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Abstract Background To assess the reporting of the certainty of the evidence using the GRADE approach in systematic reviews of interventions in pediatric dentistry. Methods The inclusion criteria were systematic reviews of randomized clinical trials (RCTs) and non-randomized studies of interventions (NRSIs) in pediatric dentistry that reported the certainty of the evidence through the GRADE approach. Paired independent reviewers screened the studies, extracted data, and appraised the methodological quality using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) tool. The certainty of the evidence was extracted for each outcome. A descriptive analysis was conducted. Results Around 28% of pediatric dentistry reviews of interventions used the GRADE approach (n = 24). Twenty reviews reported 112 evidence outcomes from RCTs and 13 from NRSIs using GRADE evidence profile tables. The methodological quality was high (16.7%), moderate (12.5%), low (37.5%), and critically low (33.3%), fulfilling the majority of the AMSTAR 2 criteria. The certainty of the evidence for outcomes generated from RCTs and NRSIs was very low (40.2% and 84.6%), low (33.1% and 7.7%), moderate (17.8% and 7.7%), and high (9.8% and 0.0%). The main reasons to downgrade the certainty were due to (for RCTs and NRSIs, respectively): risk of bias (68.8% and 84.6%), imprecision (67.8% and 100.0%), inconsistency (18.8% and 23.1%), indirectness (17.8% and 0.0%), and publication bias (7.1% and 0.0%). Conclusion The proportion of systematic reviews assessing the certainty of the evidence using the GRADE approach was considered small, considering the total initial number of published pediatric dentistry reviews of intervention. The certainty of the evidence was mainly very low and low, and the main problems for downgrading the certainty of evidence were due to risk of bias and imprecision. Registration PROSPERO database #CRD42022365443.

Abstract Methionine (Met) is one of the most limiting essential amino acids in aquafeeds, and different commercial feed‐grade Met sources are available for diet supplementation, namely L‐Met, DL‐Met, and hydroxy‐Met (OH‐Met). In this work, we compared the bioefficacy of OH‐Met and DL‐Met as diet supplements for gilthead seabream (Sparus aurata) juveniles reared at normal (22°C) and high (29°C) water temperatures. Two isoproteic (50%) and isolipidic (20%) practical diets (24% fish meal; 6% fish oil) were formulated to contain 1% Met and were supplemented with 0.2% DL‐Met (diet DL‐Met) or OH‐Met (diet OH‐Met). The diets were fed to triplicate groups of fish with an initial body weight of 13 g for 78 days. Growth performance and N retention (%) were higher at 29°C. However, feed efficiency, protein efficiency ratio, and hepatic and visceral indexes were higher at 22°C. Hepatic oxidative stress indicators were not affected by dietary Met source. In the muscle, however, oxidative stress index and lipid peroxidation were lower in fish fed the OH‐Met diets. Overall, DL‐Met and OH‐Met proved to be similarly effective as dietary methionine sources for gilthead seabream, while OH‐Met seemed to be more effective in reducing oxidative stress in fish reared at high temperatures.

Introduction: Colovesical fistula (CVF) is a condition with various aetiologies and presentations. Surgical treatment is necessary in most cases. Due to its complexity, open approach is preferred. However, laparoscopic approach is reported in the management of CVF due to diverticular disease. The aim of this study was to analyse the management and outcome of patients with CVF of different aetiologies treated with laparoscopic approach. Patients and Methods: This was a retrospective study. We retrospectively reviewed all patients undergoing elective laparoscopic management of CVF from March 2015 to December 2019. Statistical Analysis Used: None. Results: Nine patients underwent laparoscopic management of CVF. There were no intraoperative complications or conversions to open surgery. A sigmoidectomy was performed in eight cases. In one patient, a fistulectomy with sigmoid and bladder defect closure was performed. In two cases of locally advanced colorectal cancer with bladder invasion, a multi-stage procedure with temporary colostomy was chosen. In three cases, with no intraoperative leakage, we did not perform bladder suture. Four Clavien I–II complications were recorded. Two fragile patients died in the post-operative period. No patients required re-operation. At a median follow-up of 21 months (interquartile range: 6–47), none of the patients had recurrence of fistula. Conclusions: CVF can be managed with laparoscopic approach by skilled laparoscopic surgeons in different clinical scenarios. Bladder suture is not necessary if leakage is absent. Informed counselling to the patient must be guaranteed concerning the risk of major complications and mortality in case of CVF due to malignant disease.

Introducción. Las escuelas hospitalarias son un contexto educativo que se caracteriza por la alta heterogeneidad de sus estudiantes (distintas edades, distintas enfermedades y distintos repertorios educativos previos), y por prácticas pedagógicas que se materializan a través de procesos dialécticos y de negociación, en tiempos y espacios relativos. Propósito. Analizar ciertas tensiones que se producen en el proceso educativo de estudiantes que se educan en escuelas hospitalarias. Tres factores claves del proceso son parte de este análisis. Discusión. Se entrelazan aspectos filosóficos, económicos y tecnológicos que moldean el panorama educativo actual de las escuelas en el hospital. Desde una perspectiva filosófica, el tiempo y el espacio en las escuelas hospitalarias se presentan como dimensiones que posibilitan la introducción de enfoques educativos no convencionales, desafiando lo tradicional. En lo económico, surge la cuestión problemática de la financiación de estas escuelas, debido a su implementación particular. Por último, lo tecnológico emerge como un factor crucial en asegurar la continuidad del proceso educativo para niños, niñas y jóvenes aquejados por enfermedades. Conclusión. Los tres factores examinados ilustran cómo las modificaciones desarrolladas en el contexto de las escuelas hospitalarias podrían ofrecer pautas valiosas al sistema educativo convencional. La irrupción de la pandemia de Covid-19 ha resaltado la imperiosa necesidad de contar con mecanismos adaptables y eficaces, capaces de sostener la continuidad de los procesos educativos de todos los grupos de estudiantes. Se invita a aprender de enfoques fuera de lo habitual para enriquecer y fortalecer nuestro sistema educativo en su totalidad.

Over the past decade, an increasing number of studies have emphasized the importance of the host microbiome in influencing organismal health and development. Aligned with this understanding, our study aimed to investigate the potential association between the turbot (Scophthalmus maximus) phenotypic traits and the post-larval bacteriome. Turbot post-larvae were sampled from twenty randomly selected production cycles thirty days after hatching (DAH) across multiple post-larval production batches over a three-month period (April to June). Fish were selectively sampled based on five phenotypic traits, namely, normal, large, small, malformed, and depigmented. Our results showed that small-sized post-larvae had significantly higher bacterial phylogenetic diversity in their bacterial communities than all other phenotypes. A more in-depth compositional analysis also revealed specific associations between certain bacterial taxa and fish phenotypes. For example, the genera Aliivibrio and Sulfitobacter were enriched in small-sized post-larvae, while the family Micrococcaceae were predominantly found in larger post-larvae. Furthermore, genus Exiguobacterium was linked to depigmented larvae, and genus Pantoea was more prevalent in normal post-larvae. These observations underscore the importance of further research to understand the roles of these bacterial taxa in larval growth and phenotypic differentiation. Such insights could contribute to developing microbiome modulation strategies, which may enhance turbot post-larval health and quality and improve larviculture production.

Existe en Latinoamérica, entre un cierto grupo de artistas, una profunda conciencia del sol. José Luis Macas Paredes es uno de ellos. En su obra, esto que juntos hemos denominado “conciencia solar”, se manifiesta como una sensibilidad aguda hacia los ciclos solares, los movimientos de la luz y la sombra, y su impacto en la geografía y las culturas andinas. Es una forma de percepción que reconoce la importancia del sol como una fuerza vital que moldea la realidad física y simbólica de un lugar, y en su caso específico, ha moldeado desde su origen la urbanidad de la ciudad de Quito en Ecuador. A lo largo de esta conversación, Jose Luis nos lleva a través de su experiencia personal a partir de caminatas, fotografía y dibujo en cianotipia, a reconsiderar la relación entre lo que él llama la urbandinidad y la luz solar ecuatorial.

