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The genus Cecropia belongs to the Urticaceae family and has a wide diversity of species in several regions of South America. In folk medicine, they have many uses, such as hypoglycemic, antihypertensive, anti-inflammatory, and sedative. Species of the genus Cecropia, such as Cecropia pachystachya, Cecropia glaziovii, and Cecropia obtusifolia, have been the subject of several phytochemical studies, and the main isolated compounds were orientin, isoorientin, isovitexin, vitexin, as well as c-glycosylflavonoid compounds. These active compounds were characterized as responsible for the use of Cecropia plants in the treatment of inflammation and also as antimicrobial agents. This review aims to describe the main characteristics of the genus Cecropia, exploring the compounds responsible for the medicinal uses of these species and focusing on anti-inflammatory and antimicrobial uses.

Background The main side effect of long-term laparoscopic sleeve gastrectomy is the onset of severe gastroesophageal reflux disease (GERD). Objectives The aim of this study was to evaluate the effectiveness of gastric bypass conversion in controlling postsleeve GERD. Setting University Hospital and Private Hospital, France and Private Hospital, Italy. Methods This retrospective multicenter study included patients who underwent laparoscopic sleeve gastrectomy and suffered from postoperative GERD, who did not respond to medical treatment and were converted to laparoscopic Roux-en-Y gastric bypass. The study involved 2 French university hospitals, 4 French private centers, and an Italian public hospital. Results A total of 80 patients were reviewed. Treatment of a hiatal hernia was performed during laparoscopic sleeve gastrectomy in 3 patients, while 19 patients were operated for hiatal hernia during conversion to bypass (P = .0004). Six months after surgery, 23 of 80 patients maintained reflux symptomatology with a daily frequency, for which continued proton pump inhibitor treatment was required. The persistence of GERD was significantly more frequent among patients with previous gastric banding (n = 19) compared with patients with no history of gastric banding (n = 4, P = .02). In other words, the likelihood of having poor clinical success from conversion of the sleeve to bypass because of intractable GERD was 3 times higher if the patient had a history of gastric banding (relative risk = 2.89, odds ratio = 3.69). Conclusion The results of this study show that, despite the conversion, the symptomatology of GERD does not always disappear, especially in patients with previous gastric banding.

Ozone was discovered over a hundred years ago and since then, it has been widely used in many areas, with the primary use as a disinfectant in various ways, but with applications in diverse conditions. More recently, the use of ozone has extended to other fronts, using it to treat different pathologies. Extensive studies have shown its effects, as well as the safety of its application in various modalities of use. Other studies showed its toxicity, which depends on the doses of use. Emerging evidence revealed that ozone also plays an important role in the wound healing and modulation of immune cells, describing the molecular pathways responsible for these actions and describing therapeutic actions in the treatment of wounds, pain, postoperative and infectious diseases. Ozone use has already been documented in different doses, forms of use and routes of application, depending on the clinical situation and an adaptation is necessary for a better result. Thus, this review summarizes the main clinical uses of ozone, presenting the molecular pathways responsible for its actions, as well as discussing the main routes of use, doses and, vehicles used in the clinic.

When restrictive surgery fails, conversion to more malabsorptive techniques is frequently proposed. The aim of this study is to evaluate the weight loss figures between Roux-en-Y Gastric Bypass (RYGB) and One Anastomosis Gastric Bypass (OAGB) in patients who have already undergone Multiple Restrictive Procedures (MRP).All patients who underwent conversion of Laparoscopic Sleeve Gastrectomy (LSG) to RYGB or OAGB between 2010 and 2019 were retrospectively analyzed. Only patients who had conversion for Weight Regain (WR) or Insufficient Weight Loss (IWL) after both Laparoscopic Gastric Banding (LGB) and LSG entered the study population. Finally, 44 patients underwent conversion to RYGB, and 24 patients to OAGB.Concerning Excess Weight Loss (%EWL) at 3, 6, 12, 24 postoperative months, the results for RYGB were 33.7%, 47.95%, 61.8%, 61.8%, while for OAGB were 38.3%, 51.9%, 63.75%, 79.45%. A significant difference was recorded in favor of OAGB at 3 (p=0.03) and 24 (p=0.046) postoperative months. % EWL at 24 months in the case of IWL was 57.8% for RYGB, while for OAGB was 72.7% (p=0.047). No significant difference was found considering patients with WR (80.9% and 80.5%; p= 0.999). Patients with better results at 24 months after surgery had a significantly longer time between sleeve and bypass than those with a lower % EWL.The results of the present study seem to show that both techniques give good results at 24 months in patients who have undergone MRP. However, OAGB shows overall better results, particularly in patients with IWL.

