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Abstract Background In the search for new therapies novel drugs and medications are being discovered, developed and tested in laboratories. Highly diluted substances are intended to enhance immune system responses resulting in reduced frequency of various diseases, and often present no risk of serious side-effects due to its low toxicity. Over the past years our research group has been investigating the action of highly diluted substances and tinctures on cells from the immune system. Methods We have developed and tested several highly diluted tinctures and here we describe the biological activity of M1, M2, and M8 both in vitro in immune cells from mice and human, and in vivo in mice. Cytotoxicity, cytokines released and NF-κB activation were determined after in vitro treatment. Cell viability, oxidative response, lipid peroxidation, bone marrow and lymph node cells immunophenotyping were accessed after mice in vivo treatment. Results None of the highly diluted tinctures tested were cytotoxic to macrophages or K562. Lipopolysaccharide (LPS)-stimulated macrophages treated with all highly diluted tinctures decreased tumour necrosis factor alpha (TNF-α) release and M1, and M8 decreased IFN-γ production. M1 has decreased NF-κB activity on TNF-α stimulated reporter cell line. In vivo treatment lead to a decrease in reactive oxygen species (ROS), nitric oxide (NO) production was increased by M1, and M8, and lipid peroxidation was induced by M1, and M2. All compounds enhanced the innate immunity, but M1 also augmented acquired immunity and M2 diminished B lymphocytes, responsible to acquired immunity. Conclusions Based on the results presented here, these highly diluted tinctures were shown to modulate immune responses. Even though further investigation is needed there is an indication that these highly diluted tinctures could be used as therapeutic interventions in disorders where the immune system is compromised.

The aim of this two-phase study was to evaluate the use of beet pulp concentrate (BPC) in athletic horses. On the first trial the effects of supplementation with 820g of BPC for 12 weeks were assessed and a crossover postprandial curves of blood biomarkers were determined in five adult Arabian mares. Differences were found in T-chol, HDL-chol, TPP and MCHC (p < 0.05). Postprandial curves varied among challenges (p < 0.05) for glucose, insulin, and hematocrit. These results confirmed that BPC supplementation led to changes in blood biomarkers, without inducing major metabolic disruption. The aim of the second trial was to evaluate effects of resistance training using a horse walker in eight yearling gaited foals fed with BPC (16 %) for 12 weeks. Blood samples were collected before and at 30, 60 and 90 days of training and results demonstrated the highest level of [NEFA] and [triglycerides] at end of experimental period (p < 0.05) and increased of growth hormone after exercise sections after 60 days (p < 0.05). Also, [MCHC] and [Hb] increased 30 days after beginning of training program (p < 0.05), maintaining until the end of trial period. Association of the training program with highly digestible fiber as BPC possibly led to a greater availability of NEFA and hCG certainly helping the physical conditioning of these young animals., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Francesco Fazio reports a relationship with Heliyon journal that includes: board membership. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

The objective of this study was to evaluate the fractal dimension (FD) and lacunarity of the mandibular bone, comparing patients with and without osteoradionecrosis (ORN). In a cross-sectional study with a control group, 25 patients were included and divided into a case group (with ORN, n = 14) and a control group (without ORN, n = 11). A digital panoramic radiograph taken after the end of radiotherapy (RT) was evaluated for each patient. FD and lacunarity of the mandibular bone were determined using ImageJ software. Descriptive, bivariate, and ROC curve analyses were performed. Cohen's d effect sizes were calculated. Significance was established at p < 0.05. The mean FD and lacunarity values were not significantly different between the groups. The area under the curve for FD and lacunarity were 0.579 and 0.661, respectively. The cut-off point for FD was ≤1.1714 and for lacunarity, > 0.3821, correctly classifying the majority of cases and controls. Most participants in the case group (63.6%) had a FD ≤ 1.1714 and the majority of participants in the control group (63.6%) had a FD >1.1714 (p = 0.395). For lacunarity, most individuals in the case group (72.7%) had a value > 0.3821 and most participants in the control group (63.6%) had a value ≤ 0.3821 (p = 0.198). In conclusion, the FD and lacunarity values did not show statistically significant differences between patients with and without ORN. However, the moderate and large magnitude of the effects seem to indicate that the results may be clinically relevant.

Background: Skin physiology seems to be influenced by dietary choices and body composition, although links between these factors remain poorly characterised. In the present manuscript, we elaborate on the potential relationships among food groups, body composition and skin physiology in omnivores and vegetarians., Material and Methods: This cross-sectional observational study involved 181 participants, 129 omnivores and 52 vegetarians. The main functions of the skin measured in our laboratory were transepidermal water loss, deep and superficial epidermal hydration, skin elasticity, and carotenoid content. Skin variables obtained from different body regions were made comparable by a new Proportional Skin Index calculated to respect their relative representativity., Results: No statistical differences were found when comparing both groups' body composition and skin variables from different body regions, with the exception of the skin carotenoid content significantly higher in the vegetarian group (p < 0.001)., Conclusion: Although dietary patterns significantly differed between groups, with vegetarians consuming fewer animal-derived products and more plant-based foods, multiple linear regression analysis revealed no differences or association between the dietary pattern and the skin physiology. These findings highlight the need for further research to elucidate the specific impact of diet and food groups and body composition on skin physiology., (© 2024 The Author(s). Skin Research and Technology published by John Wiley & Sons Ltd.)

In anaerobic digestion (AD), the choice of inoculum type seems to be relevant for methane production for complex substrates, such as lignocellulosic material. Previous work demonstrated that the addition of fresh manure and ruminal fluid to anaerobic sludge improved methane productivity and kinetics of AD of crude sugarcane bagasse (CSB). Considering that the improvement of methane production could be a result of a more adapted microbial community, the present study performed the Next Generation Sequencing analysis to identify changes in the microbiome of anaerobic sludge inoculum, resulting from fresh manure and ruminal fluid addition. In comparison with AD performed only with anaerobic sludge inoculum (50:50, U), accumulated methane production was 15% higher with anaerobic sludge plus ruminal fluid inoculum (50:50, UR) and even higher (68%) with anaerobic sludge with fresh bovine manure inoculum (50:50, UFM), reaching the value of 143 NmL CH4. g VS -1 . Clostridium species were highly abundant in all inocula, playing an important role during the hydrolysis and fermentation of CSB, and detoxifying potential inhibitors. Microbial composition also revealed the occurrence of Pseudomonas and Anaerobaculum at UFM inoculum that seem to have contributed to the higher methane production rate, mainly due to their hydrolytic and fermentative ability on lignocellulosic substrates. On the other hand, the presence of Alcaligenes might have had a negative effect on methane production due to their ability to perform methane oxidation.

