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Osteoarthritis (OA) is characterized by pain and inflammation. Electroacupuncture (EA) and swimming (SW) are non-pharmacological interventions recommended for treating OA. The study evaluated the benefits of electroacupuncture (EA) and swimming (SW) association when compared with isolated protocols in an OA rodent model. Experimental.An ankle monoarthritis model was induced in rats by applying Complete Freund's Adjuvant (CFA). After seven days of induced OA, the groups were submitted to EA (ST36 and the GB 30 Acupoint), SW, or the EA + SW protocol. The nociceptive behavior was measured by the Von Frey test, the Cold Stimulation test, and the Paw Flick Immersion test. Inflammatory activity was evaluated by measuring TNF levels, myeloperoxidase, NAGase, immunological parameters and the histology from the subcutaneous tissue.Compared to CFA group, EA decreased the nociceptive scores in the cold stimulation test (p 0.05), and it also increased the latency time in thermal cold (p 0.01) and heat hyperalgesia (p 0.001). Also, EA reduced NAGase (p 0.01). SW reduced the edema (p 0.05) and did not increase the inflammatory infiltrates or congestion, neither in the histological measurements nor by analyzing the levels of TNF. The association of EA + SW decreased the neutrophils and the monocytes, MPO (p 0.05), and the glutamate levels in the cerebrospinal fluid (CSF, p 0.001).There were statistical differences between combination therapy and monotherapy as seen by the inflammatory parameters, which could be associate to the delay of the chronification osteoarthritis retardation. However, EA + SW did not show benefits when compared to isolated protocols in nociceptive behavior.

PURPOSE International guideline recommendations may not always be extrapolated to developing countries where access to resources is limited. In metastatic castration-sensitive prostate cancer (mCSPC), there have been successful drug and imaging advancements that were addressed in the Prostate Cancer Consensus Conference for Developing Countries for best-practice and limited-resource scenarios. METHODS A total of 24 out of 300 questions addressed staging, treatment, and follow-up for patients with mCSPC both in best-practice settings and resource-limited settings. Responses were compiled and presented in percentage of clinicians supporting each response. Questions had 4-8 options for response. RESULTS Recommendations for staging in mCSPC were split but there was consensus that chest x-ray, abdominal and pelvic computed tomography, and bone scan should be used where resources are limited. In both de novo and relapsed low-volume mCSPC, orchiectomy alone in limited resources was favored and in relapsed high-volume disease, androgen deprivation therapy plus docetaxel in limited resources and androgen deprivation therapy plus abiraterone in high-resource settings were consensus. A 3-weekly regimen of docetaxel was consensus among voters. When using abiraterone, a regimen of 1,000 mg plus prednisone 5 mg/d is optimal, but in limited-resource settings, half the panel agreed that abiraterone 250 mg with fatty foods plus prednisone 5 mg/d is acceptable. The panel recommended against the use of osteoclast-targeted therapy to prevent osseous complications. There was consensus that monitoring of patients undergoing systemic treatment should only be conducted in case of prostate-specific antigen elevation or progression-suggestive symptoms. CONCLUSION The treatment recommendations for most topics addressed differed between the best-practice setting and resource-limited setting, accentuating the need for high-quality evidence that contemplates the effect of limited resources on the management of mCSPC.

PURPOSE To present a summary of the treatment and follow-up recommendations for the biochemical recurrence in castration-sensitive prostate cancer (PCa) acquired through a questionnaire administered to 99 PCa experts from developing countries during the Prostate Cancer Consensus Conference for Developing Countries. METHODS A total of 27 questions were identified as related to this topic from more than 300 questions. The clinician's responses were tallied and presented in a percentage format. Topics included the use of imaging for staging biochemical recurrence, treatment recommendations for three different clinical scenarios, the field of radiation recommended, and follow-up. Each question had 5-7 relevant response options, including “abstain” and/or “unqualified to answer,” and investigated not only recommendations but also if a limitation in resources would change the recommendation. RESULTS For most questions, a clear majority (> 50%) of clinicians agreed on a recommended treatment for imaging, treatment scenarios, and follow-up, although only a few topics reached a consensus > 75%. Limited resources did affect several areas of treatment, although in many cases, they reinforced more stringent criteria for treatment such as prostate-specific antigen values > 0.2 ng/mL and STAMPEDE inclusion criteria as a basis for recommending treatment. CONCLUSION A majority of clinicians working in developing countries with limited resources use similar cutoff points and selection criteria to manage patients treated for biochemically recurrent castration-sensitive PCa.

The purpose of this overview was to assess different antibiotic regimens used in orthognathic surgery and to establish an evidence-based protocol so that beneficial and adverse effects can be determined. A comprehensive literature search for systematic reviews and/or meta-analyses was conducted in MEDLINE (PubMed), EMBASE, and the Cochrane Library until March 2020. Grey literature was investigated in Google Scholar, and a manual search was done of references lists. Two meta-analyses and four systematic reviews met the inclusion criteria. The AMSTAR-2-tool was used to ascertain the potential risk of bias in the included studies, which presented moderate to high methodological quality. Lower infection rates were associated with long-term therapies of penicillin, cefazolin-cephalexin, and amoxicillin-clavulanic-acid, with rates varying from 0% - 3.13%. Higher rates were reported in placebo groups (52.6%) and short-term penicillin therapy (60%). Side effects were reported with cefazolin, clindamycin, and penicillin therapies, including nausea, pain, swelling, headache, vomiting, and skin rash. Evidence suggests that long-term antibiotics can reduce the risk of a surgical site infection (SSI) in orthognathic surgery, but there is uncertainty regarding the effects of one dose of antibiotics preoperatively versus short-term antibiotics. In the same way, intravenous penicillin, cefazolin, clindamycin, and amoxicillin-clavulanic acid kept the infection rates associated with bimaxillary procedures under 3.5%.

Objectives Previous studies in a high-income country have demonstrated that people with and without low back pain (LBP) have an implicit bias that bending and lifting with a flexed lumbar spine is dangerous. These studies present two key limitations: use of a single group per study; people who recovered from back pain were not studied. Our aims were to evaluate: implicit biases between back posture and safety related to bending and lifting in people who are pain-free, have a history of LBP or have current LBP in a middle-income country, and to explore correlations between implicit and explicit measures within groups. Methods Exploratory cross-sectional study including 174 participants (63 pain-free, 57 with history of LBP and 54 with current LBP). Implicit biases between back posture and safety related to bending and lifting were assessed with the Implicit Association Test (IAT). Participants completed paper-based (Bending Safety Belief [BSB]) and online questionnaires (Tampa Scale of Kinesiophobia; Back Pain Attitudes Questionnaire). Results Participants displayed significant implicit bias between images of round-back bending and lifting and words representing “danger” (IATD-SCORE: Pain-free group: 0.56 (IQR=0.31–0.91; 95% CI [0.47, 0.68]); history of LBP group: 0.57 (IQR=0.34–0.84; 95% CI [0.47, 0.67]); current LBP group: 0.56 (IQR=0.24–0.80; 95% CI [0.39, 0.64])). Explicit measures revealed participants hold unhelpful beliefs about the back, perceiving round-back bending and lifting as dangerous (BSBthermometer: Pain-free group: 8 (IQR=7–10; 95% CI [7.5, 8.5]); history of LBP group: 8 (IQR=7–10; 95% CI [7.5, 9.0]); current LBP group: 8.5 (IQR=6.75–10; [7.5, 9.0])). There was no correlation between implicit and explicit measures within the groups. Conclusions In a middle-income country, people with and without LBP, and those who recovered from LBP have an implicit bias that round-back bending and lifting is dangerous.

