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A classificação da perturbação neurológica funcional (PNF) tem evoluído ao longo da História, desde fenómenos sobrenaturais até à mais recente síndrome conversiva. Não estão disponíveis dados nacionais, mas de acordo com a literatura estima-se uma incidência em Neuropediatria de cerca de 23%. O diagnóstico, anteriormente considerado de exclusão, hoje é afirmativo, exigindo por isso uma avaliação neurológica cuidadosa e sobretudo uma comunicação eficaz no sentido de desmistificar estigmas e promover a aceitação da doença. Uma abordagem biopsicossocial é essencial, permitindo identificar fatores desencadeantes e que perpetuam os sintomas. As estratégias terapêuticas incluem: avaliação multidisciplinar, comunicação empática do diagnóstico, plano de tratamento personalizado e envolvimento familiar. Por fim, a comunicação eficaz e a intervenção precoce são cruciais na gestão da PNF em adolescentes. Embora a literatura apresente estratégias promissoras, a implementação prática pode variar sendo necessárias normas de orientação e dados estatísticos nacionais para otimizar os cuidados.

Salma Firdaus,1,&ast; Lívia Figueiredo Pereira,2,&ast; Ge Yang,3 Yumin Huang-Link4 1Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; 2Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil; 3Huizhou Aier Eye Hospital, Aier Eye Hospital Group, Huizhou, Guangdong Province, People’s Republic of China; 4Division of Neurology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden&ast;These authors contributed equally to this workCorrespondence: Ge Yang, Huizhou Aier Eye Hospital, Aier Eye Hospital Group, Huizhou, Guangdong Province, People’s Republic of China, Email geyang95@sina.comPurpose: To compare the interocular symmetry and investigate the intermachine reproducibility of optic disc and macular data measured by spectral-domain high-definition optical coherence tomography (HD-OCT) Cirrus HD-OCT 4000 and HD-OCT 5000 from healthy subjects.Patients and Methods: Forty-three volunteers were examined with both HD-OCT 4000 and HD-OCT 5000 at the same visit. Optic nerve head (ONH) and macular data were acquired using ONH Cube 200× 200 scans and macular volume cube 512× 128 scans, respectively.Results: The average age of the participants was 33 ± 8.6 years. Interocular OCT parameters of ONH and macula showed a high correlation between the right and left eyes regardless of HD-OCT models, displaying a low coefficient of variation (CV). However, the average retinal nerve fiber layer (RNFL) was thicker (96.67± 11.19μm vs 95.3± 10.89μm, p< 0.01), and the average central subfield thickness (261.51± 17.45μm vs 262.51± 17.39 μm, p< 0.01) and cube average thickness (283.91± 13.59μm vs 286.55± 13.09μm, p< 0.05) were thinner when measured by Cirrus 4000 compared to 5000. Intermachine reproducibility and reliability of RNFL and macular parameters exhibited a high intraclass correlation coefficient (ICC) (0.985) and low CV (2.4%). Ganglion cell-inner plexiform layer (GCIPL) measured by two OCT models showed similar values with an average thickness of 85 μm and had high intermachine reproducibility with high ICC (0.993) and low CV (1.2%).Conclusion: High interocular symmetry was observed across both HD-OCT models. Intermachine reproducibility for RNFL and all macular parameters was also high. GCIPL showed minimal intermachine differences with high reproducibility and reliability. Thus, the results imply that GCIPL values measured by two Cirrus OCT models may be used interchangeably.Keywords: neuro imaging, optical coherence tomography, interocular symmetry, intermachine reproducibility, retina, ganglion cell-inner plexiform layer, interchangeability

Camila Faria de Amorim Pereira,1,&ast; Michelle Nonato de Oliveira Melo,1,&ast; Vania Emerich Bucco de Campos,2 Ivania Paiva Pereira,1 Adriana Passos Oliveira,1 Mariana Souza Rocha,1 João Vitor da Costa Batista,3,4 Valter Paes de Almeida,5 Irailson Thierry Monchak,5 Eduardo Ricci-Júnior,6 Rafael Garrett,7 Aline Gabrielle Alves Carvalho,7 Jane Manfron,5 Stephan Baumgartner,3,8,9 Carla Holandino1,3 1Multidisciplinary Laboratory of Pharmaceutical Sciences, Faculty of Pharmacy, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; 2Department of Pharmacy, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; 3Society for Cancer Research, Hiscia Institute, Arlesheim, Switzerland; 4Department of Pharmaceutical Sciences, Division of Pharmaceutical Technology, University of Basel, Basel, Switzerland; 5Postgraduate Program in Pharmaceutical Sciences, Universidade Estadual de Ponta Grossa, Ponta Grossa, Paraná, Brazil; 6Galenic Development Laboratory (LADEG), Department of Drugs and Medicines, Faculty of Pharmacy, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; 7Metabolomics Laboratory, Chemistry Institute, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; 8Institute of Integrative Medicine, University of Witten/Herdecke, Herdecke, Germany; 9Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland&ast;These authors contributed equally to this workCorrespondence: Carla Holandino, Multidisciplinary Laboratory of Pharmaceutical Sciences, Universidade Federal do Rio de Janeiro, Faculty of Pharmacy, Block B basement, Room 34, 373, Carlos Chagas Filho Avenue, Cidade Universitária, Rio de Janeiro, RJ, 21941-902, Brazil, Email cholandino@gmail.com Stephan Baumgartner, Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland, Email St.Baumgartner@vfk.chBackground and Purpose: Natural products are potential sources of anticancer components. Among various species, the lipophilic extract of the Viscum album subsp. austriacum (Wiesb.) Vollm. (VALE) has shown promising therapeutic potential. The present work aimed to qualify the plant source and characterize the extract’s chemical profile. In addition, a self-nanoemulsifying drug delivery system (SNEDDS) containing VALE (SNEDDS-VALE) was developed.Methods: V. album subsp. austriacum histochemistry was performed, and the chemical profile of VALE was analyzed by GC-MS. After the SNEEDS-VALE development, its morphology was visualized by transmission electron microscopy (TEM), while its stability was evaluated by the average droplet size, polydispersity index (PdI) and pH. Lastly, SNEDDS-VALE chemical stability was evaluated by LC-DAD-MS.Results: The histochemical analysis showed the presence of lipophilic compounds in the leaves and stems. The major compound in the VALE was oleanolic acid, followed by lupeol acetate and ursolic acid. SNEDDS was composed of medium chain triglyceride and Kolliphor® RH 40 (PEG-40 hydrogenated castor oil). A homogeneous, isotropic and stable nanoemulsion was obtained, with an average size of 36.87 ± 1.04 nm and PdI of 0.14 ± 0.02, for 14 weeks.Conclusion: This is the first histochemistry analysis of V. album subsp. austriacum growing on Pinus sylvestris L. which provided detailed information regarding its lipophilic compounds. A homogeneous, isotropic and stable SNEDDS-VALE was obtained to improve the low water solubility of VALE. Further, in vitro and in vivo experiments should be performed, in order to evaluate the antitumoral potential of SNEDDS-VALE. Keywords: Viscum album subsp. austriacum, mistletoe, lipophilic extract, oleanolic acid, SNEDDS

