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Introduction: International societies recommend microbiological surveillance of endoscopes to reduce the incidence of endoscope-associated infections, particularly for duodenoscopes. However, surveillance protocols are not internationally standardized, both regarding sample collection, processing, and culture. This study aims to provide a framework protocol encompassing the experience of a tertiary large volume endoscopy center and the microbiology laboratory for collecting and culturing of endoscope samples for microbiological surveillance. Methods: A sample collection and processing protocol was designed as a result of a cooperation between the Endoscopy Center of the Gastroenterology Department and the Microbiology Laboratory of the Department of Clinical Pathology. This protocol reflects international recommendations in this topic and the human and technological resources of the involved departments. Results: The established protocol for collecting samples varies according to the type and model of endoscope. The specimens are collected as sterile saline liquid samples, as well as swabs (with and without transport media). Together with the collection of samples from the endoscope, samples from the final rinse water as well as the water bottle are also collected. For duodenoscopes and curvilinear echoendoscopes, we perform microbiological surveillance every 3 months; for gastroscopes and colonoscopes, at least, once a year; and for specific endoscopes, such as the pediatric or dual-channel therapeutic endoscopes, enteroscopes, or radial echoendoscopes, every 6 months. Conclusion: Endoscopy units should have detailed protocols for microbiological surveillance of endoscopes. These protocols should be drawn up by a multidisciplinary team that includes endoscopy nurses, gastroenterologists, microbiologists, and the antimicrobial stewardship team, following international recommendations, adapted to each institution resources.

Abstract Background Globally, the counting of deaths based on gender identity and sexual orientation has been a challenge for health systems. In most cases, non-governmental organizations have dedicated themselves to this work. Despite these efforts in generating information, the scarcity of official data presents significant limitations in policy formulation and actions guided by population needs. Therefore, this manuscript aims to evaluate the accuracy, potential, and limits of probabilistic data relationships to yield information on deaths according to gender identity and sexual orientation in the State of Rio de Janeiro. Methods This study evaluated the accuracy of the probabilistic record linkage to obtain information on deaths according to gender and sexual orientation. Data from two information systems were used from June 15, 2015 to December 31, 2020. We constructed nine probabilistic data relationship strategies and identified the performance and cutoff points of the best strategy. Results The best data blocking strategy was established through logical blocks with the first and last names, birthdate, and mother’s name in the pairing strategy. With a population base of 80,178 records, 1556 deaths were retrieved. With an area under the curve of 0.979, this strategy presented 93.26% accuracy, 98.46% sensitivity, and 90.04% specificity for the cutoff point ≥ 17.9 of the data relationship score. The adoption of the cutoff point optimized the manual review phase, identifying 2259 (90.04%) of the 2509 false pairs and identifying 1532 (98.46%) of the 1556 true pairs. Conclusion With the identification of possible strategies for determining probabilistic data relationships, the retrieval of information on mortality according to sexual and gender markers has become feasible. Based on information from the daily routine of health services, the formulation of public policies that consider the LGBTQ + population more closely reflects the reality experienced by these population groups.

Objetivo: identificar o conhecimento dos enfermeiros e as práticas relacionadas a úlceras ou infecções em membros inferiores nas pessoas com diabetes mellitus. Método: estudo qualitativo realizado com 24 enfermeiros de equipes de saúde da família de um município do interior do estado de Minas Gerais - Brasil. Entrevistas semiestruturadas foram realizadas nos meses de outubro e novembro de 2022, analisadas pela técnica de análise temática e discutidas pela literatura relativa à temática. Resultados: foram identificadas duas categorias temáticas: “Conhecimento sobre úlceras ou infecções em membros inferiores em pessoas com diabetes mellitus” e “Trabalho do enfermeiro no cuidado às pessoas com diabetes mellitus”. Conclusão: o estudo demonstrou que os conhecimentos e as práticas sobre úlceras ou infecções em membros inferiores estão fragilizados, evidenciando a necessidade de construção do conhecimento na área da enfermagem e o incentivo para a adoção de medidas preventivas pelos profissionais de saúde, em especial, os enfermeiros da atenção básica.

Objetivo: identificar los conocimientos y prácticas del personal de enfermería relacionados con las úlceras o infecciones de los miembros inferiores en personas con diabetes mellitus. Método: estudio cualitativo realizado con 24 enfermeros de equipos de salud familiar de un municipio del interior del estado de Minas Gerais - Brasil. En octubre y noviembre de 2022 se llevaron a cabo entrevistas semiestructuradas, que se analizaron mediante la técnica del análisis temático y se debatieron a partir de la bibliografía sobre el tema. Resultados: se identificaron dos categorías temáticas: "Conocimientos sobre úlceras o infecciones de los miembros inferiores en personas con diabetes mellitus" y "El trabajo del enfermero en el cuidado de las personas con diabetes mellitus". Conclusión: El estudio demostró que los conocimientos y las prácticas sobre las úlceras o infecciones de los miembros inferiores son frágiles, lo que pone de relieve la necesidad de aumentar los conocimientos en el campo de la enfermería y fomentar la adopción de medidas preventivas por parte de los profesionales sanitarios, especialmente los enfermeros de atención primaria.

