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The essential oil (EO) of Hesperozygis ringens (Benth.) Epling, which has several proven properties, is comprised mainly of monoterpenes and sesquiterpenes, and pulegone is the major compound. However, this is an endemic and endangered species. The aim of this study is to evaluate the viability of cultivating Hesperozygis ringens in different regions of Rio Grande do Sul and in a greenhouse. Seedlings obtained by using cuttings were transferred and cultivated for a year at each site. Then, leaves were collected and underwent EO extraction through steam distillation. During the same period, EO was also obtained from the natural population from which the cuttings were obtained. The chemical composition of EO samples in triplicates from each cultivation site and from the natural population were characterized in GC-MS. EO yield (%) was obtained by the ratio between leaf biomass (g) and EO mass (g) and it showed differences between areas; the yield obtained in the natural population was higher (3.14%) than the yield obtained in the cultivated areas (1.29%) and in the greenhouse (0.86%). The chemical compounds had low variation between areas, and most of them were oxygenated monoterpenes (74.82%). The commercial exploitation of H. ringens in different regions is feasible, as the plants tolerated climatic and edaphic conditions that were different from the ones of its natural occurrence area, and their EO yield remained high. The exception was the greenhouse, with lower yield yet with higher pulegone concentration. Furthermore, EO maintained its compounds, with few changes in their concentration.

Background: Sequential occurrences of acute ischaemic stroke in patients with acute myocardial infarction (MI) and vice versa have been reported, but not the simultaneous occurrence of both conditions. We report a case of simultaneous occurrence of MI and systemic embolism caused by a mechanism not reported to date., Case Summary: A 52-year-old female patient presented with concurrent chest pain, right arm weakness, and dysphasia. An electrocardiogram demonstrated ST-elevation MI. A computed tomography angiography ruled out aortic dissection and showed an ischaemic stroke and infarction in the right kidney and spleen. A right coronary thrombotic occlusion at the ostium was successfully recanalized. Transoesophageal echocardiography showed preserved left ventricular function with no intracardiac thrombi., Discussion: The reported case presentation does not align with the mechanisms typically associated with simultaneous MI and stroke. The most plausible hypothesis is that the thrombus in the right coronary ostium extended into the aorta, resulting in a concurrent systemic embolism., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Leishmaniasis is a group of parasitic diseases with the potential to infect more than 1 billion people; however, its treatment is still old and inadequate. In order to contribute to changing this view, this work consisted of the development of complexes derived from M I metal ions with thioureas, aiming to obtain potential leishmanicidal agents. The thiourea ligands (HL R ) were obtained by reactions of p -toluenesulfohydrazide with R-isothiocyanates and were used in complexation reactions with Ag I and Au I , leading to the formation of complexes of composition [M(HL R ) 2 ]X (M = Ag or Au; X = NO 3 - or Cl - ). All compounds were characterized by FTIR, 1 H NMR, UV-vis, emission spectroscopy and elemental analysis. Some representatives were additionally studied by ESI-MS and single-crystal XRD. Their properties were further analyzed by DFT calculations. Their cytotoxicity on Vero cells and the extracellular leishmanicidal activity on Leishmania infantum and Leishmania braziliensis cells were evaluated. Additionally, the interaction of the complexes with the Old Yellow enzyme of the L. braziliensis (LbOYE) was examined. The biological tests showed that some compounds present remarkable leishmanicidal activity, even higher than that of the standard drug Glucantime, with different selectivity for the two species of Leishmania . Finally, the interaction studies with LbOYE revealed that this enzyme could be one of their biological targets.

Purpose: To compare the effectiveness, adverse events (AEs), stent patency, and patient survival with suprapapillary and transpapillary uncovered self-expandable metallic stent placement for perihilar cholangiocarcinoma., Materials and Methods: A single-center retrospective study of 54 patients with inoperable perihilar cholangiocarcinoma who underwent percutaneous transhepatic biliary stent placement between January 1, 2019, and August 31, 2021, was conducted. According to stent location, the patients were classified into 2 groups: suprapapillary (S) and transpapillary (T). Demographic data, Bismuth-Corlette classification, type and location of the stent, laboratory data, postprocedural AEs, procedural success, stent occlusion, reintervention rate, and mortality were compared between the groups., Results: Stent placement was suprapapillary in 13 (24.1%) patients and transpapillary in 41 (75.9%) patients. Mean age was higher in Group T (78 vs 70.5 years; P = .046). Stent occlusion rates were similar in the 2 groups (Group S, 23.8%; Group T, 19.5%), as were AE rates, the most common being cholangitis (Group S, 23.1%; Group T, 24.4%). There were no significant differences in revision rate (Group S, 7.7%; Group T, 12.2%) and 30-day mortality rate (Group S, 15.4%; Group T, 19.5%). Ninety-day mortality rate was statistically significantly higher in Group T (46.3% vs 15.4%; P = .046). Preprocedural bilirubin level was higher in Group T, as were postprocedural leukocyte and C-reactive protein (CRP) levels., Conclusions: Suprapapillary and transpapillary stent placement procedures were similar in terms of procedural success, occlusion rate, revision rate, postprocedural AEs, and 30-day mortality. Ninety-day mortality rate and postprocedural leukocyte and CRP levels were higher in Group T, although these patients were also older and had higher preprocedural bilirubin levels., (Copyright © 2023 SIR. Published by Elsevier Inc. All rights reserved.)

Using two different energy levels, dual-energy computed tomography (DECT) allows for material differentiation, improves image quality and iodine conspicuity, and allows researchers the opportunity to determine iodine contrast and radiation dose reduction. Several commercialized platforms with different acquisition techniques are constantly being improved. Furthermore, DECT clinical applications and advantages are continually being reported in a wide range of diseases. We aimed to review the current applications of and challenges in using DECT in the treatment of liver diseases. The greater contrast provided by low-energy reconstructed images and the capability of iodine quantification have been mostly valuable for lesion detection and characterization, accurate staging, treatment response assessment, and thrombi characterization. Material decomposition techniques allow for the non-invasive quantification of fat/iron deposition and fibrosis. Reduced image quality with larger body sizes, cross-vendor and scanner variability, and long reconstruction time are among the limitations of DECT. Promising techniques for improving image quality with lower radiation dose include the deep learning imaging reconstruction method and novel spectral photon-counting computed tomography.

