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Eduardo José Pereira Ferreira,1– 4 Lucas Villar Shan de Carvalho Cardoso,3,5 Carlos José Oliveira de Matos,6 Igor Larchert Mota,3,4 Juliana Maria Chianca Lira,3,5 Mayara Evelyn Gomes Lopes,3,5 Giulia Vieira Santos,3,5 Maria Luiza Dória Almeida,2,3,5 Manuel Herminio Aguiar-Oliveira,2,3,5 Antônio Carlos Sobral Sousa,2– 5 Enaldo Vieira de Melo,3,5 Joselina Luzia Menezes Oliveira2– 5 1Department of Medicine, Federal University of Sergipe, Lagarto, 49400-000, Brazil; 2Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil; 3University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil; 4São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil; 5Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil; 6Department of Physiotherapy, Federal University of Sergipe, Lagarto, 49400-000, BrazilCorrespondence: Eduardo José Pereira Ferreira, Federal University of Sergipe, Avenida Marechal Rondon, s/n- Jardim Rosa Elze, São Cristóvão, Sergipe, 49100-000, Brazil, Tel + 55 79 999319810, Email ejpferreira@yahoo.com.brBackground: Chronic obstructive pulmonary disease (COPD) worsens prognosis in patients with coronary artery disease (CAD). However, the cardiovascular prognosis in patients with stable or mildly symptomatic COPD remains unclear. Here, we sought to determine the long-term cardiovascular events in patients with subclinical or early-stage COPD with concomitant CAD.Methods: This was a longitudinal analytical study involving 117 patients with suspected or established CAD who underwent assessment of pulmonary function by spirometry and who were followed up for six years (March 2015–January 2021). The patients were divided into two groups, one comprising COPD (n=44) and the other non-COPD (n=73) patients. Cox regression was used to evaluate the association between COPD and cardiovascular events, with adjustment for the established CAD risk factors, and the effect size was measured by the Cohen test.Results: COPD patients were older (p=0.028), had a greater frequency of diabetes (p=0.026), were more likely to be smokers (p< 0.001), and had higher modified Medical Research Council scores (p< 0.001). There was no difference between the groups regarding gender, body mass index, hypertension, dyslipidemia, family history of CAD, and type of angina. CAD frequency and the proportion of patients with severe and multivessel CAD were significantly higher among COPD than among non-COPD patients (all p< 0.001). At six-year follow-up, patients with COPD were more likely to have experienced adverse cardiovascular events than those without COPD (p< 0.001; effect size, 0.720). After adjusting for established CAD risk factors, COPD occurrence remained an independent predictor for long-term adverse cardiovascular events (OR: 5.13; 95% CI: 2.29– 11.50; p< 0.0001).Conclusion: COPD was associated with increased severity of coronary lesions and a greater number of adverse cardiovascular events in patients with suspected or confirmed CAD. COPD remained a predictor of long-term cardiovascular events in stable patients with subclinical or early-stage of COPD, independently of the established CAD risk factors.Keywords: COPD, coronary artery disease, risk factors, ischemic heart disease, myocardial infarction

Aldenice Magalhães Capeletti,1 Adriana do Carmo Santos Sousa,1 Carla Lima Feitoza,1 Renata Pedrolongo Basso-Vanelli,2 Evelim LFD Gomes,1 Dirceu Costa11Rehabilitation Sciences Program, UNINOVE, São Paulo, Brazil; 2Spirometry and Respiratory Physiotherapy Laboratory – LEFiR, Universidade Federal de São Carlos – UFSCar, São Carlos, São Paulo, BrazilIntroduction: COPD is characterized by the ventilatory limitation, with reduction of the inspiratory reserve volume and dynamic hyperinflation (DH), which changes the configuration of the thoracic compartment, resulting in a disadvantage in respiratory muscle kinetics, and reduced functional capacity. The optoelectronic plethysmography (OEP) has been used to monitor changes in thoracoabdominal mobility. The Glittre-ADL test is a short battery of functional tests that simulate activities of daily living. In mild and moderate COPD, the effect of Glittre-ADL on thoracoabdominal kinetics and DH is understudied.Objective: The aim of our study was to evaluate the acute effects of the Glittre-ADL test on lung function and thoracoabdominal mobility using OEP in patients with mild and moderate COPD.Materials and methods: Twenty-five male and female patients between 45 and 80 years of age with COPD were submitted to the exercises that simulated Glittre-ADL test. Spirometry and OEP were performed before and after the test.Results: After the Glittre test, increases were found in EV (p=0.005), percentage of contribution of the abdominal compartment (p=0.054) and expiratory reserve volume (ERV) (p=0.006) and reductions were found in the contribution of the upper thoracic compartment (p=0.008) and inspiratory capacity (IC) (p=0.040).Conclusion: The acute effect of ADL was a change in thoracoabdominal kinetics, especially the percentage of contribution of the abdominal compartment, as demonstrated by OEP. These findings, together with the reduction in IC and increase in ERV, after the Glittre-ADL test suggest the occurrence of DH, even in patients with mild to moderate COPD according to the GOLD classification.Keywords: COPD, dynamic hyperinflation, plethysmography

Juliana Maria Dantas Mendonça Borges,1,2,* Fernanda Oliveira de Carvalho,1,* Isla Alcântara Gomes,3,* Mario Borges Rosa,4,* Antonio Carlos Sobral Sousa1,* 1Nucleus of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Brazil; 2Nucleus of Pharmacy, Tiradentes University, Aracaju, Brazil; 3Nucleus of Post-Graduation in Pharmaceutical Sciences, Federal University of Sergipe, São Cristóvão, Brazil; 4Institute for Safe Practice in Drug Use, Belo Horizonte, Brazil *These authors contributed equally to this work Background: When prescribing antiplatelet agents, physicians face the challenge of protecting patients from thromboembolic events without inducing bleeding damage. However, especially in the perioperative period, the use of these medications requires a carefully balanced assessment of their risks and benefits.Objective: To conduct a systematic review to check whether the antiplatelet agent is to be maintained or suspended in the perioperative period of noncardiac surgeries.Search strategy: A comprehensive literature search using Science Direct, Scopus, MEDLINE-PubMed, and Web of Science was undertaken.Selection criteria: Clinical trials of noncardiac surgeries with patients taking regular antiplatelet therapy, published between 2013 and 2018.Results: A total of 1,302 studies were initially identified, with only four meeting the inclusion criteria. The selected studies were conducted in different countries such as, including India (2), Serbia (1), and the USA (1). The age group was similar in all studies, from 61 to 75 years. The most frequent surgery was related to tooth extraction and transurethral resection of bladder cancer. There was a group of patients who used single antiplatelet agents and groups who used single therapy and double therapy. Acetylsalicylic acid was the common drug in all studies.Conclusion: It was concluded that the clinical trials were classified as good quality and that it was not necessary to suspend antiplatelet therapy prior to surgical procedures such as dental extraction and transurethral resection of bladder cancer. It should be noted that it is necessary to jointly evaluate the type of antiplatelet agent, the thrombotic risk of the patient, and the hemorrhagic risk of the surgical procedure. Keywords: platelet aggregation inhibitors, antiplatelet agent, surgery, systematic review