Objective: To identify nurses' knowledge and practices related to lower limb ulcers or infections in people with diabetes mellitus. Method: A qualitative study was conducted with 24 nurses from family health teams in a municipality in the countryside of the State of Minas Gerais – Brazil. Semi-structured interviews were conducted in October and November 2022, analyzed using the thematic analysis technique, and discussed using the literature on the subject. Results: The study's findings revealed two crucial thematic categories: "Knowledge about lower limb ulcers or infections in people with diabetes mellitus" and "The work of nurses in caring for people with diabetes mellitus". These findings underscore the urgent need to improve knowledge and practices about ulcers or infections in the lower limbs, emphasizing the pivotal role of nurses in this process. Conclusion: The study showed that knowledge and practices about ulcers or infections in the lower limbs are fragile, highlighting the need to build knowledge in the nursing field and encourage the adoption of preventive measures by health professionals, especially primary care nurses.

Background/Objectives: The aim of this study was to evaluate incidental findings in the mandible after the placement of dental implants using a new cone–beam computed tomography (CBCT) software. Methods: The initial sample consisted of 2872 CBCT scans of patients of both sexes. The parameters evaluated in this study were the location of the implants in the mandible, implant length, anatomical relationship of the implant with the mandibular canal, presence or absence of damage to the adjacent teeth, presence or absence of implant fractures, and presence or absence of bone support. Fisher’s exact test was performed to compare the variables. The significance level was set at p = 0.05. Results: Out of 2872 CBCT scans, 214 images of patients with an average age of 44.5 years were included. The most frequent location of the implants was the posterior region (93.5%), with 54% of the implants having a length between 9 and 14 mm. It was found that 92% of the implants were positioned above the mandibular canal. Damage to adjacent teeth was observed, with no correlation with the implant positioning (p = 1.000). In 100% of cases of implants in the anterior region, there was bone support. Fracture was observed in 1.7% of implants with a length between 9 and 14 mm. Conclusions: The installation of implants in the mandible occurs more frequently in the posterior region, with a high presence of bone support and a low incidence of damage to adjacent teeth, anatomical structures, and fractures.

Background: Cryoballoon ablation (CBA) for pulmonary vein isolation (PVI) has been growing as an alternative technique, not only in patients with paroxysmal atrial fibrillation (PAF) but also in persistent atrial fibrillation (AF). Cryoballoon ablation has demonstrated encouraging acute and mid-term results. However, data on long-term follow-up of CB-based PVI are scarce. Objective: We sought to examine efficacy, safety, and long-term outcomes of CBA in PAF and persistent AF in four Portuguese centers. Methods: All patients that were treated with the cryoballoon catheter according to routine practices with a second-generation 28-mm CB in four centers were included. This was a retrospective, non-randomized analysis. Patients were followed-up for >12 months and freedom from atrial arrhythmias (AA) was evaluated at the end of follow-up. Results: Four hundred and six patients (57.7 ± 12.4 years, 66% men) participated. AF was paroxysmal in 326 patients (80.2%) and persistent in 80 (19.7%). The mean procedure time duration was 107.7 ± 50.9 min, and the fluoroscopy time was 19.5 ± 9.7 min. Procedural/periprocedural complications occurred in 30 cases (7.3%), being transient phrenic nerve palsy the most frequent incident (2 out of 3 complications). Anatomic variations of the PV were present in 16.1% of cases. At a mean follow-up of 22.0 ± 15.0 months, 310 patients (76.3%) remained in stable sinus rhythm, with at least one AF episode recurrence documented in 98 cases (24.1%). The recurrence rate was 20.5% in the PAF group and 37.8% in the persistent AF group. Conclusion: In this multicenter experience, a single CBA procedure resulted in 75.9% freedom from AF at a 22-month follow-up. This technique was demonstrated to be a safe and effective option in experienced centers for the treatment of PAF and PersAF. Resumo: Introdução: Observa-se um crescimento progressivo na utilização do cateter de balão de CrioEnergia (CBC) para isolamento das veias pulmonares (IVP), não apenas em doentes com fibrilhação auricular paroxística (FAParox), mas também com fibrilhação auricular persistente (FAPers). Esta tecnologia tem apresentado resultados – a curto e a médio prazo – encorajadores. No entanto, ainda há escassez de dados sobre o acompanhamento de longo prazo do IVP baseado em CBC. Objetivo: Procurámos examinar a eficácia, segurança e os resultados clínicos a longo prazo da ablação com CBC em doentes com FAParox e FAPers nos procedimentos realizados em quatro centros portugueses. Métodos: Foram incluídos todos os doentes submetidos a ablação com CBC de 28 mm de segunda geração, em quatro centros de eletrofisiologia. Esta foi uma análise retrospetiva e não randomizada. Os doentes foram acompanhados por um período >12 meses, tendo sido avaliada a presença de taquiarrimtias auriculares (TA) nesse período, bem como a ocorrência de complicações do procedimento. Resultados: Nesta análise, foram incluídos 406 (57,7 ± 12,4 anos, 66% homens). Nestes, observou-se que a FA era paroxística em 326 doentes (80,2%) e persistente em 80 (19,7%). O tempo médio de procedimento foi de 107,7 ± 50,9 minutos e o tempo de fluoroscopia de 19,5 ± 9,7 minutos. Ocorreram complicações no procedimento/periprocedimento em 30 casos (7,3%), sendo a paralisia do nervo frénico o incidente mais frequente (2 de 3 complicações). Observaram-se variações anatómicas das VPs em 16,1% dos casos. Em um seguimento médio de 22,0 ± 15,0 meses, 310 doentes (76,3%) permaneceram em ritmo sinusal estável, sendo documentado, pelo menos um episódio de FA em 98 casos (24,1%). A taxa de recorrência foi de 20,5% no grupo FAParox e 37,8% no grupo FAPers. Conclusão: Nesta experiência multicêntrica, um único procedimento com CBC resultou em 75,9% de ausência de FA em 22 meses de acompanhamento. Essa técnica demonstrou ser uma opção segura e eficaz em centros experientes no tratamento da FAParox e FAPers.

