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Abstract Background: Dysphagia is a frequent finding on intensive care units (ICUs) and is associated with increased reintubation rates, pneumonia, and prolonged ICU-stay. Only a limited numbers of ICUs have access to a Speech and Language Pathologist (SLP). Hence, it falls upon the critical care team to estimate dysphagia risk and define the safest feeding route. Therefore, the aim of this study was to evaluate if the feeding route established by the ICU-team is changed after a standardized dysphagia assessment (DA) by an SLP. Furthermore, we tried to identify predictors for the need of a SLP assessment looking at the change in feeding route (CIFR) after DA. Methods: We performed a retrospective analysis of patients consecutively admitted for at least 48 h in 2018, to the ICU of the Department of Neurology and Neurosurgery. Following variables were assessed: Referral to an SLP, feeding route before and after DA by an SLP, main diagnosis, and ventilation parameters. Results: From 497 included patients (65 years, IQR 51–77), 148 received a DA, confirming dysphagia in 125 subjects. DA by the SLP resulted in a significant CIFR, with 32 (21.6%) subjects receiving stricter diets, and in 29 (19.6%) cases a reduction of dietary recommendations. 50 patients lacked readiness for oral intake due to severely affected oral phase or reduced consciousness. Conclusion: Dysphagia is a frequent finding in the Neuro-ICU. Assessment of dysphagia-risk and safest feeding route differ significantly between the SLP and the critical care team. Besides implementation of standardized operating procedures for DA, the presence of ICU-specific trained SLP should be mandatory.

Abstract Background Intragastric botulinum neurotoxin injections (IBNI) are offered off-label in the private medical sector in a few European countries as a safe and effective weight-loss measure. In February and March 2023, an outbreak of iatrogenic botulism occurred in several European countries following IBNI treatment in Turkey. This case series describes the clinical features of severe iatrogenic botulism after IBNI. Methods We retrospectively summarize the clinical course and emergency department and intensive care unit interventions in ten cases of severe iatrogenic botulism that occurred after receiving IBNI in this sudden outbreak in Austria and Germany. Results Seven out of ten cases initially showed characteristic symptoms of botulism with diplopia, dysphagia, dysarthria, dysarthrophonia, and descending paralysis. All patients were hospitalized, six in an intensive care unit and partially requiring mechanical ventilation. All patients recovered and were discharged without relevant permanent deficits. Conclusion Our study highlights ten clinical cases in this iatrogenic botulism outbreak, representing the largest reported outbreak worldwide. Clinicians should be aware of the risks associated with medical procedures involving botulinum neurotoxins and ensure measures to minimize the risk of iatrogenic botulism.

Abstract Selenium (Se) is essential for human and animal nutrition, playing a key role in antioxidant and immune functions. Organic Se is better for supplementation because it is more efficiently assimilated and less toxic than its inorganic form. Due to the scarcity of Se in European soils, supplementation in feed and food is necessary. Currently, inorganic Se (sodium selenite and selenate) and organic Se in Se-enriched yeast are approved by the European Food Safety Authority (EFSA) to address Se deficiency. However, Se-enriched microalgae present a promising alternative. By supplementing their growth media with Se, microalgae convert it into organic forms like Se-cysteine and Se-methionine, creating Se-enriched biomass. This biomass can serve as a valuable Se source with the additional benefits of microalgae. This review evaluates the viability of microalgae as a Se supplementation vehicle in food and feed and explores its commercial applications in the European Union (EU), along with emerging projects and innovations in the field.

Asthma is a chronic inflammatory respiratory condition, characterized by variable airflow limitation, leading to clinical symptoms such as dyspnea and chest tightness. These symptoms result from an underlying inflammatory process. The β2 agonists are bronchodilators prescribed for the relief of the disease. Nevertheless, their efficacy exhibits substantial interindividual variability. Currently, there is widespread recognition of the association between specific genetic variants, predominantly located within the ADRB2 and ADCY9 genes and their efficacy. This association, usually represented by the presence of non-synonymous single nucleotide polymorphisms (SNPs) have a strong impact in the protein functionality. The prevalence of these mutations varies based on the ethnic composition of the population and thus understanding the profiles of variability in different populations would contribute significantly to standardizing the use of these medications. In this study, we conducted a sequence-based genotyping of the relevant SNPs within the ADRB2 and ADCY9 genes in patients undergoing treatment with bronchodilators and/or corticosteroids at two healthcare facilities in the state of Rio de Janeiro, Brazil. We investigated the presence of c.46A>G, c.79C>G, c.252G>A, and c.491C>T SNPs within the ADRB2, and c.1320018 A>G within the ADCY9. Our results were in line with existing literature data with both for individuals in Brazil and Latin American.

