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Conflict of interest: No Introduction and Objectives: Decompensated cirrhosis (DC) is an important cause of death worldwide, including in Latin America. This study aimed to evaluate in-hospital and 30-day post-discharge mortality in a multinational cohort in Latin America. Patients / Materials and Methods: Non-elective cirrhosis admissions from Nov 2021 to Aug 2022 in sites from Mexico, Brazil, Argentina and Chile were included. Demographics, admission medications, prior conditions, etiology, and other data around admission were collected from patients and their medical records. Continuous variables were summarized using mean (± SD), and categorical variables as counts (%). Main outcomes were inpatient mortality/hospice and 30-day post-discharge mortality. Univariable comparisons were compared between outcomes using two-sample t-tests or chi-squared tests as appropriate. Multivariable models controlling for all variables significantly associated with outcomes at the p < 0.05 level were fit. Results and Discussion: Of 651 patients with valid inpatient outcomes, 158 died in-hospital or were moved to hospice (24.3%). At 30-days, 139 were lost to follow-up, leaving 512 patients. Of these, 172 died by 30 days (33.6%). In-hospital and 30-days mortality were not affected by etiology (HBV, HCV, MASLD, crypto). Variables significantly associated with mortality at both timepoints were prior LVP/HE, admission medications, prior infection, liver-related admission, and higher MELD-Na (Table 1). On multivariable analysis, admission betablockers and lactulose were associated with high mortality; MELD-Na and infection on admission were associated to death at both timepoints (Table 2) Conclusions: DC is associated with significant in-patient and 30-day mortality in the region, regardless of etiology and country, especially in patients with higher MELD-Na and/or infected on admission.

Conflict of interest: No Introduction and Objectives: Liver transplantation (LT) is the definitive treatment for decompensated cirrhosis and liver failure. Patients with ascites refractory to the use of diuretics fit the criteria for a special situation, according to technical note No. 32/2021, issued in 2021 by the Ministry of Health (MS). Cases with refractory ascites now directly and immediately receive 29 points on the MELD score. Thus, changes in the waiting time for LT are expected after the aforementioned technical standard, but the real impact on morbidity and mortality is unknown.This study aims to compare the waiting time for LT for refractory ascites before and after technical note No. 32/2021. In addition, the study will also evaluate the proportion of those transplanted for refractory ascites after the 2021 resolution. Patients / Materials and Methods: The electronic medical records of patients undergoing LT in a tertiary service during the years before (2018 and 2019) and after (2022 and 2023) technical note No. 32/2021 were evaluated. Patients undergoing LT of both sexes and aged 18 or over were included. The data was stored in a spreadsheet and compared. Results and Discussion: There was a 59-day reduction in the median waiting time, considering the interval between the special situation being granted and the actual LT being performed. In addition, there was a 5.85% increase in the number of LT for refractory ascites, considering the years 2018 and 2019 versus 2022 and 2023. Conclusions: The implementation of technical note No. 32/2021 correlated with a reduction in the waiting time for LT for patients with refractory ascites. In addition, the implementation of this resolution was also correlated with a small increase in the number of transplants for refractory ascites. Despite the initial results, a longer observation period is needed for more in-depth analyses of survival and morbidity.

Background The integration of diagnostic methods holds promise for advancing the surveillance of malaria transmission in both endemic and non-endemic regions. Serological assays emerge as valuable tools to identify and delimit malaria transmission, serving as a complementary method to rapid diagnostic tests (RDT) and thick smear microscopy. Here, we evaluate the potential of antibodies directed against peptides encompassing the entire amino acid sequence of the PvMSP-1 Sal-I strain as viable serological biomarkers for P. vivax exposure. Methods We screened peptides encompassing the complete amino acid sequence of the Plasmodium vivax Merozoite Surface Protein 1 (PvMSP-1) Sal-I strain as potential biomarkers for P. vivax exposure. Here, immunodominant peptides specifically recognized by antibodies from individuals infected with P. vivax were identified using the SPOT-synthesis technique followed by immunoblotting. Two 15-mer peptides were selected based on their higher and specific reactivity in immunoblotting assays. Subsequently, peptides p70 and p314 were synthesized in soluble form using SPPS (Solid Phase Peptide Synthesis) and tested by ELISA (IgG, and subclasses). Results This study unveils the presence of IgG antibodies against the peptide p314 in most P. vivax-infected individuals from the Brazilian Amazon region. In silico B-cell epitope prediction further supports the utilization of p314 as a potential biomarker for evaluating malaria transmission, strengthened by its amino acid sequence being part of a conserved block of PvMSP-1. Indeed, compared to patients infected with P. falciparum and uninfected individuals never exposed to malaria, P. vivax-infected patients have a notably higher recognition of p314 by IgG1 and IgG3.

Abstract Background Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable. Methods A bibliographic search using major databases was performed using the terms “emergency surgery” “diaphragmatic hernia,” “traumatic diaphragmatic rupture” and “congenital diaphragmatic hernia.” GRADE methodology was used to evaluate the evidence and give recommendations. Results CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients. Conclusions Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving.

The objectives were to evaluate the effects of recipient category, season and administration of a gonadorelin analogue at the time of fixed-time embryo transfer (FTET) on pregnancy per FTET at 30 and 60 days after oestrus and on pregnancy losses (PL). Recipients were randomly assigned to: treated group (n = 624), in which recipients received an intramuscular injection of 0.2 mg of gonadorelin (Fertagyl®) at FTET; or a control group (n = 687) that remained untreated. Recipients were previously treated with a synchronisation protocol based on progesterone and oestradiol. All embryos were produced in vitro. The data with binomial distribution were analysed by multivariate logistic regression, using the GLIMIX procedure of SAS. Higher P/FTET was observed at 30 days (45.8 vs. 40.0%; P = 0.03) and 60 days (43.0 vs. 37.0%; P = 0.01) in the treated group. There was a tendency toward reduced PL in the treated group (4.0 vs. 7.0%; P = 0.09). Dry cows (2.70%) and lactating cows (2.47%) had less PL (P = 0.001) compared with heifers (10.42%). In the spring/summer season the P/FTET at 60 days was smaller (P =0.024). Greater PL tended to occur in the warmer season. Treatment with gonadorelin at the time of bovine ET increased the pregnancy per ET at days 30 and 60 and reduced PL. Additionally, dry and lactating recipient cows showed a lower PL rate compared to heifers. Furthermore, ET performed in the warmer seasons of the year resulted in a lower pregnancy rate at day 60 and greater PL.

