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Background: The exploration of lipid-lowering resources, such as phytosterols, for the complementary nutritional treatment of hypercholesterolemia is relevant to reduce cardiovascular risk. The use of phytosterols in capsules or tablets can bring advantages in the context of diet therapy, but such format is still less studied when compared to fortified foods., Objective: Systematically review randomized clinical trials on the effects of phytosterol supplementation, in capsules or tablets, on the lipid profile and its use in the treatment of hypercholesterolemia in adults., Design: A systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, with a PROSPERO protocol registered under number CRD42021249539. The process was conducted by two independent reviewers. Only randomized clinical trials with phytosterol supplementation in adult individuals with hypercholesterolemia were included. The terms were searched in the databases: PubMed/MEDLINE, Cochrane Library/CENTRAL, Embase, LILACS and Web of Science, without restriction of time and language. The manual search was also performed through the list of references of articles included in this review., Results: The searches resulted in 977 articles. 22 articles were selected, whose full text was read, and according to the eligibility criteria 10 were incorporated into the review. The studies were separated into groups according to the association of the intervention with changes in lifestyle and the characteristics extracted from the studies were summarized and displayed in tables. Most studies have revealed a positive association between phytosterol supplementation and cholesterol reduction, despite the short duration of interventions., Conclusion: The analyzed studies showed that phytosterol supplements can be useful to modulate the lipid profile, helping to reduce the plasma concentration of LDL cholesterol. However, more research with the aforementioned supplementation in such pharmaceutical formats should be encouraged., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest related to this study., (Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Working in a hospital environment is known for presenting unhealthy features that affect the workers' health-features which have currently been intensified due to the COVID-19 pandemic. Hence, this longitudinal study aimed to ascertain the level of job stress before and during the COVID-19 pandemic, how this changed, and its association with the dietary patterns of hospital workers. Data on sociodemographic, occupational, lifestyle, health, anthropometric, dietetic, and occupational stress were collected before and during the pandemic from 218 workers at a private hospital in the Recôncavo of Bahia, Brazil. McNemar's chi-square test was used for comparison purposes, Exploratory Factor Analysis to identify dietary patterns, and Generalized Estimating Equations to evaluate the interested associations. During the pandemic, participants reported increased occupational stress, shift work, and weekly workloads, compared with before the pandemic. Additionally, three dietary patterns were identified before and during the pandemic. No association was observed between changes in occupational stress and dietary pattens. However, COVID-19 infection was related to changes in pattern A (0.647, IC95%0.044;1.241, p = 0.036) and the amount of shift work related to changes in pattern B, (0.612, IC95%0.016;1.207, p = 0.044). These findings support calls to strengthen labour policies to ensure adequate working conditions for hospital workers in the pandemic context.

Objective: Surgical patients constitute a group of individuals who are commonly underdiagnosed and undertreated, where nutritional impairment can be either a preexisting finding or a result of the hypercatabolic and hypermetabolic state. The purpose of this study was to assess the prevalence of malnutrition, according to the GLIM criteria, and its association with clinical and nutritional factors, in individuals admitted to a surgical unit of a general hospital., Methods: A cross-sectional, retrospective study was conducted, involving patients in the preoperative period due to gastrointestinal diseases. Demographic, clinical, and nutritional data were collected from adult and elderly patients admitted to a surgical unit between March and December 2019. Nutritional risk was assessed using the Nutritional Risk Screening tool (NRS-2002). The prevalence of malnutrition was found using the GLIM criteria. Binary logistic regression modeling was performed to determine the association between the diagnosis of malnutrition using the GLIM method and clinical and nutritional variables., Results: The majority of the sample presented nutritional risk (50.2%) according to the NRS-2002. The prevalence of malnutrition according to the GLIM criteria was 32.3%, with severe malnutrition being predominant (21.2%) in all age groups. There was an association between malnutrition and nutritional risk detected by the NRS-2002 (OR: 5.791; 95%CI 3.201-10.478). There was a predominance of patients undergoing cancer surgery (64%) and these patients were more likely to be diagnosed with malnutrition (OR: 2.068; 95%CI: 1.161-3.683), after statistical adjustment., Conclusion: An important prevalence of nutritional risk assessed by the NRS-2002 and of malnutrition assessed by the GLIM method was identified, especially in its severe form. In addition, preoperative patients with nutritional risk, as detected using the NRS-2002 nutritional screening tool, and candidates for oncologic surgery are more likely to be diagnosed as malnourished using the GLIM criteria.