Igor Larchert Mota,1 Antônio Carlos Sobral Sousa,1–3 Maria Luiza Doria Almeida,1,2 Enaldo Vieira de Melo,2 Eduardo José Pereira Ferreira,2,3 José Barreto Neto,2 Carlos José Oliveira Matos,1,3 Caio José Coutinho Leal Telino,2,3 Maria Júlia Silveira Souto,2,3 Joselina Luzia Menezes Oliveira1–3 1Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil; 2Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil; 3Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil Background: Systemic inflammation is the pathophysiological link between coronary artery disease (CAD) and COPD. However, the influence of subclinical COPD on patients with suspected or diagnosed CAD is largely unknown. Thus, this study was designed to evaluate the degree of coronary involvement in patients with COPD and suspected or confirmed CAD. Methods: In this cross-sectional study, carried out between March 2015 and June 2017, 210 outpatients with suspected or confirmed CAD were examined by both spirometry and coronary angiography or multidetector computed tomography. These patients were divided into two groups: with and without COPD. Size, site, extent, and calcification of the coronary lesions, and the severity of COPD were analyzed. Results: COPD patients (n = 101) presented with a higher frequency of obstructive coronary lesions ≥50% (n = 72, 71.3%), multivessels (n = 29, 28.7%), more lesions of the left coronary trunk (n = 18, 17.8%), and more calcified atherosclerotic plaques and higher Agatston coronary calcium score than the patients without COPD (P < 0.0001). The more severe the COPD in the Global Initiative for Obstructive Lung Disease stages, the more severe the CAD and the more calcified coronary plaques (P < 0.0001). However, there was no difference between the two groups with respect to the main risk factors for CAD. In the univariate analysis, COPD was an independent predictor of obstructive CAD (odds ratio [OR] 4.78; 95% confidence interval: 2.21–10.34; P < 0.001). Conclusion: In patients with suspected CAD, comorbid COPD was associated with increased severity and extent of coronary lesions, calcific plaques, and elevated calcium score independent of the established risk factors for CAD. In addition, the more severe the COPD, the greater the severity of coronary lesions and calcification present. Keywords: COPD, coronary artery disease, spirometry, coronary angiography, multidetector computed tomography

The COVID-19 pandemic's prolonged extension may have had a long-term negative impact on weight and metabolic parameters associated with the effectiveness of bariatric surgery. The aim of this study was to assess the impact of the COVID-19 pandemic on cardiometabolic risk markers and weight outcomes of post-bariatric patients. This is a longitudinal study carried out with patients who underwent bariatric surgery before the COVID-19 pandemic. Anthropometric, lipid, glycemic profile, blood pressure, eating behavior and physical activity parameters obtained through face-to-face consultations from 2019 to 2022 were evaluated. An increase in BMI (p = 0.001), percentage of weight gain (p < 0.001), postoperative weight regain rate (p = 0.002), fasting blood glucose (p < 0.001), and glycosylated hemoglobin (p < 0.001) was identified. There were reductions in the percentages of excess weight loss (p = 0.001) and physically active individuals (p = 0.016). These changes were only triggered after the pandemic years. Uncontrolled eating, emotional eating, and physical inactivity were identified as risk factors for weight gain during the pandemic. Prepandemic weight regain rate was risk factor for increased fasting blood glucose. Two years after the pandemic onset, the study participants exhibited increased rates of weight regain, reduced excess weight loss, and an increase in fasting blood glucose and glycosylated hemoglobin parameters., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

This study examined factors associated with the recurrence of interpersonal violence against children and adolescents in Mato Grosso state, considering cases recorded in the Notifiable Diseases Information System, from 2013 to 2019. Associations between variables were estimated by logistic regression and stratified by age group (children and adolescents). The frequency of recurrent violence against children was 49.0% and, against adolescents, 42.9%. For both, recurrent violence was positively associated with occurrence at home, psychological or emotional violence, aggressors' being more than two, their being relatives and threats being the means of aggression. Neglect or abandonment and male or both-sex aggressors were positively associated with recurrent violence against children. Against adolescents, poor education, sexual violence and intimate-partner aggressors were positively associated with recurrent violence, while other aggressors and firearms or physical force were negatively associated. The findings offer significant contributions to knowledge of factors associated with recurrent violence, which is still little studied in the national and international literature. This is essential in order to inform strategies to reduce the recurrence of violence and protect children and adolescents.

Background: Achieving nutritional goals established by scientific societies is a constant challenge and not always achieved., Objective: To investigate the dietary adequacy of individuals with cardiovascular disease (CVD), participants in the Cardioprotective Brazilian Food Program residing in the Northeast region of Brazil, according to the recommendations of the Brazilian Society of Cardiology (SBC)., Methods: Cross-sectional analysis with data from the study implementing the Brazilian Cardioprotective Diet (DICA BR), which evaluated individuals with CVD treated in specialized cardiovascular health centers in eight states in the Northeast region. Food consumption was obtained by 24-hour dietary records and dietary adequacy followed SBC recommendations. Values of p < 0.05 were considered significant., Results: 647 patients were studied, with a mean (standard deviation) age of 63.1 (9.4) years, 50.2% of whom were female. When evaluating food intake, a low adequacy of carbohydrates (52.3%), proteins (70.9%), lipids (38.8%), and fiber (22.4%) was observed. It was observed that the majority of women consumed a low-protein diet (59.2%) and the elderly had a greater inadequacy in carbohydrate consumption (52.6%). Regarding sodium intake, men had a higher intake (72.9%), while the elderly showed a 13% reduction. Furthermore, it was shown that men ate more fiber (28.1%) and individuals with higher education had a high consumption of saturated fatty acids (70.5%)., Conclusions: Most individuals did not achieve the recommended dietary therapy goals for secondary cardiovascular prevention. The findings of the present study reinforce the need to implement structured strategies to encourage healthy eating habits in these individuals.