Introduction: Recently in Portugal, several social and demographic changes have been observed with an emphasis on the increasing number of foreign citizens. The linguistic, cultural and social barriers cause challenges to maternal and child health care. This study aimed to characterize the sociodemographic and obstetrical data of mothers and newborns hospitalized in the maternity ward of a tertiary hospital in the southern region of Portugal. Methods: Cross-sectional observational study. A questionnaire was applied in the postpartum period to women admitted to the maternity ward of a tertiary hospital in Lisbon from 1 March 2021 to 30 June 2021. Results: 347 surveys were obtained from a total of 785 hospitalizations. The average maternal age was 31.8 years and the average paternal age was 33.7 years. Most mothers (79.1%) and fathers (77.3%) reported having, at least, secondary education. 19.5% of mothers and 7.7% of fathers were students or unemployed, 18.9% of parents were unqualified workers and 32.0% of mothers and 23.4% of fathers were professionals in the group of intellectual and scientific activities. More than a quarter of our population were migrants (27.6% of mothers and 26.2% of fathers) and, of these, 14.9% of mothers and 11.2% of fathers were not fluent in Portuguese. 7.9% of pregnancies did not meet the criteria for adequate prenatal care defined at the national level. There was an association (p < 0.01) between inadequate pregnancy surveillance and lower maternal age and lower educational level. There was no difference between the migrant and non-migrant population regarding the completion of the prenatal care program. Conclusions: The percentage of the migrant population is currently very expressive, with a non-negligible number of parents not fluent in Portuguese, which requires an adaptation of health resources to optimize the care provided. Lack of adequate prenatal care was expressive and was associated with lower maternal age and lower level of education.

Objective: To assess the methodological quality and characteristics of systematic reviews (SRs) of interventional studies in orthodontics and assess how the certainty of the evidence is reported using the GRADE approach. Material and Methods: Six electronic databases were searched, followed by a hand search of the reference lists of eligible studies (PROSPERO #CRD42020180852). The required study design was randomized and nonrandomized studies of interventions published between January 2019 and May 2020. The Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) tool was used for the quality appraisal of the included SRs. Paired reviewers independently screened the studies, extracted data, and appraised the methodological quality. Results: The study included 46 SRs; 19.5% had moderate to high methodological quality, and the remaining had low to critically low methodological quality. Fifty-four percent of the reviews assessed the certainty of evidence using the GRADE approach, and 34.8% followed all GRADE criteria. Conclusion: Most reviews had a good judgment of the AMSTAR2 items, although some critical items contributed to decreased overall quality. Half of the reviews used the GRADE approach to assess the certainty of the evidence, and this approach should be included in future systematic reviews of interventions.

The association of thyroid function with essential and non-essential amino acids is understudied, despite their common metabolic roles. Thus, our aim was to evaluate the association of thyroid function with the levels of branched-chain amino acids (BCAAs—leucine, isoleucine, and valine) and of alanine in the general population. We utilized data from the São Paulo research center of ELSA-Brasil, a longitudinal population-based cohort study. Thyroid parameters included thyroid stimulating hormone (TSH), free T4 and free T3 levels, and the FT4:FT3 ratio. BCAAs and alanine were analyzed on a fully automated NMR platform. The current analysis included euthyroid participants and participants with subclinical hyperthyroidism and hypothyroidism. We used Pearson’s coefficient to quantify the correlation between thyroid-related parameters and amino acids. Linear regression models were performed to analyze whether thyroid parameters were associated with BCAAs and alanine levels. We included 4098 participants (51.3 ± 9.0 years old, 51.5% women) in this study. In the most adjusted model, higher levels of TSH were associated with higher levels of alanine, FT4 levels were inversely associated with isoleucine levels, FT3 levels were statistically significant and positively associated with valine and leucine, and the T3:T4 ratio was positively associated with all amino acids. We observed that subclinical hypothyroidism was positively associated with isoleucine and alanine levels in all models, even after full adjustment. Our findings highlight the association of subclinical hypothyroidism and thyroid-related parameters (including TSH, free T4, free T3, and FT4:FT3 ratio) with BCAAs and alanine. Further studies are needed to explore the mechanisms underlying this association. These insights contribute to our understanding of the influence of thyroid-related parameters on BCAA and alanine metabolism.

Summary: Coral reefs underpin the environmental, social, and economic fabrics of much of the world's tropical coast. Yet, the fine-scale distribution and composition of coral reefs have never been reported consistently across the planet. Here, we present new area estimates enabled by global geomorphic zone and benthic substrate maps at 5 m pixel resolution. We revise global coral reef estimates to 348,361 km2 of shallow coral reefs and 80,213 km2 (46,237–106,319 km2, 95% confidence interval) of coral habitat. The mapping used more than 1.5 million training samples supported by 480+ data contributions to deploy a coral reef classification of over 100 trillion pixels from the Sentinel-2 satellites and the Planet Dove CubeSat constellation. The publicly available maps are accessible via the Allen Coral Atlas and Google Earth Engine and are already being used by thousands of people to improve the conservation, management, and research of coral reef ecosystems. Science for society: Coral reefs possess a quarter of all marine life and contribute to the well-being and livelihoods of a billion people worldwide. Maps of ecosystems underpin many science and conservation activities, but until recently, there were no consistent high-resolution maps of the world’s coral reefs. In this paper, we describe new global coral reef maps from the Allen Coral Atlas, detailing the underlying methodology and our new understanding of the global distribution of coral reefs. The transparent and repeatable nature of our mapping framework allows the maps to be updated based on user feedback, and the ease of access has led to downstream applications such as coral bleaching monitoring and usage in scientific, management, and conservation activities. Hundreds of thousands of people have already accessed the maps, and they are already being used directly around the world for marine spatial planning, marine protected areas, environmental accounting and assessments, restoration, and education.

Single amino acid changes in the parasite protein Kelch13 (K13) result in reduced susceptibility of P. falciparum parasites to artemisinin and its derivatives (ART). Recent work indicated that K13 and other proteins co-localising with K13 (K13 compartment proteins) are involved in the endocytic uptake of host cell cytosol (HCCU) and that a reduction in HCCU results in reduced susceptibility to ART. HCCU is critical for parasite survival but is poorly understood, with the K13 compartment proteins among the few proteins so far functionally linked to this process. Here we further defined the composition of the K13 compartment by analysing more hits from a previous BioID, showing that MyoF and MCA2 as well as Kelch13 interaction candidate (KIC) 11 and 12 are found at this site. Functional analyses, tests for ART susceptibility as well as comparisons of structural similarities using AlphaFold2 predictions of these and previously identified proteins showed that vesicle trafficking and endocytosis domains were frequent in proteins involved in resistance or endocytosis (or both), comprising one group of K13 compartment proteins. While this strengthened the link of the K13 compartment to endocytosis, many proteins of this group showed unusual domain combinations and large parasite-specific regions, indicating a high level of taxon-specific adaptation of this process. Another group of K13 compartment proteins did not influence endocytosis or ART susceptibility and lacked detectable vesicle trafficking domains. We here identified the first protein of this group that is important for asexual blood stage development and showed that it likely is involved in invasion. Overall, this work identified novel proteins functioning in endocytosis and at the K13 compartment. Together with comparisons of structural predictions it provides a repertoire of functional domains at the K13 compartment that indicate a high level of adaption of endocytosis in malaria parasites.

The pandemic context has presented new challenges for education. In a short time, higher education institutions (HEIs) adapted their students, staff, technology, and infrastructures for a fast migration to distance learning. This change brought new challenges but also new opportunities that justify more contributions. The purpose of this paper is to study distance education (DE) methods and approaches, with a focus on management studies that are understudied. The research adopted a descriptive quantitative approach. Based on a sample of 400 documents using the Scopus database, a bibliometric analysis was carried out, aiming to identify the most prominent keywords, authors, sources, and countries for DE in general, with a focus on management courses in HEIs. The results suggest that innovation can be an asset for HEIs and can be seen as an ally for both teachers and students in learning new practices that involve digitalization. The bibliometric analysis highlights that motivation and collaboration are very important aspects and should be considered, especially when students are at the center of the teaching process. The main limitation regards the dominance of papers about DE, mostly based on the education sciences, and just a small number focusing on management courses. This limitation can influence the results achieved, but also allows this research to contribute for a better understanding of this field. This is one of few studies that has innovated by identifying the main subjects in DE literature, with a special emphasis on management courses, thus complementing previous scarce research in the field.