Este estudo tem como objetivo analisar a atuação dos Núcleos de Inovação Tecnológica (NIT) frente às atividades de pesquisas direcionadas para inovação dos Institutos Federais (IFs) de educação do Brasil. Foi realizado um estudo do tipo exploratório e descritivo, com a participação de 15 dos 38 IFs existentes no território nacional. Obteve-se as informações sobre a produção científico-tecnológica, forças, oportunidades, fraquezas e ameaças dos NITs por meio de um questionário. Os IFs participantes estavam assim distribuídos entre as regiões brasileiras: três, região norte; quatro, nordeste; dois, centro-oeste; quatro, sudeste; e dois, sul. Verificou-se que 53,4% da pesquisa produzida geram produtos tecnológicos passíveis de proteção intelectual, principalmente nas áreas de ciências exatas e da terra (18,75%) e ciências biológicas (18,75%). Observou-se que a principal dificuldade interna dos NITs para a gestão da inovação foi a carência de quadro efetivo de recursos humanos capacitados (22,6%). Como ponto fraco dos NITs, a indicação da não existência de redes de relacionamentos entre instituição-empresa. Conclui-se que a atuação dos NITs dos IFs é limitada à consolidação das atividades internas na instituição, cabendo a adoção de estratégias para fortalecer a cultura da inovação e desenvolvimento tecnológico.

Excessive exposure to solar ultraviolet (UV) radiation causes human health damages, such as sunburns and skin cancer. Thus, the use of sun-protective clothing is a simple, easy, and practical method for UV protection of the human organism. In this perspective, incorporation, coating, and anchorage of UV-protective compounds in textile fibers have been employed to enhance the UV-blocking ability and/or promote functional finishings to smart fabrics. This review describes recent research efforts on the development of UV-protective compound-containing smart fabrics highlighting the UV-blocking properties and multifunctional activities. Different compound class examples and discussions are presented in order to contribute to new insights into sun-protective clothing and future applications of multifunctional textiles.

Abstract Background The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p

Introdução: A osteoartrite (OA) é uma condição degenerativa debilitante que afeta as articulações e envolve inflamação, levando à degradação da cartilagem e ao comprometimento articular. Essa doença pode causar dor, desconforto e diminuição gradual da função articular. De acordo com a National Health and Nutrition Examination Survey, aproximadamente 37% das pessoas com mais de 60 anos têm osteoartrite no joelho nos EUA. No Brasil, a OA afeta 80% da população acima de 60 anos, sendo mais comum entre aqueles com idades entre 70 e 79 anos, e cerca de 33,7% apresentam OA no joelho. Devido à sua prevalência entre idosos, várias abordagens terapêuticas surgiram para tratar a OA. Geralmente, o tratamento envolve medicamentos anti-inflamatórios e analgésicos. Também são usados inibidores específicos da COX-2 ou anti-inflamatórios não hormonais (AINHs) não seletivos. No entanto, esses medicamentos podem ter efeitos colaterais que afetam a qualidade de vida e a adesão ao tratamento. Portanto, o uso de fitoterápicos se tornou uma alternativa para aliviar a dor em pacientes com OA, visando reduzir a dependência de medicamentos. Objetivos: Revisar a literatura sobre a ação de medicamentos fitoterápicos mais utilizados para tratamento de OA e identificar comprovações científicas no período posterior à criação da renisus. Material e Método: Realizou-se um levantamento bibliográfico de artigos científicos publicados entre 2010 a 2017 nas bases de dados do Google Acadêmico e PubMed. A pesquisa teve como foco os fitoterápicos com propriedades antiartríticas, analgésicas ou antiinflamatórias, destinados ao tratamento da osteoartrite (OA) em seres humanos e animais. Foram selecionados os fitoterápicos mais mencionados, incluídos na Relação Nacional de Plantas Medicinais de Interesse ao Sistema Único de Saúde (RENISUS). Resultados: Foram analisados artigos que destacaram os seguintes diferentes contextos clínicos. fitoterápicos como os mais empregados para tratar sinais e sintomas relacionados à OA: Curcuma longa: A curcumina exibiu propriedades antiinflamatórias e analgésicas tanto em estudos com animais quanto em ensaios clínicos, com potencial de alívio da dor. A substância está associada à redução de diversos sinais inflamatórios. Boswellia serrata: Contém ácidos boswellicos, que se mostraram potentes inibidores da enzima 5-lipoxigenase. Harpagophytum procumbens: O harpagosideo, um glicosídeo presente nessa planta, atua inibindo precursores inflamatórios, como a cicloxigenase 2 (COX-2). Esse composto exerce um efeito anti-inflamatório em condições patológicas associadas à osteoartrite. Uncaria tomentosa: Contém mitrafilines e isomitrafilines, bioativos que demonstraram propriedades anti-inflamatórias, inibindo a liberação de citocinas por células imunes ativadas. Salix alba: Padronizado pelo seu conteúdo de salicina, esse fitoterápico tem sido amplamente usado para tratar condições ligadas à dor, inflamação e febre. Evidências indicam reduções significativas na dor articular. Chenopodium ambrosioides: Contendo ascaridol, um composto com possíveis efeitos anti-inflamatórios e analgésicos, essa planta também exibe propriedades cicatrizantes em feridas. Discussão e Conclusões: Esses fitoterápicos mostraram potencial para reduzir a dor e melhorar a função física em pacientes com osteoartrite (OA). No entanto, são necessárias mais pesquisas para avaliar sua eficácia, dosagens adequadas e possíveis efeitos colaterais. Os fitoterápicos podem ser considerados como opções terapêuticas complementares ou alternativas aos medicamentos convencionais para o tratamento da osteoartrite, mas seu uso deve ser avaliado individualmente e sob orientação médica.

