemodialysis stands out as an eligible treatment for patients with chronic kidney disease. The subsequent inflammatory process resulting from this disease and hemodialysis per se is exacerbated in this therapy. Selenium (Se) is an essential trace element that can participate in the inhibition of pro-oxidant and pro-inflammatory processes and could be considered a measurement that indicates the progression of chronic kidney disease and inflammation.Objective:The present study investigated selenemia in hemodialysis patients of the ABC region of São Paulo and aimed to establish the correlation between an inflammatory marker and selenemia in this conditions disease.Methods:This is an observational cross-sectional study of the Faculdade de Medicina do ABC in patients submitted to hemodialysis three times a week for at least six months. The eligible group composed of 21 patients, who filled out forms and underwent biochemical tests (colorimetric enzyme methods, flow cytometer, turbidimetric method and mass spectrometry).Results:The study population showed, women (70%), men (30%) with a mean age of 47 ± 17 years, Caucasians (36%) and non-Caucasian (64%), hypertensive (68%), smokers (53%) and non-smokers (64%). There was a hegemonic prevalence of systolic arterial hypertension (SAH) 68.1% in relation to diabetes mellitus (DM) (50%). Pre and post hemodialysis (HD) selenemia showed statistical significance, which did not occur with Creactive protein. There was a predominance of females in our sample; the pre- and post- HD selenemia were within the normal range of the reference values; there was a statistically significant correlation between pre and post-HD selenemia; there was no correlation with statistical significance between values of pre and post-HD C-reactive protein.Conclusion:Our data showed that there was no direct relationship between pre- and post- HD inflammation and pre- and post-HD selenemia.

BACKGROUND: Etrolizumab is a gut-targeted anti-β7 integrin monoclonal antibody. In a previous phase 2 induction study, etrolizumab significantly improved clinical remission versus placebo in patients with moderately to severely active ulcerative colitis. We aimed to evaluate the efficacy and safety of etrolizumab for maintenance of remission in patients with moderately to severely active ulcerative colitis. METHODS: We conducted a randomised, placebo-controlled, double-blind, phase 3 study (LAUREL) across 111 treatment centres worldwide. We included adults (age 18-80 years) with moderately to severely active ulcerative colitis (Mayo Clinic total score [MCS] of 6-12 with an endoscopic subscore of ≥2, a rectal bleeding subscore of ≥1, and a stool frequency subscore of ≥1) who were naive to tumour necrosis factor inhibitors. Patients were required to have had an established diagnosis of ulcerative colitis for at least 3 months, corroborated by both clinical and endoscopic evidence, and evidence of disease extending at least 20 cm from the anal verge. During open-label induction, participants received subcutaneous etrolizumab 105 mg once every 4 weeks. Participants who had clinical response at week 10 (MCS with ≥3-point decrease and ≥30% reduction from baseline, plus ≥1-point decrease in rectal bleeding subscore or absolute rectal bleeding score of 0 or 1) proceeded into the double-blind maintenance phase and were randomly assigned (1:1) to receive subcutaneous etrolizumab 105 mg once every 4 weeks or matched placebo until week 62. Randomisation was stratified by baseline concomitant treatment with corticosteroids, treatment with immunosuppressants, baseline disease activity, and week 10 remission status. All participants and study site personnel were masked to treatment assignment. The primary endpoint was remission at week 62 (MCS ≤2, with individual subscores ≤1, and rectal bleeding subscore of 0) among patients with a clinical response at week 10, measured in the modified intention-to-treat population (all randomised patients who received at least one dose of study drug). This trial is registered with ClinicalTrials.gov, NCT02165215, and is now closed to recruitment. FINDINGS: Between Aug 12, 2014, and June 4, 2020, 658 patients were screened for eligibility and 359 were enrolled into the induction phase. 214 (60%) patients had a clinical response at week 10 and were randomly assigned to receive etrolizumab (n=108) or placebo (n=106) in the maintenance phase. 80 (74%) patients in the etrolizumab group and 42 (40%) in the placebo group completed the study through week 62. Four patients in the placebo group did not receive study treatment and were excluded from the analyses. At week 62, 32 (29·6%) of 108 patients in the etrolizumab group and 21 (20·6%) of 102 in the placebo group were in remission (adjusted treatment difference 7·7% [95% CI -4·2 to 19·2]; p=0·19). A greater proportion of patients reported one or more adverse events in the placebo group (82 [80%] of 102) than in the etrolizumab group (70 [65%] of 108); the most common adverse event in both groups was ulcerative colitis (16 [15%] patients in the etrolizumab group and 37 [36%] in the placebo group). Ten (9%) patients in the etrolizumab group and eight (8%) in the placebo group reported one or more serious adverse events. No deaths were reported in either treatment group. INTERPRETATION: No significant differences were observed between maintenance etrolizumab and placebo in the primary endpoint of remission at week 62 among patients who had a clinical response at week 10. Etrolizumab was well tolerated in this population and no new safety signals were identified. FUNDING: F Hoffmann-La Roche. ispartof: LANCET GASTROENTEROLOGY & HEPATOLOGY vol:7 issue:1 pages:28-37 ispartof: location:Netherlands status: published

Tracheobronchial mucoepidermoid carcinomas are exceedingly rare and can mimic other pulmonary diseases. We report a case of a 31-year-old man initially exhibiting a three-month history of wheezing and coughing. The patient was initially diagnosed as asthmatic and treated with bronchodilators. However, further workup revealed a neoplasm measuring 2,7cm in diameter, reaching the carina and obstructing both main bronchi. Although endoscopic resection was performed, the patient needed subsequent surgical resection for complete treatment. Mucoepidermoid carcinoma of the trachea should be included in the differential diagnosis of patients with persistent cough and wheezing. Rapid identification and prompt treatment of this disease are crucial for a good outcome.

Purpose To evaluate the quality of referrals for a first Rheumatology consultation at a tertiary care center in a southern Brazilian capital (Porto Alegre, RS), having as background findings from a similar survey performed in 2007/2008. Since then, our state has implemented referral protocols and a triage system with teleconsulting support exclusively for referrals from locations outside the capital, permitting a comparison between patients screened and not screened by the new system. Methods Physicians of the Rheumatology Service at Hospital Nossa Senhora da Conceição prospectively collected information regarding first visits over a 6-month period (Oct 2017 to March 2018). We recorded demographic characteristics, diagnostic hypotheses, date of referral, and the municipality of origin (within the state of Rio Grande do Sul). We considered adequate referrals from primary health care when a systemic autoimmune inflammatory disease (SIRD) was suspected at first evaluation by the attending rheumatologist. Results Three hundred fifty-seven patients/appointments were eligible for analysis (193 from the capital and 164 from small and medium towns). In 2007/2008, suspected SIRD occurred in 76/260 (29.2%) and 73/222 (32.9%) among patients from the capital and outside counties, respectively (P = 0.387). In 2017/2018, suspected SIRD occurred in 75/193 (38.9%) and 111/164 (67.7%) in patients from the capital and outside counties, respectively (difference: 28.8, 95% CI: 19.0 to 38.9, P Conclusion The quality of Rheumatology referrals in our state improved over the 10-year interval under study, particularly among patients from locations submitted to referral protocols and teleconsulting support.