Total hip arthroplasty stem fracture is an important contributor to morbidity rate and increases the cost of revision surgery. Failure is usually caused by issues related to overload, inadequate stem support, inappropriate stem design or dimensions and material processing. In this study, the role of the relationship between material characterization and biomechanical performance in the fracture of retrieved stems was explored. The stems were manufactured with forged stainless steel, had the same length, 12/14 trunnion, and 28-mm head. These stems were evaluated by macroscopic and microscopic examination to identify the causes of premature failure. Each stem was sectioned into four regions, and the cross-sections were used for the microhardness and grain size analysis. Finite element analysis (FEA) was carried out, considering the stem positioned at the femur, a musculoskeletal model, and biomechanical loading. All stems had fractured through a fatigue mechanism, mainly a unidirectional bending loading condition, with crack nucleation on the lateral side and propagation on the medial side. The numerical analysis revealed maximum mechanical stress on the lateral side of the stem neck, but this was below the yield stress calculated via the hardness. The use of a shorter head neck length could reduce the maximum mechanical stress at the neck. At a cross-section near the plane of the stem fracture, the hardness was lower than that normally reported by the ASM, and there were heterogonous and coarse grain sizes on the lateral side. The main cause of failure of the two stems analyzed was a combination of low hardness and coarse grain size, due to inappropriate materials processing, worsen by a high level of stress on the lateral side of the neck due to the large stem-head offset selected by the orthopedic surgeon.

Purpose Dysphagia is an underrecognized concern in people with chronic obstructive pulmonary disease (COPD) and may contribute to disease exacerbations. In this review article, we share information regarding dysphagia in people with COPD, synthesizing knowledge both from the literature and from studies performed in the context of a multidisciplinary clinical pulmonary rehabilitation program at the Federal University of Santa Maria in Brazil. Results This narrative review presents evidence showing that awareness of dysphagia and patient-reported symptoms of dysphagia are rare in individuals with stable COPD. However, evidence from the routine collection of patient-reported symptom data using the Eating Assessment Tool 10 and about dysphagia-related quality of life using the Swallowing Quality of Life questionnaire do suggest that dysphagia is experienced by some individuals with COPD. Several studies suggest that patients with stable COPD present with altered swallowing physiology on videofluoroscopic exams, including silent aspiration in a small number of these individuals. However, both patient self-report and clinical screening using the Volume–Viscosity Swallowing Test have been found to be poor predictors of these videofluoroscopic findings. We discuss the possibility that altered laryngeal sensation and respiratory–swallow discoordination play a role in dysphagia in people with COPD, and highlight assessment tasks that appear to have the highest sensitivity for detecting penetration–aspiration in this population. Finally, we review preliminary evidence suggesting that physical therapy techniques targeting altered respiratory muscle biomechanics may benefit swallowing in people with COPD. Knowledge gaps requiring further research are identified, and implications for clinical practice are discussed.

The spontaneously hypertensive rat (SHR) is an excellent animal model that mimics the behavioral and neurochemical phenotype of attention-deficit/hyperactivity disorder (ADHD). Here, we characterized the striatal GABA transport of SHR and investigated whether caffeine, a non-selective antagonist of adenosine receptors, could influence GABAergic circuitry. For this purpose, ex vivo striatal slices of SHR and Wistar (control strain) on the 35th postnatal day were dissected and incubated with [3H]-GABA to quantify the basal levels of uptake and release. SHR exhibited a reduced [3H]-GABA uptake and release, suggesting a defective striatal GABAergic transport system. GAT-1 appears to be the primary transporter for [3H]-GABA uptake in SHR striatum, as GAT-1 selective blocker, NO-711, completely abolished it. We also verified that acute exposure of striatal slices to caffeine improved [3H]-GABA uptake and release in SHR, whereas Wistar rats were not affected. GABA-uptake increase and cAMP accumulation promoted by caffeine was reverted by A1R activation with N6-cyclohexyl adenosine (CHA). As expected, the pharmacological blockade of cAMP-PKA signaling by H-89 also prevented caffeine-mediated [3H]-GABA uptake increment. Interestingly, a single caffeine exposure did not affect GAT-1 or A1R protein density in SHR, which was not different from Wistar protein levels, suggesting that the GAT-1-dependent transport in SHR has a defective functional activity rather than lower protein expression. The current data support that caffeine regulates GAT-1 function and improves striatal GABA transport via A1R-cAMP-PKA signaling, specifically in SHR. These results reinforce that caffeine may have therapeutic use in disorders where the GABA transport system is impaired.

Introdução: A doença hepática gordurosa não-alcoólica (DHGNA) atinge em média 25% da população mundial. De acordo com o estágio da doença podem ocorrer alterações metabólicas e declínio da capacidade física. O objetivo do estudo foi analisar e associar o estágio da DHGNA com a capacidade física dos pacientes. Métodos: Foi realizado um estudo observacional transversal em pacientes do Serviço de Gastroenterologia/Hepatologia da Irmandade da Santa Casa de Misericórdia de Porto Alegre (ISCMPA), submetidos a biópsia hepática e análise histopatológica conforme a classificação de Kleiner. Os pacientes informaram dados autorreferidos, executaram o Teste de Caminhada de Seis Minutos (TC6M) e o Teste de Força de Preensão Palmar (FPP) para avaliação da capacidade física. Na análise estatística foi utilizado o teste de Kolmogorov-Smirnov e Wilcoxon para verificar a normalidade, o teste T pareado para a significância do TC6M observado x previsto, a Análise de Variâncias (ANOVA) com Post-Hoc de Tukey para histologia, TC6M e FPP, e o teste não paramétrico de Spearman para as correlações. Resultado: Foram analisados 54 pacientes, de ambos os sexos, diagnosticados com DHGNA. Houve correlação entre a prática de exercícios físicos com o TC6M (ρ ,462; p

The interruption of the maternal-filial bond in young calves can alter the physiological responses due to increased stress at this moment. Therefore, we aimed to analyze the association between age at weaning and the immune responses of 64 beef calves weaned abruptly. The animals were distributed in three weaning (W) treatments: hyper-early (W30), early (W75) and conventional (W180). The treatments agree with the weaning ages used in cow-calf systems in South America. Blood samples were collected of all experimental animals on the day of weaning and days 1, 2 and 7 post-weaning day of the three treatments. Blood samples were used to analyze hematological variables, total plasma proteins (TPP), fibrinogen, serum amyloid A protein (SAA) and cortisol. The variables analyzed were influenced by the sampling day (P 0.001) and the calf gender (P 0.05), and an interaction between treatment x sampling day was observed. Over the study period, high serum cortisol levels were observed for W30 calves. The serum amyloid A protein was significantly influenced by sampling day. When compared to W180 calves, W30 and W75 animals showed prolonged concentrations in plasma fibrinogen. In addition, they presented neutrophilia and lymphopenia during the 180-187 days period, which resulted in a greater neutrophil:lymphocyte ratio (N:L ratio). Calf gender resulted in changes in the number of blood leukocytes (P 0.05). This result provides an alert for weaning at an early age, indicating that different management strategies must be tested to minimize physiological instabilities in critical periods of the life of animals.

p-Cymene is a monoterpene found in over 100 plant species. It shows a range of biological activity, including anti-inflammatory and antimicrobial effects. It is possibly a new therapeutic alternative for autism spectrum disorder characterized by deficits in interaction and behavioral abnormalities. These symptoms can occur in response to maternal immune activation through prenatal exposure to lipopolysaccharide. Thus, this study aimed to evaluate the behavioral, memory, and biochemical effects of chronic administration of p-cymene in an animal model of autism by prenatal maternal exposure to lipopolysaccharide. Twenty-four pregnant Wistar rats were used, who received 100 μg/kg of lipopolysaccharide or saline intraperitoneally (i.p.) on the 9.5 gestational day. After birth, the male offspring remained with the mothers until weaning and underwent model validation tests on postnatal day 30. From postnatal day 31 on, chronic administration, via i.p., of saline (1 mL/kg), risperidone (0.2 mg/kg), or p-cymene (100 mg/kg) for 22 days was performed. The animals were submitted to behavioral (postnatal day 52) and memory tests (postnatal days 52–53) and subsequently sacrificed (postnatal day 54) when their brain structures were removed for quantification of proinflammatory cytokines (TNF-α, interleukin 1β, and interleukin 6). Prenatal exposure to lipopolysaccharide significantly increased episodes of stereotyped movement (p=0.0001) and decreased parameters of social interaction in offspring, including sniffing, following, mounting, and allowing mounting (p=0.0043, p

