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This paper proposes a new Frequency Selective Surface (FSS) with modifications on the Jerusalem Cross (JC) geometry to provide a multiband response. Fractal levels are created by introducing concentric self-similar JC copies in the original unit cell. This modification results in new dipoles at the structure which allows for the appearance of new bands proportional to these diploles' lengths, while maintaining total unit cell size. Three fractal levels of the JC FSS are studied in this paper, and third level presents five resonant frequencies which are ƒ1 = 1.78 GHz, ƒ2 = 6.42 GHz, ƒ3 = 8.69 GHz, ƒ4 = 10.94 GHz and ƒ5 = 12.98 GHz. Simulation results for the insertion loss (S21), surface current distribution and measurement results are presented. [ABSTRACT FROM AUTHOR]

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Objective: The aim of this study was to compare periapical radiographs with cone beam CT (CBCT) imaging in detecting and localizing alveolar bone loss by comparing linear measurements of the height, depth and width of the defects and identifying combined bone defects in tomographic images. Methods: The images were selected from a secondary database containing images of patients referred for periodontal evaluation. The sample consisted of 51 sites showing both horizontal and vertical bone loss, assessed by 3 trained examiners. Results: The results showed that there were no statistically significant differences between the imaging methods in terms of identification of the pattern of bone loss. However, there were differences between the two methods when the distance between the cemento-enamel junction (CEJ) and the alveolar crest (AC) was measured. When the distance between the CEJ and the deepest point and width of the defect were measured, the methods showed no statistically significant difference. In this study, 30.8% of the 39 teeth evaluated had combined bone defects. Conclusions: The two methods differ when detecting the height of the alveolar bone crest but present similar views of the depth and width of bone defects. CBCT was the only method that allowed for an analysis of the buccal and lingual/palatal surfaces and an improved visualization of the morphology of the defect. [ABSTRACT FROM AUTHOR]

Objectives: To identify the clustering of physical inactivity in leisure, work, commuting and household contexts, and the sociodemographic factors associated with the clustering of inactive behaviour in different domains among Brazilian adults. Study design: Cross-sectional population-based study. Methods: The study was performed in Florianopolis, capital of Santa Catarina, one of the southern states of Brazil, from September 2009 to January 2010. Adults aged 20-59 years were interviewed. Physical inactivity in each domain was defined as non-participation in specific physical activities, using a validated Brazilian questionnaire. Clustering of physical inactivity was identified by the ratio between observed prevalence and expected prevalence of 16 different combinations. Multinomial logistic regression was used in the analysis of sociodemographic factors associated with clustering of physical inactivity. Results: Of the 1720 interviewees, the greatest differences between the observed and expected proportions were observed in simultaneous physical inactivity in the leisure and household domains for men, and physical inactivity in the leisure domain alone for women (59% and 88%, respectively); these differences were higher than expected if the behaviours were independent. Physical inactivity in two or more domains was observed more frequently in men and in individuals with a higher per-capita family income. Ageing was associated with physical inactivity in three or four domains. Conclusions: Physical inactivity was observed in different domains according to gender. Men and older individuals with a higher per-capita family income were more likely to exhibit physical inactivity when all domains were considered together. [ABSTRACT FROM AUTHOR]

Pseudomonas aeruginosa demonstrates a remarkable capacity for adaptation and survival in diverse environments. Furthermore, its clinical importance is underscored by its intrinsic and acquired resistance to a wide range of antimicrobial agents, posing a substantial challenge in healthcare settings. Amidst this complex landscape of resistance, the Type VI Secretion System (T6SS) in P. aeruginosa adds yet another layer of intricacy and allows bacteria to engage in interbacterial competition, potentially influencing their resilience and pathogenicity. Whole genome sequencing (WGS) was conducted on the five isolates under investigation, enabling the identification of antibiotic resistance genes (ARGs) and mutations associated with resistance. All isolates exhibit class C and D β-lactamases, displaying variant differences. The Resistance-nodulation-division (RND) antibiotic efflux pumps, crucial for multidrug resistance, have been encoded chromosomally. When exploring the role of the T6SS in urinary tract infections involving other bacteria, it was noted that P. aeruginosa isolates exhibited reduced counts when co-cultivated with other bacteria. The downregulation of the tssJ gene, associated with the T6SS under bacterial stress, and the exclusion of several cluster genes in this study suggest the hypothesis of a basal state rather than an attack/defence mechanism in the initial contact., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024. Published by Elsevier Ltd.)