Aims The definition of sarcopenia based on appendicular lean mass/height (2) (ALM/height (2)) is often used, although it can underestimate the prevalence of sarcopenia in overweight/obese patients with heart failure. Therefore, new methods have been proposed to overcome this limitation. We aimed to evaluate the prevalence of sarcopenia by three methods and compare body composition in this population. Methods and results We enrolled 168 male patients with heart failure (left ventricular ejection fraction

Background: The most active agents for the treatment of breast cancer are the anthracyclines whose clinical usefulness is limited by cumulative dose-dependent cardiotoxicity, which results in congestive heart failure among other limiting factors. With all the attempts to minimize chemotherapeutic cardiotoxicity, remote ischemic preconditioning (RIPC) has been considered as a potent endogenous mechanism capable of inhibiting inflammatory responses. Objective: This study aimed to verify if RIPC may be effective as prophylaxis to prevent anthracycline- induced cardiotoxicity in oncological patients. Methods: The preconditioning method was based on four to five-minute cycles of a blood pressure cuff insufflation around the upper arm (either left or right) from 200 mmHg to 250 mmHg, inducing ischemic intervals interspersed with 5 minutes of reperfusion. Results: In this work, echocardiogram results showed a ventricular mass variation that can get worse during chemotherapeutic treatment; however, in patients who had been undergoing RIPC sessions over a period of 6 months, it was observed that this change did not occur. The parameters for troponin T levels were considered; they were higher in patients who were not undergoing RIPC in relation to those who were. When both cases were compared, it was possible to infer that there was a clinically significant improvement for those who went through the procedure. Conclusion: Thus, through the analysis of this study, it is possible to conclude that RIPC is a lowcost, non-invasive procedure which brings cardiac protection for patients undergoing chemotherapy with anthracyclines, providing support in the treatment of cancer.

Diabetic nephropathy (DN) is a pathological condition that affects diabetic patients around the world, and it is the main cause of chronic kidney diseases. It is known that the inflammatory pathway is activated in diabetic patients. Thus, the aims of this study were to evaluate the gene expression of Nuclear factor-κappa B (NF-κB) in liquid samples (urine and blood), then to evaluate the correlation between NF-κB gene expression with classical biochemical markers of kidney disease to investigate if the gene expression of this molecule can be used as a biomarker of loss of kidney function in diabetic patients. We recruited 35 patients with type 2 diabetes mellitus for at least 5 years and 29 healthy donors and collected samples of urine and blood to quantify the NF-κB expression. It was found higher expression of NF-κB in both samples in diabetes patients. We verified elevated levels of microalbuminuria, serum creatinine, urea and BMI in diabetic patients, as well as a fall in GFR, without alteration in serum creatinine and proteinuria levels. Our data suggest that overexpression of NF-κB participates in the onset of diabetic nephropathy and that it is possible to quantify these changes in liquid biopsy (blood and urine) through gene expression of this molecule. The NF-κB expression is correlated with increased BMI data.

COVID-19 is a viral disease characterized as a pandemic by the World Health Organization in March 2020. Since then, researchers from all over the world have been looking for ways to fight this disease. Many cases of complications arise from insufficient immune responses due to low immunity, with intense release of pro-inflammatory cytokines that can damage the structure of organs such as the lung. Thus, the hypothesis arises that photobiomodulation therapy (PBMT) with the use of a low-level laser (LLLT) may be an ally approach to patients with COVID-19 since it is effective for increasing immunity, helping tissue repair, and reducing pro-inflammatory cytokines. This systematic review was performed with the use of PubMed/MEDLINE, Web of Science, Scopus and Google Scholar databases with the following keywords: “low-level laser therapy OR photobiomodulation therapy AND COVID-19”. The inclusion criteria were complete articles published from January 2020 to January 2021 in English. The exclusion criteria were other languages, editorials, reviews, brief communications, letters to the editor, comments, conference abstracts, and articles that did not provide the full text. The bibliographic search found 18 articles in the Pubmed/MEDLINE database, 118 articles on the Web of Science, 23 articles on Scopus, and 853 articles on Google Scholar. Ten articles were included for qualitative synthesis, of which four commentary articles discussed the pathogenesis and the effect of PBMT in COVID-19. Two in vitro and lab experiments showed the effect of PBMT on prevention of thrombosis and positive results in wound healing during viral infection, using the intravascular irradiation (ILIB) associated with Phthalomethyl D. Two case reports showed PBMT improved the respiratory indexes, radiological findings, and inflammatory markers in severe COVID-19 patients. One case series reported the clinical improvement after PBMT on 14 acute COVID-19 patients, rehabilitation on 24 patients, and as a preventive treatment on 70 people. One clinical trial of 30 patients with severe COVID-19 who require invasive mechanical ventilation, showed PBMT-static magnetic field was not statistically different from placebo for the length of stay in the Intensive Care Unit, but improved diaphragm muscle function and ventilation and decreased the inflammatory markers. This review suggests that PBMT may have a positive role in treatment of COVID-19. Still, the necessity for more clinical trials remains in this field and there is not sufficient research evidence regarding the effects of PBMT and COVID-19 disease, and there is a large gap.

The highlight of the shortcomings in the regulation and surveillance of veterinary drugs in Brazil is the absence of a system to report adverse drug events (ADEs). The aim of this study was evaluate the use of triggers in dogs to detect ADEs by estimating the prevalence of ADE and identifying the possible triggers. We screened medical records for ADEs and degree of harm caused by an ADE, using known triggers, with the Global Trigger Tool: translated, adapted and validated for use in animal health. The triggers comprised two-fold increase in blood urea nitrogen or serum creatinine levels compared to baseline, administration of vitamin K, administration of diphenhydramine or promethazine, excessive sedation or hypotension, administration of an antiemetic, abrupt cessation of medication, or others. The association between the occurrence of ADEs and variables, such as age, race, duration of hospitalization, polypharmacy, and clinical outcome was evaluated. A total of 148 medical records were analyzed. The trigger tools identified the known triggers 109 times in 68 medical records. Additionally, 14 ADEs were identified; the prevalence of ADEs was 9.5%. Positive predictive values of the triggers were 12.8%, and “vitamin K administration” had the best performance. The duration of hospitalization (p-value = 0.030) and polypharmacy (p-value < 0.001) were associated with the occurrence of ADEs. Approximately 46% of the hospitalized dogs presented with at least one trigger. One out of five hospitalized dogs suffered from temporary harm due to an ADE. The duration of hospitalization and polypharmacy were found to be risk factors for ADEs in dogs., O destaque das deficiências na regulamentação e vigilância de medicamentos veterinários no Brasil é a ausência de um sistema de notificação de eventos adversos a medicamentos (EAM). O objetivo deste estudo foi avaliar o uso de rastreadores em cães para detectar EAM, estimando a prevalência de EAM e identificando os possíveis rastreadores. Rastreamos prontuários médicos para identificar EAM e grau de danocausado por um EAM, usando rastreadores conhecidos, com a Global Trigger Tool: traduzida, adaptada e validada para uso em saúde animal. Os rastreadores consistiram no aumento de duas vezes nos níveis de nitrogênio ureico no sangue ou creatinina sérica em comparação com a linha de base, administração de vitamina K, administração de difenidramina ou prometazina, sedação excessiva ou hipotensão, administração de um antiemético, interrupção abrupta da medicação ou outros. Foi avaliada a associação entre a ocorrência de EAM e variáveis como idade, raça, tempo de internação, polifarmácia e evolução clínica. Foram analisados 148 prontuários. Os rastreadores foram gatilhados 109 vezes em 68 registros médicos. Ademais, 14 EAM foram identificados e a prevalência de EAM foi de 9,5%. O valor preditivo positivo do rastreador foi 12,8%, e “administração de vitamina K” teve o melhor desempenho O tempo de internação (p-valor = 0,030) e a polifarmácia (p-valor