BackgroundThe relapsing nature ofPlasmodium vivaxinfection is a major barrier to its control and elimination. Factors such as adequate dosing, adherence, drug quality, and pharmacogenetics can impact the effectiveness of radical cure ofP. vivaxand need to be adequately evaluated. CYP2D6 pathway mediates the activation of primaquine (primaquine) into an active metabolite(s) in hepatocytes, and impaired activity has been linked to a higher risk of relapse.Cases presentationThree patients diagnosed withP. vivaxmalaria presented repeated relapses after being initially treated with chloroquine (25 mg/kg) and primaquine (3.5 mg/kg in 14 days) at a non-endemic travel clinic. Recurring episodes were subsequently treated with a higher dose of primaquine (7 mg/kg in 14 days), which prevented further relapses in two patients. However, one patient still presented two episodes after a higher primaquine dose and was prescribed 300 mg of chloroquine weekly to prevent further episodes. Impaired CYP2D6 function was observed in all of them.ConclusionLack of response to primaquine was associated with impaired CYP2D6 activity in three patients presenting multiple relapses followed in a non-endemic setting. Higher primaquine dosage was safe and effectively prevented relapses in two patients and should be further investigated as an option in Latin America. It is crucial to investigate the factors associated with unsuccessful radical cures and alternative therapeutic options.

Resumo Fundamentos As doenças isquêmicas do coração (DIC) são a primeira causa de mortes dentre as doenças cardiovasculares (DCV). Objetivo Descrever o perfil sociodemográfico e analisar tendência da taxa de mortalidade por DIC, segundo sexo e por faixa etária, nos estados da região Nordeste do Brasil, 1996-2016. Métodos Estudo ecológico envolvendo a mortalidade por DIC nos estados do Nordeste. Variáveis analisadas: sexo, idade, escolaridade, estado civil, categoria do CID-10 e estado de residências. Foram calculadas taxas brutas e padronizadas. Os dados de óbitos foram coletados do Sistema de Informações sobre Mortalidade; e os dados populacionais, do Instituto Brasileiro de Geografia e Estatística (IBGE). Nas análises temporais, utilizou-se o modelo de regressão por pontos de inflexão, com cálculo do percentual de variação anual (APC, Annual Percent Change) e do percentual de variação médio do período (AAPC, Average Annual Percent Change). Considerou-se intervalo de confiança de 95% e significância de 5%. Resultados Registrou-se 405.916 óbitos por DIC na região Nordeste durante o período estudado. O perfil de óbitos caracteriza-se por homens (n=229.006; 56,42%), idosos (n=301.379; 74,25%), raça/cor parda (n=197.936; 48,76%), fundamental ou

Background Survivors of critical care may demonstrate mental health disorders in the months after discharge. Research Question What are risk factors for mental health disorders after ICU discharge and is there an association between the burden of mental illness and health-related quality of life (HRQoL)? Study Design and Methods Multicenter prospective cohort study that included 579 adult ICU survivors with an ICU stay of > 72 h in 10 ICUs. Results The outcomes were anxiety and depression assessed by the Hospital Anxiety and Depression Scale, posttraumatic stress disorder (PTSD) assessed by the Impact Event Scale 6, and HRQoL assessed by the Short Form 12 version 2. The 6-month prevalences of any mental health disorder were 36.2% (the prevalences of anxiety, depression, and PTSD were 24.2%, 20.9%, and 15.4%, respectively). ICU survivors with mental health disorders showed worse HRQoL scores in both physical and mental dimensions than those without. The higher the number of psychiatric syndromes manifested, the worse the mental dimension of HRQoL. Age of Interpretation The network of potential risk factors for mental illness among patients discharged from an ICU is complex and involves multiple factors (age, premorbid mental health, acute emotional stress, and physical impairment after ICU stay). The negative impact of the burden of mental illness on HRQoL among critical care survivors is of concern.

Summary Objective To determine whether an association exists between auditory skills and the reliability of judgments of the vocal deviation grade and the degrees of roughness and breathiness and to evaluate whether these skills are predictive of interrater reliability in auditory-perceptual evaluations. Methods The sample consisted of 20 speech-language pathology students without previous training in auditory-perceptual evaluation. The students underwent a basic audiological evaluation and a central auditory processing evaluation. They then participated in two auditory-perceptual evaluation sessions assessing the general grade (GG) and the degrees of roughness and breathiness of 44 samples of sustained vowel production with the presence or absence of dysphonia. For statistical analysis, the intraclass correlation coefficient (ICC) and a beta regression model were used. Results A difference was found in the average ICCs of the GG parameter between listeners with high and low temporal resolution and binaural interaction skills. Temporal resolution skills and binaural interaction affected the ICC of listeners in the GG evaluation, reducing the likelihood of reliability by 2.8 and 3.6 times, respectively. Conclusion An association exists between temporal resolution skills and binaural interaction and the reliability of listeners in evaluations of vocal deviation severity. Listeners with low levels of these skills show less reliability in evaluations of the severity of vocal deviation. In addition, temporal resolution and binaural interaction are predictors and explain 42.7% of the variability in the reliability of evaluations of vocal deviation severity.

BACKGROUND: Studies demonstrate the benefits of upper limbs cycle ergometer (ULCE) in subacute and chronic stroke subjects, but the literature still needs to explore the acute phase of the disease. OBJECTIVE: Verify the effects of ULCE on muscular strength, trunk control and independence of post-stroke subjects in hospital acute phase. METHODS: In this randomized clinical trial participants were allocated into two groups. The control group (CG) performed two daily sessions of conventional physiotherapy, while the intervention group (IG) had one daily session of conventional physiotherapy and one of ULCE. The interventions were carried out for 20 minutes for five days. Both groups were assessed before and after the treatment for upper limbs strength by manual dynamometer, trunk control by Trunk Impairment Scale and level of independence by the Modified Rankin Scale. RESULTS: Twenty subjects with mean ages of 63.5±4.5 were enrolled. There was a significant intra-group difference of palmar grip, shoulder abductors, elbow flexor and wrist extensor strength, trunk control and functional independence only in IG. Inter-group difference for all variables showed superiority in IG. CONCLUSIONS: ULCE is an effective device for increasing muscle strength, trunk control and consequently improving the independence of post-stroke subjects in the acute hospital phase.

There is no consensus in the literature as to the best platelet-rich plasma (PRP) acquisition method or the ideal platelet concentration to stimulate tissue repair. Besides that, most studies do not provide a clear and replicable description of the methods used, which makes standardization and result comparison difficult. Thus, this study aimed to accurately describe the method and evaluate factors influencing PRP preparation in equines. In this regard, two protocols were used, P1 and P2, based on two centrifugation methods, which differed in blood volume, speed and time, and platelet pipetting and resuspension. In conclusion, factors such as centrifugation strength and time are essential to obtain PRP with adequate platelet count. However, other factors such as tube type and plasma pipetting and resuspension methods directly interfere with the replicability of the technique, and hence influencing PRP applicability. Não há consenso na literatura quanto ao melhor método de obtenção do plasma rico em plaquetas (PRP) ou à concentração plaquetária ideal com o objetivo de estimular o reparo tecidual. Além disso, grande parte dos trabalhos não faz descrição clara e reprodutível dos métodos utilizados, o que dificulta a padronização e a comparação dos resultados. Dessa forma, este trabalho teve por objetivo descrever detalhadamente a metodologia e avaliar fatores que influenciam o preparo do PRP em equinos. Para isso, foram utilizados dois protocolos, P1 e P2, baseados em duas centrifugações, que diferiram quanto ao volume de sangue colhido, velocidade e tempo das centrifugações e método de pipetagem e ressuspensão das plaquetas. Conclui-se que fatores como força e tempo de centrifugação são essenciais à obtenção de um PRP com concentração plaquetária adequada. Contudo, fatores adicionais como tipo de tubo e métodos de pipetagem e ressuspensão do plasma interferem diretamente na repetibilidade da técnica, influenciando a aplicabilidade prática do PRP.

