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Introdução: Os bisfosfonatos são usados no tratamento de condições ósseas como metástases ósseas de tumores sólidos e mieloma múltiplo. Esses medicamentos podem causar osteonecrose dos maxilares, efeito adverso incomum que prejudica a qualidade de vida dos pacientes. Objetivo: Descrever o perfil clínico-epidemiológico dos pacientes em uso de bisfosfonatos do Instituto Nacional de Câncer. Método: Estudo transversal retrospectivo, com informações de prontuários de pacientes atendidos na seção de odontologia entre 2018 e 2022. Resultados: Entre os 108 pacientes incluídos de acordo com os critérios do estudo, a maioria era do sexo masculino (56,5%), acima de 50 anos (82,4%), com mieloma múltiplo (76,9%). O pamidronato dissódico foi o bisfosfonato mais prescrito (37,0%), na dose de 90 mg (94,7%), mensalmente (74,3%), para tratamento de mieloma múltiplo (77,8%). As consultas odontológicas ocorreram predominantemente antes e durante o uso dos bisfosfonatos, embora a quantidade de consultas tenha sido maior após o uso. Os pacientes foram majoritariamente dentados e usuários de próteses insatisfatórias. A mobilidade dentária foi mais comum antes do bisfosfonato (60,9%), e também nesse momento o procedimento que teve maior demanda foi a exodontia (45,8%). Já no decorrer e após, os mais realizados foram as raspagens (51,3%). As lesões periapicais foram os achados radiográficos mais comuns antes e durante o tratamento, e a rarefação óssea após. Dois pacientes (1,85%) apresentaram osteonecrose em mandíbula. Conclusão: Foram observados alta demanda de cuidados odontológicos invasivos antes do tratamento, perda de follow-up após e maior demanda por procedimentos conservadores para manutenção da saúde bucal.

Bipolar disorder is a chronic disease that represents a significant problem to the affected individual. To date, the mainstay treatment for bipolar disorder consists in mood stabilizers, mainly lithium, which have been linked to acute and chronic kidney injury. To investigate the association between Estimated Glomerular Filtration Rate (eGFR) and sociodemographic and clinical characteristics in a group of patients with bipolar disorder (BD) undergoing lithium treatment, with or without concomitant use of other psychopharmaceuticals. In this cross-sectional study data was collected using the instruments: 1 – Clinical and sociodemographic data questionnaire, developed by the Brazilian Consortium for Bipolar Disorder Research; 2 – Structured Clinical Interview for the DSM-IV Axis I Disorders; 3 – Hamilton’s Rating Scale for Depression, to evaluate depressive symptoms and 4 – Young’s Rating Scale for Mania to evaluate mania symptoms. Renal function was calculated through the CKD/EPI formula for eGFR. 95 patients were included in the final analysis. 26 (27.4%) patients presented reduction in eGFR, 21 (22,1%) with eGFR between 60 to 89 and 5 (5,2%) below 60. Higher serum lithium levels and age were associated with such reduction (β = -18.06 [95% CI: -34.70 to -1.42]); (β = -0.72 (95% CI: -1.10 to -0.33)), respectively. Although lithium is considered the “gold standard” in the treatment of BD, its toxicity and tolerability profile in relation to renal function still needs to be better understood. The results of this study reinforce the idea that periodic control of lithium levels is essential for preserving renal function. Long-term longitudinal studies are needed to assess the relationship between renal function and lithium therapy in BD patients. Keywords Lithium, Bipolar Disorder, Kidney, Renal Insufficiency

BackgroundCardiac arrhythmias are the main cause of sudden death due to Chronic Chagasic Cardiomyopathy (CCC). Here we investigated alterations in connexin 43 (Cx43) expression and phosphorylation in cardiomyocytes as well as associations with cardiac arrhythmias in CCC.MethodsC57Bl/6 mice infected with Trypanosoma cruzi underwent cardiac evaluations at 6 and 12 months after infection via treadmill testing and EKG. Histopathology, cytokine gene expression, and distribution of total Cx43 and its phosphorylated forms Cx43S368 and Cx43S325/328/330 were investigated. Human heart samples obtained from subjects with CCC were submitted to immunofluorescence analysis. In vitro simulation of a pro-inflammatory microenvironment (IL-1β, TNF, and IFN-γ) was performed in H9c2 cells and iPSC-derived cardiomyocytes to evaluate Cx43 distribution, action potential duration, and Lucifer Yellow dye transfer.ResultsMice chronically infected with T. cruzi exhibited impaired cardiac function associated with increased inflammation, fibrosis and upregulated IL-1β, TNF, and IFN-γ gene expression. Confocal microscopy revealed altered total Cx43, Cx43S368 and Cx43S325/328/330 localization and phosphorylation patterns in CCC, with dispersed staining outside the intercalated disc areas, i.e., in lateral membranes and the cytoplasm. Reduced co-localization of total Cx43 and N-cadherin was observed in the intercalated discs of CCC mouse hearts compared to controls. Similar results were obtained in human CCC heart samples, which showed Cx43 distribution outside the intercalated discs. Stimulation of human iPSC-derived cardiomyocytes or H9c2 cells with IL-1β, TNF, and IFN-γ induced alterations in Cx43 localization, reduced action potential duration and dye transfer between adjacent cells.ConclusionHeart inflammation in CCC affects the distribution and phosphorylation pattern of Cx43, which may contribute to the generation of conduction disturbances in Chagas disease.

