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Jaquellyne Gurgel Penaforte-Saboia,1,2 Carlos Eduardo Barra Couri,3 Natasha Vasconcelos Albuquerque,1,4 Vanessa Lauanna Lima Silva,5 Natália Bitar da Cunha Olegario,1,2 Virgínia Oliveira Fernandes,1,2,4 Renan Magalhães Montenegro Junior1,2,4 1Clinical Research Unit, Walter Cantidio University Hospital, Federal University of Ceará, Fortaleza, Brazil; 2Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil; 3Center for Cell-Based Therapy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; 4Department of Community Health, Federal University of Ceará, Fortaleza, Brazil; 5Department of Clinical Medicine, Hospital and Maternity Dra Zilda Arns Neumann, Fortaleza, BrazilCorrespondence: Renan Magalhães Montenegro JuniorFederal University of Ceará, Rua Coronel Nunes de Melo s/n, Fortaleza, 60430-270, Ceará, BrazilTel +55 8533668600Fax +55 85 3366-8619Email renanmmjr@gmail.comAbstract: Type 1 diabetes mellitus (T1DM) results from the immune cell-mediated destruction of functional pancreatic β-cells. In the presymptomatic period, T1DM is characterized by the presence of two or more autoantibodies against the islet cells in patients without glycemic decompensation. Therapeutic strategies that can modify the autoimmune process could slow the progression of T1DM. Dipeptidyl peptidase-4 (DPP-4) or CD26, a multifunctional serine protease with a dual function (regulatory protease and binding protein), can modulate inflammation and immune cell-mediated β-cell destruction. CD26 is involved in T-cell co-stimulation, migration, memory development, thymic maturation, and emigration patterns. DPP-4 degrades the peptide hormones GLP-1 and GIP. In addition to regulating glucose metabolism, DPP-4 exerts anti-apoptotic, regenerative, and proliferative effects to promote β-cell mass expansion. GLP-1 receptor signaling may regulate murine lymphocyte proliferation and maintenance of peripheral regulatory T-cells. In patients with T1DM, the serum DPP-4 activity is upregulated. Several studies have suggested that the upregulated DPP-4 activity is correlated with T1DM pathophysiology. DPP-4, which is preferentially expressed on the Th1 surface, can promote the polarization of Th1 immunity, a prerequisite for T1DM development. CD26 inhibition can suppress T-cell proliferation and Th1 cytokine production and stimulate tumor growth factor beta-1 (TGF-β 1) secretion, which plays an important role in the regulation of autoimmunity in T1DM. Studies on humans or animal models of T1DM have suggested that DPP-4 inhibitors can improve β-cell function and attenuate autoimmunity in addition to decreasing insulin dependence. This review summarizes the emerging roles of DPP-4 inhibitors in potentially delaying the progression of T1DM.Keywords: CD26, type 1 diabetes mellitus, autoimmunity, autoantibodies, therapeutic targets, prevention

Background. Mucormycosis is a deadly invasive fungal infection whose characteristics are only partially understood. Methods. Data on mucormycosis obtained in France between 2005 and 2007 from 2 notification systems were merged. The 2008 European Organisation for Research and Treatment of Cancer/Mycoses Study Group definition criteria were applied and risk factors for death were analyzed by hazard ratios (HRs) calculated from the Cox proportional hazards regression model. Results. A total of 101 cases (60 proven, 41 probable), mostly in men (58%) .50 years (mean age, 50.7 ± 19.9) were recorded. Hematological malignancies represented 50% (median time for occurrence, 8.8 months after disease onset), diabetes 23%, and trauma 18% of cases. Sites of infection were lungs (28%; 79% in hematology patients), rhinocerebral (25%; 64% in diabetic patients), skin (20%), and disseminated (18%). Median time between first symptoms and diagnosis was 2 weeks. The main fungal species were Rhizopus oryzae (32%) and Lichtheimia species (29%). In cases where the causative species was identified, R. oryzae was present in 85% of rhinocerebral forms compared with only 17% of nonrhinocerebral forms (P <.001). Treatment consisted of surgery in 59% and antifungals in 87% of cases (liposomal amphotericin B in 61%). Ninety-day survival was 56%; it was reduced in cases of dissemination compared with rhinocerebral (HR, 5.38 [2.0-14.1]; P, .001), pulmonary (HR, 2.2 [1.0-4.7]; P = .04), or skin localization (HR, 5.73 [1.9-17.5]; P = .002); survival was reduced in cases of hematological malignancies compared with diabetes mellitus (HR, 2.3 [1.0-5.2]; P < .05) or trauma (HR, 6.9 [1.6-28.6], P =.008) and if &ges;2 underlying conditions (HR, 5.9 [1.8-19.0]; P = .004). Mucormycosis localization remained the only independent factor associated with survival. Conclusions. This 3-year study performed in one country shows the diverse clinical presentation of mucormycosis with a high prevalence of primary skin infection following trauma and a prognosis significantly influenced by localization. [ABSTRACT FROM AUTHOR]