Autologous bone grafts, used mainly in extensive bone loss, are considered the gold standard treatment in regenerative medicine, but still have limitations mainly in relation to the amount of bone available, donor area, morbidity and creation of additional surgical area. This fact encourages tissue engineering in relation to the need to develop new biomaterials, from sources other than the individual himself. Therefore, the present study aimed to investigate the effects of an elastin and collagen matrix on the bone repair process in critical size defects in rat calvaria. The animals (Wistar rats, n = 30) were submitted to a surgical procedure to create the bone defect and were divided into three groups: Control Group (CG, n = 10), defects filled with blood clot, E24/37 Group (E24/37, n = 10), defects filled with bovine elastin matrix hydrolyzed for 24 h at 37 °C and C24/25 Group (C24/25, n = 10), defects filled with porcine collagen matrix hydrolyzed for 24 h at 25 °C. Macroscopic and radiographic analyses demonstrated the absence of inflammatory signs and infection. Microtomographical 2D and 3D images showed centripetal bone growth and restricted margins of the bone defect. Histologically, the images confirmed the pattern of bone deposition at the margins of the remaining bone and without complete closure by bone tissue. In the morphometric analysis, the groups E24/37 and C24/25 (13.68 ± 1.44, 53.20 ± 4.47, respectively) showed statistically significant differences in relation to the CG (5.86 ± 2.87). It was concluded that the matrices used as scaffolds are biocompatible and increase the formation of new bone in a critical size defect, with greater formation in the polymer derived from the intestinal serous layer of porcine origin (C24/25).

Background Sacubitril/valsartan reduces mortality in patients with heart failure with reduced ejection fraction (HFrEF) when compared with enalapril. However, it is unknown the effect of both treatments on exercise capacity. We compared sacubitril/valsartan versus enalapril in patients with HFrEF based on peak oxygen consumption (VO2) and 6-minute walk test (6-MWT). Methods We included 52 participants with HFrEF with a left ventricular ejection fraction Results At 12 weeks, the sacubitril/valsartan (mean dose 382.6 ± 57.6 mg daily) group had increased peak VO2 of 13.1% (19.35 ± 0.99 to 21.89 ± 1.04 mL/kg/min) and enalapril (mean dose 34.4 ± 9.2 mg daily) 5.6% (18.58 ± 1.19 to 19.62 ± 1.25 mL/kg/min). However, no difference was found between groups (P = .332 interaction). At 24 weeks, peak VO2 increased 13.5% (19.35 ± 0.99 to 21.96 ± 0.98 mL/kg/min) and 12.0% (18.58 ± 1.19 to 20.82 ± 1.18 mL/kg/min) in sacubitril/valsartan (mean dose 400 ± 0 mg daily) and enalapril (mean dose 32.7 ± 11.0 mg daily), respectively. However, no differences were found between groups (P= .332 interaction). At 12 weeks, 6-MWT increased in both groups (sacubitril/valsartan: 459 ± 18 to 488 ± 17 meters [6.3%] and enalapril: 443 ± 22 to 477 ± 21 meters [7.7%]). At 24 weeks, sacubitril/valsartan increased 18.3% from baseline (543 ± 26 meters) and enalapril decreased slightly to 6.8% (473 ± 31 meters), but no differences existed between groups (P= .257 interaction). Conclusions Compared to enalapril, sacubitril/valsartan did not substantially improve peak VO2 or 6-MWT after 12 or 24 weeks in participants with HFrEF. (NEPRIExTol-HF Trial, ClinicalTrials.gov number, NCT03190304)

Objectives Advances in telemedicine offer a unique opportunity to expand access to the health system. Nevertheless, few studies have described the impact of telediagnosis implementation on health and economic outcomes. Methods An ophthalmology telediagnosis service (TeleOftalmo) was compared with traditional face-to-face care provided by the Brazilian public health system. For both groups, utility data were collected at 2 time points using the Visual Function Questionnaire–Utility Index instrument from interviews with 536 patients. The cost per patient encounter was analyzed according to the time-driven activity-based costing. Value analyses were conducted to ascertain whether and how telemedicine service has the potential to generate cost savings for the health system. Results Visual function–related quality of life did not differ significantly between TeleOftalmo and face-to-face care groups. Using the current model, the telemedicine service assisted an average of 1159 patients per month at a median cost per telediagnosis of Int$97 (interquartile range, Int$82-Int$119) versus Int$77 (interquartile range, Int$75-Int$80) for face-to-face care. If the telemedicine service was redesigned, considering the opportunities for improvement identified, it could operate at a cost of Int$53 per telediagnosis (a 31% cost savings) and could serve 3882 patients per month. Conclusions This study demonstrates the potential value of a telemedicine service. There was no difference in patient-perceived utility between a telediagnostic ophthalmology service and face-to-face care by an eye specialist. TeleOftalmo has the potential to be a cost-saving strategy for the Brazilian health system and could be a template for implementation of telediagnostic services in other regions.

Purpose To develop and validate a chest cavity simulator for teaching video-assited thoracic surgery (VATS). Methods The first phase of the study consisted of developing a chest cavity simulator. A quasi-experimental study was performed in the second phase, and 25 surgeons and residents participated in a three-stage pulmonary suture experiment. The videos were recorded and timed. Generalized linear regression models for repeated measures were used to analyze the outcome change over time. Results The chest cavity simulator consists of a console simulating the left hemithorax. Among the participants, 96% rated the design, visual aspect, positioning ergonomics, and triangulation of the portals as very good or excellent (face validity). There was a decrease in suturing time in step 1 from 435.7 ± 105 to 355.6 ± 76.8 seconds compared to step 3 (p = 0.001). The evaluation of the simulation effectiveness and performance (content validity) was rated as very good or excellent by 96% ofparticipants. The most experienced surgeon showed significant reduction in procedure time (p = 0.021) (construct validity). Conclusions The thoracic cavity simulator is realistic, showing content and construct validity, and can be used in VATS training. The simulation model allowed skill gain in the endoscopic suture.