Background: Ultrasound-based classification systems allow stratification of thyroid nodules to recommend fine-needle aspiration (FNA) based on their malignancy risk. However, these have discrepancies that may have an impact in thyroid cancer detection. We aimed to compare European Thyroid Association (EU-TIRADS) and American College of Radiology (ACR TI-RADS), in terms of FNA indication and diagnostic performance., Methods: Retrospective study of 665 thyroid nodules from 598 patients who underwent ultrasound and fine-needle aspiration at a tertiary-care institution between January 1 st of 2016 and July 31 st of 2019. Based on their sonographic features they were classified according to the EU-TIRADS and ACR TI-RADS classification and then their cytological results were obtained. Differences in FNA indications according to these two classifications were analysed. In patients who underwent surgical removal of the nodules, the final pathological diagnosis was obtained., Results: A statistically significant association was found between EU-TIRADS and ACR TI-RADS classification systems (p < 0.001). ACR TI-RADS allowed greatest reduction in FNA performed (32% vs 24.5%). A different risk category was obtained in 174 (26.1%) nodules, mostly higher with EU-TIRADS. The indication to FNA changed in 54 (8.1%) nodules (49 only indicated following EU-TIRADS recommendations), of which 4 had Bethesda IV and 5 had Bethesda III cytology. The FNA indication in a higher number of nodules using EU-TIRADS was due to difference in the dimensional threshold for FNA on low-risk nodules; to the fact that hypoechogenicity in a mixed nodule ascribes it moderate risk, while using ACR TI-RADS it would only be considered of low risk, and to the use of isolated sonographic features, namely marked hypoechogenicity, microcalcifications and irregular margins, to automatically categorize a nodules as high risk in EU-TIRADS, while ACR TI-RADS requires a group of potentially suspicious features to consider a nodule of high risk. The analysis of pathology proven nodules revealed equally good sensitivity of both systems in the detection of malignancy, but weak specificity, slightly greater with ACR TI-RADS (27.1% vs 18.6%)., Conclusions: The EU-TIRADS and ACR TI-RADS are both suitable to assess thyroid nodules and through risk stratification avoid unnecessary FNA. FNA was less performed using ACR TI-RADS, which was slightly more efficiency in excluding malignancy., (© 2023. The Author(s).)

Purpose: To study the association between median arcuate ligament compression (MALC) of celiac artery (CA) and splanchnic artery aneurysms/pseudoaneurysms (SAAPs) submitted to endovascular embolization., Methods: Single center retrospective study of embolized SAAPs between 2010 and 2021, to evaluate the prevalence of MALC, and compare demographic data and clinical outcomes between patients with and without MALC. As a secondary objective, patient characteristics and outcomes were compared between patients with different causes of CA stenosis., Results: MALC was found in 12.3% of 57 patients. SAAPs were more prevalent in the pancreaticoduodenal arcades (PDAs) in patients with MALC, compared to those without MALC (57.1% vs. 10%, P = .009). Patients with MALC had a greater proportion of aneurysms (71.4% vs. 24%, P = .020), as opposed to pseudoaneurysms. Rupture was the main indication for embolization in both groups (71.4% and 54% of patients with and without MALC, respectively). Embolization was successful in most cases (85.7% and 90%), with 5 immediate (28.6% and 6%) and 14 non-immediate (28.6% and 24%) post-procedure complications. Thirty and 90-day mortality rate were 0% in patients with MALC, and 14% and 24% in patients without MALC. Atherosclerosis was the only other cause of CA stenosis, in 3 cases., Conclusions: In patients with SAAPs submitted to endovascular embolization, the prevalence of CA compression by MAL is not uncommon. The most frequent location for aneurysms in patients with MALC is in the PDAs. Endovascular management of SAAPs is very effective in patients with MALC, with low complications, even in ruptured aneurysms., (© 2023. The Author(s).)

Background: Patients with advanced non-small cell lung cancer (NSCLC) are a heterogeneous population with short lifespan. We aimed to develop methods to better differentiate patients whose survival was >90 days., Methods: We evaluated 83 characteristics of 106 treatment-naïve, stage IV NSCLC patients with Eastern Cooperative Oncology Group Performance Status (ECOG-PS) >1. Automated machine learning was used to select a model and optimize hyperparameters. 100-fold bootstrapping was performed for dimensionality reduction for a second ("lite") model. Performance was measured by C-statistic and accuracy metrics in an out-of-sample validation cohort. The "lite" model was validated on a second independent, prospective cohort (N = 42). Network analysis (NA) was performed to evaluate the differences in centrality and connectivity of features., Results: The selected method was ExtraTrees Classifier, with C-statistic of 0.82 (p < 0.01) and accuracy of 0.81 (p = 0.01). The "lite" model had 16 variables and obtained C-statistic of 0.84 (p < 0.01) and accuracy of 0.75 (p = 0.039) in the first cohort, and C-statistic of 0.706 (p < 0.01) and accuracy of 0.714 (p < 0.01) in the second cohort. The networks of patients with lower survival were more interconnected. Features related to cachexia, inflammation, and quality of life had statistically different prestige scores in NA., Conclusions: Machine learning can assist in the prognostic evaluation of advanced NSCLC. The model generated with a reduced number of features showed high accessibility and reasonable metrics. Features related to quality of life, cachexia, and performance status had increased correlation and importance scores, suggesting that they play a role at later disease stages, in line with the biological rationale already described., (© 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Dual-energy computed tomography (DECT) uses different energy spectrum x-ray beams for differentiating materials with similar attenuation at a certain energy. Compared with single-energy CT, it provides images with better diagnostic performance and a potential reduction of contrast agent and radiation doses. There are different commercially available DECT technologies, with machines that may display two x-ray sources and two detectors, a single source capable of fast switching between two energy levels, a specialized detector capable of acquiring high- and low-energy data sets, and a filter splitting the beam into high- and low-energy beams at the output. Sequential acquisition at different tube voltages is an alternative approach. This narrative review describes the DECT technique using a Q&A format and visual representations. Physical concepts, parameters influencing image quality, postprocessing methods, applicability in daily routine workflow, and radiation considerations are discussed. Differences between scanners are described, regarding design, image quality variabilities, and their advantages and limitations. Additionally, current clinical applications are listed, and future perspectives for spectral CT imaging are addressed. Acknowledging the strengths and weaknesses of different DECT scanners is important, as these could be adapted to each patient, clinical scenario, and financial capability. This technology is undoubtedly valuable and will certainly keep improving.

Objective: to analyze the implications of health conditions on rural workers' quality of life in the context of soybean production., Method: a cross-sectional study, with an intentional sample of 299 male rural workers. Data collection took place between October and December 2019. The following instruments were used: World Health Organization Quality Life-bref; Rural Workers' Living & Health Conditions questionnaire; International Physical Activity Questionnaire; Cut down, Annoyed, Guilty, and Eye-opener. They were analyzed via descriptive and inferential statistics, using bivariate (Mann-Whitney; Kruskal-Wallis) and multivariate tests (generalized additive models for location, scale and shape)., Results: the presence of a diagnosis of morbidity, alcohol dependence, occupational accidents and absenteeism implied a decrease in workers' quality of life scores., Conclusion: the existence of unfavorable health conditions has a negative impact on rural soybean workers' quality of life.

Objective: to report an experience using the Team-Based Learning methodology for the development of a standard model for Birth Plans by health professionals., Methods: experience report on the use of Team-Based Learning to develop care technology, with the participation of 120 professionals from two municipalities located in the Midwest Region., Results: the use of Team-Based Learning in this experience enabled the construction of a Child Delivery Plan model based on the theoretical approach to the theme, a critical reflection exercise, an in-depth discussion, decision-making, after what a consensus was reached. The methodology enabled the (co) construction of knowledge in small groups, teamwork, accountability, and satisfaction among the participants., Final Considerations: the use of the TeamBased Learning methodology proved to be effective as a discussion strategy, building consensus and syntheses for the elaboration of a care technology aimed at the pregnancy-parturition period.