Abstract Background The International Health Regulations (IHR (2005)) require countries to notify WHO of any event which may constitute a public health emergency of international concern. This notification relies on reports of events occurring at the local level reaching the national public health authorities. By June 2012 WHO member states are expected to have implemented the capacity to "detect events involving disease or death above expected levels for the particular time and place" on the local level and report essential information to the appropriate level of public health authority. Our objective was to develop tools to assist European countries improve the reporting of unusual events of public health significance from frontline healthcare workers to public health authorities. Methods We investigated obstacles and incentives to event reporting through a systematic literature review and expert consultations with national public health officials from various European countries. Multi-day expert meetings and qualitative interviews were used to gather experiences and examples of public health event reporting. Feedback on specific components of the toolkit was collected from healthcare workers and public health officials throughout the design process. Results Evidence from 79 scientific publications, two multi-day expert meetings and seven qualitative interviews stressed the need to clarify concepts and expectations around event reporting in European countries between the frontline and public health authorities. An analytical framework based on three priority areas for improved event reporting (professional engagement, communication and infrastructure) was developed and guided the development of the various tools. We developed a toolkit adaptable to country-specific needs that includes a guidance document for IHR National Focal Points and nine tool templates targeted at clinicians and laboratory staff: five awareness campaign tools, three education and training tools, and an implementation plan. The toolkit emphasizes what to report, the reporting process and the need for follow-up, supported by real examples. Conclusion This toolkit addresses the importance of mutual exchange of information between frontline healthcare workers and public health authorities. It may potentially increase frontline healthcare workers' awareness of their role in the detection of events of public health concern, improve communication channels and contribute to creating an enabling environment for event reporting. However, the effectiveness of the toolkit will depend on the national body responsible for dissemination and training.

Nutritional problems are a common manifestation of psychological suffering of an infant and the dysfunction of the mother-infant interaction. The results of a psychological support programme run by Me´decins Sans Frontie&grave;res for severely malnourished children and their mothers in Hebron (Palestine) are described. From December 1995 to May 2000, 382 infants from 0 to 3 years of age were admitted into an integrated nutritional programme involving psychotherapy after treatment failure in a strictly medico-nutritional programme. The mother-infant interaction as well as the psychological state of the mother and infant were evaluated on inclusion, after 3 months and at discharge from the programme. Early interaction between the mother and malnourished infant are described in this article. A resolution of psychological issues and nutritional status was seen after psychotherapy. The parallel between the improvement of mother-child interaction and improvement of nutritional status raises the question of whether psychological screening should be included in nutritional programmes, in all contexts of food scarcity, in order to improve the care of malnourished infants. [Copyright &y& Elsevier]

Introduction: Providing good communication is at the core of recent international guidelines for improving women's outcomes at birth. Communication barriers are identified as major obstacles to providing effective and equal care among foreign-born women. There is a need for accurate communication tools in antenatal care. The aim of this study was to describe challenges met by researchers when developing culturally sensitive content in a Swedish-Arabic application for communication support at antenatal care in Sweden., Methods: A co-design methodology was used for the development of the application, entailing collaboration between users and researchers in five different phases: users' needs and preferences, development, field testing I, refinement, and field testing II., Results: Five challenges emerged: evidence-based information, time frame, realistic photographs, norm-critical perspective, and cultural issues. One challenge was to meet the needs of the users and combine it with information following evidence-based obstetric welfare guidelines. It was also challenging to produce short informational videos that could be adjusted for the duration of the visit with the midwife without omitting important information and to produce photographs which can become outdated. It was also a challenge to portray a less clinical environment and to maintain parents' integrity. It was also challenging to produce norm-critical content from the women's perspective., Conclusions: When developing content of an application for antenatal care, converting content proposals into a finished product is challenging. Collaboration between a cross-disciplinary research team, midwives and target-language women is essential to ensure that the content is usable and reliable., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2022 Bitar D. et al.)