Silver nanoparticles (AgNPs) possess unique characteristics ideal for enhancing device sensitivity, primarily due to their high surface-to-volume ratio facilitating heightened interaction with analytes. Integrating AgNPs into polymers or carbon-based materials results in nanocomposites with synergistic properties, enabling the detection of minute changes in the environment across various applications. In this study, we investigate the adsorption kinetics of AgNPs within multilayered layer-by-layer (LbL) structures, specifically examining the impact of AgNPs concentration in the LbL film formation that is further explored as sensing units in an impedimetric microfluidic e-tongue. Although absorption kinetic studies are infrequent, they are crucial to optimize the AgNPs adsorption and distribution within LbL structures, significantly influencing upcoming applications. Through systematic variation of AgNPs concentration within identical LbL architectures, we applied the films as sensing units in a microfluidic e-tongue capable of distinguishing food enhancers sharing the umami taste profile. Across all tested scenarios, our approach consistently achieves robust sample separation, evidenced by silhouette coefficient, principal component analyses, and long-term stability. This work contributes to exploring controlled nanomaterial-based developments, emphasizing the importance of precise parameter control for enhanced sensor performance across diverse analytical applications.

Resumo Objetivo refletir sobre as implicações e os riscos associados ao novo registro de identificação do Brasil para a população trans. Método trata-se de estudo reflexivo que explora o conceito de identidade social como um fenômeno complexo, fundamentado nos princípios da autodeterminação e da dignidade humana. São consideradas perspectivas feministas pós-humanistas e críticas, que desafiam o essencialismo biológico dos indivíduos, com foco especial na teoria de Judith Butler. Resultados o Brasil está atualmente implementando um registro nacional de identificação capaz de reconhecer a identidade de gênero das pessoas trans. Este estudo aborda as implicações do novo sistema nacional de identificação, incluindo possíveis retrocessos e avanços na luta pelos direitos das pessoas trans. Para proteger a identidade e a segurança dessas pessoas, este artigo defende a criação de um novo sistema de identificação emitido pelo governo que armazene informações pessoais em bancos de dados, exibindo apenas o nome social e o marcador de gênero no cartão. Considerações finais e implicações para a prática as altas taxas de violência contra pessoas trans no Brasil destacam a necessidade urgente do novo sistema. O reconhecimento precoce e o respeito pela identidade de gênero são fundamentais para promover o sucesso do novo sistema.

The purpose of this study was to examine the perceived impact of a Service-Learning (SL) experience titled “Educating for Sustainable Development Goals (SDGs),” at the Porto campus of Universidade Católica Portuguesa (UCP), in which 15 university students from different programs were challenged to train other students about the SDGs. The main aim of the SL project was to raise awareness about the SDGs among the recipients (200 high school students, 20 students from a University in Angola and 40 from a University in Brazil). Besides the development of soft skills in UCP students, the learning objectives also focused on training socially responsible citizens who can take the SDGs into their future professions and help create a better and more sustainable world. UCP students were asked to reflect on their SL experience in the middle and at the end of the semester, based on structured reflection prompts. Based on these reflections, the present study aimed to understand the perceived impact of the SL experience on UCP students, particularly on their understanding of sustainable development (e.g., knowledge of SDGs), and the recipients (e.g., knowledge of strategies to achieve SDGs). Qualitative analysis was performed through NVIVO software. The results showed an impact not only on the academic learning and the UCP students’ personal and professional domains, but also on their literacy about the SDGs. According to the UCP students’ perceptions, the SL experience was particularly helpful in promoting SDGs awareness in the recipients and predisposing them to change attitudes and behaviors. Therefore, we conclude that the SL project accomplished its purpose of promoting awareness of the SDGs among the recipients. The implications of these findings are discussed in the context of the role of higher education institutions and SL experiences in sustainable development.