IntroductionThis study aimed to describe the evolution of bone regeneration in children with hip osteonecrosis associated with sickle cell disease, treated with bone marrow-derived mesenchymal stem cell implants at the Professor Edgar Santos University Hospital Complex.Materials and methodsA non-randomized clinical trial was conducted with 48 patients of both sexes, aged between 11 and 18 years, diagnosed with femoral head osteonecrosis secondary to sickle cell disease. Patient selection was based on strict criteria, including confirmed diagnosis of sickle cell anemia and a stage of osteonecrosis compatible with the proposed treatment. Bone regeneration assessment was performed through radiographic examinations and magnetic resonance imaging, following the Ficat & Arlet criteria and the Salter-Thompson classification.ResultsStatistical analysis revealed a significant association between the patients’ age and positive treatment outcomes, suggesting that autologous bone marrow cell implantation is a safe and effective approach in the early stages of osteonecrosis. The majority of patients (87.5%) reported complete pain relief, while 10.42% experienced significant symptom improvement. Only one patient (2.08%) did not observe improvement. The results indicate that cell therapy can regenerate or slow the progression of bone necrosis, reducing the need for more invasive surgical procedures.ConclusionThe study demonstrates the potential of bone marrow-derived mesenchymal stem cell implantation in treating hip osteonecrosis in children with sickle cell disease, emphasizing the importance of long-term monitoring of bone structure stability.

Objective: The aim was to evaluate the difference in the heat generated between zirconia (Zr) and steel (SS) drills, during implant site preparation. Material and methods: This systematic review followed the PRISMA methodology criteria and used the JBI Critical Assessment Guidelines for Quasi-Experimental Studies for quality assessment. The electronic search was conducted by using the PubMed/MEDLINE, Embase, and Cochrane Library databases to January 2023. The formulated population, intervention, comparison, outcome (PICO) question was “Do zirconia drills generate less heat than steel drills during implant site preparation?“. The meta-analysis was based on an inverse variance (IV) method. Results: This review included 10 studies in vitro that used zirconia drills compared to steel drills with or without coatings. The meta-analysis indicated a significant difference between Zr drills and SS drills, with a lower bone temperature variation with Zr drills. Conclusions: Despite the limitations of this review, it was concluded that Zr drills had significantly less temperature variation than SS drills.

Objetivo: O presente estudo se propôs a caracterizar o perfil metabólico e estado nutricional de pacientes após doze meses da realização do TxR. Metodologia: Trata-se de um estudo observacional, transversal, de abordagem quantitativa. Amostra composta por 111 pacientes adultos de ambos os sexos, que realizaram TxR entre janeiro de 2018 e dezembro de 2019. Variáveis apuradas mediante dados secundários presentes nos prontuários dos pacientes. Foram coletados aspectos demográficos, clínicos e laboratoriais. O banco de dados foi construído no programa Microsoft Office Excel 2010® e submetido à análise de prevalência, tendo os resultados expressos em percentual. Resultados: A maior prevalência de TxR se deu no sexo masculino com (64,9%), o estado nutricional mais recorrente foi sobrepeso ou obesidade totalizando uma prevalência de 51,4% a doença de base mais significativa na amostra foi HAS e DM com (32,4%) o perfil metabólico foi constituído por glicemia de jejum, colesterol total, triglicerídeos, LDL e HDL. Observou-se que os pacientes apresentaram uma maior prevalência de sobrepeso e obesidade, entretanto os níveis de glicemia e da maioria dos parâmetros lipídicos não demonstraram elevações superiores aos valores de normalidade, com exceção do HDL colesterol que se mostrou reduzido em (54,1%) da amostra. Conclusão: A caracterização do estado nutricional e metabólico desta população torna-se uma ferramenta importante para um bom acompanhamento destes pacientes e a elaboração de uma melhor terapêutica.

Este artigo identifica transformações urbanas e relações entre formas, usos do solo e movimento no Bairro Miramar em João Pessoa – PB, nas últimas três décadas. Localizado em uma das avenidas estruturantes da cidade com vista-mar, o bairro Miramar passou por muitas transformações recentes, atraindo o mercado imobiliário para a área. Esse estudo se baseia na teoria da Sintaxe Espacial, alinhado à teoria do movimento natural. O estudo foi feito através de mapeamentos comparativos entre 1990 e 2020, relacionando características dos conjuntos edilícios (tipo, interface, gabarito) e usos do solo, com centralidades na malha urbana, utilizando mapas axiais e de segmentos e gráficos de correlação. Em uma análise mais específica foram selecionadas cinco ruas diferentes com centralidades similares, contabilizando o movimento de pedestres e automóveis. Resultados identificaram um aumento de edificações multifamiliares; uma tendência de renovação edilícia em vias mais centrais; um aumento do número de comércios e serviços em ruas integradas, corroborando a teoria do movimento natural. Ao contabilizar o movimento de passantes, foi constatado que ruas com mais diversidade de uso apresentaram mais movimento, ao contrário de ruas monofuncionais com edificações verticalizadas do “tipo isolado”, apontando indícios de efeitos negativos das edificações recentes à vitalidade urbana.