The article proposes a history of the concepts of “Global South” and “South-South Cooperation” and suggests that it has been progressively moving away from critical meanings and promises of transformation of the world system and the international arena. A fashionable concept in the international debate and of vague geographical/geopolitical origin, “Global South” has been associated or sharing space with other ideas that are even vaguer than it, such as “developing countries” and “emerging countries”. To make this brief history of the concept, it will be interesting to map ideas throughout a global history (since it began to exist) that have served to name roughly the same geographical space that today corresponds to the Global South. The article defends the thesis that, among all the alternatives that have already been developed, the notions of “center/periphery” and “dependency” are the ones with the greatest critical and emancipatory potential.

Caroline Tianeze de Castro,1 Lisiane Freitas Leal,2 Dandara de Oliveira Ramos,1 Jerusa da Mota Santana,3 Rosa Cândida Cordeiro,3,4 Maria da Conceição Costa Rivemales,3,4 Edna Maria de Araújo,5 Carlos Alberto Lima da Silva,5 Marcos Pereira,1 Djanilson Barbosa dos Santos3– 5 1Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil; 2Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, Quebec, Canada; 3Center for Health Sciences, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil; 4Postgraduation Program in Health for the Black and Indigenous Population, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil; 5State University of Feira de Santana, Feira de Santana, Bahia, BrazilCorrespondence: Caroline Tianeze de Castro, Institute of Collective Health, Federal University of Bahia, Basílio da Gama Street, no number, Canela Campus, Salvador, Bahia, 40.110-040, Brazil, Email carolinetianeze@gmail.comPurpose: This study aimed to evaluate racial disparities in medication use and associated factors among pregnant women receiving prenatal care at Brazilian Unified Health System primary care health units in the northeast region.Patients and Methods: A total of 1058 pregnant women in the NISAMI Cohort were interviewed between June 2012 and February 2014. Medicines used during pregnancy were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and ANVISA pregnancy risk categories. Prevalence ratios (crude and adjusted) and 95% confidence intervals (CIs) were estimated using Poisson regression with robust error variance. All analyses were stratified by race (Asian, black, brown/mixed, Brazilian indigenous, and white).Results: Approximately 84% of the pregnant women used at least one medication, with a lower proportion among white women. The most reported medications were antianemic preparations (71.08%; 95% CI 68.27– 73.72%), analgesics (21.74%; 95% CI 19.36– 24.32%), and drugs for functional gastrointestinal disorders (18.81%; 95% CI 16.57– 21.28%). Approximately 29% of women took potentially risky medications during pregnancy, with a higher prevalence among Asian and white women. Factors associated with medication use during pregnancy include a greater number of prenatal consultations, higher education levels, health problems, and smoking. In addition, maternal age above 25 years, smoking status, and two or more previous pregnancies were associated with potentially risky medication use during pregnancy.Conclusion: A high prevalence of medication use during pregnancy was found; however, this prevalence was lower among white women. Nonetheless, black and brown women used antianemic preparations less frequently. This finding suggests that race is a factor of inequity in prenatal care, demanding public policies to mitigate it.Keywords: drug utilization, racial groups, pregnancy, pharmacoepidemiology, cohort studies