Amiodarone is the most potent antiarrhythmic drug available and is commonly prescribed to treat and prevent not only life-threatening ventricular arrhythmias but also atrial fibrillation (AF). The latest European Society of Cardiology AF guidelines state that amiodarone is recommended for long-term rhythm control in all AF patients but that other antiarrhythmic drugs should be considered first whenever possible, due to its extracardiac toxicity. In patients without significant or with only minimal structural heart disease, amiodarone is not listed as a possibility in their therapeutic scheme. Still, amiodarone is widely and liberally used, and is the most prescribed antiarrhythmic drug for patients with AF despite its high toxicity profile. Non-cardiovascular death was more frequent with amiodarone treatment than with a rate control strategy in AFFIRM, while meta-analyses suggest an association between amiodarone use in patients without structural heart disease and increased non-cardiovascular mortality. Severe or even fatal outcomes due to amiodarone may occur years after treatment initiation and are often not acknowledged by the prescribing physician, who may no longer be following the patient. The lack of widely accepted diagnostic criteria and symptom definitions may lead to underestimation of the incidence of severe side effects and of its toxicity. Unlike the underestimated risk of toxicity with amiodarone, severe complications associated with catheter ablation are usually directly ascribed to the treatment even by non-medical personnel, possibly resulting in overestimation of risks. This brief review will address the issue of amiodarone overuse and the frequent underestimation of its toxicity, while suggesting scenarios in which its use is entirely reasonable, and compare it with catheter ablation. Resumo: A amiodarona é o fármaco antiarrítmico mais potente de que dispomos e é frequentemente prescrita para tratar e prevenir não apenas arritmias ventriculares malignas, mas também fibrilhação auricular (FA). Nas mais recentes diretrizes da Sociedade Europeia de Cardiologia, a «Amiodarona é recomendada para o controlo do ritmo a longo prazo em todos os doentes com FA». No entanto, os autores afirmam que «outros fármacos antiarrítmicos devem ser considerados primeiro sempre que possível» atendendo à toxicidade extracardíaca da amiodarona. Em doentes sem cardiopatia estrutural significativa, a amiodarona não está sequer listada como uma possibilidade no seu diagrama terapêutico. Ainda assim, a amiodarona é amplamente prescrita e liberalmente utilizada, representando o fármaco antiarrítmico mais prescrito para doentes com FA, apesar do seu elevado perfil de toxicidade. A morte não cardiovascular foi mais frequente com a amiodarona do que com uma estratégia de controlo de frequência no estudo AFFIRM, enquanto dados meta-analíticos sugerem uma associação entre o uso de amiodarona em doentes sem doença cardíaca estrutural e o aumento da mortalidade não cardiovascular. Eventos adversos graves e mesmo fatais devidos à amiodarona podem ocorrer anos após o início do tratamento e, muitas vezes, não são reconhecidos pelo médico que prescreveu o fármaco que pode já não estar a seguir o doente. A falta de critérios de diagnóstico amplamente aceites pode levar a uma subestimativa da incidência de efeitos secundários graves e a uma perceção subestimada da sua toxicidade. Contrariamente ao risco subestimado de toxicidade da amiodarona, as complicações graves associadas à ablação por cateter são facilmente atribuíveis ao tratamento, mesmo por pessoal não médico, resultando numa perceção possivelmente sobrestimada dos seus riscos. Esta breve revisão abordará o problema do uso excessivo de amiodarona e a perceção por norma subestimada da sua toxicidade e sugerirá cenários em que a sua utilização é inteiramente razoável.

RESUMO Os objetivos deste estudo de caráter longitudinal prospectivo foram analisar telefonemas mensais e calendários como registro da taxa de quedas de idosos da comunidade ao longo de 22 semanas e verificar os fatores relacionados à adesão ao calendário de quedas. Os participantes passaram por avaliações de anamnese, nível de atividade física, medidas neuropsicológicas e mobilidade. Receberam também um calendário de quedas que deveria ser preenchido, ao longo das 22 semanas, no(s) dia(s) em que o evento ocorresse. Ademais, os idosos foram contatados mensalmente por telefone para o questionamento da ocorrência de quedas naquele período. Para análise dos dados, foi adotado nível de significância de α=0,05, e para execução dos testes estatísticos foi utilizado o software SPSS 20.0. Os dois instrumentos foram comparados quanto à “sensibilidade” e à “especificidade”. Foram incluídos 52 idosos no estudo, com média de idade de 70,5 anos. A adesão ao método do calendário foi de 63,4% em comparação à estratégia dos telefonemas. Dos nove participantes que relataram quedas pelos telefonemas, três as notificaram no calendário, resultando em uma sensibilidade de 33%. Dos 43 idosos que não relataram quedas por telefonemas, 31 entregaram o calendário sem registro, o que resultou em uma especificidade do calendário de 72%. Anos de escolaridade, pontuação no Miniexame de Estado Mental e desempenho no exame cognitivo de Addenbrooke (versão revisada) influenciaram significativamente na adesão ao calendário de quedas. Concluiu-se que houve maior notificação de quedas pelo método do telefonema mensal em comparação ao do calendário em idosos da comunidade.