Introdução: Os Medicamentos Isentos de Prescrição (MIPs) podem ser adquiridos sem exigência de prescrição. A Organização Mundial da Saúde destaca que o uso de MIPs promove a capacidade de autocuidado, reconhecendo o indivíduo como agente ativo no gerenciamento de sua própria saúde. A automedicação com MIPs está se tornado cada vez mais comum, sendo essencial a atuação do farmacêutico na prática do uso racional de medicamentos na indicação e prescrição de MIPs. Objetivo: Analisar o perfil farmacológico, grau de risco, nível de evidência e força de recomendação dos MIPs registrados no Brasil. Material e Método: Analisou-se os MIPs que constam no rol da Instrução Normativa nº 120/2022 da Agência Nacional de Vigilância Sanitária (ANVISA) em três etapas: I) Análise do perfil farmacológico e de uso: coleta de informações sobre os medicamentos por meio de bulas do repositório da ANVISA e na base Micromedex®; II) Análise do nível de evidência e força de recomendação: verificada a partir dos dados do Micromedex® e reclassificadas segundo o método Grading of Recommendations Assessment Development and Evaluation (GRADE); III) Análise do grau de risco dos medicamentos: considerando o uso em pediatria, gravidez e lactação. Resultados: Foram identificados 188 diferentes fármacos entre os MIPs, somando-se um total de 376 apresentações. Os grupos Trato Alimentar e Metabolismo e Respiratório tiveram o maior número de fármacos disponíveis (19%). Em relação à disponibilidade de MIPs no Sistema Único de Saúde, apenas 10% estão listados na Relação Nacional de Medicamentos, nos quais os grupos Dermatológico e Sistema Nervoso possuem 4 fármacos disponíveis em cada classificação. Quanto ao nível de evidência, 61% dos fármacos foram classificados como alto/moderado e 39% como baixo/ muito baixo/sem evidência. O grupo com maior percentual de evidência alto/moderado foi o Respiratório. Em relação à força de recomendação, 45% dos MIPs possuem recomendações fortes para as indicações clínicas propostas, com destaque ao grupo Digestivo. Considerando o grau de risco dos medicamentos, 23% dos MIPs possuem restrições de faixa etária, enquanto 14% não dispõem de evidências de idade mínima, indicando uma lacuna de estudos nessa população. Na gravidez, apenas 3% dos MIPs foram considerados seguros, enquanto 55% apresentaram risco fetal, sugerindo a necessidade de uso criterioso. Na fase da lactação, somente 11% dos MIPs são considerados seguros e 47% apresentam uso criterioso. Discussão e Conclusões: A ampla disponibilidade de MIPs desempenha um importante papel ao possibilitar o acesso mais fácil e direto a uma variedade de condições de saúde, como cefaleia, azia, resfriado e outras demandas de problemas autolimitados. Embora se acredite que o uso de medicamentos de venda livre seja relativamente seguro, o uso inadequado pode acarretar sérias implicações. Os sistemas de avaliação da qualidade da evidência são importantes fontes para informar o grau de confiança, fornecendo subsídio científico para tomada de decisão clínica. Embora haja uma considerável quantidade de fármacos com qualidade de evidência mais baixa, é necessário reconhecer as limitações existentes. Para auxiliar no diagnóstico mais preciso, a avaliação de medicamentos com baixa qualidade de evidência não deve ser conduzida de maneira isolada. Quanto aos graus de risco, persistem obstáculos éticos, legais e de segurança que permeiam a pesquisa científica, especialmente nos contextos da pediatria, gravidez e lactação. É comum o uso off-label de medicamentos devido à falta de informações apropriadas de rotulagem, uma vez que muitos medicamentos clinicamente aprovados carecem dessa orientação específica. Mais da metade dos MIPs apresentam um nível de evidência considerável, no entanto, é fundamental que se tenha cautela quanto aos possíveis riscos que esses medicamentos podem provocar, principalmente em populações especiais. Embora a literatura apresente carência de informações, entende[1]se que a prática da saúde baseada em evidências contribui para uma tomada de decisão mais acertada quanto à prescrição de MIPs, destacando o papel do farmacêutico no processo de orientação da melhor escolha terapêutica e contribuindo para a redução dos riscos associados ao uso indevido de medicamentos.

Introdução: A tuberculose (TB) é uma doença infecciosa amplamente reconhecida e estudada, porém ainda persiste como uma causa significativa de óbitos anualmente. Nesse sentido, o papel desempenhado pelo farmacêutico revela-se importante no tratamento da TB, assim como na prevenção e promoção da saúde, seja pela sua contribuição quanto ao uso seguro de medicamentos, ou pelo papel que a assistência farmacêutica ao facilitar o acesso aos tratamentos essenciais no combate a essa enfermidade. Objetivos: Abordar as contribuições farmacêuticas na adesão ao tratamento de indivíduos com tuberculose, de forma a evidenciar fatores que podem desencadear interferências no tratamento, identificar o perfil do paciente e os fatores que influenciam no abandono ao tratamento. Material e Método: às informações utilizadas foram obtidas por meio de uma análise minuciosa de artigos científicos publicados entre 2018 a 2022 nas bases de dados do Scientific Electronic Library Online (SciELO), Public Medical (PubMed) e Google Scholar, dos quais treze artigos foram incluídos na amostra final, de acordo com os critérios de inclusão e exclusão, levando em consideração a leitura prévia do título e do resumo, com a finalidade de checar sua relação com o tema. Resultados: Nos artigos analisados foram observadas que as principais causas da não adesão ao tratamento da TB estão relacionadas a sua longa duração (geralmente seis meses), questões sociodemográficas, aspectos clínico epidemiológicos e a desinformação relacionada à doença. Dentre as consequências do abandono ao tratamento estão a resistência medicamentosa, alta redução das chances de cura, reincidência da doença, aumento do custo e do tempo de tratamento. Além disso, os autores retratavam que o farmacêutico desempenha um papel na garantia da adesão eficaz à farmacoterapia, acompanhando de perto os pacientes e fornecendo orientações claras para sanar quaisquer dúvidas relacionadas ao uso dos medicamentos. Um profissional que não apenas monitora a necessidade de intervenções necessárias, mas também oferece diretrizes precisas quanto à dosagem adequada, visando assegurar a continuidade e a eficácia do tratamento. Discussão e Conclusões: Embora seja uma doença tratável há muitos anos, a tuberculose ainda perdura como um desafio significativo para a saúde pública. Dentre os fatores que dificultam seu controle, destacam-se a demora no diagnóstico e a interrupção do tratamento. Considerando que a incidência da tuberculose pode estar intrinsecamente ligada a determinantes sociais, como obstáculos no acesso aos serviços de saúde, condições sanitárias precárias e a coexistência de outras enfermidades, o profissional farmacêutico emerge como aquele que está mais próximo da comunidade, desempenhando um papel relevante na luta contra essa doença. Os resultados alcançados evidenciam a relevância do cuidado farmacêutico no tratamento da tuberculose. Isso se deve à participação ativa desse profissional em todas as etapas, desde a devida orientação sobre a utilização dos medicamentos até a supervisão regular do paciente ao longo de todo o processo terapêutico. Essa atuação desempenha, portanto, um papel crucial na garantia da continuidade do tratamento e na prevenção da resistência aos medicamentos, com isso, consegue obter resultados terapêuticos mais eficazes, o que, consequentemente, contribui para uma melhoria na qualidade de vida do paciente devido à sua maior aderência à farmacoterapia. Isso é fundamental para combater a resistência aos medicamentos e alcançar melhores resultados em termos de saúde e bem-estar.

Osteoarthritis (OA) remains a chronic incurable condition, presenting substantial challenges in treatment. This study explores a novel strategy by investigating the concurrent use of cuminaldehyde, a natural compound, with indomethacin in animal models of MIA-induced OA. Our results demonstrate that the co-administration of cuminaldehyde and indomethacin does indeed produce a superior effect when compared to these compounds individually, significantly enhancing therapeutic outcomes. This effect is evidenced by a marked reduction in pro-inflammatory cytokines IL-6 and IFN-γ, alongside a significant increase in the anti-inflammatory cytokine IL-10, compared to treatments with each compound alone. Radiographic analyses further confirm the preservation of joint integrity and a reduction in osteoarthritic damage, highlighting the association’s efficacy in cartilage-reducing damage. These findings suggests that the association of cuminaldehyde and indomethacin not only slows OA progression but also offers enhanced cartilage-reducing damage and fosters the production of protective cytokines. This study underscores the potential benefits of integrating natural products with pharmaceuticals in OA management and stresses the importance of further research to fully understand the mechanisms underlying the observed potentiated effects.