ABSTRACT Objective: To determine the relationship between psoriasis, thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triodothyronine (FT3), thyroid peroxidase antibodies (TPOAb), and subclinical thyroid dysfunctions in middle-aged and older adults. Materials and methods: Cross-sectional analyses included a self-reported medical diagnosis of psoriasis and thyroid function from the 3rd visit (2017-2019) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). TSH, FT4, and FT3 levels were analyzed as continuous variables and quintiles, and TPOAb positivity and subclinical hypothyroidism as a yes/no variable. Logistic regression models were built as crude and adjusted by main confounders (age, sex, education level, race/ethnicity, and smoking). Results: From 9,649 participants (52.3% women; 59.2 ± 8.7 years old), the prevalence of psoriasis was 2.8% (n = 270). TSH, FT4, TPOAb positivity, and subclinical hypothyroidism were not associated with psoriasis in the main analyses. In the stratified analysis, our findings showed positive associations of the lowest (OR = 2.01; 95% CI 1.05-3.84; p = 0.036) and the highest (OR = 2.13; 95% CI 1.12-4.05; p = 0.022) quintiles of FT4 and a protective association of TPOAb positivity (OR = 0.43; 95% CI 0.19-0.98; p = 0.046) with prevalent psoriasis in women. In the logistic regression for FT3, participants in the 1st quintile showed a statistically significant association with psoriasis for the whole sample (OR = 1.66; 95% CI 1.11-2.46; p = 0.013) and for men (OR = 2.25; 95% CI 1.25-4.04; p = 0.007) in the sex-stratified analysis. Conclusions: The present study showed that the association of FT4 levels with psoriasis are different according to sex, with a possible U-shaped curve in women but not in men. Although there were some associations of FT3 with psoriasis, they may be a consequence of non-thyroidal illness syndrome. Further prospective data may clarify the association of thyroid function and psoriasis.

Abstract Crown‐of‐thorns starfish (CoTS) naturally occur on coral reefs throughout the Indo‐Pacific region. On Australia's Great Barrier Reef (GBR), outbreaks of CoTS populations are responsible for ecologically significant losses of corals, and while they have been documented for decades, they now undermine coral recovery from multiple stressors, especially anthropogenic warming. Culling interventions are currently the best approach to control CoTS outbreaks on the GBR, but assessing control effectiveness under multiple stressors is complicated. Using an ensemble of two reef community models simulating the temporal and spatial dynamics of CoTS and corals under future climate scenarios, we evaluate the present‐day and future effectiveness of the current implementation of the GBR CoTS Control Program. Specifically, we determine the culling effort needed (i.e., number of vessels) to achieve the maximum ecological benefits as predicted by the models under possible warming futures. Benefits were measured by comparing projections of coral cover and CoTS densities under scenarios of increasing control effort and baseline scenarios where no control was simulated. Projections of present‐day control efforts (five vessels) show that the number of individual reefs subject to CoTS outbreaks is reduced by 50%–65% annually, yielding a benefit of 5%–7% of healthy GBR coral area per decade, equivalent to gaining 104–150 km2 of live corals by 2035. A threefold increase in current control efforts is sufficient to reach more than 80% of the maximum coral benefits predicted by each model, but the future amount of effort required to control CoTS effectively depends on the intensity of warming and the early detection of CoTS outbreaks. While culling CoTS across the entire GBR is unfeasible, we provide a framework for maximizing ecosystem‐wide benefits of CoTS control and guide management decisions on the required culling effort needed to reduce CoTS outbreaks to levels that may ensure coral persistence in the face of future climate change impacts.

Cardiovascular diseases (CVDs) are the leading causes of mortality worldwide, accounting for nearly 18 million deaths per year. Among other considerations, treating CVDs requires better understanding their risk factors. Sleep-disordered breathing, especially obstructive sleep apnea (OSA), is a likely contributor to several CVDs. We review key epidemiological data that addresses the link between OSA and cardiovascular outcomes such as hypertension, atrial fibrillation (AF), stroke, atherosclerosis, and heart failure (HF), and proposed pathophysiological mechanisms underlying this association. There are several biological pathways linking OSA and an increased propensity to cardiovascular diseases, and we discuss the evidence on the benefits of treatments of OSA on the prevalence of cardiovascular complications.

SUMMARY Thyroid cancer is the most common endocrine malignancy, and papillary thyroid carcinoma (PTC) is the main subtype. The cribriform morular variant is a histological phenotype of PTC characterized by its relationship with familial adenomatous polyposis (FAP). Description of the case: We report the genetic assessment of a 20-year-old female patient diagnosed with a cribriform-morular variant of PTC and FAP. We aimed to assess the genetic background of the reported patient, looking for variants that would help us explain the predisposition to tumorigenesis. Genomic DNA was extracted from peripheral blood lymphocytes, and whole exome sequencing was performed. We applied an overrepresentation and gene-set enrichment analysis to look for an accumulation of effects of variants in multiple genes at the genome. We found an overrepresentation of single nucleotide variants (SNVs) in extracellular matrix interactions and cell adhesion genes. Underrepresentation of SNVs in genes related to the regulation of autophagy and cell cycle control was also observed. We hypothesize that the package of alterations of our patient may help to explain why she presented colonic manifestations and thyroid cancer. Our findings suggest that multiple variants with minor impact, when considered together, may be helpful to characterize one particular clinical condition.

ObjectivesSelective caries removal aims to remove carious tissue in deep dentin lesions. However, a discussion stands on the value of antiseptics and chemomechanical adjuvant methods to reduce the bacterial load on residual caries lesions. This systematic review has addressed two main clinical questions to compare the antimicrobial efficacy of available methods using (1) antiseptic or (2) chemomechanical agents before restoring dentin carious lesions.MethodsWe included randomized and non-randomized controlled trials (RCTs/ NRCTs). We searched eight databases from inception to October 2021. Paired reviewers independently screened studies, extracted data, and assessed the risk of bias. The primary outcome was the reduction in the number of total bacterial in dentin, whereas secondary outcomes were reduction in the number of Lactobacillus and Streptococcus. We used the ratio of ratio of post-treatment to baseline means between two interventions in the logarithmic scale as a proper effect measure. Certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation approach.ResultsWe included 14 RCTs and 9 NRCTs, with nine interventions. Regardless the method, the number of bacteria at baseline was similar or exceeded that after the intervention, particularly in NRCTs. The evidence was inconclusive for most comparisons. Among antiseptic agents, chlorhexidine (CHX) resulted in an average of 1.14 times [95% confidence interval (CI): 1.08–1.21] more total bacterial than photodynamic therapy in RCTs. Among NRCTS, the natural agents resulted in five times more total bacterial than CHX (95% CI: 2–11). For chemomechanical methods, the control resulted in eight times (95% CI: 4–17) more total bacterial than Carisolv (SHAA).ConclusionsThe certainty of the evidence was very low for all comparisons showing uncertainty whether one treatment could be more effective than another for dentin disinfection. So far, exclusively removing soft carious dentin would be enough to reduce the bacterial count.

Abstract Brewer’s spent grain (BSG) is the largest by-product originated from the brewery industry with a high potential for producing carbohydrases by solid-state fermentation. This work aimed to test the efficacy of a carbohydrases-rich extract produced from solid-state fermentation of BSG, to enhance the digestibility of a plant-based diet for European seabass (Dicentrarchus labrax). First, BSG was fermented with A. ibericus to obtain an aqueous lyophilized extract (SSF-BSG extract) and incorporated in a plant-based diet at increasing levels (0—control; 0.1%, 0.2%, and 0.4%). Another diet incorporating a commercial carbohydrases-complex (0.04%; Natugrain; BASF) was formulated. Then, all diets were tested in in vitro and in vivo digestibility assays. In vitro assays, simulating stomach and intestine digestion in European seabass, assessed dietary phosphorus, phytate phosphorus, carbohydrates, and protein hydrolysis, as well as interactive effects between fish enzymes and dietary SSF-BSG extract. After, an in vivo assay was carried out with European seabass juveniles fed selected diets (0—control; 0.1%, and 0.4%). In vitro digestibility assays showed that pentoses release increased 45% with 0.4% SSF-BSG extract and 25% with Natugrain supplemented diets, while amino acids release was not affected. A negative interaction between endogenous fish enzymes and SSF-BSG extract was observed in both diets. The in vivo digestibility assay corroborated in vitro data. Accordingly, the dietary supplementation with 0.4% SSF-BSG increased the digestibility of dry matter, starch, cellulose, glucans, and energy and did not affect protein digestibility. The present work showed the high potential of BSG to produce an added-value functional supplement with high carbohydrases activity and its potential contribution to the circular economy by improving the nutritional value of low-cost and sustainable ingredients that can be included in aquafeeds.