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

Veterinarians have a fundamental role to play in the detection of animal abuse and domestic violence cases. Therefore, it is essential that veterinary colleges provide appropriate training in animal welfare and veterinary forensics. The aim of this article is to characterize the perception and knowledge of veterinary students about training in veterinary forensics, animal welfare and the association between animal abuse and human violence. An online survey was made available to veterinary students at 227 veterinary colleges in Brazil and 22 in Colombia. The Chi-square test of independence was performed to compare responses of Brazilian and Colombian students for categorical survey items. Most of the surveyed students indicated that their college offered animal welfare training. However, only 21.8% (47/216) of the Colombian and 43.1% (216/523) of the Brazilian students mentioned that their veterinary colleges offered veterinary forensics training. Deficits in training in identification of non-accidental traumas, reporting of animal abuse and awareness of the association between interpersonal violence and animal abuse were identified in both countries. Despite this, more than 90% of students were aware of the relationship between these two crimes and in the importance of receiving compulsory training in animal abuse and veterinary forensics. Likewise, most of the respondents recognized that animal abuse includes both physical and mental abuse. The results highlight the need to improve education in animal welfare, animal abuse, human violence and veterinary forensics in veterinary colleges in Brazil and Colombia.

This study systematically reviewed the relationship between occupational risks and quality of life (QoL) and quality of work life (QWL) in hospitals. A systematic review was performed according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide, and the protocol was submitted on the PROSPERO website (CRD 2019127865). The last search was performed in June 2021 by two independent reviewers in the main databases, a gray literature database, and a manual search (LILACS, MEDLINE/PubMed, PsycINFO, CINAHL, Scopus, Embase, Brazilian Digital Library of Theses and Dissertations, Ovid). As eligibility criteria, we included observational studies, with adult hospital workers, with no restrictions on date and language, any type of instrument to assess QoL and QWL, any definition of QoL and QWL, and studies that presented the relationship between exposure and outcome. Newcastle-Ottawa was used to assess the methodological quality and RTI-Item Bank to assess the risk of bias. Given the impossibility of performing a meta-analysis, a qualitative synthesis was used to present the results. Thus, 11 studies met the criteria and were included in the review, with 6923 individuals aged 18 to 64 years. The studies were mainly carried out with health professionals (81.81%), women (63.60%), and in Asian countries (63.63%). All studies used different instruments and ways to categorize the QoL and QWL, and occupational risks. Only one study assessed occupational noise and another the ergonomic risk. All of them presented a relationship between occupational risk and quality of work life. They pointed to the need for measures to improve the lives of these professionals in the work environment. Therefore, studies show a relationship between occupational risks (noise, ergonomics, and stress) and workers' perception of low or moderate quality of work life. However, more homogeneous studies are necessary for instruments, conceptualization, and categorization of quality of work life.