ABSTRACT A comprehensive knowledge about micronutrient dynamics in leaves and bunches of black pepper is needed in order to proper diagnose nutrient needs, and thus facilitate fertilization management. This study aimed to evaluate micronutrient concentration and accumulation in leaves and bunches of black pepper bunches to understand the crop nutritional demand. The experiment was carried out on in a commercial field of Piper nigrum ‘Bragantina’ located in São Mateus, Espírito Santo, Brazil. Composite samples of leaves and bunches were taken periodically during two crop cycles and the concentration of Fe, Zn, Mn, Cu, and B were assessed. The micronutrient accumulation curves behaved linearly and quadratically, reaching the maximum accumulation point during the time of harvesting. Fe, Mn and B were the micronutrients with highest concentration in both bunches and leaves of black pepper. The nutrient concentration in leaf tissues varied seasonally. These results may contribute to a more sustainable agriculture, in which fertilization rates should consider different needs through the crop stage.

BackgroudAntithrombotic therapy is the cornerstone of chronic coronary syndrome (CCS) management. However, the best treatment option that optimally balances bleeding risk and efficacy remains undefined. Our objective was to evaluate the effectiveness and safety of antithrombotic options and identify the optimal treatment option for patients with CCS.MethodsWe used the MEDLINE, CENTRAL and Embase databases to search for randomized controlled trials with follow-up periods longer than 12 months that compared aspirin (ASA) monotherapy with other antithrombotic therapies in patients with CCS. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Extracted data [hazard ratios (HR)] were pooled using Bayesian fixed-effect models, allowing the estimation of credible intervals (CrI) and posterior probabilities of benefit, harm, and practical equivalence. Confidence in the results was assessed with the Confidence In Network Meta-Analysis (CINeMA) tool. The primary efficacy and safety outcomes were major adverse cardiovascular events (MACE) and primary bleeding, respectively. Secondary outcomes were acute myocardial infarction, ischemic stroke, all-cause, and cardiovascular-specific mortality.ResultsFive trials with a total of 80,605 patients were included. Mean patient age ranged from 61 to 69 years, while 20.3% to 31.4% were women. The reference treatment was ASA monotherapy. ASA + prasugrel 10 mg and clopidogrel 75 mg monotherapy presented the greatest benefit for MACE [HR 0.52 (95% CrI, 0.39–0.71); and 0.68 (95% CrI, 0.54–0.88)]. There was a probability of 98.8% that ASA + ticagrelor was practically equivalent to ASA monotherapy. Regarding the primary bleeding outcome, clopidogrel 75 mg monotherapy performed best [HR 0.64 (0.42, 0.99)]. There was a probability of 97.4% that ASA + Prasugrel 10 mg increases bleeding (HR > 1.0). Secondary outcome results followed a similar treatment ranking pattern as in primary outcomes. Overall, CINeMA confidence ratings were judged as either low or very low.ConclusionsThese results revealed that clopidogrel monotherapy might provide the best risk-benefit balance in treating CCS. However, low CINeMA confidence ratings may preclude more forceful conclusions. Our analysis suggests that current guidelines recommending ASA as first-line therapy for CCS management need to be revised to include additional pharmacological options.

Biochar is a product rich in carbon, which improve the soil attributes and crop yield. In the Brazilian tropical dry region, common bean is cultivated under rainfed, in poor, acidic, and with low water retention soils. This work aims to evaluate the effect of biochar on soil physical and chemical attributes, on evapotranspiration (ET), water use efficiency (WUE), and on bean yield. The field experiment was conducted over four biochar rates (B0: no biochar; B10: biochar at 10 t ha−1; B20: 20 t ha−1 and B40: 40 t ha−1), and three replications. Our analysis revealed that different rates of biochar do not affect the soil physical attributes due to a mismatch between soil texture and the particle size of biochar. Treatments with biochar promoted an increase in soil pH, P content, cation exchange capacity, reduced the Al+H content, which caused an increase in bean yield and consequently WUE. Our findings expand our knowledge about the effect of the biochar applied to the Acrisols on decreasing the soil acidity and to increase the yield and WUE, and add important information that can be suitable for development of strategy to mitigate problems caused by instability of rains and poor fertility soils.

Endogenous retroviruses (ERVs) compose a significant portion of mammalian genomes; however, how ERVs are regulated is not well known. Here the authors performed a genome-wide sgRNA screen to identify Morc3 as a mediator of ERV silencing. They show Morc3 associates with the H3.3 chaperone Daxx, and that loss of Morc3 leads to reduced H3.3 at ERVs.

Intercropped systems with Conilon coffee might provide a better environment for coffee production. The aim of this study was to assess the microclimate and development of Conilon coffee intercropped with papaya trees. Papaya was planted with spacing of 3.20 x 2.40 m. The coffee trees were planted after eight months, with spacing of 3.20 x 1.60 m, in-between papaya trees (in the same row). The measurements were taken 0, 40 and 80 cm away from the coffee plants, both in the north and south direction. Concomitantly, an adjoining full sunlight coffee system (not intercropped) was also assessed. The measurements included atmospheric parameters (temperature, irradiance, and relative humidity) and vegetative parameters for the coffee plants (leaf area, relative chlorophyll index, length of plagiotropic branches, length of orthotopic branches and number of nodes) in three periods of the year. The intercropped system of Conilon coffee and papaya trees led to a decrease in both irradiance and temperature, and higher means of relative humidity during daytime in all the periods assessed, which contributes to a better environment for coffee cultivation. The shadow provided by papaya trees in the coffee plants contributed to a higher leaf area but did not affect neither the growth of both plagiotropic and orthotopic branches, nor the number of nodes and the etiolation. The intercropped system of Conilon coffee and papaya trees may be potentially used as a farming system to mitigate climate change.

PytuTester is an open-source ventilator tester developed to help bio-engineers in the design and verification of new ventilator prototypes. A ventilator tester allows measuring the flow, pressure, volume, and oxygen concentration provided to the patient. During the global pandemic COVID-19, several open-source ventilators prototypes were developed; however, due to high cost and demand testers, they were not available. In this context, a low-cost tester was developed using a Raspberry Pi and medical-grade sensors for the test ventilators prototypes. This paper presents the design files, software interface, and validations tests. Our results indicate that the tester has good accuracy to evaluate the efficacy and performance of new prototypes. When tested on two ventilator designs developed in Paraguay, PytuTester reported flow profiles that were concordant with the industry-standard VT650 Gas Flow Analyzer. PytuTester was then field deployed to test several DIY ventilator designs in low-resource areas.

