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Background: Insulin icodec is a novel, long-acting, once-weekly basal insulin analog. Its comparative efficacy and safety with basal once-daily insulins in type 2 diabetes mellittus is uncertain. Objective: Evaluate potential efficacy, benefits and risks associated with icodec compared to once-daily basal insulin analogs (degludec or glargine). Methods: We systematically searched PubMed, Cochrane, and Embase for randomized controlled trials (RCTs) published until June 2023 comparing icodec versus long-acting insulin analogs (degludec and glargine) in type 2 diabetes mellitus (T2DM) with at least 12 weeks of follow-up. Binary endpoints were assessed with risk ratios (RRs) and continuous endpoints were compared using mean differences (MDs), with 95% confidence intervals (CIs). The protocol was registered in PROSPERO (CRD42023452468). Results: A total of seven RCTs and 3286 patients with T2DM were included, of whom 1509 (60.6%) received icodec treatment. The follow-up period ranged from 16 to 78 weeks. Compared with once-daily basal insulin analogs, icodec led to a greater improvement in HbA1c (MD -0.15%; 95% CI -0.21, −0.10; p

Introdução: A sífilis é uma infeção de notificação obrigatória, maioritariamente transmitida por via sexual, causada pela bactéria Treponema pallidum. As manifestações clínicas variam conforme o estadio da doença: sífilis precoce (doença primária e secundária) e sífilis tardia (latente ou terciária). A doença secundária é sistémica e desenvolve-se, após semanas ou meses, em aproximadamente 1/4 dos indivíduos com infeção primária não tratada. Neste estadio, a doença pode manifestar-se através de sintomas constitucionais, adenopatias, erupções cutâneas maculopapulares palmoplantares, manifestações hepáticas, renais ou neurológicas, entre outras. A serologia fornece um diagnóstico presuntivo, sendo necessários testes não treponémicos e treponémicos para estabelecer o diagnóstico de sífilis. A difícil interpretação dos achados serológicos associada a uma grande variedade de manifestações clínicas e a uma incidência crescente nos últimos anos torna o seu diagnóstico um desafio. Descrição do caso: Os autores descrevem o caso clínico de um adulto que apresenta um quadro de edema inaugural dos membros inferiores, cansaço e noção de distensão abdominal. Objetivamente apresenta lesões maculopapulares eritematosas, com descamação periférica, não pruriginosas, nas palmas das mãos e plantas dos pés. Após entrevista clínica completa coloca-se a hipótese de descompensação de doença hepática em contexto de sífilis secundária/hepatite sifilítica e envia-se o doente ao serviço de urgência, onde é confirmada a infeção. Comentário: Este caso demonstra que a grande variedade de manifestações clínicas torna o diagnóstico de sífilis um desafio. Uma vez feito o diagnóstico deve ser instituído tratamento com dose única de penicilina intramuscular, evitando potenciais consequências graves decorrentes da doença sistémica. Em suma, um médico de família deve ser capaz de reconhecer esta infeção, interpretando corretamente os testes serológicos e instituindo o tratamento recomendado.

Contextualização: A administração pública tem passado por inúmeras transformações ao longo das últimas décadas. O engajamento no trabalho se consolida como fenômeno central para compreender resultados dos servidores e mecanismos para melhor prestação de serviços públicos aos cidadãos. Objetivo: Esta pesquisa testou o impacto da identificação com o propósito organizacional no engajamento no trabalho de servidores do Senado Federal do Brasil. Método: Uma amostra de 282 participantes respondeu ao questionário composto por medidas de itens fechados. Análise fatorial confirmatória e modelagem por equações estruturais foram conduzidas. Resultados: Verificou-se que a identificação com o propósito organizacional exerceu uma influência positiva e forte no engajamento dos servidores. O propósito organizacional se revelou como um importante antecedente, constituindo-se, portanto, como um fenômeno central para a compreensão e discussão do engajamento no trabalho no setor público. Conclusões: Este estudo avança ao estimular o debate sobre o tema no serviço público brasileiro, contribuindo para preencher lacunas teórico-empíricas existentes no campo e lançando possibilidades de investigações futuras.

RESUMO Este artigo aborda os usos do hatha-yoga como parte da oferta do Serviço de Orientação ao Exercício (SOE), vinculado à Secretaria Municipal de Saúde (Semus), da cidade de Vitória (ES). Utilizando como estratégia metodológica entrevistas semiestruturadas, aplicação de questionários e diário de campo, tem como objetivo interpretar as motivações vinculadas às escolhas pelo yoga, uma prática corporal que integra espiritualidade e bem-estar nas aulas do serviço público em Vitória. Conclui-se que as estruturas e a reflexividade fazem parte do repertório de ação para que as pessoas consigam acionar projetos de vida que os tirem de situações de insegurança e risco social.