The COVID-19 pandemic is a major health crisis associated with adverse mental health consequences. This study examined 2908 calls made to a national mental health helpline over a 10 month period, 2 months prior to (Pre-COVID) and 8 months during the pandemic phase, that incorporated the imposition of a partial lockdown, followed by the removal and reintroduction of restrictive measures locally. Data collected included reason/s for call assistance, gender, age and number of daily diagnosed cases and deaths due to COVID-19. In the Pre-COVID phase, calls for assistance were related to information needs and depression. With the imposition of a partial lockdown, coupled with the first local deaths and spikes in number of diagnosed cases, a significant increase in number of calls targeting mental health, medication management and physical and financial issues were identified. Following the removal of local restrictions, the number of calls decreased significantly; however, with the subsequent reintroduction of restrictions, coupled with the rise in cases and deaths, assistance requested significantly targeted informational needs. Hence, whilst calls in the initial phase of the pandemic mainly targeted mental health issues, over time this shifted towards information seeking requests, even within a context where the number of deaths and cases had significantly risen.

Humans are repeatedly exposed to variants of influenza virus throughout their lifetime. As a result, preexisting influenza-specific memory B cells can dominate the response after infection or vaccination. Memory B cells recalled by adulthood exposure are largely reactive to conserved viral epitopes present in childhood strains, posing unclear consequences on the ability of B cells to adapt to and neutralize newly emerged strains. We sought to investigate the impact of preexisting immunity on generation of protective antibody responses to conserved viral epitopes upon influenza virus infection and vaccination in humans. We accomplished this by characterizing monoclonal antibodies (mAbs) from plasmablasts, which are predominantly derived from preexisting memory B cells. We found that, whereas some influenza infection-induced mAbs bound conserved and neutralizing epitopes on the hemagglutinin (HA) stalk domain or neuraminidase, most of the mAbs elicited by infection targeted non-neutralizing epitopes on nucleoprotein and other unknown antigens. Furthermore, most infection-induced mAbs had equal or stronger affinity to childhood strains, indicating recall of memory B cells from childhood exposures. Vaccination-induced mAbs were similarly induced from past exposures and exhibited substantial breadth of viral binding, although, in contrast to infection-induced mAbs, they targeted neutralizing HA head epitopes. Last, cocktails of infection-induced mAbs displayed reduced protective ability in mice compared to vaccination-induced mAbs. These findings reveal that both preexisting immunity and exposure type shape protective antibody responses to conserved influenza virus epitopes in humans. Natural infection largely recalls cross-reactive memory B cells against non-neutralizing epitopes, whereas vaccination harnesses preexisting immunity to target protective HA epitopes., (Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

Although the concept of the therapeutic milieu has been given prominence, the perceptions of care receivers in this regard are sparse. This study aimed to explore service users' perceptions of the therapeutic milieu in a mental health rehabilitation unit. The method used was document analysis of annual reports generated by the unit through data collection from the care receivers. Four themes were identified, namely, the 'physical environment', the 'structure of the therapeutic programme', 'relationships with the professionals' and the 'experience of living as a community'. The study contributed to previous research through meaningful ramifications for research, practice and education.