Stress substantially increases the risk of developing painful temporomandibular disorders (TMDs) by influencing the release of endogenous catecholamines. Propranolol, an antagonist of β-adrenergic receptors, has shown potential in alleviating TMD-associated pain, particularly when the level of catecholamines is elevated. The aim of this study was to explore whether intra-articular propranolol administration is effective in diminishing temporomandibular joint (TMJ) pain during repeated stress situations. Additionally, we investigated the effect of repeated stress on the expression of genes encoding β-adrenoceptors in the trigeminal ganglion. In the present study, rats were exposed to a stress protocol induced by sound, then to the administration of formalin in the TMJ (to elicit a nociceptive response), followed immediately afterward by different doses of propranolol, after which the analgesic response to propranolol was evaluated. We also assessed the levels of beta-1 and beta-2 adrenergic receptor mRNAs (Adrb1 and Adrb2, respectively) using reverse transcription-quantitative PCR (RT-qPCR). Our findings revealed that propranolol administration reduces formalin-induced TMJ nociception more effectively in stressed rats than in non-stressed rats. Furthermore, repeated stress decreases the expression of the Adrb2 gene within the trigeminal ganglion. The findings of this study are noteworthy as they suggest that individuals with a chronic stress history might find potential benefits from β-blockers in TMD treatment., (© 2023 Scandinavian Division of the International Association for Dental Research. Published by John Wiley & Sons Ltd.)

Follicular lymphoma is a hematolymphoid neoplasm that originates from germinal center B cells. It is made up of a combination of small cleaved centrocytes and a varying quantity of larger non-cleaved centroblasts to describe the clinical, microscopic, immunohistochemical, and molecular features of oral follicular lymphomas. Follicular lymphomas affecting the oral cavity were retrieved from pathology files. Immunohistochemistry was performed to confirm the diagnosis, and fluorescence in situ hybridization (FISH) was employed to detect rearrangements in BCL2, BCL6, and MYC genes. Clinical and follow-up data were obtained from the patient's medical and pathology files. Twenty cases were obtained. There was an equal sex distribution (10 males: 10 females) and a mean age of 60.9 years (range: 10-83 years-old). Lesions presented as asymptomatic swellings, usually in the palate (10 cases) and the buccal mucosa (7 cases). Five patients presented with concomitant nodal involvement. Microscopic evaluation depicted the follicular growth pattern with diffuse areas in six cases. Grades 1 and 2 follicular lymphomas represented 12 cases, while grade 3A neoplasms accounted for other 8 cases. Two cases showed rearrangements in MYC, BCL2, and BCL6 genes, while single BCL2 translocation was found in eight cases. Two cases had no translocation. Three patients deceased and the 2-year overall survival achieved 88%. Follicular lymphoma affecting the oral cavity is uncommon, usually affects the palate as a non-ulcerated swelling and the presence of a systemic disease most always be ruled out., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: This pilot study aimed to evaluate the mutagenic effects in cells of the oral mucosa after exposure to two different cone beam computed tomography (CBCT)., Methods: Eighteen adults were submitted to the different CBCT (Carestream CS8100 3D and I-CAT). The cells were collected immediately before the CBCT exposure and 10 days later, when the material was placed on a slide and stained using the Feulgen/Fast Green technique. Microscopic analysis counted micronuclei and other nuclear alterations, which are indicative of cytotoxicity such as pyknosis, karyolysis, karyorrhexis, and binucletion. 2000 cells were analyzed. The statistical analysis was performed with the Wilcoxon Signed-Rank test to compare the frequency of cellular alterations, and the Mann-Whitney U test to compare different CBCTs, both with a significance level of 5%., Results: There was no statistically significant difference in the micronucleated cell count before and after the exposition to the ionizing radiation from I-CAT (p = .298) and CS8100 3D (p = .203) A significate increase of pyknosis (p < .001), karyolysis (p < .001), karyorrhexis (p < .001), and binucletion (p < .001) were noted on I-CAT CBCT. There was no statistically significant difference in cellular alterations in CS8100 3D CBCT., Conclusion: Despite the increase in micronuclei after exposure, this study indicates that there is no evidence of genotoxicity. On the other hand, the I-CAT CBCT produced cytotoxic effects., (© 2023 Wiley Periodicals LLC.)

Background and Objectives: Nandrolone decanoate (ND) is the most widely used among the anabolic androgenic steroids (AAS), synthetic substances derived from testosterone, to improve muscular and health gains associated with exercises. The AAS leads to physical performance enhancement and presents anti-aging properties, but its abuse is associated with several adverse effects. Supraphysiological doses of AAS with or without physical exercise can cause morphological and functional alterations in neuromuscular interactions. This study aims to investigate the effects of ND supraphysiological doses in neuromuscular interactions, focusing on the soleus muscle and its neuromuscular junctions (NMJs) in rats, associated or not with physical exercise. Materials and Methods: Forty male Sprague Dawley rats were divided into four groups: sedentary and exercised groups, with or without ND at the dose of 10 mg/kg/week. The animals were treated for eight weeks, with intramuscular injections, and the soleus muscle was collected for morphological analyses. Results: The supraphysiological doses of ND in the sedentary group caused muscle degeneration, evidenced by splitting fibers, clusters of small fibers, irregular myofibrils, altered sarcomeres, an increase in collagen deposition and in the number of type I muscle fibers (slow-twitch) and central nuclei, as well as a decrease in fibers with peripheral nuclei. On the other hand, in the ND exercise group, there was an increase in the NMJs diameter with scattering of its acetylcholine receptors, although no major morphological changes were found in the skeletal muscle. Thus, the alterations caused by ND in sedentary rats were partially reversed by physical exercise. Conclusions: The supraphysiological ND exposure in the sedentary rats promoted an increase in muscle oxidative pattern and adverse morphological alterations in skeletal muscle, resulting from damage or post-injury regeneration. In the ND-exercised rats, no major morphological changes were found. Thus, the physical exercise partially reversed the alterations caused by ND in sedentary rats.

Dermoid cysts (DCs) and epidermoid cysts (ECs) are uncommon developmental cysts affecting the oral cavity. This study aims to evaluate patients with oral DCs and ECs and their demographic and clinicopathologic features. A retrospective descriptive cross-sectional study was performed. A total of 105,077 biopsy records of oral and maxillofacial lesions from seven Brazilian oral pathology centers were analyzed. All cases diagnosed as oral DCs and ECs were reviewed, and clinical, demographic, and histopathological data were collected. The series comprised 32 DCs (31.4%) and 70 ECs (68.6%). Most of the DCs occurred on the floor of the mouth (n = 14; 45.2%) of women (n = 17; 53.1%) with a mean age of 34.6 ± 21.6 years. All DCs were lined partially or entirely by stratified squamous epithelium (100%). Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were observed in the fibrous capsule . Most of the ECs affected the labial mucosa (n = 20; 31.7%) of men (n = 39; 56.5%) with a mean age of 48.0±19.8 years. Microscopically, most ECs (n = 68; 97.1%) were lined entirely by stratified squamous epithelium. Two cysts (2.9%) showed areas of respiratory metaplasia. Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were also observed in the fibrous capsule. Conservative surgical excision was the treatment of choice in all cases. Oral DCs and ECs are uncommon and often clinically misdiagnosed lesions. Clinicians should consider DCs and ECs in the differential diagnosis of soft tissue lesions in the oral cavity, mainly located on the floor of the mouth and labial mucosa.