Sars-Cov 2 viral infection can cause an intense inflammatory reaction, hypoxemia and acute respiratory failure. The disease spreads more easily in chronic comorbidities, such as sickle cell anemia and overweight. Among the various professionals involved in the recovery of patients with Covid-19, the role of the physiotherapist stands out, not only for acting in the management of the disease but also for preventing and rehabilitating the respiratory deficiencies and the functional limitations caused by it. The present report aims to elucidate the multidisciplinary work carried out in the patient with overweight and sickle cell anemia during the period of hospitalization in the Pediatric Intensive Care Unit by Covid-19. This is an observational, longitudinal single-arm case report. The patient’s medical data collection was carried out retrospectively through record, including anamnesis reports, physical examination, and multi-professional procedures used from admission to discharge, including anamnesis reports, physical examination, and multi-professional procedures used from admission to discharge. The present study is a rare case of pediatric Covid-19 with severe signs and symptoms. The treatment performed by the multidisciplinary team resulted in a favorable outcome since the beginning of hospitalization. Physiotherapy, including early mobilization and rehabilitation may help prevent or mitigate sequelae related to bed rest, thus improving physical function and outcomes and reducing length of stay by increasing ventilator free-days.

Objectives We compared physical activity levels before the outbreak and quarantine measures with COVID-19-associated hospitalization prevalence in surviving patients infected with SARS-CoV-2. Additionally, we investigated the association of physical activity levels with symptoms of the disease, length of hospital stay, and mechanical ventilation. Design Observational, cross-sectional. Methods Between June 2020 and August 2020, we invited Brazilian survivors and fully recovered patients infected with SARS-CoV-2 to respond to an online questionnaire. We shared the electronic link to the questionnaire on the internet. We collected data about clinical outcomes (symptoms, medications, hospitalization, and length of hospital stay) and cofactors, such as age, sex, ethnicity, preexisting diseases, socioeconomic and educational, and physical activity levels using the International Physical Activity Questionnaire (IPAQ short version). Results Out of 938 patients, 91 (9.7%) were hospitalized due to COVID-19. In a univariate analysis, sex, age, and BMI were all associated with hospitalizations due to COVID-19. Men had a higher prevalence of hospitalization (66.6%, p = 0.013). Patients older than 65 years, obese, and with preexisting disease had a higher prevalence of COVID-19-related hospitalizations. In a multivariate regression model, performance of at least 150 min/wk (moderate) and/or 75 min/wk (vigorous) physical activity was associated with a lower prevalence of hospitalizations after adjustment for age, sex, BMI, and preexisting diseases (PR = 0.657; p = 0.046). Conclusions Sufficient physical activity levels were associated with a lower prevalence of COVID-19-related hospitalizations. Performing at least 150 min a week of moderate-intensity, or 75 min a week of vigorous-intensity physical activity was associated with 34.3% reduction in prevalence.

Introduction Coronary atherosclerosis is an important pathophysiological mechanism in the development of coronary artery disease (CAD). While it has been proven via multiple studies that elevated levels of low-density lipoprotein (LDL) contribute to the development of atherosclerosis, high-density lipoprotein (HDL) is widely thought to have atheroprotective effects. Multiple epidemiologic studies have given the idea that high HDL levels protect against CAD, however, other trials also shown that its benefit can be paradoxical. Objective To evaluate the relationship between HDL levels and the extent of CAD (one vessel vs multivessel disease) in coronary artery patients. Materials and methods Study analyses of 1676 patients selected from GENEMACOR study population, with at least one >75% coronary stenosis by angiography (median age 53.3±7.9 years, 78.6% male, median HDL 43.0±11.1 mg/dL). Population was divided according to the HDL level quartiles (1st quartile HDL 49 mg/dL). Population of the 1st and 4th quartiles (825 patients, median age of 53.3±7.9 years and 78.7% male) were adjudicated and prospectively followed-up by 5.0±4.8 years. χ2 and T student tests were used to analyze the demographic, laboratorial, angiographic and anthropometric characteristics of the population according to HDL level. Results 420 (50.9%) patients were included in the 1st quartile group (median age 53.2±7.9 years, 85.7% men) and 405 (49.1%) patients were included in the 4th quartile group (median age 53.4±8.0 years, 71.4% men). In our population, lower levels of HDL were associated with increased risk of multivessel coronary disease (OR 1.63, 95% CI 1.23–2.14, p 0.001). Conclusion Despite uncertainties about HDL benefit, in our population a higer level of HDL was associated with a shortest extent of coronary artery disease. We conclude that higher levels of HDL can be considered protective in coronary patients, and strategies to increase HDL levels may indeed translate in improved outcomes in CAD disease. Funding Acknowledgement Type of funding source: None

ObjectivesWe compared physical activity levels before the outbreak and quarantine measures with COVID-19-associated hospitalization prevalence in surviving patients infected with SARS-CoV-2. Additionally, we investigated the association of physical activity levels with symptoms of the disease, length of hospital stay, and mechanical ventilation.MethodsBetween June 2020 and August 2020, we invited Brazilian survivors and fully recovered patients infected with SARS-CoV-2 to respond to an online questionnaire. We shared the electronic link to the questionnaire on the internet. In this cross-sectional study, we collected data about clinical outcomes (symptoms, medications, hospitalization, and length of hospital stay) and cofactors, such as age, sex, ethnicity, preexisting diseases, socioeconomic and educational, and physical activity levels using the International Physical Activity Questionnaire (IPAQ short version).ResultsOut of 938 patients, 91 (9.7%) were hospitalized due to COVID-19. In a univariate analysis, sex, age, and BMI were all associated with hospitalizations due to COVID-19. Men had a higher prevalence of hospitalization (66.6%, P=0.013). Patients older than 65 years, obese, and with preexisting disease had a higher prevalence of COVID-19-related hospitalizations. In a multivariate regression model, performance of at least 150 min/wk (moderate) and/or 75 min/wk (vigorous) physical activity was associated with a lower prevalence of hospitalizations after adjustment for age, sex, BMI, and preexisting diseases (PR=0.657; P=0.046).ConclusionsSufficient physical activity levels are associated with a lower prevalence of COVID-19-related hospitalizations. Performing at least 150 minutes a week of moderate-intensity, or 75 minutes a week of vigorous-intensity physical activity reduces this prevalence by 34.3%.(EXTRA SARS-CoV-2 Study, ClinicalTrials.gov number, NCT04396353)

Background: Cancer ranks second as a cause of death in Brazil. Although preventive practices are part of the daily routine of primary healthcare (PHC) teams, organized screening programs are lacking. This study aimed to evaluate the adequacy of preventive interventions in the main cancer types, as defined by the Brazilian government. Methods: We analyzed cross-sectional data from a larger project conducted in 2016 with PHC service users and physicians from all over Brazil, interviewed by trained research staff. The sample was stratified by the number of PHC physicians per geographic region, who were eligible for inclusion if they had been working in the same PHC unit for at least one year. Twelve adult patients with at least two encounters were included per participating physician. Only the data from service users were analyzed in this study. We evaluated the questions about preventive practices and calculated the following indicators: coverage, focus, screening errors, and screening ratio. National guidelines and international evidence were used as a comparison parameter. Results: The study population consisted of 6160 service users. The data indicate that the recommendations for cervical, breast, and prostate cancer screening and for treatment of tobacco dependence are not adequately followed. Coverage for breast and cervical cancer screening presented an overutilization bias, with rates 50% and 9% above the expected, respectively. The screening focus was also inadequate: 24%, 47%, and 54% of the screening tests for the three cancer types were performed in individuals outside the recommended age range. 31% of smokers were not approached for treatment. Conclusion: These findings indicate that the Brazilian population has been subjected to inadequate and potentially iatrogenic interventions in PHC. New policies based on stricter criteria of adequacy and increased use of the concept of quaternary prevention may improve the effectiveness and equity of the health system.