Jaime Guedes,1,2 Sacha Fernandes Pereira,3 Dillan Cunha Amaral,4 Larissa C Hespanhol,5 Adriano Cypriano Faneli,6 Ricardo Danilo Chagas Oliveira,2,7 Denisse J Mora-Paez,1 Bruno M Fontes2 1Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA; 2Ophthalmology, Opty Group, Rio de Janeiro, RJ, Brazil; 3Faculty of Medical Sciences of Paraiba, AFYA, João Pessoa, PB, Brazil; 4Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; 5Faculty of Medicine, Federal University of Campina Grande, Campina Grande, PB, Brazil; 6Faculty of Medicine, Bahiana School of Public Health and Medicine, Salvador, BA, Brazil; 7Ophthalmology, Federal University of Bahia, Salvador, BA, BrazilCorrespondence: Jaime Guedes, Email jguedes@willseye.orgBackground: Cataract surgery is one of the most frequently performed eye surgeries worldwide, and among several techniques, phacoemulsification has become the standard of care due to its safety and efficiency. We evaluated the advantages and disadvantages of two phacoemulsification techniques: phaco-chop and divide-and-conquer.Methods: PubMed, Cochrane, Embase, and Web of Science databases were queried for randomized controlled trial (RCT), prospective and retrospective studies that compared the phaco-chop technique over the divide-and-conquer technique and reported the outcomes of (1) Endothelial cell count change (ECC); (2) Ultrasound time (UST); (3) Cumulated dissipated energy (CDE); (4) Surgery time; and (5) Phacoemulsification time (PT). Heterogeneity was examined with I2 statistics. A random-effects model was used for outcomes with high heterogeneity.Results: Nine final studies, (6 prospective RCTs and 3 observational), comprising 837 patients undergoing phacoemulsification. 435 (51.9%) underwent the phaco-chop technique, and 405 (48.1%) underwent divide-and-conquer. Overall, the phaco-chop technique was associated with several advantages: a significant difference in ECC change postoperatively (Mean Difference [MD] − 221.67 Cell/mm2; 95% Confidence Interval [CI] − 401.68 to − 41.66; p < 0.02; I2=73%); a shorter UST (MD − 51.16 sec; 95% CI − 99.4 to − 2.79; p = 0.04; I2=98%); reduced CDE (MD − 8.68 units; 95% CI − 12.76 to − 4.60; p < 0.01; I2=84%); a lower PT (MD − 55.09 sec; 95% CI − 99.29 to − 12.90; p = 0.01; I2=100). There were no significant differences in surgery time (MD − 3.86 min; 95% CI − 9.55 to 1.83; p = 0.18; I2=99%).Conclusion: The phaco-chop technique proved to cause fewer hazards to the corneal endothelium, with less delivered intraocular ultrasound energy when compared to the divide-and-conquer technique.Keywords: meta-analysis, systematic review, cataract, cataract extraction, phaco-chop, divide-and-conquer, phacoemulsification

Magda Ines Teixeira Abreu,1,&ast; Adalberto Fernandes Santos,1– 3,&ast; Jorge MR Gama,4 Salete Valente,1,5 Maria Jesus Valente,1,5 Henrique Pereira,6,7 Frederico Regateiro,2,8– 10 Bernardo Sousa-Pinto,11,12 Maria Teresa Ventura,13,14 Jean Bousquet,15– 17 Luis Taborda-Barata1,2,18,19 1Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal; 2CICS-UBI – Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal; 3Faculty of Medicine, Agostinho Neto University, Luanda, Angola; 4Center of Mathematics and Applications, Faculty of Sciences, University of Beira Interior, Covilhã, Portugal; 5Department of Pulmonology, Cova da Beira University Hospital Centre, Covilhã, Portugal; 6Psychology and Education Department, Faculty of Human and Social Sciences, University of Beira Interior, Covilhã, Portugal; 7The Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Beira Interior, Covilhã, Portugal; 8Institute of Immunology, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal; 9Centro de Neurociências e Biologia Celular, CIBB, University of Coimbra, Coimbra, Portugal; 10Allergy & Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 11MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; 12CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal; 13Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy; 14Institute of Science of Food Production, National Research Council (Ispa-Cnr), Bari, Italy; 15Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; 16Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany; 17Department of Pulmonology, University Hospital Montpellier, Montpellier, France; 18UBIAir - Clinical & Experimental Lung Centre, UBIMedical, University of Beira Interior, Covilhã, Portugal; 19Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal&ast;These authors contributed equally to this workCorrespondence: Luis Taborda-Barata, Faculty of Health Sciences, University of Beira Interior, Avenida Infante D, Covilhã, Henrique, 6200-506, Portugal, Tel +351 275329001, Fax +351 275329003, Email tabordabarata@fcsaude.ubi.ptPurpose: To analyse factors affecting the ability to use the digital asthma monitoring application Mask-Air® in old-age individuals living in inland Portugal.Patients and Methods: In this observational study, patients with medically confirmed asthma who agreed to participate were interviewed and subdivided into Non-users Group: those who could not use the application and Users Group: those who could. Sociodemographic and psychological data, comorbidities, and asthma status were compared between groups. Assessment of reasons for refusal was based on a 6-item questionnaire.Results: Among the 72 sequentially recruited patients (mean age±SD 73.26± 5.43 yrs; 61 women; 11 men), 44 (61.1%; mean age±SD 74.64± 5.68 yrs; 38 women; 6 men)) were included in Non-users Group and 28 (38.9%; mean age±SD 71.11± 4.26 yrs; 23 women; 5 men) in Users Group. Non-users Group patients were significantly older, had lower socioeconomic level, and more frequently had severe asthma (25% vs 3.6%; Odds ratio=0.08 (95% CI=0.01– 0.81; p=0.033)) and diabetes (32.6% vs 7.4%; Odds ratio=0.17 (95% CI=0.03– 0.80; p=0.025)) than Users Group. The main reasons for not using the App were “Lack of required hardware” (n=35) and “Digital illiteracy” (n=26), but lack of interest to use the App among those who had conditions to use it was uncommon.Conclusion: Most old-age asthmatics living in Beira Interior either lack a smartphone or digital skills, which are significant obstacles to implementing app-based monitoring studies.Plain Language Summary: This study was done to see whether it was possible to use a mobile phone application (App) to help old-age asthmatics living in inner Central Portugal better monitor and self-manage their disease.The researchers interviewed a group of 72 patients with proven asthma who agreed to participate in the study. This group was subdivided into two subgroups: Non-users Group (44 patients) included those who could not use the App because they did not have a smartphone; Users Group (28 patients) included those who had all the conditions to use the App. Patients were helped to download the App (called MASK-Air), were given a thorough explanation about it, and about how it should be used on a daily basis to monitor their asthma symptoms.The researchers found that patients in Non-users Group were significantly older, had worse socioeconomic conditions, and more often had severe asthma and diabetes. They also discovered that the main reasons for not using the App were lack of a smartphone and not knowing how to use a smartphone.These results show that lacking a smartphone and not knowing how to use digital tools are frequent situations in old-age asthmatics living in inner Central Portugal, and these may be obstacles for patients in monitoring their own asthma symptoms.Keywords: asthma, mHealth, digital literacy, disease monitoring, old-age

