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Multiple myeloma (MM) is a blood cell neoplasm characterized by excessive production of malignant monoclonal plasma cells (activated B lymphocytes) by the bone marrow, which end up synthesizing antibodies or antibody fragments, called M proteins, in excess. The accumulation of this production, both cells themselves and of the immunoglobulins, causes a series of problems for the patient, of a systemic and local nature, such as blood hyperviscosity, renal failure, anemia, bone lesions, and infections due to compromised immunity. MM is the third most common hematological neoplasm, constituting 1% of all cancer cases, and is a disease that is difficult to treat, still being considered an incurable disease. The treatments currently available cannot cure the patient, but only extend their lifespan, and the main and most effective alternative is autologous hematopoietic stem cell transplantation, but not every patient is eligible, often due to age and pre-existing comorbidities. In this context, the search for new therapies that can bring better results to patients is of utmost importance. Protein tyrosine kinases (PTKs) are involved in several biological processes, such as cell growth regulation and proliferation, thus, mutations that affect their functionality can have a great impact on crucial molecular pathways in the cells, leading to tumorigenesis. In the past couple of decades, the use of small-molecule inhibitors, which include tyrosine kinase inhibitors (TKIs), has been a hallmark in the treatment of hematological malignancies, and MM patients may also benefit from TKI-based treatment strategies. In this review, we seek to understand the applicability of TKIs used in MM clinical trials in the last 10 years.

Objective: to describe the technical-assistance arrangements developed within the scope of work management in the COVID-19 pandemic care network, from the managers' perspective., Method: a qualitative research study, of the incorporated single case type, conducted with 23 managers of a Health Care Network. The analysis was applied in two thematic coding cycles, with the aid of the ATLAS.ti software., Results: the arrangements were analyzed in categories related to health care; management; incorporation of technologies; implementation of a field hospital; and retrospective analysis of the experiences as a whole. There was emphasis on the implementation of care flows, virtual health bulletins, Telemonitoring, chatbots, use of applications, and implementation of field hospitals and of basic urgency services within the scope of the Basic Health Units. Hyperjudicialization in the system was identified; as well as weaknesses in information management, intersectoriality and technical-political leadership at the national level; the role of nurses in management positions and for coping with the pandemic., Conclusion: despite the health services' unpreparedness to face the pandemic, the actors' resilience promoted dynamism and technical-assistance arrangements in the context of management and humanized care. The study has a potential to contribute to the qualification of the public policy management and development practices.

Introduction: Ciliated hepatic foregut cyst (CHFC) is a rare cystic lesion that arises from the embryonic foregut with approximately 100 cases reported. Most commonly identified in segment IV of the liver, CHFC is typically asymptomatic and incidentally found on abdominal imaging. It is important to consider this entity in the differential diagnosis of atypical liver lesions since CHFC carries a risk of transformation into squamous cell carcinoma. A suspicion of CHFC is therefore an indication for surgical resection., Case Presentation: A 62-year-old male presented to surgery consultation for further evaluation of a hepatic cyst incidentally found on abdominal ultrasound. The patient was completely asymptomatic. Both abdominal computerized tomography and magnetic resonance imaging scan confirmed a 4 cm subcapsular cyst in segment IVa. Additional workup was unremarkable. Considering the diagnostic doubt the patient underwent laparoscopic cyst enucleation. Histology revealed a ciliated pseudostratified epithelium consistent with a CHFC., Clinical Discussion: CHFC is a rare diagnostic entity that should be considered in the differential diagnosis of cystic hepatic lesions, particularly those located in segment IV of the liver. Since it is frequently asymptomatic, CHFC is usually found incidentally during surgery or imaging studies. Diagnosis of CHFC preoperatively is difficult due to the lack of specific radiographic findings. Moreover, metaplasia and squamous carcinoma can occur. Therefore complete surgical excision is the recommended treatment., Conclusion: Despite its rarity, CHFC carries a risk of malignant transformation. Accurate diagnosis is mandatory and surgical excision is recommended even in asymptomatic CHFC., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Aquatic ecosystems provide habitats for many organisms. Historically, riverbanks have always been inhabited and exploited for subsistence and navigation. The present study evaluates the contamination and ecological risks caused by potentially toxic elements in surface sediments of the Paraguaçu River, Bahia, Brazil. Seven sediments samples were collected, and eight heavy metals were determined employing inductively coupled plasma spectrometry mass (ICP-MS). The concentrations range as (mg kg -1 ) found were 6.78-18.68 for lead, 14.21-42.16 for zinc, 27.61-48.63 for nickel, 2.03-6.50 for chromium, 6.06-12.90 for vanadium, 5.99-13.33 for cupper, 1.25-3.19 for cobalt, and 79.52-286.08 for manganese. Nickel showed significant enrichment (EF: 5.75; 7.62, and 14.11), followed by zinc, which showed moderate enrichment (EF: 2.16; 2.19, and 4.52). These enrichment levels are possible of anthropogenic origin. When the pollution index (PI) was evaluated, the elements V, Ni, Zn, Mn, Co, and Cu were strongly polluted (PI ≥3). In general, the pollution index (PI), geoaccumulation index (I geo ), enrichment factor (EF), and potential ecological risk indices (E r and PERI) show that contaminated sediments have adverse effects on aquatic environments, especially for o Mn, Ni, Pb, V, and Zn., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objectives: to report the implementation of a monitoring system of the operative field, surgical gown, and utilized fields as sterile barrier system of products for health, manufactured from cotton fabrics., Methods: technological innovation report of a monitoring system of the use and processing of surgical textiles in a medium-size hospital., Results: steps: planning, confection, exchange of the surgical textiles, monitoring, and 12 months of supervision. The new pieces were silkscreened with a black indelible marker., Final Considerations: the implemented system is practical, low cost, and easily manageable for the team, it favored the work process management, contributing to the quality and security of the textile used in health care, and being able to be implemented in other health services.

Objective: To verify, through a systematic review, the accuracy of nutritional assessment in children and adolescents using the length/height-for-age and BMI-for-age growth charts of the Centers for Disease Control and Prevention (CDC) (2000), the World Health Organization (WHO) (2006/2007) and the International Obesity Task Force (IOTF) (2012)., Data Source: We selected articles from the databases Medical Literature Analysis and Retrieval System Online (MEDLINE), through PubMed, National Library of Medicine and The National Institutes of Health (NIH), Scientific Electronic Library Online (SciELO) and Virtual Health Library (VHL). The following descriptors were used for the search: "Child", "Adolescent", "Nutritional Assessment", "Growth Chart", "Ethnic Groups", "Stature by age", "Body Mass Index", "Comparison", "CDC", "WHO", and "IOTF". The selected articles were assessed for quality through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the NIH., Data Synthesis: Thirty-three studies published between 2007 and 2020 were selected and, of these, 20 presented good quality, 12 presented fair quality and one presented poor quality. For children under five years old, the WHO length/height-for-age growth charts were shown appropriate for children from Argentina, South Africa, Brazil, Gabon, Qatar, Pakistan and the United States. For those five years old and older, the WHO BMI-for-age growth charts were accurate for the Brazilian and Canadian populations, while the IOTF growth charts were accurate for the European populations., Conclusions: There are difficulties in obtaining international growth charts for children from 5 years old and older that go along with a long period of growth, and which include genetic, cultural and socioeconomic differences of multiethnic populations who have already overcome the secular trend in height.