Background & Aims: Overweight children and adolescents are more likely to evolve with high cholesterol, be obese adults and develop cardiovascular disease. The objective of this study was to identify the influence of anthropometric status on the changes in the lipid profile of children and adolescents during an 18-month follow-up period., Methods: A cohort study involving 540 boys and girls from 7 to 15 years of age was conducted over 18 months' follow-up. The outcome variables were the lipid indicators and the principal exposure variable was anthropometric status, measured by different indicators. A generalized estimating equation (GEE) approach was used to identify the associations of interest., Results: Irrespective of age, sex, socio-economic status, physical activity and diet, for each gain of 1 cm in the waist circumference (WC) mean in the adjusted model, triglyceride levels increased by a mean of 0.5 mg/dl (p < 0.000) and there was an increase of 0.21 mg/dL in the total cholesterol after the 18-month period. The increase of 0.1 in the mean body mass index (BMI) Z-score promoted a gain of 2.7 mg/dL in the triglycerides mean levels (p < 0.000) and an increase of 1.5 mg/dL in the total cholesterol mean levels (p = 0.014) after the follow-up period. Regarding the waist-to-height ratio (WHtR) and conicity index (CI), an increment of 40.6 mg/dL (p = 0.02) and of 30.1 mg/dL (p = 0.01) was observed in the triglycerides' mean when the participants increased 0.1 in the WHtR mean and CI mean, and the same was observed in the total cholesterol mean, with an increase of 45.4,g/dL (p = 0.02) and 19.3 mg/dL (p = 0.03), for each indicator, respectively. Changes of the traditional anthropometric indicators (WC and BMI) did not promote variations in the mean levels of LDL-cholesterol. HDL-cholesterol was not influenced by the changes in the anthropometric indicators., Conclusions: At the baseline, a higher triglyceride mean and lower levels of HDL-c were observed in children and adolescents with altered anthropometric status for all measures. Mean triglyceride and total cholesterol levels are influenced by changes in the anthropometric status, regardless of the measure, after 18 months of follow-up. However, for LDL-cholesterol, it was observed that changes in the traditional anthropometric indicators (WC and BMI) did not promote variations in the mean levels of this biochemical variable, while HDL-c was not influenced by changes in any of the anthropometric indicators., Competing Interests: Declaration of Competing Interest We declare that we have no conflicts of interest., (Copyright © 2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Identification and report of animal abuse by veterinarians are fundamental to the promotion of animal welfare and the prosecution of this crime. Likewise, these professionals have an important responsibility to cope with the cycle of violence. This study aims to characterize the perception, knowledge, and attitudes of small animal practitioners regarding animal abuse and interpersonal violence in Brazil and Colombia. An online survey containing 27 questions was distributed to small animal practitioners of both countries. Multiple correspondence analysis (MCA) was employed to construct relationships among categorical variables and the chi-square statistic was used for testing these relationships. An important number of respondents had suspected that their patients could be victims of animal abuse (Brazil 48.1%; Colombia 64.5%). However, only a minority reported this situation to competent authorities (Brazil 32.7%; Colombia 10.8%). To receive training about veterinary forensics and/or animal welfare sciences in veterinary college was associated with identifying and denouncing animal abuse (p < .05). Deficiency in training received by veterinarians on veterinary forensic and animal welfare science in veterinary college was evident. Despite this, small animal practitioners recognize the existence of an association between animal abuse and interpersonal violence (Brazil 94.2%; Colombia 96.8%). The results highlight the need to strengthen education on animal abuse and promote the participation of veterinarians in the prosecution of this crime in Latin America., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Habitat modification may change vertebrate and vector-borne disease distributions. However, natural forest regeneration through secondary succession may mitigate these effects. Here we tested the hypothesis that secondary succession influences the distribution of birds and their haemosporidian parasites (genera Plasmodium and Haemoproteus) in a seasonally dry tropical forest, a globally threatened ecosystem, in Brazil. Moreover, we assessed seasonal fluctuations in parasite prevalence and distribution. We sampled birds in four different successional stages at the peak and end of the rainy season, as well as in the middle and at the end of the dry season. A non-metric multidimensional scaling analysis revealed that bird communities in the pasture (i.e., highly modified) areas were different from those in the early, intermediate, and late successional areas (secondary forests). Among 461 individual birds, haemosporidian prevalence was higher in pasture areas than in the more advanced successional stages, but parasite communities were homogeneous across these areas. Parasite prevalence was higher in pasture-specialists birds (resilient species) than in forest-specialists species, suggesting that pasture-specialists may increase infection risk for co-occurring hosts. We found an increase in prevalence between the middle and end of the dry season, a period associated with the beginning of the breeding season (early spring) in southeastern Brazil. We also found effects of seasonality in the relative prevalence of specific parasite lineages. Our results show that natural forest recovery through secondary succession in SDTFs is associated with compositional differences in avian communities, and that advanced successional stages are associated with lower prevalence of avian haemosporidian parasites.

Background: Biliary reconstitution has been considered the Achilles's heel of liver transplantations due to its high rate of postoperative complications., Aim: To evaluate the risk factors for occurrence of biliary strictures and leakages, and the most efficient methods for their treatment., Method: Of 310 patients who underwent liver transplantation between 2001 and 2015, 182 medical records were retrospectively analyzed. Evaluated factors included demographic profile, type of transplantation and biliary reconstitution, presence of vascular and biliary complications, their treatment and results., Results: 153 (84.07%) deceased donor and 29 (15.93%) living donor transplantations were performed. Biliary complications occurred in 49 patients (26.92%): 28 strictures (15.38%), 14 leakages (7.7%) and seven leakages followed by strictures (3.85%). Hepatic artery thrombosis was present in 10 patients with biliary complications (20.4%; p=0,003). Percutaneous and endoscopic interventional procedures (including balloon dilation and stent insertion) were the treatment of choice for biliary complications. In case of radiological or endoscopic treatment failure, surgical intervention was performed (biliodigestive derivation or retransplantation (32.65%). Complications occurred in 25% of patients treated with endoscopic or percutaneous procedures and in 42.86% of patients reoperated. Success was achieved in 45% of patients who underwent endoscopic or percutaneous procedures and in 61.9% of those who underwent surgery., Conclusion: Biliary complications are frequent events after liver transplantation. They often require new interventions: endoscopic and percutaneous procedures at first and surgical treatment when needed. Hepatic artery thrombosis increases the number of biliary complications.