Objective: to evaluate the association between different forms of childhood trauma and postpartum depression in Brazilian puerperal women., Method: this cross-sectional survey included 253 puerperal women who were evaluated using the Edinburgh Postnatal Depression Scale and the Childhood Trauma Questionnaire. Multivariate logistic regression analyses were performed to verify the association of different types of trauma and the co-occurrence of forms of abuse and neglect with postpartum depression., Results: postpartum depression was identified in 93 women (36.8%; 95% Confidence Interval: 30.8-42.7). All forms of childhood trauma assessed (emotional abuse, emotional neglect, physical abuse, physical neglect and sexual abuse) were independently associated with postpartum depression after adjusting for confounding variables. Emotional abuse remained associated with postpartum depression when the co-occurrence of all forms of childhood trauma was analyzed., Conclusion: the results suggest an association between the different forms of childhood trauma and postpartum depression. In this sense, childhood trauma is an indicator for Nursing professionals to screen for risk factors of postpartum depression during obstetric&#95;follow-up.

Post-acute COVID-19 syndrome, or long COVID, presents with persistent symptoms, including cough, dyspnea, and fatigue, extending beyond one month after SARS-CoV-2 infection. Cardiac complications such as chest pain and arrhythmias have raised concerns, with chronotropic incompetence (CI), an inadequate heart rate increase during exercise, emerging as a significant condition contributing to diminished exercise tolerance and quality of life. This study estimated the prevalence of CI and explored its association with aerobic capacity and physical activity levels in long COVID patients. A cross-sectional study was conducted at a private hospital in Sergipe, Brazil, involving 93 patients over 18 years old with persistent post-COVID-19 symptoms after confirmed SARS-CoV-2 infections. Exclusion criteria included beta-blocker use, inadequate respiratory exchange ratio, and inability to complete cardiopulmonary exercise testing (CPET). Clinical histories, CPET results, and chronotropic index calculation were used to identify CI, with logistic regression analyzing associated factors. Of the participants (mean age 45 years; average duration since COVID-19 diagnosis 120 days), 20.4% were diagnosed with CI. Logistic regression identified a strong association between CI and sedentary behavior (OR 11.80; 95% CI 2.54 to 54.78; p=0.001). Patients with CI showed lower predicted peak heart rates and maximal oxygen uptake. The prevalence of CI among long COVID patients in this study was approximately 20%, associated with decreased aerobic capacity and increased sedentary behavior. These findings highlight the need for timely diagnosis and therapeutic interventions, including cardiopulmonary rehabilitation, to enhance the quality of life in post-COVID patients with CI. The study's cross-sectional design and its specific context have limited causality inference and generalizability, underscoring the importance of further research in diverse settings.

(1) Background: An elevated wrist circumference may indicate excess weight and cardiometabolic risk. The present study aims to identify wrist circumference cutoff points (WrC) to determine excess weight levels and predict cardiometabolic risk in adults. (2) Methods: A cross-sectional study was conducted with adults aged 20 to 59 years old, attending the outpatient clinic at University Hospital/Federal University of Sergipe HU/UFS-EBSERH. Demographic, anthropometric, biochemical, and blood pressure (BP) data were collected. Cardiometabolic risk was assessed, according to the global risk score (ERG) and Framingham score criteria. The descriptive analysis included calculating medians and frequencies of anthropometric, demographic, biochemical, and blood pressure variables. The gender and age of adult groups were compared using the Mann-Whitney test. Spearman's correlation coefficient and multiple regression analysis were used to assess the association between wrist circumference (WrC) and the variables mentioned above. The predictive validity of WrC in identifying excess weight levels and cardiometabolic risk was analyzed using the ROC curve. The sample consisted of 1487 adults aged 20 to 59 years, 55.7% of whom were female; (3) Results: WrC correlated positively with other adiposity indicators such as waist circumference and Body Mass Index. WrC was the anthropometric indicator most significantly associated with cardiometabolic risk factors. WrC cutoff points identified by the study for determining excess weight were categorized by gender and age group. For males aged 20 to 40 years and >40 years, respectively, the cutoff points for overweight were 17.1 cm and 17.3 cm, and for obesity, 17.9 cm and 17.5 cm. For females aged 20 to 40 years and >40 years, respectively, the cutoff points for overweight were 15.6 cm and 15.4 cm, and for obesity, 16.1 cm and 16 cm (4). Conclusions: Wrist circumference showed a significant correlation with other adiposity indicators and can be used to identify adults with excess weight and predict cardiometabolic risk.

Background: Adhering to a diet adequate in macronutrients is crucial for the secondary prevention of cardiovascular diseases., Objective: To assess the prevalence of adherence to recommendations for the consumption of dietary fatty acids for the prevention and treatment of cardiovascular diseases and to estimate whether the presence of certain cardiovascular risk factors would be associated with adherence., Methods: Cross-sectional study using baseline data from 2,358 participants included in the "Brazilian Cardioprotective Nutritional Program Trial". Dietary intake and cardiovascular risk factors were assessed. Adequate intake of polyunsaturated fatty acids (PUFA) was considered as ≥10% of total daily energy intake; for monounsaturated fatty acids (MUFA), 20%; and for saturated fatty acids (SFA), <7% according to the Brazilian Society of Cardiology. A significance level of 5% was considered in the statistical analysis., Results: No participant adhered to all recommendations simultaneously, and more than half (1,482 [62.9%]) did not adhere to any recommendation. Adherence exclusively to the SFA recommendation was the most prevalent, fulfilled by 659 (28%) participants, followed by adherence exclusively to the PUFA (178 [7.6%]) and MUFA (5 [0.2%]) recommendations. There was no association between the number of comorbidities and adherence to nutritional recommendations (p = 0.269). Participants from the Brazilian Northeast region showed a higher proportion of adherence to SFA consumption recommendations (38.42%) and lower adherence to PUFA intake (3.52%) (p <0.001) compared to other regions., Conclusions: Among the evaluated sample, there was low adherence to nutritional recommendations for dietary fatty acid consumption.

Purpose: Translate, investigate reliability, and construct validity of the Brazilian Early Activity Scale for Endurance (EASE)., Materials and Methods: Translation followed the international guidelines. Test-retest reliability was tested by 100 parents of children with cerebral palsy (CP): 18 months-5 years and 6-11 years. To determine construct validity, 94 parents of typically children completed the EASE. Statistical analysis included Bland-Altman, Intraclass Correlation Coefficient (ICC), Internal Consistency, and Floor and Ceiling Effect., Results: The majority of the sample consisted of children with CP in GMFCS (IV-V). EASE showed good test-retest reliability for younger (ICC = 0.8) and excellent test-retest reliability for older children with CP (ICC = 0.9), and good internal consistency of 0.7 and 0.8 for the young and older group, respectively. Bland-Altman showed the bias close to zero, with no ceiling or floor effect. Regarding construct validity, younger children showed lower scores when compared to the older children. Endurance differed significantly between children with CP who were walking and those who were not walking and also for age groups. Children with CP showed lower endurance compared to typically participants in the same age group., Conclusions: Brazilian EASE is reliable and valid to estimate endurance in children with CP. Results provide evidence of construct validity.