Objective: Police officers, particularly the ones who are trained to be on "special forces", perform a wide range of hazardous and physically demanding activities when aiming to protect and serve. The purpose of this study was to investigate the association between lower limb and trunk muscle endurance with drop vertical jump (DVJ) height in a special military police force., Methods: One hundred and three male military men (age: 36 ± 5.0 years; height: 1.76 ± 0.05 m; weight: 81.8 ± 9.7 kg) volunteered to take part in this study., Six Tests Were Performed: DVJ, McGill core battery (trunk flexion, trunk extension, and side bridge test-right and left), and single-leg squat repetitions. Correlations were analyzed using the Pearson correlation coefficient (r). The level of significance for all analyses was set at p ≤ 0.05., Results: Single-leg squat repetitions were positively associated with DVJ height, contact time and flight time (p = 0.00093∗∗, p = 0.00085∗∗, and p = 0.00098∗∗ respectively). No correlation was observed between trunk muscle endurance and DVJ., Conclusion: Therefore, it was concluded that greater endurance of the lower limb muscles, as demonstrated by the single leg squat, was associated with better performance in a DVJ. Individuals should consider incorporating single leg squats into their fitness program to develop muscular endurance and possibly perform better in the DVJ., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The threats posed by insecticide resistance to Aedes aegypti in the context of controlling dengue have led to an urgent search for an environmentally safer alternative chemical with more effective larvicidal properties. Among many molecules tested, 2-methylanthraquinone showed the lowest LC50 for A. aegypti in a previous study and the highest LC50 for zebrafish embryos. Embryos were exposed at concentrations of 1.0, 2.19, 4.78, 10.46, 22.87, 50.0 and 100.0 mg/L, and malformations and mortality were significantly observed only at the highest exposures of 50 and 100 mg/L after 96 h. Micronucleus test and comet assay in zebrafish adults were both negative after exposures at 6.25, 12.5, 25.0, 50.0 and 100.0 mg/L for 96 h. Several biochemical biomarkers were analyzed in adults, and 2-methylanthraquinone did not interfere with acetylcholinesterase activity. The lactate dehydrogenase activity was higher at concentrations of 25 and 100 mg/L. Glutathione-S-Transferase (GST) activities were tested in the gill and body (muscle tail). The gill was more sensitive than body for GST activity after exposure to 2-methylanthraquinone, showing the highest activities, and 2-methylanthraquinone showed low toxicity to a non-target organism.

Several non-dairy probiotic beverages are already available to consumers and have been considered suitable carriers for probiotic bacteria. This study aimed to investigate the effect of Lactiplantibacillus plantarum CCMA 0743 in single and co-culture on the volatile compounds and sensory profiles of fermented passion fruit juice. The viability of strains inoculated in juice and MRS matrices was evaluated in a simulated gastrointestinal condition. The bacterial viability after 28 days of refrigerated storage of the juices was also evaluated. L. plantarum CCMA 0743 showed high viability (6.18 Log CFU/mL) after passage throughout simulated digestion in the passion fruit juice matrix. Both juices maintained high probiotic counts (>8.0 Log CFU/mL) during storage. Also, the yellow color was stable after 28 days of storage. Volatile compounds of passion fruit juices were modified after the fermentation process, such as ketones and alcohol formation degradation. The sensory profile of passion fruit juice was modified by single and co-culture fermentations. The fermented samples were mainly correlated with the terminologies "salty, acidic and bitter tastes" and "sweetener aftertaste". Overall, passion fruit juice proved to be an adequate food matrix to deliver the evaluated strains. However, individual strains or strain-strain interactions with the food matrix affect the fermented product, demonstrating that strain and matrices evaluations are essential for developing novel products with acceptable characteristics., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Acquisition of surgical instruments (SI) and implants by loaner system is a worldwide practice. Although quality of device reprocessing has been reported to be lower in low and middle-income countries compared with higher income countries, few investigations have been conducted on the management and reprocessing of loaned devices. Thus, in this study we evaluate the practices of management and reprocessing of loaner SI and non-sterile implants (NSI) in a high (Australia) and a middle-income (Brazil) country., Methods: Cross-sectional surveys (hardcopy or online form) was self-administered by sterilising service unit's personnel of Brazilian and Australian hospitals. Only those units that sourced orthopaedic surgical instruments and non-sterile loaned implants from independent companies were eligible., Results: A total of 65 questionnaires from Australia and 168 from Brazil were analysed. Quality indicators regarding structure and work process for the management and reprocessing of loaned SI and NSI was of a higher standard in Australia than in Brazil. However, failures were detected in both countries, for instance delivery delays and improper point-of-use pre-cleaning practices., Conclusion: There are key challenges inherent of the multifaceted reusable medical devices loaner system in both countries, such as communication failures, implementation of non-recommended practices, reprocessing of NSI, and other related to structure and process quality indicators, that must be faced. Initial and ongoing education and training should be provided and should embrace the themes of technical proficiency, effective communication and teamwork, and should include all personnel involved in this process, even loaner company staff., Competing Interests: Conflict of interest None., (Copyright © 2021 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.)

Introduction: Sleep deprivation and social jet lag are observed in college students from highly urbanized cities. However, does these consequences also present in college students from a low urbanization city?, Objective: To evaluate the prevalence and social, biological and behavioral factors associated with sleep deprivation and social jet lag in university students from a low urbanized city of Brazil., Methods: A total of 298 university students participated in the study through application of the Health and Sleep and the Munich Chronotype Questionnaires. Multiple linear regression with stepwise-forward method was adopted to assess the associations of the factors with the outcome variables., Results: Doing leisure activities (LA) (B = 23.24) and academic demand (AD) before bedtime (B = 19.51), both on the weekend, and doing household chores (HC) before bedtime (B = 17.61) in the week were associated with an increase in social jet lag, while stimulating drinks (SD) were associated with a decrease (B = -15.17). Shorter sleep duration in the week was related to chronotype (B = -0.56), male (B = -26.51), doing LA (B = -27.63), poor perception about sleeping place (PPSP) (B = -43.02) and daily commute (B = -68.97). The shorter sleep duration in the weekend was associated to male (B = -36.36), PPSP (B = -58.16), have recreational and religious activities (B = -31.11), doing LA (B = -25.10) and AD (B = -23.60). Just chronotype was associated with longer sleep duration in the weekend (B = 0.25)., Conclusion: University students from a low urbanized city present social jet lag, shorter sleep duration on school days and longer sleep duration on free days as a result of biological and social factors, and mostly behavioral factors., Competing Interests: The authors declare that there is no conflicts of interest in this work., (© 2022 de Medeiros Lopes et al.)

Introduction: Endoscopic transnasal access to the skull base, both for treatment and reconstruction, can cause olfactory morbidity. Knowing the main consequences of this intervention is essential to have objective criteria for decision-making regarding the appropriate surgical technique., Objectives: The aim of this study is to determine the impact on olfactory function of the endonasal endoscopic access to the skull base with the creation of the nasoseptal flap., Methods: A prospective research was carried out in which 22 patients who underwent endoscopic transnasal surgery at the skull base, with the creation of a nasoseptal flap. The Connecticut Chemosensory Clinical Research Center test was applied before and at the 1 st , 3 rd and 6 th postoperative months., Results: The results showed that only in the first month of follow-up the mean patient classification was statistically worse than at the other evaluation moments (p<0.05), but there was no mean difference in the Connecticut score classification between the other moments (p>0.05); that is, patients showed worsening in the 1 st month and returned to the preoperative mean after the 3 rd month of follow-up., Conclusion: The present study showed that the postoperative decrease in olfaction is transient, since the patient's sense of smell returns to pre-surgical values in the 3 rd postoperative month., (Copyright © 2020 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Fruit juices have shown promising results as new probiotic carriers. This study aimed to evaluate acerola, jelly palm, and passion fruit juices as substrates for fermentation using Lactiplantibacillus plantarum CCMA 0743 and Lacticaseibacillus paracasei LBC-81 in single and mixed cultures. First, the juices were evaluated as substrate and selected based on bacterial growth performance during fermentation. Afterward, the impact of fermentation on sugars, organic acids, and bioactive compounds was also appraised. Phytochemical modification of three different juices fermented by lactic acid bacteria at 37 °C/24 h was evaluated. After 18 h of fermentation, passion fruit juice showed higher cell viable counts of single and mixed L. plantarum CCMA 0743 culture, above 9.00 Log CFU/mL, and pH between 4.07 and 4.10. Sugars consumption and organic acid production were influenced by juice composition and culture used. The mixed culture reduced the total sugars in the passion fruit juice by approximately 53.0% (8.51 g/L). Lactic acid was the main product of the sugars fermentation, with higher concentrations detected in passion fruit juice (8.39-11.23 g/L). Bioactive compounds were analyzed on the selected substrate. The fermentative process reduced antioxidant activity and carotenoid content. However, single L. plantarum CCMA 0743 culture increased the yellow flavonoid content of passion fruit juice by approximately 3.0 µg/mL. L. plantarum CCMA 0743 showed high and suitable cell, viable counts, to claimed probiotic products, increasing bioactive compounds in passion fruit juice. Therefore, this strain and passion fruit substrate showed attractive potential to produce alternative and functional fermented fruit beverages., (© 2021. Sociedade Brasileira de Microbiologia.)