Purpose of Review In 2016, the World Health Organization declared the Zika virus (ZIKV) outbreak a Public Health Emergency of International Concern following a cluster of associated neurological disorders and neonatal malformations. Our aim is to review the clinical and neuroimaging findings seen in congenital Zika syndrome. Recent Findings ZIKV injures neural progenitor cells in the hippocampus, a brain region important for learning, memory, cognition, and emotion/stress response. Positron emission tomography has revealed global neuroinflammation in ZIKV infection in animal models. Summary Congenital Zika syndrome is associated with a spectrum of brain abnormalities, including microcephaly, parenchymal calcifications, malformations of cortical development and defective neuronal migration, corpus callosum abnormalities, ventriculomegaly, and brainstem and cerebellar abnormalities.

The aim of the study was to determine the possibility of using panoramic X-ray as an auxiliary tool for the identification of talent in young athletes using the physical body growth indicator. Thirty three radiographs were used of athletes aged 13 to 15 years. Analysis was performed using the Eklof and Ringertz method. Dental age (40 %) came the closest to chronological age. Dental age determined in this study proved to be the most effective radiographic method for the determination of bone maturity for use in the identification of talent through imaging exams. This method was also the simplest and can be performed by the dentist of a sports club without exposing athletes to unnecessary radiation.

Background: Since renal failure is one of the main causes of death in patients with Fabry disease (FD), renal follow-up is an important part of clinical monitoring in these patients. Despite its known limitations, serum creatinine is still the most widely used biomarker. While new renal biomarkers are described, their effectiveness has not yet been fully evaluated in relation to FD. Objectives: This study aimed to compare renal biomarkers commonly and rarely used in the evaluation of FD patients. Method: The usual biomarkers for renal monitoring (microalbuminuria, proteinuria, and creatinine) and some more rarely used (cystatin C, beta 2-microglobulin [β2M], neutrophil gelatinase-associated lipocalin/lipocalin-2) were quantified in the blood and/or urine samples of 40 FD patients, 39 controls without chronic kidney disease (CKD) paired by age and sex and 38 controls with CKD undergoing hemodialysis. Results: Significant statistical differences (p < 0.05) were observed for cystatin C and lipocalin-2 in plasma levels, for β2M and serum creatinine levels and by estimated glomerular filtration rate when compared FD patients and control group with CKD and for proteinuria and microalbuminuria in urine samples and for lipocalin-2 in plasma levels when compared FD patients and control group without CKD. Urine creatinine (UCreat), pH, and urine specific gravity did not present a significant statistical difference between groups. Conclusion: Considering serum creatinine as gold standard, all renal parameters evaluated, including receiver operating characteristic curve, indicated β2M as the best biomarker, followed by cystatin C, proteinuria and microalbuminuria, while the results for lipocalin-2 and UCreat do not indicate good predictors of renal impairment. It suggests that at least 2 altered biomarkers should be considered to characterize a renal alteration, thereby establishing a better therapeutic course for FD patients. If possible, along with serum creatinine, measurement of β2M or cystatin C for renal evaluation of Fabry’s patients should be considered.

Objective The purpose of this systematic review is to summarize information on the use of teledentistry in the diagnosis of oral lesions. Materials and Methods A systematic literature search conducted in August 2018 included articles published until December 2018 in 4 databases. Two reviewers evaluated the search results separately. If they were uncertain as to whether to include an article, a third reviewer made the final decision. Studies related to the diagnosis of oral lesions using teledentistry were included. The methodological quality of the studies was analyzed using the Quality Assessment of Studies of Diagnostic Accuracy. Results Eleven articles were included in the study. The selected articles were published between 1999 and 2018, predominantly in developing countries. The professionals acting as patient examiners are dental students and dentists, as well as other health professionals. Most of the patients evaluated in the studies were from rural populations or locations distant from large centers. The tools used to obtain patient data were smartphones, videoconference, email, questionnaires, histopathological exams, and telemedicine applications and systems. Most studies concluded that there is a high level of agreement between teledentistry and clinical consultation and that the use of this resource for diagnostic purposes can reduce costs and the travel time to consult a specialist personally. Nine of the 11 studies were of good quality. Conclusions Teledentistry has the potential to improve the care quality related to diagnosis and management of oral lesions, shortening distances between patients who need specialized diagnoses and specialists.

Summary Objective The purpose of this study was to analyze the effects of self-selected and randomly selected music on perceptual and performance responses during a sprint interval training (SIT) session. Equipment and Methods 16 physically active males (M age = 27.0, SD = 3.9 years; M body mass = 78.1, SD = 9.6 kg; M height = 1.77, SD = 0.05 meters) performed a low-volume SIT session composed by 8 × 15s all-out bouts against a fixed load of 9% of body mass interspersed by 120s of passive recovery under three conditions: self-selected music (high-tempo subject's favorite music), randomly selected music (playlist from an online streaming music platform) and no-music. Affective responses, perceived exertion, and power output were measured throughout the protocols. Enjoyment and attentional focus were measured after the exercise sessions. Results Perceived exertion and affective responses did not differ between conditions; however, a main effect of time was detected for both variables, with perceived exertion increasing throughout protocols and affective responses decreasing (P 0.05 for all comparisons). Conclusion Music does not seem to promote effects on performance, perceived exertion, affective responses and enjoyment during an SIT session, however, listen to music during the recovery moments can improve the recovery status immediately before the next bout.