The varied clinical presentations of SARS-CoV-2 infection have raised concerns about long-term consequences, especially "long-COVID" or "post-COVID-19 syndrome." In this context, the cardiorespiratory optimal point (COP) within the Cardiopulmonary Exercise Test (CPET) emerges as a crucial metric for evaluating functional capacities and detecting cardiovascular and pulmonary anomalies post-COVID-19. This study aimed to assess COP values among post-COVID-19 patients and categorized them based on the initial severity of their disease. In this cross-sectional study conducted in the Northeast Brazil, 80 patients (26 females and 54 males) previously infected with SARS-CoV-2 underwent CPET. We clinically stratified patients into mild, moderate, or severe COVID-19 categories and assessed COP values and other cardiorespiratory metrics. We found differences in the predicted COP between patients with mild and severe COVID-19 (p=0.042). Additionally, patients with moderate and severe COVID-19 record had an average COP value exceeding 22. Other parameters, including respiratory exchange ratio, heart rate, and oxygen uptake efficiency slope, did not differ across the groups. Patients with a history of severe COVID-19 showed altered COP values, suggesting potential discrepancies in cardiovascular and respiratory system integration. The outcomes emphasize the importance of continuous monitoring and assessment of the cardiorespiratory domain for post-COVID-19 patients. Further research is needed to understand the relationship between elevated COP in post-severe COVID-19 and its long-term prognostic implications.

Ethnopharmacological Relevance: Amburana cearensis (Allemão) A.C. Smith is a medicinal plant with wide distribution in South America, popularly known in Brazil as "cumaru" or "amburana de cheiro". In folk medicine, in the semi-arid region of Northeastern Brazil, infusions, teas and decoctions of leaves of Amburana cearensis have their practical use for treating fever, gastrointestinal disorders, inflammation, and inflammation pain. However, none of the ethnopharmacological properties has been scientifically evaluated using volatile compounds obtained from its leaves (essential oil)., Aim of the Study: This study investigated the chemical composition, acute oral toxicity, and antinociceptive and anti-inflammatory activities of the essential oil from the leaves of A. cearensis., Material and Methods: The acute toxicity of the essential oil was investigated in mice. The antinociceptive effect was evaluated using the formalin test and, abdominal writhing induced by acetic acid, being investigated the possible mechanisms of action involved in antinociception. The acute anti-inflammatory effect was investigated through models of carrageenan-induced peritonitis, yeast-induced pyrexia, and carrageenan- and histamine-induced paw inflammation., Results: No acute toxicity was observed at doses up to 2000 mg/kg; p.o. The antinociceptive effect was statistically equal to morphine. In the formalin assay, the oil showed analgesic activity in the neurogenic and inflammatory phases, having as mechanisms the cholinergic, adenosinergic system, and ATP-sensitive potassium channels (K-ATP). In peritonitis, a reduction in TNF-α and IL-1β levels and leukocyte migration were observed. The antipyretic effect was statistically superior to dipyrone. The reduction in paw edema was statistically superior to the standard in both models., Conclusion: The results obtained not only support the traditional use of the species in inflammatory conditions and pain in folk medicine but also demonstrate that this is a rich source of phytocomponents such as germacrone, which can be used as a natural and sustainable therapeutic agent with industrial applications., 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 Elsevier B.V. All rights reserved.)

Background: Central Illustration : Exaggerated Systolic Blood Pressure Increase with Exercise and Myocardial Ischemia on Exercise Stress Echocardiography ESBPRE: exaggerated systolic blood pressure response to exercise; HR: heart rate; SBP: systolic blood pressure., Background: The association between exaggerated systolic blood pressure response to exercise (ESBPRE) and myocardial ischemia is controversial and little studied in patients with established or suspected chronic coronary syndrome., Objective: To verify the relationship between myocardial ischemia and ESBPRE in patients undergoing exercise stress echocardiography (ESE)., Methods: This is a cross-sectional study with 14,367 patients undergoing ESE, from January 2000 to January 2022, divided into the following 2 groups: G1, composed of patients whose peak systolic pressure increased ≥ 90 mmHg (value corresponding to the 95th percentile of the study population), and G2, patients who did not demonstrate an exaggerated hypertensive response. The groups were compared using Student's t and chi-square tests. P values < 0.05 were considered significant. Logistic regression was also performed to identify independent risk factors for myocardial ischemia, ESBPRE, complaints of typical chest pain prior to the exam, and angina during the test., Results: Of the 14,367 patients, 1,500 (10.4%) developed ESBPRE, and 7,471 (52.0%) were female. The percentages of previous complaints of typical chest pain, angina during the test, and myocardial ischemia in patients with ESBPRE were 5.8%, 2.4% and 18.1%, compared to 7.4%, 3.9%, and 24.2%, in patients without ESBPRE, respectively (p = 0.021,p = 0.004, p < 0.001). In multivariate analysis, ESBPRE was independently associated with a lower probability of myocardial ischemia (odds ratio: 0.73; 95% confidence interval: 0.58 to 0.93; p = 0.009)., Conclusion: Exaggerated increase in systolic blood pressure during ESE may be a marker for excluding myocardial ischemia.

Background: An individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors., Methods: This is a cross-sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann-Whitney or Pearson's chi-squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal-Wallis was used. For the confounding analysis, a multinomial regression model was used. p < 0.05 was considered statistically significant., Results: In total, 2360 individuals were evaluated: 58.5% male and 64.2% elderly. The median (interquartile range [IQR]) of the mAHEI was 24.0 (20.0-30.0), ranging from 0.4 to 56.0 points. When comparing the odds ratios (ORs) for the low (first tertile) and medium (second tertile) diet quality groups with the high-quality group (third tertile), it was observed that there was an association between diet quality with a family income of 1.885 (95% confidence intervals [CI] = 1.302-2.729) and 1.566 (95% CI = 1.097-2.235), as well as physical activity of 1.391 (95% CI = 1.107-1.749) and 1.346 (95% CI = 1.086-1.667), respectively. In addition, associations were observed between diet quality and region of residence., Conclusions: A low-quality diet was associated with family income, sedentarism and geographical area. These data are extremely relevant to assist in coping with cardiovascular disease because they enable an assessment of the distribution of these factors in different regions of the country., (© 2023 The British Dietetic Association Ltd.)