Introduction: Some patients with positive antiphospholipid antibodies (aPL) have not been included in randomized clinical trials or observational registries and, therefore, information on their ris...

Hospitalizations are frequent in Systemic Lupus Erythematosus (SLE) and carry a significant economic burden. The focus of this review was to summarize the information available on the main causes of SLE hospitalizations over recent decades. A literature review was conducted, using PubMed and Scopus, for articles related to SLE hospital admissions from 1981 onward. Active disease/ flare and infection were the leading causes of admission across the study period. More recently, other comorbidities gained relevance, such as cardio and cerebrovascular disease, pregnancy-related morbidity, adverse drug reactions, thromboembolic events, malignancy and renal, pulmonary and gastrointestinal disease. African and Southeast Asian studies seemed to display particularly high percentages of patients admitted with active disease/flare, while European and North American studies appeared to report more admissions due to comorbidities and accumulated disease/treatment damage. Some data support a temporal change of certain admission causes, but the limited number, heterogeneity and variance among studies weakens a consistent analysis. In conclusion, despite the developments in SLE management, causes of hospitalization have not prominently changed across recent decades.

Background: Primary arterial hypertension is the most prevalent chronic disease globally and significantly impacts public health. It is hypothesized that 16:8 early time-restricted feeding (eTRF) bolsters blood pressure management. To date, there are no randomized trials evaluating its benefits in the treatment of hypertension as a primary outcome.Objective: To determine if eTRF combined with lifestyle modifications is superior to the standard lifestyle modifications treatment of primary hypertension recommended by the 2018 European hypertension guidelines.Methods: This will be a superiority, parallel, open-label, randomized, phase II trial carried out in a single center in Zurich, Switzerland. Participants between 30 and 60 years of age, recently diagnosed with high normal and grade I hypertension will be randomly assigned to the eTRF 18:6 plus lifestyle modifications group or the standard lifestyle interventions group. The primary outcome will be the difference between the mean systolic blood pressure at eight weeks with the baseline measurement.Discussion: This will be the first trial to evaluate the effects of intermittent fasting in patients with primary hypertension. Potential limitations include patient compliance to the intervention. However, in a previous study, self-reported adherence was observed in 1128 of 1351 participants (83.50%). In addition, this study seeks strategies to improve adherence.Conclusion: We hope that this trial directs other authors to carry out future studies aiming for higher external validity and evaluation of long-term effects of intermittent fasting for the treatment of primary hypertension.

Introduction It has been suggested that visceral adipose tissue (VAT) is associated with several non-communicable chronic diseases, but measuring it is difficult. Thus, anthropometry could be used because is easily applied in clinical practice. Objectives The present study aimed to develop and validate VAT estimation equations (Eq) in military men. Methods The sample consisted of 409 (mean age, 36.5 ± 6.7 years) military men in the Brazilian Army (BA) divided into an equation group (EG) ( n = 270; mean age, 37.0 ± 6.3 years) and a validation group (VG) ( n =139; mean age, 36.0 ± 7.2 years). Anthropometric, hemodynamic and DXA body composition evaluations ( GE iLunar ) were performed. The Student’s t test, Pearson’s correlation, and stepwise general linear regression were applied. Bland-Altman graphics were used to assess the concordance between VAT by Eq and by DXA. The level of significance was 95% ( p < 0.05). Results Age, waist circumference (WC), hip circumference and body mass index presented the main significant positive correlations with the VAT-DXA. Four Eq were created Eq1 ( r 2 = 0.793), Eq2 ( r 2 = 0.810), Eq3 ( r 2 = 0.817), and Eq 4 ( r 2 = 0.823) ( p < 0.05). No differences were observed between VAT by DXA and VAT by Eq ( p = 0.982, p = 0.970, p = 0.495 and p = 0.698). Bland-Altman analysis also presented good concordance as the bias was close to zero and was not statistically significant. Conclusion Eq2 (age*13.0 + WC*60.0 - 4975,.5) was more suitable because it is easier to apply, has a higher predictive power (81.0%), less bias (1.86) and validation yielded average VAT values close to those found in DXA. It may still be considered a valuable tool for other extensive epidemiological studies in military men in the BA and can be used in adult men. Evidence Level I: Development of diagnostic criteria on consecutive patients (with universally applied reference ‘‘gold’’ standard). RESUMO Introdução A literatura científica tem sugerido que o tecido adiposo visceral (TAV) está associado a doenças crônicas não transmissíveis, mas é difícil fazer sua mensuração. Assim, a antropometria pode ser empregada por ser de fácil aplicação na prática clínica. Objetivos Este estudo teve como objetivo desenvolver e validar equações de estimativa (Eq) do TAV em militares. Métodos A amostra consistiu em 409 (média de idade 36,5 ± 6,7 anos) militares do Exército Brasileiro (EB) divididos em Grupo equação (GE) (n = 270; média de idade 37,0 ± 6,3 anos) e Grupo validação (GV) (n = 139; média de idade 36,0 ± 7,2 anos). Foram realizadas avaliações antropométricas, hemodinâmicas e de composição corporal por DXA (GE iLunar). O teste t de Student, a correlação de Pearson e a regressão linear geral Stepwise foram aplicados. Os gráficos de Bland-Altman foram usados para avaliar a concordância entre os resultados de TAV pela Eq e por DXA. O nível de significância adotado foi de 95% (p

Brazil experienced moments of collapse in its health system throughout 2021, driven by the emergence of variants of concern (VOC) combined with an inefficient initial vaccination strategy against Covid-19.To support decision-makers in formulating COVID-19 immunization policy in the context of limited vaccine availability and evolving variants over time, we evaluate optimal strategies for Covid-19 vaccination in Brazil in 2021, when vaccination was rolled out during Gamma variant predominance.Using a discrete-time epidemic model we estimate Covid-19 deaths averted, considering the currently Covid-19 vaccine products and doses available in Brazil; vaccine coverage by target population; and vaccine effectiveness estimates. We evaluated a 5-month time horizon, from early August to the end of December 2021. Optimal vaccination strategies compared the outcomes in terms of averted deaths when varying dose intervals from 8 to 12 weeks, and choosing the minimum coverage levels per age group required prior to expanding vaccination to younger target populations. We also estimated dose availability required over time to allow the implementation of optimal strategies.To maximize the number of averted deaths, vaccine coverage of at least 80 % should be reached in older age groups before starting vaccination into subsequent younger age groups. When evaluating varying dose intervals for AZD1222, reducing the dose interval from 12 to 8 weeks for the primary schedule would result in fewer COVID-19 deaths, but this can only be implemented if accompanied by an increase in vaccine supply of at least 50 % over the coming six-months in Brazil.Covid-19 immunization strategies should be tailored to local vaccine product availability and supply over time, circulating variants of concern, and vaccine coverage in target population groups. Modelling can provide valuable and timely evidence to support the implementation of vaccination strategies considering the local context, yet following international and regional technical evidence-based guidance.

Introduction: Caloric protein malnutrition is prevalent in critically ill patients. This can be aggravated by an inadequate supply of enteral nutrition. Therefore, it is crucial to investigate nutritional adequacy and to identify the most frequent barriers to its administration. Methods: A longitudinalstudy was performed between June and December 2017 at the intensive care unit (ICU) of a hospital in the South of Santa Catarina, approved under the protocol 2.274.728. Patients ≥ 18 years, in enteral nutrition therapy (ENT) for ≥72 hours were included. Socio-demographic data, ICU length of stay and nutrition therapy and laboratory tests were collected. Results: Among the patients in the unit, 147 were evaluated. Of these, 78.9% received ≥70% of the prescribed diet and 36.1% (n=53) started the EN only after ICU admission, with median onset of 20 (13-33) hours. The main reason for interruption of NET was fasting for procedures in 37.4% (n=55) of the patients analyzed. Nutritional inadequacy was associated with the presence of vomiting (p=0.012) and abdominal distension (p=0,009), such as shorter use of ENT (p=0.017) and longer time to ENT (p=0,046). Conclusions: The early start of the ENT is in line with what is recommended by the guidelines. The most prevalent nutritional barrier was fasting for procedures. The presence of some gastrointestinal symptoms, such as vomiting and abdominal distention, shorter time to ENT and longer time to start of ENT appear to be associated with protein calorie inadequacy.