Objectives: The aim was to evaluate the effectiveness of photobiomodulation and antimicrobial photodynamic therapy in the treatment of oral mucositis., Background: Oral Mucositis is a frequent complication of oral cavity and oropharynx cancer. Considering the OM aggravation by microorganisms contamination, disinfection provide by antimicrobial photodynamic therapy could be an effective approach., Material and Methods: This comparative study included fourteen patients undergoing radiochemotherapy for oral cavity and oropharynx cancer treatment, who developed oral mucositis., Control Group: photobiomodulation. Intervention group: photobiomodulation and antimicrobial photodynamic therapy. The lesion size, duration, pain, and identification of microorganisms were evaluated., Results: The mean reduction in oral mucositis size in the intervention group was 0.70 cm² (±0.35) and 0.30 cm² (±1.10) for the control group. The mean duration of oral mucositis was 18.37 days (±12.12) for the intervention group and 23 days (±14.78) for the control group. The intervention group had a mean reduction of 3.40 points on the pain scale (±2.44), while the control group had 0.17 (±2.28). In the intervention group, the predominant isolated microbiota was featured as mixed culture (n = 4/ 50%), followed of Gram Positive (n = 3/ 37.50%), and Gram Negative (n = 1/ 12.55%). In the control group, mixed culture was also more frequent (n = 4 / 66%), followed by Gram Positive (n = 2 /34%). Gram Negative was not predominantly isolated in the control group., Conclusion: No statistical significance was found between PBM-T alone and PBM-T + PDT. However, the better outcomes reached by PBM-T + PDT group would suggest there could be a role for combined treatment in the management of OM lesions., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Vasculitis is an uncommon complication of biologics used to treat inflammatory bowel disease (IBD). This study describes a case series of vasculitis induced by anti-tumor necrosis factor (TNF) therapy in IBD patients., Methods: Retrospective assessments were performed using the medical records of adult IBD patients who underwent outpatient clinical follow-ups between January 2010 and December 2019 in order to identify patients with vasculitis caused by anti-TNF therapy., Results: There were 2442 patients altogether. Of these, 862 (35%) took anti-TNF medication. Five patients (0.6% of the overall patients; n = 3 (60%) Crohn's disease; n = 2 (40%), ulcerative colitis) were identified as having leukocytoclastic vasculitis (LCV) due to anti-TNF therapy; these patients were white, female, and non-smokers. The mean age of LCV diagnosis was 32.2 years, and the mean IBD duration was 7.2 years. The mean time between the start of biologic therapy and LCV onset was 30.8 months. Most of the patients were using adalimumab (80%; n = 4). All the patients were in remission at the time of the LCV diagnosis, and the vasculitis affected the skin in all cases. Anti-TNF therapy was discontinued in the five abovementioned patients, and the response of LCV to the oral steroids was significantly positive. Remarkably, all five patients experienced complete remission from LCV within 4-12 weeks after starting prednisone therapy, and none of them had LCV recurrence in the follow-up period (a mean duration of 28 months)., Conclusions: LCV is an unusual complication of anti-TNF therapy in the IBD setting. In this context, clinicians should have a high degree of suspicion of LCV in patients who develop an unexplained cutaneous rash.

Introduction: Spinal cord injury (SCI) is a serious disabling syndrome, and the clinical picture depends on the level and extent of the injury. The International Spinal Cord Society (ISCoS) and the American Spinal Cord Association (ASIA) have developed instruments (Data Sets) to assess the various aspects of the SCI. In 2012, the International SCI Pulmonary Function Basic Data Set was elaborated. It is composed of four questions and spirometry for the collection of lung function basic data., Objective: The objective was to translate and validate the International SCI Pulmonary Function Basic Data Set to the Portuguese language., Methods: The entire methodology followed the recommendations of the ISCoS and ASIA. Two translations of the original version into Portuguese were performed, and after consensus among the translators, the Portuguese version was sent for back-translation. After back-translation and comparison with the original version, the final Portuguese version was obtained. For the second phase of the study, 30 SCI individuals were selected. Two interviewers applied the questionnaire in two distinct moments., Results: All results presented constant, excellent, or perfectly concordant data, except for the third question in the inter-rater comparison, where the Kappa coefficient showed value reasonable in the first interview and good in the second., Conclusion: The translation into Brazilian Portuguese of the "International SCI Pulmonary Function Basic Data Set" created a valid and highly reliable instrument, like the original without linguistic and cultural disagreements that allow its use in the evaluation of patients with SCI in Brazil., (© 2022. The Author(s), under exclusive licence to International Spinal Cord Society.)

Introduction and Objective: In Spain, vitamin K antagonists (VKA) remain the standard treatment for the prevention of thromboembolic and hemorrhagic complications in patients with atrial fibrillation (AF), despite the high risks of suffering adverse effects. The objective of this study was to characterize the profile of VKA-treated patients suffering from stroke/systemic embolism (SE) or major hemorrhagic episodes, their evolution and the actions taken after those episodes., Materials and Methods: EVENTHO was an observational multicenter study conducted in 22 Anticoagulation Spanish Units. The study included patients ≥18 years with AF who suffered major hemorrhagic episodes (67.8%) or stroke/SE (32.1%) during 2016 whileon VKA treatment [acenocoumarol (98.2%) or warfarin (1.8%)]. Time in therapeutic range (TTR) was calculated according to the Rosendaal method based on the international normalized ratio (INR) values of the previous 6 months., Results: The study included 585 patients (median age [range] 82.3 [43.6-96.2] years; 51.1% men; mean [95% confidence interval, CI] CHA 2 DS 2 -VASc: 4.3 [4.2-4.4] and HAS-BLED: 2.2 [2.1-2.3]). Poor anticoagulation and VKA maintenance were higher in patients with major hemorrhagic episode (p<0.0001). The most common situations after hospital discharge were: functional dependence, neurological sequelae and death., Conclusions: In the sample studied, half of the AF patients who suffered stroke/SE or major hemorrhagic episode had inadequate TTR and, despite this, after hospital discharge, they restarted treatment with VKA. These results highlight the need to evaluate safer and effective therapeutic alternatives in AF patients with poor TTR control after suffering a stroke/SE or major hemorrhagic episode., (Copyright © 2022 Elsevier España, S.L.U. All rights reserved.)

This study was conducted to characterize the transmission cycle of the tegumentary leishmaniasis (TL) in an old colonization area at Pernambuco State, Brazil. The aims were to identify autochthonous cases, sandflies fauna, domestic animals as possible reservoir hosts and the Leishmania species involved in this endemic area. A total of 168 suspected human cases of TL and 272 domestic animals (canine, feline, equine, goat, and sheep) were included. The sandflies were captured and identified by species. Patients were predominantly male and the average age was 37+18.1 years old. Of 85 patients who had skin lesions, 25.6% of them had direct positive smears for TL and 34 isolates were identified as Leishmania (Viannia) braziliensis. The confirmation for TL diagnosed by molecular detection (PCR) was almost three times more sensitive than the direct test [p < 0.001; PR = 2.72] associated with clinical examination. The Kappa test on PCR between two different specimens, biopsy, and skin lesion swab was 60.8% (p < 0.001). More than 200 specimens of sandflies (80 males and 159 females) were captured and identified as Lutzomyia whitmani (99.6%) and Lu. evandroi (0.4%). The detection of L. (V.) braziliensis by Real-Time PCR in the blood of a captured fed female was positive in 59.3% of Lu. whitmani. Of the 272 domestic animals included, 61.76% were male (n = 168). Thirty-six animals (13.2%) had lesions compatible with TL (34 dogs, 1 cat and 1 sheep) and 3 of them, all dogs, had lesions on the snout, showing destruction of cartilage and mucosa. The study suggests the participation of domestic animals as possible reservoirs. However, further studies are necessary to better understand the transmission cycle and take recommended measures in order to control the disease.

