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Context: Regular exercise improves glucose control in diabetes, but the association of different exercise training interventions on glucose control is unclear.Objective: To conduct a systematic review and meta-analysis of randomized controlled clinical trials (RCTs) assessing associations of structured exercise training regimens (aerobic, resistance, or both) and physical activity advice with or without dietary cointervention on change in hemoglobin A(1c) (HbA(1c)) in type 2 diabetes patients.Data Sources: MEDLINE, Cochrane-CENTRAL, EMBASE, ClinicalTrials.gov, LILACS, and SPORTDiscus databases were searched from January 1980 through February 2011.Study Selection: RCTs of at least 12 weeks' duration that evaluated the ability of structured exercise training or physical activity advice to lower HbA(1c) levels as compared with a control group in patients with type 2 diabetes.Data Extraction: Two independent reviewers extracted data and assessed quality of the included studies.Data Synthesis: Of 4191 articles retrieved, 47 RCTs (8538 patients) were included. Pooled mean differences in HbA(1c) levels between intervention and control groups were calculated using a random-effects model. Overall, structured exercise training (23 studies) was associated with a decline in HbA(1c) level (-0.67%; 95% confidence interval [CI], -0.84% to -0.49%; I(2), 91.3%) compared with control participants. In addition, structured aerobic exercise (-0.73%; 95% CI, -1.06% to -0.40%; I(2), 92.8%), structured resistance training (-0.57%; 95% CI, -1.14% to -0.01%; I(2), 92.5%), and both combined (-0.51%; 95% CI, -0.79% to -0.23%; I(2), 67.5%) were each associated with declines in HbA(1C) levels compared with control participants. Structured exercise durations of more than 150 minutes per week were associated with HbA(1c) reductions of 0.89%, while structured exercise durations of 150 minutes or less per week were associated with HbA(1C) reductions of 0.36%. Overall, interventions of physical activity advice (24 studies) were associated with lower HbA(1c) levels (-0.43%; 95% CI, -0.59% to -0.28%; I(2), 62.9%) compared with control participants. Combined physical activity advice and dietary advice was associated with decreased HbA(1c) (-0.58%; 95% CI, -0.74% to -0.43%; I(2), 57.5%) as compared with control participants. Physical activity advice alone was not associated with HbA(1c) changes.Conclusions: Structured exercise training that consists of aerobic exercise, resistance training, or both combined is associated with HbA(1c) reduction in patients with type 2 diabetes. Structured exercise training of more than 150 minutes per week is associated with greater HbA(1c) declines than that of 150 minutes or less per week. Physical activity advice is associated with lower HbA(1c), but only when combined with dietary advice. [ABSTRACT FROM AUTHOR]

Background Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used in sports medicine to reduce time of incapacity. Objective To describe the frequency of NSAIDs use by athletes in the XV Pan-American Games. Methods All athletes who were tested by the anti-doping control filled a form. The voluntarily declared medications were recorded and categorised according to sport modality, sex, region and control situation according to the World Anti-Doping Agency. Results Among the 1261 athletes tested (231 out-competition (OC) and 1030 in-competition (IC); 733 men and 528 women), 63% reported use of drugs, NSAIDs being the most frequently (64% of users) used medications. The use of medications was not significantly different between sexes or among different regions of the world. The number of users of only one type of NSAID was higher than those who used more than one type of NSAIDs or a combination with analgesics (335 vs 168 cases). IC reports presented higher use of NSAIDs than OC. Conclusion Athletes tested by the anti-doping control of the XV Pan-American Games reported a high frequency of NSAIDs use. The frequent utilisation in competition suggests that these medications might be used as ergogenic aid. [ABSTRACT FROM AUTHOR]