Malaria represents a challenging global public health task, with Plasmodium vivax being the predominant parasite in Brazil and the most widely distributed species throughout the world. Developing a vaccine against P. vivax malaria demands innovative strategies, and targeting gametocyte antigens shows promise for blocking transmission prevention. Among these antigens, Pvs47, expressed in gametocytes, has shown remarkable efficacy in transmission blocking. However, remains underexplored in vaccine formulations. This study employed in silico methods to comprehensively characterize the physicochemical properties, structural attributes, epitope presence, and conservation profile of Pvs47. Additionally, we assessed its antigenicity in individuals exposed to malaria in endemic Brazilian regions. Recombinant protein expression occurred in a eukaryotic system, and antigenicity was evaluated using immunoenzymatic assays. The responses of naturally acquired IgM, total IgG, and IgG subclasses were analyzed in three groups of samples from Amazon region. Notably, all samples exhibited anti-Pvs47 IgM and IgG antibodies, with IgG3 predominating. Asymptomatic patients demonstrated stronger IgG responses and more diverse subclass responses. Anti-Pvs47 IgM and IgG responses in symptomatic individuals decrease over time. Furthermore, we observed a negative correlation between anti-Pvs47 IgM response and gametocytemia in samples of symptomatic patients, indicating a gametocyte-specific response. Additionally, negative correlation was observed among anti-Pvs47 antibody response and hematocrit levels. Furthermore, comparative analysis with widely characterized blood antigens, PvAMA1 and PvMSP1 19 , revealed that Pvs47 was equally or more recognized than both proteins. In addition, there is positive correlation between P. vivax blood asexual and sexual stage immune responses. In summary, our study unveils a significant prevalence of anti-Pvs47 antibodies in diverse Amazonian samples and the importance of IgM response for gametocytes depuration. These findings regarding the in silico characterization and antigenicity of Pvs47 provide crucial insights for potential integration into P. vivax vaccine formulations., 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 © 2024 Soares da Veiga, Donassolo, Forcellini, Ferraboli, Kujbida Junior, Nisimura, Bassai, Kessler, Serpeloni, Bittencourt, Salazar, Guimarães, Louzada, Barros, Lopes, Carvalho, Nóbrega de Sousa, Kano, Costa, Fanini Wowk and Albrecht.)

The cerebellar cognitive affective syndrome is a neuropsychiatric syndrome composed of affective (anxiety, depression, euphoria, and emotional lability) and cognitive symptoms (executive, attentional, and visuospatial deficits) that was described in the 1990s. We present the case of a 49-year-old woman with a history of an acute neurological episode at the age of 28, after which she reported a change in personality, brief and alternating periods of depression, hypomania, and mixed episodes, and cognitive impairment that had a major impact on her personal and occupational level of functioning. She was initially diagnosed with bipolar disorder, but a clinical, neuropsychological, and imaging re-evaluation prompted a diagnostic reconsideration in favor of a cerebellar cognitive affective syndrome. This enabled therapeutical and prognostic refinement. Here, we discuss the diagnostic challenges of this syndrome and the implications that an accurate diagnosis has for patients.

Objectives: To evaluate the association of ultra-processed food (UPF) consumption with depression among Brazilian adults (≥18 years)., Study Design: Cross-sectional study., Methods: Data were obtained from a population-based survey conducted in 2023 (n = 21,690). UPF consumption was investigated using a questionnaire regarding the consumption on the previous day of 13 subgroups of UPF selected from those most consumed in Brazil according to a previous national survey (cutoff score ≥5 subgroups). The medical diagnosis of depression was self-reported. Logistic regression models were used to estimate the adjusted (by sex, age, education, presence of partner/spouse, and overweight) Odds Ratio (aOR) of UPF consumption according to the presence of depression. Analyses were conducted for the total population and stratified by sex., Results: Medical diagnosis of depression was reported by 12.3%. The prevalence of high UPF consumption (≥5 subgroups) was 17.7%, being higher in men (22.0%) and those with depression (19.3%). Depression increased the chance of presenting a high UPF consumption among the total population (aOR 1.35; CI 95% 1.08-1.68) and women (aOR 1.35; CI 95% 1.03-1.77), with no association among men., Conclusion: The presence of depression was associated with greater consumption of UPF among Brazilian adults, especially among the female population. Public health actions to reduce UPF consumption could benefit from targeting this population group., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