Aelurostrongylosis, caused by the metastrongylid nematode Aelurostrongylus abstrusus, is an underestimated feline respiratory disease. Cats infected by A. abstrusus may show subclinical to severe clinical signs. Aelurostrongylus abstrusus has a worldwide distribution. Nevertheless, studies on this parasite in Brazil are scarce, and most have been conducted in the southern regions. This study investigated the occurrence of A. abstrusus in cats in Vilhena, Rondônia, Brazil, from April 2020 to February 2021. Three consecutive individual fecal samples from 101 cats were examined using Baermann and Hoffman tests. Two cats (1.98%) scored positive for A. abstrusus, one with the Baermann examination, and one with the Hoffman technique. No other lungworms were retrieved. The clinicopathological and epizootiological implications are described and discussed.

Objective: To evaluate the association between the degree of food processing, overweight, and abdominal obesity in adolescents., Methods: This is a cross-sectional study, with 576 adolescents aged 10 to 17 years, of both sexes. Food consumption was collected using the Food Frequency Questionnaire and foods classified as in natura or minimally processed, processed foods associated with culinary ingredients, and ultraprocessed foods. Sociodemographic data, body mass index, waist circumference and waist-to-height ratio were collected. The analysis was evaluated by the Mann-Whitney test and prevalence ratio with 95% confidence interval, considering p<0.05., Results: An intake above the third quartile of processed foods associated with culinary ingredients (prevalence ratio of 1.64; 95%CI: 1.12-2.42) and ultraprocessed (prevalence ratio of 1.58; 95%CI: 1.07-2.34) was associated with a higher prevalence of overweight. Consumption above the third quartile of ultraprocessed foods was associated with a higher prevalence of abdominal obesity, assessed by waist circumference (prevalence ratio of 2.48; 95%CI: 1.41-4.36), and waist-height ratio (prevalence ratio of 2.09; 95%CI: 1.11-3.92)., Conclusion: A higher consumption of processed foods associated with culinary ingredients was related to being overweight, and ultraprocessed foods with overweight and abdominal obesity.

Objective: To identify the prevalence of adverse events and the critically ill patient's need for care in an intensive care unit., Method: This is a cross-sectional study, carried out from January to March 2020. The adverse events investigated were pressure injury, accidental orotracheal extubation, fall, loss of central venous access, and healthcare-associated infection. The number of hours required for patient care was measured by the Nursing Activities Score. The categorical independent variables were described by absolute and relative frequencies, and the continuous ones, by central tendency. The magnitude measure was the odds ratio and a confidence interval of 95% was considered., Results: of the 88 patients evaluated, 52.3% had adverse events, which were associated with a greater need for care, severity, and longer hospital stay. The mean Nursing Activities Score was 51.01% (12 h 24 min), with a deficit of 20% to 30% of nursing staff in the unit being identified., Conclusion: The prevalence of adverse events in the unit is high and the shortage of nursing staff in the unit revealed the need for adequate staffing to reduce the damage caused by the care provided to critically ill patients.

Objective:  To examine the possible effects of adrenal prohormones in the prediction of clinical and metabolic abnormalities in women with polycystic ovary syndrome (PCOS)., Methods:  The present study enrolled 299 normal cycling non-PCOS, 156 normoandrogenemic, and 474 hyperandrogenemic women with PCOS. Baseline characteristics were compared using a chi-squared test or analysis of variance (ANOVA) as appropriate. The roles of adrenal prohormones and their ratios with total testosterone in predicting co-occurring morbidities in women PCOS were evaluated using univariate and multivariate logistic regression analyses., Results:  Adrenal hyperandrogenism per dehydroepiandrosterone sulfate (DHEAS) levels were found in 32% of women with PCOS. In non-PCOS women, dehydroepiandrosterone (DHEA) and its sulfate had no predictive role concerning clinical, anthropometric, and metabolic parameters. In PCOS women, mainly in the hyperandrogenemic group, DHEA showed to be a significant predictor against most anthropometric-metabolic index abnormalities (odds ratio [OR] = 0.36-0.97; p  < 0.05), and an increase in triglycerides (TG) levels (OR = 0.76; p  = 0.006). Dehydroepiandrosterone sulfate presented a few predictive effects regarding PCOS-associated disorders. In controls, DHEAS predicted against the increase in estimated average glucose (OR= 0.38; p  = 0.036). In the normoandrogenic group, it predicted against elevation in the waist/hip ratio (WHR) (OR= 0.59; p  = 0.042), and in hyperandrogenemic PCOS women, it predicted against abnormality in the conicity index (CI) (OR = 0.31; p  = 0.028)., Conclusion:  Dehydroepiandrosterone was shown to be a better predictor of abnormal anthropometric and biochemical parameters in women with PCOS than DHEAS. Thus, regarding adrenal prohormones, DHEA measurement, instead of DHEAS, should be preferred in PCOS management. The effects of androgen prohormones on the prediction of PCOS abnormalities are weak., Competing Interests: The authors have no conflict of interests to declare., (Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Morphological tools can assist in the evaluation of effects of insecticides on non-target insects. Pyriproxyfen, a juvenile hormone analog, is known to interfere with growth and metamorphosis of insects. However, there are studies showing indirect effects on natural enemies, including green lacewings. Few prior studies describe morphological effects of pyriproxyfen on target insect organs, especially on natural enemies. Through morphological tools, this study aimed to characterize the midgut and fat body, both important organs of digestion and great metabolic activity respectively, of the predator Ceraeochrysa claveri after chronic exposure to pyriproxyfen. Larvae of C. claveri were fed Diatraea saccharalis egg clusters treated with pyriproxyfen in solution of 50 or 100 mg a.i. L -1 throughout the larval stage. The biological data revealed significant increases in development time, especially in the third instar, and in cumulative mortality from the prepupal into the pupal stage. Morphological analysis of adult midgut (≤24 h old) showed damage including formation of epithelial folds, intercellular spaces, emission of cytoplasmic protrusions. Both fat body regions presented decrease of lipid droplets, vacuolization of trophocytes and mitochondrial injury featuring a multisystemic action. In both organs, pyriproxyfen exposure induced significant oxidative stress by mitochondrial superoxide production. Cytoprotective responses were induced in midgut and fat body cells by augmenting the number of cytoplasmic granules containing calcium and expression of HSP 90. Both organs proved to be efficient in presenting histopathological alterations, showing the sensitivity and applicability of this morphological tool for evaluating other insecticides in non-target organisms., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Head and neck squamous cell carcinoma (HNSC) etiopathogenesis remains unclear, and the biological changes with the activation of heat shock proteins (HSPs) and prion protein (PRNP) promoted by hypoxia in HNSC are undetermined. This study investigates hypoxia's effect in lymph node metastasis by PRNP expression changes and its main partners., Methods: The study combined a theoretical/cell culture study with a case-control study. First, bioinformatics and cell culture were performed. A case-control study was performed in a second step by comparing HNSC patients with and without lymph node metastasis., Analyses: The Cancer Genome Atlas (TCGA) data source validates the theory in the global population study., Results: Bioinformatics analysis suggests that hypoxia-inducible factor-1α (HIF1A) is associated with HSPA4, HSP90AA1 and PRNP expression. TCGA data validate the hypothesis that higher HSP90AA1, HSPA4 and PRNP are related to metastases and low survival. Herein, the cell study demonstrated that muted PRNP did not respond to hypoxia., Discussion: Our results collectively provide the first evidence that PRNP promotes HNSC lymph node metastasis progression through the upregulation of HSPA4, HSP90AA1 and HIF1A. Our findings may provide a molecular basis for the promoting Role of PRNP in HNSC progression., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background & Aims: Evidence suggests the existence of an association between the institution of nutritional therapy and clinical outcomes in patients with critical COVID-19. Thus, the aim of this study was to evaluate the influence of nutritional assistance on COVID-19 mortality in patients admitted to intensive care units (ICU)., Methods: This is a subset of the cohort "Influence of nutritional therapy on clinical prognosis in patients with COVID-19: a multicenter retrospective cohort study". Clinical and nutrition assistance information (type of assistance, evaluation of anthropometric status, and time of introduction of nutritional therapy) and presence of diabetes, hypertension and previous respiratory disease were collected from electronic medical records. To evaluate the association between the variables of interest and mortality, the hazard ratio was estimated., Results: We evaluated 153 critically ill patients ≥18 years old, affected by COVID-19, with a rate of mortality of 77.8%. Among non survivors 58.8% were female, 52.9% aged <65 years, 66.4% had arterial hypertension, 46.2% diabetes mellitus and 81.5% had an early onset of nutritional support. Initiation of nutritional therapy after 48 h (HR: 2.57; 95% CI: 1.57-4.20) and the presence of obesity (HR: 1.55; 95% CI: 1.04-2.31) were associated with higher mortality, even after adjustment for potential confounders., Conclusions: Our data suggests that the provision of early nutritional therapy should be prioritized, with greater attention directed to obese patients, and the nutritional assistance can contribute favorably to the clinical evolution and prognosis of critically ill patients with COVID-19., Competing Interests: Declaration of competing interest Authors declared they have no conflicts of interest., (Copyright © 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background: Cognitive decline is a common condition, but is still underrepresented in studies conducted in developing countries., Objective: To calculate the prevalence of cognitive decline and depression in an elderly community-dwelling population in a city in southern Brazil., Methods: We calculated the prevalences of dementia, cognitive impairment with no dementia (CIND) and symptoms of depression in an elderly population relying on the public healthcare system. This epidemiological study in Pelotas, Brazil, was conducted within the primary care setting. It included 299 older adults (mean age = 69.75 ± 7.6 years) who presented low levels of education (mean = 4.16 ± 3.17 years of education). They underwent cognitive screening and their medical records were analyzed., Results: Among these older adults, 142 (47.5%) presented cognitive decline: 104 (34.8%) matching the cognitive criteria for CIND and 38 (12.7%) matching the cognitive criteria for dementia. Among all the individuals who completed the cognitive screening, 141 (48.4%) were positive for symptoms of depression, of whom 99 (34%) did not have any previous diagnosis in their medical records., Conclusion: There was high prevalence of cognitive impairment among these older adults in a primary care setting. A large number of older adults were found to have symptoms of depression without any diagnosis.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The COVID-19 pandemic in Brazil is extremely severe, and Brazil has the third-highest number of cases in the world. The goal of the study is to identify the prevalence rates and several predictors of depression and anxiety in Brazil during the initial outbreak of COVID-19. We surveyed 482 adults in 23 Brazilian states online on 9-22 May 2020, and found that 70.3% of the adults ( n = 339) had depressive symptoms and 67.2% ( n = 320) had anxiety symptoms. The results of multi-class logistic regression models revealed that females, younger adults, and those with fewer children had a higher likelihood of depression and anxiety symptoms; adults who worked as employees were more likely to have anxiety symptoms than those who were self-employed or unemployed; adults who spent more time browsing COVID-19 information online were more likely to have depression and anxiety symptoms. Our results provide preliminary evidence and early warning for psychiatrists and healthcare organizations to better identify and focus on the more vulnerable sub-populations in Brazil during the ongoing COVID-19 pandemic.