ABSTRACT Objective To establish the diagnostic performance of fine-needle aspiration in detecting benign and malignant neoplasm in comparison with post-thyroidectomy histopathological findings among patients who received a thyroidectomy. Methods Retrospective observational data collected between 2011–2021 were included from patients who received partial or total thyroidectomy. The Bethesda system was used to classify neoplasms from fine-needle aspiration procedures as benign or malignant. Sample characteristics, diagnostic accuracy, sensitivity, specificity, and predictive values were evaluated. Results Patients (n=360) who underwent thyroidectomy were analyzed, of whom 142 (39.4%) and 218 (60.6%) had benign and malignant neoplasms, respectively. Using the Bethesda system, 23 (6.4%) were classified as unsatisfactory result (BI), 83 (23.1%) as benign (BII), 50 (13.9%) as atypia of undetermined significance (BIII), 23 (6.4%) as suspected follicular or Hürthle cell neoplasia (BIV), 102 (28.3%) as suspected malignancy (BV) and 79 (21.9%) as malignant (BVI). The fine-needle aspiration diagnostic accuracy for carcinomas was 92%, while the sensitivity and specificity were 94.4% and 86.9%, respectively. The negative and positive predictive values were 87.9% and 93.9%, respectively. Conclusion Fine-needle aspiration has high diagnostic accuracy, sensitivity and specificity, and is a reliable test for distinguishing between benign and malignant thyroid pathologies.

Objetivo: analisar a relação entre a raça/cor da pele e a morbimortalidade por COVID-19 no estado de São Paulo - SP. Métodos: Estudo ecológico, retrospectivo e analítico, cujos dados foram coletados no Sistema Estadual de Análise de Dados (SEADE) do Governo do Estado de São Paulo e correspondem ao período de fevereiro de 2020 a setembro de 2021. Na análise de dados, utilizou-se o modelo de regressão com distribuição binomial-negativa múltipla, para comparar a incidência e a mortalidade específica entre as raças/cores de pele. Resultados: ao se compararem as curvas de incidência de COVID-19, houve diferença estatística significativa entre as comparações de todos os grupos de raça/cor da pele. Na comparação entre tendências branca vs parda, o resultado foi p = 0,007; na comparação entre tendências branca vs preta, p =

ABSTRACT Eimeria tenella is an obligate intracellular parasite responsible for avian coccidiosis. Like other apicomplexan parasites, such as Toxoplasma gondii, cell invasion and intracellular development rely on apical organelle content discharge, named micronemes and rhoptries. Some rhoptry (ROP) kinases (ROPK) are key virulence factors in T. gondii. To date, among the 28 ropk genes carried by E. tenella, only two to four were confirmed by proteomic analysis or immunostaining to be expressed at the sporozoite stage. We have previously shown that EtROP1 is implicated in the inhibition of host cell apoptosis by interacting with the cellular p53. This work functionally described the second ROP kinase expressed at the sporozoite stage in E. tenella. EtROP2 is an active kinase that phosphorylates cell substrates of approximately 50 kDa. Its overexpression leads to the shortening of the prepatent period and to the early development of first-generation schizonts. Conduction of RNA sequencing analysis and reverse transcriptase quantitative PCR (RT-qPCR) on the host cell allowed us to identify the mitogen-activated protein kinase (MAPK) pathway and the transcription factor cFos to be upregulated by EtROP2. We also showed by immunofluorescence assay that the active kinase EtROP2 is implicated in the p38 MAPK pathway activation. We established here that EtROP2 activates the p38 MAPK pathway through a direct or indirect phosphorylation, leading to the overexpression of the master transcription factor cFos known to be implicated in E. tenella development. IMPORTANCE Rhoptries are specialized secretory organelles found in zoite stages of apicomplexan parasites. In addition to well-conserved rhoptry neck proteins, their protein consists mostly of kinase proteins, highly divergent from eukaryotic kinases. Some of those kinases are described as major virulence factors in Toxoplasma gondii, secreted into the host cell to hijack signaling pathways. Most of those kinases remain to be characterized in Eimeria tenella. Deciphering their cellular function is a prerequisite to supporting their relevance as a druggable target in development of new means of Eimeria tenella control. Secreted divergent kinases that interact with host cell partners to modulate pathways are good candidates, as they coevolve with their host targets to ensure their function within the host and are less prone to mutations that would lead to drug resistance. The absence of any orthologous kinase in host cells makes these parasite kinases a promising drug target candidate.