Background: Influenza infection is a highly preventable transmissible viral disease associated with mild upper respiratory symptoms and more severe conditions such as lethal pneumonia. Studies have shown that a broader spectrum influenza vaccine could reduce influenza's burden of disease in low- and middle-income countries. A considerable number of systematic reviews reported that quadrivalent influenza vaccines are considered more effective compared to trivalent vaccines, hence, there is a need for an overview in order to synthesize the current evidence pertaining to the comparison between quadrivalent and trivalent inactivated influenza vaccines., Objective: The aim was to summarize the evidence from systematic reviews that investigated the immunogenicity and safety of the Influenza's inactivated quadrivalent vaccine (QIV) compared to the trivalent vaccine (TIV), in the general population., Methods: We searched articles up to December 2022 at: Web of Science, EMBASE, MEDLINE, Cochrane Library, and SCOPUS. The search strategy was conducted following the PICO model. We included systematic reviews comparing the primary outcomes of immunogenicity (seroprotection rate and seroconversion rate) and adverse events using risk ratios. The AMSTAR 2 and ROBIS were used for quality assessments, and GRADE was used for evidence certainty assessments., Findings: We included five systematic reviews, totalling 47,740 participants. The Quadrivalent Inactivated Influenza Vaccine (QIV) exhibited enhanced immunogenicity in the context of B-lineage mismatch when compared to the Trivalent Inactivated Influenza Vaccine (TIV). While the safety profile of QIV was found to be comparable to that of TIV, the QIV showed a higher incidence of solicited local pain among children and adolescents, as well as an increased frequency of local adverse events within the adult population., Conclusion: Our findings suggest that the QIV provides a superior immunogenicity response compared to the TIV in all age groups evaluated, especially when a lineage mismatch occurred. The safety of QIV was considered similar to the TIV, with no serious or systemic solicited or unsolicited adverse events; tough pain at the injection site was greater for QIV. We recommend caution owing to the high risk of bias in the selection process and no protocol registration., (© 2023. BioMed Central Ltd., part of Springer Nature.)

This study evaluated the genotoxicity of Ethanol Extract (EEEp), Dichloromethane Fraction (FDCMEp) and isoeleutherin isolated from Eleutherine plicata , using the micronucleus test and the impact of structural alterations on toxicity and molecular docking (topoisomerase II and DNA complex). The extract was obtained by maceration and fractionation in a chromatography column. The genotoxicity was evaluated by the micronucleus test in human hepatoma cells (HepG2). Isoeleutherin was the starting molecule in the search for analogues by structural similarity, using the ZINC and e-Molecules databases. Isoeleutherin and analogues were subjected to in silico toxicity prediction, and compounds free of toxicological risks (CP13, CP14, CP17 and isoeleutherin) were selected for molecular docking in Topoisomerase II (PDB: 1ZXM). In the micronucleus test, isoeleutherin was less genotoxic. Among the 22 isoeleutherin analogues there were variations in the toxicity profile. Molecular docking studies showed that the compounds have good complementarity in the active site with important hydrogens bonds. Therefore, the structural changes of isoeleutherin led to the obtaining of a molecule with a lower mutagenic potential, and the CP13 can be considered a prototype compound for the development of new molecules with pharmacological potential.

The global production of aquatic organisms has grown steadily in recent decades. This increase in production results in high volumes of by-products and waste, generally considered to be of low commercial value and part of them are consequently discarded in landfills or in the sea, causing serious environmental problems when not used. Currently, a large part of the reused aquaculture waste is destined for the feed industry. This generally undervalued waste presents an important source of bioactive compounds in its composition, such as: amino acids, carotenoids, chitin and its derivatives, fatty acids and minerals. These compounds are capable of offering numerous benefits due to their bioactive properties. However, the applicability of these compounds may be opportune in several other sectors. This review describes studies that seek to obtain and apply bioactive compounds from different sources of aquaculture waste, thus adding commercial value to these underutilized biomasses.HIGHLIGHTSVolume of aquaculture industrial waste from crustaceans and mollusks.Quantity and quality of bioactive components in aquaculture waste.Applications of recovered proteins, lipids, chitin, carotenoids and minerals.Future prospects for the destination of aquaculture waste.

Cancer is a multifactorial organic dysfunction for which great efforts are being devoted in searching for new treatments and therapeutic adjuvants. Annona muricata is a fruit that has promising activity against several types of cancer, as it contains acetogenins, the metabolite group associated with this action. Thus, the objective of this study was to evaluate, in experimental models, the toxic behavior of an extract and fraction rich in acetogenins from A. muricata seeds and study the acetogenin, Annonacin, in silico. Phytochemical characterization was made by thin layer chromatography, spectroscopy in the infrared region and nuclear magnetic resonance. Toxicity was evaluated by tests of Allium cepa and Artemia salina , and in silico studies using the SwissDock servers DockThor, PharmMapper, ADMETLab, PreADME, Osiris and ProTox. The extract and fraction showed genotoxic activity against meristematic cells of A. cepa , reducing the mitotic index; however, the extract produced great deleterious effects on the system, even causing cell necrosis. In A. Saline, the extract was more toxic than the fraction, but both samples were considered toxic. Annonacin was effectively linked to complex I, and presented different activities regarding toxicity. Thus, the results of this study are promising, highlighting the anticancer potential of acetogenins.

Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p < 0.05) than SUS users did. They also showed better adherence to physical activity (p = 0.047). There was no distinction between the groups regarding smoking cessation. The secondary prevention measures after ACS were more effective in PHCS users than in SUS users due to better adherence, especially to pharmacotherapy and regular physical activity., Competing Interests: 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., (© 2022 Published by Elsevier Inc.)

Introduction: In Brazil, the Unified Health System (SUS) controls and oversees public health care, and the Family Health Strategy (FHS) is its primary access, with 60% of the population registered in it. The surveillance of risk factors for cardiovascular diseases (CVD) is the responsibility of the FHS. In 2010, the American Heart Association (AHA) proposed the evaluation of seven metrics (smoking, Body Mass Index (BMI), physical activity, diet, total cholesterol, blood pressure and blood glucose) with an aim to monitoring cardiovascular health (CVH). However, the results of the FHS regarding the CVH of the Brazilian population are unascertained., Objective: Evaluate the control of CVH among adult patients treated by the FHS in the city of Aracaju, Sergipe, Brazil., Material and Methods: A cross-sectional study was conducted using the seven metrics recommended by the AHA to evaluate CVH among patients treated by the FHS. The city of Aracaju has a population of 571,149 inhabitants, with 394,267 > 20 years of age; therefore, it was admitted that in a simple random sample, sampling error of 5% with 95% CI, 329 individuals would be needed., Results: Among 400 patients, only 32.5% had controlled CVH. In a univariate analysis, the adjusted multivariate analysis found that being female (aOR: 2.07 IC: 1.20 to 3.60 p : 0.006) under 45 years old (aOR: 1.61 IC: 1.15 to 2.28 p : 0.006) and with the habit of following health advice from family members and neighbors (aOR: 1.28 IC: 1.15 to 2.28 p : 0.040) were associated with control of CVH. On the other hand, those ones who had a greater number of children (aOR: 0.91 IC: 0.84 to 0.95 p : 0.020) were associated with less control of CVH., Conclusions: The study showed that only 32.5% of patients have controlled CVH. Being a woman, young and following health advice from family members and neighbors have a positive influence in controlling CVH. More children reduced controlling these metrics., Competing Interests: Authors MA-S, AS, and JB-F were employed by Rede D'Or São Luiz. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Tavares, Ribeiro, Almeida-Santos, Sousa and Barreto-Filho.)