Background Perianal fistulizing Crohn’s disease (PFCD) is the main risk factor for anal cancer in patients with inflammatory bowel disease. It is not known whether this occurs due to a higher frequency of human papillomavirus (HPV) in this population or due to the chronic inflammatory condition resulting from perianal fistulas. We aimed to evaluate whether there is a higher prevalence of HPV and high-risk HPV in patients with PFCD compared to the control group, estimate the prevalence of HPV and the subtypes most frequently associated with PFCD. Methods We performed a bicentric cross sectional study in which participants were matched by age and sex. A total of 108 patients with surgical indication for perianal fistula, were recruited, 54 patients in PFCD group and 54 patients with anorectal fistula without Crohn’s disease, from December 2018 through November 2020. These patients were subject to histological material collection during exam under anesthesia with biopsy of the fistulous pathway. The sample was sent for HPV detection and genotyping by INNO-LiPA HPV Genotyping Extra II. Results The PFCD group showed a statistically higher frequency of HPV in the fistulous path compared to control group (33.3% vs 16.7%, p = 0.046). The isolated analysis of the high-risk subtypes numerically demonstrated double the frequency in PFCD group, however, not statistically significant (18.5% vs 9.3%, p = 0.164). After multiple logistic regressions, patients with PFCD had a chance of HPV 3.42 times higher than patients without Crohn’s disease (OR = 3.42, 95% CI, 1.25–9.40), regardless of other variables. The subtypes most frequently identified in PFCD group were HPV11 (12.72%) and HPV16 (9.09%). Conclusion Perianal fistulizing Crohn’s disease is associated with a higher prevalence of HPV compared to patients with anorectal fistula without Crohn’s disease.

Introduction: Homocysteine (Hcy) is one of the metabolites of methionine (Met), an essential diet-derived amino acid. There is a close relationship between high plasma Hcy levels and declining renal function. Plasma and urinary Hcy level has been the target of studies as a biomarker that forecasts poor outcome in renal patients and in hemodialysis patients. This review evaluates the main studies that sought to correlate Hcy and poor prognosis in renal disease as well as the treatments proposed for the reduction of plasma Hcy levels in these patients. Conclusion: Hcy could be an important biomarker of renal disease progression mainly in hemodialysis patients. We emphasize the importance of normalizing plasma levels of this amino acid to ensure a better prognosis in kidney disease. RESUMO Introdução: A homocisteína (Hcy) é um dos metabólitos da metionina (Met), um aminoácido essencial proveniente da dieta. Existe uma estreita relação entre os altos níveis plasmáticos de Hcy e o declínio da função renal. A Hcy plasmática e urinária tem sido alvo de estudos como um biomarcador capaz de sinalizar o prognóstico em doentes renais e em pacientes em hemodiálise. Esta revisão avalia os principais estudos que buscaram correlacionar a Hcy e o prognóstico da doença renal e descreve os tratamentos propostos para a redução dos níveis plasmáticos de Hcy nesses pacientes. Conclusão: A Hcy pode ser um biomarcador da progressão na doença renal, principalmente em pacientes hemodialíticos. Ressaltamos a importância da normalização dos níveis plasmáticos desse aminoácido para garantir um melhor prognóstico na doença renal.

PURPOSE Increased resting muscle sympathetic nerve activity (MSNA) and lower forearm blood flow (FBF) were observed in young men who use anabolic androgenic steroids (AAS). However, the response of MSNA and FBF in AAS users triggered by muscle mechanoreflex and central command has never been tested. In addition, we evaluated the blood pressure (BP) and heart rate (HR) responses during these maneuvers. METHODS Nineteen AAS users (AASU) 31 ± 6 yr of age and 18 AAS nonusers (AASNU) 29 ± 4 yr of age were recruited. All participants were involved in strength training. AAS use was determined using a urine test (liquid chromatography with tandem mass spectrometry). MSNA was measured using the microneurography technique. FBF was measured by using venous occlusion plethysmography. BP was measured using an automatic oscillometric device. HR was recorded continuously through ECG. Isometric handgrip exercise was performed at 30% of the maximal voluntary contraction for 3 min, and mental stress was elicited by the Stroop color-word test for 4 min. RESULTS The MSNA and FBF responses during exercise were similar between AASU and AASNU, with a trend toward higher MSNA (bursts per minute; P = 0.084) and lower forearm vascular conductance (FVC; units; P = 0.084) in AASU than in AASNU. During mental stress, AASU showed a significantly higher MSNA (P < 0.05) and lower FBF (P < 0.05) compared with AASNU. During both maneuvers, HR and BP increased linearly in both groups; however, AASU showed a significantly higher HR compared with AASNU. CONCLUSIONS During muscle mechanoreflex activation (isometric exercise), AASU have normal MSNA and FBF responses, whereas during central command (mental stress) stimulation, AASU have exacerbated MSNA and blunted vasodilation. Therefore, mental stress seems to exacerbate neurovascular control throughout stress reaction situations in AASU.

Introduction: Cisgender women (CW) are usually weaker than cisgender men (CM), but when the strength is expressed in relation to the body weight (BW) or fat free mass (FFM) it is observed that the difference disappears what suggests that the innate qualities of the muscle and its motor control mechanisms are similar in CW and CM. The effects of prior exposure to testosterone during puberty on the performance of transgender women (TW) undergoing physical effort are not well known. Objective: To evaluate muscular strength of TW in long-term gender affirming hormone therapy (GAHT). Methods: A cross-sectional study was carried out with 8 TW (average age of 34.0 yo, SD ±4.8), 8 CM and 8 CW matched by age and body mass index (BMI). All TW were non-gonadectomized subjects and were in estrogen plus cyproterone acetate therapy (average time of 15.6 years (SD ±8.7) of treatment). Mean total testosterone (ng/dL) levels of TW, CW and CM were 83.5, 20.5 and 480.5 at the time of the study, respectively. Hemoglobin levels of TW, CW and CM were 14,2 (range 13,5-14,9), 14,35 (range 12,8-14,7) and 15,35 (range 14,0-18,2), respectively BC was assessed by InBody 720. Handgrip strength tests were carried out using the Stoelting hand-held hydraulic dynamometer. Results: The mean maximum strength was 31,9 kg (SD±2.4) in TW, 29.2 kg (SD±4.4) in CW, and 47.5 (SD±8.6) in CM (TWvs.CW p=0.0743; TWxCM p0.9999). Discussion: The expression of muscle strength/FFM is the same in CM and CW, which suggests that the innate quality of the muscles as well as their motor control is similar in these groups, as showed in many data in the literature. However, the analysis of this ratio in TW showed a significant lower rate than the other groups. Conclusion: After GAHT muscle strength of TW is equal of CW. There is a decrease in the functionality of the muscular unit in producing strength in this group of TWs since strength decreased disproportionately to muscle mass which leads us to believe that there are important functional changes in intracellular oxidation mechanism.

Introdução: Nos últimos anos, a Doença Renal Crônica tem sido considerada um grave problema de saúde pública. Isso se deve principalmente à elevada mortalidade anual, devido a distúrbios cardiovasculares. Alguns dos principais responsáveis pela mortalidade dessa população são as doenças cardíacas e dentro delas os episódios arrítmicos. Diante dessa perspectiva, o presente estudo objetivou investigar a prevalência de arritmias ventriculares e supraventriculares em pacientes portadores de doença renal crônica dialítica. Método: Trata-se de um estudo de coorte prospectivo, no qual foi avaliada a presença de arritmias cardíacas e risco de morte súbita cardíaca em 35 pacientes do Real Hospital Português de Pernambuco. Resultados: Foi observado que 71,4% dos pacientes são do sexo masculino, 85,7% não é de cor negra e 57,1% possui idade acima de 50 anos. Pacientes com níveis plasmáticos inadequados de potássio, cálcio e aqueles que não utilizavam medicamentos, apresentaram maior prevalência de arritmias ventriculares e supraventriculares. Discussão: Alterações dos níveis normais de cálcio e potássio geram intercorrências cardiovasculares, principalmente, arritmias. Maior prevalência de arritmias em indivíduos sem uso de medicamentos pode estar relacionado pelo fato de muitos pacientes serem subdiagnosticados. Além disso, houve maior prevalência de arritmia ventricular durante a hemodiálise, quando comparada à arritmia supraventricular. A idade mostrou-se um importante fator relacionado às arritmias em pacientes dialíticos. Conclusão: Constata-se que pacientes renais crônicos dialíticos apresentam alterações dos níveis normais de eletrólitos e hipertensão arterial que aumentam a ocorrência de arritmias cardíacas, principalmente ventriculares, aumentando o risco de morte súbita nessa população.