The main concern of this investigation was the relation between the representative volume element of the scattered flux from 2D random agglomerates, composed of sub-wavelength interacting particles, and the extraction of their effective electromagnetic properties. Using a constant ratio between agglomerates radius and wavelength, behaviors of the scattered flux mean value and standard deviation were studied as a function of the agglomerate surface, in the case of relevant particle permittivities. Using the mean or standard deviation functions, two criteria for homogenization were derived. Compared to the extraction of the effective refractive index, both criteria failed to predict the minimal surface needed for homogenization, questioning the existence of a link between the accuracy of the scattered flux evaluation and homogenization. However, it is shown that when no surface-plasmon resonances are excited, a single minimal representative surface for homogenization can be defined.

Objective: To identify the learning outcomes and skills obtained of undergraduate nursing students involved in research projects., Methods: This was an integrative literature review, based on a research protocol in the CINAHL Complete databases; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Cochrane Methodology Register; MedicLatina; MEDLINE, Scopus and JBI, including primary and secondary studies, published between 2015 and 2020., Results: A total of five heterogeneous articles were included, which were categorized using Kirkpatrick's (adapted) model. Seventeen learning outcomes acquired through participation in research projects were identified, from the learning of new knowledge and skills to the development of new attitudes and behaviors., Final Considerations: The involvement of nursing students in research projects is important to their professional development. Future investment in research on this topic can help cement the potential of this type of student involvement.

Background: Breast cancer (BC) is largely prevalent worldwide. HER2-positive BC account for roughly 20-25% of all BC cases and has an overall survival lower than other BC. Innovation on BC therapeutics is a constant, but novel therapies have higher costs. Therefore, cost-effectiveness research is essential to provide healthcare decision-makers with solid foundations for a resource allocation. This study aims to estimate the average direct medical costs/patient and cost-effectiveness of adding pertuzumab in neoadjuvant treatment (NeoT) for HER2-positive breast cancer (BC)., Methods: Two retrospective real-world consecutive cohorts of ≥18yo female patients diagnosed with HER2-positive BC treated with NeoT at the Breast Clinic of IPO-Porto were studied. The AC-DH regimen (2012-2015) comprised 8 cycles of neoadjuvant therapy (4 cycles of doxorubicin + cyclosphosphamide followed by 4 cycles ofdocetaxel + trastuzumab), while the AC-DHP regimen (2015-2017) included also pertuzumab as NeoT. NeoT was followed by surgery and adjuvant trastuzumab. Micro-costing technique and a bottom-up approach was used comprising all medical direct costs from the hospital perspective. Unit costs were obtained from government official prices or from IPO-Porto costing system. Costs were adjusted to 2017 and are expressed in euros. Multivariable logistic regression models were used for effectiveness assessment, while generalized linear models with gamma distribution were used for costs. ICER was calculated using the pathological complete response (pCR) as the preferential measure of effectiveness. Sensitivity analysis was also performed., Results: AC-DHP (n = 40) and AC-DH (n = 54) cohorts had heterogenous patient profiles (median age 43y/53y; 67.5%/59.3% positive HR; 60.0%/27.8% operable; 25.0%/24.1% inflammatory, respectively). The AC-DHP average total cost/patient was 56,375€, with pertuzumab accounting for 13,978€ (24.79%) and increasing in 15,982€ the average cost/patient (p < 0.001). Clinical staging and hormone receptors (HR) were significantly associated with pCR. ICER was 1.370€ per percentage point of pCR., Conclusions: ICER was more favourable in stage III HR negative BC patients compared to other patient profiles. Innovative treatments access is critical to deliver high-quality healthcare, but sustainability must be considered. These results suggest the importance of establishing a cost-effectiveness profile of Pertuzumab in NeoT for HER2-positive BC., (© 2021. The Author(s).)

Rhipicephalus sanguineus sensu lato (s.l.), commonly known as brown dog tick, is a widely distributed tick species that is substantially important for human and veterinary medicine. Therefore, it is the target of different control methods. Carvacrol and its semisynthetic derivative, acetylcarvacrol, are promising chemical compounds for alternative tick control. Thus, this study aimed to compare the repellent activities of carvacrol and acetylcarvacrol at different concentrations and drying times. Additionally, morphological alterations found in salivary glands were evaluated through histological techniques after exposure to acetylcarvacrol. The impact of the morphological changes on the development and survival of acini/cells in salivary glands was measured by a semiquantitative analysis. The repellent action of both compounds did not differ when evaluated at different concentrations, although acetylcarvacrol increased its effects as the concentration raised. Regarding the different drying times, acetylcarvacrol maintained its effects after 3 hours of exposure, while the efficacy of carvacrol decreased during this time period. Salivary glands of unfed R. sanguineus s.l. females showed dose-dependent alterations in the size and shape of acini as well as cytoplasmic vacuolization. Loss of the acinar cell limit, rupture of secretory granules and nuclear changes in the cells were also observed in the treated groups. Thus, our results demonstrated the potential of acetylcarvacrol to act as repellent against R. sanguineus s.l. Additionally, the morphological alterations found in salivary glands may interfere with the feeding process of ticks, which contributes to mitigate infestation by this species., (Copyright © 2021. Published by Elsevier GmbH.)

Background: Physical health is an important factor for what is considered successful aging. Using valid and reproducible tools to classify PH of older adults may help to develop appropriate rehabilitation protocols for this population., Objective: To evaluate the convergent validity and reproducibility of the International Classification of Functioning, Disability and Health (ICF) core set to classify the physical health of older adults., Methods: A total of 101 older adults were evaluated for handgrip strength, physical performance (Short Physical Performance Battery), and physical activity level (International Physical Activity Questionnaire). Physical health was classified with the ICF core set (14 categories of body functions, 4 of body structures, 9 of activity and participation, and 3 environmental factors) and an impairment index was calculated for each component., Results: Higher levels of physical activity were associated to lower impairment index in the body function and activity and participation components, but was not associated to environmental factors. Better physical performance and handgrip strength were also related to lower impairment index in all components. The Intraclass Correlation Coefficient analysis indicated good reproducibility for body function, body structure, the capacity component of the activity and participation, and for two environmental factors (use of medications and assistive devices), but moderate reproducibility for the performance component of activity and participation, and poor reproducibility for the environmental factor related to access to health services., Conclusion: The ICF core set for the physical health of older adults is a valid and reproducible tool and can be used in clinical practice and research., (Copyright © 2021 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