Summary: Background: Although tuberculosis (TB) poses a significant global health threat to children and adolescents, there is limited information on the factors associated with TB treatment outcomes in this group. This study investigated the social and health factors associated with unfavourable treatment outcomes in children and adolescents with TB in Brazil, a high TB burden country. Methods: We conducted a population-based national retrospective cohort study of children (0–9 years) and adolescents (10–17 years) with TB in Brazil notified to the national Sistema de Informação de Agravos de Notificação (Sinan) from Jan 1, 2001, to Dec 31, 2022. Unfavourable treatment outcomes were defined as loss to follow-up, treatment failure, and death. Logistic regression and multinomial models examined the association between social and health factors, unfavourable treatment outcomes overall, and loss to follow-up and death, respectively. Findings: A total of 88,270 children and adolescents with TB were included of whom 25,600 (30.6%) had healthcare worker-supervised directly observed therapy (DOT). Of these, 9303 (10.5%) individuals experienced unfavourable TB treatment outcomes. For children, HIV infection (adjusted Odds Ratio 2.4, 95% confidence interval 1.9–3.1) and did not receive DOT (2.3, 1.9–2.7) were associated with unfavourable treatment outcomes. For adolescents, alcohol use (1.6, 1.2–2.0), illicit drug use (4.2, 3.4–5.1), tobacco use (1.6, 1.3–2.1), HIV infection (2.7, 2.2–3.4), and not receiving DOT (2.6, 2.3–2.9) were associated with unfavourable TB treatment outcome. Receiving social protection through government cash transfers protected against death (0.5, 0.3–0.9). Interpretation: In Brazil, TB treatment success rates were comparable to WHO End TB Strategy targets (90%). Substance use, HIV infection, and the absence of supervised treatment were the main factors associated with unfavourable treatment outcomes. Strategies to improve equity of TB treatment outcomes in this vulnerable group, including integrated HIV-TB services, DOT in healthcare facilities or communities, and holistic, person-centred healthcare and social protection, should be evaluated. Funding: Department of Health and Social Care (DHSC), the Foreign, Commonwealth & Development Office (FCDO), the Medical Research Council (MRC) and Wellcome, UK.

Objective: To analyze the Benefit of Modulated Masking (BMM) on hearing in young, adult and elderly normal-hearing individuals. Methods: The sample included 60 normal-hearing individuals aged 18–75 years who underwent behavioral assessment (sentence recognition test in the presence of steady and modulated noise) and electrophysiological assessment (cortical Auditory Evoked Potential) to investigate BMM. The results were analyzed comparatively using the paired t-test and ANOVA for repeated measures, followed by the Bonferroni post-hoc test (p-value

Dengue is an arboviral infection found in tropical and subtropical regions transmitted by hematophagous mosquitoes from the genus Aedes spp. and responsible for millions of cases every year. Public campaigns and educational curriculum are designed to educate people, including children. However, what has been reported is that many decide not to follow these guidelines, even though they allegedly know what has to be done. To understand this phenomenon, this study aims to identify psychological barriers behind the adoption of pro-environmental behaviors that seek to reduce Aedes aegypti’s population. For that, middle school students participated on two studies responsible for (1) adapting the Dragons of Inaction Psychological Barrier (DIPB) scale to the target group (n = 150) and then (2) testing it on a larger group (n = 449). In the exploratory factor analysis, Bartlett correlation (p