The aim of this study was to identify the epidemiological profiles of violence against children, victims, and their aggressors, and their correlations between socioeconomic and demographic factors analyzed before and during the COVID-19 pandemic. This was a cross-sectional, retrospective observational study based on a review of Individual Notification Forms from the Information System for Notifiable Diseases, including child victims of violence, under 18 years, assisted by a pediatric emergency service in Brazil, from 2016–2020. Data were stratified, then statistical analysis was performed using the two-proportion equality test and the Chi-square test, with p &lt, 0.05 and a 95% confidence interval. A total of 609 notifications were analyzed and a prevalence of sexual violence (63.2%) was reported. The prevalent profile of victim was female (76.7%), aged between 2–9 years (38.1%) and 14–18 years (35.6%). The violence occurs in the victim’s home (58.9%). The prevalent profile of perpetrator was male (82.4%), young adolescent (59.2%), living as family (64%), mainly the parents (18.4%). No correlation was found between the classified socioeconomic and demographic variables and violence. There was an increase in notifications during the COVID-19 pandemic, compared to the same period in the previous year, self-harm was reported in 59.7% of physical violence in 2020. Prevalence of sexual violence was higher for females, aged between 2–9 and 14–18 years, victimized in their homes, by male offenders, living as family, mainly by their parents. No association was found between child violence and the socioeconomic and demographic.

Summary Introduction: Obstructive sleep apnea and hypopnea syndrome (OSAHS) is one of the developmental factors of high blood pressure (HBP), a relevant global public health problem. OSAHS is characterized by the reduction or complete cessation of respiratory airflow due to intermittent airway collapse. Additionally, significant changes in sleep rhythm and pattern are observed in these patients. Objective: To evaluate the association between OSAHS and sleep quality in essential and resistant hypertensives. Method: A cross-sectional, observational study evaluated 43 hypertensive patients treated at the outpatient clinics of the Faculdade de Medicina do ABC (FMABC) who were medicated with two or more antihypertensive drugs and divided into nonresistant or resistant to treatment. Results: Group I (using up to two antihypertensive agents – 60.47% of the sample) presented mean systolic blood pressure (SBP) of 127.5±6.4 mmHg, mean diastolic blood pressure (DBP) of 79.6±5.2 mmHg, mean body mass index (BMI) of 27.2±5.3 kg/m2 and mean age of 51.2±15.1 years. Group II (using more than two antihypertensive drugs – 37.2% of the sample) presented mean SBP of 132.1±9.3 mmHg, mean DBP of 84.5±5.8 mmHg, mean BMI of 27.2±7.2 kg/m2 and mean age of 55.5±13.4 years. The patients presented low quality of sleep/sleep disorder evaluated by the Pittsburgh Sleep Quality Index (PSQI), which represents a preponderant factor for OSAHS. Conclusion: Patients at high risk for OSAHS had poor sleep quality and high levels of DBP, suggesting a causal relation between these parameters. However, they did not present a higher prevalence of resistant high blood pressure (RHBP).

Introduction Recent studies have shown that in chronic kidney disease (CKD) 25(OH)D deficiency or insufficiency are a significant risk factor for cardiovascular diseases, sudden cardiac death and mortality. The high incidence of premature ventricular complexes (PVCs) have increasingly been recognized as a primary cause for worsening left ventricular systolic function and heart failure in some patients, specialty when these subjects are under optimal treatment and have implantable cardiac defibrillator (ICD) with cardiac resynchronization therapy (CRT), because the great amount of PVCs reduces the percentage of cardiac resynchronization. Aim Our aim was to evaluate the influence of reposition of cholecalciferol in patients with deficiency of vitamin D in the changes of the numbers of PVCs, and consequently in the percentage of cardiac resynchronization time, during 6 months of follow-up. Methods and results We conducted a prospective, longitudinal study of 56 patients with high incidence of PVCs, heart failure under optimal treatment, ICD + CRT, deficiency of vitamin D (≤ 20 ng/mL) and CKD (estimated glomerular filtration rate measured by MDRD equation, between 16 and 59 mL/min/1.73 m 2 ). All patients were treated with cholecalciferol. We observed significant ameliorating after cholecalciferol onset in the number of PVCs, CRT % time, renal function, vitamin D levels and plasmatic ions at the 6th month of follow-up vs. baseline. Conclusions We suggest that the effectiveness of cholecalciferol reposition for subjects with high incidence of PVCs, heart failure under optimal treatment, ICD + CRT, deficiency of vitamin D and CKD, restoring the function of the CRT, bringing the biventricular pacing to nearby 97%.

Body wasting is a serious complication that affects a large proportion of patients with heart failure. Muscle wasting, also known as sarcopenia, is the loss of muscle mass and strength, whereas cachexia describes loss of weight. After reaching guideline-recommended doses of heart failure therapies, the most promising approach to treating body wasting seems to be combined therapy that includes exercise, nutritional counselling, and drug treatment. Nutritional considerations include avoiding excessive salt and fluid intake, and replenishment of deficiencies in trace elements. Administration of omega-3 polyunsaturated fatty acids is beneficial in selected patients. High-calorific nutritional supplements can also be useful. The prescription of aerobic exercise training that provokes mild or moderate breathlessness has good scientific support. Drugs with potential benefit in the treatment of body wasting that have been tested in clinical studies in patients with heart failure include testosterone, ghrelin, recombinant human growth hormone, essential amino acids, and β2-adrenergic receptor agonists. In this Review, we summarize the pathophysiological mechanisms of muscle wasting and cachexia in heart failure, and highlight the potential treatment strategies. We aim to provide clinicians with the relevant information on body wasting to understand and treat these conditions in patients with heart failure.