Supplemental material, sj-docx-1-wmr-10.1177_0734242X221080090 for Education and training: Key solution to self-management and economic sustainability of waste pickers organisations by Carolina Ibelli-Bianco, Julia Paula Soprani Guimar��es, Luciana Harue Yamane and Renato Ribeiro Siman in Waste Management & Research

Supplemental material, sj-docx-2-wmr-10.1177_0734242X221080090 for Education and training: Key solution to self-management and economic sustainability of waste pickers organisations by Carolina Ibelli-Bianco, Julia Paula Soprani Guimar��es, Luciana Harue Yamane and Renato Ribeiro Siman in Waste Management & Research

This study aims to explore the concept, benefits, challenges and activities related to Internationalization at Home (IaH), defined as the integration of international/intercultural dimensions into the formal/informal curriculum in domestic learning environments (Beelen & Jones, 2015), as an alternative for more inclusive activities in higher education, within the process of internationalization. The study also offers a review of studies carried out mainly in Brazil by a Brazilian research group. Considering the importance of information and communication technologies (ICTs) in current practices of education and international exchange, this study explores possibilities of approaches such as COIL (Collaborative Online International Learning), allied with the Intercomprehension approach (IA) to suggest the development of more multilingual and inclusive activities, which foster IaH as an alternative to current and hegemonic internationalization practices. The paper concludes with some suggestions for the incorporation of such approaches, assuming that IaH should be prioritized in the internationalization agenda once it caters for a larger audience and, as such, is more inclusive and democratic.

Dilute water solutions of sodium alginate are used in molecular cooking and the dairy industry as thickening and gelling agents and also as edible films. Typically, they are obtained from brown algae or seaweeds and form stable gels in the presence of calcium ions. Calcium alginate gels can be easily prepared in the form of small solid spheres by dropping, with a syringe or a pipette, the sodium alginate solution into a water bath of calcium ions (“direct method”). After rinsing the calcium alginate spheres, fully or just partially jellified, their external pH can be easily regulated using ordinary acid and/or basic solutions. The chapter describes in detail the various steps of the procedure adopted for the preparation of calcium alginate spheres and for detecting the diffusion of protonated water inside them by observing the colour change of a suitable pH indicator contained in the spheres.

Este trabalho trata-se de um estudo ecológico no qual foram extraídos dados do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS) sobre insuficiência cardíaca na cidade de Presidente Prudente e no Estado de São Paulo durante o período de 2016 a 2020. O objetivo central foi relacionar a insuficiência cardíaca com os fatores que podem influenciar na qualidade do serviço hospitalar de saúde e que favorecem o prognóstico do paciente. Os resultados apresentados que foram relevantes no estudo demonstraram que na cidade do interior paulista a taxa de mortalidade média foi inferior, o gasto médio por internação foi maior, o tempo médio de internação foi superior e o caráter de atendimento por urgência foi reduzido quando comparados a São Paulo. Diante disso, Presidente Prudente mostrou ter maior suporte e melhor aproveitamento do serviço de saúde e administração de seus gastos, atendendo as necessidades da população para essa patologia. This work is an ecological study in which data were extracted from the Hospital Information System of the Unified Health System (SIH/SUS) on heart failure in the city of Presidente Prudente and in the State of São Paulo during the period from 2016 to 2020 The main objective was to relate heart failure with the factors that can influence the quality of hospital health services and that favor the patient's prognosis. The results presented, which were relevant in the study, showed that in the city of São Paulo, the average mortality rate was lower, the average expense per hospitalization was higher, the average hospitalization time was higher, and the character of emergency care was reduced when compared to Sao Paulo. In view of this, Presidente Prudente showed to have greater support and better use of the health service and administration of its expenses, meeting the needs of the population for this pathology. Este trabajo es un estudio ecológico en el que se extrajeron datos del Sistema de Información Hospitalaria del Sistema Único de Salud (SIH/SUS) sobre insuficiencia cardíaca en la ciudad de Presidente Prudente y en el Estado de São Paulo durante el período de 2016 a 2020. El objetivo principal fue relacionar la insuficiencia cardiaca con los factores que pueden influir en la calidad de los servicios de salud hospitalarios y que favorecen el pronóstico del paciente. Os resultados apresentados que foram relevantes no estudo demonstraram que na cidade do interior paulista a taxa de mortalidade média foi inferior, o gasto médio por internação foi maior, o tempo médio de internação foi superior e o caráter de atendimento por urgência foi reduzido quando comparados a San Pablo. Ante ello, Presidente Prudente mostró mayor apoyo y mejor aprovechamiento del servicio de salud y administración de sus gastos, atendiendo las necesidades de la población por esta patología.