In this paper, we analyze the autothermal reforming (ATR) of methane through Gibbs energy minimization and entropy maximization methods to analyze isothermic and adiabatic systems, respectively. The software GAMS® 23.9 and the CONOPT3 solver were used to conduct the simulations and thermodynamic analyses in order to determine the equilibrium compositions and equilibrium temperatures of this system. Simulations were performed covering different pressures in the range of 1 to 10 atm, temperatures between 873 and 1073 K, steam/methane ratio was varied in the range of 1.0/1.0 and 2.0/1.0 and oxygen/methane ratios in the feed stream, in the range of 0.5/1.0 to 2.0/1.0. The effect of using pure oxygen or air as oxidizer agent to perform the reaction was also studied. The simulations were carried out in order to maintain the same molar proportions of oxygen as in the simulated cases considering pure oxygen in the reactor feed. The results showed that the formation of hydrogen and synthesis gas increased with temperature, average composition of 71.9% and 56.0% using air and O2, respectively. These results are observed at low molar oxygen ratios (O2/CH4 = 0.5) in the feed. Higher pressures reduced the production of hydrogen and synthesis gas produced during ATR of methane. In general, reductions on the order of 19.7% using O2 and 14.0% using air were observed. It was also verified that the process has autothermicity in all conditions tested and the use of air in relation to pure oxygen favored the compounds of interest, mainly in conditions of higher pressure (10 atm). The mean reductions with increasing temperature in the percentage increase of H2 and syngas using air under 1.5 and 10 atm, at the different O2/CH4 ratios, were 5.3%, 13.8% and 16.5%, respectively. In the same order, these values with the increase of oxygen were 3.6%, 6.4% and 9.1%. The better conditions for the reaction include high temperatures, low pressures and low O2/CH4 ratios, a region in which there is no swelling in terms of the oxygen source used. In addition, with the introduction of air, the final temperature of the system was reduced by 5%, which can help to reduce the negative impacts of high temperatures in reactors during ATR reactions.

A experiência acadêmica dos estudantes de medicina, ainda que traga muito conhecimento técnico e prático para os estudantes, é repleta de dificuldade, desafios e complexidade. Dessa forma, muitos estudantes tentam encontrar formas de abrandar essa trajetória através de estratégias que compreendem o exercício de práticas para o autocuidado. As Práticas Integrativas e Complementares em Saúde (PICS) podem se tornar aliadas desse período. Esse texto trata de um relato de experiência em que uma estudante de medicina descreve e analisa suas vivências com as PICS durante o processo de formação acadêmica, no período compreendido entre 2019 e 2021. Uma narrativa científica na forma auto narrativa, na qual a escritora analisa os acontecimentos baseando-se na importância e no impacto destes na sua trajetória. O objetivo desse texto é entender o impacto e o relacionamento das PICS com uma estudante de medicina em formação, de forma a também assimilar a importância dessas práticas em sua saúde física e mental. A partir deste trabalho foi possível entender a relação dessas práticas com a formação acadêmica de um estudante de medicina, que é historicamente marcada por grande custo psíquico.

Esse artigo analisa transformações (1990-2020) na forma e usos do bairro Miramar, em João Pessoa – Paraíba, identificando padrões relacionados à localização na malha urbana. O Bairro Miramar situa-se no eixo de expansão da cidade em direção ao mar – sítio natural atrativo, em terrenos em aclive visando o mar. Conforme registra a teoria da Lógica Social do Espaço e do movimento natural, a configuração espacial caracteriza centralidades e hierarquias de acesso que facilitam movimento e influenciam na localização de usos. Para entender transformações no bairro foram comparados diacronicamente análises sintáticas da malha urbana da cidade e mapeamentos relacionando à forma urbana no bairro Miramar em plataforma georreferenciada. Dados foram coletados a partir de leituras de registros anteriores da década de 1990, bases da prefeitura e visitas in loco. Foram relacionados usos do solo, gabarito e localização na malha urbana. Transformações edilícias relacionadas à localização mostram um bairro recorrentemente acessível topologicamente na cidade com muitas modificações nas últimas décadas dado o aumento da verticalização, e caracteriza padrões diferenciados localmente. Mais renovações edilícias aconteceram em vias mais centrais topologicamente, atualmente também com mais edificações para vender ou alugar, e aumento de comércio e serviços. Por outro lado, residências térreas adensadas se situam em vias reclusas. Achados apontam para mudanças maiores entre espaços públicos e privados em algumas ruas, substituindo casas que mantinham uma relação mais amigável com a rua, cujos impactos serão avaliados em uma próxima etapa.

Introdução: As Práticas Integrativas e Complementares em Saúde (PICS) trazem uma proposta de cuidado centrada no sujeito que valoriza os saberes tradicionais e os mecanismos naturais de manutenção e recuperação da saúde, e vêm se expandindo após a publicação da Política Nacional de PICS (PNPIC) e pela definição das estratégias da OMS para as Medicinas Tradicionais e Complementares (MTCI). Tais ações políticas podem repercutir na formação em saúde e implicar em um posicionamento de resistência e discussão epistemológica nas IES por parte dos docentes e formadores. Objetivos: Conhecer o entendimento de coordenadores e professores dos cursos de graduação em saúde sobre a inserção das PICS na formação em saúde e a sua interface com as políticas públicas. Metodologia: Estudo exploratório-descritivo, elaborado a partir de um questionário eletrônico estruturado (REDCap), aplicado a coordenadores e professores dos cursos de graduação em saúde da Bahia. Resultados/Discussão: Os professores e coordenadores identificam as PICS como práticas promotoras do cuidado ampliado, integral, complementar e alternativo, as reconhecem como racionalidades em saúde distintas do modelo biomédico e estimulam a inserção destas na formação discente, com a finalidade de sensibilizá-los para outras possibilidades de cuidado e autocuidado, atuação profissional e conhecimento das políticas públicas em PICS. Considerações Finais: Este trabalho analisa a complexidade envolvida nos processos de formação em saúde e discute a necessidade de fortalecimento das ações de formação em PICS no campo das políticas públicas, do SUS e como respostas às demandas de cuidado da sociedade contemporânea, especialmente fragilizada pela vivência recente de uma pandemia.