Aims Autonomic dysfunction determines the advance of dilated cardiomyopathy (DCM) and is related to poor outcomes. However, this autonomic imbalance is unknown in patients with restrictive cardiomyopathy (RCM) even though they have similar symptoms and poor quality of life as DCM patients have. The aim of this study was to evaluate if autonomic and neurovascular controls were altered in RCM patients. Methods and results Fifteen RCM patients, 10 DCM patients, and 10 healthy subjects were evaluated. Heart rate and blood pressure (BP) were recorded. Peripheral sympathetic activity [muscle sympathetic nerve activity (MSNA)] by microneurography and cardiac sympathetic activity by power spectrum analysis of heart rate variability. Spontaneous baroreflex sensitivity (BRS) was evaluated by the sequence method and forearm blood flow by venous occlusion plethysmography. Both cardiomyopathy groups had higher MSNA frequency (P

// Marcio Galindo Kiuchi 1, 3 , Shaojie Chen 2, 3 , Luis Marcelo Rodrigues Paz 1 and Helmut Purerfellner 3 1 Department of Medicine, Division of Artificial Cardiac Stimulation, Hospital e Clinica Sao Goncalo, Sao Goncalo, Rio de Janeiro, Brazil 2 Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China 3 Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria Correspondence to: Marcio Galindo Kiuchi, email: marciokiuchi@gmail.com Keywords: ventricular arrhythmias, anti-tachycardia therapy pacing, automatic cardioverter-defibrillator, chronic renal disease, renal sympathetic denervation Received: February 01, 2017 Accepted: March 01, 2017 Published: March 16, 2017 ABSTRACT Chronic kidney disease (CKD) patients on stage 4 present greater risk rates for malignant ventricular arrhythmia events. This study examined patients with CKD in stages 1, 2, 3 and 4, left ventricular dysfunction and automatic implantable cardioverter-defibrillator (ICD). Our goal was to record the appropriate therapies, “Anti-tachycardia Therapy Pacing” (ATP) and shock events during the 18 months of follow-up and compare the incidence and severity of these at different stages of CKD, mainly in patients with CKD stage 4 underwent renal sympathetic denervation (RSD) guided by renal nerve stimulation (RNS). One hundred and fifteen patients were evaluated once every three months till 18 months of follow-up. The arrhythmic events were assessed at each follow-up visit. Comparing the groups, we can see the number of ATP and shock events recorded by ICD during 18 months of follow-up, and differences in the number of therapeutic events between the various stages of CKD. The hazard ratio (HR), 95% confidence interval (CI) and P value for ATP and shock events between all the CKD stages were evaluated by the log-rank/Mantel-Haenszel test. At the 18 th month of follow-up, 75% of patients with CKD stage 4 received ATP, and 70% were treated with shock while only 20% of the subjects with CKD stage 4 that were submitted to RSD received ATP and 20% were treated with shock, P

Introduction Diabetic nephropathy is associated with specific histological changes. Early detection of poor glomerular and tubular function can be achieved with biomarkers of diabetes. The aim of this study was to evaluate the accuracy of kidney dysfunction biomarkers in type 2 diabetes (T2D). Methods Patients with T2D were grouped according to their glycated hemoglobin level. Patients’ urine and blood samples were taken to measure cystatin C (CysC), neutrophil gelatinase-associated lipocalin, beta-trace protein levels, and the first morning void albumin-to-creatinine ratio. Patients in the end stage of renal disease or receiving dialysis were not included. Receiver operating characteristic curves were generated, and the areas under the curve were compared with the performance of the biomarkers used to evaluate kidney dysfunction in T2D. Results Ninety patients with T2D were chosen. CysC was positively correlated with creatinine (P < 0.001), estimated glomerular filtration rate (P < 0.001), and urinary beta-trace protein (P = 0.01). The area under the curve was 0.635 for CysC, 0.621 for serum neutrophil gelatinase-associated lipocalin, and 0.660 for the albumin-to-creatinine ratio. A crude logistic regression model showed a positive association between serum CysC (P = 0.01) and serum neutrophil gelatinase-associated lipocalin (P < 0.001). A linear regression model showed a positive association between serum CysC, creatinine, and estimated glomerular filtration rate (P < 0.001) but did not show a positive association with glycated hemoglobin (P = 0.892). Discussion Neutrophil gelatinase-associated lipocalin and serum CysC were positively associated with the presence of renal dysfunction and had better performance on receiver operating characteristic analysis than the other markers evaluated in patients with T2D without kidney dysfunction.

Introduction Recent studies have shown that in chronic kidney disease (CKD) 25(OH)D deficiency or insufficiency is a significant risk factor for cardiovascular diseases (CVDs), sudden cardiac death (SCD) and mortality. Premature ventricular complexes (PVCs) are very common in patients with CKD, hypertension, obesity, sleep apnea, and structural heart disease. Often PVCs in the structurally normal heart are considered benign, although they seem to be associated with a more than two-fold higher risk of cardiovascular complications, including stroke disease and death. Aim In the present study we aimed to evaluate the influence of different 25(OH)D levels on the changes of the numbers of PVCs in all patients, assessed by 24-hour-Holter monitoring 3months after β-blocker onset. Methods and results We conducted a prospective, longitudinal study of 824 patients with PVCs and CKD (estimated glomerular filtration rate measured by MDRD equation, between 16 and 59mL/min/1.73m 2 ). All patients were treated with a β-blocker (bisoprolol 10mg daily). We observed that the 3 groups presented a significant decrease in the number of PVCs from baseline 26,091±3327 (25(OH)D deficiency group), 25,902±3501 (25(OH)D insufficiency group), and 25,554±3637 (25(OH)D sufficiency group) to 20,554±3782, 19,885±3945 and 15,433±4059, respectively, after 3months of β-blocker therapy ( P vs. 25(OH)D sufficiency groups showed a mean difference of 5121 PVCs ( P vs. 25(OH)D sufficiency groups showed a mean difference of 4452 PVCs ( P vs. 25(OH)D insufficiency groups ( P =0.3181). Conclusions We suggest that the effectiveness of β-blocker treatment for PVCs in CKD patients was observed in all 25(OH)D levels. However, the responsiveness was higher in patients with a normal range of 25(OH)D in comparison to patients with deficiency or insufficiency in 25(OH)D levels. Whether vitamin D supplementation increases the efficacy of beta-blocker mediated suppression of PVCs requires further evaluation.

A 24-year-old woman with severe intellectual disability presented with refractory epilepsy since the first day of life. She had global developmental delay and remarkable abnormalities in both primary and secondary teeth (figure). Brain MRI was normal. A whole exome sequencing revealed SLC13A5 compound heterozygous mutations C>T at chr17:6.606.350, p.Gly219Arg, and G>A at chr17:6.590.909, p.Pro505Leu.

The last several years have seen increasing interest in understanding cachexia, muscle wasting, and physical frailty across the broad spectrum of patients with cardiovascular illnesses. This interest originally started in the field of heart failure, but has recently been extended to other areas such as atrial fibrillation, coronary artery disease, peripheral artery disease as well as to patients after cardiac surgery or transcatheter aortic valve implantation. Tissue wasting and frailty are prevalent among many of the affected patients. The ageing process itself and concomitant cardiovascular illness decrease lean mass while fat mass is relatively preserved, making elderly patients particularly prone to develop wasting syndromes and frailty. The aim of this review is to provide an overview of the available knowledge of body wasting and physical frailty in patients with cardiovascular illness, particularly focussing on patients with heart failure in whom most of the available data have been gathered. In addition, mechanisms of wasting and possible therapeutic targets are discussed.