The process of ovulation involves multiple and iterrelated genetic, biochemical, and morphological events: cessation of the proliferation of granulosa cells, resumption of oocyte meiosis, expansion of cumulus cell-oocyte complexes, digestion of the follicle wall, and extrusion of the metaphase-II oocyte. The present narrative review examines these interrelated steps in detail. The combined or isolated roles of the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are highlighted. Genes indiced by the FSH genes are relevant in the cumulus expansion, and LH-induced genes are critical for the resumption of meiosis and digestion of the follicle wall. A non-human model for follicle-wall digestion and oocyte release was provided., Competing Interests: The authors have no conflict of interests to declare., (Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Aedes aegypti is a cosmopolitan vector for arboviruses dengue, Zika and chikungunya, disseminated in all Brazilian states. The Eco-Bio-Social (EBS) strategy is vital in Aedes aegypti control as it mobilizes stakeholders (government, professionals, society, and academics) to promote healthy environments. This paper describes the rationale and methods of expanding the EBS strategy for Aedes aegypti control in Fortaleza, Northeast Brazil. A cluster, non-randomized controlled clinical trial was developed to analyze the strategy's effectiveness in vulnerable territories (high incidence of dengue and violent deaths; low HDI; substandard urban infrastructure, high population density, and water scarcity). We selected two intervention and two control groups, resulting in a sample of approximately 16,000 properties. The intervention consisted of environmental management by sealing large elevated water tanks, introduction of beta fish in waterholes, elimination of potential breeding sites, and mobilization and training of schoolchildren, endemic disease workers, health workers, social mobilizers, and community leaders; community surveillance of arboviruses; construction and validation of a booklet for the prevention of arboviruses in pregnant women. We analyzed the costs of arboviruses to government and households, the intervention cost-effectiveness, chikungunya's chronicity, and acceptance, sustainability, and governance of vector control actions. The primary outcome (infestation) was analyzed using the house, container, and Breteau indices. We hope that this study will help us understand how to scale up strategies to fight Aedes aegypti in vulnerable areas.

Objectives: to verify nurses' perceptions about comprehensive care to human beings from the ecosystem perspective, with Therapeutic Touch use., Methods: an exploratory-descriptive, qualitative study, conducted with 11 nurses who use/used Therapeutic Touch in daily work. Data were collected through online semi-structured interviews and submitted to discursive textual analysis. The ecosystem framework was used., Results: participants talked about the theme in a polysemic way, but understand that comprehensive care is associated with nursing professionals and intrinsic in their being and doing, considering the philosophical theoretical bases of nursing, which aim at the comprehensiveness of being., Final Considerations: Therapeutic Touch was considered as a way to achieve comprehensive care caring to human being ins. The objective of the study was achieved; however, it is understood the need for other research to advance this knowledge and enable innovations in professional practice of nurses.