BACKGROUND: Aerobic training (AT) and circuit weight training (CWT) improve peak oxygen uptake (VO(2)peak). During CWT the circulatory system is exposed to higher pressure, which could induce left ventricle morphological adaptations, possibly distinct from those derived from aerobic training. OBJECTIVE: To compare the effects of aerobic training and CWT upon morphological and functional cardiac adaptations detected by magnetic resonance imaging. METHODS: Twenty healthy sedentary individuals were randomly assigned to participate in a 12-week programme of aerobic training (n = 6), CWR (n = 7) or no intervention (n = 7, controls). Training programmes consisted of 36 sessions, 35 min each, 3 times per week, at 70% of maximal heart rate, and CWT included series of resistance exercises performed at 60% of 1 maximal repetition. Cardiopulmonary exercise testing and cardiac magnetic resonance imaging were performed before and after the intervention. RESULTS: There was a similar improvement in VO(2)peak following aerobic training (mean (SD) increment: 12 (4)%) and CWT (12 (4)%), while there was no change in the control group. Aerobic training (12 (6)%) and CWT (16 (5)%) improved strength in the lower limbs, and only CWT resulted in improvement of 13 (4)% in the strength of the upper limbs. However, there were no detectable changes in left ventricular mass, end-diastolic volume, stroke volume or ejection fraction. CONCLUSION: In previously sedentary individuals, short-term CWT and aerobic training induce similar improvement in functional capacity without any adaptation in cardiac morphology detectable by cardiac magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

Background: Myocardial infarction remains as a major cause of mortality worldwide and a high rate of survivors develop heart failure as a sequel, resulting in a high morbidity and elevated expenditures for health system resources. We have designed a multicenter trial to test for the efficacy of autologous bone marrow (ABM) mononuclear cell (MC) transplantation in this subgroup of patients. The main hypothesis to be tested is that treated patients will have a significantly higher ejection fraction (EF) improvement after 6 months than controls.Methods: A sample of 300 patients admitted with ST elevation acute myocardial infarction (STEMI) and left ventricle (LV) systolic dysfunction, and submitted to successful mechanical or chemical recanalization of the infarct-related coronary artery will be selected for inclusion and randomized to either treated or control group in a double blind manner. The former group will receive 100 x 106 MC suspended in saline with 5% autologous serum in the culprit vessel, while the latter will receive placebo (saline with 5% autologous serum).Implications: Many phase I/II clinical trials using cell therapy for STEMI have been reported, demonstrating that cell transplantation is safe and may lead to better preserved LV function. Patients with high risk to develop systolic dysfunction have the potential to benefit more. Larger randomized, double blind and controlled trials to test for the efficacy of cell therapies in patients with high risk for developing heart failure are required.Trial Register: This trial is registered at the NIH registry under the number NCT00350766. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to evaluate the efficacy of dietary intervention on blood lipids of human immunodeficiency virus (HIV)-1-infected patients who are started on highly active antiretroviral therapy (HAART).Background: Current guidelines recommend diet as first-step intervention for HIV-1-infected individuals with HAART-related dyslipidemia, but there is no evidence from randomized trials to support this recommendation.Methods: Eighty-three HIV-1-infected patients, naive from HAART, were randomly assigned to HAART with dietary intervention (diet group, n = 43) or HAART without dietary intervention (control group, n = 40) for 12 months. Diet, according to the National Cholesterol Education Program, was given every 3 months. Before and after intervention, 24-h food records and lipid profile were obtained. Data were analyzed by intention to treat, using mixed-effects models.Results: Diet resulted in reduction of percentage of fat intake (from 31 ± 7% to 21 ± 3% of calories), while controls presented no change in percentage of fat intake. Plasma cholesterol (from 151 ± 29 mg/dl to 190 ± 33 mg/dl) and low-density lipoprotein cholesterol (from 85 ± 24 mg/dl to 106 ± 31 mg/dl) increased in the control group and were unchanged in the diet group. Plasma triglycerides were reduced by diet (from 135 ± 67 mg/dl to 101 ± 42 mg/dl) and increased in the control group (from 134 ± 70 mg/dl to 160 ± 76 mg/dl). After 1-year follow-up, 21% of patients who received diet had lipid profile compatible with dyslipidemia compared with 68% (p < 0.001) of controls.Conclusions: Among HIV-1-positive individuals naive of previous treatment, diet prevents dyslipidemia associated with HAART. (Effect of Nutritional Intervention on the Lipid Profile of HIV-Positive Patients Who Start HAART: a Randomized Trial; NCT00429845). [ABSTRACT FROM AUTHOR]