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

Background: Upgrade to cardiac resynchronization therapy (CRT) is common in Europe, despite little and conflicting evidence. Objective: To compare long-term clinical outcomes in a cohort of patients receiving de novo or upgrade to CRT. Methods: Single-center retrospective study of 295 consecutive patients submitted to CRT implantation between 2007 and 2018. Upgraded and de novo patients complying with a dedicated follow-up protocol were compared in terms of clinical (NYHA class improvement without major adverse cardiac events [MACE] in the first year of follow-up) and echocardiographic (left ventricle end-systolic volume reduction of >15% during the first year) response. Results: No differences in the rate of clinical (59.3% vs 62.6%, P = .765) or echocardiographic response (72.2% vs 71.9%, P = .970) between groups were observed. Device-related complications were also comparable between groups (8.9% vs 8.4%, P = .892). Occurrence of MACE and all-cause mortality were analyzed over a median follow-up of 3 (interquartile range 1–6) years: MACE occurred less frequently in the de novo group (hazard ratio [HR]: 0.55, 95% confidence interval [CI]: 0.34–0.90, P = .018), but all-cause mortality was similar among groups (HR: 0.87, 95% CI: 0.46–1.64, P = .684). Propensity score–matching analysis was performed to adjust for possible confounder variables. In the propensity-matched samples, all-cause mortality (HR: 1.26, 95% CI: 0.56–2.77, P = .557) and MACE (HR: 0.84, 95% CI: 0.46–1.54, P = .574) were comparable between upgrade and de novo patients. Conclusion: Survival after upgrade to resynchronization therapy was comparable to de novo implants. Additionally, clinical and echocardiographic response to CRT in upgraded patients were similar to de novo patients.

Critical COVID-19 has been associated with altered patterns of cytokines. Distinct inflammatory processes in systemic and pulmonary sites have been reported, but studies comparing these two sites are still scarce. We aimed to evaluate the profile of pulmonary and systemic cytokines and chemokines in critically ill COVID-19 patients. Levels of cytokines and chemokines were measured in plasma samples and minibronchoalveolar lavage of critical COVID-19 patients within 48 h and 5–8 days after intubation. Distinct inflammatory processes were observed in the lungs and blood, which were regulated separately. Survivor patients showed higher lung cytokine levels including IFN-γ, IL-2, IL-4, G-CSF, and CCL4, while nonsurvivors displayed higher levels in the blood, which included IL-6, CXCL8, CXCL10, CCL2, and CCL4. Furthermore, our findings indicate that high TNF and CXCL8 levels in the mini-BAL were associated with better lung oxygen exchange capacity, whereas high levels of IFN-γ in plasma were associated with worse lung function, as measured using the PaO2/FiO2 ratio. These results suggest that a robust and localized inflammatory response in the lungs is protective and associated with survival, whereas a systemic inflammatory response is detrimental and associated with mortality in critical COVID-19.

This study aimed to evaluate the effects of supplementation with non-protein nitrogen (NPN) or ruminal undegradable protein (RUP) on intake, digestibility, and amino acid (AA) use efficiency of Nellore cattle grazing during the dry season. Eight Nellore steers (12 ± 2 months old) were used in quadruplicate Latin squares (2 × 2). The animals were placed on Urochloa brizantha cv. Xaraés under continuous grazing. The treatments included the following: (1) urea supplementation (NPN) and (2) supplementation of corn gluten meal 60 (CGM, RUP). Animals supplemented with CGM showed higher intakes of dry matter (DM) supplement, total AA, essential AA, and individual AA. The supplementation did not affect the total AA digestibility, total AA flux, and the AA fluxes of microbial origin and RUP from the diet (p > 0.05). The ruminal microorganism origin flux of total AA to the duodenum was 44.5% and 52.7% for animals supplemented with NPN and CGM, respectively. Animals supplemented with CGM showed an increase in blood concentrations of isoleucine (+19.09 μmol/L), cystine (+27.29 μmol/L), and albumin (+0.11 g/dL) (p < 0.05), but this increase was not accompanied by an improvement in N use efficiency of steers (p > 0.05). RUP supplementation via CGM can be an efficient nutritional strategy to enhance the intake and absorption of AA by Nellore cattle grazing low-quality forage during the dry season.