O Grupo Votorantim foi criado em 1891, na cidade paulista de Sorocaba (Brasil). Desde 1930, passou a concentrar suas atividades no setor de bens intermediários (cimento, zinco, alumínio, produtos químicos e siderúrgicos), expandindo-se junto ao processo de industrialização do Brasil e convertendo-se no maior grupo privado da indústria nacional. Todavia, a partir dos anos 1980 — com a crise da dívida externa —, o modelo de industrialização liderado pelo Estado se perdeu e iniciou-se a desindustrialização do país. Neste artigo, analisam-se as estratégias da Votorantim para se adaptar à instabilidade econômica do Brasil pós-1980, utilizando como fonte os relatórios anuais do Grupo e apreendendo as seguintes estratégias: internacionalização, revisão do portfólio e mudanças na gestão do grupo no período de 1980 a 2019.

Abstract The role of liver stiffness measurement (LSM) after sustained virological response (SVR) in HCV patients treated by direct-acting antivirals (DAAs) remains unclear. We aimed to evaluate LSM regression value after SVR and to identify risk factors associated with liver related complications (LRC) or death. This retrospective study analyzed patients with LSM ≥ 10 kPa with LSM by transient elastography pre-DAAs and post-SVR. Patients with previous hepatic decompensation were excluded. Medical records were reviewed to identify primary outcomes. Kaplan–Meier curves and time-to-event Cox proportional-hazard models were performed. 456 patients [65% female, 62 years (IQR 57–68)] were included. During a follow-up of 2.3 years (IQR 1.6–2.7), 28 patients developed 37 outcomes [rate = 29.0 (95% CI 20.0–42.0) per 1000 person-years]. The cumulative incidence of outcomes was significantly lower in patients who regressed LSM ≥ 20% [3.4% (95% CI 1.8–7.0) vs. 9.0% (5.5–14.5), p = 0.028]. In a multivariate Cox-model [HR(95% CI)], male gender [HR = 3.00 (1.30–6.95), p = 0.010], baseline albumin

Geonoma is one of the more diverse genera of palms in the neotropical region, which comprises 68 species distributed from southern Mexico to south-western Brazil. In Maranhão, a Brazilian state lo-cated in a transition area between the Eastern Amazon, the Cerrado, and the Caatinga, the knowledge about this genus still is deficient. For this reason, we elaborated a taxonomic study of the genus Geono-ma for the state, based on the descriptive analysis of voucher specimens of national and interna-tional herbaria, and specimens collected in our expeditions. A total of five species were identified:G. baculifera and G. leptospadix species were previously cited in the literature, whereas G. maxima sub-sp. maxima, G. pohliana subsp. weddelliana and G. poiteauana are presented as new records. Taxo-nomic descriptions and distribution information are shared, as well as preliminary conservation status assessments of these species. Moreover, an identification key for all species in the state is also supplied. These findings extend the distribution and conservation knowledge of some Geonoma species, and are an important contribution to the identification of the taxa in the region.

Bokashi is fermented organic compost capable of improving the physical, chemical, and biological conditions of the soils. The compost action in the agricultural production system is influenced by its preparation, resulting in products with different physicochemical characteristics. The study aimed to characterize bokashi produced on-farm and compare it with commercial products. The produced composts in southern Brazil were obtained through efficient microorganisms (EM), collected in an area of permanent preservation, and kefir. Two commercial composts were used for comparison (Plantae FertTM and Bokashi Sementes BrasilTM). Physical characteristics related to apparent specific gravity, water content, and water retention capacity and chemical characteristics related to nutrient contents, pH, and electrical conductivity were analyzed. For the physical characteristics, the mean and standard deviation were determined. The data from chemical parameters were submitted to the analysis of variance, and the means were compared by the Tukey test with 5% significance. Bokashi produced on-farm and commercial Bokashi showed similar physical characteristics. Commercial bokashi composts showed higher contents of nutrients than the composts produced on-farm. The analyzed composts showed adequate physicochemical parameters, with no factors limiting their use in agriculture.

Resumo Em que pese o crescimento recente do campo história de empresas no Brasil, ainda permanecem lacunas sobre como e quem constituiu algumas das grandes firmas nacionais presentes no início do avanço industrial paulista, caso da Cia. Mecânica e Importadora de São Paulo, criada em 1890 na capital paulista. Dessa forma, o artigo busca mostrar que na formação da maior empresa de bens de capital paulista do final do XIX e décadas iniciais do século XX, a Cia. Mecânica e Importadora de São Paulo - a partir da incorporação da Lacerda, Camargo & Cia. e da Engelberg, Siciliano & Cia. - concorreram tanto nacionais quanto estrangeiros, que comandavam as empresas que foram incorporadas. Para tanto, utilizaremos demonstrações financeiras, relatórios, contratos e atas das seguintes empresas: J. Arbenz & Cia.; Lacerda, Camargo & Arbenz; Lacerda, Camargo & Cia; Cia. Mecânica e Importadora de São Paulo, além de anúncios do jornal Correio Paulistano no período 1882-1893.

Resumo Este artigo objetiva mostrar que a Bunge Brasil se consolidou como grupo econômico na segunda metade do século XX. Fundada em Amsterdam em 1818, atua no país desde 1905, chegando via Argentina onde estava presente desde o final do século XIX com o nome de Bunge y Born. Na década de 1990, o grupo Bunge Brasil chegou a ter 127 firmas independentes. Para este artigo selecionamos quatro delas, que representam diversos setores: trigo e moagem (Moinho Fluminense); tintas, vernizes e derivados (Tintas Coral); agronegócio e exportações (Sanbra); setor têxtil e confecções (Santista Têxtil). Teoricamente o texto segue os autores que discutem a formação de grupos econômicos em economias periféricas. Os dados primários foram levantados junto ao Centro de Memória Bunge, em São Paulo, e através de entrevistas. Como conclusão prévia pode-se afirmar que a Bunge se consolidou como grupo econômico na medida em que foi diversificando suas atividades e transformando algumas de suas 127 empresas em conglomerados industriais, elas mesmas tendo suas próprias coligadas e constituindo-se em outros grupos econômicos.

Background: Most remote areas have restricted access to healthcare services and are too small and remote to sustain specialist services. In 2017, the World Society of Emergency Surgery (WSES) published guidelines for the management of intra-abdominal infections. Many hospitals, especially those in remote areas, continue to face logistical barriers, leading to an overall poorer adherence to international guidelines. Methods: The aim of this paper is to report and amend the 2017 WSES guidelines for the management of intra-abdominal infections, extending these recommendations for remote areas and low-income countries. A literature search of the PubMed/MEDLINE databases was conducted covering the period up until June 2020. Results: The critical shortages of healthcare workers and material resources in remote areas require the use of a robust triage system. A combination of abdominal signs and symptoms with early warning signs may be used to screen patients needing immediate acute care surgery. A tailored diagnostic step-up approach based on the hospital's resources is recommended. Ultrasound and plain X-ray may be useful diagnostic tools in remote areas. The source of infection should be totally controlled as soon as possible. Conclusions: The cornerstones of effective treatment for intra-abdominal infections in remote areas include early diagnosis, prompt resuscitation, early source control, and appropriate antimicrobial therapy. Standardization in applying the guidelines is mandatory to adequately manage intra-abdominal infections.