ABSTRACT Objective: Although some previous data have suggested a high iodine intake in Brazil, the prevalence of antithyroperoxidase antibodies (TPOAb) in the country is compatible with rates from countries with adequate iodine intake. This observation emphasizes the importance of knowing the incidence of TPOAb in Brazil. Materials and methods: This prospective analysis included euthyroid participants with negative TPOAb at baseline and a thyroid function assessment at a 4-year follow-up. TPOAb was measured by electrochemiluminescence and considered positive when titers were ≥34 IU/mL. TSH and free T4 (FT4) levels were determined by a third-generation immunoenzymatic assay. The incidence of TPOAb is expressed in percentage per year or as a cumulative incidence within the 4-year follow-up period. Results: Of 8,922 euthyroid participants (mean age 51.1 years; 50.9% women) with a negative TPOAb test at baseline, 130 presented incident TPOAb at the 4-year follow-up, yielding an annual incidence of TPOAb of 0.38%/year (95% confidence interval [95% CI], 0.37-0.39%/year) and a cumulative incidence over 4 years of 1.46% (95% CI, 1.21-1.71%). In men, the annual incidence was 0.32% (95% CI, 0.31-0.33%), and the cumulative incidence over 4 years was 1.23% (95% CI, 0.90-1.56%). In women, the annual incidence was 0.43%/year (95% CI, 0.42-0.44%/year) and the cumulative incidence over 4 years was 1.67% (95% CI, 1.30-2.04%). The only factor associated with incident TPOAb was the occurrence of thyroid diseases at follow-up. No differences in TPOAb incidence were detected across ELSA-Brasil research centers. Conclusion: Based on the results of this study, the incidence of TPOAb per year and at a 4-year follow-up period are compatible with those of a country with adequate iodine intake.

A classical strategy to analyse the protein content of a biological sample is the two-dimensional gel electrophoresis (2D-GE). This technique separates proteins by both isoelectric point and molecular weight, and images are taken for subsequent analyses. However, analyses of 2D-GE images require standardized image analysis due to susceptibility of gels to get deformed, presence of overlapping spots and stripes, fuzzy and unstained spots, and others. This represent a difficulty for final users (researchers), which demand for free and user-friendly solutions. We have previously reported the standardization of a protocol to analyse 2D-GE images, and in the current study we applied it to two new bacterial isolates Pseudomonas aeruginosa C25 and C50. We first extracted periplasmic proteins after exposure to antibiotics, and we then run a 2D-GE analysis. Images were analysed using our standardized protocol, achieving the identification of protein spots using CellProfiler after pre-processing step. Comparison between strains was done using differential spot analysis, revealing a specific pattern in the protein expression between bacteria. These results will help to study the biological meaning of these strains using proteomic profiling under different conditions.

ObjectiveThe aim of this study was to estimate the antimicrobial resistance in microorganisms present in periodontal diseases.MethodsA systematic review was conducted according to the PRISMA statement. The MEDLINE (PubMed/Ovid), EMBASE, BVS, CINAHL, and Web of Science databases were searched from January 2011 to December 2021 for observational studies which evaluated the antimicrobial resistance in periodontal diseases in permanent dentition. Studies that allowed the antimicrobial consumption until the time of sample collection, studies that used laboratory acquired strains, studies that only characterized the microbial strain present, assessment of cellular morphological changes, sequencing system validation, and time series were excluded. Six reviewers, working in pairs and independently, selected titles, abstracts, and full texts extracting data from all studies that met the eligibility criteria: characteristics of patients, diagnosis of infection, microbial species assessed, antimicrobial assessed, identification of resistance genes, and virulence factors. “The Joanna Briggs Institute” critical appraisal for case series was adapted to assess the risk of bias in the included studies.ResultsTwenty-four studies (N = 2.039 patients) were included. Prevotella and Porphyromonas species were the most cited microorganisms in the included studies, and the virulence factors were related to Staphylococcus aureus. The antimicrobial reported with the highest frequency of resistance in the included studies was ampicillin (39.5%) and ciprofloxacin showed the lowest frequency of resistance (3.4%). The most cited genes were related to macrolides. The quality of the included studies was considered critically low.ConclusionNo evidence was found regarding the profile of antimicrobial resistance in periodontal diseases, requiring further research that should focus on regional population studies to address this issue in the era of increasing antimicrobial resistance.Clinical relevanceThe knowledge about the present microorganism in periodontal diseases and their respective antimicrobial resistance profiles should guide dentists in prescribing complementary therapy for these infections.Systematic review registration[http://dx.doi.org/10.1097/MD.0000000000013158], identifier [CRD42018077810].

Introdução: As infeções das vias aéreas superiores (IVAS) em crianças são dos motivos mais comuns de consulta aguda nos cuidados de saúde primários e habitualmente têm bom prognóstico. No entanto, em certos quadros clínicos, as complicações ou doenças menos comuns, como a miosite, devem ser consideradas. Descrição do caso: Uma criança de oito anos de idade, previamente saudável, foi observada pela primeira vez no centro de saúde em novembro de 2019 por tosse e febre com dois dias de evolução, sem alterações de relevo no exame objetivo – foi assumida uma IVAS e prescrito tratamento com antipirético e reforço da hidratação oral. O doente volta três dias depois à unidade com manutenção do quadro clínico, marcha anormal e dor na região posterior da perna, na região dos músculos gastrocnemius bilateralmente. Ao exame objetivo e neurológico, além da alteração da marcha, não apresentava outros achados. Pela evolução suspeita do quadro foi referenciado para o serviço de urgência pediátrico hospitalar para avaliação. Não foram encontradas outras alterações ao exame objetivo. Foi submetido a estudo analítico, que revelou uma creatina cinase (CK) de 7110U/L, mioglobina de 1935ng/ml e aspartato aminotransferase (AST) de 191U/L, sem alteração de função renal. Perante resultados sugestivos de miosite foi decidido internamento para fluidoterapia intravenosa. Em regime de internamento foi realizado aspirado nasofaríngeo para cultura e virologia, que testou positivo para vírus Influenza B; foi, assim, assumido o diagnóstico de miosite vírica por Influenza B. O doente recebeu tratamento com oseltamivir durante quatro dias em regime de internamento, com boa resposta. Teve alta hospitalar após estes quatro dias, assintomático e com indicação para repouso e reforço da hidratação oral. Comentário: Devemos estar atentos a sintomas menos comuns em casos de presumíveis de IVAS e aumentar a acessibilidade dos cuidados de saúde primários para reavaliações de certos casos.

Objective: To assess the incidence of caries in a two-year period among low birth weight (LBW), very low birth weight (VLBW), and extremely low birth weight (ELBW) children considering socioeconomic indicators, dietary factors and oral hygiene. Material and Methods: A convenience sample was formed of 42 low birth weight children aged two to five years at baseline. Two examiners diagnosed caries using the World Health Organization criteria. Birth weight, socioeconomic indicators and diet were collected from medical records and questionnaires. Binomial models were used to estimate unadjusted and adjusted rate ratios (RR) and respective 95% confidence intervals for the factors evaluated. Results: Thirty-six children were re-examined after two years. The incidence of dental caries was 36.7%. The dmft index was 0.44 (±1.25) at baseline and increased to 1.36 (±3.85) at follow-up. VLBW children (1,000 to 1,500 g) (RR=0.23; 95%CI: 0.08-0.72) and LBW children (1,500 to 2,500 g) (RR=0.06; 0.01-0.55) had fewer carious lesions compared to ELBW children (

Summary: Different immune-mediated diseases have been described after SARS-CoV-2 vaccination, with antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) being one of the possible side effects. In this study, a total of 35 patients presented ANCA for the first time during 2021, with the number during 2019 being 15. Twenty-seven out of thirty-five patients developed ANCA after vaccination. Two of them developed these antibodies after receiving the first dose (7.4%), and 25 patients developed ANCA after the second dose of the vaccine (92.6%), with BNT162b2 being the main vaccine received by these patients. In 97.1% of the patients who developed ANCA during 2021, the positivity of ANCA was accompanied by systemic involvement, with renal and respiratory tracts being the main organs affected. Therefore, an increase in the development of AAV has been observed during 2021 in comparison with 2019, which could be due to the administration of SARS-CoV-2 vaccine.

Recent decades have seen a rapid acceleration in global participation in formal education, due to worldwide initiatives aimed to provide school access to all children. Research in high income countries has shown that school quality indicators have a significant, positive impact on numeracy and literacy--skills required to participate in the increasingly globalized economy. Schools vary enormously in kind, resources, and teacher training around the world, however, and the validity of using diverse school quality measures in populations with diverse educational profiles remains unclear. First, we assessed whether children's numeracy and literacy performance across populations improves with age, as evidence of general school-related learning effects. Next, we examined whether several school quality measures related to classroom experience and composition, and to educational resources, were correlated with one another. Finally, we examined whether they were associated with children's (4-12-year-olds, N = 889) numeracy and literacy performance in 10 culturally and geographically diverse populations which vary in historical engagement with formal schooling. Across populations, age was a strong positive predictor of academic achievement. Measures related to classroom experience and composition were correlated with one another, as were measures of access to educational resources and classroom experience and composition. The number of teachers per class and access to writing materials were key predictors of numeracy and literacy, while the number of students per classroom, often linked to academic achievement, was not. We discuss these results in the context of maximising children's learning environments and highlight study limitations to motivate future research.