Introduction: Psychiatric comorbidities have a significant impact on patients' quality of life and often go undetected in neurologic practice. The aim of this study was to describe and characterize psychiatric comorbidities among patients hospitalized due to a neurologic disorder in mainland Portugal., Methods: A retrospective observational study was performed by analyzing hospitalization with a primary diagnosis of neurologic disorder defined as categories 76, 77, 79 - 85, 95, 109 of the Clinical Classification Software for International Classification of Diseases, Ninth Revision, Clinical Modification, occurring between 2008 and 2015 in adult patients (≥ 18 years of age). Psychiatric comorbidities were determined as the presence of a secondary diagnosis belonging to the Clinical Classification Software categories 650 to 670., Results: A total of 294 806 hospitalization episodes with a primary diagnosis of a neurologic disorder were recorded in adult patients between 2008 - 2015 in Portuguese public hospitals. Approximately 26.9% (n = 79 442) of the episodes had a recorded psychiatric comorbidity (22.1%; 32.2%, female versus male hospitalizations). Patients with registered psychiatric comorbidities were younger (66.2 ± 16.2 vs 68.6 ± 17.2 with no psychiatric comorbidities, p < 0.001), presented lower all-cause in-hospital mortality rates, and significantly longer mean hospital stays. 'Delirium, dementia, amnestic and other cognitive disorders' were recorded in 7.4% (n = 21 965) of the hospitalizations, followed by alcohol-related disorders in 6.5% (n = 19 302) and mood disorders in 6.1% (n = 18 079). Epilepsy/seizures were the neurologic disorders with the highest proportion of recorded psychiatric comorbidities (39.9%)., Conclusion: Psychiatric comorbidities were recorded in more than a quarter of the hospitalizations with a primary diagnosis of a Neurologic disorder. Psychiatric comorbidities varied among neurological disorders and were associated with different demographic and clinical features.

Objective: To investigate the role of central obesity on immunometabolic response in peripheral blood mononuclear cells (PBMCs) from normal weight and overweight/obese young men., Methods: Eighteen individuals were classified as normal weight (NW; n = 9 - age: 25 ± 5 and BMI: 21.4 ± 1.7) and overweight/obese (OW; n = 9 - age: 29 ± 7 and BMI: 29.2 ± 2.7). The body composition was evaluated by dual-energy x-ray absorptiometry (DXA), waist circumference, and visceral and subcutaneous fat depots by ultrasound. Physical activity levels, metabolic parameters, immune phenotypic characterization, cytokine production by lipopolysaccharide (LPS) -stimulated whole blood cells and LPS or phorbol 12-myristate 13-acetate (PMA)-stimulated PBMC, and mitochondrial respiration in PBMCs were evaluated. Expression of AMP-activated protein kinase (AMPK), peroxisome proliferator-activated receptor gamma (PPAR-γ), nuclear factor-kappa B (NF-κB), toll-like receptor 4 (TLR-4), hypoxia-inducible factor-1 alpha (HIF-1α), and adrenergic receptor beta 1 and 2 (AR-β1 and β2) genes were evaluated in cultured PBMC using quantitative real-time polymerase chain reaction (qRT-PCR)., Results: Individuals with overweight/obese (OW) presented higher glucose (P = 0.009) and leptin (P = 0.010) than individuals with normal weight (NW). PBMCs of OW under stimulation with LPS presented a lower production of interleukin-10 (IL-10) (P = 0.011) and macrophage inflammatory protein-1alpha (MIP-1α) (P = 0.048) than NW. Mitochondrial respiration rates were not different between NW and OW subjects. Cultured PBMCs in LPS-stimulated condition indicated higher gene expression of AR-β2 in OW, while PMA-stimulated PBMCs presented lower expression of AMPK (P = 0.002) and higher expression of NF-κB (P=<0.0001) than NW. OW presented higher numbers of CD3 + CD4 + T cells (P = 0.009) and higher expression of programmed cell death protein 1 (PD-1) in CD8 + T cells (P = 0.001) than NW., Conclusion: Central obesity promoted reductions in interleukin 10 production response and increase in AR-β2 expressions in mitogen-stimulated PBMCs. Furthermore, central obesity altered the phenotype of PBMCs, also increasing the expression of PD-1 exhaustion markers in young adults., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