The objective of this study was to analyze the available evidence of systematic reviews that evaluated the efficacy of antenatal corticosteroids in order to contribute to a reduction in magnitude and transcendence of respiratory distress syndrome of the newborn (RDS). Thus, an overview was conducted including all systematic reviews of randomized controlled trials (RCTs) that evaluated women who received corticosteroid treatment during pregnancy to prevent RDS. Therefore, a search strategy was developed using the terms "respiratory distress syndrome, newborn," "corticosteroids," "perinatal death," "neonatal death," "neonate," and "pregnancy." The electronic databases searched were MEDLINE, EMBASE, Cochrane Library, LILACS, and Google Scholar, for studies published until June 2020. We identified 354 references, 38 of which were relevant after the initial screening. Ten systematic reviews met the inclusion criteria. For RDS, 1522 cases occurred in the control group composed of 8716 participants, while in the intervention group was 1088 in 8740 participants (RR = 0.67, 95% CI 0.60-0.75). For neonatal death, 343 cases occurred in 5248 participants of the control group, while in the intervention group, there were 227 cases in 5246 participants (RR = 0.66, 95% CI 0.56-0.78). For perinatal death, there were 344 cases in 3345 participants in the control group, while in the intervention group, the number of cases was 264 in 3384 participants (RR = 0.72, 95% CI 0.58-0.89). Thus, the use of corticosteroids during pregnancy in women at risk of preterm birth is effective for the prevention of RDS in neonates and reducing the number of neonatal and perinatal deaths in preterm. PROSPERO protocol no: CRD42017074604.

Early childhood caries (ECC) is a global problem, disproportionately affecting disadvantaged populations. The aim of this study was to evaluate systematically the available scientific evidence on the effectiveness of methods for ECC prevention. Six electronic databases were searched. Two independent reviewers selected the publications and analysed the quality of the included systematic reviews. Thirteen studies were included. Overall, eight reviews were classified with methodological quality critically low using the AMSTAR 2, whereas five reviews achieved a high risk of bias using the ROBIS tool. The methods identified that were positively related to the prevention of ECC were as follows: preventive dental programmes for pregnant women; advice on diet and feeding; prenatal oral health care; integration of maternal and children's oral health promotion into nursing practice; maternal oral health programmes undertaken by non-dental health professionals; dental health education in combination with the use of fluoride for children; early preventive dental visits; and the use of fluoride varnish and toothpastes with more than 1000 ppm of fluoride. The currently available evidence supporting the effectiveness of methods for prevention of ECC, although suggesting some methods of greater potential, is still lacking due to the methodological quality of the systematic reviews and the included primary studies.

Background: Tuberculosis (TB) is seldom thought of as a differential diagnosis although being the leading cause of death from infectious disease worldwide. It is estimated that abdominal TB (in the...

Objective To describe and compare the findings of endoscopic sensory assessment in COPD patients and healthy controls. Design A prospective cross-sectional study. Setting Otorhinolaryngology outpatient clinic at a university hospital. Participants 27 adults with COPD and 11 age-matched healthy controls. Main outcome measures Group differences in light-touch endoscopic tests of pharyngeal and laryngeal sensation, controlling for pooled salivary secretions in the pharynx and laryngo-pharyngeal reflux as measured by the Reflux Finding Score (RFS). Results A significant difference in laryngeal sensation was found between the study groups (p = 0.047), with reduced laryngeal sensation in the COPD patients. Additionally, a significant relationship was found between impaired oropharyngeal sensation and the presence of pooled salivary secretions in the pharynx (p = 0.018), especially in the pyriform sinuses (p = 0.012). No differences in the frequency of abnormal Reflux Finding Scores were found between groups. Conclusion Individuals with COPD were significantly more likely to present with impaired laryngeal sensation. Additionally, impaired sensation in the oropharynx was associated with pooled salivary secretions in the pharynx.

BACKGROUND: Studies demonstrate the benefits of aerobic cycling training in subacute and chronic stroke subjects, but there is a lack in the literature about its effects on the acute phase. OBJECTIVE: Verify the effects of aerobic cycling training on lower limbs muscle strength, gait speed, balance, mobility and functionality of acute stroke subjects. METHODS: Control group (CG) performed conventional physiotherapy twice a day and the intervention group (IG) performed a conventional physiotherapy and a cycle ergometer session, for five consecutive days. Subjects were assessed for muscle strength by a digital dynamometer, gait speed by the 10-meter-walk-test, balance by the Berg Balance Scale, mobility by the ICU-Mobility-Scale and functionality by the Perme Score. RESULTS: Twenty subjects were enrolled in the study, 10 in the CG and 10 in the IG. Lower limbs muscle strength, the main endpoint, was better in the IG compared to the CG. The same was found in the secondary endpoints. The intragroup analysis was also positive for the CG in the mobility and functionality. CONCLUSIONS: Conventional physiotherapy combined with cycling exercise showed better results in the improvement of muscle strength of lower limbs, mobility and functionality of subjects who suffered from acute stroke.

Objetivo: Conhecer a influência dos fatores de riscos modificáveis "sobrepeso" e "sedentarismo" no aparecimento precoce de diabetes melitus tipo 2 (DM 2) em mulheres com Sí­ndrome do Ovário Policí­stico (SOP). Método: revisão da literatura com busca dos uni termos no esquema boolanao: (sí­ndrome dos ovários policí­sticos AND diabetes mellitus tipo 2) OR (estilo de vida, obesidade e comportamento sedentário), nos sites PUBME e SciELO. Resultados: Foram encontrados 3611 artigos no PUBMED e 1713 no SciELO; no qual – após triagem pelos pesquisadores – encontrou-se 16 artigos que atendiam os critérios estabelecidos. Etnia trata-se de um fator que predispõe a risco, bem como tempo gasto com televisão e celulares, que elevam risco de obesidade em até 23% e de DM 2 em mulheres com SOP em até 14%. Conclusão: Necessidade de ações para as mulheres com SOP para evitar DM2 precoce, incluindo ações em planos municipais de saúde, com ênfase na atenção primária.

Background Burning mouth syndrome (BMS) it is characterized by burning and uncomfortable sensations with no clinical alterations or laboratory findings. The evaluation of the salivary characteristics of people with BMS can help the understanding of the pathogenesis of this condition. This case-control study aimed to trace the salivary profile of women with burning mouth syndrome (BMS). Material and Methods 40 women with BMS and 40 control women were recruited. Unstimulated salivary flow rate (uSFR), pH, salivary cortisol levels, salivary viscosity, and oral health impact profile (OHIP-14 questioner) were determined. P< 0.05 was considered statistically significant. Results For uSFR, mean values obtained for BMS and for control group respectively were 0.35 and 0.61 mL/min; for pH, 7.23 and 7.34; for cortisol levels, 0.36 and 0.15 μg/dL; for viscosity values, 31.1 and 45.01 mPas and for OHIP-14 scores, 21.7 and 5.7. To uSFR, cortisol levels, viscosity values and OHIP-14 scores, differences were statistically significant. Salivary cortisol levels and OHIP-14 scores were correlated positively (rho = 0.624; p< 0.05). Conclusions BMS women have lower uSFR and salivary viscosity and higher salivary cortisol levels that were associated with worse quality of life, compared with the control group. Key words:Xerostomia, Burning mouth syndrome, Viscosity.