Os bisfosfonatos (BFs), como alendronato, risedronato, ibandronato e clodronato, são potentes drogas inibidoras de osteoclastos e são considerados a terapia de primeira escolha em doenças que afetam o metabolismo ósseo. Um efeito adverso significativo observado em pacientes em uso de BFs orais ou intravenosos que foram submetidos a procedimentos odontológicos invasivos, como a terapia com implantes, é a osteonecrose da mandíbula relacionada aos bisfosfonatos (OMRB), que é caracterizada clinicamente pela exposição dolorosa do osso na região maxilofacial. Nesse sentido, este estudo possui como objetivo revisar a literatura acerca do protocolo em cirurgias dento-alveolares em pacientes que fazem uso do medicamento bisfosfonatos, bem como descrever as manifestações clinicas da osteonecrose mandibular relacionada ao fármaco. Para a construção deste artigo foi realizado um levantamento bibliográfico nas bases de dados SciVerse Scopus, Scientific Eletronic Library Online (Scielo), U.S. National Library of Medicine (PUBMED) e ScienceDirect, com auxílio do gerenciador de referências Mendeley. Os artigos foram contemplados entre os anos de 2010 a 2022. A osteonecrose dos maxilares por bifosfonatos é uma consequência adversa incomum, mas potencialmente muito séria, da terapia medicamentosa para PB. Está principalmente associado ao uso de amino-bifosfonatos mais potentes por longos períodos de tempo. O evento antecedente mais comum ao desenvolvimento de lesões clínicas é o tratamento odontológico invasivo, sendo, portanto, particularmente importante que os profissionais de saúde bucal tenham uma compreensão de suas causas e manejo. A prevenção continua sendo o aspecto mais importante do manejo e começa no momento da primeira prescrição e deve continuar pelo resto da vida do paciente devido ao efeito duradouro desses medicamentos no osso.

As drogas ósseas específicas (BSDs) atuam de forma fundamental no tratamento de indivíduos com baixar densidade óssea mineral, fraturas ou metástase óssea. Elas podem ser classificadas como antirreabsotivos ou anabólicos. O ONJ foi associado pela primeira vez ao tratamento com bisfosfonatos em 2003, e agora é amplamente reconhecido como um efeito adverso do tratamento com bisfosfonatos e outros BSD. Nesse sentido, este estudo objetivou revisar a literatura acerca da osteonecrose dos maxilares induzidas pelo uso de medicamentos, abordando os métodos de diagnóstico, bem como os protocolos de prevenção e tratamento dessa doença. Para a construção deste artigo foi realizado um levantamento bibliográfico nas bases de dados SciVerse Scopus, Scientific Eletronic Library Online (Scielo), U.S. National Library of Medicine (PUBMED) e ScienceDirect, com auxílio do gerenciador de referências Mendeley. Os artigos foram contemplados entre os anos de 2010 a 2022. A osteonecrose dos maxilares induzidas por medicamentos é uma consequência adversa incomum, mas potencialmente muito séria, da terapia medicamentosa para PB. Está principalmente associado ao uso de amino-bifosfonatos mais potentes por longos períodos de tempo. O evento antecedente mais comum ao desenvolvimento de lesões clínicas é o tratamento odontológico invasivo, sendo, portanto, particularmente importante que os profissionais de saúde bucal tenham uma compreensão de suas causas e manejo. A prevenção continua sendo o aspecto mais importante do manejo e começa no momento da primeira prescrição e deve continuar pelo resto da vida do paciente devido ao efeito duradouro desses medicamentos no osso.

Background Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases. Objectives To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG. Setting Retrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center. Methods EID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)–guided deployment of DPS or lumen apposing metal stents. Results A total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818). Conclusion Early EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results.