The raw materials for the tanning industry, namely hides and skins, are preserved (curing stage) and carried with common salt, i.e., sodium chloride (NaCl). Proceeding to conversion into leather, pickling is a key stage of the tannery process, which entails high demand of water and salt. In this work, the salt-derived brine (SdB) generated from the curing of hides was treated by iron-driven electrocoagulation (EC), aiming at its later application in the pickling stage of the tanning industry, promoting a transition to zero waste emission policy. Focusing on reducing the brine's total organic carbon (TOC), central composite rotational design and response surface methodology were adopted to study the effect of electrolysis time (6.2-14.2 min) and current density (74-431 A·m -2 ) on the treatment of the SdB (≅ 7.5 % wt. NaCl). The quality of the treated brines was then assessed in pickling trials and compared with virgin brine. 68-83 % removal of TOC from the SdB were achieved under electrolysis time ranging 6.2-14.2 min and current density ranging 126-252 A·m -2 . Under these operating ranges the quality of the wet-blue leathers was guaranteed. Lowest power consumption (0.44 kWh·m -3 ) was achieved under electrolysis time of 6 min and current density of 126 A·m -2 , yielding 68 % removal of TOC. Moreover, the shrinkage temperature of the hides was improved with treated brine (103.5 °C-110.5 °C) compared to virgin brine (103.0 °C). The present study provides strong evidence that contaminated salt from the curing stage can be valorised within the tanning industry through electrocoagulation treatment and then used in another production stage, instead of being landfilled., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

The work describes the combination of granulated biomass fly ash (G BFA ) with Fenton process to enhance the removal of adsorbable organic halides (AOX) from pulp bleaching wastewater. At optimal operating conditions, wastewater's chemical and biochemical oxygen demand (COD and BOD 5 , respectively) and colour were also quantified, and operating cost of treatment assessed. For the first time, raw pulp bleaching wastewater was used to granulate BFA, instead of water, reducing the water footprint of the treatment. Five wastewater treatment setups were studied: (i) conventional Fenton process; (ii) G BFA application; (iii) simultaneous application of G BFA and Fenton process; (iv) sequential treatment by G BFA followed by Fenton process; (v) sequential treatment by Fenton process followed by G BFA . The latter yielded the highest AOX removal (60-70%), whilst COD was also reduced (≈15%) and wastewater biodegradability (BOD 5 /COD) was enhanced from 0.075 to a maximum of 0.134. Another positive feature of the proposed solution was that G BFA were successfully recovered and reused without regeneration, yielding similar AOX removal compared with fresh G BFA . The operating cost of removing 1 g of AOX from the pulp bleaching wastewater by the optimal treatment setup (60-70% removal of AOX) was 14-26% lower than the operating cost of conducting Fenton process alone (50% removal of AOX)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Supply Chain Management is in constant evolution, and Supply Chain Resilience (SCR) appears as a recent offspring result of changes in how companies do business. Research efforts on the topic have led to a focus on the basic concepts of SCR, leaving a relevant research gap on the modelling and quantification of the SCR behaviour. In fact, there is not yet a consensus on SCR metrics or on how to quantify SCR. Most SCR models fail to incorporate relevant characteristics of the supply chain's performance, as are the impacts perceived by downstream customers. This work addresses such gaps, and a new resilient SC metric is proposed, which is incorporated into a developed optimisation model, where economic and responsiveness objectives are maximised when designing and planning resilient SC considering all SC entities. The model is applied to a case study that shows that decision-makers should avoid adopting universal strategies when managing their SC and instead should define the best plan for their SC operation. The impacts perceived by downstream customers are analysed. Moreover, it can be concluded that there is a correlation between the SC performance and the new SCR metric, easing the process of designing and planning the SC when resilience concerns are at stake., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022.)