A pandemic is capable of generating a great impact, not only from the point of view of health, but also socioeconomically. In March 2020, the World Health Organization (WHO) declared that a new pandemic situation had arisen, due to the SARS-CoV-2 virus, whose probable origin was zoonotic. The largest number of cases of this disease is concentrated in the United States of America (USA), India, and Brazil. The mortality rate is estimated at 3.4%, but regional differences may exist, and places with a high demographic density have become true epicentres and may be related to higher rates of transmission. In addition to the above, lower human development indexes (HDI) can be related to worse outcomes, especially in the North and Northeast regions of Brazil since they are the least developed places. The Northeast region is the second-most-affected place in the number of COVID-19 cases in Brazil. An analytical observational study of an ecological type was carried out from April to October 2020 to assess the epidemiological situation of COVID-19 in the state of Sergipe and specifically to analyse the incidence of cases and deaths resulting from COVID-19 in the different health regions of the state of Sergipe, in relation to the values of the HDI and demographic density. During the study period, 84,325 cases of COVID-19 were identified, in which 2205 resulted in death. In most of the regions studied, there was a positive association between the number of cases and deaths and the greater the demographic density, but there was no increase in the risk of becoming ill, nor of dying the lower the HDI. Large and crowded cities are places of greatest vulnerability to illness, due to their greater capacity of transmitting the virus; however, further studies are needed to identify other factors that are decisive in the outcomes of this new disease.

Background: Physical therapists provide treatment for pain and other common complaints for women in the postpartum period, thereby contributing to the improvement of their functioning. However, before applying any interventions, physical therapists should assess their patients to identify the desired therapeutic goals. In this context, the International Classification of Functioning, Disability and Health (ICF) may be a useful tool for documenting functioning data and operationalizing collaborative goal setting., Objective: To identify ICF categories and the respective domains that should be considered in the evaluation of women postpartum., Methods: A consensus-building, three-round e-mail survey was conducted using the Delphi method. The sample included Brazilian physical therapists with expertise in women's health. Meaningful content was analyzed in accordance to the ICF linking rules. The kappa coefficient and content validity index (CVI) were calculated., Results: The panel consisted of 45 participants with a median age of 33 years and more than 10 years of experience in women's health. A total of 1261 meaningful contents were identified from the responses in the first round. After consensus was achieved, a final list of 62 items was prepared, including 53 categories (11 were on structures; 15 on body functions; 12 on activities and participation; 15 on environmental factors) and nine personal factors (CVI=0.89)., Conclusion: From the perception of physical therapists, an ICF-based postpartum assessment to describe functioning and disability must comprise 53 ICF categories and nine personal factors., (Copyright © 2020 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To investigate epidemiological factors related to treatment-resistant schizophrenia (TRS) in Northeast Brazil, a region where data about mental health are still scarce., Methods: This retrospective cross-sectional study included all patients with schizophrenia currently receiving treatment at the outpatient psychiatric clinic of a tertiary hospital in Northeast Brazil. They were divided into TRS and treatment-responsive groups, and epidemiological characteristics of both groups were compared. A logistic regression model investigated factors related to treatment resistance., Results: Two hundred and five patients were included, 155 treatment-resistant and 50 treatment-responsive. The TRS group had higher use of benzodiazepines (36.1 vs. 18%, p = 0.017) and antiepileptics (36.8 vs. 8.0%, p < 0.001), antipsychotic polypharmacy (28.6 vs. 8%, p = 0.003) and suicide attempts (35.6 vs. 20%, p = 0.04). Age at onset was younger (19.7±7.3 vs. 24.6±8.6 years, p = 0.001) and CGI was higher in TRS (3.72±1.00 vs. 3.16±1.00, p = 0.001). In logistic regression, being married was a protector (odds ratio [OR] = 0.248, 95% confidence interval [95%CI] 0.091-0.679, p = 0.007) and younger age at onset was a predictor (OR = 1.076, 95%CI 1.034-1.120, p < 0.001) of treatment resistance., Conclusion: Early onset of disease was associated with more treatment resistance, while being married with less resistance. Clinicians should identify early predictors of resistance in order to reduce unfavorable outcomes., Competing Interests: Alcides Ferreira Rêgo Neto has received fees from Servier, Lundbeck, Pfizer, Boehringer Ingelheim, Eli Lilly, Janssen. No other conflicts of interest declared concerning the publication of this article.

Some respiratory muscles work in synergy with the pelvic floor (PF). Pelvic organ prolapse (POP) is characterized by weak PF muscles and has been associated with worse pulmonary ventilation function in women. To date no studies have investigated the association between respiratory muscle strength and POP. This study aimed to determine whether symptomatic POP is associated with respiratory muscle strength in middle-aged and older women. In this observational cross-sectional study, 204 community-dwelling women (41-80 years old) from Santa Cruz (Northeastern Brazil) provided information on socioeconomic characteristics, health behavior, reproductive history and symptomatic POP via a structured questionnaire. A digital manometer was used to measure their maximal inspiratory and expiratory pressures (MIP and MEP). Multiple linear regression analyses, adjusted for covariates (age, income, education, body mass index, and smoking), evaluated the association between POP and MIP/MEP. The results show that 14.7% of the sample reported symptomatic POP. These women exhibited lower mean MIP and MEP than those reporting no POP, but the intergroup difference was only significant for MEP ( p = .01). The association between POP and MEP remained statistically significant, even after covariates (β = 11.9, p = .04) were adjusted. Symptomatic POP is associated with expiratory muscle strength in middle-aged and older women. This innovative research provides important information regarding the need to evaluate the integrity of PF muscles when assessing respiratory muscle strength, which may help clinicians devise preventive and treatment strategies to improve women's health during the aging process.

Objectives: to analyze the nurse's educational practice in Family Health Strategy., Methods: descriptive study with a qualitative approach, whose data production used the World Café group technique, in two meetings, with 26 nurses of a health district of Manaus-AM. The technique used was Categorial-Thematic Content Analysis., Results: the study generated two units of analysis: Political and Organizational Configuration of Educational Work at ESF and Operational Configuration of Educational Work at ESF, revealing the necessary (re)configurations in co-management, in the centrality of the subject for the planning of educational work, and in (re)pactuation between the management of services and training institutions to overcome contradictions in the implementation of National Policies on Permanent Education and Basic Health Care., Conclusions: the configuration of nurses' educational practice at ESF works toward interactions, organized to respond to health policies, incorporating creativity in doing, but facing numerous obstacles.

The northern and northeastern portion of the Todos os Santos Bay (TSB) is known for the presence of an oil refinery in addition to the development of other activities with significant potential for impact on the environment. 30 samples of superficial mangrove sediment were collected in two different locations: on the banks of the São Paulo River near the Landulpho Alves Mataripe Refinery (RLAM) and at Caboto Beach, a place that was once a control point in studies of metal pollution. After the determination of potentially toxic elements (Al, As, Cd, Cr, Cu, Fe, Mn, Ni, Pb, Ti, V, Zn), the quality of the sediment was evaluated using the concentrations of these elements associated with geochemical parameters (TOC, P, S, and granulometry). In this way, the pollution indexes (EF, I geo , P N ) were calculated in addition to the comparison with the guide values for the sediment quality (TEL, PEL, ERL, ERM). Among the elements analyzed, Cu also showed levels (92.71-97.54 mg kg -1 ) very close to PEL (108 mg kg -1 ). At 13 sampling points, Cr concentrations were higher (56.16-66.01 mg kg -1 ) than TEL (52.3 mg kg -1 ). Ba showed significant concentrations in 6 samples collected on the São Paulo River, a region close to the oil refining area. The enrichment factor (EF) showed that most elements did not show enrichment, except for Zn. Through Igeo there was a tendency towards serious pollution of Ba, Cu, and Zn; moderately polluted by Cr. Principal component analysis (PCA) and Spearman's classification showed a correlation greater than 70% between the variables. According to Nemerow Synthetic Pollution (P N ), both areas are polluted by Al, Ba, Cr, Cu, Fe, Mn, Ni, Ti, V, and Zn., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To analyze the obstacles to the educational praxis of nurses in the Family Health Strategy of the Eastern Health District, Manaus, Amazonas, Brazil., Method: Qualitative, exploratory, and descriptive study that used the Word Café technique for data production, with 26 nurses, between June and August 2018. The data were organized in the Atlas.ti8 software, and the analysis was categorical-thematic., Results: The units of analysis "Organizational Obstacles for Educational Praxis in the Family Health Strategy" and "Operational Obstacles for Educational Praxis in the Family Health Strategy" reveal difficulties, tensions, resistances and the impossibilities to adhere to emerging models of work organization, in general, and in particular, in educational work., Conclusion: What presents itself in reality as an obstacle is, at the same time, indicative of the possibility of overcoming and potentiality for co-creation of educational work as a strategy to rescue professional motivation, and an alternative on the agenda for the permanent qualification of workers and institutions.