Background:. Not all patients who exercise regularly and follow a balanced diet will obtain a well-defined abdomen. Medium definition liposuction, together with the removal of abdominal skin, can recreate an adequate connection between the skin/subcutaneous components and the myo-aponeurotic layer, resulting in the perception of muscle definition. Methods:. Over a period of 36 months, 351 patients underwent medium definition liposuction associated with abdominoplasty performed by a single surgeon (G.B.). All patients underwent an evaluation through digital photographs by two independent senior plastic surgeons, using an objective grading system for aesthetic outcomes proposed by Strasser, 12 months after the operation. Results:. According to the Strasser Scale, 326 patients (93%) were considered to have good and excellent results. Twenty-two patients (6.2%) had moderate/mediocre results‚ and three patients (0.8%) had poor results. The overall complication rate was 4.8%. Conclusion:. Medium definition liposuction associated with abdominoplasty has been shown to be effective, safe, and reproducible for most patients.

The data included in this article supplement the research article titled “Forest-to-pasture conversion modifies the soil bacterial community in Brazilian dry forest Caatinga (manuscript ID: STOTEN-D-21-19067R1)”. This data article included the analysis of 18 chemical variables in 36 composite samples (included 4 replicates) of soils from the Microregion of Garanhuns (Northeast Brazil) and also partial 16S rRNA gene sequences from genomic DNA extracted from 27 of these samples (included 3 best quality replicates) for paired-end sequencing (up to 2 × 300 bp) in Illumina MiSeq platform (NCBI - BioProject accession: PRJNA753707). Soils were collected in August 2018 in a tropical subhumid region from the Brazilian Caatinga, along with 27 composite samples from the aboveground part of pastures to determine nutritional quality based on leaf N content. The analysis of variance (ANOVA) and post-hoc tests of environmental data and the main alpha-diversity indices based on linear mixed models (LMM) were represented in the tables. In this case, the collection region (C1 – Brejão, C2 – Garanhuns, and C3 – São João) was the random-effect variable and adjacent habitats formed by a forest (FO) and two pastures (PA and PB succeeded by this forest) composed the fixed-effect variable (land cover), both nested within C. In addition, a table with similarity percentages breakdown (SIMPER) was also shown, a procedure to assess the average percent contribution of individual phyla and bacterial classes. The figures showed the details of the study location, sampling procedure, vegetation status through the Normalized Difference Vegetation Index (NDVI), in addition to the general abundance and composition of the main bacterial phyla.

RESUMO O artigo apresenta um breve percurso crítico-reflexivo pela região central de Lisboa, cidade que constrói, preserva e cultiva uma herança percebida como pombalina. O autor se atenta à conformação de marcos, narrativas e usos de aspectos de um passado ligado ao marquês de Pombal. Tomam-se como foco o Lisboa Story Centre, as tentativas de fazer da Lisboa Pombalina Patrimônio Mundial da UNESCO e a praça do Comércio; espaço vinculado ao discurso mais difundido sobre a reconstrução da capital após o terremoto de 1755 - discurso duradouro que se remete, no fundo, às ideias e justificativas elaboradas e divulgadas pelo marquês e por seus colaboradores.

Francisco de Paula Rodrigues Alves, nascido em Guaratinguetá-SP em 1848, teve uma longeva carreira política, iniciada como deputado provincial e que teve como ápice as duas vezes em que foi eleito presidente da República. Em meio aos cargos eleitorais, ele teve duas passagens como Ministro da Fazenda (novembro de 1891 a agosto de 1892; novembro de 1894 a novembro de 1896). Em que pese a existência de uma historiografia sobre a vida e obra de Rodrigues Alves, ela pouco se debruçou sobre suas propostas e tentativas de ação quando ministro, tampouco fez o confronto destes aspectos com o debate econômico nacional do final do século XIX. Dessa forma, o artigo busca dar uma contribuição ao estudo da atuação ministerial de Rodrigues Alves, utilizando como base documental os Relatórios do Ministério da Fazenda para os anos de 1891, 1894 e 1895. Constata que o conservadorismo que Rodrigues Alves demonstrou desde os tempos de estudante o guiou na sua vida ministerial, expressando-se pela sua luta pelas finanças saudáveis do Estado.

Abstract Background Peptic ulcer disease is common with a lifetime prevalence in the general population of 5–10% and an incidence of 0.1–0.3% per year. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10–20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment. Methods The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached. Conclusions The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.

The present work aims to assess the ethical and political conceptions of Marti's thought in his letters testaments and their potential for strengthening values in students of Higher Education. The paper addresses theoretical considerations about the letter as textual typology and Marti letters, with emphasis on his letters testaments. It is based on the results of an investigation proyect in which investigative techniques were applied, such as the bibliographic tracking and the procedures inherent to the semantic lexical analysis.

Abstract Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines.

Neste trabalho foi realizado um levantamento sobre os aplicativos móveis disponibilizados de forma gratuita e em língua portuguesa, voltados para a gestão no setor agropecuário e seu alcance. Para isto, foram realizadas pesquisas com palavras-chave nas lojas online Google Play e Apple Store, nas plataformas Android e iOS, respectivamente. O alcance foi estimado pelo número de downloads diretos para cada aplicativo móvel identificado. Foram encontrados trinta e cinco aplicativos móveis, destes, vinte e nove são pertencentes a empresas de iniciativa privada e seis oriundos de programas de esfera pública. A maioria dos aplicativos foi disponibilizada em 2017, denotando aumento da demanda no setor. Mais da metade dos aplicativos identificados são voltados para o setor de bovinocultura de corte ou leite, contudo, há indícios de uma potencial demanda para as demais categorias de aplicativos, indicada pelo alcance via downloads diretos. O comportamento observado nos dados é que aplicativos específicos tem alcance direto maior do que aplicativos genéricos de gestão. As ferramentas digitais vêm gradativamente conquistando espaço na produção animal, a internet mostra-se um excelente veículo para difundir informações técnicas geradas por pesquisadores e levá-las ao campo, atendendo à crescente demanda por informações técnicas e atuais em todos os segmentos da pecuária.

Expansion of the geographic distribution of Rapatea paludosa Aubl. (Rapateaceae) to the state of Maranhão, northeastern Brazil. The occurrence of R. paludosa is reported for the flora of Maranhão from the municipality of Cândido Mendes. This is the second species of the genus found in the state. The collected samples are also the second record of R. paludosa in the Northeastern Region of Brazil, adding information on its geographic distribution. Rapatea paludosa is described, illustrated, and its distribution mapped.

Abstract The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified as foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma. These lesions can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs. Early diagnosis and timely therapeutic intervention are the keys of successful management.

Sunscreen formulations containing inorganic/organic filters or mixture of them were synthesized by oil/water dispersion. The viscosity measurements show that sunscreen formulations are time-dependent non-newtonian fluids. In the CIELab color diagram, the white and/or beige colors presented by formulations do not compromise the aesthetics of the cosmetic product. UV-VIS absorption spectra show that sunscreen creams have high UV shielding ability, mainly the formulations containing inorganic and organic filters mixtures, which provide in vitro SPF and critical wavelength values recommended for UV protection.