The COVID-19 pandemic caused by the new coronavirus (SARS-CoV-2) has become a global emergency issue for public health. This threat has led to an acceleration in related research and, consequently, an unprecedented volume of clinical and experimental data that include changes in gene expression resulting from infection. The SARS-CoV-2 infection database (SARSCOVIDB: https://sarscovidb.org/) was created to mitigate the difficulties related to this scenario. The SARSCOVIDB is an online platform that aims to integrate all differential gene expression data, at messenger RNA and protein levels, helping to speed up analysis and research on the molecular impact of COVID-19. The database can be searched from different experimental perspectives and presents all related information from published data, such as viral strains, hosts, methodological approaches (proteomics or transcriptomics), genes/proteins, and samples (clinical or experimental). All information was taken from 24 articles related to analyses of differential gene expression out of 5,554 COVID-19/SARS-CoV-2-related articles published so far. The database features 12,535 genes whose expression has been identified as altered due to SARS-CoV-2 infection. Thus, the SARSCOVIDB is a new resource to support the health workers and the scientific community in understanding the pathogenesis and molecular impact caused by SARS-CoV-2.

O objetivo deste estudo foi identificar característica sociodemográficas e clínicas relacionadas a cuidados com a saúde de pessoas com diabetes mellitus. Estudo de caráter quantitativo, do tipo observacional descritivorealizado com pessoas com diabetes mellitus, hospitalizadas em unidades de clínica cirúrgica e clínica médica, em um hospital escola do sul do Brasil. Coleta de dados por consulta de enfermagem à beira do leito e em prontuários, realizada entre agosto e dezembro de 2017. Os dados foram submetidos à estatística descritiva. Participaram da pesquisa 37 pessoas, a maioria, 33 (89,2%) com diabetes tipo 2, a média de idade de 60 anos e tempo médio de diagnóstico de 9,6 anos; 27 (72,9%) tiveram episódios de hiperglicemia na internação; seis (16,2%) eram insulinodependentes; 26 (70,2%) eram hipertensos. Em suma, o perfil evidenciado por este estudo converge para perfis regionais e globais de pessoas com diabetes e, especificamente, em situação de hospitalização. Destacaram-se as características relacionadas à faixa etária maior de 40 anos mais acometida pela doença, com baixa escolaridade e com comorbidades associadas, especialmente as doenças cardiovasculares e a obesidade. O conhecimento deste perfil é potencial para um cuidado de enfermagem contextualizado, sobretudo para estratégias de educação em saúde.

Introducción: La litiasis biliar (LB) es un problema muy frecuente en la consulta diaria de un cirujano general, por lo que actualmente, del 10 al 15% de la población adulta en los países desarrollados presenta LB. Metodología: Se realizó un estudio descriptivo, observacional y transversal con los pacientes sometidos a colecistectomía laparoscópica en un período comprendido entre el 1 de enero del 2018 y el 31 de diciembre del 2018. El objetivo principal de este estudio es determinar diferencias de media del score de riesgo de colecistectomía dificultosa según conversión a cirugía abierta en pacientes con diagnóstico de litiasis biliar sintomática. Resultados: A través de los datos registrados se puede decir que ser hombre, con recuento de leucocitos >12.000 mm3, con IMC >30, presencia de coledocolitiasis y pared vesicular mayor a 3 mm son factores que incrementan el riesgo de conversión a cirugía abierta en esta serie de pacientes. Es factible y seguro utilizar este score para determinar aquellos pacientes con mayor riesgo de conversión dado que todos los factores independientes identificados no son modificables. Conclusión: En definitiva, ser hombre, con recuento de leucocitos >10.000 mm3, con IMC >30, presencia de coledocolitiasis y pared vesicular mayor a 3 mm son factores que incrementan el riesgo de conversión a cirugía abierta en una serie de pacientes sometidos a video laparoscopía en un Hospital universitario y es factible y seguro utilizar este score para identificar esos pacientes con mayor riesgo de conversión.

Cellular death and survival signaling plays a key role in the progress of adverse cardiac remodeling after acute myocardial infarction (AMI). Therapeutic strategies, such as co-treatment with beta-blocker carvedilol and thyroid hormones (THs), give rise to new approaches that can sustain the cellular homeostasis after AMI. Therefore, we sought to investigate the effects of carvedilol and TH co-administration on apoptosis and survival proteins and on cardiac remodeling after AMI. Male Wistar rats were distributed in 5 groups as follows: sham-operated group (SHAM), infarcted group (MI), infarcted plus carvedilol group (MI+C), infarcted plus TH group (MI+TH), and infarcted plus carvedilol and TH co-treatment group (MI+C+TH). Echocardiographic analysis was performed, and hearts were collected for western blot evaluation. The MI group presented systolic posterior wall thickness loss, an increase in the wall tension index, and an increase in atrial natriuretic peptide tissue levels than the SHAM group. However, in the MI+C+TH group, these parameters were equally to the SHAM group. Moreover, whereas the MI group showed Bax protein expression elevated in relation to the SHAM group, the MI+C+TH group presented Bax reduction and also Akt activation compared with the MI group. In addition, the MI+TH group revealed beta-1 adrenergic receptor (β1AR) upregulation compared with the MI and MI+C groups, whereas the MI+C+TH group presented lower levels of β1AR in relation to the SHAM and MI+TH groups. In conclusion, we suggest that carvedilol and TH co-administration may mediate its cardioprotective effects against adverse cardiac remodeling post-AMI through the Bax reduction, Akt activation, and β1AR decrease.

Summary Clinical manifestations of COVID-19 are varied in the general population. This study aimed to systematize the literature regarding clinical manifestations of patients with confirmed COVID-19. A systematic review of the literature was conducted. A total of 8070 scientific productions were found in the databases. Among the studies, 184 met the initial inclusion criteria, with a total of 114,046 patients. After complete reading, 32 studies that did not report clinical manifestations were excluded. The 152 publications finally included a total of 41,409 individuals from at least 23 countries and 26 different clinical manifestations were reported. In percentage terms, 6 symptoms had a general prevalence greater than or equal to 25%, namely, fever (58.66%), cough (54.52%), dyspnea (30.82%), malaise (29.75%), fatigue (28.16%) and sputum/secretion (25.33%). Neurological symptoms (20.82%), dermatological manifestations (20.45%), anorexia (20.26%), myalgia (16.9%), sneezing (14.71%), sore throat (14.41%), rhinitis (14.29%), goosebumps (13.49%), headache (12.17%), chest pain (11.49%) and diarrhea (9.59%) were other common symptoms. Only one study reported dermatological manifestations. The least frequent sign/symptom was hemoptysis (1.65%). In studies with more than 100 patients, the 3 main symptoms were fever (57.93%), cough (54.21%), and dyspnea (30.64%). Dermatological manifestations do not appear among the main symptoms. The identification of all clinical manifestations of COVID-19 is essential for an early diagnosis and the adoption of preventive measures. Electronic supplementary material The online version of this article (10.1007/s00508-020-01760-4) contains supplementary material, which is available to authorized users.

Angiogenesis is considered to mediate the beneficial effects of mesenchymal cell therapy in spinal cord injury. After a moderate balloon-compression injury in rats, injections of either human adipose tissue-derived stromal/stem cells (hADSCs) or their conditioned culture media (CM-hADSC) elicited angiogenesis around the lesion site. Both therapies increased vascular density, but the presence of hADSCs in the tissue was required for the full maturation of new blood vessels. Only animals that received hADSC significantly improved their open field locomotion, assessed by the BBB score. Animals that received CM-hADSC only, presented haemorrhagic areas and lack pericytes. Proteomic analyses of human angiogenesis-related factors produced by hADSCs showed that both pro- and anti-angiogenic factors were produced by hADSCs in vitro, but only those related to vessel maturation were detectable in vivo. hADSCs produced PDGF-AA only after insertion into the injured spinal cord. hADSCs attracted resident pericytes expressing NG2, α-SMA, PDGF-Rβ and nestin to the lesion, potentially contributing to blood vessel maturation. We conclude that the presence of hADSCs in the injured spinal cord is essential for tissue repair.