Esse ensaio traçar uma análise de algumas interações entre corpo, saúde, política e poder ao longo do tempo, explorando como essas interações moldam nossas percepções individuais e coletivas e influenciam as trajetórias históricas e sociais, especialmente no contexto brasileiro. Três categorias de análise desenham as leituras sobre o trinômio corpo, saúde e política que são historicizadas a partir das: Trajetórias na Modernidade, Trajetórias Neoliberais na Atualidade e Fragmentos de Trajetórias Brasileiras. O objetivo é historizar como o corpo enquanto categoria é objeto de controle e subordinação pela ciência, moldado por categorias normativas, referenciais hegemônicos e estruturas de poder. Saúde e suas derivações conceituais têm sido enodadas ao determinista modelo universalizante moderno/colonial, que projeta formas de ser, adoecer e sucumbir em uma perspectiva de vida que estratifica viveres. As trajetórias são historicidades sobre as concepções da saúde e de corpo, realçando os efeitos da lógica moderna de adestramento pelo biopoder e de consumo na lógica neoliberal da psicopolítica. Discute-se como corpo-físico, corpo-pessoa espelha sentidos e significados de eus e de nós, subjetividades e coletividades tramando coreografias de corpos que se associam ao território por uma expressão de cultura, contemplando cumplicidades, dissidências, insurgências, negociações e enfrentamentos. Por fim, sinaliza recortes da violenta trajetórias brasileira onde o ecocídio é tramado.

Este texto resulta de uma pesquisa-formação que intencionou compreender experiências formativas de licenciandos/as, vivenciadas na Educação de Jovens e Adultos, a partir do Programa Residência Pedagógica, núcleo Pedagogia, da Universidade Federal da Bahia. Com discussão situada no entendimento da EJA como direito e na compreensão da formação docente como complexa e multirreferencial, tensiona concepções limitadas ao saber e ao saber-fazer e propõe ampliação dos itinerários formativos para contemplar, também, o saber-ser. Discorre sobre a construção de uma epistemologia docente fundada nas relações, apresentando eixos significantes engendrados no âmbito do Programa e que balizaram o trabalho pedagógico realizado. Apresenta experiências formativas destacadas pelos/as licenciandos/as como potencializadoras de uma educação sensível e apresenta como resultados o entendimento de que a apropriação simultânea de teorias curriculares, a compreensão da complexidade do fenômeno educativo e a experienciação de dinâmicas que abarcam a indissociabilidade entre o sensível e o inteligível, potencializam uma formação docente relevante para uma prática pedagógica inclusiva e humanizada, essencial aos sujeitos da EJA

Abstract To investigate similarities in the gene profile of Oral Lichen Planus and Oral Squamous Cell Carcinoma that may justify a carcinogenic potential, we analyzed the gene expression signatures of Oral Lichen Planus and Oral Squamous Cell Carcinoma in early and advanced stages. Based on gene expression data from public databases, we used a bioinformatics approach to compare expression profiles, estimate immune infiltrate composition, identify differentially and co-expressed genes, and propose putative therapeutic targets and associated drugs. Our results revealed gene expression patterns related to processes of keratinization, keratinocyte differentiation, cell proliferation and immune response in common between Oral Lichen Planus and early and advanced Oral Squamous Cell Carcinoma, with the cornified envelope formation and antigen processing cross-presentation pathways in common between Oral Lichen Planus and early Oral Squamous Cell Carcinoma. Together, these results reveal that key tumor suppressors and oncogenes such as PI3, SPRR1B and KRT17, as well as genes associated with different immune processes such as CXCL13, HIF1A and IL1B are dysregulated in OLP.

Objetivo: Avaliar o ganho de peso e mudanças no perfil lipídico e glicêmico em receptores de transplante renal no primeiro ano pós-transplante e sua correlação com a utilização de diferentes protocolos de imunossupressão. Materiais e Métodos: Estudo observacional do tipo coorte retrospectiva analítica, envolvendo 152 pacientes maior ou igual a 19 anos, de ambos os sexos, submetidos ao transplante renal entre janeiro de 2018 e dezembro de 2019, acompanhados durante o primeiro ano pós-transplante. Foram coletados dados secundários do prontuário, incluindo demográficos, clínicos, exames laboratoriais e antropometria. Foram utilizados os Teste de Shapiro-Wilk, Paired T test e Wilcoxon test. Resultados: Houve maior prevalência de indivíduos adultos (75%, n=114), do sexo masculino (67,76%, n=103), tendo como principal doença de base a Hipertensão Arterial (32,89%, n=50). Pacientes que receberam o esquema 1 de imunossupressão (micofenolato + tacrolimus) apresentaram significativamente menor média de glicemia de jejum, de colesterol total e LDL-colesterol após 12 meses de tratamento. Pacientes submetidos ao esquema II (micofenolato + prednisona + tacrolimus) também tiveram menor média de glicemia de jejum após 12 meses. Houve redução significativa na média de triglicerídeos e LDL-colesterol nos pacientes que receberam o esquema III (sirolimus + tacrolimus). Conclusão: As alterações, principalmente nos primeiros meses pós-transplante, estão associadas à altas doses de imunossupressores, enquanto a redução gradativa está associada à redução destas, além do acompanhamento nutricional ambulatorial ao longo do pós-transplante.