Malnutrition in heart failure (HF) is frequent and associated with a worse prognosis. Due to differences in investment and the profile of those assisted, the objective of this study was to evaluate the frequency of malnutrition in hospitalized patients with HF and its association with clinical outcomes in the public and private health systems. Methodology: A cross-sectional study, with 247 volunteers hospitalized with HF in three public hospitals and one private hospital in Aracaju, SE, Brazil. A subjective global nutritional assessment (SGA) and mini nutritional assessment (MNA) were performed. Results: Sample with 72.5% users of the public health system and 75.3% with malnutrition (public = 74.9%; private = 76.5%; p = 0.793). Regardless of the healthcare system, hospital stay (>14 days) was longer (p = 0.020) among those with malnutrition (48.4%) than well-nourished patients (29.5%). Malnutrition in the public system had higher mortality (7.5%; 5.8%; p < 0.001) and hospital transfer rate (21.1%; 0.0%; p < 0.001) than those in the private system. Death after discharge was observed only in the public system (p = 0.039). Conclusion: Malnutrition was frequent in both systems and was associated with longer hospital stays and, in the public hospital, in-hospital death and transfers.

Sweetener type can influence sensory properties and consumer's acceptance and preference for low-calorie products. An ideal sweetener does not exist, and each sweetener must be used in situations to which it is best suited. Aspartame and sucralose can be good substitutes for sucrose in passion fruit juice. Despite the interest in artificial sweeteners, little is known about how artificial sweeteners are processed in the human brain. Here, we applied the convolutional neural network (CNN) to evaluate brain signals of 11 healthy subjects when they tasted passion fruit juice equivalently sweetened with sucrose (9.4 g/100 g), sucralose (0.01593 g/100 g), or aspartame (0.05477 g/100 g). Electroencephalograms were recorded for two sites in the gustatory cortex (i.e., C3 and C4). Data with artifacts were disregarded, and the artifact-free data were used to feed a Deep Neural Network with tree branches that applied a Convolutions and pooling for different feature filtering and selection. The CNN received raw signal as input for multiclass classification and with supervised training was able to extract underling features and patterns from the signal with better performance than handcrafted filters like FFT. Our results indicated that CNN is an useful tool for electroencephalography (EEG) analyses and classification of perceptually similar tastes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Atzingen, Arteaga, Silva, Ortega, Costa and Silva.)

(1) Background: Quality of life (QOL) is used as a health indicator to assess the effectiveness and impact of therapies in certain groups of patients. This study aimed to analyze the QOL of patients with acute coronary syndrome (ACS) who received medical treatment by a public or private health care system. (2) Methods: This observational, prospective, longitudinal study was carried out in four referral hospitals providing cardiology services in Sergipe, Brazil. QoL was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey. The volunteers were divided into two groups (public or private health care group) according to the type of health care provided. Multiple linear regression models were used to evaluate QoL at 180 days after ACS. (3) Results: A total of 581 patients were eligible, including 44.1% and 55.9% for public and private health care, respectively. At 180 days after ACS, the public health care group had lower QoL scores for all domains (functional capacity, physical aspects, pain, general health status, vitality, social condition, emotional profile, and health) (p < 0.05) than the private group. The highest QoL level was associated with male sex (p < 0.05) and adherence to physical activity (p ≤ 0.003) for all assessed domains. (4) Conclusions: This shows that social factors and health status disparities influence QoL after ACS in Sergipe.

Animal mitogenomes are typically devoid of introns. Here, we report the largest number of mitochondrial introns ever recorded from bilaterian animals. Mitochondrial introns were identified for the first time from the phylum Bryozoa. They were found in four species from three families (Order Cheilostomatida). A total of eight introns were found in the complete mitogenome of Exechonella vieirai, and five, 17 and 18 introns were found in the partial mitogenomes of Parantropora penelope, Discoporella cookae and Cupuladria biporosa, respectively. Intron-encoded protein domains reverse transcriptase and intron maturase (RVT-IM) were identified in all species. Introns in E. vieirai and P. penelope had conserved Group II intron ribozyme domains V and VI. Conserved domains were lacking from introns in D. cookae and C. biporosa, preventing their further categorization. Putative origins of metazoan introns were explored in a phylogenetic context, using an up-to-date alignment of mitochondrial RVT-IM domains. Results confirmed previous findings of multiple origins of annelid, placozoan and sponge RVT-IM domains and provided evidence for common intron donor sources across metazoan phyla. Our results corroborate growing evidence that some metazoans with regenerative abilities (i.e. placozoans, sponges, annelids and bryozoans) are susceptible to intron integration, most likely via horizontal gene transfer., (© 2022. Crown.)

Background: "The effective treatment of Heart Failure (HF) involves care with food intake. Recently, the Ministry of Health created the Brazilian Cardioprotective Diet and its dietary index, BALANCE, which assesses adherence to the standard's recommendations"., Methods: This observational prospective study is part of the Congestive Heart Failure Registry (VICTIM-CHF) of Aracaju/SE. Observations and data collection took place from April 2018 to February 2021. Sociodemographic and clinical aspects and food consumption were evaluated. Food intake was determined using the food frequency questionnaire. Foods were categorized using the BALANCE dietary index into green, yellow, blue and red food groups. The BALANCE dietary index was obtained using median and interquartile ranges, scores of the Mann-Whitney U test, and associations between clinical variables and the index, through linear regression., Results: Participants included 240 patients with HF (61.12 ± 1.06 years), who were assisted by the Unified Health System (67.5%). Individuals with a partner showed greater adherence to the green food group recommendations (0.09; 0.00-0.17). The lowest adherence to recommendations regarding the blue food group was observed in individuals with excess weight, who had a higher consumption of foods rich in animal protein (0.54; 0.38-0.78). As for the red food group (ultra-processed foods) the highest adherence was observed by patients with diabetes mellitus (0.41; 0.05-0.77). The greatest adherence to the yellow food group, and a higher score, was observed in patients with the smallest left ventricular systolic diameter (LVSD)., Conclusions: Being married was directly associated with the consumption of foods in the green group, while being overweight and having diabetes were inversely associated with adherence to the blue and red food groups, respectively. Greater adherence to the yellow food group recommendations was inversely associated with less change in the DSFVE.