O trabalho teve como objetivo avaliar o efeito da utilização de um tratamento homeopático preventivo com o produto Masthe HM1000® (Hágil terapêutica) na ocorrência de mastite subclínica em vacas leiteiras, na produção de leite e no percentual de gordura e proteína. Os dados foram coletados de duas propriedades leiteiras da região noroeste do estado do Rio Grande do Sul, os quais eram mantidos em sistema a pasto com suplementação no cocho e composto por vacas Holandesas e Jersey, sendo coletado dados de dois meses antes e dois meses após a utilização do produto homeopático. Em cima disso, pode-se concluir que a utilização da homeopatia Masthe HM1000® (Hágil terapêutica) para mastite reduziu a ocorrência da mastite subclínica e a contagem de CCS do leite das vacas em lactação sem afetar a produção ou a composição de gordura e proteína presente no leite. A mastite é uma doença que causa grandes prejuízos no rebanho leiteiro e é um dos problemas mais frequentes nas propriedades de leite, com isso novas medidas para o controle e prevenção da mastite são um dos grandes gargalos no dia a dia do médico veterinário, sendo possível utilizar novas terapêuticas para auxiliar o produtor em frente as perdas sanitárias e financeiras que a mastite acarreta ao rebanho.

The Sturge-Weber syndrome (SSW) is a congenital neurocutaneous malformation, with angiomas involving the leptomeningea and facial skin. This syndrome is characterized by corticocerebral angiomatosis, cerebral calcifications, ocular affections, mental retardation, increased risk of stroke, counterlateral hemiplegia, and seizures. Another important feature of SSW is the flameus nevus on the face. In the oral cavity, SSW appears as hemangiomatous lesions affecting the mucous membranes and occasionally the dental pulp. Gingival hyperplasia may be present due to the use of anticonvulsant drugs. The present article reports the management of 2 female patients with Sturge-Weber syndrome who required oral surgery in regions affected by hemangiomatous lesions. In the first case, no hemostatic agents were necessary. On the other hand, the second case required the use of several hemostatic agents to control hemorrhage during surgery. Both patients recovered uneventfully without episodes of bleeding or infection.

Root canal filling aims at eliminating empty spaces into the root canal system using biologically compatible materials. Three-dimensional root canal obturation must prevent or minimize the reinfection caused by microorganisms' leakage. This study aimed at evaluating whether fluorophore (Rhodamine or Fluo-3) influences the CLSM images of intratubular penetration of four endodontic sealers. Eighty bovine teeth were prepared using K files up to a size #70 and irrigated with 2.5% sodium hypochlorite. All roots were divided into eight groups (n = 10) according to the sealer and fluorophore used: AH Plus/Rhodamine, AH Plus/Fluo-3, Sealer Plus/Rhodamine, Sealer Plus/Fluo-3, Sealer Plus BC/Rhodamine, Sealer Plus BC/Fluo-3, Endosequence/Rhodamine, and Endosequence/Fluo-3. All roots were filled using cold lateral compaction technique. After 7 days, the roots were transversely sectioned, and three slices, one of each canal third, were obtained. Intratubular penetration was evaluated using CLSM. Sealer Plus BC/Rhodamine and Endosequence BC/Rhodamine presented higher intratubular penetration than AH Plus/Fluo-3 and Sealer Plus/Fluo-3 (p ˂ .05). The intragroup analysis showed similar intratubular penetration, regardless of the root third, except for the apical third in AH Plus/Fluo-3 and Sealer Plus BC/Fluo-3 groups. The type of fluorophore influences the calcium silicate sealers' tubular penetration but not of epoxy resin-based ones using CLSM. Bioceramic sealers should not be used associated with Rhodamine for CLSM evaluation. RESEARCH HIGHLIGHTS: The type of fluorophore influences the calcium silicate sealers' tubular penetration but not of epoxy resin-based ones when CLSM is used for assessment. Bioceramic sealers should not be used associated with Rhodamine.

Bipolar disorder (BD) is a mood psychiatric disorder described by changes between depressive, hypomanic, or manic episodes. The aimed of the present study was evaluated possible changes in the AA pathway in BD through a systematic review of observational studies. A search in the electronic databases was proceeded, on Cochrane Library, MEDLINE, EMBASE, PsycINFO, Google Scholar and the British Library for studies published until August 2020. A search strategy was developed using the terms: "Bipolar Disorder" and "Phospholipase A2" or "Arachidonic Acids" or "Cyclooxygenase 2" or "Prostaglandins E" as text words and Medical Subject Headings (i.e., MeSH and EMTREE). Seven primary studies were included in the systematic review, with a total of 246 BD patients, 20 depression patients, and 425 heathy controls (HC). The studies showed contradictory results in the AA and PLA2, no primary articles with COX and PGE2 assessments were included in this review. According to the Newcastle-Ottawa quality score scale (NOS), our systematic review presented high quality. The investigation of the inflammatory pathway of AA still needs further investigation and evidence, given the growing number of studies suggesting the efficacy of anti-inflammatory drugs as adjunctive therapy in the pharmacological treatment of BD.

Objectives This study aims to determine whether transcranial direct current stimulation (tDCS): a) is effective in the treatment of tinnitus by decreasing its annoyance and severity; b) modulates the cortical electrical activity of such individuals. Methods A double-blind, placebo-controlled clinical trial was conducted with 24 patients with tinnitus, randomized into two groups: Group 1 (n = 12) received anodal tDCS over the left temporoparietal area (LTA) and cathodal tDCS over the right dorsolateral prefrontal cortex (DLPFC) and Group 2 (n = 12) received placebo intervention. Tinnitus perception using a visual analog scale (VAS) and the Tinnitus Handicap Inventory (THI) questionnaire, in addition to electroencephalogram (EEG) was measured with eyes opened and closed at baseline and after the intervention. For the treatment, patients were subjected to five consecutive sessions of tDCS with the anodal electrode over the LTA and cathodal electrode over the right DLPFC (7 × 5 cm, 2 mA for 20 min). tDCS was turned off after 30 s in the sham group. Results Active tDCS significantly improved tinnitus annoyance and severity. It was associated with decreased beta and theta EEG frequency bands with eyes opened and decreased alpha frequency with eyes closed. sLORETA identified changes in frequency bands in the frontal, temporoparietal, and limbic regions. Finally, there were negative correlations between baseline EEG frequency bands and tDCS-induced change in tinnitus annoyance and severity. Conclusions These results demonstrate that tDCS modulates the EEG activity and alleviates tinnitus perception. This effect may be related to baseline EEG activity.

Objetivo: Caracterizar tipos de risco cardiovascular nos pacientes hipertensos atendidos por uma equipe de saúde da famí­lia do municí­pio do Rio de Janeiro através do escore de Framingham. Métodos: Estudo observacional, transversal, realizado em uma Clí­nica de Saúde da Famí­lia no municí­pio do Rio de Janeiro, no mês de outubro de 2017, através de consulta a prontuários dos pacientes hipertensos cadastrados. Os dados foram categorizados em um banco de dados no programa Excel® 2013 e realizado testes estatí­sticos descritivos. Resultados: Foram obtidos dados de 221 indiví­duos e a maioria dos participantes foram considerados de alto e médio risco para desenvolvimento de evento cardiovascular maior em 10 anos. Conclusão: O Escore de Risco de Framingham foi uma ferramenta exitosa para a estratificação de risco de usuários na Atenção Primária í Saúde e merece ser incorporado como instrumento pela equipe de saúde na promoção da saúde cardiovascular.

Background Currently, pediatric-inspired regimens are commonly applied to adults with acute lymphoblastic leukemia (ALL) after the recent recognition that these protocols improve survival. While asparaginase in whatever available formulation is a key component of modern treatment of ALL, many adult oncologists and hematologists struggle to deal with its particular toxicities in clinical practice. We reviewed toxicity outcomes of pegylated asparaginase (PEG-ASP) in adults with ALL treated in 3 reference centers in Brazil. Patients and Methods This was a cross-sectional retrospective chart-review study encompassing patients aged 15 years and older diagnosed with ALL or ambiguous-lineage leukemia who received at least one dose of PEG-ASP, regardless of the adopted regimen. Results A total of 57 patients were included (age range, 15-57 years). Most patients (70%) received 2000 IU/m2 as the initial dose, by intravenous route (72%). The incidence of thromboembolic events was 17.5%, and the main site was cerebral venous sinus (4/10). Thrombosis was more frequent in patients receiving second-line treatment. In obese patients, grade 3 hepatotoxicity and hyperbilirubinemia were more common. Clinical pancreatitis (grade 3 or higher) was found in 2 of 57 cases. PEG-ASP had to be discontinued in 19.3% of exposed patients (11/57). Conclusion By reviewing the medical charts of adult patients with ALL from 3 reference centers, we found that our incidence of thrombotic and hepatic adverse events is similar to those reported in other trials involving PEG-ASP. Usually these effects should not preclude further use of the drug because most events are manageable in routine clinical practice.