Introdução: A deficiência de vitamina B12 depois da cirurgia bariátrica já está bem estabelecida, porém alguns estudos relatam que esta hipovitaminose se associa com à obesidade e que a deficiência está presente desde o pré-operatório. Objetivo: Estimar a prevalência de deficiência de vitamina B12 e identificar alguns fatores associados em pacientes encaminhados à cirurgia bariátrica. Materiais e Métodos: Estudo descritivo de corte transversal com dados secundários. Variáveis utilizadas: dados antropométricos, sociodemográficos e clínicos, compreendendo a vitamina B12. Para análise estatística utilizou-se o programa SPSS for Windows® versão 20.0. Sendo realizado: teste t de Student, qui-quadrado de Pearson e correlação de Pearson. Foram calculadas as prevalências e razões de prevalência com intervalos de confiança de 95%, e considerados estatisticamente significantes valores de p

The thermal cracking process of methane does not present the emissions of polluting gases, forming only hydrogen with a high degree of purity and solid carbon that can be commercialized for other industrial purposes globally. Thermodynamic methodologies based on Gibbs energy minimization and entropy maximization are used in the present study to simulate operating conditions of isothermal and adiabatic reactors, respectively. The chemical equilibrium and combined phases problem were written in a non-linear programming form and optimized with the GAMS software using the CONOPT 3 solver. The results obtained by the methodology described in this study present a good agreement with the data reported in the literature, with mean relative deviations lower than 1.08%. High temperatures and low pressures favor the decomposition of methane and the formation of products. When conditioned in an isothermal reactor, total methane conversions are obtained at temperatures above 1200 K at 1 bar. When conditioned to an adiabatic reactor, due to the lack of energy support provided by the isothermal reactor and taking into account that it is an endothermic process, high methane-conversion rates are obtained for temperatures above 1600 K at 1 bar. As an alternative, the combined effects of the addition of hydrogen to the feed combined with a system of extreme pressure variation indicate a possibility of conducting the thermal cracking process of methane in adiabatic systems. Setting the CH4/H2 ratio in the system feed at 1:10 at 1600 K and 50 bar, following severe depressurization through an isentropic valve, varying the pressure from 50 to 1 bar, the methane conversion varies from 0 to 94.712%, thus indicating a possible operational conformation for the process so that the amount of carbon generated is not so harmful to the process, taking into account that the formation of the same occurs only after the reaction and heating processes. Under the same operating conditions, it is possible to use about 40.57% of the generated hydrogen to provide energy for the process to occur.

We describe a case of Marfan syndrome, referred for evaluation due to an important family history of sudden death. In the first evaluation, he presented dilation of the aortic root in addition to other clinical manifestations of the disease. Our objective is to emphasize the importance of family history as a starting point in Marfan syndrome investigation, in an effort to prevent unfavorable outcomes like aortic dissection and sudden death.

ABSTRACT Objective The extrinsic muscles, such as the posterior tibialis and long flexor of the hallux and the intrinsic of the foot, are part of the active subsystem of the central system of the foot and play an essential role in the control of the medial longitudinal arch resulting from difficulty in contracting the muscle, neuromuscular electrostimulation (NMES) becomes a resource combined with strengthening and recommended for rehabilitation. T this work aims to evaluate the effectiveness of NMES associated with exercise in deforming the medial longitudinal arch. Methods This is a randomized blind clinical trial. 60 asymptomatic participants were divided into three groups: NMES, exercise and control. The NMES and exercise group performed seven exercises for the intrinsic and extrinsic muscles twice a week for 6 weeks, and the NMES group used an NMES associated with five exercises. Navicular height and medial longitudinal arch angle were taken before and after the intervention period. Results No statistically significant differences existed between groups for navicular height and medial longitudinal arch angle. Conclusion NMES associated with exercise does not change the characteristics of the medial longitudinal arch in association with asymptomatic. Level of Evidence I; Randomized clinical trial.

This study focuses on developing accurate immunoassays for diagnosing Chagas disease (CD), a challenging task due to antigenic similarities between Trypanosoma cruzi and other parasites, leading to cross-reactivity. To address this challenge, chimeric recombinant T. cruzi antigens (IBMP-8.1, IBMP-8.2, IBMP-8.3, and IBMP-8.4) were synthesized to enhance specificity and reduce cross-reactivity in tests. While these antigens showed minimal cross-reactivity with leishmaniasis, their performance with other trypanosomatid infections was unclear. This study aimed to assess the diagnostic potential of these IBMP antigens for detecting CD in patients with Crithidia sp. LVH-60A, a parasite linked to visceral leishmaniasis-like symptoms in Brazil. This study involved seven Crithidia sp. LVH-60A patients and three Leishmania infantum patients. The results indicated that these IBMP antigens displayed 100% sensitivity, with specificity ranging from 87.5% to 100%, and accuracy values between 90% and 100%. No cross-reactivity was observed with Crithidia sp. LVH-60A, and only one L. infantum-positive sample showed limited cross-reactivity with IBMP-8.1. This study suggests that IBMP antigens offer promising diagnostic performance, with minimal cross-reactivity in regions where T. cruzi and other trypanosomatids are prevalent. However, further research with a larger number of Crithidia sp. LVH-60A-positive samples is needed to comprehensively evaluate antigen cross-reactivity.

Teaching and research laboratories generate wastes of various compositions and volumes, ranging from diluted aqueous solutions to concentrated ones, which, due to milder self-regulation waste-management policies, are carelessly discarded, with little attention given to the consequences for the environment and human health. In this sense, the current study proposes the application of the supercritical water oxidation (SCWO) process for the treatment of complex refractory wastewater generated in research and teaching laboratories of universities. The SCWO, which uses water in conditions above its critical point (T > 647.1 K, p > 22.1 MPa), is regarded as an environmentally neutral process, uniquely adequate for the degradation of highly toxic and bio-refractory organic compounds. Initially, the wastewater samples were characterized via headspace gas chromatography coupled with mass spectrometry. Then, using a continuous tubular reactor, the selected operational parameters were optimized by a Taguchi L9 experimental design, aiming to maximize the total organic carbon reduction. Under optimized conditions—that is, temperature of 823.15 K, feed flow rate of 10 mL min−1, oxidizing ratio of 1.5 (50% excess over the oxygen stoichiometric ratio), and sample concentration of 30%—TOC, COD, and BOD reductions of 99.9%. 91.5% and 99.2% were achieved, respectively. During the treatment process, only CO2, methane, and hydrogen were identified in the gaseous phase. Furthermore, the developed methodology was applied for the treatment of wastewater samples generated in another research laboratory and a TOC reduction of 99.5% was achieved, reinforcing the process’s robustness. A thermodynamic analysis of SCWO treatment of laboratory wastewater under isothermal conditions was performed, using the Gibbs energy minimization methodology with the aid of the GAMS® 23.9.5. (General Algebraic Modeling System) software and the CONOPT 4 solver. Therefore, the results showed that SCWO could be efficiently applied for the treatment of wastewater generated by different teaching and research laboratories without the production of harmful gases and the addition of hazardous chemicals.