Diarrhea is a prevalent and economically impactful ailment in cattle herds, resulting in substantial losses attributed to mortality, treatment expenses, and impaired calf growth. The aim of this study was to establish data about the occurrence of the main bacterial agents involved in diarrhea in dairy calves in the state of Maranhão, as well as to determine the most effective and/or resistant antibiotics, establishing a foundation for treatment and prevention protocols. The samples were collected with rectal swabs and initially cultivated on sheep blood agar (5%) and MacConkey agar and later on Salmonella-Shigella agar and eosin-methylene blue agar. Gram staining, biochemical tests, and antibiograms were performed on the obtained colonies. Ten municipalities were studied, with 230 calves evaluated from ten dairy farms. A total of 21 animals exhibited clinical signs of diarrhea, representing a frequency of 9.13%. The frequency of positive farms was 35%, and in 50% of municipalities. Bacteria isolated belonged to the Enterobacteriaceae family, with 71.4% Escherichia coli, 14.3% Enterobacter sp., 9.5% Proteus sp. and 4.8% Klebsiella sp. On the antibiogram, the bacteria that showed the highest resistance levels were those of the Proteus genus, followed by Enterobacter sp. and E. coli. The bacteria found are relevant for both animal and human health due to their zoonotic potential and serve as a public health alert since the isolates in this study showed in vitro resistance to several antibiotics, which predisposes them to the emergence of multidrug-resistant bacteria.

Ilhame Anwar,1 Aissatou Faye,1 Jessica Pereira Gonçalves,1 Laélia Briand Madrid,1 Gwenaëlle Maradan,2 Laurence Lalanne,3,4,&ast; Marie Jauffret-Roustide,5– 7,&ast; Marc Auriacombe,8– 10,&ast; Perrine Roux1 1Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France; 2ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France; 3INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, 67000, France; 4Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, 67000, France; 5CERMES3 (Inserm U988/UMR CNRS 8211/EHESS/Paris Descartes University), Paris, France; 6British Columbia Center on Substance Use, Vancouver, Canada; 7Baldy Center on Law and Social Policy, Buffalo University, New York, NY, USA; 8Univ. Bordeaux, Bordeaux, France; 9Addiction Team (Laboratoire de psychiatrie)/SANPSY, CNRS USR 3413, Bordeaux, France; 10Pôle Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France&ast;These authors contributed equally to this workCorrespondence: Ilhame Anwar, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale (SESSTIM), Faculté des sciences médicales et paramédicales, 27 Bd Jean Moulin 13385 Marseille Cedex 5, Marseille, France, Email ilhame.anwar@inserm.frPurpose: Injection drug use is strongly associated with stigmatization by loved ones, healthcare providers, and society in general. This stigmatization can have negative consequences on the health of people who inject drugs (PWID) and limit their access to care. Women who inject drugs face greater stigma than men because of gendered social norms and the intersectional effect between gender and drug use identities. For this analysis, we aimed to study discrimination - which is closely linked to stigmatization - experienced by PWID, considering the intersectionality between drug use discrimination and gender discrimination in the French context.Methods: We used data from the COSINUS cohort study, conducted between June 2016 and May 2019 in four French cities. We selected 427 of the 665 PWID who regularly injected drugs enrolled in COSINUS, at three months of follow-up, and performed multivariable logistic regression to identify factors associated with self-reported drug use discrimination.Results: Women comprised 20.6% of the study sample. Sixty-nine percent of the participants declared drug use discrimination and 15% gender discrimination. In the multivariable regression analysis, PWID who had hurried injection out of fear of being seen were almost twice as likely to have experienced drug use discrimination (OR [95% CI]: 1.77 [1.15, 2.74], p = 0.010). Likewise, women experiencing gender discrimination were almost three times as likely to have experienced drug use discrimination (OR [95% CI]: 2.84 [1.07,7.56], p=0.037).Conclusion: Women who inject drugs experienced gender and drug use intersectional discrimination. This could be a reason for the low attendance rates of women in healthcare settings. In addition, discrimination negatively impacted injection drug use practices (eg, hurried injection), particularly for people with unstable housing who injected in public spaces. We recommend introducing adapted services in healthcare facilities for women who inject drugs, and creating a favorable social and physical environment for all PWID in order to improve their health and access to care.Keywords: gender, injection drug use, intersectionality, discrimination

Abstract Background In 2021, there were approximately 450,000 cases of drug-resistant tuberculosis (DR-TB) worldwide. The treatment of DR-TB historically included expensive and toxic injectable drugs leading to adverse effects including ototoxicity and Electrocardiogram (ECG) abnormalities. This study described the perspectives of healthcare providers and people with DR-TB on the usability of simplified audiometry and ECG for monitoring treatment adverse effects. Methods A qualitative study was conducted in December 2019 across four provinces in Mozambique, namely Maputo, Gaza, Zambézia, and Nampula. Sixteen outpatient primary care health facilities equipped with simplified Audiometry and/or ECG devices (specifically, SHOEBOX Audiometer® and/or SmartHeart Pro ECG®) installed for at least 6 months before the study initiation were selected. The data was collected using in-depth interviews (IDI) and Focus Group Discussions (FGD) techniques. Interviews were audio-recorded, transcribed verbatim in Portuguese, coded, and analyzed using Nvivo 12 software®. We generated two themes and fit our results into a conceptual framework consisting of three domains in the implementation of technological innovations in health. Results A total of 16 healthcare providers and 91 people undergoing treatment for DR-TB were enrolled in the study. Most people with DR-TB had experienced audiometry testing and demonstrated a good understanding of the assessments. Conversely, while most healthcare providers demonstrated robust knowledge of the importance of both audiometry and ECG assessments, they were not confident in managing ECG devices and interpreting the results. Conclusions While healthcare providers demonstrated a consolidated understanding of the importance of audiometry, the limited number of devices and lack of training were constraints, impeding optimal usage and service delivery.