Objetivo: Determinar la frecuencia de pluripatología en una Unidad de Insuficiencia Cardíaca, definir las características de los pacientes pluripatológicos y su pronóstico vital según dos modelos: el índice PROFUND y el Seattle Heart Failure Model. Material y métodos: Se han analizado de forma consecutiva los pacientes observados en la consulta de insuficiencia cardíaca de un hospital de tercer nivel durante dos meses. Se han registrado comorbilidades, categorías de pluripatología y los índices de Charlson, Barthel, Seattle Heart Failure Model y PROFUND. Resultados: Se incluyeron 246 pacientes, de los que 118 (48%) fueron pluripatológicos, con índice de Charlson 7,9±3,8 y PROFUND 3,5±7,1. La categoría de pluripatología más prevalente fue la A, seguida de la B y C. Los pluripatológicos fueron mayores (77 vs. 73 años, p=0,001), más frágiles, con mayor limitación funcional (Barthel: 84,7 vs. 96,1, p

Background/Objectives: The aim of this study was to evaluate incidental findings in the mandible after the placement of dental implants using a new cone–beam computed tomography (CBCT) software. Methods: The initial sample consisted of 2872 CBCT scans of patients of both sexes. The parameters evaluated in this study were the location of the implants in the mandible, implant length, anatomical relationship of the implant with the mandibular canal, presence or absence of damage to the adjacent teeth, presence or absence of implant fractures, and presence or absence of bone support. Fisher's exact test was performed to compare the variables. The significance level was set at p = 0.05. Results: Out of 2872 CBCT scans, 214 images of patients with an average age of 44.5 years were included. The most frequent location of the implants was the posterior region (93.5%), with 54% of the implants having a length between 9 and 14 mm. It was found that 92% of the implants were positioned above the mandibular canal. Damage to adjacent teeth was observed, with no correlation with the implant positioning (p = 1.000). In 100% of cases of implants in the anterior region, there was bone support. Fracture was observed in 1.7% of implants with a length between 9 and 14 mm. Conclusions: The installation of implants in the mandible occurs more frequently in the posterior region, with a high presence of bone support and a low incidence of damage to adjacent teeth, anatomical structures, and fractures. [ABSTRACT FROM AUTHOR]

Introduction: In patients with supraventricular arrhythmias and high ventricular rate, unresponsive to rate and rhythm control therapy or catheter ablation, atrioventricular (AV) node ablation may be performed. Objectives: To assess long-term outcomes after AV node ablation and to analyze predictors of adverse events. Methods: We performed a detailed retrospective analysis of all patients who underwent AV node ablation between February 1997 and February 2019, in a single Portuguese tertiary center. Results: A total of 123 patients, mean age 69±9 years and 52% male, underwent AV node ablation. Most of them presented atrial fibrillation at baseline (65%). During a median follow-up of 8.5 years (interquartile range 3.8-11.8), patients improved heart failure (HF)functional class (NYHA class III-IV 46% versus 13%, p=0.001), and there were reductions in hospitalizations due to HF (0.98±1.3 versus 0.28±0.8, p=0.001) and emergency department (ED) visits (1.1±1 versus 0.17±0.7, p=0.0001). There were no device-related complications. Despite permanent pacemaker stimulation, left ventricular ejection fraction did not worsen (47±13% vs. 47%±12, p=0.63). Twenty-eight patients died (23%). The number of ED visits due to HF before AV node ablation was an independent predictor of the composite adverse outcome (OR 1.8, 95% CI 1.24-2.61, p=0.002). Conclusions: Despite pacemaker dependency, the clinical benefit of AV node ablation persisted at long-term follow-up. The number of ED visits due to HF before AV node ablation was an independent predictor of the composite adverse outcome. AV node ablation should probably be considered earlier in the treatment of patients with supraventricular arrhythmias and HF, especially in cases that are unsuitable for selective ablation of the specific arrhythmia. Resumo: Introdução: Nos doentes com disritmias supraventriculares e frequência ventricular elevada, irresponsivos à terapêutica para controlo da frequência e do ritmo, ou à ablação por catéter, a ablação do nódulo auriculoventricular (ANAV) pode ser realizada. Objetivos: Avaliar os resultados em longo prazo após a ANAV e analisar preditores de eventos adversos. Métodos: Análise retrospetiva detalhada, dos doentes submetidos à ANAV entre fevereiro 1997 e fevereiro 2019, num centro terciário português. Resultados: Foram submetidos 123 doentes à ANAV: idade média 69 ± 9 anos e 52% homens. A maioria apresentou fibrilhação auricular (65%). Num período mediano de seguimento de 8,5 anos (intervalo interquartil 3,8-11,8), houve melhoria da classe funcional de insuficiência cardíaca (IC) (classe NYHA III-IV 46% versus 13%, p = 0,001) e redução dos internamentos por IC (0,98±1,3 versus 0,28±0,8, p=0,001), redução dos recursos ao serviço de urgência (SU) (1,1±1 versus 0,17±0,7, p=0,0001). Não houve complicações relacionadas ao dispositivo. Apesar da estimulação permanente de pacemaker, a FEVE não agravou (47%±13 versus 47%±12, p=0,63). Faleceram 28 doentes (23%). O número de recursos ao SU por IC antes do procedimento foi preditor independente do composto de eventos adversos (OR 1,8, IC95%, 24-2,61, p=0,002). Conclusões: Apesar da dependência de pacemaker, o benefício clínico da ANAV persistiu a longo prazo. O número de recursos ao SU por IC antes do procedimento foi preditor do composto de eventos adversos. Provavelmente, a ANAV deveria ser considerada mais cedo no tratamento de doentes com disritmias supraventriculares e IC, sobretudo nos casos em que a ablação seletiva da disritmia seja inapropriada.