[Purpose] The purpose of this study to measure four components of executive function: (1) cognitive flexibility, (2) inhibition, (3) working memory and (4) processing speed, along with the ability to dual task in recreational athletes. [Participants and Methods] This was a cross-sectional study of (n=102) male and female participants, between the ages of 18-40 years of age across different levels and types of sport related physical activity. The International Physical Activity Questionnaire (IPAQ), short version, Dual Task Abilities (DTA) were measured utilizing a quantitative, dual task, gait test and Executive Function (EF) was measured through Stroop Color Word Test and Trail Making Test. [Results] Differences in EF and Dual Task-Interference (DTI) in recreational athletes did not show a significant difference between varying types of sport and level of sport related activity, with reported values high across all groups. Males reported better dual task interference abilities than females, though there were no significant differences in executive function between males and females. Executive function performance was the highest among the age group (18-24 years) population, but there were no significant differences between those in the higher age groups (25-34 years) and (35-40 years). [Conclusion] Overall, those participating in the study exhibited high prevalence of strong EF ability, regardless of sport activity type or level. This may suggest that type and level of sport activity may not be important when considering executive function performance maintenance for recreational athletes., Competing Interests: The authors declare that there is no conflict of interest., (2020©by the Society of Physical Therapy Science. Published by IPEC Inc.)

Objectives: The purpose of this study was to explore Arabic-speaking women´s experiences of communication at antenatal care in Sweden when using a tablet application (app)., Design: The study is a part of a major research project, where a Swedish-Arabic app was developed to improve and facilitate communication between Arabic-speaking women and midwives. The first prototype was developed in 2017 and tested at six antenatal clinics in southeast of Sweden. Ten Arabic-speaking women were purposively recruited, and individual interviews were performed. Content analysis was used., Findings: Four main categories emerged: "Adapting the content to the patient group", "language and communication", "user-friendly" and "improvement proposal". The women reported that the content was educational, reliable and understandable. The information gave the women a sense of security. It was time effective and allowed opportunity for dialogue. Depending on language skills, there were different opinions as to whether the App should be a complement to having an interpreter or used separately., Key Conclusion: Arabic-speaking women perceived the App as being a communication tool despite their language skills in Swedish. There is a need for digital support for communication in maternity care., Competing Interests: Declaration of Competing Interest The researcher who performed the interviews with Arabic speaking women is a midwife but was not working at antenatal care. We have no conflict of interest., (Copyright © 2020. Published by Elsevier Ltd.)

Joint arthroplasty had revolutionized the outcome of orthopaedic surgery. Extensive and collaborative work of many innovator surgeons had led to the development of durable bearing surfaces, yet no single material is considered absolutely perfect. Generation of wear debris from any part of the prosthesis is unavoidable. Implant loosening secondary to osteolysis is the most common mode of failure of arthroplasty. Osteolysis is the resultant of complex contribution of the generated wear debris and the mechanical instability of the prosthetic components. Roughly speaking, all orthopedic biomaterials may induce a universal biologic host response to generated wear débris with little specific characteristics for each material; but some debris has been shown to be more cytotoxic than others. Prosthetic wear debris induces an extensive biological cascade of adverse cellular responses, where macrophages are the main cellular type involved in this hostile inflammatory process. Macrophages cause osteolysis indirectly by releasing numerous chemotactic inflammatory mediators, and directly by resorbing bone with their membrane microstructures. The bio-reactivity of wear particles depends on two major elements: particle characteristics (size, concentration and composition) and host characteristics. While any particle type may enhance hostile cellular reaction, cytological examination demonstrated that more than 70% of the debris burden is constituted of polyethylene particles. Comprehensive understanding of the intricate process of osteolysis is of utmost importance for future development of therapeutic modalities that may delay or prevent the disease progression.

To determine the epidemiology and trends of invasive fungal infections (IFIs) in France, we analyzed incidence, risk factors, and in-hospital death rates related to the most frequent IFIs registered in the national hospital discharge database during 2001-2010. The identified 35,876 IFI cases included candidemia (43.4%), Pneumocystis jirovecii pneumonia (26.1%), invasive aspergillosis (IA, 23.9%), cryptococcosis (5.2%), and mucormycosis (1.5%). The overall incidence was 5.9/100,000 cases/year and the mortality rate was 27.6%; both increased over the period (+1.5%, +2.9%/year, respectively). Incidences substantially increased for candidemia, IA, and mucormycosis. Pneumocystis jirovecii pneumonia incidence decreased among AIDS patients (-14.3%/year) but increased in non-HIV-infected patients (+13.3%/year). Candidemia and IA incidence was increased among patients with hematologic malignancies (>+4%/year) and those with chronic renal failure (>+10%/year). In-hospital deaths substantially increased in some groups, e.g., in those with hematologic malignancies. IFIs occur among a broad spectrum of non-HIV-infected patients and should be a major public health priority.