O paradigma de nuvem vem sendo cada vez mais utilizado para prover ambientes inovadores de ensino com escalabilidade. Neste contexto, este trabalho propõe uma arquitetura de baixo custo com tecnologias abertas para alocação de Laboratórios Virtuais sob demanda, explorando o conceito de encadeamento de funções de rede virtualizadas. Como resultado, um professor pode usar políticas de alto nível para configurar o acesso remoto dos alunos aos recursos da instituição de acordo com as necessidades específicas da sua aula, sem necessitar de apoio técnico especializado. Os experimentos realizados demostram a viabilidade e avaliam o desempenho da proposta em um protótipo com as tecnologias de nuvem Openstack e OSM.

Introduction: Achalasia after bariatric surgery is a rare pathological entity. Nonetheless, several cases have been described in literature. Per oral endoscopic myotomy has recently emerged as the preferred approach for the management of esophageal motility disorders. Material and Methods: We report a video case of POEM performed in a female patient with prior multiple bariatric surgical procedures. In her past medical history, she underwent to laparoscopic lap band, sleeve gastrectomy, and Roux-Y-gastric bypass. Results: POEM was carried out without complication. Myotomy was performed only for 1 cm below the cardias due to the presence of the gastro-jejunal anastomosis. Post-operative course was uneventful and oral diet was restarted after one day. At 2 months follow-up, the patient is asymptomatic with no weight regain. Conclusion: We report the first case of POEM after three different bariatric surgical procedure. Fibrosis due to prior interventions did not hampered POEM procedure, and the shorter myotomy due to the presence of small gastric pouch did not reduced its efficacy.

A Estratégia Saúde da Família trouxe benefícios à saúde da população, pois promove além da recuperação de agravos, a promoção e a prevenção, oferecendo um cuidado continuado à saúde, além de facilitar o acesso da população aos serviços de saúde. O artigo tem por objetivo avaliar a percepção dos enfermeiros sobre a implantação da Estratégia Saúde da Família, buscando identificar as reais mudanças e melhorias obtidas na saúde pública, assim como os desafios e impasses para sua implementação e consolidação. Trata-se de em estudo exploratório descritivo de natureza qualitativa. As entrevistas foram realizadas através de um questionário para caracterizar o perfil dos enfermeiros e um roteiro estruturado. Para análise dos dados foi utilizado o método de análise de conteúdo segundo Bardin. Os resultados apontam alguns entraves como a questão cultural da comunidade, a baixa cobertura das equipes, a grande rotatividade médica e a estrutura física das unidades, muitas vezes precárias. Conclui-se que embora os enfermeiros tenham avaliado de forma positiva a implantação da Estratégia Saúde da Família, muitos desafios e impasses precisam ser trabalhados para que se consiga alcançar todos os princípios do Sistema Único de Saúde.

Epidemiological profile of people living with HIV/AIDS in an inland county in Espírito Santo State, Brazil

Over the course of diet-induced obesity (DIO), adipose tissue macrophage (ATM) populations transition from highly oxidative and protective to highly inflammatory and metabolically deleterious. Here, we demonstrate that the Interferon Regulatory Factor (IRF)-5 is a key molecular switch mediating repression of macrophage oxidative capacity early in DIO. ATMs from mice with a myeloid-specific deletion of IRF5 are characterised by increased mitochondrial activity and oxidative respiration compared to ATMs from wild-type mice. This hyper-oxidative phenotype is inducible and reversible in vitro by delivery of an inhibitory IRF5-decoy peptide and through IRF5 adenoviral over-expression, respectively. In a data-driven approach, using public IRF5-cistrome data and in-house RNA-sequencing, we identified a transcriptional mechanism by which cellular oxidative capacity is repressed in an IRF5-dependent manner. The hyper-oxidative phenotype of IRF5-deficient macrophages is mediated by the Growth Hormone Inducible Transmembrane Protein (GHITM), known for maintaining mitochondrial architecture for optimal oxidative respiration. Cas9-mediated simultaneous knock-down of GHITM and of IRF5 reverses the hyper-oxidative phenotype associated with IRF5-deficiency in vitro. IRF5-dependent regulation of GHITM expression and mitochondrial activity extends to human ATMs and monocytes from obese and diabetic patients.