The effectiveness of motor imagery (MI) training on sports performance is now well-documented. Recently, it has been proposed that a single session of MI combined with low frequency sound (LFS) might enhance muscle activation. However, the neural mechanisms underlying this effect remain unknown. We set up a test-retest intervention over the course of 2 consecutive days to evaluate the effect of (i) MI training (MI, n = 20), (ii) MI combined with LFS (MI + LFS, n = 20), and (iii) a control condition (CTRL, n = 20) on force torque produced across repeated maximal voluntary contractions of the quadriceps before (Pretest), after (Posttest) and at +12 h (Retention) post-intervention. We collected the integrated electromyograms of the quadriceps muscles, as well as brain electrical potentials during each experimental intervention. In the CTRL group, total force torque decreased from Pretest to Retention and from Posttest to Retention. By contrast, there was an increase between Posttest and Retention in both MI + LFS and MI groups (both η P 2 = 0.03, p < 0.05). Regression analyses further revealed a negative relationship between force performance and EEG activity in the MI + LFS group only. The data support a transient interference of LFS on cortical activity underlying the priming effects of MI practice on force performance. Findings are discussed in relation to the potential for motor reprogramming through MI combined with LFS., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this article., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: Primaquine is essential for the radical cure of Plasmodium vivax malaria and must be metabolized into its bioactive metabolites. Accordingly, polymorphisms in primaquine-metabolizing enzymes can impact the treatment efficacy. This pioneering study explores the influence of monoamine oxidase-A (MAO-A) on primaquine metabolism and its impact on malaria relapses., Methods: Samples from 205 patients with P. vivax malaria were retrospectively analysed by genotyping polymorphisms in MAO-A and cytochrome P450 2D6 (CYP2D6) genes. We measured the primaquine and carboxyprimaquine blood levels in 100 subjects for whom blood samples were available on the third day of treatment. We also examined the relationship between the enzyme variants and P. vivax malaria relapses in a group of subjects with well-documented relapses., Results: The median carboxyprimaquine level was significantly reduced in individuals carrying low-expression MAO-A alleles plus impaired CYP2D6. In addition, this group experienced significantly more P. vivax relapses. The low-expression MAO-A status was not associated with malaria relapses when CYP2D6 had normal activity. This suggests that the putative carboxyprimaquine contribution is irrelevant when the CYP2D6 pathway is fully active., Conclusions: We found evidence that the low-expression MAO-A variants can potentiate the negative impact of impaired CYP2D6 activity, resulting in lower levels of carboxyprimaquine metabolite and multiple relapses. The findings support the hypothesis that carboxyprimaquine may be further metabolized through CYP-mediated pathways generating bioactive metabolites that act against the parasite., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)

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.