Background: The high rates of hospitalization and mortality caused by Heart Failure (HF) have attracted the attention of health sectors around the world. Dietary patterns that involve food combinations and preparations with synergistic or antagonistic effects of different dietary components can influence the worsening and negative outcomes of this disease. Objectives: To describe the dietary patterns of patients hospitalized for HF decompensation and associate them with demographic, economic, and clinical factors, and the type of care provided in Sergipe. Materials and Methods: Cross-sectional study that is part of the Congestive Heart Failure Registry (VICTIM-CHF)” of Aracaju/SE. Prospective data collection took place with all patients hospitalized between April 2018 and February 2021 in cardiology referral hospitals, 2 public and 1 private. The data collected were sociodemographic, clinical, lifestyle, anthropometric and food consumption variables. Daily dietary intake was estimated by applying a semiquantitative food frequency questionnaire. The extraction of dietary patterns, by exploratory factor analysis, was performed after grouping the foods according to the nutritional value and form of preparation into 34 groups. To assess the association between the factorial scores for adherence to the standards and the variables studied, the Mann-Whitney U test was applied. Linear regressions were also performed, considering the dietary pattern (one for each pattern) as a dependent variable. Results: The study included 240 patients hospitalized for HF decompensation, most of them elderly (mean age 61.12 ± 1.06 years), male (52.08%) and attended by the Unified Health System—SUS (67.5%). Three dietary patterns were identified, labeled “traditional” (typical foods of the Brazilian northeastern population added to ultra-processed foods), “Mediterranean” (foods recommended by the Mediterranean diet) and “dual” (healthy foods combined with fast and easy-to-prepare foods like snacks, bread, sweets and desserts). Adherence to the “traditional” pattern was greater among men (p < 0.031) and non-diabetics (p < 0.003). The “Mediterranean” was more consumed by the elderly (p < 0.001), with partners (p = 0.001) and a lower income (p < 0.001), assisted by the SUS (p < 0.001) and without hypertension (p = 0,04). The “dual” diet pattern had greater adherence by the elderly (p < 0.001), self-declared non-black (p = 0.012), with higher income (p < 0.001), assisted in the private sector (p < 0.001) and with less impaired functional capacity (p = 0.037). It was also observed that being female (p = 0.031) and being older reduced the average scores of performing the “traditional” pattern (p = 0.002). Regarding the type of service, being from the public service reduced the average scores for adhering to the “dual” pattern (p = 0.008). Conclusions: Three dietary patterns representative of the population were found, called traditional, Mediterranean and dual, which were associated with demographic, economic and clinical factors. Thus, these standards must be considered in the development of nutritional strategies and recommendations in order to increase adherence to diets that are more protective against cardiovascular diseases.

Chickpeas (Cicer arietinum L.) belong to the Fabaceae family and are one of the most grown crops in the world and an important source of protein for humans. Spodoptera frugiperda (JE Smith) (Lepidoptera: Noctuidae) is a polyphagous pest that causes significant crop damage. The objective of this study was to examine antibiosis to S. frugiperda in chickpea genotypes. The following genotypes were studied: Jamu 96 and Blanco Sinaloa 92 (Mexico); Nacional 29 (Cuba); BG 1392 (Spain), and BRS Kalifa, BRS Cristalino, BRS Toro, Nacional 27, 004UP, 003UP, BRS Cícero, and BRS Aleppo (Brazil). The chickpea genotypes influenced the biological parameters of S. frugiperda, of which larval period, larval weight, and pupal period were most affected. Nacional 29 caused high mortality in the larval and pupal stages of S. frugiperda. The larvae on BRS Aleppo had the longest larval stage, lowest weight, and longest pupal stage. The genotypes Nacional 29, Nacional 27, and BRS Cícero showed antibiosis resistance to S. frugiperda. These genotypes could be used as a source of resistance to S. frugiperda in conjunction with other methods of pest control in integrated pest management programs for chickpea crops. These resistant genotypes could also be used as donor sources in breeding programs for insect resistance.

Background and Objectives : In severe obesity, a relevant weight loss can promote the reduction of comorbidities, such as systemic arterial hypertension (SAH), dyslipidemia, and diabetes mellitus (DM2). Bariatric surgery (BS) has been an essential resource in the therapy of this disease with a short-term reduction of cardiometabolic risk (CR). This study aimed to evaluate the reduction of factors associated with the CR in patients undergoing BS at a 5-year follow-up. Materials and Methods: This is a longitudinal, retrospective study carried out with patients undergoing BS by the Brazilian Public Healthcare System (PHS). Anthropometric and clinical parameters related to the CR (DM2, dyslipidemia, and SAH), quantified by the Assessment of Obesity-Related Comorbidities (AORC) score, were evaluated at the following moments: admission and preoperative and postoperative returns (3 months, 6 months, 1 to 5 years). Results: The sample had a mean age of 44.69 ± 9.49 years and were predominantly in the age group 20-29 years (34.80%) and women (72.46%). At admission to the service, 42.3% had DM2, 50.7% dyslipidemia, and 78.9% SAH. Regarding BS, the gastric bypass technique was used in 92.86% of the sample, and the waiting time for the procedure was 28.3 ± 24.4 months. In the pre- and postoperative period of 3 months, there was a significant reduction in the frequency of DM2 ( p < 0.003), dyslipidemia ( p < 0.000), and SAH ( p < 0.000). However, at postoperative follow-up from 6 months to 5 years, there was no significant reduction in the comorbidities studied. After five years, 35.7% had total remission of DM2 and 2.9% partial remission of DM2, 44.2% had control and remission of dyslipidemia, and 19.6% of SAH (AORC score ≤ 2 for the comorbidities) . Conclusion: BS promoted a reduction of the CR in the first three months after BS in severely obese PHS users.

Background:  Different treatments have been proposed for Fibromyalgia, but only few studies have compared their effects on multiples outcomes over time.  Objective:  The objective of this study was to investigate the effects of aquatic physiotherapy (AP) or a health education program (HEP) in a sample of women with Fibromyalgia (FM).  Methods:  Forty-six women with FM, aged between 25 and 60 years old, whose BMI was less than 30, were assigned to either AP (27 women) or HEP (19 women) groups in a blind randomized clinical trial lasting eleven weeks. Pain (McGill Pain questionnaire), fatigue (Piper Fatigue Scale-Revised), functional capability (Fibromyalgia Impact questionnaire), anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory) and quality of sleep (Pittsburgh Sleep Quality Index) data were collected at baseline, after six weeks and post intervention. Two-factor mixed-model analysis of variance (ANOVAs) were used to examine the effects of the treatment on each outcome variable.  Results:  The AP and HEP interventions showed statistically significant within-group differences on all outcome measures except reducing the pain. Between-group differences was statistically significant only for impact of FM on the participant's life [ F (1.82,80.41)  = 31,99; p ≤ 0.01] indicating that patients receiving HEP experienced a greater decrease in FIQ than those treated with AP.  Conclusion:  The findings do not allow to affirm that one intervention is superior to the other for the treatment of people with FM. Future studies should investigate whether the combination of HEP and PA can be effective and long-lasting.