Intraarticular dislocation of the patella is an uncommon condition, with displacement in the horizontal or vertical plane, which may be associated with total or partial lesion/rupture of the quadriceps tendon, with osteochondral or collateral ligament injury. Risk factors are ligament laxity, patellar hypermobility, high patella, and trochlear dysplasia. This condition is more common in young people and may require blood reduction. Cases of intraarticular dislocation of the patella are rare events, requiring diagnostic suspicion and differentiated management. The aim of the present study is to report a rare case of intraarticular dislocation of the patella, as well as its clinical condition, diagnosis, management and literature review., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Staphylococcus aureus and Staphylococcus epidermidis are the main agents involved with implant-related infections. Their ability to adhere to medical devices with subsequent biofilm formation is crucial to the development of these infections. Herein, we described the antibacterial and antibiofilm activities of a quinazoline-based compound, N 4 -benzyl-N 2 -phenylquinazoline-2,4-diamine, against both biofilm-forming pathogens. The minimum inhibitory concentrations (MIC) were determined as 25 µM for S. aureus and 15 µM for S. epidermidis. At sub-MIC concentrations (20 µM for S. aureus and 10 µM for S. epidermidis), the compound was able to inhibit biofilm formation without interfere with bacterial growth, confirmed by scanning electron microscopy. Moreover, surfaces coated with the quinazoline-based compound were able to prevent bacterial adherence. In addition, this compound presented no toxicity to human red blood cells at highest MIC 25 µM and in vivo toxicity assay using Galleria mellonella larvae resulted in 82% survival with a high dose of 500 mg/kg body weight. These features evidence quinazoline-based compound as interesting entities to promising applications in biomedical fields, such as antimicrobial and in anti-infective approaches., (© 2020 John Wiley & Sons A/S.)

Ethnopharmacological Relevance: Maytenus robusta Reissek (Celesteraceae), popularly named as cafezinho do mato or coração de bugre, is employed to treat inflammatory digestive diseases in the south of Brazil. However, despite popular usage, the effects of this species on an experimental model of ulcerative colitis are unknown., Aim of the Study: To evaluate the effects of M. robusta extract (HEMR) on colon and liver from mice with colitis induced by dextran sulfate sodium (DSS)., Materials and Methods: Firstly, the cytotoxicity of HEMR and its effects on ROS and nitrite production in IEC-6 cells were evaluated. The experimental colitis was established by adding 3% DSS on drinking water of mice and the effects of HEMR (1-100 mg/kg, p.o, once a day by 7 days) in colonic and hepatic tissues were analyzed., Results: The HEMR (1-100 μg/mL) did not alter the cell viability but reduced nitrite production of IEC-6 stimulated by LPS. Moreover, HEMR (100 mg/Kg) attenuates macro and microscopic alterations in the colon from mice exposed to DSS, as evidenced by a reduction of the colon shortening, attenuation of the epithelial erosion, submucosal edema and preservation of the Goblet cells integrity, as well as the restoration of mucin depletion. The treatment with HEMR increased GSH amount, reduced LOOH levels and normalizes CAT activity in the colon. The group treated with HEMR showed increased GST activity, reduced MPO activity and decreased inflammatory cytokines secretion (TNF and IL-6) in the colonic tissue. In the liver, HEMR increased GST activity, decreased the GPx activity and reduced IL-6 levels. Furthermore, the HEMR treatment reduced AST and ALT serum levels in mice exposed to DSS. Finally, the HEMR was able to reduce intestinal transit., Conclusions: HEMR treatment minimizes inflammation of the colon and maintaining the antioxidant homeostasis. In addition, HEMR may be a potential tool to prevent hepatic injury secondary to ulcerative colitis., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Inflammatory bowel diseases (IBD) are chronic inflammatory affections of recurrent nature whose incidence and prevalence rates have increased, including in Brazil. In long term, they are responsible for structural damage that impacts quality of life, morbidity and mortality of patients., Objective: To describe the profile of physicians who treat IBD patients as well as the characteristics of IBD care, unmet demands and difficulties., Methods: A questionnaire containing 17 items was prepared and sent to 286 physicians from 101 Brazilian cities across 21 states and the Federal District, selected from the register of the State Commission of the "Study Group of Inflammatory Bowel Disease of Brazil" (GEDIIB)., Results: The majority of the physicians who answered the questionnaire were gastroenterologists and colorectal surgeons. More than 60% had up to 20 years of experience in the specialty and 53.14% worked at three or more locations. Difficulties in accessing or releasing medicines were evident in this questionnaire, as was referrals to allied healthy professionals working in IBD-related fields. More than 75% of physicians reported difficulties in performing double-balloon enteroscopy and capsule endoscopy, and 67.8% reported difficulties in measuring calprotectin. With regard to the number of patients seen by each physician, it was shown that patients do not concentrate under the responsibility of few doctors. Infliximab and adalimumab were the most commonly used biological medicines and there was a higher prescription of 5-ASA derivatives for ulcerative colitis than for Crohn's disease. Steroids were prescribed to a smaller proportion of patients in both diseases. The topics "biological therapy failure" and "new drugs" were reported as those with higher priority for discussion in medical congresses. In relation to possible differences among the country's regions, physicians from the North region reported greater difficulty in accessing complementary exams while those from the Northeast region indicated greater difficulty in accessing or releasing medicines., Conclusion: The data obtained through this study demonstrate the profile of specialized medical care in IBD and are a useful tool for the implementation of government policies and for the Brazilian society as a whole.

Objective: To analyze the studies that identified the frequency of meals ingested by Brazilian adolescents and associated habits., Data Sources: A systematic search was made in the databases and electronic databases: MEDLINE/PubMed, The Latin American and Caribbean Center of Information in Health Sciences (BIREME), Scopus, Web of Science and Embase, with articles published between January/2007 until December/2017, which addressed the evaluation of the frequency of meals performed by adolescents, considering or not associations with eating patterns and meal replacement., Data Synthesis: 6,608 studies were obtained through the search and nine were included in this review, all of them with a cross-sectional design. Eight studies used school surveys and only one was a population survey. Seven studies evaluated the frequency of the main daily meals that ranged from 47.0 to 79.0% at breakfast, from 65.0 to 98.4% at lunch, and from 51.0 to 94.0% at dinner. Five studies identified the frequencies of consumption of snacks between meals, finding higher values for afternoon snack (variation from 42.0 to 78.0%). Regarding the substitution of meals for snacks, in three of the four selected studies; it was observed that this practice occurred mainly in substitution of dinner (24.6 to 42.0%)., Conclusions: Breakfast was the most omitted meal for adolescents, and dinner was replaced with snacks. Among the between meal snacks, the afternoon snack was the most consumed.