In this work, the performance of residual iron dust (RID) from metallurgic industry was assessed as Fenton catalyst for the treatment of real pulp bleaching wastewater. The focus was on the removal of recalcitrant pollutants AOX (adsorbable organic halides), by a novel, cleaner, and cost-effective circular solution based on a waste-derived catalyst. The behaviour of RID as iron source was firstly assessed by performing leaching tests at different RID:wastewater w/v ratios and contact time. Afterwards, RID-catalysed homogeneous and heterogeneous Fenton processes were conducted to maximise AOX removal from the pulp bleaching wastewater. Reusability of RID was assessed by a simple collect-and-reuse methodology, without any modification. Similar AOX removal under less consumption of chemicals was achieved with the novel heterogeneous Fenton process. Reaction in the bulk solution was the main pathway of AOX removal, given that the low surface area and porosity of the material did not allow for a high contribution of surface reaction to the overall performance. Moreover, AOX removal was similar over two consecutive treatment cycles, with Fenton process being responsible for 56.7-62.1% removal of AOX from the wastewater, and the leaching step adding 11.4-13.2%. At the end of treatment, COD either decreased (1 st cycle) or remained unchanged (2 nd and 3 rd cycle). The operating cost of the optimised heterogeneous Fenton was 3-11% lower than under conventional Fenton process. This work presented a novel, circular solution based on a low-cost waste-derived catalyst, advancing the knowledge needed to foster industrial application of such technologies to increase industrial environmental performance and efficiency., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Bone is a vascularized organic-inorganic composite tissue that shows a heavily-mineralized extracellular matrix (ECM) on the nanoscale. Herein, the nucleation of calcium phosphates during the biomineralization process was mimicked using negatively-charged cellulose nanocrystals (CNCs). These mineralized-CNCs were combined with platelet lysate to produce nanocomposite scaffolds through cryogelation to mimic bone ECM protein-mineral composite nature and take advantage of the bioactivity steaming from platelet-derived biomolecules. The nanocomposite scaffolds showed high microporosity (94-95%), high elasticity (recover from 75% strain cycles), injectability, and modulated platelet-derived growth factors sequestration and release. Furthermore, they increased alkaline phosphatase activity (up to 10-fold) and up-regulated the expression of bone-related markers (up to 2-fold), without osteogenic supplementation, demonstrating their osteoinductive properties. Also, the scaffolds promoted the chemotaxis of endothelial cells and enhanced the expression of endothelial markers, showing proangiogenic potential. These results suggest that the mineralized nanocomposite scaffolds can enhance bone regeneration by simultaneously promoting osteogenesis and angiogenesis., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Depression is a prevalent disease, being one of the most relevant contributors of disability in the overall global burden of diseases. Hospitalization episodes are important quality indicators in psychiatric care. The primary aim of this study is to analyse depressive disorder related hospitalizations in Portuguese public hospitals and to detail clinical and sociodemographic differences among various subtypes of depression. Admissions with a primary diagnosis of depression in adult patients(> = 18 years) were selected from a national mainland hospitalization database. ICD-9-CM codes were used to select the diagnoses of interest: 296.2 × to 296.3x (Major depressive disorder), 300.4 (Dysthymic disorder) and 311 (Depressive disorder, not elsewhere classified). Birth date, sex, residence address, primary and secondary diagnoses, admission date, discharge date, length of stay (LoS), discharge status, and hospital estimated charges were obtained. A total of 28,569 hospitalizations (22,387 patients) with a primary diagnosis of depression were analysed. In the 8-year period of the study, 19.1% of all hospitalizations with a primary diagnosis of psychiatric disorder were linked to Depression. Major Depressive episodes were the most common (n = 15,384; 53.8%), followed by Depression unspecified episodes (n = 6,793; 23.8%), and Dysthymia (n = 6,392; 22.4%). Most episodes occurred in female patients (70.2%; n = 20,052), with a mean age of 50.6 years, and 37.0% (n = 10,564) of the episodes were associated to other psychiatric comorbidities. Depressive disorders are one of the leading causes of hospitalization in Portuguese psychiatric departments, being responsible for approximately 1 in 5 hospitalizations with a psychiatric diagnosis., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Studies have pointed to a complicated and mutual relationship between attention deficit hyperactivity disorder (ADHD) and attachment. In an observational follow-up study conducted in 2015 60 children from 7 years to 12 years recently diagnosed with ADHD were included and assessed according to attachment representation showing 85% of the children to be insecurely attached., Aim: The aim of this study was to investigate the stability of this remarkably high frequency of insecure attachment in the same cohort of children., Methods: Children previously assessed using the child attachment interview (CAI) when diagnosed with ADHD were contacted three years later for a follow-up CAI assessment., Results: At follow-up, 31 children participated in the CAI-interviews. Since their diagnosis with ADHD, the children had received treatment as usual. The CAI-interviews showed a continued high rate of insecure attachment with 90% of the children classifying as insecurely attached compared to expected 38% in the normal population. Of these, the majority of children (77%) were classified as dismissing., Conclusion: Our findings suggest that targeting ADHD-symptoms with our current treatment strategies does not in itself improve attachment security. Attachment security may in turn be a factor of importance when evaluating general functioning and prognosis.