Objectives: To describe the differences in clinical presentation and relative disease burden of congenital Zika syndrome (CZS)-associated microcephaly at 2 large hospitals in Salvador, Brazil that serve patients of different socioeconomic status (SES). Methods: Clinical and serologic data were collected prospectively from pregnant women and their infants, who delivered at 2 study centers during the 2015–2016 Zika virus (ZIKV) epidemic in Salvador, Brazil. Results: Pregnant women from Salvador, Brazil delivering in a low SES hospital had 3 times higher ZIKV exposure rate than women at a high SES hospital. However, different SES hospitals had similar prevalence of infants with CZS-associated microcephaly (10% vs 6%, p = 0.16) after controlling for ZIKV exposure in their mothers. Conclusions: Our study supports the positive association between low SES, high maternal ZIKV exposure, and high rates of CZS-associated microcephaly.

Introduction: Maxillofacial prostheses are a therapeutic option for repairing affected structures in the facial and/or intraoral region of cancer patients submitted to surgery. Objective: To report the use of maxillofacial prosthetics in the aesthetic-functional rehabilitation of cancer patients. Case reports: The first two cases show extraoral rehabilitations using adhesive silicone prosthetics in female patients. The first one, an 83-year-old woman, diagnosed with basal cell carcinoma in the right nasal wing, who underwent surgical resection and was rehabilitated with a nasal prosthesis 7 months ago. The second case refers to a 51-year-old female, diagnosed with multiple sclerodermiform basal cell carcinomas, treated with surgery and rehabilitated with a facial prosthesis 8 months ago. The third case addresses the rehabilitation of a 58-year-old female patient, diagnosed with squamous cell carcinoma of the hard palate, treated with surgery and radiotherapy. She was rehabilitated 1 year and 6 months ago with a polymethylmethacrylate obturator prosthesis. Conclusion: The presented cases show that maxillofacial prostheses are essential tools in the reestablishment of esthetics and function of cancer patients, as well as their contribution to psychological issues, in the process of reinsertion in social life and by improving the quality of life of these individuals. Furthermore, they confirm the importance of inserting the dentist in the multidisciplinary oncology team, with an emphasis on postoperative rehabilitation through maxillofacial prostheses.

Introduction: The experience of living with chronic pain allows for the appearance of changes in sleep patterns, mood, and stress levels. Objective: To describe the phases of stress and the quality of sleep in patients with chronic pain. Material and Methods: Cross-sectional study carried out at the pain clinic of the HUPES Complex, Salvador-Bahia. Data collection between March 2016 and November 2017. Instruments: Sociodemographic questionnaire, Numerical Pain Scale (EVN), Mini-Sleep Questionnaire (MSQ), and Stress Symptoms Inventory for LIPP adults (ISSL). Categorical variables were expressed by absolute and relative frequency and quantitative variables by means and standard deviation (SD). The comparison of categorical variables was performed using the chi-square test. Values of p

ABSTRACT: The objective of this research was to estimate genetic parameters and genetic trends (GT) for 305-day milk yield (MY305) and 305-day fat yield (FY305) of purebred Dairy Gir animals of the National Dairy Gir Breeding Program. The restricted maximum likelihood method was used in an animal model. GT were obtained via linear regression and divided into two periods (1935-1992 and 1993-2013 for PL305; 1935-1992 and 1993-2010 for MY305). The estimated heritabilities were 0.23 (MY305) and 0.10 (FY305). The GT (kg/year) values for MY305 in the 2nd period for measured females (25.49), females (26.11), and males (35.13) were higher than those found in the 1st period (2.52; 2.06, and 1.00, respectively). The heritability estimated for MY305 confirmed the possibility of genetic improvement by selection and indicated a lower additive genetic effect on FY305 of purebred animals. The genetic progress for MY305 in all purebred population is denoted by the more expressive gains found from 1990’s, when the first bull catalogs were published.

Abstract Cutaneous leishmaniasis represents a public health problem that affects 85 countries. It is an endemic disease in Brazil, having an important socioeconomic impact. An exuberant case of cutaneous leishmaniasis is reported herein. A 28-year-old male patient with Down syndrome had had verrucous plaques on the back for over a year, with progressive growth. PCR of a lesion sample was positive for Leishmania braziliensis. The patient’s condition was classified as atypical cutaneous leishmaniasis. He was successfully treated with amphotericin B and miltefosine. The treatment remains a challenge, given the toxicity and low cure rate of the currently recommended drugs.