Introduction: In rhinoplasty, the nasal dorsum has important relevance regarding the esthetic and functional aspects of the surgery. Its reduction should be performed with maximum accuracy and controlled resection to prevent or minimize potential complications. The septum pyramidal adjustment and repositioning consists of a conservative surgical technique of the nasal dorsum, which does not require the detachment of the upper lateral cartilages of the nasal septum, allowing the remodeling of the nasal dorsum while maintaining esthetic lines and nasal function, potentially reducing frequent complications in more traditional surgeries. Objective: To describe the septum pyramidal adjustment technique in detail, presenting its advantages and disadvantages in relation to the other surgical approaches, as well as to disclose results of this surgical procedure in patients submitted to primary rhinoplasty in a specific hospital. Methods: The medical records of all patients submitted to surgery from 2011 to 2015 through this surgical technique were evaluated by the same team. Of these cases, certain variables were analyzed such as gender, age, indication for reoperation and surgical complications. Results: 153 patients underwent rhinoplasty through septum pyramidal adjustment. Of these, 13 patients experienced an indication for a second surgery and four had some type of postoperative complication. Conclusion: The septum pyramidal adjustment surgical technique is a simple procedure, as it does not require the reconstruction of the nasal dorsum. It has a low number of complications and preserves the anatomical structures. Resumo: Introdução: Na rinoplastia, o dorso nasal tem importante relevância no quadro estético e funcional. A sua redução deve ser realizada com máxima precisão e ressecção controlada a fim de prevenir ou minimizar complicações potenciais. O termo septum pyramidal adjustment and repositioning consiste em uma técnica cirúrgica conservadora do dorso nasal, que não requer a desinserção das cartilagens laterais superiores do septo nasal, que permite remodelar o dorso nasal, manter as linhas estéticas e a função nasal, reduz potencialmente complicações frequentes nas cirurgias mais tradicionais. Objetivo: Descrever em detalhes o septum pyramidal adjustment, expor suas vantagens e desvantagens em relação às outras abordagens cirúrgicas, bem como apresentar resultados desse procedimento cirúrgico em pacientes submetidos à rinoplastia primária em um hospital específico. Método: Foram avaliados os registros médicos de todos os pacientes operados de 2011 a 2015 por essa técnica cirúrgica, pela mesma equipe. Desses casos, foram analisadas algumas variáveis, como: sexo, idade, indicação de reoperação e complicações cirúrgicas. Resultados: Foram submetidos 153 pacientes à rinoplastia por septum pyramidal adjustment. Desses, 13 tiveram segunda indicação cirúrgica e quatro apresentaram alguma complicação pós-operatória. Conclusão: A técnica cirúrgica septum pyramidal adjustmen apresenta-se como um procedimento de fácil execução, pois não exige a reconstrução do dorso nasal. Apresenta baixo número de complicações e preserva as estruturas anatômicas. Keywords: Rhinoplasty, Nasal dorsum, Nasal pyramid, Nasal function, Palavras-chave: Rinoplastia, Dorso nasal, Pirâmide nasal, Função nasal

Background & Aims: The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). Herein, we evaluated whether the schedule of LC screening or procedures has been interrupted or delayed because of the COVID-19 pandemic. Methods: An international survey evaluated the impact of the COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international, and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave. Results: Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia, and Africa (73.7%, 17.1%, 5.3%, 2.6%, and 1.3% per continent, respectively). Eighty-seven percent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening programme, 50% cancelled curative and/or palliative treatments for LC, and 41.7% modified the liver transplantation programme. Forty-five out of 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service before the COVID-19 pandemic (n = 19/37). Conclusions: The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with liver cancer. Modifications in screening, diagnostic, and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision-making. Lay summary: The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems globally. Herein, we assessed the impact of the first wave pandemic on patients with liver cancer and found that routine care for these patients has been majorly disrupted, which could have a significant impact on outcomes.

Since it acquired pandemic status, SARS-CoV-2 has been causing all kinds of damage all over the world. More than 6.3 million people have died, and many cases of sequelae are in survivors. Currently, the only products available to most of the world’s population to fight the pandemic are vaccines, which still need improvement since the number of new cases, admissions into intensive care units, and deaths are again reaching worrying rates, which makes it essential to compounds that can be used during infection, reducing the impacts of the disease. Plant metabolites are recognized sources of diverse biological activities and are the safest way to research anti-SARS-CoV-2 compounds. The present study computationally evaluated 55 plant compounds in five SARS-CoV-2 targets such Main Protease (Mpro or 3CL or MainPro), RNA-dependent RNA polymerase (RdRp), Papain-Like Protease (PLpro), NSP15 Endoribonuclease, Spike Protein (Protein S or Spro) and human Angiotensin-converting enzyme 2 (ACE-2) followed by in vitro evaluation of their potential for the inhibition of the interaction of the SARS-CoV-2 Spro with human ACE-2. The in silico results indicated that, in general, amentoflavone, 7-O-galloylquercetin, kaempferitrin, and gallagic acid were the compounds with the strongest electronic interaction parameters with the selected targets. Through the data obtained, we can demonstrate that although the indication of individual interaction of plant metabolites with both Spro and ACE-2, the metabolites evaluated were not able to inhibit the interaction between these two structures in the in vitro test. Despite this, these molecules still must be considered in the research of therapeutic agents for treatment of patients affected by COVID-19 since the activity on other targets and influence on the dynamics of viral infection during the interaction Spro x ACE-2 should be investigated.

ABSTRACT Purpose To analyze the effectiveness of vertical gastrectomy in the treatment of obese patients, adherence to clinical follow-up and the influence of factors such as gender and age. Methods This is a retrospective, observational and descriptive study, conducted with patients undergoing vertical gastrectomy, operated at Hospital São Domingos, between January 2016 and July 2018. Results Most patients undergoing vertical gastrectomy were female (n = 193, 72.28%) and had a mean age of37.11 ± 8.96 years old. The loss of follow-up was 56.18%. Among adherent patients (n = 117; 43.82%), most patients were female (n = 89; 76.07%) and had a mean age of 37.92 ± 9.85 years old. The mean body mass index (BMI) of the adherents in the preoperative was 37.85 ± 3.72 kg/m2. Both BMI and excess weight (EW) showed a statistically significant difference between pre- and postoperative period. Percentage of excess weight loss (% EWL) was satisfactory for 96.6% of adherent patients. Older patients had a statistically significant lower % EWL compared to the other groups. Conclusions Vertical gastrectomy was effective in the treatment of obese patients, with significant weight loss.