Introdução: A disqueratose congênita (DC) é uma doença rara, hereditária causada por mutações nos genes que codificam a biologia dos telômeros. A atividade da telomerase é reduzida formando telômeros mais curtos, resultando em morte celular prematura e cromossomos instáveis. São descritos 18 genes abrangendo herança autossômica dominante, recessiva ou ligada ao X. As manifestações são compostas por uma tríade clássica: distrofia ungueal, pigmentação anormal da pele e leucoplasia da cavidade oral, podendo evoluir com falência medular, Esses pacientes possuem risco aumentado para câncer, fibrose e malformações arteriovenosas pulmonares, imunodeficiências, estenose de uretra, esôfago ou ductos lacrimais, necrose avascular de quadril e/ou ombros, entre outros. O diagnóstico é feito por critérios clínicos e citometria de fluxo com hibridização fluorescente in situ (FISH) dos leucócitos, analisando o comprimento dos telômeros. O tratamento é direcionado conforme as manifestações clínicas de cada paciente. Objetivo: : Descrever um caso raro de DC, ressaltando os métodos utilizados para realizar diagnóstico e a abordagem terapêutica adotada. Materiais e métodos: Utilização de prontuário da paciente com levantamento de história clínica, exames e revisão bibliográfica. Relato de caso: FCL, 30 anos, branca, iniciou acompanhamento com equipe de hematologia do Centro Infantil Boldrini em 2001 com leucopenia e histórico de infecções de repetição como otite média aguda, vias aéreas superiores, pneumonia e erisipela. Em acompanhamento com a equipe de dermatologia, devido lesões ungueais, pigmentação anormal em pele e leucoplasia em região oral. Realizado diagnóstico de DC forma autossômica recessiva por meio de critérios clínicos e exames anatomopatológicos das lesões. Há 3 meses durante internação por pneumonia evoluiu com falência medular e foi diagnosticada com doença pulmonar restritiva. Foi encaminhada à Hematologia Clínica da UNICAMP para acompanhamento multidisciplinar e monitoramento de complicações clínicas e necessidade de transplante de medula óssea. Discussão: DC é uma doença que acomete a linhagem germinativa com encurtamento dos telômeros, promovendo heterogeneidade nos sintomas. Os pacientes podem ter dificuldades no diagnóstico pela variabilidade de apresentação clínica e o acesso restrito o FISH. A avaliação das múltiplas especialidades como hematologia, genética, dermatologia, pneumologia e otorrino podem ajudar neste cuidado. As neoplasias de pele, pulmão, trato gastrointestinal e cabeça e pescoço tem maior incidência nestes pacientes e o monitoramento ao longo da vida é mandatório. Conclusão: Este relato amplia o conhecimento de uma patologia rara com complexidade na obtenção do diagnóstico e contribuiu para que a equipe envolvida no cuidado sistematizasse os dados clínicos e se interessasse em novos estudos que poderão elucidar a relação genótipo-fenótipo da DC e buscar o melhor tratamento para os pacientes, impactando na qualidade de vida.

Abstract Since spring 2022, the global epidemiology of the monkeypox virus (MPXV) has changed. The unprecedented increase of human clade II MPXV cases worldwide heightened concerns about this emerging zoonotic disease. We analysed the positivity rates, viral loads, infectiousness, and persistence of MPXV DNA for up to 4 months in several biological samples from 89 MPXV-confirmed cases. Our data showed that viral loads and positivity rates were higher during the first two weeks of symptoms for all sample types. Amongst no-skin-samples, respiratory specimens showed higher MPXV DNA levels and median time until viral clearance, suggesting their usefulness in supporting MPXV diagnosis, investigating asymptomatic patients, and monitoring viral shedding. Infectious virus was cultured from respiratory samples, semen, and stools, with high viral loads and collected within the first 10 days. Notably, only one saliva and one semen were found positive for viral DNA after 71 and 31 days from symptoms, respectively. The focus on bloodstream samples showed the best testing sensitivity in plasma, reporting the overall highest MPXV DNA detection rate and viral loads during the 3-week follow-up as compared to serum and whole-blood. The data here presented can be useful for MPXV diagnostics and a better understanding of the potential alternative routes of its onward transmission.

Liquid biopsy (LBx) provides diagnostic, prognostic and predictive insights for malignant diseases and offers promising applications regarding tumor burden, tumor heterogeneity and clonal evolution.