Objective: The objective of this systematic review was to evaluate the efficacy of non-surgical periodontal therapy on rheumatoid arthritis activity. Material and methods: Articles published until April 2019 were electronically searched and screened using PubMed / MEDLINE, Scopus, and Cochrane databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). This study was recorded in the international PROSPERO database (CRD42019132205). The PICO question (population, intervention, comparison, results) was: in adult patients with rheumatoid arthritis and periodontitis (P), does non-surgical periodontal treatment (I), as compared to no treatment (C), provides better outcomes in rheumatoid arthritis activity (O). Results: After searching the databases, seven articles were selected for qualitative and five for quantitative analysis. The total number of participants included was 292, with an average age of 50.5 years. All patients had rheumatoid arthritis and periodontal disease. Non-surgical periodontal treatment significantly reduced Disease Activity Score 28 (P = 0.004; I2 = 92%) and erythrocyte sedimentation rate (P = 0.01; I2 = 78%), but with no significant effect on C-reactive protein (P = 0.34; I2 = 92%). Conclusions: It can be concluded that non-surgical periodontal treatment can benefit patients with rheumatoid arthritis.

BackgroundChagas disease (CD) is caused by Trypanosoma cruzi. The chronic phase of CD is characterized by the presence of IgG anti-T. cruzi antibodies; and diagnosis is performed by serological methods. Because there is no reliable test that can be used as a reference test, WHO recommends the parallel use of two different tests for CD serodiagnosis. If results are inconclusive, samples should be subjected to a confirmatory test, e.g., Western blot (WB) or PCR. PCR offers low sensitivity in the chronic phase, whereas few confirmatory tests based on the WB method are commercially available worldwide. Therefore, new diagnostic tools should be evaluated to fill the gap in CD confirmatory tests. In recent years, four chimeric recombinant antigens (IBMP-8.1, IBMP-8.2, IBMP-8.3 and IBMP-8.4) have been evaluated in phase I, II and III studies using ELISA, liquid microarray and immunochromatography with 95-100% accuracy. Given the high diagnostic performance of these antigens, the present study investigated the ability of these molecules to diagnose chronic CD using a WB testing platform.Methodology/principal findingsIn this study, we analyzed the diagnostic potential of four chimeric antigens using 40 T. cruzi-positive, 24-negative, and three additional positive samples for visceral leishmaniasis (i.e., potentially cross-reactive) using WB as the diagnostic platform. Checkerboard titration with different dilutions of antigens, conjugated antigens, and serum samples was performed to standardize all assays. All IBMP antigens achieved 100% sensitivity, specificity, and accuracy, with the exception of IBMP-8.3, which had 100% specificity despite lack of significance, but lower sensitivity (95%) and accuracy (96.9%). No cross-reactivity was observed in samples positive for leishmaniasis.Conclusions/significanceThe present phase I (proof-of-concept) study demonstrated the high diagnostic potential of these four IBMP antigens to discriminate between T. cruzi-positive and -negative samples, making them candidates for phase II and confirmatory testing with WB.

Objective: This review is to compare patient-satisfaction with ball-type overdenture attachment systems with others attachment systems. Material and methods: This study was registered in PROSPERO (CRD42018097234) and adheres the PRISMA guidelines. Electronic searches on PubMed/MEDLINE, Scopus, Cochrane, and Web of Science databases for published articles were performed before October 2020. The PICO question was: “Do patients with a ball-type overdenture retention system have greater satisfaction, when compared to other attachment systems?” The evaluation of risk of bias was performed using the Cochrane risk of bias tool. Results: After searching the databases, seven articles were selected out of a total of 2583. A total of 312 implants were placed in 139 patients, with a mean age of 65.9 years. The risk of bias in the included studies varied according to the different domains in a risk of uncertain bias or low bias risk. No difference was found between the ball attachment systems and the others systems, with respect to patient-satisfaction. The meta-analysis revealed no statistically significant difference between the ball systems and another systems (P = 0.11; MD: 10.90; 95% CI: −2.55 to 24.35). Conclusions: Regarding patient general satisfaction, it was not possible to determine differences between the ball system and another types of attachment system for overdenture. The ball-type system was statistically superior only to the magnet system.

ABSTRACT Objective: The medial longitudinal arch is the main structure of load bearing and shock absorption of the foot. The evaluation of medial longitudinal arch, such as the navicular height, the medial longitudinal arch angle and the Feiss line should be performed with the subtalar joint in the neutral and relaxed position. Our study analyzed the correlation between the measurements of the subtalar joint in neutral and relaxed positions during the evaluation tests of the medial longitudinal arch. Methods: This is a cross-sectional study, in which 51 healthy volunteers (102 feet; 36 women; 28 ± 5 years, 1.66 ± 0.10 m; 24.5 ± 4.5 kg/m2) had their navicular height, medial longitudinal arch angle and Feiss line measured in the neutral and relaxed positions. The correlation between the measures was evaluated using Pearson’s test. Results: A strong correlation of the 102 feet Feiss line measurements between neutral and relaxed positions (r = 0.81) was observed, and a moderate correlation between the medial longitudinal arch angle (r = 0.78) and between navicular height in neutral and relaxed positions (r = 0.76). Conclusion: The measurements of the longitudinal medial arch between the neutral and relaxed positions are strongly correlated. Therefore, it is not necessary to measure the medial longitudinal arch in both neutral and relaxed positions. Level of Evidence II, Diagnostic Studies - Investigating a diagnostic test.

RESUMO A partir do movimento da Reforma Psiquiátrica no Brasil, o campo da saúde mental tem sido marcado pela importância do debate teórico-prático e político sobre a interprofissionalidade devido à complexidade dos cuidados psicossociais. Nesse contexto, as transformações laborais colocam em relevo as identidades individuais e coletivas dos profissionais. Este estudo discute e analisa o trabalho em equipe de um grupo de trabalhadores da saúde mental como território de constituição de identidades coletivas que podem dar suporte a um fazer clínico interprofissional sintônico às demandas da reforma psiquiátrica.