Jessica Peterson,1– 3 Grant Chesbro,1 Michael G Bemben,1 Rebecca D Larson,1 Hugo M Pereira,1 Christopher D Black1 1Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA; 2Department of Kinesiology, New Mexico State University, Las Cruces, NM, USA; 3North Florida Foundation of Research and Education, Malcom Randall Veterans Medical Center, Gainesville, FL, USACorrespondence: Jessica Peterson, Department of Kinesiology MSC 3M, New Mexico State University, P.O. Box 30001, Las Cruces, NM, 88003-8001, USA, Tel +1 405 318-9494, Email jpeters@nmsu.eduIntroduction: Many clinical musculoskeletal pain conditions are characterized by chronic inflammation that sensitizes nociceptors. An unresolved issue is whether inflammation affects all nociceptors in a similar manner. Exercise-induced muscle damage (EIMD) has been proposed as a model for simulating clinical inflammatory pain in healthy samples. We sought to test the effect of EIMD on various painful stimuli (pressure and thermal), central pain processing (via the nociceptive flexion reflex) and endogenous pain modulation via conditioned pain modulation and exercise-induced hypoalgesia.Methods: Eighteen participants (9F, age: 24.6 ± 3.3) were recruited for repeated measures testing and each completed pain sensitivity testing prior to and 48 hours after an eccentric exercise protocol. The participants performed a minimum of 6 rounds of 10 eccentric knee extension exercises to induce muscle damage and localized inflammation in the right quadriceps. Force decrements, knee range-of-motion, and delayed onset muscle soreness (DOMS) were used to quantify EIMD.Results: There was a significant main effect of time for pressure pain (%diff; − 58.9 ± 23.1; p = 0.02, ηp2 = 0.28) but no significant main effect was observed for limb (%diff; − 15.5 ± 23.9; p = 0.53, ηp2 = 0.02). In contrast, there was a significant interaction between time and limb (p < 0.001, ηp2 = 0.47) whereby participants had lower pressure pain sensitivity in the right leg only after the damage protocol (%diff; − 105.9 ± 29.2; p = 0.002).Discussion: Individuals with chronic inflammatory pain usually have an increased sensitivity to pressure, thermal, and electrical stimuli, however, our sample, following muscle damage to induce acute inflammation only had sensitivity to mechanical pain. Exercise induced inflammation may reflect a peripheral sensitivity localized to the damaged muscle rather than a global sensitivity like those with chronic pain display.Keywords: pain sensitivity, exercise induced muscle damage, acute inflammation, pain modulation

Milena Barbosa Porto,1 Geovanna da Mata e Castro,1 Samara Socorro Silva Pereira,2 Elza Maria Gonçalves Santos Uchoa,2 Raffael Zatarin,3 Lysa Bernardes Minasi,1 Aparecido D da Cruz1– 3 1Graduate Program in Genetics, School of Medical and Life Sciences, Pontifical Catholic University of Goiás, Goiânia, GO, Brazil; 2Federal University of Goiás, Graduate Program in Genetics and Molecular Biology, Goiânia, GO, Brazil; 3Clinical Genetics Service, Center for Rehabilitation and Readaptation Dr. Henrique Santillo, State Health Secretary of Goiás, Goiânia, GO, BrazilCorrespondence: Aparecido D da Cruz, Email acruz@pucgoias.edu.brAbstract: Baker-Gordon Syndrome (BAGOS) is a genetically determined 4 (NDD), represented by a phenotypic spectrum of moderate to severe intellectual disability, resulting from mutations in the synaptotagmin 1 (SYT1) gene. Its prevalence is estimated at 1:1,000,000 and the known gene variants have indicated complete penetrance with variable expressivity. SYT1 is a membrane trafficking protein in presynaptic vesicles, which exerts a complex influence on synaptic transmission, with fundamental roles in the release of neurotransmitters and facilitators of endocytosis, impacting both neurotransmission and neuron plasticity. The current case report describes the first Brazilian male patient diagnosed at 17-year-old, and the 39th reported case globally using whole-exome sequencing. A de novo heterozygous missense mutation at chr12q:79448958 (NM_005639.2; c.1103T>C; p.Ile368Thr) in the SYT1 was found and classified as a pathogenic variant. The proband’s clinical phenotype was compatible with BAGOS, involving behavioral changes such as irritability and severe intellectual disability. Knowledge about the mechanism of action and the extent of the genotypic and phenotypic presentations of the mutations in the SYT1 is still unfolding. Thus, we aimed to describe additional genotype–phenotype correlation for BAGOS, contributing to the expansion of the existing knowledge of such a heterogeneous ultra-rare syndrome, and, therefore, improve its diagnostic yield, case management, and therapeutic journey for future patients. Keywords: SYT1, hypotonia, congenital malformations, NDD, WES