Background and Aims: There is a need to consolidate reporting guidance for nutrition randomised controlled trial (RCT) protocols. The reporting completeness in nutrition RCT protocols and study characteristics associated with adherence to SPIRIT and TIDieR reporting guidelines are unknown. We, therefore, assessed reporting completeness and its potential predictors in a random sample of published nutrition and diet-related RCT protocols., Methods: We conducted a meta-research study of 200 nutrition and diet-related RCT protocols published in 2019 and 2021 (aiming to consider periods before and after the start of the COVID pandemic). Data extraction included bibliometric information, general study characteristics, compliance with 122 questions corresponding to items and subitems in the SPIRIT and TIDieR checklists combined, and mention to these reporting guidelines in the publications. We calculated the proportion of protocols reporting each item and the frequency of items reported for each protocol. We investigated associations between selected publication aspects and reporting completeness using linear regression analysis., Results: The majority of protocols included adults and elderly as their study population (n = 73; 36.5%), supplementation as intervention (n = 96; 48.0%), placebo as comparator (n = 89; 44.5%), and evaluated clinical status as the outcome (n = 80; 40.0%). Most protocols described a parallel RCT (n = 188; 94.0%) with a superiority framework (n = 141; 70.5%). Overall reporting completeness was 52.0% (SD = 10.8%). Adherence to SPIRIT items ranged from 0% (n = 0) (data collection methods) to 98.5% (n = 197) (eligibility criteria). Adherence to TIDieR items ranged from 5.5% (n = 11) (materials used in the intervention) to 98.5% (n = 197) (description of the intervention). The multivariable regression analysis suggests that a higher number of authors [β = 0.53 (95%CI: 0.28-0.78)], most recent published protocols [β = 3.19 (95%CI: 0.24-6.14)], request of reporting guideline checklist during the submission process by the journal [β = 6.50 (95%CI: 2.56-10.43)] and mention of SPIRIT by the authors [β = 5.15 (95%CI: 2.44-7.86)] are related to higher reporting completeness scores., Conclusions: Reporting completeness in a random sample of 200 diet or nutrition-related RCT protocols was low. Number of authors, year of publication, self-reported adherence to SPIRIT, and journals' endorsement of reporting guidelines seem to be positively associated with reporting completeness in nutrition and diet-related RCT protocols., Competing Interests: Conflicts of interest Flávia Moraes Silva received a postdoctoral fellowship from COPPETEC Foundation. Michael Maia Schlussel, Shona Kirtley, Jennifer A de Beyer and Gary Collins are funded by Cancer Research UK (grant C49297/A27294). Matthew J Page is supported by an Australian Research Council Discovery Early Career Researcher Award (DE200101618). Colby Vorland has received honoraria from The Obesity Society and the Alliance for Potato Research and Education, and his university has received funds to support his research from: National Cattlemen's Beef Association; Alliance for Potato Research and Education; the Gordon and Betty Moore Foundation; and NIH. All authors work directly or have collaborations with the EQUATOR Network, an international initiative that seeks to improve the reliability and value of published health research literature by promoting transparent and accurate reporting and wider use of robust reporting guidelines., (Copyright © 2024. Published by Elsevier Ltd.)

Dihydroartemisinin-piperaquine is efficacious for the treatment of uncomplicated malaria and its use is increasing globally. Despite the positive results in fighting malaria, inhibition of the Kv11.1 channel (hERG; encoded by the KCNH2 gene) by piperaquine has raised concerns about cardiac safety. Whether genetic factors could modulate the risk of piperaquine-mediated QT prolongations remained unclear. Here, we first profiled the genetic landscape of KCNH2 variability using data from 141,614 individuals. Overall, we found 1,007 exonic variants distributed over the entire gene body, 555 of which were missense. By optimizing the gene-specific parametrization of 16 partly orthogonal computational algorithms, we developed a KCNH2 -specific ensemble classifier that identified a total of 116 putatively deleterious missense variations. To evaluate the clinical relevance of KCNH2 variability, we then sequenced 293 Malian patients with uncomplicated malaria and identified 13 variations within the voltage sensing and pore domains of Kv11.1 that directly interact with channel blockers. Cross-referencing of genetic and electrocardiographic data before and after piperaquine exposure revealed that carriers of two common variants, rs1805121 and rs41314375, experienced significantly higher QT prolongations (ΔQTc of 41.8 ms and 61 ms, respectively, vs 14.4 ms in controls) with more than 50% of carriers having increases in QTc >30 ms. Furthermore, we identified three carriers of rare population-specific variations who experienced clinically relevant delayed ventricular repolarization. Combined, our results map population-scale genetic variability of KCNH2 and identify genetic biomarkers for piperaquine-induced QT prolongation that could help to flag at-risk patients and optimize efficacy and adherence to antimalarial therapy., Competing Interests: V.M.L. is co-founder, CEO, and shareholder of HepaPredict AB, as well as co-founder and shareholder of PersoMedix AB.