Objective: Discuss evidence referring to the genetic role in congenital heart diseases, whether chromosomic alterations or monogenic diseases., Data Source: LILACS, PubMed, MEDLINE, SciELO, Google Scholar, and references of the articles found. Review articles, case reports, book chapters, master's theses, and doctoral dissertations were included., Summary of Findings: Congenital heart diseases are among the most common type of birth defects, afflicting up to 1% of the liveborn. Traditionally, the etiology was defined as a multifactorial model, with both genetic and external contribution, and the genetic role was less recognized. Recently, however, as the natural evolution and epidemiology of congenital heart diseases change, the identification of genetic factors has an expanding significance in the clinical and surgical management of syndromic or non-syndromic heart defects, providing tools for the understanding of heart development., Conclusions: Concrete knowledge of congenital heart disease etiology and recognition of the genetic alterations may be helpful in the bedside management, defining prognosis and anticipating complications., (Copyright © 2020 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Six typical Brazilian lignocellulosic biomasses (rice straw, corn cob, peanut shell, sawdust, coffee husk and sugarcane bagasse) were evaluated for methane production by solid-state anaerobic co-digestion with poultry manure. The results showed the highest methane production was obtained with corn cob and poultry manure (126.02 Nm 3 CH 4 . ton residue -1 ) using a food to inoculum ratio of 0.5, which lowered volatile fatty acids accumulation. In this condition, the thermal energy production (1.73 MJ.kg live chicken -1 ) would be able to replace 53.2% of the energy with firewood in poultry farming. The high hemicellulose and low lignin content in corn cob seem to explain the biomethanation of such biomass, and this agrees with the microbial analysis which revealed the predominance of bacteria related to plant polysaccharides hydrolysis and carbohydrate conversion in the inoculum. The methane production was best modelled by Groot's multi-stage model, and the microbial adaptation to lignin might explain this., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective to analyse the magnitude and factors associated with activity limitation and social participation restriction of people with leprosy from 2001 to 2014 in Picos, Piauí, Brazil. Methods this was a cross-sectional study with data collected through interviews and physical examinations; the SALSA Scale (Screening of Activity Limitation and Safety Awareness) and Social Participation Scale were used; crude prevalence ratios (PR) were calculated. Results 263 people with leprosy participated in the study; activity limitation was associated with grade I/II disability (PR=1.66; 95%CI 1.14;2.41), age ≥60 years (PR=1.68; 95%CI 1.09;3.02) and low schooling (PR=1.76; 95%CI 1.26;2.45); correlation was found between eye-hand-foot score and activity limitation (r=0.29; p<0.001) and participation restriction (r=0.27; p<0.001). Conclusion activity limitation and participation restriction had high prevalence in the context studied and were associated with disease severity, advanced age and social vulnerability.

Objective  To prospectively analyze the radiographic variables of lumbosacral sagittal balance in the pre- and postoperative period of patients submitted to total hip arthroplasty (THA). Methods  A prospective, observational, comparative study that evaluated pre- and postoperative radiographic parameters of 71 patients, submitted to 72 total hip arthroplasties in a 3-year period (2014-2017) for primary coxarthrosis, of whom 28 performed late postoperative control (6 months) through the Surgimap Spine software (Surgimap, New York, NY, USA). Statistical analysis was performed using the Student t-test, the analysis of covariance (ANCOVA) model, and the Kolmogorov-Smirnov test. The data were analyzed using the IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA). A p-value < 0.05 indicated statistical significance. Results  A total of 72 cases, presenting a mean age of 57.9 years old, predominantly females (60.6%) and patients > 50 years old (71.8%). There was an overall decrease in lumbar lordosis values in the immediate postoperative period, without major global changes in late evolution. It was found that patients with a pelvic incidence ≥ 60° tended to have their other sagittal balance parameters elevated. Conclusion  There was no significant difference between the radiographic variables of sagittal lumbopelvic balance in the evaluated periods. Lumbar lordosis and pelvic incidence were the main modifying factors. Improvement of low back pain after THA, without changes in parameters, suggests different pathology mechanisms still to be clarified., Competing Interests: Conflitos de Interesses Os autores declaram não haver conflitos de interesses.

Multiple sclerosis (MS) is a chronic central nervous system inflammatory disease that leads to demyelination and neurodegeneration. The third trimester of pregnancy, which is characterized by high levels of estrogens, has been shown to be associated with reduced relapse rates compared with the rates before pregnancy. These effects could be related to the anti-inflammatory properties of estrogens, which orchestrate the reshuffling of the immune system toward immunotolerance to allow for fetal growth. The action of these hormones is mediated by the transcriptional regulation activity of estrogen receptors (ERs). Estrogen levels and ER expression define a specific balance of immune cell types. In this review, we explore the role of estradiol (E2) and ERs in the adaptive immune system, with a focus on estrogen-mediated cellular, molecular, and epigenetic mechanisms related to immune tolerance and neuroprotection in MS. The epigenome dynamics of immune systems are described as key molecular mechanisms that act on the regulation of immune cell identity. This is a completely unexplored field, suggesting a future path for more extensive research on estrogen-induced coregulatory complexes and molecular circuitry as targets for therapeutics in MS.

The study aimed to analyze the magnitude and sociodemographic profile of leprosy cases linked to household contact networks with overlapping of the disease in two Brazilian municipalities (counties), one in the North and the other in the Northeast, from 2001 to 2014. This was a cross-sectional, descriptive, analytical study based on primary and secondary data from new leprosy cases in Picos, Piauí State, and Rolim de Moura, Rondônia State. "Overlapping" was defined as new cases with the occurrence of at least one more leprosy case in the individual's household contact network. Each household contact network consisted of the index case (first reported case), co-prevalent cases (contacts that became new cases), and household contacts of the index case. A total of 437 new cases treated by the INTEGRAHANS North-Northeast and Piauí projects were assessed, of which 287 (65.7%) were in Picos and 150 (34.3%) in Rolim de Moura. Of all the cases assessed, 129 (44.9%) in Picos and 98 (65.3%) in Rolim de Moura reported overlapping. There were proportionally more females in Rolim de Moura (n = 95, 63.3%) and males in Picos (n = 147, 51.2%); in the 41-60-year age bracket (Rolim de Moura n = 70, 46.7%; Picos n = 115, 40.1%); with elementary schooling (Rolim de Moura n = 80, 54%; Picos n = 125, 44.5%); and individuals living in the same household with up to 3 persons in Rolim de Moura (n = 105, 70%) and with more than 4 persons in Picos (n = 287, 100%). Overlapping of leprosy cases in household contact networks was considerably high in the contexts analyzed here, displaying aspects of expanded vulnerability. This perspective should be considered and integrated into leprosy surveillance and control activities.

In this study the anaerobic co-digestion (AcD) of sugarcane biorefinery by-products, i.e. hemicelluloses hydrolysate (HH) (obtained by hydrothermal pretreatment of sugarcane bagasse), vinasse, yeast extract (YE) and sugarcane bagasse fly ashes (SBFA), was optimized by means of biochemical methane potential experiments. The best experimental conditions of AcD (25-75% HH-to-vinasse mixture ratio; 1.0 g L -1 YE; 15 g L -1 SBFA and 100-0% HH-to-Vinasse; 1.5 g L -1 YE; 45 g L -1 SBFA) led to the production of 0.279 and 0.267 Nm 3 of CH 4 per kg of chemical oxygen demand (COD) with an energy surplus of 0.43 and 0.34 MJ kg SB -1 , respectively. Adsorption experiments using SBFA were carried out and showed this residue could adsorb up to 61.71 and 17.32 mg g -1 of 5-hydroxymethyl-2-furfuraldehyde and 2-furfuraldehyde, thereby reducing toxicity and improving biogas production., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The aim of this study was to evaluate the radiographic periapical repair and the synthesis of inflammatory mediators after endodontic treatment in a single session, using different irrigation protocols, in teeth with apical periodontitis. Experimental apical periodontitis were induced in dog's teeth randomly assigned into 4 groups: G1 - Irrigation by Negative Apical Pressure (n= 20); G2 - Passive Ultrasonic Irrigation (n= 20), G3 - Positive Pressure Irrigation (n= 20); G4 - apical periodontitis without treatment (n= 20). After 180 days, the animals were euthanized, the tissues removed and submitted to histotechnical processing for immunohistochemical analysis of osteopontin (OPN), tumor necrosis factor-a (TNF-a) and interleukin 1-a (IL-1a). Radiographic analysis was performed using the Periapical Index (PAI), obtained prior to and 180 days following endodontic treatment. Data were analyzed using Wilcoxon signed-rank test, Fisher's Exact test or Kruskal-Wallis test and Dunn's post-test (a = 5%). Radiographically, after endodontic treatment, apical periodontitis persisted in 35% of G1 specimens, 40% of G2 and 40% of G3 (p>0.05), although a PAI reduction was observed (p<0.05). By immunohistochemical evaluation, endodontic treatment resulted in lower synthesis of TNF-a and OPN in periapical region, compared to apical periodontitis without treatment (p<0.05). Production of IL-1 was not modulated by endodontic treatment (p>0.05). Periapical healing was observed in approximately 60% of the cases after endodontic treatment performed in a single session with lower synthesis of TNF-a and OPN in the periapical region, regardless of the irrigation protocol used.