ABSTRACT Objective: To evaluate incidence of subclinical and overt hyperthyroidism and hypothyroidism. Subjects and methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study of 15,105 civil servants, examined at baseline and over a 4-year follow-up. This analysis included 9,705 participants with normal thyroid function at baseline, follow-up information about thyroid function and with no report of using drugs that may interfere in the thyroid function. Thyroid function was defined by TSH/FT4 levels or routine use of thyroid hormones/anti-thyroid medications. Annual and cumulative (over 4-year) incidence rates were presented as percentages (95% Confidence Intervals). Results: The incidence of all overt and subclinical thyroid disease was 6.7% (1.73%/year): 0.19% for overt hyperthyroidism (0.048%/year), 0.54% for subclinical hyperthyroidism (0.14%/year), 1.98% for overt hypothyroidism (0.51%/year), and 3.99% for subclinical hypothyroidism (1.03%/year). The incidence of all thyroid diseases was higher in women, when compared to men, with a low women:men ratio (1.36). For Blacks the highest incidence was for overt hyperthyroidism, while for Whites, the highest incidence was for overt hypothyroidism. However, the highest incidence of overt hyperthyroidism was detected in Asian descendants. The presence of antithyroperoxidase antibodies at baseline was associated with higher incidence of overt thyroid diseases. Conclusion: These results showed a high incidence of hypothyroidism, which is compatible with a country with a more-than-adequate iodine intake. The low women:men ratio of the incidence of thyroid dysfunction highlights the importance of the diagnosis of thyroid diseases among men in Brazil.

This study aimed to determine the effects of dietary inclusion of Tenebrio molitor larvae (yellow worms) meal (TM) on meagre fish (Argyrosomus regius) whole-body fatty acids (FA) profile and hepatic and intestine oxidative status. For that purpose, fish were fed for 9 weeks a fishmeal-based diet (control) or diets including 10%, 20%, or 30% TM. With the increase in dietary TM level, whole-body oleic acid, linoleic acid, monounsaturated FA, and n−6 polyunsaturated FA (PUFA) increased while saturated FA (SFA), n−3 PUFA, n−3 long chain-PUFA, SFA:PUFA ratio, n3:n6 ratio, and FA retention decreased. Hepatic superoxide dismutase (SOD), glucose-6-phosphate dehydrogenase (G6PDH), and glutathione reductase (GR) activities increased and catalase (CAT) and glutathione peroxidase (GPX) activities decreased with dietary TM inclusion. Hepatic total and reduced glutathione were lower in fish fed 20% TM. Intestinal CAT activity and oxidized glutathione increased and GPX activity decreased with dietary TM inclusion. Intestine SOD, G6PDH, and GR activities increased and malondialdehyde concentration decreased in fish fed the diets with lower TM inclusion levels. Liver and intestine oxidative stress index and liver malondialdehyde concentration were unaffected by dietary TM. In conclusion, to avoid major whole-body FA changes or antioxidant status imbalances, it is recommended to limit TM to 10% inclusion in meagre diets.

Objective. The aim of this study was the development and validation of an UV-Vis spectrophotometric method for the quantification of oclacitinib in commercial capsule formulation since pharmacopeias have not yet provided an official monograph for this drug. Methods. The parameters linearity, limit of detection, limit of quantitation, specificity, precision, accuracy, and robustness were determined according to Brazilian and international guidelines. Results. Linearity was determined for the analytical range of 5-15 μg/mL, and a limit of detection of 1.18 μg/mL and limit of quantification of 3.58 μg/mL were obtained. The method was selective and the precision was demonstrated through repeatability and intermediate precision, with relative standard deviations of 1.96% and 1.78%, respectively. In its turn, accuracy presented recovery percentages of 98.32-100.91%. All robustness and sample stability (48 h at 25 °C) results revealed no statistical variation among the groups. Conclusions. The presented method is suitable for the quantification of oclacitinib in commercial capsule formulation.

1. Colombia with 1941 known recorded bird species is one of the most species rich countries in the world. Efforts are necessary to conserve, study and promote sustainable use of this important taxonomic group throughout Colombia’s vast territory.2. In an ideal world, informed decisions that are based on sound scientific information should be likelier to have successful outcomes. Nevertheless, there are barriers that make it difficult to access and use information in a timely fashion. Those same barriers impede the study, conservation, and sustainable use of birds in Colombia. On the other hand, given that there is good documentation about the ecology of a large number of species, information about the distribution of birds can be easily incorporated into decision-making processes, once this information becomes readily available in a consumable format using Geographic Information Sciences tools.3. In this context the main objective of this paper is to present the first compilation of the current distribution of 1889 (97%) species of birds in Colombia, using expert criteria. The shapefiles were used to show the distribution and diversity of bird species in Colombia under both geopolitical and conservation geographic units.4. The information provided in this paper can be used as a baseline for a huge number of initiatives that aim to strengthen conservation efforts and improve knowledge about one the most unique taxonomic groups in the country. These range from land use planning strategies at the municipal or department scale to sustainable use of bird species - such as those initiatives related to bird watching - in Colombia.This study has considered three key aspects: 1) the importance of birds for Colombia’s ecosystems, 2) the privileged place of Colombia in bird species richness, and 3) the importance of data mobilization in formats easily consumable by Geographic Information Systems (GIS) to facilitate the processes of informed decision-making. We present the first compilation - in shapefile format - for 1889 of the 1941 bird species recorded from Colombia. Using this novel collection we showed the species richness of birds in Colombia’s 33 departments plus its Captial District (DP), 1122 municipalities (MNs), 58 protected areas (PAs), 39 Regional Autonomous Corporations (the authorities responsible within their respective jurisdictions for regulating the environment and renewable natural resources in Colombia; CARs), and 916 Collectively Titled Territories (including both indigenous reservations and afro-descendant communities; CTTs). In addition, we provide a list of known bird species richness for the above geographic units found in the available literature. The information provided here can be used as a baseline for a huge number of initiatives concerning the study, conservation and sustainable use of bird species present in Colombia, providing access to key features of bird distribution that should facilitate decision-making.

Purpose: The aim of the present study was to evaluate the prevalence of active and passive smoking during pregnancy and its association with sociodemographic indicators, as well as perinatal and postnatal outcomes in newborns. Methods: This cross-sectional study was comprised of 431 pairs of mothers/ newborns. The study variables were: preterm birth, birth weight, oral mucosal lesions, sociodemographic indicators and smoking data. We collected data from medical records and through a self-administered questionnaire answered by mothers. A pediatric dentist examined the newborns for oral mucosal lesions. Bivariate and multivariate logistic regression models were used to evaluate the association between active and passive smoking and the other variables (α=5%). Results: The prevalence of active (9.5%) and passive smoking (4.2%) during pregnancy was low. Active smoking was statistically associated with low birth weight (OR: 2.4; 95%CI:1.1-5.3), lower schooling level (OR: 0.2; 95%CI:0.1-0.5) and mothers aged ≥36 years old (OR: 4.9; 95%CI:1.2-20.0). Passive smoking was not statistically associated with the other variables. There was no association between active or passive smoking during pregnancy and premature birth and oral lesions of the newborn. Conclusions: The prevalence of active and passive smoking were low. Active smoking was associated with low birth weight, maternal age and mother's schooling, suggesting a social influence of smoking behavior among a population with a lower educational level. There was no association between active and passive smoking and prematurity and oral lesions of the newborn.

Brewer’s spent grain (BSG) is the main brewery industry by-product, with potential applications in the feed and food industries due to its carbohydrate composition. In addition, the lignocellulosic nature of BSG makes it an adequate substrate for carbohydrases production. In this work, solid-state fermentation (SSF) of BSG was performed with Aspergillus ibericus, a non-mycotoxin producer fungus with a high capacity to hydrolyze the lignocellulosic matrix of the agro-industrial by-products. SSF was performed at different scales to produce a crude extract rich in cellulase and xylanase. The potential of the crude extract was tested in two different applications: -(1) - the enzymatic hydrolysis of the fermented BSG and (2) - as a supplement in aquafeeds. SSF of BSG increased the protein content from 25% to 29% (w/w), while the fiber content was reduced to 43%, and cellulose and hemicellulose contents were markedly reduced to around 15%. The scale-up of SSF from 10 g of dry BSG in flasks to 50 g or 400 g in tray-type bioreactors increased 55% and 25% production of cellulase and xylanase, up to 323 and 1073 U g−1 BSG, respectively. The optimum temperature and pH of maximal activities were found to be 55°C and pH 4.4 for xylanase and 50°C and pH 3.9 for cellulase, cellulase being more thermostable than xylanase when exposed at temperatures from 45°C to 60°C. A Box–Behnken factorial design was applied to optimize the hydrolysis of the fermented BSG by crude extract. The crude extract load was a significant factor in sugars release, highlighting the role of hydrolytic enzymes, while the load of fermented BSG, and addition of a commercial β-glucosidase were responsible for the highest phenolic compounds and antioxidant activity release. The lyophilized crude extract (12,400 and 1050 U g−1 lyophilized extract of xylanase and cellulase, respectively) was also tested as an enzyme supplement in aquafeed for European seabass (Dicentrarchus labrax) juveniles. The dietary supplementation with the crude extract significantly improved feed and protein utilization. The processing of BSG using biological treatments, such as SSF with A. ibericus, led to the production of a nutritionally enriched BSG and a crude extract with highly efficient carbohydrases capable of hydrolyzing lignocellulosic substrates, such as BSG, and with the potential to be used as feed enzymes with remarkable results in improving feed utilization of an important aquaculture fish species.