Pseudomonas aeruginosa and Klebsiella pneumoniae are notorious for their resistance to antibiotics and propensity for biofilm formation, posing significant threats to human health. Epsilon-poly-L-lysine (ε-PL) emerges as a naturally occurring antimicrobial poly(amino acid), which positions it as a prospective agent for addressing challenges linked to multidrug resistance. ε-PL symbolizes a promising avenue in the pursuit of efficacious therapeutic strategies and warrants earnest consideration within the realm of clinical treatment. Thus, our objective was to determine the antibiotic susceptibility profiles of 38 selected P. aeruginosa and ESBL-producing K. pneumoniae clinical isolates and determine the ability of ε-PL to inhibit biofilm formation. After PCR analysis, detection of genes related to β-lactamases was observed among the selected isolates of P. aeruginosa [ bla SPM (35.7%), bla KPC (35.7%), bla SHV (14.3%), bla CTX-M (14.3%), bla OXA (14.3%), bla TEM (7.1%), bla PER (7.1%), bla VIM (7.1%), and bla VIM-2 (7.1%)] and K. pneumoniae [ bla CTX-M (91.7%), bla TEM (83.3%), bla KPC (16.7%), bla NDM (12.5%), and bla OXA (4.2%)]. The results of testing the activity of ε-PL against the clinical isolates showed relatively high minimum inhibitory concentrations (MICs) for the P. aeruginosa (range: 8-64 µg/mL) and K. pneumoniae isolates (range: 16-32 µg/mL). These results suggest the need for prior optimization of ε-PL concerning its viability as an alternative to antibiotics for treating infections caused by P. aeruginosa and K. pneumoniae of clinical origin. It is noteworthy that, in the context of a low antibiotic discovery rate, ε-PL could play a significant role in this quest, considering its low toxicity and the unlikely development of resistance. Upon exposure to ε-PL, P. aeruginosa and K. pneumoniae isolates exhibited a reduction in biofilm production, with ε-PL concentration showing an inverse relationship, particularly in isolates initially characterized as strong or moderate producers, indicating its potential as a natural antimicrobial agent with further research needed to elucidate optimal concentrations and application methods across different bacterial species. Further research is needed to optimize its use and explore its potential in various applications.

Bladder cancer (BC) stands as one of the most prevalent urological malignancies, with over 500 thousand newly diagnosed cases annually. Treatment decisions in BC depend on factors like the risk of recurrence, the type of tumor, and the stage of the disease. While standard therapeutic approaches encompass transurethral resection of the bladder tumor, radical cystectomy, and chemo- or immunotherapy, these methods exhibit limited efficacy in mitigating the aggressive and recurrent nature of bladder tumors. To overcome this challenge, it is crucial to develop innovative methods for monitoring and predicting treatment responses among patients with BC. Metabolomics is gaining recognition as a promising approach for discovering biomarkers. It has the potential to reveal metabolic disruptions that precisely reflect how BC patients respond to particular treatments, providing a revolutionary method to improve accuracy in monitoring and predicting outcomes. In this article, we present a comprehensive review of studies employing metabolomics approaches to investigate the metabolic responses associated with different treatment modalities for BC. The review encompasses an exploration of various models, samples, and analytical techniques applied in this context. Special emphasis is placed on the reported changes in metabolite levels derived from these studies, highlighting their potential as biomarkers for personalized medicine in BC.

Background: More than 60 years after the enactment of the first Licensing Regulations for Dentists (ZÄPrO), a new Licensing Regulations for Dentists, the ZApprO, was implemented in 2020. The aims of this study were to evaluate and compare the "Course in Technical Propaedeutics" (TPK) with the course "Dental Propaedeutics with a Focus on Dental Technology" (ZPDT), which are based on different legal foundations., Methods: The following parameters were compared after completion of the courses: (1) theoretical and practical knowledge, (2) regular department-internal learner evaluation, and (3) special evaluation of learning conditions by the learners and (4) by the instructors. The theoretical and practical exams and the questionnaires were analyzed in terms of their test-statistical characteristics (difficulty, discrimination index, internal consistency). Group comparisons between TPK and ZPDT were conducted using t‑tests for independent groups., Results: Significant differences were only detected in the students' evaluation of their learning conditions, with theoretical and practical knowledge transfer being rated lower in the TPK than in the ZPDT., Discussion: The comparable results of the knowledge assessments and the regular learner evaluation, triangulated with the comprehensive learner and instructor evaluation, allowed a broad assessment of both courses. The significant differences identified provide opportunities for optimization of the newly implemented ZPDT course., (© 2023. The Author(s).)