The year 2020 was atypical due to the pandemic caused by the SARS-CoV-2 virus (COVID-19), providing a unique opportunity to understand changes in air quality due to the reduction in urban activity. Therefore, the aim of the present study was to perform an integrated evaluation on the influence of the effects of the 2020 pandemic on air quality in the city of Fortaleza, investigating levels of PM 2.5 , PM 10 , NO 2 , NO, SO 2 , CO, and O 3 , corresponding health risks, as well as the influence of meteorological variables and urban activity. In all phases analyzed, significant reductions were found in NO x , NO, NO 2 , and CO. A considerable reduction in PM 2.5 and PM 10 was found in the early phases, with an increase in the later phases. These findings are explained by the nearly 50% reduction in vehicular traffic and the consequent reduction in fossil fuel emissions, mainly in the partial lockdown and total lockdown periods, as well as reductions in commercial (stores/shops) and industrial activities. The variation in O 3 was initially non-significant, followed by a considerable increase in the last three phases analyzed; this increase was influenced by changes in temperature and the incidence of sunlight. SO 2 concentrations increased in the period studied, demonstrating that the vehicular fleet, local commerce, and other activities are not the predominant sources of this compound. Estimated health risks were reduced by half during the lockdown period, especially for non-smokers, followed by a drastic increase in the last three phases. The planetary boundary layer was positively correlated with O 3 and PM 10 and negatively correlated with NO x , NO 2 , and NO, indicating its influence on the distribution of pollutants in the lower atmosphere and, consequently, air quality., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Bipolar Disorder (BD) is a mental disorder which frequently requires long hospitalizations and need for acute psychiatric care. The aim of this study was to describe a nationwide perspective of BD related hospitalizations and to use a BigData based approach in mental health research. We performed a retrospective observational study using a nationwide hospitalization database containing all hospitalizations registered in Portuguese public hospitals from 2008-2015. Hospitalizations with a primary diagnosis of BD were selected based on International Classification of Diseases version 9, Clinical Modification (ICD-9-CM) codes of diagnosis 296.xx (excluding 296.2x; 296.3x and 296.9x). From 20,807 hospitalizations belonging to 13,300 patients, around 33.4% occurred in male patients with a median length of stay of 16.0 days and a mean age of 47.9 years. The most common hospitalization diagnosis in BD has the code 296.4x (manic episode) representing 34.3% of all hospitalizations, followed by the code 296.5x (depressed episode) with 21.4%. The mean estimated hospitalization charge was 3,508.5€ per episode, with a total charge of 73M€ in the 8-year period of this study.This is a nationwide study giving a broad perspective of the BD hospitalization panorama at a national level. We found important differences in hospitalization characteristics by sex, age and primary diagnosis., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Postoperative management of patients undergoing tonsillectomy is challenging. Photobiomodulation therapy (PBMT) has emerged as a new tool providing therapeutic benefits. However, the contribution of PBMT to the postoperative outcomes of tonsillectomy is still undefined. This systematic review and meta-analysis evaluated the published literature addressing the effects of PBMT on post-tonsillectomy. Methods: Searches in Scopus, PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and grey literature were carried out for the identification of randomised controlled trials reported up to August/2021. The risk of bias with the Cochrane Collaboration tool and meta-analysis was performed. Outcomes were assessed with the Kaplan-Meier method and the log-rank test. Results: A total of 1183 articles were retrieved, of which only two were included for qualitative and quantitative analysis. The wavelengths were 685 nm and 980 nm with energy density set at 4 J/cm 2 . The mandibular angle and the surgical wound were the sites of laser irradiation. Individuals who had not undergone PBMT after tonsillectomy were more likely to report pain and odynophagia in the first 24 hours after surgery than individuals who had undergone PBMT after tonsillectomy ( P <0.001). Children who received PBMT after tonsillectomy were equally affected by pain and odynophagia in the first seven days after surgery compared to children who had not undergone PBMT after tonsillectomy ( P >0.05). However, both studies found a significant association of PBMT with reduced analgesic consumption. Conclusion: Although PBMT seems promising for the management of individuals undergoing tonsillectomy, a limited number of studies are available in the literature., (Copyright © 2022 J Lasers Med Sci.)