O presente trabalho tem como objetivo descrever o caso de um potro da raça Quarto de Milha, com 9 meses de idade e pesando 166 kg, atendido pelo setor de clínica médica e cirúrgica de grandes animais do Hospital Veterinário da Universidade Federal do Paraná para correção de uma fenda palatina. Como medicação pré-anestésica, fez-se o uso de xilazina 0,5 mg/kg. Posteriormente, a indução foi realizada com propofol 1mg/kg e cetamina 1 mg/kg. Para manutenção anestésica, optou-se pela utilização de isoflurano, lidocaína (3 mg/kg/h), cetamina (0,6 mg/kg/h) e dexmedetomidina (1 ug/kg/h). A analgesia transoperatória foi somada com a realização de bloqueios locorregionais, sendo executados por referências anatômicas os bloqueios dos nervos maxilar, mentual e alveolar inferior com lidocaína e bupivacaína, utilizando 3 ml por ponto. Dentre os parâmetros fisiológicos monitorados, destaca-se a frequência cardíaca, pressão arterial sistólica, pressão arterial média e pressão arterial diastólica, as quais mantiveram-se estáveis durante todo o período anestésico. Por fim, a técnica de bloqueio dos nervos maxilar, mentual e alveolar inferior mostraram-se alternativas viáveis para o procedimento proposto, uma vez que foram inexistentes as alterações paramétricas de nocicepção no transoperatório.

Objective: Evaluate adverse perinatal outcomes related to previous systemic arterial hypertension (SAH). Methods: This is a case-control study conducted at Darcy Vargas Maternity Hospital, in Joinville, SC, Brazil, from August to December 2020. A sample composed of patients older than 18 years old who have recently given birth was interviewed. Patients were divided into two groups, patients with and without previous SAH. In the adjusted odds ratio calculation (OR), a 95% confidence interval (95%CI) was used. Results: Two groups were analyzed: one with previous SAH (n=110/6.5%) and one without previous SAH (n=1,560/93.4%). Regarding maternal characteristics, patients with SAH were older, more obese, had more previous regnancies, caesarean sections, abortions, prenatal appointments, gestational diabetes mellitus (GDM), pregnancy induced hypertension (PIH), and previous diabetes mellitus (DM). About the characteristics of the newborns of mothers with SAH, lower gestational age at birth, higher incidence of caesarean section, prematurity, low birth weight and neonatal intensive care unit (ICU) were observed. After calculating the adjusted odds ratio, it was found that pregnant women with SAH had higher chance of GDM (CR=2.157; 95%CI 1.373-3.390), PIH (CR=2.739; 95%CI 1.619- 4.663), and prematurity (CR=2.552; 95%CI 1.090-5.979). Conclusion: The presence of previous SAH increased the chance of GDM by 2.1 times, PIH by 2.7 times and prematurity by 2.5 times

ABSTRACT Objective: Insulin Icodec is a novel basal insulin analogue designed for once-weekly administration, therefore might propitiate reduction in the frequency of injections and facilitate treatment adherence. This study aimed to determine the glycemic control and safety profile of Insulin Icodec, compared with Glargine U100 in patients with diabetes mellitus type 2. Materials and methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCT) data comparing Once-Weekly Insulin Icodec and Once-Daily Insulin Glargine U100 in patients with type 2 diabetes mellitus. PubMed, Embase, and Cochrane databases were searched for trials published up to May 14, 2022. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. Results: Three studies were included comprising 453 patients, 230 (50.77%) using Once-Weekly Insulin Icodec and 223 (49.22%) using Once-Daily Insulin Glargine U100. In the pooled data, Glycated Hemoglobin (MD -0.20% CI -0.33 to -0.07%; P=0.002) change from baseline demonstrated a significantly higher reduction in the Icodec group. Time with Glucose in Range (MD 6.60% CI 3.63 to 9.57%; P < 0.0001) and Insulin Dose Difference (MD 0.97UI CI 0.76 to 1.18UI; P < 0.0001) were higher in the Icodec group. There was no significant difference in fasting plasma glucose, body weight change, hypoglycemia or any adverse event evaluated. Conclusions: Once-Weekly Insulin Icodec was associated with a small reduction in Glycated Hemoglobin, as well as higher Time with Glucose in Range, with similar hypoglycemic adverse events, when compared with Once-Daily Insulin Glargine U100.