Pseudomonas aeruginosa is among the most ubiquitous bacteria in the natural world, exhibiting metabolic and physiological versatility, which makes it highly adaptable. Imipenem + cilastatin and tetracycline are antibiotic combinations commonly used to treat infections caused by P. aeruginosa , including serious infections such as sepsis. In the context of bacterial infections, biofilm, formed by bacterial cells surrounded by extracellular substances forming a matrix, plays a pivotal role in the resistance of P. aeruginosa to antibiotics. This study aimed to characterize a representative panel of P. aeruginosa isolates from septicemias, assessing their susceptibility to various antibiotics, specifically, imipenem + cilastatin and tetracycline, and the impact of these treatments on biofilm formation. Results from antibiotic susceptibility tests revealed sensitivity in most isolates to six antibiotics, with four showing near or equal to 100% sensitivity. However, resistance was observed in some antibiotics, albeit at minimal levels. Notably, tetracycline showed a 100% resistance phenotype, while imipenem + cilastatin predominantly displayed an intermediate phenotype (85.72%), with some resistance (38.1%). Microdilution susceptibility testing identified effective combinations against different isolates. Regarding biofilm formation, P. aeruginosa demonstrated the ability to produce biofilms. The staining of microtiter plates confirmed that specific concentrations of imipenem + cilastatin and tetracycline could inhibit biofilm production. A significant proportion of isolates exhibited resistance to aminoglycoside antibiotics because of the presence of modifying genes ( aac (3)- II and aac (3)- III ), reducing their effectiveness. This study also explored various resistance genes, unveiling diverse resistance mechanisms among P. aeruginosa isolates. Several virulence genes were detected, including the las quorum-sensing system genes ( las I and las R) in a significant proportion of isolates, contributing to virulence factor activation. However, genes related to the type IV pili (T4P) system ( pil B and pil A) were found in limited isolates. In conclusion, this comprehensive study sheds light on the intricate dynamics of P. aeruginosa , a remarkably adaptable bacterium with a widespread presence in the natural world. Our findings provide valuable insights into the ongoing battle against P. aeruginosa infections, highlighting the need for tailored antibiotic therapies and innovative approaches to combat biofilm-related resistance.

The combination of active pharmaceutical ingredients in the form of ionic liquids or organic salts (API-OSILs) with mesoporous silica nanoparticles (MSNs) as drug carriers can provide a useful tool in enhancing the capabilities of current antibiotics, especially against resistant strains of bacteria. In this publication, the preparation of a set of three nanomaterials based on the modification of a MSN surface with cholinium ([MSN-Chol][Cip]), 1-methylimidazolium ([MSN-1-MiM][Cip]) and 3-picolinium ([MSN-3-Pic][Cip]) ionic liquids coupled with anionic ciprofloxacin have been reported. All ionic liquids and functionalized nanomaterials were prepared through sustainable protocols, using microwave-assisted heating as an alternative to conventional methods. All materials were characterized through FTIR, solution 1 H NMR, elemental analysis, XRD and N 2 adsorption at 77 K. The prepared materials showed no in vitro cytotoxicity in fibroblasts viability assays. The minimum inhibitory concentration (MIC) for all materials was tested against Gram-negative K. pneumoniae and Gram-positive Enterococcus spp., both with resistant and sensitive strains. All sets of nanomaterials containing the anionic antibiotic outperformed free ciprofloxacin against resistant and sensitive forms of K. pneumoniae , with the prominent case of [MSN-Chol][Cip] suggesting a tenfold decrease in the MIC against sensitive strains. Against resistant K. pneumoniae , a five-fold decrease in the MIC was observed for all sets of nanomaterials compared with neutral ciprofloxacin. Against Enterococcus spp., only [MSN-1-MiM][Cip] was able to demonstrate a slight improvement over the free antibiotic.