Objectives: The primary aim of this study was to describe a Portuguese nationwide epidemiological perspective on the use of electroconvulsive therapy (ECT) in hospitalized psychiatric patients. The secondary aims of the study were to characterize clinical and sociodemographic trends of hospitalized patients treated with ECT., Methods: A retrospective-observational study was conducted using an administrative database gathering every registered Portuguese public hospital hospitalizations from 2008 to 2015. We selected all hospitalizations with a procedure code 94.27 (Other electroshock therapy) defined by the International Classification of Diseases version 9, Clinical Modification. Variables included birth date, sex, address, primary and secondary diagnoses, admission/discharge date, length of stay, and discharge status from each single hospitalization episode. We also calculated Portugal's inpatient ECT prevalence rate (iP%)., Results: There were a total of 879 registered hospitalizations with ECT within the 8-year period of this study. Most occurred in female patients (53.4%), belonging to the age group of 51 to 70 years old, with a mean age of 50.5 years. The median length of stay was 43.0 days with an interquartile range of 27.0 to 68.0. The most frequent primary diagnosis was major depressive disorder, recurrent episode, representing 19.6% of all hospitalizations. The iP% for the study period was 0.71%., Conclusions: In Portugal, most of the patients who received ECT were women above middle age, and depressive disorders were the most common indication. Portugal's iP% represents a low rate when compared with other European countries, which might indicate an underutilization of ECT in Portuguese psychiatric hospitals., Competing Interests: The authors have no conflicts of interest or financial disclosures to report., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Mayaro virus (MAYV) has historically been associated with sylvatic transmission; however, urban outbreaks have been reported in Brazil, including cases of co-detection with dengue virus (DENV). Therefore, we performed a molecular survey to investigate MAYV circulation and cocirculation with DENV within Goiania, a major city in Central-West Brazil. Among 375 subjects with arbovirus-like symptoms, 259 were positive for DENV and 26 for MAYV. Of these, 17 were coinfected with DENV-2, suggesting co-transmission of the viruses. The most common complaints at the time of inclusion were myalgia, headache, fever, arthralgia, retro-orbital pain, and skin rash. No specific symptoms were associated with MAYV when either detected alone or co-detected with DENV, compared to that when DENV was detected alone. Most MAYV-infected subjects were women with no recent travel history to rural/sylvatic areas. Phylogenetic reconstruction indicated that the MAYV identified in this study is closely related with a lineage observed in Peru, belonging to genotype D. Our results corroborate the growing circulation of MAYV in urban environments in Brazil and reinforce the need to implement laboratory diagnosis in the Unified Health System, considering that the clinical manifestations of Mayaro fever are similar to those of other arboviruses, particularly dengue. Furthermore, most cases occurred in association with DENV-2. Further phylogenetic studies are needed to evaluate MAYV, which has not been widely examined., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background : Attention deficit hyperactivity disorder is the most common childhood psychiatric disorder. Current treatment strategies do not provide a convincing improvement on overall functioning, and further, reciprocity between ADHD and attachment has been suggested. This suggests that we do not fully comprehend the mechanisms of the disorder. This study was part of a larger project investigating factors of potential importance when a child is diagnosed with ADHD. Aim: In this current study we aimed to gain a clearer understanding about whether the mothers experienced the diagnostic process and treatment as helpful. Method : Sixty children newly diagnosed with ADHD and their mothers were included three years prior to this study. Fifty-two (87%) completed a survey about their experience with the diagnostic process and the years after in the psychiatric system and the secondary healthcare sector. Forty-three had also participated in an attachment interview in the original study and answered questions about this. Discussion: The follow-up questionnaire was based on conversations with the mothers was not meant to be used as a quantitative measure. However, one point to take is that the mothers did often not feel the help offered to be sufficient. In our opinion, this underlines that we are still far from understanding what ADHD is and what causes the differences in developmental trajectories as well as how differences in etiological factors may call for more customized approaches in treatment strategies.