Objectives: Identifying simple biomarkers to determine muscle atrophy in non-small-cell lung cancer (NSCLC) patients remains a critical research gap. Since creatinine is mainly a product from intramuscular creatine metabolism, we tested the hypothesis that low serum creatinine levels would be associated to skeletal muscle atrophy in NSCLC patients. Materials and Methods: This is a prospective cohort study including 106 treatment-naive patients with histologically confirmed stage IV NSCLC. All patients performed routine serum creatinine laboratory tests. We divided patients into two groups based on low (<0.7 mg/dL for male and <0.5 mg/dL for female) or normal creatinine levels. We compared body mass index (BMI), psoas muscle cross-sectional area, adipose tissue area and complete blood counts between groups. Results: Male and female NSCLC patients with low serum creatinine levels had low muscle cross-sectional area as compared to patients with normal serum creatinine levels. Male NSCLC patients with low serum creatinine also displayed reduced BMI, reduced adipose tissue area, and elevated systemic inflammation compared to NSCLC patients with normal serum creatinine levels. There were no significant differences between female groups for BMI, adipose tissue area and inflammatory markers. Conclusions: Serum creatinine is a potential prognostic biomarker of skeletal muscle atrophy in NSCLC patients. Since serum creatinine is a simple and accessible measurement, we suggest that it should be monitored in longitudinal follow-up of NSCLC patients as a biomarker of muscle atrophy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 das Neves, Alves, de Souza Borges and de Castro.)

Purpose: The purpose of this study was to conduct a systematic review to assess the effect of exercise on symptoms and quality of life in lung cancer patients., Methods: We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Medline, Embase, Scopus, Web of Science, and SciELO were searched for studies published from January 1998 to January 2019. The review included all randomized controlled trials that evaluated the effect of exercise on symptoms and quality of life of lung cancer patients. Two reviewers independently assessed the quality of all the included studies using the Physiotherapy Evidence Database scale., Results: In total, ten studies (835 participants) met all inclusion criteria. Three studies investigated the effect of exercise after lung resection, whereas four studies investigated it as a pre-surgery intervention. Two studies investigated the effect of exercise in patients under systemic treatment only, and one study included patients on diverse treatment plans. Exercise protocols consisted of different combinations of strength, aerobic, and inspiratory muscle training. Two trials, including 101 participants, found significant difference in quality of life between groups, favoring the intervention group; and five trials, including 549 participants, found significant inter-group differences in isolated symptoms, also favoring the intervention group., Conclusions: Exercise can lead to improvements of symptoms and of quality of life in lung cancer survivors. Providing resistance training combined with high-intensity interval aerobic exercise after lung resection seems to be particularly effective. Further studies are warranted to investigate exercise for patients with poor performance status.

Nocardia asiatica causing pyogranulomatous pleuropneumonia is reported for the first time in a dog coinfected with canine morbillivirus (CM), diagnosed based on epidemiological, clinical, haematological, images, microbiological, histopathological, polymerase chain reaction and hsp65 gene sequencing findings. The immunosuppression of CM probably favoured the opportunistic behaviour of N. asiatica. Despite the therapeutic measures, the animal died, mainly due to respiratory distress. The association of methods to improve early diagnosis, therapy procedures and prognosis of canine nocardiosis is discussed, as well as the close relationship between pets and their owners, which may favour the transmission of pathogens such as Nocardia from pets-to-humans, which poses an emerging public health issue., (© 2019 The Authors. Veterinary Medicine and Science Published by John Wiley & Sons Ltd.)

This study intends to develop a Prioritization Scoring Index of Iberian Peninsula comprising Portuguese and Spanish citizens, to weigh the importance assigned to rationing criteria used to prioritize patients. Data were collected through an online survey from 2 samples of 355 Portuguese and 564 Spanish members of the general public. Respondents faced 12 hypothetical rationing scenarios and should reveal their level of agreement with each one according to a Likert scale. The statements comprise 3 allocative considerations: egalitarianism, efficiency, and equity. Findings suggest that Portuguese and Spanish respondents gave greater importance to the treatments outcomes, to the severity of the illness, and to younger patients. Furthermore, Iberian respondents assigned 57% of the weighting to equity considerations, 40% to efficiency considerations, and approximately only 3% to egalitarianism. Spaniards weighted more than Portuguese both equity and efficiency considerations while weighted less the egalitarian principle. Iberian Peninsula respondents require resource allocation decisions in health to be informed by considerations of equity as well as efficiency. As the first was most valued, it seems plausible that Portuguese and Spanish respondents are willing to sacrifice some efficiency to achieve a more equitable distribution of health.

Background: Clinical studies demonstrate that up to 40% of patients do not respond to cardiac resynchronization therapy (CRT), thus, appropriate patient selection is critical to the success of CRT in heart failure., Objective: Evaluation of mortality predictors and response to CRT in the Brazilian scenario., Methods: Retrospective cohort study including patients submitted to CRT in a tertiary hospital in southern Brazil from 2008 to 2014. Survival was assessed through a database of the State Department of Health (RS). Predictors of echocardiographic response were evaluated using Poisson regression. Survival analysis was performed by Cox regression and Kaplan Meyer curves. A two-tailed p value less than 0.05 was considered statistically significant., Results: A total of 170 patients with an average follow-up of 1011 ± 632 days were included. The total mortality was 30%. The independent predictors of mortality were age (hazard ratio [HR] of 1.05, p = 0.027), previous acute myocardial infarction (AMI) (HR of 2.17, p = 0.049) and chronic obstructive pulmonary disease (COPD) (HR of 3.13, p = 0.015). The percentage of biventricular stimulation at 6 months was identified as protective factor of mortality ([HR] 0.97, p = 0.048). The independent predictors associated with the echocardiographic response were absence of mitral insufficiency, presence of left bundle branch block and percentage of biventricular stimulation., Conclusion: Mortality in patients submitted to CRT in a tertiary hospital was independently associated with age, presence of COPD and previous AMI. The percentage of biventricular pacing evaluated 6 months after resynchronizer implantation was independently associated with improved survival and echocardiographic response.

Background: We evaluated whether different personal responsibilities should influence the allocation healthcare resources and whether attitudes toward the penalization of risk behaviours vary among individual's sociodemographic characteristics and health related habits., Study Design: A cross-sectional study., Methods: We developed an online survey and made it available on various social networks for six months, during 2015. The sample covered the population aged 18 yr and older living in Portugal and we got 296 valid answers. Respondents faced four lifestyle choices: smoking, consumption of alcoholic beverages, unhealthy diet and illegal drug use, and should decide whether each one is relevant when establishing healthcare priorities. Logistic regressions were used to explore the relation of respondents' sociodemographic characteristics and health related behaviours in the likelihood of agreeing with the patients engaged in risky behaviour deserve a lower priority., Results: Using illegal drugs was the behaviour most penalized (65.5%) followed by heavy drinkers (61.5%) and smoking (51.0%). The slight penalization was the unhealthy dieting (29.7%). The sociodemographic characteristics had different impact in penalization of the risks' behaviours. Moreover, the respondents who support the idea that unhealthy lifestyles should have a lower priority, all strongly agreed that the smoking habit (OR=36.05; 95% CI: 8.72, 149.12), the unhealthy diets (OR=12.87; 95% CI: 3.21, 51.53), drink alcohol in excess (OR=20.51; 95% CI: 12.09, 85.46) and illegal drug use (OR=73.21; 95% CI: 9.78, 97.83) must have a lower priority in the access to healthcare., Conclusions: The respondents accept the notion of rationing healthcare based on lifestyles.