Interictal dysphoric disorder (IDD) is a poorly understood psychiatric disorder of epilepsy patients. Interictal dysphoric disorder is characterized by depressive, somatoform, and affective symptoms observed in up to 5.9% of drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). This study aimed to evaluate the association between ictal fear (IF) and the psychiatric symptoms and diagnosis in MTLE-HS patients. We included 116 (54.3% male) consecutive adult patients (36 ± 11 years) with MTLE-HS. Anxiety and depression symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS) and the psychiatric diagnosis were according to Fourth Edition of the Diagnosis and Statistical Manual of Mental Disorders (DSM-IV). The independent association between the occurrence of IF aura and the psychiatric diagnosis was determined by binary regression. When compared to those with other auras or without aura, patients reporting IF have higher HADS anxiety, but not HADS depression, scores. Ictal fear was independently associated with the diagnosis of interictal dysphoric disorder (OR, IC 95% = 7.6, 1.3-43.2, p = 0.02), but not with the diagnosis of anxiety (OR, CI 95% = 0.72, 0.08-6.0, p = 0.73), depression (OR, CI 95% = 0.94, 0.19-4.8, p = 0.94) or psychotic disorders (p = 0.99). Only patients with drug-resistant MTLE-HS were included and the small number of cases with DD diagnosis in the sample. In MTLE-HS patients, the occurrence of IF is associated with higher levels of anxiety symptoms and IDD. The results provide insights about fear-related neural network connections with anxiety symptoms and the IDD in MTLE-HS., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To identify and to discuss the progress of actions for the protection, promotion and support of breastfeeding in Brazil from the perspective of the indicators proposed by the Global Breastfeeding Collective., Data Source: A narrative review was conducted according to the methodological orientation of the implementation research and through a qualitative approach. Publications from the World Health Organization and the United Nations Children's Fund were selected, as well as publications from the Brazilian Ministry of Health were collected from the Virtual Health Library and from the libraries of the Department of Primary Care's portal and the Brazilian's Institute of Geography and Research., Data Synthesis: Brazil has shown promising results regarding the implementation of breastfeeding protection legislation, the participation of municipalities in community breastfeeding support programs, and the continued evaluation of these programs. However, reports of breastfeeding rates have not been produced every five years and the progress of these indicators is very far from the agreed targets for 2030. There is also a need to improve the number of births in child-friendly hospitals and financial donations for breastfeeding programs., Conclusions: It is necessary to strengthen systematic monitoring of breastfeeding and following up current strategies to more effectively impact the breastfeeding rates in the country. Furthermore, it is suggested that the practice of donations is a pathway to be explored to support breastfeeding programs.

Purpose: The changes in gustatory function resulting from oncological treatment occur mainly after radiotherapy. However, the head and neck tumors, because of the anatomical location of the lesion, can themselves trigger significant changes in the feeding-related functions - including taste. To assess the gustatory function in patients diagnosed with advanced oral cavity and oropharyngeal cancer., Method: This descriptive cross-sectional study comprised 31 individuals with advanced oral cavity and oropharyngeal cancer, referred for oncological treatment with radiotherapy, either alone or in combination with chemotherapy. The "taste strips" test was applied; it consists of inserting solutions with four different concentrations each for salty, sweet, and sour tastes, and three concentrations for the bitter taste, on the tongue., Results: Most of the individuals were diagnosed with oropharyngeal cancer. Approximately half of the sample already had taste-related complaints, and more than 80%, swallowing-related complaints. The overall frequency of hypogeusia was 38.7%, in which the bitter taste stood out in its isolated assessment. The association of change in gustatory function proved to be significant in patients in stage T4., Conclusion: The decrease in gustatory function in individuals with oral cavity and oropharyngeal cancer was evidenced in this study, especially when associated with tumors in stage T4. Regarding feeding, most of them reported complaints of dysphagia, suggesting the importance of the speech-language-hearing assessment and follow-up, even before the oncological treatment, to minimize the risks of dysphagia.

Background: Rheumatic diseases are increasingly present in the world population, represented by chronic joint and musculoskeletal pain. Among them, osteoarthritis (OA) is the most prevalent. It is considered the third most prevalent chronic non-communicable disease in the Brazilian population, being responsible for a high rate of physical disability and reduced quality of life. Little has been discussed about the social factors associated with this health condition. This study aimed to analyze the social factors associated with arthritis in the Brazilian population., Methods: This is a cross-sectional study based on data from the 2013 National Health Survey in Brazil with arthritis as its main outcome. Sex, age, body weight, usual activities, physical activity, self-perceived health and diagnosis of depression were analyzed as independent variables. Descriptive and inferential statistics were used. Poisson multiple regression was performed, and the prevalence ratio (PR) and confidence interval (CI) of 95% were calculated using a significance level of 5% (p ≤ 0.05)., Results: A total of 60,202 individuals of both sexes took part in this study and the rheumatic diseases or arthrtitis prevalence was 6.4%. The individual factors associated with a higher prevalence of arthritis were female (PR = 2.09; CI = 1.95-2.25), age over 35 years (PR = 2.88; CI = 2.57-3.24) and excess body weight (PR = 1.61; CI = 1.25-2.07). The presence of rhemautic diseases showed an association with lower performance of usual activities (PR = 1.61; CI = 1.50-1.73) and self-perceived health as very poor (PR = 3.96; CI = 3.31-4.72). In addition, it was associated with a higher prevalence of mental illnesses such as depression (PR = 1.77; CI = 1.64-1.90)., Conclusion: Social and modifiable factors which are associated with a higher prevalence of arthritis can be controlled through incentive measures such as social participation and physical activity.

Introduction: The emergence of a pandemic highlights the translational demands regarding science. This communication aims to propose theoretical-methodological elements for research on health work in pandemic context., Methods: This reflective essay sets an framework for a research project on health work in Manaus, Amazonas, Brazil., Results: Three axes or subsidies are presented: the construction of work environments as an analytical component, the approach of ergology as a potential and the centrality of the experiences of the worker-subject., Conclusions: New health care challenges require attention to what workers have to say about their forms of confrontation and translation of knowledge.