Introduction. Solutions to car weight-bearing capacity problems currently tend to benefit from the properties of aluminium alloys. Aluminium alloy wagon units are about three times lighter than steel ones, which helps to carry more freight with the same number of cars while maintaining the specified axle load. The Ural Wagon Factory was the first to use aluminium as a structural material for the manufacture of axle box mount in the 1950s.Materials and methods. This paper reviews the research on the production of wagon wheel pair axle boxes from aluminium alloys in Russia and abroad. It examines the manufacturing techniques of the aluminium axle box and the results of bench and operational tests.Results. The analysis of production technologies of aluminium alloy axle boxes and the results of operational tests of the pilot batch of axle boxes revealed the advantages and disadvantages of this design and led to the conclusions about its feasibility.Discussion and conclusion. The authors propose to resume the use of aluminium alloys in wagon axle boxes considering modern operating conditions. Confirmation of its technical and economic efficiency requires a set of bench and operational tests with the use of modern diagnostic tools.

Abstract Background In patients with prostate cancer (PCa), imaging with gastrin-releasing peptide receptor (GRPR) ligands is an alternative to PSMA-targeted tracers, particularly if PSMA expression is low or absent. [99mTc]Tc-N4-BTG is a newly developed GRPR-directed probe for conventional scintigraphy and single photon emission computed tomography (SPECT) imaging. The current study aims to investigate the safety, biodistribution and dosimetry of [99mTc]Tc-N4-BTG in patients with biochemical recurrence (BCR) of PCa. Results No adverse pharmacologic effects were observed. Injection of [99mTc]Tc-N4-BTG resulted in an effective dose of 0.0027 ± 0.0002 mSv/MBq. The urinary bladder was the critical organ with the highest mean absorbed dose of 0.028 ± 0.001 mGy/MBq, followed by the pancreas with 0.0043 ± 0.0015 mGy/MBq, osteogenic cells with 0.0039 ± 0.0005 mGy/MBq, the kidneys with 0.0034 ± 0.0003 mGy/MBq, and the liver with 0.0019 ± 0.0004 mGy/MBq, respectively. No focal tracer uptake suggestive of PCa recurrence could be revealed for any of the patients. Conclusion [99mTc]Tc-N4-BTG appears to be a safe diagnostic agent. Compared to GRPR-targeted PET tracers, this 99mTc-labelled SPECT agent could contribute to a broader application and better availability of this novel approach. Further research to assess its clinical value is warranted.

O objetivo deste estudo consistiu em avaliar o potencial de utilização das espécies presentes em áreas campestres e florestais localizadas na Fazenda Santa Rita, com cerca de 200 hectares, situada na região da Coxilha Rica, Lages – SC. Para o levantamento florístico foi adotado o método de coletas por caminhamento, no período de março de 2021 a dezembro de 2022. Os espécimes coletados em campo, todos férteis, foram catalogados e incorporados ao acervo do Herbário LUSC, da Universidade do Estado de Santa Catarina. Foram identificadas 110 espécies de Asteraceae. Para a etapa de verificação dos usos das espécies, foram pesquisados artigos científicos publicados em periódicos digitais disponíveis nos bancos de dados da Scielo, CAPES e Web of Science. Além disso, foram consultados livros impressos e artigos publicados em revistas específicas da área de botânica, para a seleção de trabalhos relevantes que tratavam sobre o potencial de uso de espécies de Asteraceae. As palavras-chave utilizadas na pesquisa foram: "uso econômico da Família Asteraceae", "Asteraceae de uso ornamental", "Asteraceae de uso medicinal", "Asteraceae de uso melífero e apícola", "Asteraceae de uso alimentício convencional e não convencional". Também houve a substituição do nome “Asteraceae” por “Compositae” em cada uma das utilidades, para localização dos artigos, bem como a análise individual das espécies, sendo, posteriormente, as mesmas avaliadas quanto ao seu potencial de uso. Das espécies confirmadas na área de estudo, 60 (54,55%) delas possuem informações sobre o uso, enquanto para as outras 50 (45,45%) espécies não foi possível localizar na literatura o seu potencial de uso. Essa pesquisa evidencia a necessidade de estudos básicos sobre espécies nativas e a importância de aprofundar o conhecimento sobre suas funcionalidades, para a manutenção dos ecossistemas, podendo oferecer diversas aplicações potenciais.