Objectives: The need to improve the sustainability of public health expenditure, in a climate of growing pressure on national budgets, inevitably leads to a discussion about resource rationing, and the extent of society's responsibility for those expenditures. To contribute to this discussion empirically, this study evaluated the willingness of Portuguese respondents to pay for other individuals' healthcare expenditures through out-of-pocket payments., Study Design: A questionnaire addressed to the general public was developed, with 296 respondents. The survey was divided into three sections: (i) sociodemographic characteristics of the respondents; (ii) health-related habits; and (iii) willingness to pay other individuals' healthcare expenditures and, if so, how much., Methods: Logit and ordered logit models were applied., Results: Respondents were divided fairly even between those who were willing to pay for other individuals' healthcare expenditures and those who were not. Respondents with health insurance contracts were more willing to contribute, and the contribution value was higher. Having a degree-level education was associated with reduced willingness to pay for other individuals' healthcare expenditures, and reduced probability of paying a larger amount, which may be associated with holding individuals accountable for their choices. Considering self-reported risky behaviours, the respondents who consumed alcohol were more likely to be willing to pay for other individuals' healthcare expenditures, and to a greater extent, whereas smokers were less likely to pay larger amounts. These effects suggest that respondents with different unhealthy behaviours are not equally altruistic., Conclusions: These findings highlight the need to combine health policy and social beliefs. The respondents seem to be interested to discuss healthcare funding, given that they agreed to reveal their willingness to pay for other individuals' healthcare expenditures. Moreover, respondents' sociodemographic characteristics and health-related behaviours play a role in their willingness to contribute to social well-being through healthcare expenditures. The differences observed denote that no agreement exists regarding the extent of society's responsibility., (Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Periodontal disease is a highly prevalent illness that affects many dogs, reaching up to 85 % prevalence in individuals over the age of 4 years. Currently the drug of choice for combating the formation of dental plaque in these animals, the etiologic agent of the disease, is chlorhexidine, which has several side effects reported. Thus, surveys are conducted throughout the world in order to identify potential substitutes for antimicrobial therapy and prevention of periodontal disease. The objective of the work was to evaluate the antimicrobial activity of β-caryophyllene against bacteria from dog's dental plaque in vitro and in vivo. The minimum inhibitory concentration was evaluated by agar microdilution assay, the induction or inhibition of bacterial adherence by sub-inhibitory concentrations in 96-well plates, and reduction of dental plaque formation in mongrel dogs subjected to topical solution with β-caryophyllene for 15 days., Results: Results showed minimum inhibitory concentrations above 100 mg/mL for 25 % of the isolates, 100 mg/mL for 3 %, 50 mg/mL for 25 %, 25 mg/mL for 12 %, 12.5 mg/mL for 19 % and 6.25 mg/mL for 16 %. Bacterial adherences of three Enterococcus sp., one Streptococcus sp., one Haemophilus sp., one Aerococcus sp., one Bacillus sp. and one Lactococcus sp. isolates were inhibited by subinhibitory concentration. One Lactococcus sp., one Bacillus sp. and one Streptococcus sp. were stimulated to adhere by concentrations of 0.19, 1.56 and 0.78 mg/mL, respectively. In vivo assay showed reduction in dental plaque formation by β-caryophyllene, with final plaque coverage of 23.3 ± 2.6 % of the total area of the teeth, with significant difference compared with chlorhexidine group (37.5 ± 3.7 % - p < 0.05) and negative control group (65.5 ± 2.5 % - p < 0.001)., Conclusions: The results showed that β-caryophyllene has antimicrobial activity against the proliferation of dog's dental plaque-forming bacteria representing a suitable alternative to the use of chlorhexidine in prophylaxis and treatment of periodontal disease of dogs.

Introduction: Elderly people with cognitive impairment are at greater risk for falls; thus, an understanding of the earliest stages of cognitive decline is necessary., Objective: To compare postural balance between elderly people with and without mild cognitive impairment using a three-dimensional system., Methods: Thirty elderly people with mild cognitive impairment and thirty healthy elderly subjects were selected. Static posturography was performed using three-dimensional electromagnetic equipment and the following parameters were evaluated: maximum displacement, mean speed and total trajectory. Open- and closed-eye stabilometric variable comparisons between groups and within each group were carried out, and a relationship between the Mini Mental State Examination and the total trajectory of all elderly subjects was determined., Results: The analysis among open- and closed-eye conditions showed a significant difference in maximum anteroposterior displacement in the control group and a significant difference in all stabilometric variables in the mild cognitive impairment group. A significant difference between the groups in all variables in the closed-eye condition was observed. There was a strong correlation between cognitive performance and total trajectory., Conclusion: Evaluations showed decrease in balance in elderly people with mild cognitive impairment. Presence of anteroposterior displacement can be an early sign of postural control impairment, and the evaluation with visual restriction can be useful in detecting small postural instabilities., (Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Objectives: Atrial fibrillation is the most common sustained arrhythmia and is associated with poor outcomes, including stroke. The ability of anticoagulation therapy to reduce the risk of stroke has been well established; however, the prevalence of anticoagulation therapy use in the Public Health System is unknown. The aim of this study is to evaluate both the prevalence of anticoagulation therapy among patients with atrial fibrillation and the indications for the treatment., Methods: In this cross-sectional study, we included consecutive patients who had atrial fibrillation documented by an electrocardiogram performed between September 2011 and March 2012 at a university hospital of the Public Health System. The variables analyzed included the risk of a thromboembolic event and/or bleeding, the use of antiplatelet or anticoagulation therapy, the location where the electrocardiogram report was initially reviewed and the specialty of the physician who initially reviewed it., Results: We included 162 patients (mean age 68.9 years, 56% men). Hypertension (90.1%), heart failure (53.4%) and stroke (38.9%) were the most prevalent diseases found. Only 50.6% of the patients knew that they had atrial fibrillation. Regarding the use of therapy, only 37.6% of patients classified as high risk according to the CHADS2 scores and 35.5% according to the CHA2DS2VASc used oral anticoagulation. A presumptive diagnosis of heart failure and the fact that the electrocardiogram was evaluated by a cardiologist were the only independent predictors of the use of anticoagulants., Conclusions: Our study found a low prevalence of oral anticoagulation therapy among patients with atrial fibrillation and an indication for stroke prophylaxis for the use of this therapy, including among those with high CHADS2 and CHA2DS2VASc scores.