ABSTRACT Avian mycoplasmosis is a disease of significant economic impact, potentially leading to restrictions on the international trade of poultry products. Mycoplasma synoviae (MS) and Mycoplasma gallisepticum (MG) are well-established as pathogenic, while Mycoplasma gallinaceum (Mgc) is considered commensal. Nevertheless, the latter can exacerbate clinical conditions in cases of co-infections with other pathogens. Due to the slow growth rates of MS and MG, they are susceptible to being outpaced by fast growing mycoplasmas, thereby complicating cultivation, and potentially yielding false-negative results. Thus, this study aimed to report a mixed infection of Mgc and MS in commercial laying hens and the compromised isolation of MS caused by this non-pathogenic mycoplasma. Twenty tracheal samples from chickens were collected, subjected to PCR, and cultured in a modified Frey’s medium. Samples displaying colonies compatible with mycoplasmas underwent three passages to obtain pure cultures. PCR-positive samples for the Mycoplasma spp., and negative ones for MS and MG, were subsequently subjected to DNA sequencing. All clinical samples tested via PCR were positive for MS (20/20) and negative for MG (0/20). During isolation, only five samples exhibited colonies with characteristic mycoplasma growth. However, PCR analysis of these cultures produced negative results for MS and MG, but were positive for Mycoplasma spp. DNA sequencing confirmed that all isolated strains were Mgc. Mgc displayed rapid growth, posing challenges to obtaining MS strains for isolation. The coexistence of MS and Mgc in the respiratory tract of commercial laying hens has the potential of inducing a synergistic effect on respiratory manifestations.

Ornamental peppers have a significant economic importance in the national and international markets; however, few cultivars intended for this purpose are grown in Brazil. The objective of this study was to select partially inbred lines (PIL) of peppers with ornamental potential, based on quantitative and qualitative variables with high heritability. The study was conducted over six generations for 4 consecutive years, using the single seed descent method. The last phase (VI) consisted of growing plants of the F5 generation for selection. Qualitative (LD) and quantitative (QD) descriptors were considered and the ideal genotypes were defined. The statistical analyses consisted of estimating variance components and genetic parameters and predicting genetic values, using REML/BLUP for QD, except for cycle to flowering (CF) and cycle to maturation (CM), which were analysed qualitatively. Therefore, CF and CM were analysed through frequency distribution of continuous variables within class intervals. Descriptive statistics were used to evaluate LD. The results showed that residual values exceeded genetic values, resulting in low heritability for QD, and therefore, they were not considered for PIL selection. Regarding LD, genetic variability was found among the population genotypes for all evaluated descriptors. The selection based on ideal genotypes enabled the selection of 82 PIL with LD of high ornamental value, which differ from the materials already available on the market. The selected genotypes will be used for developing future generations until allele fixation, focussed on subsequent selection of candidate lines for new ornamental pepper cultivars.

Brazil is home to a great diversity of species of the genus Dyckia. However, many of these species are threatened due to habitat destruction and predatory exploitation. An alternative to conserving these plants is sexual propagation using plant regulators to stimulate germination. Gibberellic acid (GA3) is an effective regulator in this process, but its instability and ease of degradation pose challenges. Therefore, nanoencapsulation of GA3 could be used to protect the molecule and allow controlled release. In this study, the effects of different doses of GA3 were evaluated on the germination of four species: D. cabrerae, D. dusenii, D. pottiorum and D. walteriana. The first stage consisted of soaking the seeds in different concentrations of GA3, in which the species D. dusenii and D. walteriana showed significant responses to GA3, with an increase from 35% to more than 60% germination. However, the species D. cabrerae and D. pottiorum responded positively to GA3 only in vegetative growth parameters. In the second stage, the use of nanoparticles of alginate/chitosan (NP ALG/CS) and chitosan/tripolyphosphate (NP CS/TPP) containing GA3 was compared with free GA3 and with NPs without GA3. It was verified that the use of nanoencapsulated GA3 resulted in a more efficient germination response in D. walteriana seeds, using smaller doses of the regulator (between 0.75 mg · L−1 and 1.0 mg · L−1), mainly with the ALG/ CS NPs. Therefore, the use of GA3 is recommended for D. dusenii and D. walteriana, and for the latter, nanoparticles containing ALG/CS-GA3 allow a reduction in the required dose.

Sustainable bioeconomy is one of the concepts that makes it possible to achieve the European Green Deal. A similar understanding of the term bioeconomy gives the opportunity to simultaneously take proportionate actions leading to the implementation of the Sustainable Development Goals in EU countries. Parallel understanding of the concept of bioeconomy is crucial for achieving a common consensus on actions aimed at introducing optimal plans for the development of green technologies. Therefore, the goal of the paper was to compare knowledge and perception about the bioeconomy in different countries. Realization of the work's objective was possible thanks to the use of the C&RT classification tree method. It was shown that the level of knowledge of respondents working or studying at selected universities was similar, while their perception of the bioeconomy differed significantly.

To determine if systemic stress affects the biological reactions occurring during orthodontic tooth movement.

Sentiment analysis approaches have offered a useful tool for decision support systems in various fields, including politics, network management, marketing, and healthcare. Owing to the increasing impact of online social networks on these fields and the fact that they are rich sources of information, the current sentiment analysis techniques in this scenario have evolved successfully. WhatsApp is a social network platform that enables users interact with close ties in a particular manner to communicate more meaningful, genuine, tangible, and personal information to the recipient, such as a sentiment. Hence, WhatsApp domain can be defined as a sub-language of the first language. However, only few studies have focused on WhatsApp sentiment analysis. These works usually employ outdated sentiment lexicon techniques and do not assess the most modern techniques based on deep learning. This study aims to evaluate this techniques for sentiment analysis based on deep neural networks and transfer learning, considering the intrinsic features of sub-language in WhatsApp domain. BERT1 and ALBERT1 (transfer learning approaches) achieve the best performance in accuracy and F1 (88% on average for both metrics and classifiers) similarly to other domains (Twitter). Although DCNN and LSTM with static embeddings usually achieve good performance when they are pre-trained on a larger corpus of other domains, these approaches reach the worst performance for WhatsApp domain. Furthermore, ELMo provides a good trade-off between the accuracy and training time complexity, mainly when taking into account the small size of our corpus training of WhatsApp. Hence, it can be inferred that the specific characteristics of the WhatsApp sub-language has an impact on the performance of some traditional SA classifiers