To analyze and compare surgical and audiological outcomes of conventional approaches versus laser CO2 surgery in stapes surgery. 333 patients who underwent stapes surgery were enrolled in the study; the patient population was divided into three groups: group 1: 170 patients treated with conventional stapedotomy with manual microdrill (average age 49.13 years); group 2: 119 patients treated with conventional stapedotomy with electrical microdrill (average age 51.06 years); group 3: 44 patients (average age 50.4 years) who underwent CO2 laser stapedotomy. Intra-operative, postoperative outcomes and audiological results were investigated. The average surgical time of laser CO2 surgery was longer than for other surgical procedures. No statistical differences emerged in post-operative abnormal taste sensation. There was also no difference in postoperative dizziness. Air-bone gap (ABG) went down from 29.7 ± 10 dB (group 1) and 27.32 ± 9.20 (group 2) to 10 ± 6.9 dB (group 1) and 10.7 ± 6.03 dB (group 2). In group 3 the preoperative ABG was lowered from 28.3 ± 10.1 to 11.8 ± 10.9, with a statistical difference in auditory recovery (p = 0.0001); The group of patients treated with laser CO2 showed a percentage of patients with an ABG closure of between 0 and 10 dB higher than in the group treated with manual microdrills (77.2% vs. 60%, respectively; p = 0.03). Overall surgical results of CO2 laser and conventional stapedotomy are comparable without any significant difference; however, the group treated with CO2 laser appears to have a percentage of patients with an ABG closure 0–10 dB higher than the group treated using the conventional technique.

The purpose of this study was to evaluate the efficacy and safety of the OAGB at least 10 years after surgery. We retrospectively reviewed our prospectively collected data on consecutive morbid patients with obesity receiving OAGB from January 2005 to December 2007. A total of 385 patients met the inclusion criteria. The mean follow-up was 149 months. Of all patients, 52% underwent OAGB as a primary procedure and 48% as a revisional procedure. At the 10-year follow-up, the mean body mass index (BMI) was 30.7 ± 11.8, the mean %TWL was 33.4 ± 10.6, and the mean %EWL was 64.1 ± 24.6. We did not find a significant statistical difference in terms of weight loss between primary OAGB and secondary OAGB. In total, 43% of patients achieved a %EWL greater than 75%, while 29% of the patients had an EWL% that was below 50%. All of the comorbidities related to obesity showed a high improvement or fully resolved. Early complications occurred in 9 patients (2.3%), while the overall rate of late complications was 17.1%. Nineteen patients (4.9%) developed an ulcer at the gastrojejunal anastomosis level, nine patients (2.3%) were re-hospitalized for major malnutrition, thirty-eight patients (9.8%) showed a postoperative biliary reflux, and five patients (2.7%) experienced severe anemia, which required several hospitalizations for iron I.V. supplementation. According to results of the present study, we believe that OAGB has shown to be a technique with a reasonable balance between long-term efficacy and undesirable sequelae.

Hippeastrum puniceum is a species that belongs to the Amaryllidaceae family. A particular characteristic of this family is the consistent and very specific presence of isoquinoline alkaloids, which have demonstrated a wide range of biological activities such as antioxidant, antiviral, antifungal, antiparasitic, and acetylcholinesterase inhibitory activity, among others. In the present work, fifteen alkaloids were identified from the bulbs of Hippeastrum puniceum (Lam.) Kuntz using a GC-MS approach. The alkaloids 9-O-demethyllycoramine, 9-demethyl-2α-hydroxyhomolycorine, lycorine and tazettine were isolated through chromatographic techniques. The typical Amaryllidaceae alkaloids lycorine and tazettine, along with the crude and ethyl acetate extract from bulbs of the species were evaluated for their inhibitory potential on α-amylase, α-glucosidase, tyrosinase and acetylcholinesterase activity. Although no significant inhibition activity was observed against α-amylase, α-glucosidase and tyrosinase from the tested samples, the crude and ethyl acetate extracts showed remarkable acetylcholinesterase inhibitory activity. The biological activity results that correlated to the alkaloid chemical profile by GC-MS are discussed herein. Therefore, this study contributed to the knowledge of the chemical and biological properties of Hippeastrum puniceum (Lam.) and can subsidize future studies of this species.

The response time is one of the main functional parameter for gas sensors, including metal oxide chemiresistors. This parameter is widely investigated for devices working in isothermal mode but it is much less investigated for gas sensors working in temperature modulation mode. In this work, considering ethanol as target gas, we compare the response times of a metal oxide chemiresistor working according to these two modes. In order to compare them, we worked with nearly the same average temperature in both cases, supplying a constant voltage to the heater in the isothermal mode and a squared voltage wave in temperature modulation. Our results show that, depending on the average working temperature, one mode or the other may be faster. At high average working temperature, the response time recorded with the isothermal mode is shorter than the thermal-period of the temperature modulation mode. Lowering the average working temperature, the response time increases for both modes, but the increase is more marked for the isothermal mode, which become slower than the temperature modulation one.