Implantable cardiac pacing systems are a safe and effective treatment for symptomatic irreversible bradycardia. Under the proper indications, cardiac pacing might bring significant clinical benefit. Evidences from literature state that the action of the artificial pacing system, mainly when the ventricular lead is located at the apex of the right ventricle, produces negative effects to cardiac structure (remodeling, dilatation) and function (dissinchrony). Patients with previously compromised left ventricular function would benefit the least with conventional right ventricle apical pacing, and are exposed to the risk of developing higher incidence of morbidity and mortality for heart failure. However, after almost 6 decades of cardiac pacing, just a reduced portion of patients in general would develop these alterations. In this context, there are not completely clear some issues related to cardiac pacing and the development of this cardiomyopathy. Causality relationships among QRS widening with a left bundle branch block morphology, contractility alterations within the left ventricle, and certain substrates or clinical (previous systolic dysfunction, structural heart disease, time from implant) or electrical conditions (QRS duration, percentage of ventricular stimulation) are still subjects of debate. This review analyses contemporary data regarding this new entity, and discusses alternatives of how to use cardiac pacing in this context, emphasizing cardiac resynchronization therapy.

Background: Oral treatment in women with breast cancer has been increasingly used. However, a potentially negative side of oral medication is poor patient adherence and/or discontinuation, which reduces the treatment effectiveness, accelerating progression of the disease and reducing the patient survival rate., Aim of the Review: To compare the rates of adherence and/or discontinuation and the methodologies used to assess these outcomes. It was conducted an integrative review of original articles published from 2000 to 2012, in which their primary outcome was to quantify medication adherence and/or discontinuation of oral hormonal therapy in patients with hormone receptor positive breast cancer., Methods: Original studies were searched in the PubMed/MEDLINE, Scopus, Embase and SciELO databases. The Medical Subject Heading was used to define descriptors. The descriptor "breast neoplasms" was used in all combinations. Each of the descriptors "medication adherence" and "patient compliance" were combined with each of the following descriptors "tamoxifen", "aromatase inhibitors", "selective estrogen receptor modulators", or the terms "letrozole", "anastrozole", and "exemestane"., Results: Twenty-four original articles were included. Our study showed a wide range of adherence and discontinuation rates, ranging from 45-95.7 and 12-73 %, respectively. Regarding the methodological development of the selected articles, a high prevalence (87.5 %) of prospective and/or retrospective longitudinal studies was found. In addition, there was a high prevalence of studies using a database (70.8 %). Among some of the studies, it was shown that patient adherence to hormonal therapy gradually reduces, while discontinuation increases during the treatment., Conclusions: It was observed a great diversity among rates of adherence and/or discontinuation of hormonal therapy for breast cancer, which may be due to a lack of methodology standardization. Therefore, adequate and validated methods to ensure reliability of the results and allow comparison in the literature are needed. Furthermore, adherence decreases and discontinuation increases over time, suggesting the need for patient continuous education and a pharmacotherapeutic follow up by health professionals to improve these clinical outcomes.

The Sub-Saharan part of the African continent is the area that has the highest disease burden in the world and is the only region of the planet where it is expected that the number of poor people will increase in the coming decades. The countries of this region, to different degrees, experience slow process of population aging but at the same time, it is the are where the elderly population grows fastest in absolute numbers. Based on a review of the literature, an attempt was made to highlight the social and demographic situation in which the elderly live in the Sub-Saharan region and the main challenges faced by local governments to overcome the complex problems affecting society as a whole. It was found that public policies geared to this segment of the population in the region do not represent a priority and, consequently, are unlikely to be included in the current agenda of international cooperation.

The scope of this paper was to analyze the profile of medical consultations and drugs used for the treatment of comorbidities in patients with diabetes attended in the Brazilian Unified Health System. This was a pharmaco-epidemiological cross-sectional study conducted between March 2006 and February 2007 All patients with diabetes attended in the western sanitary district of Ribeirao Preto in the state of São Paulo were included in the study. The types of medical attendance (primary, secondary and emergency care) and the drugs prescribed for the treatment of comorbidities were analyzed. The drugs were classified according to the Anatomical Therapeutic Chemical Classification System and 3,198 patients were identified. The mean age was 60.4 years and more than 55% of the patients were 60 years or older. The cardiovascular drugs most used were captopril or enalapril (60%). About 40.6% of the patients used acetylsalicylic acid in platelet antiaggregant doses. The patients had an average of 5.1 medical consultations per year (primary care, secondary care and emergency care). The utilization of statins and acetylsalicylic acid was less than that reported in the literature and the data indicate a high prevalence of admission to emergency care.

Background: Epileptic seizures are neurological disorders common in children; 4 to 10% of under 16-year olds have suffered at least one seizure. Antiepileptic drugs represent the basis of treatment for the majority of patients, but many of the drugs prescribed to pediatrics are used unlicensed and off-label., Objective: To analyze the prevalence of use of unlicensed and off-label antiepileptic drugs, by the pediatric population, according to the Food and Drug Administration and the Brazilian National Health Surveillance Agency. Setting General Hospital of the Faculty of Medicine at Ribeirão Preto, Brazil., Methods: A cross-sectional, retrospective and observational study was carried out. The daily prescriptions of children up to 12 years of age were collected for the analysis of antiepileptic drug use. Data of the registration number, sex, age, reason hospitalized, unit where hospitalized, drug prescribed, dosage, route and administration frequency were collected., Main Outcome Measure: Antiepileptic drugs prescribed for children were classified as unlicensed and off-label according to the term of the product's license registered in the Food and Drug Administration and the Brazilian National Health Surveillance Agency., Results: Of the 6,637 pediatric patients identified during the study period, 583 (9.0%) received at least one antiepileptic drug. The most used antiepileptic drugs were phenobarbital, phenytoin, carbamazepine, valproic acid and clonazepam. As expected, the number of pharmaceutical dosage form classified as unlicensed or off-label was high in both agencies, but distinct between the two. The number of patients (n = 287) using unlicensed drugs was similar in the two agencies, but the use of off-label drugs was higher according to the analysis carried out by the North American agency (40.5%)., Conclusions: Old-generation antiepileptic drugs are widely prescribed to children. The results found for the use of off-label drugs demonstrate the absence of uniformity in action between the agencies and a lack of integration between the studies carried out. Although legislation on the licensing of drugs aims to protect the patients from drugs that have not been scientifically evaluated, the scarcity of data about the safety of the therapeutic resources obliges the doctors to prescribe unlicensed and off-label antiepileptic drugs to the pediatric population.