Abstract Objective: This study aimed to review evidence from randomized controlled trials (RCTs) to describe: 1) the active ingredients and desensitizing toothpaste brands; 2) the evaluation of these active ingredients over time, and 3) the fluoride and abrasive content in the formulations designed to treat dentin hypersensitivity (DH). Methodology: In total, 138 RCTs and their tested toothpastes were included. Searches were updated up to August 19, 2021. Formulations, reported brands, active ingredients over time, and type of fluoride (ionizable or ionic fluoride) and abrasive (calcium or silica-based) were analyzed (PROSPERO #CRD42018086815). Results: Our trials assessed 368 toothpaste formulations, including 34 placebo (9%), 98 control toothpastes with fluoride (27%), and 236 (64%) with active ingredients to treat DH. We tested the following active ingredients: potassium compounds (n=68, 19%), calcium sodium phosphosilicate (CSP) (n=37, 10%), strontium compounds (n=28, 8%), arginine (n=29, 8%), stannous fluoride (SnF2) (n=21, 6%), hydroxyapatite (n=9, 2%), potassium combined with another active ingredient (n=19, 5%), inorganic salt compounds (n=11, 3%), citrate (n=5, 1%), formaldehyde (n=3, 1%), herbal (n=4, 1%), copolymer (n=1, 0.5%), and trichlorophosphate (TCP) (n=1, 0.5%). The number of toothpaste formulations increased since 1968, with the greatest increment after 2010. Most toothpastes described their type of fluoride as sodium monofluorphosphate (MFP) (n=105, 29%) and NaF (n=82, 22%), with silica-based (n=84, 23%) and calcium-based (n=64, 17%) abrasives. Conclusion: Patients and dentists enjoy an increasing number of brands and active ingredients to decide what desensitizing toothpaste to use. The most common types of fluoride are MFP and NaF.

Abstract Background Indolent T-cell lymphoproliferative disorder of the gastrointestinal tract is a rare low-grade clonal lymphoid proliferation, included as a provisional entity in the current World Health Organization classification. The disease is generally localized to the gastrointestinal tract, mainly small bowel and colon. Involvement of other organs is infrequently reported. The majority of patients show a protracted clinical course with persistent disease. A prolonged survival, even without treatment, is common. Case presentation A 28-year-old woman had a 2-year history of dyspepsia and lactose intolerance. Autoimmune diseases and celiac disease were excluded. No gross lesions were identified by endoscopy. Multiple gastric biopsies showed a small-sized lymphoid infiltrate, expanding the lamina propria, with a non-destructive appearance. The lymphoid cells were positive for CD3, CD4, CD5, CD7 and negative for CD20, CD8, CD56, CD103, PD1, CD30, ALK1, CD10, BCL6, perforin, TIA-1, Granzyme B and Epstein-Barr virus-encoded RNA. KI-67 index was low (5%). Molecular analysis revealed a clonal T-cell receptor γ rearrangement. Bone marrow was microscopically free of disease, but molecular testing identified the same T-cell receptor γ rearrangement present in the gastric biopsies. After the diagnosis of indolent T-cell lymphoproliferative disorder of the gastrointestinal tract, the patient received steroid therapy, only for 2 months. She is alive, with a stable disease restricted to the stomach, at 12 months from diagnosis. Conclusions Indolent T-cell lymphoproliferative disorder is usually a disease of adulthood (median age: 51 yrs). The small bowel and colon are the sites most commonly involved. Our case occurred in a young woman and affected the stomach, sparing small intestine and colon. Clonality testing identified involvement of bone marrow, a site infrequently affected in this disease. Our aim is focusing on the main diagnostic issues. If appropriate immunostainings and molecular analysis are not performed, the subtle infiltrate may be easily overlooked. The risk of misdiagnosis as more aggressive lymphomas, causing patient overtreatment, needs also to be considered.

Abstract Background Guidelines and quality indicators (for example as part of a quality assurance scheme) aim to improve health care delivery and health outcomes. Ideally, the development of quality indicators should be grounded in evidence-based, trustworthy guideline recommendations. However, anecdotally, guidelines and quality assurance schemes are developed independently, by different groups of experts who employ different methodologies. We conducted an extension and update of a previous systematic review to identify, describe and evaluate approaches to the integrated development of guidelines and related quality indicators. Methods On May 24th, 2019 we searched in Medline, Embase and CINAHL and included studies if they reported a methodological approach to guideline-based quality indicator development and were published in English, French, or German. Results: Out of 16,034 identified records, we included 17 articles that described a method to integrate guideline recommendations development and quality indicator development. Added to the 13 method articles from original systematic review we included a total 30 method articles. We did not find any evaluation studies. In most approaches, guidelines were a source of evidence to inform the quality indicator development. The criteria to select recommendations (e.g. level of evidence or strength of the recommendation) and to generate, select and assess quality indicators varied widely. We found methodological approaches that linked guidelines and quality indicator development explicitly, however none of the articles reported a conceptual framework that fully integrated quality indicator development into the guideline process or where quality indicator development was part of the question formulation for developing the guideline recommendations. Conclusions In our systematic review we found approaches which explicitly linked guidelines with quality indicator development, nevertheless none of the articles reported a comprehensive and well-defined conceptual framework which integrated quality indicator development fully into the guideline development process.

Tryptophan (Trp) is an essential amino acid, commercially available as a feed-grade product, and is a precursor to serotonin and melatonin, which are both important molecules in stress mitigation. Meagre have a high potential for marine aquaculture diversification but are highly susceptible to stressful conditions. This study aimed to assess the potential role of dietary tryptophan supplementation in meagre juveniles in order to minimize the deleterious effect of potential stress conditions. For this, a growth trial was performed wherein meagre juveniles were fed four isoproteic (45%DM) and isolipidic (16%DM) diets; namely, a control diet, and three diets similar to the control diet but supplemented with varying levels of tryptophan, graded according to the resulting percentage in each diet’s dry matter (Control, 0.25%Trp, 0.5%Trp, and 1%Trp), corresponding to a total dietary tryptophan of 1.06, 1.70, 2.08, and 3.24 g 16 g−1 N, respectively. Diets were tested in triplicate, and fish were fed twice a day, six days a week, for eight weeks. Five days after the end of the growth trial, a time-course blood sampling was performed at 0 h, 1 h, 3 h, 6 h, and 12 h after feeding. At the 6 h sampling point, the liver was also collected. Overall, our results indicate that 1Trp supplementation (total dietary Trp 3.24 g 16 g−1 N) may be harmful to fish, decreasing growth performance and feed utilization, although doses up to 0.5Trp do not influence these parameters. Voluntary feed intake lineally decreased with the increase in the level of dietary Trp. Whole-body lipid content decreased at the highest tryptophan inclusion, whereas no changes were observed in protein levels. After 12 h from feeding, plasma glucose levels were lower in all dietary treatments supplemented with tryptophan compared to those observed in the control. Hepatic enzyme activity of protein catabolism decreased with dietary Trp inclusion. Overall, our results suggested that while a dietary Trp level increase of up to 2.08 g 16 g−1 N did not affect growth performance and feed efficiency, both these parameters were severely compromised with a Trp level of 3.24 g 16 g−1 N.