Pseudomonas aeruginosa causes urinary tract infections associated with catheters by forming biofilms on the surface of indwelling catheters. Therefore, controlling the spread of the bacteria is crucial to preventing its transmission in hospitals and the environment. Thus, our objective was to determine the antibiotic susceptibility profiles of twenty-five P. aeruginosa isolates from UTIs at the Medical Center of Trás-os-Montes and Alto Douro (CHTMAD). Biofilm formation and motility are also virulence factors studied in this work. Out of the twenty-five P. aeruginosa isolates, 16% exhibited multidrug resistance, being resistant to at least three classes of antibiotics. However, the isolates showed a high prevalence of susceptibility to amikacin and tobramycin. Resistance to carbapenem antibiotics, essential for treating infections when other antibiotics fail, was low in this study, Notably, 92% of the isolates demonstrated intermediate sensitivity to ciprofloxacin, raising concerns about its efficacy in controlling the disease. Genotypic analysis revealed the presence of various β-lactamase genes, with class B metallo-β-lactamases (MBLs) being the most common. The bla NDM , bla S PM , and bla VIM-VIM2 genes were detected in 16%, 60%, and 12% of the strains, respectively. The presence of these genes highlights the emerging threat of MBL-mediated resistance. Additionally, virulence gene analysis showed varying prevalence rates among the strains. The exo U gene, associated with cytotoxicity, was found in only one isolate, while other genes such as exo T had a high prevalence. The exo A, exo Y, and exo T had a high prevalence. The tox A and las B genes were present in all isolates, whereas the las A gene was absent. The presence of various virulence genes suggests the potential of these strains to cause severe infections. This pathogen demonstrated proficiency in producing biofilms, as 92% of the isolates were found to be capable of doing so. Currently, antibiotic resistance is one of the most serious public health problems, as options become inadequate with the continued emergence and spread of multidrug-resistant strains, combined with the high rate of biofilm production and the ease of dissemination. In conclusion, this study provides insights into the antibiotic resistance and virulence profiles of P. aeruginosa strains isolated from human urine infections, highlighting the need for continued surveillance and appropriate therapeutic approaches.

Pseudomonas aeruginosa is a pathogenic bacterium that can cause serious infections in both humans and animals, including dogs. Treatment of this bacterium is challenging because some strains have developed multi-drug resistance. This study aimed to evaluate the antimicrobial resistance patterns and biofilm production of clinical isolates of P. aeruginosa obtained from dogs. The study found that resistance to various β-lactam antimicrobials was widespread, with cefovecin and ceftiofur showing resistance in 74% and 59% of the isolates tested, respectively. Among the aminoglycosides, all strains showed susceptibility to amikacin and tobramycin, while gentamicin resistance was observed in 7% of the tested isolates. Furthermore, all isolates carried the opr D gene, which is essential in governing the entry of antibiotics into bacterial cells. The study also investigated the presence of virulence genes and found that all isolates carried exo S, exo A, exo T, exo Y, apr A, alg D, and plc H genes. This study compared P. aeruginosa resistance patterns worldwide, emphasizing regional understanding and responsible antibiotic use to prevent multi-drug resistance from emerging. In general, the results of this study emphasize the importance of the continued monitoring of antimicrobial resistance in veterinary medicine.

Aims: Cardiovascular risk factors present a high prevalence and have an impact on the morbimortality of the elderly; however, studies evaluating the impact of cardiovascular risk factors in the elderly have had short follow-up times and have not allowed specific analyses of the effects of these factors in the aged population, including how they affect the survival of the elderly. This study aimed to analyse the survival of elderly individuals living in the community, considering the presence of cardiovascular risk factors., Methods and Results: A prospective 10-year follow-up was initiated in 2008 with a cohort of 418 elderly people living in a community in Central Brazil. The Kaplan-Meier method and the Cox proportional hazards model were used to examine the association between survival and cardiovascular risk factors. The mean age of the participants was 70.6 (±7.1) years; most participants were hypertensive (81.6%) and participated in irregular physical activity (44%), and 43.3% smoked. After a mean follow-up of 8.38 (±2.82) years, 59.3% had survived and 34.1% had died; among the deaths, 14.1% were due to cardiovascular causes. Age [hazard ratio (HR) 1.067, 95% confidence interval (CI) 1.027-1.109], hypertension (HR 3.178, 95% CI 1.144-8.826), and smoking (HR 2.235, 95% CI 1.253-3.987) were confirmed as risk factors for reduced survival, whereas physical activity was a protective factor (HR 0.456, 95% CI 0.206-1.007)., Conclusion: The results from this study highlight the need for educational policies towards hypertension and smoking prevention among elderly people, and participation in physical activity needs to be encouraged., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The present study aimed to evaluate the effectiveness of hydrogen peroxide (H 2 O 2 ) combined with antimicrobial photodynamic therapy (aPDT) on biofilms formed by Candida albicans strains which are either susceptible to or resistant to fluconazole. Biofilms were grown and treated with H 2 O 2 , followed by the application of Photodithazine® (P) and red light-emitting diode (LED) (L) either separately or combined ( n  = 12). After the treatment, biofilms were evaluated by estimating colony-forming unit ml -1 , extracellular matrix components [water -soluble and -insoluble polysaccharides, proteins, extracellular DNA (eDNA)], biomass (total and insoluble dry-weight), and protein concentration. Biofilms formed by both strains presented a significant reduction in cell viability, biomass, extracellular matrix components (both types of polysaccharides, eDNA), and proteins (in the soluble and insoluble portion of biofilms) compared to the control. Microscopy images of the biofilms after treatments showed disarticulation of the matrix and scattered fungal cells. The application of H 2 O 2 can disturb the organization of the extracellular matrix, and its association with aPDT potentiated the effect of the treatment.