The precise location in the scalp of specifically planned points can help to achieve less invasive approaches. This study aims to develop a smartphone app, evaluate the precision and accuracy of the developed tool, and describe a series of cases using the referred technique. The application was developed with the React Native framework for Android and iOS. A phantom was printed based on the patient's CT scan, which was used for the calculation of accuracy and precision of the method. The points of interest were marked with an "x" on the patient's head, with the aid of the app and a compass attached to a skin marker pen. Then, two experienced neurosurgeons checked the plausibility of the demarcations based on the anatomical references. Both evaluators marked the frontal, temporal and parietal targets with a difference of less than 5 mm from the corresponding intended point, in all cases. The overall average accuracy observed was 1.6 ± 1.0 mm. The app was used in the surgical planning of trepanations for ventriculoperitoneal (VP) shunts and for drainage of abscesses, and in the definition of craniotomies for meningiomas, gliomas, brain metastases, intracranial hematomas, cavernomas, and arteriovenous malformation. The sample consisted of 88 volunteers who exhibited the following pathologies: 41 (46.6%) had brain tumors, 17 (19.3%) had traumatic brain injuries, 16 (18.2%) had spontaneous intracerebral hemorrhages, 2 (2.3%) had cavernomas, 1 (1.1%) had arteriovenous malformation (AVM), 4 (4.5%) had brain abscesses, and 7 (7.9%) had a VP shunt placement. In cases approached by craniotomy, with the exception of AVM, straight incisions and minicraniotomy were performed. Surgical planning with the aid of the NeuroKeypoint app is feasible and reliable. It has enabled neurological surgeries by craniotomy and trepanation in an accurate, precise, and less invasive manner.

Objectives: to describe the structure used in the School Health Program and analyze the association between its material resources and the actions carried out., Methods: cross-sectional, quantitative, analytical, and normative study. A normative instrument of the program was applied to collect data from May to July 2017 with 105 Family Health Strategy professionals. Data were organized and analyzed using descriptive and inferential statistics on IBM SPSS Statistics 22.0 software., Results: financial resources were made available with low periodicity; the most used human resources were dentists; the most frequent infrastructure resource was the school; the most frequently used materials were those related to administrative support (legal-size paper and pen) and clinical resources (fluoride, toothbrush, and toothpaste). An association was identified between resources and anthropometric assessment activities and vaccination status., Conclusions: the program structure showed reduced financial resources and priority participation of human resources from the health sector, and the actions were carried out by using the school infrastructure and administrative and clinical materials.

Background There is lack of prospective data on evolution within one year of acute coronary syndromes (ACS) in a representative population of Brazilian patients. Objectives To assess the prescription of evidence-based therapies, the incidence of severe outcomes and the predictors for these outcomes in a multicenter Brazilian registry of ACS patients. Methods The ACCEPT is a prospective observational study, which included patients hospitalized with a diagnostic of ACS in 47 Brazilian hospitals. The patients were followed for a 1 year and data were collected on the medical prescription and the occurrence of major cardiovascular events (cardiovascular mortality, reinfarction and cerebrovascular accident - CVA). Values of p < 0.05 were considered statistically significant. Results A total of 5,047 patients were included in this registry from August 2010 to April 2014. The diagnosis of ACS was confirmed in 4,782 patients (94.7%) and, among those, the most frequent diagnosis was ACS with ST segment elevation (35.8%). The rate of major cardiovascular events was 13.6 % within 1 year. Adherence to prescription of evidence-based therapy at admission was of 62.1%. Age, public service, acute myocardial infarction, CVA, renal failure, diabetes and quality of therapy were associated independently with the occurrence of major cardiovascular events. Conclusions During the one-year follow-up of the ACCEPT registry, more than 10% of the patients had major cardiovascular events and this rate ranged according with the quality of therapy. Strategies must be elaborated to improve the use of evidence-based therapies to minimize the cardiovascular events among the Brazilian population. (Arq Bras Cardiol. 2020; 114(6):995-1003).

Background There is a scarcity of knowledge as to whether rates of myocardial reperfusion use and 30-day mortality for patients with ST-segment-elevation myocardial infarction are similar among patients using the Brazilian Public Health System (SUS) and those using the private healthcare system. Methods and Results A total of 707 patients were analyzed using the VICTIM (Via Crucis for the Treatment of Myocardial Infarction) register database; 589 patients from the SUS and 118 from the private network with ST-segment-elevation myocardial infarction, who attended hospitals with the capacity to perform primary percutaneous coronary intervention (PCI) were investigated. The timeline, rates of use of PCI, and the 30-day probability of death were investigated, comparing the SUS patients to those in the private system. The mean time between symptom onset and arrival at the PCI hospital was higher for SUS patients compared with users of the private system (25.4±36.5 versus 9.0±21 hours; P <0.001, respectively). Rates of primary PCI were low in both groups, but significantly lower for the SUS patients (45% versus 78%; P <0.001). The 30-day mortality rate of SUS patients was 11.9% and of private patients was 5.9% ( P =0.04). In the fully adjusted model, the odds ratio for 30-day mortality for the SUS patients was higher (odds ratio, 2.96; 95% CI, 1.15-7.61; P =0.02). Conclusions The delay in reaching a PCI hospital was almost 3 times higher for the SUS patients. Primary PCI was underused in both groups, especially in the SUS patients. The SUS patients were more likely to die during the 30-day follow-up.

Objective: Identifying the available evidence in the scientific literature about the strategies used in the evaluations of interventions for the control of tuberculosis., Method: Integrative review with searches in databases Lilacs, CINAHL and PubMed in August 2017. Thirty-three articles were selected and the theoretical referential of health assessment was used for analysis., Results: The prevalent interventions were health programs (60.7%), 69.7% focusing on results and 81.9% having quantitative character (81.9%)., Final Considerations: The evaluation of interventions for the control of tuberculosis is beneficial for the health services' users and aids in the decision making of managers and health professionals.

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD., Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels., Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P < .01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P = .15). Secondary end points did not differ between groups after follow-up., Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)