Objective: Absorbable membranes are used to promote the regeneration of periodontal defects by Guided Tissue Regeneration (GTR). However, their collapse into the defect is commonly reported, impairing regeneration. Therefore, absorbable but rigid membranes aiming at preventing such collapse were developed and analyzed in periodontal regeneration., Materials and Methods: Membranes were analyzed in class II furcation defects in dogs; procedures included periodontal disease induction, prophylaxis and GTR (treated groups) or open flap debridement alone (control group). For GTR, the membranes were made of either 25% hydroxyapatite (HA) in polyhydroxybutyrate matrix (PHB) or 35% HA in PHB. Animals were clinically evaluated for gingival recession, clinical attachment level (CAL) and biopsies were collected at 60 and 120 days. Bone volume, trabeculae number, trabecular thickness and trabecular separation were quantified by micro-computed tomography, followed by histology., Results: Membrane exposure was observed in both treated groups (25 and 35% HAP) from the 8(th) day after surgery, continuously progressing until 120 days. Mean CAL for all groups remained above normal values for dogs. Bone volumetric values were not significantly different. Partial formation of bone, cementum and periodontal ligament was observed in treated groups. An inflammatory infiltrate was observed in the dense connective tissue that partially filled the center of the treated defects with active osteoclasts on bone surface., Conclusion: Although partial regeneration of the defect was observed, it was limited by wound contamination. Consequently, rigid absorbable membranes made of HA and PHB failed to improve the regeneration of class II furcation defects in dogs.

Objective: To analyze drug prescriptions for insulin and oral antidiabetic drugs in type 1 and type 2 diabetes mellitus patients seen in the Brazilian Public Healthcare System (Unified Health System - SUS) in Ribeirao Preto, SP, Brazil., Subjects and Methods: All the patients with diabetes seen in the SUS in the western district of Ribeirao Preto, SP, Brazil between March/2006 and February/2007 were included in the study., Results: A total of 3,982 patients were identified. Mean age of the patients was 60.6 years, and 61.0% were females. Sixty percent of the patients were treated with monotherapy. Doses of oral antidiabetic drugs were lower in monotherapy than in polytherapy. Ten patients received doses of glibenclamide or metformin above the recommended maximum doses, and in elderly patients there was no reduction in drug doses., Conclusion: Monotherapy with oral antidiabetic drugs was the predominant procedure, and the doses were not individualized according to age.

eIF5A is highly conserved from archaea to mammals, essential for cell viability and the only protein known to contain the essential amino acid residue hypusine, generated by a unique posttranslational modification. eIF5A was originally identified as a translation initiation factor due to its ability to stimulate the formation of the first peptide bond. However, recent studies have shown that depletion of eIF5A causes a significant decrease in polysome run-off and an increase in the ribosome transit time, suggesting that eIF5A is actually involved in the elongation step of protein synthesis. We have previously shown that the depletion mutant tif51A-3 (eIF5A(C39Y/G118D)) shows a sicker phenotype when combined with the dominant negative mutant eft2 ( H699K ) of the elongation factor eEF2. In this study, we used the eIF5A(K56A) mutant to further investigate the relationship between eIF5A and eEF2. The eIF5A(K56A) mutant is temperature sensitive and has a defect in protein synthesis, but instead of causing depletion of the eIF5A protein, this mutant has a defect in hypusine modification. Like the mutant tif51A-3, the eIF5A(K56A) mutant is synthetic sick with the mutant eft2 ( H699K ) of eEF2. High-copy eEF2 not only improves cell growth of the eIF5A(K56A) mutant, but also corrects its increased cell size defect. Moreover, eEF2 suppression of the eIF5A(K56A) mutant is correlated with the improvement of total protein synthesis and with the increased resistance to the protein synthesis inhibitor hygromycin B. Finally, the polysome profile defect of the eIF5A(K56A) mutant is largely corrected by high-copy eEF2. Therefore, these results demonstrate that eIF5A is closely related to eEF2 function during translation elongation.

Objective: To assess the efficacy of early therapeutic laser and ultrasound in the regeneration process of an injury in rats., Methods: We used 24 rats. Eighteen underwent surgery for sciatic nerve compression by a hemostat above the popliteal fossa. The animals were divided into three groups of six animals each. Normal control group. GI: Injured control without therapeutic intervention. GII: laser ArGaAl therapeutic intervention. GIII: therapeutic intervention of Pulsed Ultrasound. We begin therapeutic interventions 24 hours after injury, with daily applications for a period of fourteen consecutive days., Results: IN ASSESSING THE GIRTH OF THE MUSCLES OF THE RIGHT THEY, THE FOLLOWING AVERAGE DECREASE (IN MM) FOR EACH GI: 0.45, GII: 0.42, GIII: 0.40 In relation to travel time, both GII and GIII presented significant difference when compared to GI. In the final evaluation of the IFC, GII excelled in the GIII. As for the healing observed, a major great improvement was observed in GII and GIII., Conclusion: The results showed that nerve recovery was higher with the laser application. Level of evidence II, Therapeutic Studies - Investigation of the results of treatment.

Objective: To investigate the effect of kinesiotherapy on the functionality of the pelvic limb of rats after ischemic and reperfusion injury., Methods: 10 rats were divided into two groups, GI (control) and GII (kinesiotherapy). All the animals underwent ischemia for a period of three hours, followed by tissue reperfusion. In Group GII, non-resistive systemic kinesiotherapy was performed (swimming) in three weekly sessions of 50 minutes, over a period of four weeks, while the GI animals remained at rest. Functional analysis of motor behavior was evaluated weekly. The animals were then sacrificed, and the soleus and gastrocnemius muscles and the sciatic nerve removed for histopathological analysis., Results: There was a significant recovery of motor behavior with kinesiotherapeutic treatment during the four weeks of treatment. However, the histological examination of the tissues showed no morphological changes of cell injury and repair., Conclusion: It was not possible to affirm that the exercise was effective in cell repair, because neither of the groups (control and experimental) showed any histological difference. On the other hand, systemic kinesiotherapy showed a beneficial effect on functional rehabilitation after ischemia and reperfusion. Level of evidence III, Case-Control Study .

Objective: To analyze the costs related to visits and drug prescription in outpatients with type 2 diabetes mellitus assisted by a pharmaceutical care service., Subjects and Methods: A prospective and experimental study was carried out. Seventy one patients were divided into two groups: control and pharmaceutical care. Patients in the pharmaceutical care group were followed up monthly by a single clinical pharmacist., Results: The pharmaceutical care group had a statistically significant reduction in costs of metformin and emergency department visits, and increased costs with their family physicians. On the other hand, the control group had a statistically significant increase of 21.3% in the general costs of treatment and visits., Conclusion: The pharmaceutical care group maintained the same costs related to drugs and visits, while the control group showed a significant increase in general costs.