Ethnopharmacological Relevance: The essential oil of Lippia sidoides (EOLS) has been used in Brazilian folk medicine as a topical antiseptic agent in skin for treatment of wounds and superficial infections of the body. The aim of this study was to investigate the effects of EOLS on intact and damaged skin, including its action on expression of mediators, COX-2 and VEGF, involved in healing full-thickness cutaneous lesions in vivo., Material and Methods: EOLS was analyzed chemically and used at different concentrations to dose-response experiments in skin mice. Skin irritation tests by one-dosage and multiple-dosages and irritation to damaged skin were assessed by macroscopy, morphometry and histological and immunohistochemical analyses. To evaluate the effects of EOLS on wound healing, excision wounds were surgically created on the dorsum of rats, and the ointments at 6% and 12% were applied daily to the wound area. Cutaneous lesions were assessed by planimetric (wound contraction) and macroscopic parameters., Results: Skin irritation tests showed that topical application of EOLS promoted cutaneous inflammation in varying degrees, which was demonstrated by increase of skin thickness and formation of cutaneous edema and erythema. Topical administration of EOLS in high concentrations presented an irritant response to skin, but this irritation is lighter when low concentrations this oil were used. Histological evaluation supported the outcome of these models, which revealed accentuated presence of inflammatory cells infiltration. In wound healing process, the lesions treated with EOLS showed intense edema and exsudation up to day 5, but there were not significant differences in the wound contraction on days 14 and 21. No immunohistochemical staining was verified to COX-2 and VEGF mediators in skin treated with EOLS 12%., Conclusion: The continuous application of EOLS in adequate concentrations on cutaneous wounds increases inflammatory response without delay the lesions closure. The association of these results with antimicrobial action previously related to EOLS allows its indication as an alternative therapeutic modality for topical treatment of infected cutaneous wound. Nevertheless, further studies need to be performed to determine the mechanism of action and support its application in clinical practice., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

The contamination of seafood by bacteria of fecal origin, especially Escherichia coli, is a widely documented sanitary problem. The objective of the present study was to isolate E. coli strains from the gills, muscle, and body surface of farmed Nile tilapias (Oreochromis niloticus) fresh-marketed in supermarkets in Fortaleza (Ceará, Brazil), to determine their susceptibility to antibiotics of different families (amikacin, gentamicin, imipenem, cephalothin, cefotaxime, ciprofloxacin, aztreonam, ampicillin, nalidixic acid, tetracycline, and sulfametoxazol-trimetoprim), and to determine the nature of resistance by plasmid curing. Forty-four strains (body surface = 25, gills = 15, muscle = 4) were isolated, all of which were susceptible to amikacin, aztreonam, cefotaxime, ciprofloxacin, gentamicin, and imipenem. Gill and body surface samples yielded 11 isolates resistant to ampicillin, tetracycline, and sulfametoxazol-trimetoprim, 4 of which of plasmidial nature. The multiple antibiotic resistance index was higher for strains isolated from body surface than from gills. The overall high antibiotic susceptibility of E. coli strains isolated from fresh-marketed tilapia was satisfactory, although the occasional finding of plasmidial resistance points to the need for close microbiological surveillance of the farming, handling, and marketing conditions of aquaculture products.

Southeast Brazil is a neotropical region composed of a mosaic of different tropical habitats and mountain chains, which allowed for the formation of bird-rich communities with distinct ecological niches. Although this region has the potential to harbor a remarkable variety of avian parasites, there is a lack of information about the diversity of malarial parasites. We used molecular approaches to characterize the lineage diversity of Plasmodium and Haemoproteus in bird communities from three different habitats in southeast Brazil based on the prevalence, richness and composition of lineages. We observed an overall prevalence of 35.3%, with a local prevalence ranging from 17.2% to 54.8%. Moreover, no significant association between prevalence and habitat type could be verified (p>0.05). We identified 89 Plasmodium and 22 Haemoproteus lineages, with 86% of them described for the first time here, including an unusual infection of a non-columbiform host by a Haemoproteus (Haemoproteus) parasite. The composition analyses of the parasite communities showed that the lineage composition from Brazilian savannah and tropical dry forest was similar, but it was different from the lineage composition of Atlantic rainforest, reflecting the greater likeness of the former habitats with respect to seasonality and forest density. No significant effects of habitat type on lineage richness were observed based on GLM analyses. We also found that sites whose samples had a greater diversity of bird species showed a greater diversity of parasite lineages, providing evidence that areas with high bird richness also have high parasite richness. Our findings point to the importance of the neotropical region (southeast Brazil) as a major reservoir of new haemosporidian lineages.