Dilson Palhares Ferreira,1,&ast; Cláudia Vicari Bolognani,2,3,&ast; Levy Aniceto Santana,2,&ast; Sérgio Eduardo Soares Fernandes,2,3,&ast; Matheus Serwy Fiuza de Moraes,3,&ast; Luana Argollo Souza Fernandes,3,&ast; Camila de Sousa Pereira,3,&ast; Gabriela Billafan Ferreira,3,&ast; Leila Bernarda Donato Göttems,2,3,&ast; Fábio Ferreira Amorim1– 4,&ast; 1Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil; 2Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil; 3Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil; 4Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil&ast;These authors contributed equally to this workCorrespondence: Fábio Ferreira Amorim; Dilson Palhares Ferreira, Coordenação de Pesquisa e Comunicação Científica - Escola Superior de Ciências da Saúde, SMHN Quadra 03, conjunto A, Bloco 1 - Edifício FEPECS, Brasília, Federal District, CEP 70701-907, Brazil, Email ffamorim@gmail.com; palhares.dilson@gmail.comPurpose: The COVID-19 pandemic posed a worldwide challenge, leading to radical changes in healthcare. The primary objective of the study was to assess the impact of the COVID-19 pandemic on birth, vaginal delivery, and cesarian section (c-section) rates. The secondary objective was to compare the maternal mortality before and after the pandemic.Patients and Methods: Time-series cohort study including data of all women admitted for childbirth (vaginal delivery or c-section) at the maternities in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. Causal impact analysis was used to evaluate the impact of COVID-19 on birth, vaginal delivery, and c-section using the CausalImpact R package, and a propensity score matching was used to evaluate the effect on maternal mortality rate using the Easy R (EZR) software.Results: There were 150,617 births, and considering total births, the effect of the COVID-19 pandemic was not statistically significant (absolute effect per week: 5.5, 95% CI: − 24.0− 33.4). However, there was an increase in c-sections after COVID-19 (absolute effect per week: 18.1; 95% CI: 11.9− 23.9). After propensity score matching, the COVID-19 period was associated with increased maternal mortality (OR: 3.22, 95% CI: 1.53− 6.81). The e-value of the adjusted OR for the association between the post-COVID-19 period and maternal mortality was 5.89, with a 95% CI: 2.43, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect.Conclusion: Our study revealed a rise in c-sections and maternal mortality during the COVID-19 pandemic, possibly due to disruptions in maternal care. These findings highlight that implementing effective strategies to protect maternal health in times of crisis and improve outcomes for mothers and newborns is crucial.Keywords: COVID-19, cesarean section, maternal health services, maternal mortality

Introduction: Clavicle fractures in adults are increasingly being treated by surgical fixation following reports of symptomatic non-union, malunion and poor functional outcome with conservative treatment. This has led to a similar trend in the management of clavicle fractures in adolescents. This study aims to evaluate the outcome and complications of non-operatively treated clavicle fractures in adolescents. Materials and methods: This is a retrospective, single institution study on adolescents aged 13-17 years who sustained a closed, isolated clavicle fracture, between 19972015. Clinical records were reviewed for demographic information, injury mode, time to radiographic fracture union, time to re-attainment of full shoulder range of motion (ROM), and time to return to full activities and sports. Complications and fracture-related issues were recorded. Radiographs were analysed for fracture location, displacement and shortening. Results: A total of 115 patients (98 males, 17 females; mean age:13.9 ± 0.89 years) were included for study. 101 (88%) sustained a middle-third fracture while the remainder sustained a lateral-third fracture. A total of 96 (95%) of the middle-third fractures were displaced, and 12 (86%) of the lateral-third fractures were displaced. All displaced fractures in this study had shortening. Sports-related injuries and falls accounted for 68 (59%) and 34 (30%) of the cases respectively. Overall, the mean time to radiographic fracture union was 7.8 ± 4.35 weeks; there were no cases of nonunion. Full shoulder ROM was re-attained in 6.6 ± 3.61 weeks, and full activities and sports was resumed in 11.4 ± 4.69 weeks. There were 5 cases of re-fracture and a single case of intermittent fracture site pain. Conclusion: Clavicle fractures in adolescents can and should be treated non-operatively in the first instance with the expectation of good outcomes in terms of time for fracture union, reattainment of shoulder full range of motion, and return to activities. Surgical stabilisation should be reserved for cases for which there is an absolute indication.