New findings What is the central question of this study? Does thyroid hormone treatment given after myocardial infarction preserve left ventricular function and treadmill exercise performance, and improve parameters of oxidative stress in the right ventricle and lungs of Wistar rats? What is the main finding and its importance? Thyroid hormone treatment improved the performance of the maximum exercise test in infarcted rats and induced effects in the heart and lungs that were similar to those observed with exercise training. This suggests there is a significant value of thyroid hormones for preserving exercise tolerance after myocardial infarction. Abstract Left ventricular myocardial infarction (MI) provokes damage in the heart and in other tissues, such as right ventricle and lungs. The present study elucidated whether thyroid hormone treatment (THT) may present positive effects in heart and lungs after MI, and whether or not these effects are similar to those of exercise training (ET). Male Wistar rats were divided into four groups: sham operated (SHAM), infarcted (MI), infarcted + exercise training (MIE), and infarcted + thyroid hormones (MIH). A maximum exercise test, left ventricle echocardiography, pulmonary histology, and oxidative stress in the right ventricle and lung were evaluated. THT and ET both reduced left ventricular dilatation and end-diastolic wall stress indexes to a similar extent. MI accentuated the content of macrophages and inflammatory infiltrate in the lungs, which was partially prevented in the MIH and MIE groups. THT and ET presented similar effects in the heart and lungs, and both improved the performance of the maximum exercise test in infarcted animals.

Background: It is estimated that the prevalence of cerebrovascular accident (CVA) increases significantly as a result of the increase in the elderly population, leading to dependence and care. Interventions with physical exercises are essential for patients with chronic CVA and hemiparesis to contribute to functional motor recovery. The gait of the hemiparetic patients is very impaired, including decreased speed, unipodal support in the abbreviated paretic limb, increased step length, decreased hip flexion, increased knee flexion and plantar flexion and involves compensatory strategies to deal with deficits of the affected limb. Rehabilitation programs of patients with CVA should focus on the restoration of the individual’s independence and ability to move. Objective: To analyze the effects of the addition of a load on a lower limb not affected in the discharge of weight and motor function of paretic lower limb. Method: Experimental, randomized, double-blind study conducted at the Physiotherapy and Occupational Therapy Outpatient Clinic of the Hospital das Clínicas (HC) - UNICAMP. Participants were assessed by the Confidence and Balance Scale, Fugl-Meyer Assessment of Physical Performance (FMA), Modified Ashworth Scale (MAS), Postural Stroke Scale for post-stroke patients (PSS), Time up and go test (TUG), 10-Meter gait test, Stroke Scale Barthel and weight transfer in the affected lower limb. Participants were treated in 12 walking training sessions on the treadmill with 1 kg added to the ankle of the lower limb. Results: There were variations between the 3 times for gait time (p= 0.005), FMA (p= 0.002), Activities-specific Balance Confidence Scale (ABC scale) (p= 0.007) and EAPA (p= 0.042). Conclusion: Treadmill therapy and weight addition in the healthy limb revealed improvement in motor function, balance in orthostatism and walking speed.

The study aimed to compare the acetaminophen administration efficacy or its combination with codeine for pain control in acute apical abscesses cases.Thirty-nine patients who sought emergency treatment in the Faculty of Dentistry of the Federal University of Rio Grande do Sul were included, all of them with acute apical abscess diagnosis. These patients were divided into two groups: acetaminophen group-prescription of acetaminophen (1000 mg) and acetaminophen-codeine group-prescription of acetaminophen (1000 mg) + codeine (30 mg), both with oral intake every 6 h for 3 days. The pain scores were recorded by the patients on their own at 6, 12, 24, 48, and 72 h after finishing clinical assistance, by filling a pain evolution journal, containing a visual analogue scale (VAS). Student t test was conducted to investigate different mean ages between groups 1 and 2. A comparison of weight and means of initial pain scores between groups was carried out using the Mann-Whitney U test. Chi-square test was performed to compare gender, affected tooth, education, initial swelling, and frequency of adverse effect between test and control groups. Mann-Whitney U test was applied to compare groups in the same period. Friedman's test was used to compare results from the same group over time.Both groups showed score reduction over time (P 0.05). Paracetamol-codeine group showed significant pain score reduction at 48 h registers when compared to baseline and at 6 h scores (P 0.05). Further, pain scores at 72 h were significantly lower, when compared to the baseline, at 6 h, and at 12 h scores (P 0.05). Acetaminophen group showed significant pain score reduction observed at 72 h, when compared to the baseline and at 6 h scores (P 0.05). There were no significant differences in pain score reduction over time between groups (P 0.05). There was no difference between the groups regarding the frequency of adverse reactions (P 0.05).Both medications were effective for pain control in acute apical abscess cases. The findings might have inferred in pain control of acute apical abscess associated pain in patients who used an antibiotic drug. External validity of the findings for acute apical abscess cases with no need for an antibiotic prescription is uncertain.This paper suggests acetaminophen 1000 mg can be used for pain control in the treatment of acute apical abscess associated with systemic manifestation.

Background: The increase in the number of pregnant women working to the end of gestation has attracted interest in studying the effects of work on maternal fetal health. A task description questionnaire (TDQ) was developed to evaluate pregnant women and labor tasks performed in this period. Objectives: The purpose of the study was to evaluate the reproducibility of the TDQ and its questions regarding the labor tasks performed by pregnant workers. Methods: Test-retest reproducibility was performed with data collected at seven-day intervals in 37 pregnant women. A Spearman test and κ coefficients were calculated for test-retest agreement. Results: With regard to κ, the results showed good to total agreement for questions 3 and 4. The Spearman correlation was excellent to moderate (for questions 5 and 6). Conclusions: The results of the reproducibility of the TDQ reflected the good understanding of this tool, because it was simple, easy and fast to apply. A TDQ can detect the need for changes in the occupational environment of pregnant workers. This ensures the examination of maternal fetal health and safety.

Symptom assessment, in Duchenne Muscular Dystrophy (DMD), allows an adequate treatment, and the Edmonton Symptom Assessment System (ESAS) assess it: evaluating clinical problems of patients in palliative care (pain, tiredness, drowsiness, nausea, appetite, shortness of breath, depression, anxiety, and well-being). Objective: To verify if patients with DMD understand the terms of the ESAS and if their symptoms could be assessed using this instrument. Methods: Ten patients with DMD were cross-sectional evaluated in relation to the understanding of the ESAS items, capacity to describe symptom (using the ESAS and the Faces Scale) and the Motor Function Measure. The patient’s symptom by ESAS was also classified by evaluator. A descriptive and correlation (Spearman's correlation coefficient) analysis of data was performed. Results: All patients understood the symptoms of pain, tiredness, drowsiness, depression (sadness), and well-being. However, some patients did not understand the symptoms of nausea, appetite, shortness of breath. The general mean of all symptoms assessed by the ESAS was below 5 points. For the symptom ‘depression’ and ‘anxiety’, a strong correlation was found between the results of the ESAS and the Face scale (r = 0.64, and r = 0.65, respectively). Additionally, a perfect and strong correlation, respectively, was found between the ESAS completed by the patient and the evaluator for the items '‘depression’," and ‘anxiety’ (r=1.0)" and a ‘drowsiness’ (r = 0.82). Conclusion: DMD patients understood the ESAS terms and graded their symptoms using this instrument. Therefore, it is not necessary to change the ESAS terms to assess patients with DMD.