Live feed enrichments are often used in fish larvicultures as an optimized source of essential nutrients to improve larval growth and survival. In addition to this, they may also play an important role in structuring larval-associated microbial communities and may help improve their resistance to diseases. However, there is limited information available on how larval microbial communities and larviculture water are influenced by different live feed enrichments. In the present study, we investigated the effects of two commercial rotifer enrichments (ER) on turbot (Scophthalmus maximus) larval and post-larval gut-associated bacterial communities during larviculture production. We evaluated their effects on bacterial populations related to known pathogens and beneficial bacteria and their potential influence on the composition of bacterioplankton communities during larval rearing. High-throughput 16S rRNA gene sequencing was used to assess the effects of different rotifer enrichments (ER1 and ER2) on the structural diversity of bacterial communities of the whole turbot larvae 10 days after hatching (DAH), the post-larval gut 30 DAH, and the larviculture water. Our results showed that different rotifer feed enrichments were associated with significant differences in bacterial composition of turbot larvae 10 DAH, but not with the composition of larval gut communities 30 DAH or bacterioplankton communities 10 and 30 DAH. However, a more in-depth taxonomic analysis showed that there were significant differences in the abundance of Vibrionales in both 10 DAH larvae and in the 30 DAH post-larval gut fed different RE diets. Interestingly, the ER1 diet had a higher relative abundance of specific amplicon sequence variants (ASVs) related to potential Vibrio-antagonists belonging to the Roseobacter clade (e.g., Phaeobacter and Ruegeria at 10 DAH and Sulfitobacter at 30 DAH). In line with this, the diet was also associated with a lower relative abundance of Vibrio and a lower mortality. These results suggest that rotifer diets can affect colonization by Vibrio members in the guts of post-larval turbot. Overall, this study indicates that live feed enrichments can have modulatory effects on fish bacterial communities during the early stages of development, which includes the relative abundances of pathogenic and antagonist taxa in larviculture systems.

Objective: The objective of this article is to present to the dental professionals, through a literature review, the main oral lesions that are part of the odontopediatric stomatology, in order to improve the knowledge and attention to the health of the pediatric patients. Methods: The searches were carried out in the following bibliographic databases: PubMed, Web of Science, LILACS and Bireme. Data synthesis: this article deals with the description of the most frequent oral lesions in Pediatric Dentistry, such as epstein’s pearls and gingival cyst of the newborn, which are the most common changes in newborns; congenital abnormalities such as ankyloglossia; lesions with fluid retention such as eruption cyst/hematoma; fungal and viral diseases such as candidosis, acute herpetic gingivostomatitis and secondary herpes simplex, respectively. There are also those related to the main infectious diseases of childhood, with clinical manifestations in the oral cavity such as measles, impetigo, varicella, mumps and hands, feet and mouth disease. Conclusion: It is very important, for General Practitioner and Pediatric Dentistry to recognize oral lesions in children, to make a correct and early diagnosis of them, in order to improve the knowledge, attention to the health and quality of life of the pediatric patients.

This study aimed to assess the effect of Hermetia illucens meal (HM) dietary inclusion on meagre oxidative status. Thus, fish were fed a fishmeal-based diet (CTR diet) and three other diets with increasing levels of HM inclusion, namely 10%, 20%, and 30% (diets HM10, HM20, and HM30, respectively). At the end of the trial, hepatic and intestine superoxide dismutase, catalase, and glucose-6-phosphate dehydrogenase activities and malondialdehyde concentration were unaffected by the diet composition. Liver glutathione peroxidase activity was higher in the fish fed the HM20 diet than in the fish fed the CTR and HM30 diets, and glutathione reductase activity linearly increased with the dietary HM level. The hepatic total glutathione and reduced glutathione contents were significantly lower in fish fed the HM20 diet than in fish fed the CTR and HM10 diets. In the intestine, the oxidized glutathione (GSSG) content and oxidative stress index linearly increased with the increase in dietary HM level, with the GSSG content of fish fed the HM20 diet being significantly higher than of fish fed the CTR diet. In conclusion, 30% HM might be included in meagre diets without negatively affecting hepatic and intestine oxidative status.

The present study aimed to evaluate the effects of feeding or feed deprivation on the orexigenic and anorexigenic responses at the central (whole brain) and peripheral (anterior and posterior intestine, stomach, and liver) system levels in European seabass. For this purpose, a group of fish (208 g) was fed a single meal daily for 8 days (fed group) and another group was feed-deprived for 8 days (unfed group). Compared to the fed group, in the whole brain, feed deprivation did not induce changes in npy, agrp1, and cart2 expression, but increased agrp2 and pomc1 expression. In the anterior intestine, feed deprivation increased cck expression, while in the posterior intestine, the npy expression increased and pyyb decreased. In the stomach, the ghr expression decreased regardless of the feeding status. The hepatic lep expression increased in the unfed fish. The present results suggest a feed intake regulation mechanism in European seabass similar to that observed in other teleosts.

O fluoreto tem efeito neurotóxico? A importância da análise crítica da informação

Abstract Background Duodenal stump fistula (DSF) remains one of the most serious complications following subtotal or total gastrectomy, as it endangers patient’s life. DSF is related to high mortality (16–20%) and morbidity (75%) rates. DSF-related morbidity always leads to longer hospitalization times due to medical and surgical complications such as wound infections, intra-abdominal abscesses, intra-abdominal bleeding, acute pancreatitis, acute cholecystitis, severe malnutrition, fluids and electrolytes disorders, diffuse peritonitis, and pneumonia. Our systematic review aimed at improving our understanding of such surgical complication, focusing on nonsurgical and surgical DSF management in patients undergoing gastric resection for gastric cancer. Methods We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. PubMed/MEDLINE, EMBASE, Scopus, Cochrane Library and Web of Science databases were used to search all related literature. Results The 20 included articles covered an approximately 40 years-study period (1979–2017), with a total 294 patient population. DSF diagnosis occurred between the fifth and tenth postoperative day. Main DSF-related complications were sepsis, abdominal abscess, wound infection, pneumonia, and intra-abdominal bleeding. DSF treatment was divided into four categories: conservative (101 cases), endoscopic (4 cases), percutaneous (82 cases), and surgical (157 cases). Length of hospitalization was 21–39 days, ranging from 1 to 1035 days. Healing time was 19–63 days, ranging from 1 to 1035 days. DSF-related mortality rate recorded 18.7%. Conclusions DSF is a rare but potentially lethal complication after gastrectomy for gastric cancer. Early DSF diagnosis is crucial in reducing DSF-related morbidity and mortality. Conservative and/or endoscopic/percutaneous treatments is/are the first choice. However, if the patient clinical condition worsens, surgery becomes mandatory and duodenostomy appears to be the most effective surgical procedure.

El artículo tiene como finalidad presentar un análisis del efecto que han generado las reformas tributarias de los últimos años en la sostenibilidad de las empresas en Colombia. El desarrollo metodológico se realizó bajo un enfoque exploratorio analítico con fuentes de información secundarias, buscando mediante la revisión de los objetivos en la promulgación de las leyes tributarias, y los principales cambios que estas motivaron, determinar de que manera afectan la sostenibilidad de las empresas. Los resultados que se encontraron se basan principalmente en que la carga tributaria para las empresas colombianas es una de las más altas del ámbito mundial, lo que sin duda afecta la inversión y la competitividad. Con las últimas reformas se logran cambios pero no estables, lo cual genera inseguridad jurídica frente a las inversiones. En las conclusiones se estableció que Colombia, se han caracterizado por el incremento en la carga impositiva, lo que ha generado ingresos tributarios, que influye positivamente en las obligaciones e inversiones del estado, pero, que afecta el consumo, la formalización, la inversión y la sostenibilidad empresarial.

Coral bleaching, cyclones, outbreaks of crown-of-thorns seastar, and reduced water quality (WQ) threaten the health and resilience of coral reefs. The cumulative impacts from multiple acute and chronic stressors on “reef State” (i.e., total coral cover) and “reef Performance” (i.e., the deviation from expected rate of total coral cover increase) have rarely been assessed simultaneously, despite their management relevance. We evaluated the dynamics of coral cover (total and per morphological groups) in the Central and Southern Great Barrier Reef over 25 years, and identified and compared the main environmental drivers of State and Performance at the reef level (i.e. based on total coral cover) and per coral group. Using a combination of 25 environmental metrics that consider both the frequency and magnitude of impacts and their lagged effects, we find that the stressors that correlate with State differed from those correlating with Performance. Importantly, we demonstrate that WQ metrics better predict Performance than State. Further, inter-annual dynamics in WQ (here available for a subset of the data) improved the explanatory power of WQ metrics on Performance over long-term WQ averages. The lagged effects of cumulative acute stressors, and to a lesser extent poor water quality, correlated negatively with the Performance of some but not all coral groups. Tabular Acropora and branching non-Acropora were the most affected by water quality demonstrating that group-specific approaches aid in the interpretation of monitoring data and can be crucial for the detection of the impact of chronic pressures. We highlight the complexity of coral reef dynamics and the need of evaluating Performance metrics in order to prioritise local management interventions.