Raiane Vieira Cardoso,1 Patricia Ribeiro Pereira,1 Cyntia Silva Freitas,1 Érika Bertozzi de Aquino Mattos,1 Anna Victoria De Freitas Silva,2 Victor do Valle Midlej,2 Mauricio Afonso Vericimo,3 Carlos Adam Conte-Júnior,1 Vania Margaret Flosi Paschoalin1 1Departamento de Bioquímica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; 2Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil; 3Departamento de Imunobiologia; Universidade Federal Fluminense, Niterói, RJ, BrazilCorrespondence: Vania Margaret Flosi Paschoalin, Av. Athos da Silveira Ramos 149 – sala 545 - Cidade Universitária, Rio de Janeiro, 21941-909, RJ, Brazil, Tel +55(21)3938-7362, Fax +55(21)3938-7266, Email paschv@iq.ufrj.brBackground: Tarin, a lectin purified from Colocasia esculenta, promotes in vitro and in vivo immunomodulatory effects allied to promising anticancer and antimetastatic effects against human adenocarcinoma mammary cells. This makes this 47 kDa-protein a natural candidate against human breast cancer, a leading cause of death among women. Tarin encapsulated in pegylated nanoliposomes displays increased effectiveness in controlling the proliferation of a mammary adenocarcinoma lineage comprising MDA-MB-231 cells.Methods: The mechanisms enrolled in anticancer and antimetastatic responses were investigated by treating MDA-MB-231 cells with nano-encapsulated tarin at 72 μg/mL for up to 48h through flow cytometry and transmission electron microscopy (TEM). The safety of nano-encapsulated tarin towards healthy tissue was also assessed by the resazurin viability assay, and the effect of nanoencapsulated tarin on cell migration was evaluated by scratch assays.Results: Ultrastructural analyses of MDA-MB-231 cells exposed to nanoencapsulated tarin revealed the accumulation of autophagosomes and damaged organelles, compatible with autophagy-dependent cell death. On the other hand, the flow cytometry investigation detected the increased occurrence of acidic vacuolar organelles, a late autophagosome trait, along with the enhanced presence of apoptotic cells, activated caspase-3/7, and cell cycle arrest at G0/G1. No deleterious effects were observed in healthy fibroblast cells following tarin nanoencapsulated exposition, in contrast to reduced viability in cells exposed to free tarin. The migration of MDA-MB-231 cells was inhibited by nano-encapsulated tarin, with delayed movement by 24 h compared to free tarin.Conclusion: The nanoliposome formulation delivers tarin in a delayed and sustained manner, as evidenced by the belated and potent antitumoral and anti-migration effects on adenocarcinoma cells, with no toxicity to healthy cells. Although further investigations are required to fully understand antitumorigenic tarin mechanisms, the activation of both apoptotic and autophagic machineries along with the caspase-3/7 pathway, and cell cycle arrest may comprise a part of these mechanisms. Keywords: tarin-controlled release, MDA-MDB-231 cells damage, kinetics of ultrastructural changes, cell cycle arrest, cell migration assay, caspase 3/7 pathway

Maria Dolores Arenas Jiménez,1 Paula Manso,1 Fabiola Dapena,1 David Hernán,1 Jesús Portillo,1 Concepción Pereira,1 Daniel Gallego,2 Juan Carlos Julián Mauro,2 Manuel Arellano Armisen,2,3 Antonio Tombas,4 Iluminada Martin-Crespo Garcia,5 Emilio Gonzalez-Parra,6 Cristina Sanz1 1Renal Foundation, Madrid, Spain; 2National Federation of Associations for the Fight Against Kidney Diseases (ALCER), Madrid, Spain; 3Platform of Patient Organizations (POP), Zaragoza, Spain; 4Association of Renal Patients of Catalonia (ADER), Barcelona, Spain; 5Madrid Association for the Fight Against Kidney Diseases, Madrid, Spain; 6Hospital Foundation Jiménez Diaz, Madrid, SpainCorrespondence: Maria Dolores Arenas Jiménez, Fundación renal Calle Jose Abascal, 42, 1 º izda, Madrid, 28003, Spain, Tel +34-673429833, Email mdarenas@friat.es; lola@olemiswebs.comAim: The opinion of hemodialysis patients, professionals and family members is rarely considered in the design of a hemodialysis unit.Purpose: To know and compare the opinion and preferences of patients, family members and professionals regarding the design of a dialysis unit and the potential activities they believe should be carried out during the session in order to provide architects with real information for the construction of a dialysis center.Patients and Methods: Anonymous and voluntary survey in electronic format addressed to patients, relatives and professionals belonging to the 18 hemodialysis centers of the renal foundation and to ALCER and its different delegations, in relation to leisure activities to be carried out in the dialysis center and preferred design of the treatment room. The results obtained between the patient-family group and the professionals were compared.Results: We received 331 responses, of which 215 were from patients and family members (65%) and 116 (35%) from professionals. The most represented category among professionals was nursing (53%), followed by assistants (24%) and physicians (12.9%). A higher proportion of patients (66%) preferred rooms in groups of 10– 12 patients as opposed to professionals who preferred open-plan rooms (p< 0.001). The options that showed the most differences between patients and professionals were chatting with colleagues and intimacy (options most voted by patients/families), versus performing group activities and visibility (professionals).Conclusion: The professionals’ view of patients’ needs does not always coincide with the patients’ perception. The inclusion of the perspective of people with kidney disease continues to be a pending issue in which we must improve both patient organizations and professionals, and the opinion of professionals and patients must be included in the design of a dialysis unit and the activities to be developed in it.Plain Language Summary: People with kidney disease on hemodialysis spend 4 hours of their lives three times a week in hemodialysis units. Although the new concept of 21st century medicine gives special prominence to the opinion of patients and family members, the reality is that this is rarely considered when establishing the requirements that a dialysis center should meet.The aim of this study is to know and compare the opinion and preferences of patients, family members and professionals regarding the design of a dialysis unit and the potential activities they believe should be carried out during the session in order to provide architects with real information for the construction of a dialysis center.This is the first survey in Spain that attempts to approach both the opinions of the patients and the professionals working in the units.The professionals’ view of patients’ needs does not always coincide with the patients’ perception. The inclusion of the perspective of people with kidney disease continues to be a pending issue in which should be improve both patient organizations and professionals, and the opinion of professionals and patients should be included in the design of a dialysis unit and the activities to be developed in it.Keywords: hemodialysis, patient experience, dialysis unit design, preferences, patients, healthcare professionals