Pollution by plastics is a global problem, in particular through the contamination of aquatic environments and biodiversity. Although plastic contamination is well documented in the aquatic fauna of the oceans and large rivers of the world, there are few data on the organisms of headwater streams, especially in tropical regions. In the present study, we evaluated the contamination of small fish by plastics in Amazonian streams. For this, we evaluated the shape and size, and the abundance of plastics in the gastrointestinal tracts and gills of 14 fish species from 12 streams in eastern Brazilian Amazon. We used a Generalized Linear Mixed Model (GLMM) to compare the levels of contamination among species and between organs. Only one individual of the 68 evaluated (a small catfish Mastiglanis cf. asopos) contained no plastic particles, and no difference was found in the contamination of the gills and digestive tract. However, Hemigrammus unilineatus presented less contamination of both the gills and the digestive tract than the other species, while Polycentrus schomburgkii had less plastic in the gastrointestinal tract, whereas Crenicichla regani and Pimelodella gerii both had a larger quantity of plastic adhered to their gills in comparison with the other species. Nanoplastics and microplastics adhered most to the gills, while plastic fibers were the most common type of material overall. This is the first study to analyze plastic contamination in fish from Amazonian streams, and in addition to revealing high levels of contamination, some species were shown to possibly be more susceptible than others. This reinforces the need for further, more systematic research into the biological and behavioral factors that may contribute to the greater vulnerability of some fish species to contamination by plastics. Amazonian stream fish show contamination by plastics. The species respond differently. The smaller the particle, the easier it is to adhere to the gills., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the sleep quality and its association with disability, fatigue and quality of life of breast cancer survivors., Methods: This is a cross-sectional pilot study developed with breast cancer survivors. The data collection instruments consisted of general and clinical information on the disease and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0); Pittsburgh Sleep Quality Index (PSQI); Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F); and Disabilities of the arm and Shoulder (DASH). Descriptive statistical analysis, correlation tests, tests for means comparison and linear regression were performed. Cohen's d analysed the effect size. The significance was set at p < 0.05., Results: 71,9% of women had poor sleep quality. Subjective poor sleep quality was a predictor of worse scores for fatigue (p = 0.007), quality of life by FACT-G (p = 0.010) and FACIT-F (p = 0.004), the functional performance of upper limbs (p = 0.001) and disability (p = 0.003)., Conclusions: Breast cancer survivors with subjective poor sleep quality had more fatigue, less upper limb-related functional performance, more disability and worse quality of life., (© 2020 John Wiley & Sons Ltd.)

Improving heat dissipation in increasingly miniature microelectronic devices is a serious challenge, as the thermal conduction in nanostructures is markedly reduced by increasingly frequent scattering of phonons on the surface. However, the surface could become an additional heat dissipation channel if phonons couple with photons forming hybrid surface quasiparticles called surface phonon-polaritons (SPhPs). Here, we experimentally demonstrate the formation of SPhPs on the surface of SiN nanomembranes and subsequent enhancement of heat conduction. Our measurements show that the in-plane thermal conductivity of membranes thinner than 50 nm doubles up as the temperature rises from 300 to 800 kelvin, while thicker membranes show a monotonic decrease. Our theoretical analysis shows that these thickness and temperature dependencies are fingerprints of SPhP contribution to heat conduction. The demonstrated thermal transport by SPhPs can be useful as a previously unidentified channel of heat dissipation in a variety of fields including microelectronics and silicon photonics., (Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).)

Objective: The aim of this study is to analyze the relationship between intestinal constipation and functioning in adult women living in a municipality in the interior of northeast Brazil., Materials and Methods: This is a cross-sectional study conducted with 195 adult women in the city of Santa Cruz-RN. Constipation was diagnosed using the Rome III criteria. Functioning was measured through WHODAS 2.0. Social conditions, habits and lifestyle were also investigated. Inferential analysis was performed using the chi-squared test and the Mann-Whitney U -test, and the effect size was determined by eta squared (η 2 ). Multivariate analysis was performed using multiple linear regression to analyze the relationship between the WHODAS total score and constipation, being adjusted by covariates with p≤0.20 in the bivariate. A statistical significance level of p<0.05 was considered., Results: Most of the participants in this study were aged 19 to 39 years (69.7%) and had an income of up to 1 minimum monthly salary (79.5%). WHODAS scores showed that women with constipation had more disability in the cognitive (p <0.001), mobility (p <0.002), self-care (p <0.001), and participation (p <0.001) domains, as well as the total score (p <0.001). After multiple linear regression analysis, the total WHODAS score remained associated with constipation (p <0.001), in which this condition increases the score by nine points., Conclusion: The results of this study show that there is a reduction in functioning associated with the presence of constipation in adult women, mainly affecting the cognition, mobility, self-care and participation domains, in addition to the total score., Competing Interests: The authors report no conflicts of interest for this work., (© 2020 Dantas et al.)

Objective: To link the content of the most common quality of life instruments for children with asthma to the International Classification of Functioning, Disability and Health (ICF)., Methods: The study was conducted in two stages. The first involved a review of the literature to select quality of life questionnaires and in the second, two independent reviewers identified questionnaire items, and categories corresponding to the ICF, according to approved methodology. The degree of agreement was calculated using the kappa coefficient., Results: Two questionnaires were selected: the Pediatric Asthma Quality of Life (PAQLQ) and Pediatric Quality of Life Asthma Module (PedsQL-Asthma), self and proxy versions. The degree of agreement was strong for all the instruments: PAQLQ (k = 0.624), PedsQL- Asthma self (k = 0.610), and PedsQL-Asthma proxy (k = 0.673). A total of 114 concepts were identified in the 77 items. Thirty-five different ICF categories were linked, 16 (45.7%) related "body function," 13 (37.1%) "activity and participation," and 6 (17.1%) "environmental factors." Two items (1.7%) could not be linked because they represent personal factors or are not covered by the ICF., Conclusion: The categories linked to the PAQLQ contained primarily "body function" and "activity and participation," but not "environmental factors." Those linked to the PedsQL-Asthma versions encompass three of the four ICF components, where the highest content frequency was associated with "body function," followed by "environmental factors" and "activities and participation.", (© 2020 Wiley Periodicals LLC.)

The Trichoderma genus comprises several species of fungi whose diversity of secondary metabolites represents a source of potential molecules with medical application. Because of increased pathogen resistance and demand for lower production costs, the search for new pharmacologically active molecules effective against pathogens has become more intense. This is particularly evident in the case of American cutaneous leishmaniasis due to the high toxicity of current treatments, parenteral administration, and increasing rate of refractory cases. We have previously shown that a fungus from genus Trichoderma can be used for treating cerebral malaria in mouse models and inhibit biofilm formation. Here, we evaluated the effect of the ethanolic extract of Trichoderma asperelloides (Ext-Ta) and its fractions on promastigotes and amastigotes of Leishmania amazonensis , a major causative agent of cutaneous leishmaniasis in the New World. Ext-Ta displayed leishmanicidal action on L. amazonensis parasites, and its pharmacological activity was associated with the low-molecular-weight fraction (LMWF) of Ext-Ta. Ultrastructural analysis demonstrated morphological alterations in the mitochondria and the flagellar pocket of promastigotes, with increased lipid body and acidocalcisome formation, microtubule disorganization of the cytoplasm, and intense vacuolization of the cytoplasm when amastigotes were present. We suggest the antiparasitic activity of Trichoderma fungi as a promising tool for developing chemotherapeutic leishmanicidal agents., (Copyright © 2020 Lopes, Santos, Dos Anjos, Silva Júnior, Paula, Vannier-Santos, Silva-Jardim, Castro-Gomes, Pirovani and Lima-Santos.)