ABSTRACT The objective of this study was to estimate genetic parameters and genetic trends of different conformation and management traits regularly measured within the context of the National Dairy Gir Breeding Program (PNMGL). The estimation of genetic and residual variances for each trait was performed using average information restricted maximum likelihood (AI-REML) procedure in AIREMLF90 program software. The population was divided into three subpopulations constituted by measured females (with phenotype records), all females, and males. Linear regressions were applied for each trait, considering two periods of birth (1st period: 1938-1996; 2nd period: 1997-2012). The estimated heritability of conformation and management traits varied from 0.01 to 0.53, denoting a perspective of genetic improvement through selection and corrective matings for purebred Dairy Gir populations. The average genetic changes in conformation and management traits were, in general, variable and inexpressive, showing that the selection of Dairy Gir may have had been directed essentially to increase milk yield. The analysis of the two periods of birth indicated that some linear traits present progress (although inexpressive) in the 2nd period (more recent period).

Hereditary hyperferritinemia-cataract syndrome (HHCS) is a rare, frequently misdiagnosed, autosomal dominant disease caused by mutations in the FTL gene. It causes bilateral pediatric cataract and hyperferritinemia without iron overload. The objective of this case series, describing three Brazilian families, is to increase awareness of HHCS, as well as to discuss possible phenotypic interactions with concurrent mutations in HFE, the gene associated with autosomal recessive inheritance hereditary hemochromatosis. Whole-exome sequencing was performed in eight individuals with HHCS from three different families, as well as one unaffected member from each family for trio analysis—a total of eleven individuals. Ophthalmological and clinical genetic evaluations were conducted. The likely pathogenic variant c.-157G>A in FTL was found in all affected individuals. They presented slowly progressing bilateral cataract symptoms before the age of 14, with a phenotype of varied bilateral diffuse opacities. Hyperferritinemia was present in all affected members, varying from 971 ng/mL to 4899 ng/mL. There were two affected individuals with one concurrent pathogenic variant in HFE (c.187C>G, p.H63D), who were also the ones with the highest values of serum ferritin in our cohort. Few publications describe individuals with pathogenic mutations in both FTL and HFE genes, and further studies are needed to assess possible phenotypic interactions causing higher values of hyperferritinemia.

Introdução: Pacientes com obesidade buscam a redução de peso por meio de diferentes tratamentos, inclusive a cirurgia bariátrica, mas essa estratégia geralmente não ocorre sem um histórico pregresso. Objetivo: Descrever as estratégias para perda de peso utilizadas pelos pacientes obesos encaminhados à cirurgia bariátrica. Materiais e Métodos: Estudo descritivo com candidatos à cirurgia bariátrica. Foram incluídos indivíduos com idade ≥ 18 anos, com IMC ³ 35 kg/m2 e excluídos aqueles com insuficiência cardíaca, hepática, pancreática, renal, respiratória, doença consumptiva, disfunção tireoidiana descompensada e com dados incompletos sobre as estratégias de emagrecimento. Os dados foram coletados dos prontuários e de questionários autoaplicados. Os fatores associados às estratégias foram: idade, sexo, IMC, escolaridade, início da obesidade e a situação conjugal. Resultados: Foram estudados 705 pacientes, com média (desvio padrão) da idade de 36,4 (10,0) anos, 54,6% com IMC ³ 40,0 kg/m2 e 71,1% do sexo feminino. As estratégias de emagrecimento mais utilizadas foram: dieta (84,5%) e atividade física (80,6%) seguida de remédios (68,7%). O sexo, o início da obesidade e a escolaridade influenciaram tanto na escolha quanto no número de estratégias de emagrecimento. Já a idade e a situação conjugal interferiram apenas na seleção das estratégias. Conclusão: Os pacientes possuíam um extenso histórico de estratégias de emagrecimento e tanto a escolha quanto a quantidade de estratégias variaram de acordo com as variáveis estudadas.

Abstract Background Approximately 5% of COVID-19 patients develop respiratory failure and need ventilatory support, yet little is known about the impact of mechanical ventilation strategy in COVID-19. Our objective was to describe baseline characteristics, ventilatory parameters, and outcomes of critically ill patients in the largest referral center for COVID-19 in Sao Paulo, Brazil, during the first surge of the pandemic. Methods This cohort included COVID-19 patients admitted to the intensive care units (ICUs) of an academic hospital with 94 ICU beds, a number expanded to 300 during the pandemic as part of a state preparedness plan. Data included demographics, advanced life support therapies, and ventilator parameters. The main outcome was 28-day survival. We used a multivariate Cox model to test the association between protective ventilation and survival, adjusting for PF ratio, pH, compliance, and PEEP. Results We included 1503 patients from March 30 to June 30, 2020. The mean age was 60 ± 15 years, and 59% were male. During 28-day follow-up, 1180 (79%) patients needed invasive ventilation and 666 (44%) died. For the 984 patients who were receiving mechanical ventilation in the first 24 h of ICU stay, mean tidal volume was 6.5 ± 1.3 mL/kg of ideal body weight, plateau pressure was 24 ± 5 cmH2O, respiratory system compliance was 31.9 (24.4–40.9) mL/cmH2O, and 82% of patients were ventilated with protective ventilation. Noninvasive ventilation was used in 21% of patients, and prone, in 36%. Compliance was associated with survival and did not show a bimodal pattern that would support the presence of two phenotypes. In the multivariable model, protective ventilation (aHR 0.73 [95%CI 0.57–0.94]), adjusted for PF ratio, compliance, PEEP, and arterial pH, was independently associated with survival. Conclusions During the peak of the epidemic in Sao Paulo, critically ill patients with COVID-19 often required mechanical ventilation and mortality was high. Our findings revealed an association between mechanical ventilation strategy and mortality, highlighting the importance of protective ventilation for patients with COVID-19.