Propulsive swimming mechanics mainly depends on upper limbs' actions that perform three-dimensional movements in each cycle. Considering that hydrodynamic drag is proportional to the square of velocity, technical execution of segmental displacement at maximal exertions should be effective to ensure high and stable propulsive forces per cycle. Nevertheless, human movement is characterized by constraints that imply variability of motor solutions to optimise kinematic patterns and performance (Newell, 1986). The aim of the study is to characterize upper limbs phases when swimming front crawl at maximal velocity. Thirteen high-level swimmers participated in the study (16.2 ± 0.7 years of age and 171.6 ± 6 cm of height) that took place in a 25 m indoor pool after the main competition of the macrocycle. After a standardized warm-up, swimmers performed a 25 m front crawl at maximal intensity and were recorded in the sagittal plane for 2D kinematical analyses using a double camera set-up (Go Pro 6, 120 Hz) fixed laterally and pushed on a chariot. Upper limbs cycles were divided by counting frames using Blender software, and phases (entry, downsweep, insweep, upsweep, and recovery) were identified. The first seven cycles of each swimmer were analysed, and the relative duration of each phase was obtained as a percentage of the cycle duration. A repeated-measures ANOVA was used to verify differences between cycles, and ICC allowed investigating the relationship between them. The significance level was set at 5%. Figure 1 presents the relative duration of front crawl upper limbs phases (entry, downsweep, insweep, upsweep, and recovery = 18, 12, 20, 23, and 26 % respectively), being possible to observe that downsweep was the shortest even though non-propulsive phases prevailed in relation to the propulsive ones. Table 1 presents the mean values ± SD of the relative duration of seven successive upper limbs cycles. Although swimmers have presented variable relative duration of front crawl upper limbs phases, no differences were reported between cycles. Complementarily, ICC demonstrated high consistency in intraindividual performance (entry, downsweep, insweep, upsweep and recovery = 0.97, 0.90, 0.97, 0.93. 0.90, respectively). Despite the well-known decrease of non-propulsive phases at sprint pace due to the fastest hand velocity/acceleration (McCabe et al., 2011), a predominance was still observed. These results were expected since a higher increase in the relative duration of the propulsive phases could reduce the efficiency, and consequently, could be a technical mistake if its increase was not mandatory for the swimmers' high velocity. In becoming skilled, the neuromuscular system ensures that movement is performed consistently well while, at the same time, develops the ability to adapt to changing constraints. In the present study, we highlighted this statement, as a slight variability is observed between cycles. However, ANOVA and ICC showed a great consistency during the swimming, supporting that the relative duration of upper limbs phases was maintained, probably due to the swimmers' high level in response to the swimming constraints.

Autoantibodies are frequently reported in patients with malaria, but whether they contribute to protection or to pathology is an issue of debate. A large body of evidence indicates that antibodies against host-self components are associated to malaria clinical outcomes such as cerebral malaria, renal dysfunction and anemia. Nonetheless, self-reactive immunoglobulins induced during an infection can also mediate protection. In light of these controversies, we summarize here the latest findings in our understanding of autoimmune responses in malaria, focusing on Plasmodium falciparum and Plasmodium vivax. We review the main targets of self-antibody responses in malaria as well as the current, but still limited, knowledge of their role in disease pathogenesis or protection.

Our goal was to carry out a comparative study to evaluate the metabolic and inflammatory effects and the redox status of commercial vegetable oils supplementation [linseed (LO), coconut (VCO), and sunflower (SO)] in metabolically healthy rats. The results found in this study showed that the LO group decreased the HOMA-IR and hepatic cholesterol, and increased the serum levels of IL-6. Supplementation with VCO increased glucose and HOMA-IR, cholesterol concentration and serum triacylglycerol (TAG). In this group, there was also an increase in TBARS. In the SO group there was a decrease in serum concentrations of cholesterol and TAG and an increase in hepatic concentration of these lipids. In addition, in the SO group there was a decrease in hepatic and serum concentrations of IL-6 and hepatic levels of TNF, as well as a decrease in the GSH/GSSG ratio, suggesting changes in glutathione metabolism and inflammatory mediators.

This paper aimed to present a development proposal for packaging for tin foil with a mobile cutting mechanism and user protection. Based on the simulation of a market research, a gap was shown, represented by consumers of tin foil dissatisfied with the results of this product cutting. Faced with this, several cases are observed in which there are difficulties associated with cutting the paper, where the consumer has to use scissors or other instruments, and thus a waste of paper occurs. Therefore, tools and decision-making techniques were used for product development processes, such as QFD, Cost Analysis, FMEA, Benchmarking, SWOT and Ergonomic Analysis. As a result, , the format of this proposal sought to provide the consumer with greater practicality, safety and precision in paper cutting, and factors such as the low cost of the raw material and the complexity of the packaging, allied to the large utility and lack of market, can further intensify the chances of the product entering the packaging sector, with larger competitive potential.

Abstract Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a “planned second-look” laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.

Nos últimos anos, a robótica tem despertado a atenção da comunidade docente e discente no âmbito do IFPB. A Instituição tem promovido diversas práticas abordando a robótica como tema central. Entre estas práticas, destacam-se as competições realizadas na Instituição ou em outros centros educacionais, nas quais as equipes são estimuladas a produzir robôs que resolvam alguns problemas propostos, inspirados em desafios práticos do cotidiano. Dessa forma, a robótica pode ser uma ferramenta prática que permite aplicar e integrar os conhecimentos abordados em sala de aula, desenvolvendo, além das habilidades técnicas, a capacidade de liderança, gerenciamento e trabalho em equipe – que são requisitos essenciais no mundo do trabalho. De modo geral, kits didáticos criados para desenvolvimento e ensino de robótica possuem um custo elevado; além disso, comumente, possuem tecnologia proprietária, de modo que as práticas são limitadas ao que é proposto pelos fabricantes. Nessa direção, este trabalho propõe o desenvolvimento de um robô móvel que possa ser utilizado para fins didáticos em estudos iniciais ou avançados de robótica autônoma. O robô desenvolvido possui sensores infravermelhos para detecção e desvio de obstáculos, medição de velocidade e um sistema de medição de coordenadas globais GPS. O robô é baseado nas plataformas open-source: Arduino e Raspberry Pi. Resultados de simulação e experimentais são apresentados para demonstrar o funcionamento do protótipo desenvolvido bem como suas potencialidades, nas quais podem-se destacar a detecção e desvio de obstáculos, navegação remota com feedback de imagens e controle de velocidade por meio de reguladores PID (Proporcional, Integrativo e Derivativo).

Una vez que el foco de la reflexión pasa de las teorías ideales a la aplicación de la justicia social, centrada en las instituciones de las sociedades democráticas, se requiere prestar especial atención a los estilos de vida. Estos tienen una alta incidencia en cómo la justicia es realizada y afectan tanto a la desigualdad económica como a la disponibilidad de los recursos naturales. En nuestras sociedades es posible establecer restricciones a los estilos de vida, especialmente en aquellos casos en que, por el efecto de algunas dinámicas sociales, aquellos se desacoplan de las concepciones del bien. Se defiende que, en tales casos, la base normativa que permite exigir el respeto a los estilos de vida se disuelve y por ello es posible justificar su restricción.

Abstract The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.