BackgroundEpidemiological and experimental studies have shown a protective effect of helminth infections in weight gain and against the development of metabolic dysfunctions in the host. However, the mechanisms Treg cells exert in the helminth-obesity interface has been poorly investigated. The present study aimed to verify the influence of Heligmosomoides polygyrus infection in early stages of high fat diet-induced obesity.Principal findingsThe presence of infection was able to prevent exacerbated weight gain in mice fed with high fat diet when compared to non-infected controls. In addition, infected animals displayed improved insulin sensitivity and decreased fat accumulation in the liver. Obesity-associated inflammation was reduced in the presence of infection, demonstrated by lower levels of leptin and resistin, lower infiltration of Th1 and Th17 cells in adipose tissue, higher expression of IL10 and adiponectin, increased infiltration of Th2 and eosinophils in adipose tissue of infected animals. Of note, the parasite infection was associated with increased Treg frequency in adipose tissue which showed higher expression of cell surface markers of function and activation, like LAP and CD134. The infection could also increase adipose Treg suppressor function in animals on high fat diet.ConclusionThese data suggest that H. polygyrus modulates adipose tissue Treg cells with implication for weight gain and metabolic syndrome.

Introduction: Transcatheter aortic valve implantation (TAVI) is associated with cardiac electrical disturbances. However, beyond the risks of pacemaker implantation, few studies have performed a detailed assessment of the effects of TAVI on several cardiac electrical properties. Objectives: To assess the frequency and type of electrocardiographic disturbances following TAVI, according to the type of prostheses and to assess predictors of these disturbances. Methods: We performed a detailed retrospective analysis of all electrocardiograms in patients who underwent TAVI, before and after the procedure, at a tertiary center from August 2007 to October 2016. Patients with permanent pacemakers were excluded. Results: We included 182 patients (78±8 years; 56% female) and self-expanding prostheses (SEP) were implanted in 54%. Most patients (80%) were in sinus rhythm at baseline. After TAVI, 21% of patients developed new-onset atrial fibrillation and there was a significant increase in PR interval at discharge (186±41 ms vs. 176±32; p=0.003), which was not maintained after at six-month follow-up (181±35 ms, p=0.06). There was also a significant increase in QRS duration at discharge (129±28 ms vs. 114±25 at baseline p

Resumo: Introdução: O conhecimento da atividade efetuada num país permite posicioná‐lo dentro da comunidade onde se insere. Objetivo: Apresentam‐se os dados referentes ao registo nacional de eletrofisiologia cardíaca da Associação Portuguesa de Arritmologia, Pacing e Eletrofisiologia (APAPE) relativo aos anos de 2015 e 2016. Métodos: Trata‐se de um registo de dados anual, voluntário, observacional, com colheita retrospetiva de dados. Resultados: São apresentados os dados dos estudos eletrofisiológicos e de ablações relativos aos anos referidos. Conclusão: Analisam‐se a sua evolução ao longo dos anos e a posição relativa dos dados nacionais em relação ao panorama europeu e eventuais implicações. Abstract: Introduction: Knowledge of the activity performed in a country enables it to be positioned within the community of which it is part. Objective: We present the results of the National Registry of Cardiac Electrophysiology of the Portuguese Association for Arrhythmology, Pacing and Electrophysiology (APAPE) for 2015 and 2016. Methods: This is a voluntary, observational, annual registry collected retrospectively. Results: The data on the electrophysiological studies and ablations performed in these two years are presented. Conclusion: Changes in these data over the years are analyzed and the relation of the Portuguese data in the European panorama and possible implications are discussed.

Host immune responses contribute to dengue’s pathogenesis and severity, yet the possibility that failure in endogenous inflammation resolution pathways could characterise the disease has not been contemplated. The pro-resolving protein Annexin A1 (AnxA1) is known to counterbalance overexuberant inflammation and mast cell (MC) activation. We hypothesised that inadequate AnxA1 engagement underlies the cytokine storm and vascular pathologies associated with dengue disease. Levels of AnxA1 were examined in the plasma of dengue patients and infected mice. Immunocompetent, interferon (alpha and beta) receptor one knockout (KO), AnxA1 KO, and formyl peptide receptor 2 (FPR2) KO mice were infected with dengue virus (DENV) and treated with the AnxA1 mimetic peptide Ac2-26 for analysis. In addition, the effect of Ac2-26 on DENV-induced MC degranulation was assessed in vitro and in vivo. We observed that circulating levels of AnxA1 were reduced in dengue patients and DENV-infected mice. Whilst the absence of AnxA1 or its receptor FPR2 aggravated illness in infected mice, treatment with AnxA1 agonistic peptide attenuated disease manifestationsatteanuated the symptoms of the disease. Both clinical outcomes were attributed to modulation of DENV-mediated viral load-independent MC degranulation. We have thereby identified that altered levels of the pro-resolving mediator AnxA1 are of pathological relevance in DENV infection, suggesting FPR2/ALX agonists as a therapeutic target for dengue disease.