Cranial microsurgery is an essential procedure for accessing the brain through the skull that can be used to introduce neural probes that measure and manipulate neural activity. Neuroscientists have typically used tools such as high-speed drills adapted from dentistry to perform these procedures. As the number of technologies available for neuroscientists has increased, the corresponding cranial microsurgery procedures to deploy them have become more complex. Using a robotic tool that automatically performs these procedures could standardize cranial microsurgeries across neuroscience laboratories and democratize the more challenging procedures. We have recently engineered a robotic surgery platform that utilizes principles of computer numerical control (CNC) machining to perform a wide variety of automated cranial procedures. Here, we describe how to adapt, configure and use an inexpensive desktop CNC mill equipped with a custom-built surface profiler for performing CNC-guided microsurgery on mice. Detailed instructions are provided to utilize this 'Craniobot' for performing circular craniotomies for coverslip implantation, large craniotomies for implanting transparent polymer skulls for cortex-wide imaging access and skull thinning for intact skull imaging. The Craniobot can be set up in <2 weeks using parts that cost <$1,500, and we anticipate that the Craniobot could be easily adapted for use in other small animals.

Background: Intestinal constipation is characterized by problems related to evacuation, and presents high prevalence in the female gender. This condition has demonstrated negative effects on the development of daily activities, causing damage to the physical and emotional well-being of individuals who are diagnosed with it. Studies that investigate what health impairments intestinal constipation can cause are scarce in the literature., Objective: This study aimed to verify the prevalence and factors associated with intestinal constipation in premenopausal women living in Northeastern Brazil., Methods: It is a cross-sectional study. This was carried out in the northeast of Brazil. Participated 195 women, adult and middle age. Social conditions, habits and lifestyle, clinical aspects and obstetric history were investigated. Constipation was diagnosed using the Rome III Criteria. Multivariate analysis was conducted using Poisson Regression with robust variance to analyze the relationship between intestinal constipation and independent variables. A statistical significance level of P<0.05 was considered., Results: Most of the women were between 25 and 39 years old (49.2%) and had an income of up to one minimum wage (79.5%). The intestinal constipation prevalence was 35.4%. In the final multivariate regression model, hemorrhoid clinical aspects (P=0.01), pain (P=0.001) and a burning sensation (P=0.01) on bowel movement, and sexual dysfunction (P=0.03) remained associated with constipation., Conclusion: The present study found a significant prevalence of constipation among premenopausal women and clinical factors such as hemorrhoids, pain and a burning sensation, and sexual dysfunction were associated with intestinal constipation.

The aim of this study was to evaluate the effects of photobiomodulation (PBM) by dual-wavelength low-power lasers on the healing and bacterial bioburden of pressure ulcer (PU) models. Twenty-five male Swiss mice were divided into five equal groups. Ischemia reperfusion cycles were employed to cause PU formation by the external application of magnetic plates. Immediately after wounding, a suspension of Pantoea agglomerans was applied at the base of all the wounds of the infected groups, using a calibrated pipette. PBM (simultaneous emission at 660 and 808 nm, 142.8 J/cm 2 , in continuous wave emission mode) was applied to the PUs for 14 sessions. The animals were euthanized 14 days after PU induction, and their tissues were analyzed for wound contraction and reepithelialization, epidermis thickness, bacterial survival, and IL-1β and IL-10 mRNA level evaluations. The PU areas appeared larger in the mice from the infected groups than in those in the laser group 4 days after PU induction and presented incomplete reepithelialization 14 days after PU induction. However, the PBM accelerated the wound healing in the infected + laser group compared with the infected group 11 and 14 days following the PU induction. The infected and irradiated PUs exhibited a thinner neo-epidermis than those in the infected group, and the bacterial survival decreased in the laser group; the relative expression IL-1β mRNA levels demonstrated an increasing tendency while the relative expression IL-10 mRNA levels demonstrated a decreasing tendency in the infected + laser and laser groups. These results suggest that PBM improves healing by killing or inhibiting bacteria in PUs as well as by accelerating the wound healing, resulting in tissue repair.

The clinical manifestations most frequently observed in cats with leishmaniasis caused by Leishmania infantum are cutaneous alterations, which suggest a high parasitic load in the skin and the possibility of infecting a vector. This study evaluated the infectiousness of to phlebotomine sand flies cats infected with L. infantum. A total of 12 cats with infection by L. infantum from the city of Teresina, Piauí, Brazil, were included in the study. Cats were diagnosed by direct visualization of the parasite. Laboratory-bred insects, free from infection by Leishmania spp. were offered a blood meal for 60 min on cats infected with L. infantum. On the fifth and sixth day after the blood meal, flies were dissected to assess promastigote forms of the parasite in the digestive system. Eight cats (67 %) were able to infect the vectors. The frequency of infected insects per cat ranged 0.0-94.4%. The mean frequency of insects feeding on cats was 95.2 %. Large numbers of the parasite were observed per insect, but were not quantified. The result confirm that cats are able to infect L. longipalpis, indicating that cats are part of the epidemiological chain of VL, acting as reservoir of the disease., Competing Interests: Declaration of Competing Interest No competing interests to declare., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The consumption of probiotics has increased due to the reported health benefits, mainly in preventing or treating gastrointestinal pathology. This study investigated the antimicrobial capacity of yeasts, Saccharomyces cerevisiae and Pichia kluyveri, previously isolated from fermented foods (indigenous beverage, kefir and cocoa) against the adhesion of foodborne pathogens to Caco-2 cells. Co-aggregation of yeasts with pathogens and were evaluated by quantitative analysis and using scanning electron and laser confocal microscopies. All yeasts strains were able to co-aggregate with the tested pathogens, however, this activity was strain-dependent. The inhibition tests showed that the adhesion of Escherichia coli EPEC, Listeria monocytogenes and Salmonella Enteritidis to Caco-2 was reduced by all the yeasts studied. Most of the evaluated yeasts showed inhibition rates equal to or greater than the commercial probiotic Saccharomyces boulardii. The yeasts were able to reduce up to 50% of the bacterial infection, as observed for CCMA0615 towards EPEC in exclusion assay; CCMA0731, CCMA0732 and CCMA0615 towards L. monocytogenes in exclusion and competition assays; and CCMA0731 in exclusion and CCMA0731, CCMA0732, CCMA0615 in competition assay towards S. Enteritidis. No antimicrobial compounds were produced by the yeasts, showing that competition for nutrients and/or receptors in the intestinal mucosa was the mechanism to bacterial inhibition., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2020. Published by Elsevier Ltd.)

Fear is a conscious state caused by exposure to real or imagined threats that trigger stress responses that affect the body and brain, particularly limbic structures. A sub-group of patients with mesial temporal lobe epilepsy related to hippocampus sclerosis (MTLE-HS) have seizures with fear, which is called ictal fear (IF), due to epileptic activity within the brain defensive survival circuit structures. Synaptic transmission efficacy can be bi-directionally modified through potentiation (long-term potentiation (LTP)) or depression (long-term depression (LTD)) as well as the phosphorylation state of Ser831 and Ser845 sites at the GluA1 subunit of the glutamate AMPA receptors, which has been characterized as a critical event for this synaptic plasticity. In this study, GluA1 levels and the phosphorylation at Ser845 and Ser831 in the amygdala (AMY), anterior hippocampus (aHIP) and middle gyrus of temporal neocortex (CX) were determined with western blots and compared between MTLE-HS patients who were showing (n = 06) or not showing (n = 25) IF. Patients with IF had an 11% decrease of AMY levels of the GluA1 subunit (p = 0.05) and a 21.5% decrease of aHIP levels of P-GluA1-Ser845 (p = 0.009) compared to patients not showing IF. The observed associations were not related to imbalances in the distribution of other concomitant types of aura, demographic, clinical or neurosurgical variables. The lower levels of P-GluA1-Ser845 in the aHIP of patients with IF were not related to changes in the levels of the serine/threonine-protein phosphatase PP1-alpha catalytic subunit or protein kinase A activation. Taken together, the GluA1 subunit levels in AMY and P-GluA1-Ser845 levels in the aHIP show an overall accuracy of 89.3% (specificity 95.5% and sensitivity 66.7%) to predict the presence of IF. AMY levels of the GluA1 subunit and aHIP levels of P-GluA1-Ser845 were not associated with the psychiatric diagnosis and symptoms of patients. Taken together with previous findings in MTLE-HS patients with IF who were evaluated by stereotactic implanted depth electrodes, we speculate our findings are consistent with the hypothesis that AMY is not a centre of fear but together with other sub-cortical and cortical structures integrates the defensive circuit that detect and respond to threats. This is the first report to address neuroplasticity features in human limbic structures connected to the defensive survival circuits, which has implications for the comprehension of highly prevalent psychiatric disorders and symptoms.