Objective: To verify the effectiveness of educational interventions based on guidance on physical activity and nutrition in schoolchildren., Data Sources: A systematic search was carried out in four electronic databases containing articles published between October 2007 and January 2017 and addressing educational interventions with emphasis on both nutritional education and physical activity in schoolchildren and adolescents aged 10 to 19 years., Data Synthesis: Twelve articles were selected for this review, of which four included only educational interventions; four made and association between educational interventions, inclusion of healthy foods and physical activity; two made a relation between guidelines and physical activity; and finally, two associated guidelines with consumption of healthy foods., Conclusions: Interventions based on physical activity and/or nutrition counseling were efficient and showed superior results in studies that associated the practice of physical activity with counseling. However, the need for new studies on educational interventions among schoolchildren and adolescents was made evident.

Ethopharmacological Relevance: The propolis is extensively used in folk medicine in natura or to prepare pharmaceutical formulations since ancient time to improve health or prevent diseases, among them gastrointestinal disorders. Aiming to contribute in the scientific validation about the popular use of Brazilian Green propolis (BGP) against gastritis and gastric ulcer, this work evaluated the antiulcer potential of isolated compounds from BGP, three prenylated p-coumaric acid derivatives and two flavonoids, respectively named: 3,5 diprenyl-4-hydroxycinnamic acid (artepillin C) (1), 3-prenyl-4-dihydroxycinnamoiloxy cinnamic acid (baccharin) (2), 3-prenyl-4-hydroxycinnamic acid (drupanin) (3), aromadendrin-4'-O-methyl-ether (4) and kaempferide (5)., Material and Methods: The compounds were characterized by nuclear magnetic resonance and mass spectrometry. Their gastroprotective effects were evaluated against ethanol/HCl- and indomethacin-induced ulcer in mice. Further, histological, histochemical, oxidative and inflammatory parameters were analyzed at ulcerated tissue. Acid antisecretory activities also were also assessed., Results: Compound 2 did not reduce the ethanol/HCl- induced ulcer at 30 mg/kg (p.o), whereas the minimum oral gastroprotective doses of 1, 3, 4 and 5 were 0.3, 0.3, 3 and 3 mg/kg, respectively. Besides, these compounds prevented ethanol/HCl-induced ulcer by intraperitoneal route, as well as indomethacin-induced ulcer by oral route. The gastroprotection was accompanied by normalization of superoxide dismutase, catalase and glutathione-S-transferase activities and reduction in myeloperoxidase activity. Moreover, the compounds 4 and 5 increased the gastric mucin content and 1 reduced TNF amount. Furthermore, 1, 3, 4 and 5 decreased volume, pH, total acidity and pepsin activity of the gastric juice from rats., Conclusions: Together, our findings showed a diversified mode of action elicited by 1, 3, 4 and 5 on the gastroprotection and contribute to explain the anti-ulcer activity reported for BGP., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Several studies have suggested that (-)-epicatechin-containing foods and plant extracts benefit conditions that affect the cardiovascular system, such as hypertension and endothelial dysfunction. However, no study was conducted so far to evaluate the potential of this flavonoid on diuretic activity assay. For that, female Wistar normotensive (NTR) and spontaneously hypertensive rats (SHR) received a single oral treatment with (-)-epicatechin (EPI), hydrochlorothiazide (HCTZ) or just vehicle (VEH). The effects of EPI in combination with diuretics for clinical use, as well as with L-NAME, atropine and indomethacin were also explored. Cumulative urine volume, plasma and urinary parameters were evaluated at the end of 8 h experiment. When given to NTR and SHR, at doses of 0.3, 1 and 3 mg/kg, EPI was able to stimulate both diuresis and saluresis (Na + , K + and Cl - ), without interfering with plasma electrolyte content or urinary pH and uric acid values, when compared with VEH-treated only rats. The combination with HCTZ, but not with furosemide or amiloride, successfully strengthened EPI-induced diuresis. This effect was not accompanied by a potentiation of the saluretic effects. On the other hand, when given EPI in combination with amiloride, a significant increase in Cl - excretion and maintenance of the potassium-sparing effects characteristic of this class of diuretics were detected. In addition, the diuretic effect of EPI was enhanced after pretreatment with L-NAME and its action was significantly precluded in the presence of indomethacin, a cyclooxygenase inhibitor. In conclusion, this study shows the diuretic and saluretic properties of EPI in rats, adding another biological activity whose effect may contribute to the different positive actions already described., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Objective: To establish the prevalence of physical, cognitive and psychiatric disabilities, associated factors and their relationship with the qualities of life of intensive care survivors in Brazil., Methods: A prospective multicenter cohort study is currently being conducted at 10 adult medical-surgical intensive care units representative of the 5 Brazilian geopolitical regions. Patients aged ≥ 18 years who are discharged from the participating intensive care units and stay 72 hours or more in the intensive care unit for medical or emergency surgery admissions or 120 hours or more for elective surgery admissions are consecutively included. Patients are followed up for a period of one year by means of structured telephone interviews conducted at 3, 6 and 12 months after discharge from the intensive care unit. The outcomes are functional dependence, cognitive dysfunction, anxiety and depression symptoms, posttraumatic stress symptoms, health-related quality of life, rehospitalization and long-term mortality., Discussion: The present study has the potential to contribute to current knowledge of the prevalence and factors associated with postintensive care syndrome among adult intensive care survivors in Brazil. In addition, an association might be established between postintensive care syndrome and health-related quality of life.

Ozone pretreatment of coffee husks (CH) was evaluated to generate hydrolysates for biogas production and to preserve cellulose of the solid phase for 2G ethanol production. Pretreatment variables included liquid-to-solid ratio (LSR), pH and specific applied ozone load (SAOL). Considering single-stage anaerobic digestion (AD), the highest methane production (36 NmL CH 4 /g CH) was achieved with the hydrolysate generated in the experiment using LSR 10 mL/g, pH 11 and SAOL 18.5 mg O 3 /g CH, leading to 0.064 kJ/g CH energy recovery. Due to the presence of toxic compounds in the hydrolysate, the addition of powdered activated carbon (4 g/L) to the reactor enhanced biogas production, leading to 86 NmL CH 4 /g CH yield and 0.58 kJ/g CH energy recovery. When two-stage AD was applied, methane production resulted in 49 NmL CH 4 /g CH, with additional 19 NmL H 2 /g CH production, resulting in a net 0.26 kJ/g CH energy recovery., (Copyright © 2018 Elsevier Ltd. All rights reserved.)