A presente pesquisa está inserida na Linha II: Processos Formativos em Educação Tecnológica, do Programa de Pós-Graduação em Educação Tecnológica (PPGET) do Centro Federal de Educação Tecnológica de Minas Gerais (CEFET-MG). Os estudos dessa linha focalizam questões da área trabalho-educação nos contextos socioeconômico e político-cultural, destacando os processos históricos e culturais, as relações entre as mudanças societárias, a educação profissional formal e não formal e o mundo do trabalho. A partir dos aportes teóricos sobre a Divisão Sexual do Trabalho (HIRATA; KERGOAT, 2002) e da Violência Simbólica (BOURDIEU, 1975, 2002, 2011), a pesquisa problematiza a violência simbólica de gênero, aqui caracterizada por assédio moral e sexual no meio acadêmico, em uma instituição federal de educação profissional e tecnológica. Buscou-se compreender como a violência simbólica de gênero se manifesta nesse contexto educacional. Foi realizado um levantamento bibliográfico acerca das temáticas discutidas em livros, bases de teses, dissertações e artigos indexados. Em seguida, foram realizadas entrevistas semiestruturadas, por meio remoto, com alunas da Educação Profissional e Tecnológica- EPT (atuais e/ou egressas), maiores de 18 anos, que vivenciaram esse tipo de violência, além da realização de entrevistas com coordenadores de curso dos diversos níveis envolvidos (Técnico, Graduação e Pós-Graduação). Após a coleta dos dados foi realizada uma exegese dos excertos de falas dos/as entrevistados/as, confrontando-os com os referenciais teóricos estudados, de forma a se inter-relacionar empiria e teoria. Como resultados, destacam-se algumas formas de violências que foram relatadas, entre elas: piadinhas e brincadeiras de mal gosto, referindo-se à falta de capacidade feminina para realizar práticas em laboratórios. Falas sugerindo “aqui não é lugar de mulher”. Discriminação em relação ao “cabelo”, como fora do modelo “padrão” imposto pela sociedade como “belo”, entre outras. Espera-se que a pesquisa possa levar ao debate e à reflexão, dentro e fora das instituições federais de educação tecnológica, e auferir mudanças nas visões de mundo e comportamentos de todos os atores envolvidos nessas tramas sociais, propiciando avanços na igualdade de gêneros nesse segmento educacional.

Background. Asthma is a chronic pulmonary disease that affects about 300 million people worldwide. Previous studies have associated antimicrobial use with allergies, but the real impact of antibiotics on asthma is still elusive. We investigated the potential impact of amoxicillin (Amox), trimethoprim/sulfamethoxazole (TMP/SMX), and metronidazole (Metro) in a murine model of OVA-induced allergic airway inflammation. Methods. BALB/c mice received three cycles of 7 days of antibiotics in drinking water followed by 7 days washout and were sensitized i.p. with OVA/Alum at days 0 and 14. After the end of the last antibiotic washout, the mice were challenged with aerosolized OVA. Pulmonary parameters were evaluated, and serum, BAL, and feces were collected for analysis. Results. Amox- and TMP/SMX-treated animals displayed more severe allergic airway inflammation parameters with increased airway hyperresponsiveness, reduced lung alveolar volume, and increased levels in BAL of IL-4 and IL-6. In contrast, Metro-treated mice showed preserved FEV-50, decreased lung inflammation, and higher levels of butyrate and propionate in their feces. Metro treatment was associated with increased OVA-specific IgA in serum. BAL microbiota was abundant in allergic groups but not in nonallergic controls with the Amox-treated group displaying the increased frequency of Proteobacteria, while Metro and TMP/SMX showed increased levels of Firmicutes. In the gut, we observed the enrichment of Akkermansia muciniphila associated with reduced airway inflammation phenotype in the Metro group, even after the recovery period. Conclusion. Our data suggest that different antibiotic treatments may impact the course of experimental allergic airway inflammation in diverse ways by several mechanisms, including modulation of short-chain fat acids production by intestinal microbiota.

This paper describes the R package cold for the analysis of count longitudinal data. In this package marginal and random effects models are considered. In both cases estimation is via maximization of the exact likelihood and serial dependence among observations is assumed to be of Markovian type and referred as the integer-valued autoregressive of order one process. For random effects models adaptive Gaussian quadrature and Monte Carlo methods are used to compute integrals whose dimension depends on the structure of random effects. cold is written partly in R language, partly in Fortran 77, interfaced through R and is built following the S4 formulation of R methods.