This study aimed to evaluate the effects of including microalgae Chlorella sp. or Nannochloropsis sp. in plant-based diets on antioxidant mechanisms of European sea bass (Dicentrarchus labrax) juveniles. For this purpose, three isoproteic (50%) and isolipidic (19%) diets were formulated: a practical diet, containing 15% fish meal (FM) and plant ingredients as the protein source and a mixture of fish oil and vegetable oils (40: 60) as lipid source (control diet); and two diets identical to the control but with the FM replaced by Nannochloropsis sp. or Chlorella sp. (diets Nanno and Chlo, respectively). The diets were offered to quadruplicate groups of 25 fish (initial body weight: 24 ± 1 g) for 11 weeks and then enzymatic and non-enzymatic antioxidant mechanisms and lipid oxidative biomarkers were assessed in the liver and intestine of these fish. Results showed that the antioxidant response was tissue-dependent, with the liver exhibiting lower glutathione peroxidase and glucose-6-phosphate dehydrogenase (only in Chlo group) activities, and intestine lower superoxide dismutase activity with the diets including microalgae compared to control diet. An increase of oxidized glutathione content was also observed in the intestine of fish fed the microalgae diets. Catalase and glutathione reductase activities, oxidative stress index, and total and reduced glutathione, were unaffected by dietary treatments in both tissues. Overall, the lipid peroxidation status was not compromised by the replacement of FM by microalgae.

Introdução: O Centro Hospitalar Universitário Lisboa Norte foi ativado para referência de doentes com infeção SARS-CoV-2 em 11 de março de 2020. O objetivo deste estudo é descrever a experiência do Departamento de Pediatria na abordagem e evolução clínica de crianças infetadas. Material e Métodos: Realizámos um estudo observacional descritivo. Incluímos as crianças e adolescentes (0 aos 18 anos) com infeção por SARS-CoV-2 diagnosticados na urgência e internamento do nosso departamento entre 11 de março e 18 de junho de 2020. Consultámos registos internos e a plataforma Trace COVID-19 e contactámos os cuidadores para avaliação de seguimento. Resultados: De 103 crianças diagnosticadas, 83% tiveram contacto prévio identificado com doente infetado, 43% doentes apresentaram febre e 42% sintomas respiratórios. Em 10% havia fatores de risco; 21% tinham idade inferior a um ano. Foram internadas 10% das crianças, uma em cuidados intensivos com síndrome inflamatória multissistémica pediátrica. Foi efetuada avaliação laboratorial em 9%, radiografia torácica em 7%. Nenhum recebeu suporte ventilatório, terapêutica antiviral ou realizou tomografia computorizada torácica. Foram reobservadas em serviço de urgência 8% das crianças, sendo internada uma. A evolução foi conhecida em 101 casos sendo favorável em todos. Discussão: A maioria dos doentes tinha link epidemiológico familiar e pouca repercussão clínica, mesmo no primeiro ano de vida. A menor gravidade esperada na criança motivou a adoção de critérios habituais noutros quadros clínicos semelhantes para a realização de exames complementares de diagnóstico e internamento hospitalar. Não foi administrada terapêutica antiviral em nenhum doente por se considerar haver pouca evidência de benefício. Conclusão: Esta estratégia traduziu-se num baixo consumo de recursos hospitalares e revelou-se segura nesta série.

Cyanobacteria are able to tolerate, and even metabolize, moderate doses of organochlorine pesticides, such as lindane (γ-hexachlorocyclohexane), one of the most persistent and widely used in recent decades. Previous work showed that Microcystis aeruginosa PCC 7806 degrades lindane and that, in the presence of the pesticide, microcystin synthesis is enhanced. In this work, using in silico approaches, we have identified in M. aeruginosa putative homologues of the lin genes, involved in lindane degradation in Sphingobium japonicum UT26S. Real-time RT-PCR assays showed that the putative linC gene was induced in the presence of 7 mg/L of lindane. Additionally, prxA, encoding a peroxiredoxin, and involved in oxidative stress response, was also induced when lindane was present. Taking into account these results, M. aeruginosa PCC 7806 may degrade lindane through a metabolic pathway involving a putative 2,5-dichloro-2,5-cyclohexadiene-1,4-diol dehydrogenase encoded by a linC homologue. However, the low similarity of the other potential lin homologues suggest the existence of an alternative pathway different to that of heterotrophic microorganisms such as S. japonicum.

This network meta-analysis (NMA) investigated the effectiveness of antioxidants as adjuncts to non-surgical periodontal therapy (NSPT) in the glycated hemoglobin (HbA1c) control of type 2 diabetes (T2D) patients with periodontitis. PubMed, Cochrane, LILACS, Web of Science, Scopus, Embase, LIVIVO, and grey literature were searched. Risk of bias was assessed with the RoB v2.0 tool. A frequentist NMA assessed HbA1c improvement, through standardized mean difference under a random-effects model. Certainty of evidence was addressed through the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) partially contextualized framework. Ten randomized controlled clinical trials were included, with 234 patients receiving alpha lipoic acid (ALA), cranberry juice, cranberry juice enriched with omega-3, fenugreek, ginger, grape seed, lycopene, melatonin, omega-3, propolis or vitamin C supplementation to NSPT, and 220 patients receiving NSPT alone or with placebo. Nine studies were meta-analyzed. HbA1c improved when NSPT was combined with propolis, ALA and melatonin supplementation (moderate-to-low certainty), compared to NSPT alone or with placebo. Risk of bias issues were found in eight studies. In conclusion, the use of propolis supplementation to NSPT probably results in HbA1c improvement in T2D patients with periodontitis (large effect with moderate certainty), while ALA and melatonin supplementation may contribute to reduce the HbA1c in T2D patients with periodontitis (large effects with low certainty).

O Guia de Gestão Autônoma de Medicação (GAM), originalmente canadense e com versão brasileira publicada em 2012, se configura como um dispositivo que visa a contribuir para que sujeitos em tratamento de saúde se responsabilizem pelo seu próprio cuidado singularizado. Este texto narra pesquisa desenvolvida na cidade de Fortaleza (CE) com a GAM. Buscou-se potencializar esse instrumento para ações de saúde, por meio da composição experimental do Guia GAM, nomeado de GAM@. Uma peculiaridade de nossa experimentação é utilizar a GAM no cuidado de pessoas que fazem uso abusivo e/ou compulsivo de substâncias (drogas), em um CAPS-ad. A pesquisa tem quatro etapas e, neste texto, relatamos as duas primeiras: os estudos preliminares e a composição experimental GAM@. Indicamos como o material foi estruturado, quais os pressupostos teóricos orientaram essa produção e seus conteúdos principais.

Se realizó la caracterización del ensamblaje de escarabajos coprófagos en la cuenca alta y media del río Bita, en el marco de la alianza interinstitucional por el “Río Bita, protegido”. Los escarabajos fueron recolectados con trampas de caída, en 4 localidades del departamento del Vichada, entre enero y junio de 2016. El conjunto de datos contiene 1904 registros procedentes de la revisión de 6253 especímenes, depositados en la colección del Instituto de Investigación de Recursos Biológicos Alexander von Humboldt (Instituto Humboldt). Un total de 17 géneros y 34 especies son reportadas para el río Bita; 15 especies con epíteto específico completo y 19 especies con código único de morfoespecie (12 códigos previamente establecidos en la colección de referencia del Instituto Humboldt (CRECC) y 7 nuevas codificaciones, con base en el estudio de los caracteres morfológicos incluyendo la genitalia del macho). Hasta la fecha no se contaba con información sobre la riqueza de escarabajos coprófagos de la cuenca del río Bita, por lo que estos resultados se consideran los primeros registros de este grupo taxonómico en el extremo nororiental del territorio nacional y aportan a la línea base para la declaratoria del río Bita bajo la figura del primer río protegido de Colombia.

ABSTRACT Objective We sought to investigate the impact of self-reported fasting duration times on the lipid profile results and its impact on the cardiovascular risk stratification and metabolic syndrome diagnosis. Subjects and methods We analyzed data from all consecutive individuals evaluated in a comprehensive health examination at the Hospital Israelita Albert Einstein from January to December 2015. We divided these patients in three groups, according to the fasting duration recalled (< 8h, 8-12h and > 12h). We calculated the global cardiovascular risk and diagnosed metabolic syndrome according to the current criteria and estimated their change according to fasting duration. Results A total of 12,196 (42.3 ± 9.2 years-old, 30.2% females) patients were evaluated. The distribution of cardiovascular risk was not different among groups defined by fasting duration in both men and women (p = 0.547 for women and p = 0.329 for men). Similarly, the prevalence of metabolic syndrome was not influenced by the fasting duration (p = 0.431 for women and p = 0.166 for men). Conclusion Self-reported fasting duration had no significant impact on the lipid profile results, including triglyceride levels. Consequently, no changes on the cardiovascular risk stratification using the Framingham risk score nor changes on the prevalence of metabolic syndrome were noted.