A dispersed plug flow heterogeneous photocatalytic reactor is investigated. A two‐dimensional (2D) model adapted to the media, a photocatalyst supported on a macroporous ceramic foam, was built. It is based on the couplings at the local scale between mass transfer, radiative transfer, and reaction kinetics. The simulations are compared to experimental results obtained in the case of the degradation of a target organic micro‐pollutant. The 2D concentration fields resulting from these couplings bring to light the very specific characteristic operation of the photoreactor. They allow the low performances of the dispersed plug flow mode when compared to the perfectly mixed, a result both unexpected and original, to be explained. Simulations also reveal the major influence of the foam thickness, the characteristic dimension of the radiative transfer, on the performance of the dispersed plug flow photoreactor. [ABSTRACT FROM AUTHOR]

Head and neck squamous cell carcinoma (SCC) predisposing factors include smoking and alcohol consumption. However, other agents have been investigated, including viruses. We aimed to investigate the presence of DNA of four different types of human polyomavirus (HPyV) in the oral cavity and oropharyngeal SCC samples from an oncology center in Brazil and evaluate the association between HPyV detection and clinical and sociodemographic characteristics. Sixty fresh frozen samples from three different anatomical sites (tongue, floor of the mouth, and oropharynx, 20 samples for each region) were retrospectively selected. Data from medical records such as age, sex, alcohol consumption, smoking, tumor staging and death in less than 5 years of diagnosis were collected. DNA was extracted for the identification of MCPyV, BKPyV, JCPyV, and TSPyV using PCR followed by Sanger sequencing of positive samples. The identity of the generated DNA sequences was confirmed by alignment reference sequences. The investigation of the presence of HPyV DNA showed positivity of 5% for MCPyV (n = 3), 0% for both BKPyV or TSPyV, and 60% for JCPyV (n = 36). No association was found between the positivity of any HPyV in samples with any clinical or sociodemographic characteristics of the patients, nor with a certain anatomical site, except for the association between death in less than 5 years after diagnosis and positivity for JCPyV (p = 0.009). Positivity for HPyV in oral cavity and oropharyngeal SCC was low for MCPyV, high for JCPyV and null for BKPyV and TSPyV. Further studies should be carried out to better understand the high prevalence of JCPyV found in oral cavity and oropharyngeal SCC. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: Evaluate the influence of isolated and associated prepregnancy obesity and gestational diabetes mellitus (GDM) on adverse perinatal outcomes. Materials and methods: Cross-sectional observational study with women who delivered at a Brazilian Maternity Hospital, between August and December 2020. Data were collected by interview with application form, and medical records. Sample was stratified by body mass index (BMI) and GDM screening in four groups: no obesity (BMI < 30 kg/m2) no GDM – reference; isolated GDM; isolated obesity (BMI ≥ 30 kg/m2); and obesity with GDM. Preeclampsia (PE), cesarean section (CS), large-for-gestational-age (LGA) newborn and admission to neonatal intensive care unit (NICU) were analyzed by odds ratio (OR) adjusted for confounding factors, adopting 95% confidence interval (CI) and P < 0.05 statistically significant. Results: From 1,618 participants, isolated obesity group (233/14.40%) had high chance of PE (OR = 2.16; CI: 1.364-3.426; P = 0.001), isolated GDM group (190/11.74%) had high chance of CS (OR = 1.736; CI: 1.136-2.652; P = 0.011) and NICU admission (OR = 2.32; CI: 1.265-4.261; P = 0.007), and obesity with GDM group (121/7.48%) had high chance of PE (OR = 1.93; CI: 1.074-3.484; P = 0.028), CS (OR = 1.925; CI: 1.124-3.298; P = 0.017) and LGA newborn (OR = 1.81; CI: 1.027-3.204; P = 0.040), compared with reference (1,074/66.38%). Conclusion: Obesity and GDM enhances the chance of different negative outcomes, worsening this prognosis when associated.

OBJETIVO: Analisar as normas do Estágio Curricular Supervisionado (ECS) em Educação Física escolar nas Instituições de Ensino Superior públicas de Pernambuco. MÉTODOS: Trata-se de uma pesquisa documental, constituída por quatro Instituições de Ensino Superior (IES). Analisamos o Projeto Pedagógico do Curso de Educação Física (PPC), regimento, ementas e manual. RESULTADOS: Os documentos não descrevem a parceria entre Universidade e escola e não abordam como o supervisor deve realizar a supervisão. Na I1 e I2 possui um documento que descreve detalhadamente as funções de cada ator do ECS, e a operacionalização do mesmo. CONCLUSÃO: As normas deveriam possuir aspectos que envolvessem a relação entre universidade e escola como corresponsáveis no processo de formação e manuais de desenvolvimento do estágio para o supervisor. Além disso, apontamos a necessidade de uma formação específica para o supervisor de estágio.