The regeneration of tissues affected by periodontal disease is a complex process; it encompasses the formation of bone, cementum and periodontal ligament. We developed a semi-rigid PLGA (polylactide-co-glycolide acid)/CaP (calcium phosphate) bilayered biomaterial construct to promote periodontal regeneration, which has a continuous outer barrier membrane and an inner topographically complex component. Our experimental model compared periodontal prophylaxis alone with prophylaxis and biomaterial implantation in the treatment of class II furcation defects in dogs. Clinical evaluation, micro-computed tomography, histology and backscattered electron imaging were used for data analysis. Healing occurred uneventfully and bone volumetric values, trabecular number and trabecular thickness were all significantly greater in the treated group; while trabecular separation was significantly greater in the control group. New cementum, bone, and periodontal ligament with Sharpey fibre insertions were only seen in the treated group. Although periodontal regeneration has been reported elsewhere, the advantages of employing our bilayered PLGA + CaP construct are twofold: 1)it did not collapse into the defect; and, 2) its inner side was able to retain the blood clot throughout the buccal defect. The result was greater periodontal regeneration than has previously been reported with traditional flexible membranes., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Angiotensin-converting enzyme (ACE) inhibitors reduce the chance of death, myocardial infarction (MI) and cerebrovascular accident (CVA) in patients with coronary disease. However there is no consensus as to its indication in patients undergoing coronary artery bypass grafting (CABG)., Objective: To assess the relationship between preoperative use of ACE inhibitors and clinical outcomes after CABG., Methods: Retrospective cohort study. We included data from 3,139 consecutive patients undergoing isolated CABG in Brazilian tertiary care hospital between January 1996 and December 2009. Follow-up was until discharge or death. Clinical outcomes after surgery were analyzed between users and nonusers of ACE inhibitors preoperatively., Results: Fifty-two percent (n=1,635) of patients received ACE inhibitors preoperatively. The use of ACE inhibitors was an independent predictor of need for inotropic support (OR 1.24, 95% CI 1.01 to 1.47, P = 0.01), acute renal failure (OR 1.23, 95% CI 1.01 to 1.73, P = 0.04) and progression to atrial fibrillation (OR 1.32, 95% CI 1.02 to 1.7, P = 0.03) postoperatively. The mortality rate among patients receiving or not preoperative ACE inhibitors was similar (10.3% vs. 9.4%, P = 0.436), as well as the incidence of myocardial infarction and stroke (15.6% vs. 15.0%, P = 0.694 and 3.4% vs. 3.5%, P = 0.963, respectively)., Conclusion: The use of preoperative ACE inhibitors was associated with increased need for inotropic support and higher incidence of acute renal failure and postoperative atrial fibrillation, not associated with increased rates of myocardial infarction, stroke or death.

Objectives: To analyze the impact of blood transfusion on the incidence of clinical outcomes postoperatively (PO) from cardiac surgery., Methods: Retrospective cohort study. We analyzed 4028 patients undergoing coronary artery bypass grafting (CABG), valve (TV), or both, in Brazilian tertiary university hospital between 1996 and 2009. We compared the postoperative complications between patients with blood transfusion (n = 916) and non-blood transfusion (n = 3112). Univariate analysis was performed using the Student t test, and multivariate logistic regression bivariate (stepwise forward). Were considered significant variables with P <0.05., Results: Patients who received blood transfusions had more infectious episodes as mediastinitis (4.9% vs. 2.2%, P <0.001), respiratory infection (27.8% vs 17.1%, P <0.001) and sepsis (6.2% vs. 2.5%, P <0.001). There were more episodes of atrial fibrillation (AF) (27% vs. 20.4%, P <0.001), acute renal failure (ARF) (14.5% vs 7.3%, P <0.001) and stroke (4.8% vs. 2.6%, P = 0.001). The length of PO hospital stay was higher in transfused (13 ± 12.07 days vs. 9.72 ± 7.66 days, P <0.001). However, mortality didn't differ between groups (10.9% vs. 9.1%, P = 0.112). The transfusion was shown to be a risk factor for: respiratory infection (OR: 1.91, 95% CI 1.59-2.29, P <0.001), AF (OR: 1.35, 95% CI 1.13-1.61, P = 0.01), sepsis (OR: 2.08, 95% CI 1.4-3.07, P <0.001), mediastinitis (OR: 2.14, 95% CI: 1.43-3.21, P <0.001), stroke (OR: 1.63, 95% CI 1.1-2.41, P = 0.014) and ARF (OR 1.8, 95% CI: 1.39-2.33, P <0.001)., Conclusion: The blood transfusion is associated with increased risk of infectious events, episodes of AF, ARF and stroke, as well as the increased length of hospital stay but not mortality.

Context and Objective: Many factors influence occurrences of vulvovaginitis. The aims here were to assess skin color and age-related differences in the vaginal flora and occurrences of vulvovaginitis., Design and Setting: Cross-sectional study; tertiary referral hospital (Universidade Federal do Triângulo Mineiro, Uberaba)., Methods: Healthy women who underwent routine outpatient gynecological assessments were assessed for vulvovaginitis and vaginal flora and then divided into whites (n = 13,881) and nonwhites (n = 5,295). Statistical analysis was performed using the X² test, logistic regression and odds ratios., Results: The vaginal microflora was skin-color dependent, with greater occurrence of clue cells, Trichomonas vaginalis and coccobacilli in nonwhite women (p < 0.0001). Döderlein bacilli and cytolytic flora were more prevalent in white women (p < 0.0001 and p < 0.05, respectively). The vaginal microflora was age-dependent within the skin color groups. Among the nonwhite women, clue cells were more prevalent in women aged 21 to 50 years; Trichomonas in women up to 40 years and coccobacili in women between 21 and 40 years (P < 0.05). During the proliferative and secretory phases, the nonwhite women were more likely to present clue cells, Trichomonas, Candida and coccobacilli (OR, proliferative phase: 1.31, 1.79, 1.6 and 1.25 respectively; secretory phase: 1.31, 2.88, 1.74 and 1.21 respectively), while less likely to present Döderlein flora (OR, proliferative phase: 0.76; secretory phase: 0.66), compared with white women, irrespective of age., Conclusions: There are differences in vulvovaginitis occurrence relating to skin color, which may be associated with variations in vaginal flora.

Objectives: The aim of this study was to evaluate the fluoride intake of 2-6-year-old Brazilian children using a semiquantitative food frequency questionnaire (FFQ) which also estimated fluoride intake from dentifrice., Methods: The FFQ was previously validated through application to 78 2-6-year-old Brazilian children and then administered to 379 children residing in an optimally fluoridated community in Brazil (Bauru, State of São Paulo). The FFQ was applied to the parents and used to estimate the food intake of the children. The constituents of the diet were divided into solids, water and other beverages. The fluoride content of the diet items was analyzed with the fluoride electrode. The questionnaire also estimated fluoride intake from dentifrice., Results: The average (+/-SD) fluoride intake from solids, water, other beverages and dentifrice was 0.008 +/- 0.005; 0.011 +/- 0.004; 0.009 +/- 0.014 and 0.036 +/- 0.028 mg F/kg body weight/day, respectively, totalizing 0.064 +/- 0.035 mg F/kg body weight/day. The dentifrice and the diet contributed with 56.3% and 43.7% of the daily fluoride intake, respectively. Among the children evaluated, 31.2% are estimated to have risk to develop dental fluorosis (intake>0.07 mg F/kg body weight/day)., Conclusions: The dentifrice was the main source of fluoride intake by the children evaluated. However, the fluoride concentration in food items also significantly contributed to the daily ingestion by 2-6-year-old children. The questionnaire used seems to be a promising alternative to duplicate diet to estimate the fluoride intake at this age range and may have potential to be used in broad epidemiological surveys.