While many bacteria have been used as probiotics by industries, only two yeasts, Saccharomyces cerevisiae var. boulardii and Kluyveromyces fragilis (B0399), have been used for this purpose. In the present work, a total of 116 yeasts isolated from Brazilian indigenous fermented food, cocoa fermentation, and kefir were in vitro characterized for probiotic attributes. From 116 isolates, 36 were tolerant to gastrointestinal conditions evaluated by tolerance to pH 2.0, bile salts (0.3% w/v), and 37 °C temperature. From those, 15 isolates showed a similar or higher percentage (P < 0.05) of hydrophobicity, autoaggregation, and coaggregation with E. coli than the reference strain S. boulardii. All these strains showed a high percentage of adhesion to Caco-2 cells (> 63%) and antioxidant activity (ranging from 18 to 62%). Phytate hydrolysis was evaluated for these yeasts and 13 strains showed positive results, which is important for nutrient availability in plant-based foods. These results are important insights for characterization of novel probiotic yeast strains as well as to aggregate functional value to these food products.

Bees are of great importance for plant diversity for being an important pollinating agents. Stingless bees such as Scaptotrigona affinis postica , is cultivated largely due to the products offered by it. Pollen is one of these products, which has been highlighted for exhibit various therapeutic properties. Considering the bioactivity of this natural product, this study investigated the antioxidant, anti-inflammatory, antinociceptive activities, and elucidated the chemical composition of pollen collected extract by Scaptotrigona affinis postica . Using in vitro assays, the antioxidant potential and inhibitory activity against the COX enzyme from pollen extract was evaluated. Additionally, tests were performed to measure the anti-inflammatory and antinociceptive activities in animal models. In our results, we found that pollen extract showed antioxidant effects and inhibitory activity against the COX enzyme. The in vivo assays showed that the extract acts on the nervous system in local and systemic levels and that the anti-inflammatory activity is due the prostanoids reducing. Chemical analyses recognize 10 molecules in the extract belonging to the polyphenol and flavonoids classes and the computational study suggests that is responsible for the observed results. Thus, it is reported for the first time the biological potential of S. aff. postica pollen extract and we conclude that this bee product can be considered as one source of potential new drugs., Competing Interests: The authors declare no conflict of interest. The funder had no role in any step of the research.

Plasmodium (P.) falciparum malaria during pregnancy has been frequently associated with severe consequences such as maternal anemia, abortion, premature birth, and reduced birth weight. Placental damage promotes disruption of the local homeostasis; though, the mechanisms underlying these events are still to be elucidated. Autophagy is a fundamental homeostatic mechanism in the natural course of pregnancy by which cells self-recycle in order to survive in stressful environments. Placentas from non-infected and P. falciparum-infected women during pregnancy were selected from a previous prospective cohort study conducted in the Brazilian Amazon (Acre, Brazil). Newborns from infected women experienced reduced birth weight (P = 0.0098) and placental immunopathology markers such as monocyte infiltrate (P < 0.0001) and IL-10 production (P = 0.0122). The placentas were evaluated for autophagy-related molecules. As a result, we observed reduced mRNA levels of ULK1 (P = 0.0255), BECN1 (P = 0.0019), and MAP1LC3B (P = 0.0086) genes in placentas from P. falciparum-infected, which was more striking in those diagnosed with placental malaria. Despite the protein levels of these genes followed the same pattern, the observed reduction was not statistically significant in placentas from P. falciparum-infected women. Nevertheless, our data suggest that chronic placental immunopathology due to P. falciparum infection leads to autophagy dysregulation, which might impair local homeostasis during malaria in pregnancy that may result in poor pregnancy outcomes., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Calorie restriction (CR) is an important intervention for reducing adiposity and improving glucose homeostasis. Recently we found that in rats, a severe calorie restriction (SCR) beginning at birth up to adult age promotes positive effects on cardiometabolic risk factors and heart. The aim of this study was to investigate the effects of this new model of SCR on adipose tissue and glucose homeostasis of rats and to evaluate the effects of refeeding., Methods: From birth to 90 d of age, rats were divided into an ad libitum (AL) group, which had free access to food, and a CR50 group, which had food limited to 50% of that consumed by the AL group. From this moment, half of the CR50 animals had free access to food (the refeeding group [CR50-R]), and the other half continued 50% restricted for an additional 90-d period. Food intake was assessed daily and body weight weekly. In the final week of the SCR/refeeding protocol, oral glucose and intraperitoneal insulin tolerance tests were performed. Thereafter, rats were sacrificed and visceral fat was collected and used for histologic and Western blot analysis., Results: Findings from this study revealed that SCR beginning at birth and up to adult life promoted a large decrease in visceral adiposity; improvement in glucose/insulin tolerance; and upregulation of adipose proliferating cell nuclear antigen, sirtuin 1, peroxisome proliferator-activated receptor-γ, and adiponectin. Refeeding abolished all of these effects. SCR from birth to adult age promoted beneficial effects on adipose tissue and glucose homeostasis; whereas refeeding abolished these effects., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Data collection for clinical research can be difficult, and electronic health record systems can facilitate this process. The aim of this study was to describe and evaluate the secondary use of electronic health records in data collection for an observational clinical study. We used Cerner Millennium®, an electronic health record software, following these steps: (1) data crossing between the study's case report forms and the electronic health record; (2) development of a manual collection method for data not recorded in Cerner Millennium®; (3) development of a study interface for automatic data collection in the electronic health records; (4) employee training; (5) data quality assessment; and (6) filling out the electronic case report form at the end of the study. Three case report forms were consolidated into the electronic case report form at the end of the study. Researchers performed daily qualitative and quantitative analyses of the data. Data were collected from 94 patients. In the first case report form, 76.5% of variables were obtained electronically, in the second, 95.5%, and in the third, 100%. The daily quality assessment of the whole process showed complete and correct data, widespread employee compliance and minimal interference in their practice. The secondary use of electronic health records is safe and effective, reduces manual labor, and provides data reliability. Anesthetic care and data collection may be done by the same professional.

The aim of this study was to analyze the analgesic potential of Arrabidaea chica extract (EHA) as an alternative to osteoarthritis (OA) treatment. Thus, the extract was initially evaluated by the cyclooxygenase inhibition test. The analgesic effect of the extract, in vivo, was also verified in a model of OA induced by sodium monoiodoacetate (2 mg). EHA was administered to rats at doses of 50, 150, and 450 mg/kg between 3 and 25 days after OA induction. The animals were clinically evaluated every 7 days, euthanized at 29 days, and the liver, spleen, kidney and knee collected for histopathological analysis. The chemical composition of EHA was identified by HPLC-MS and the identified compounds submitted to molecular docking study. The results showed that the extract promoted cyclooxygenase inhibition and produced significant improvements in disability, motor activity, hyperalgesia, and OA-induced allodynia parameters, in addition to improvements in the radiological condition of the knees (but not observed in the histopathological study). Chemically the extract is rich in flavonoids. Among them, we evidence that amentoflavone showed very favorable interactions with the enzyme COX-2 in the in silico analysis. Thus, it is concluded that A. chica has important analgesic properties for the treatment of OA.