This study compared 3 composites made of hydroxyapatite and polyhydroxybutyrate to determine their biocompatibility, osteointegration, and osteoconduction in rabbits bone defects. Hydroxyapatite-polyhydroxybutyrate was tested in a 10:90 vol/vol ratio for composite 1, 25:75 for composite 2, and 50:50 for composite 3, whereas defects in the control group remained unfilled. Limbs were clinically and radiographically evaluated, and samples were taken 8, 45, and 90 days after surgery for histologic and histomorphometrical analysis. No significant difference was found in the clinical parameters: pain, lameness, dehiscence, infection, and edema among the 4 groups. No signs of osteolysis or periosteal reaction were observed. Bone regeneration in groups 1, 2, and 3 occurred histomorphologically similar to the control group. No inflammatory infiltrate was present on any date of observation. More bone than connective tissue was significantly found in the defects of the 3 groups on all observation dates, and the percentage of bone tissue in the interface was similar for composites 2 and 3. Bone and connective tissue were observed in pores of composites 2 and 3. Osteoclasts were found in the bone-composite interface, and multinucleated giant cells were seen on the surface of composite fragments, found among mesenchymal tissue on the 45th and 90th days. No significant difference was observed in osteoclast number among the 4 groups. In summary, composites were considered biocompatible and able to integrate to bone. They also showed signs of biodegradability, and composites 2 and 3 were osteoconductive, the first displaying best characteristics for bone substitution.

Background: Scarce data are available to predict in-hospital mortality for decompensated heart failure (HF) in South American populations., Methods and Results: We evaluated 779 consecutive HF admissions defined by the Boston criteria in a tertiary care hospital. Stepwise logistic regression was used to determine independent correlates of in-hospital mortality, derived from 83 potential predictors collected on hospital admission. A clinical score rule (HF Revised Score) was created using the regression coefficient estimates derived from multivariate modeling. During hospital stay, 77 (10%) deaths occurred and 6 clinical characteristics were independently associated with in-hospital mortality: presence of cancer (P < .001), systolic blood pressure < or =124 mm Hg (P < .001), serum creatinine >1.4 mg/dL (P = .02), blood urea nitrogen >37 mg/dL (P = .03), serum sodium <136 mEq/L (P = .03), and age >70 years old (P = .03). Both the Acute Decompensated Heart Failure National Registry stratification algorithm and the proposed HF Revised Score performed adequately to predict in-hospital mortality ("c" statistics = 0.71 and 0.76, respectively). The newly proposed score, however, discriminated a very low-risk group (101 [13%]) in whom all patients were discharged home, representing patients admitted with none of the 6 predictors of risk., Conclusion: HF risk stratification can be accurately accomplished during the first day of admission with simple and easily obtained clinical variables.

Purpose: To prospectively evaluate the accuracy of transrectal ultrasonography (US)-guided biopsy directed with magnetic resonance (MR) spectroscopic imaging in patients with an elevated prostate specific antigen (PSA) level and negative findings at prior biopsy by using subsequent biopsy results as the reference standard., Materials and Methods: The committee on human research approved this study, and written informed consent was obtained. MR imaging and MR spectroscopic imaging were performed in 42 men (age range, 45-75 years; average age, 63.3 years; median age, 65 years) with negative findings at two or more prostatic biopsies and at digital rectal examination. MR spectroscopic data were rated on a scale of 1 (benign) to 5 (malignant) on the basis of standardized metabolic criteria. Abnormal voxels were overlaid on the corresponding transverse transrectal US images and used to perform voxel-guided biopsy of the prostate. All patients subsequently received an extended-pattern biopsy scheme., Results: Thirty-one of 42 patients demonstrated metabolic abnormalities that were suspicious for cancer (voxels with scores > or = 4). Eleven patients with negative MR spectroscopic imaging results also had negative biopsy findings. Cancer was detected in 17 (55%) of 31 men with positive MR spectroscopic imaging findings (voxels with scores > or = 4) with a sensitivity of 100%, specificity of 44%, positive predictive value of 55%, negative predictive value of 100%, and accuracy of 67%. In men with at least one spectroscopic voxel with a score of 5 (12 of 17 men), the sensitivity, specificity, positive and negative predictive values, and accuracy were 71%, 84%, 75%, 81%, and 79%, respectively., Conclusion: Metabolic data from MR spectroscopic imaging can be transferred to transrectal US images and used to sample regions of cancer in men with rising PSA levels and negative findings at prior biopsy with good accuracy.

Unlabelled: The aim of this study was to determine the prevalence of epilepsy in the urban population of São José do Rio Preto. This is a medium-sized city of 336000 inhabitants, located in the northwest of the state of São Paulo, Brazil., Method: A cross-sectional epidemiological investigation with a randomized sample was performed in two phases, a screening phase and a confirmation of the diagnosis phase. The gold standard was a clinical investigation and neurological examination. The chi-square test was used in analysis of the results and p-value value < 0.05 was considered significant. Prevalence was calculated with 95% confidence interval., Results: The study sample size was 17293 individuals, with distributions of gender, age, and race similar to the general population. The prevalence per 1000 inhabitants of epilepsy was 18.6, of these 8.2 were active, defined as at least one seizure within the last two years. The prevalence per 1000 inhabitants for the age groups (years) was 4.9 (04), 11.7 (514), 20.3 (1564) and 32.8 (65 or over)., Conclusion: Prevalence of both accumulated and active epilepsy was elevated, comparable to other developing nations, in particular those of Latin America. However, the prevalence of epilepsy in childhood was low, whilst in aged individuals it was high similar to industrialized nations.

This paper describes the methodology, applicability and utility of the Raven Progressive Matrix (Raven Test) and the Brazilian Intellectual Probe (TSI), comparing them with school achievement in a typical medium-size urban community of Northeastern Brazil. 388 schoolchildren (7-17 years old) were examined, with 371 Raven tests applied. Only 231 TSIs were completed, since 106 students were illiterate. School grades were obtained for all participants. A questionnaire evaluating school resources, and teacher profiles was answered by 200 teachers. Raven and TSI test scores were highly correlated (r = 0.53, p < 0.001), but both correlated weakly with overall school grade (r = 0.22, p < 0.001 and r = 0.12, p < 0.07 respectively). For individual school grades, the Raven scores showed statistically significant correlation with all subjects, while the Brazilian TSI presented statistically significant correlation only with geography, history and sciences. Boys' mean scores were higher than girls' for both the Raven and the TSI Tests, but for the school grades girls performed better. In general, level of cognitive development was below that expected for children in the age-group analyzed.

The purpose of this cross-sectional study was to evaluate the prevalence of epilepsy in a population based sample: the Bakairi indians, who live on the banks of Paranatinga river in the central plateau of Mato Grosso state, Brazil. This population is composed of 483 inhabitants. The study was outlined in two stages, and the investigation was door-to-door in a total of 103 houses. The results of the instrument showed a sensitivity of 88% (CI- 95%, 84.9-93), specificity of 97.8% (CI-95, 95-98). The prevalence of active epilepsy was 12.4 per mil, and inactive was 6.2 per mil. This prevalence of the epilepsy was considered high probably due to some familial risk factor (p=0.04) among those Indians, while other factors were not important.