Objective: To evaluate the association between the consumption of NOVA food groups (classification based on the nature, extent and purpose of food processing) and the intake of energy, macro and micronutrients among school children., Design: Cross-sectional study. Food consumption was assessed by two 24-h dietary recalls on non-consecutive days. Energy from each NOVA food groups - ultra-processed foods, unprocessed or minimally processed foods, processed culinary ingredients and processed foods - was estimated. For analysis, the percentage of energy from ultra-processed foods and unprocessed or minimally processed foods were categorised into tertiles and associated with intake of energy, macro and micronutrients using analysis of covariance and linear regression., Setting: Public schools in Belo Horizonte, Minas Gerais, Brazil., Participants: School children aged 8-12 years ( n 797; 406 girls; 391 boys)., Results: Mean energy intake was 2050·18 ± 966·83 kcal/d, 25·8 % was from ultra-processed foods, 56·7 % from unprocessed or minimally processed foods, 8·9 % from processed culinary ingredients and 8·6 % from processed foods. A higher energy contribution from ultra-processed foods was negatively associated with the intake of protein, fibre, vitamin A, Fe and Zn ( P < 0·001) and positively associated with total energy, lipid and Na intake ( P < 0·001). Concurrently, a higher energy contribution from unprocessed or minimally processed foods was positively associated with the consumption of protein, fibre, Fe and Zn ( P < 0·001) and negatively associated with total energy ( P = 0·002), lipid and Na intake ( P < 0·001)., Conclusions: In conclusion, higher ultra-processed food consumption presented a negative association with the nutrient intake profile of school children.

Objective: This study aimed to assess the association between ultra-processed foods (UPF) consumption and some lifestyle factors during pregnancy and the baby's anthropometric measurements at birth., Methods: Cross-sectional study conducted with immediate postpartum women and their babies. Food consumption during pregnancy was assessed retrospectively by a semi-quantitative food frequency questionnaire, and the baby's anthropometric measurements were obtained from the medical records. The percentual of energy from UPF was estimated, categorized in tertiles, and associated with the baby's anthropometric measurements using multinomial logistic regression, adjusting by maternal characteristics (per capita income, maternal age, gestational weight gain, parity, physical activity, and number of prenatal consultations)., Results: A total of 626 immediate postpartum women and their babies were evaluated. The mean percentual of energy from UPF consumption during pregnancy was 30.56%. Before adjustment, there was a greater chance of insufficient birth weight among babies of immediate postpartum women in the highest tertile of UPF consumption (OR 1.72; 95% CI 1.09-2.70; p = 0.020); however, such an association was not significant in the adjusted analyses., Conclusions: No association between UPF consumption during pregnancy and baby's anthropometric measurements at birth was observed, probably due to the multifactorial nature of anthropometry and the interference of sociodemographic, gestational, and environmental factors in the baby's health outcomes.

Malaria is an acute febrile disease caused by a protozoan of the genus Plasmodium . Light microscopy (LM) is the gold standard for the diagnosis of malaria. Despite this method being rapid and inexpensive, it has a low limit of detection, which hampers the identification of low parasitemia infections. By using multicopy targets and highly sensitive molecular techniques, it is possible to change this scenario. In this study, we evaluated the performance of droplet digital PCR (ddPCR) to detect Plasmodium DNA obtained from saliva samples (whole saliva and buccal swab) of 157 individuals exposed to malaria transmission from the Brazilian Amazon region. We used the highly sensitive ddPCR method with non-ribosomal multicopy targets for Plasmodium vivax (Pvr47) and Plasmodium falciparum (Pfr364). There was good concordance between the quantitative real-time PCR (qPCR) results from the saliva and blood, except for mixed-species infections. The sensitivity of qPCR was 93% for blood, 77% for saliva, and 47% for swabs. Parasite DNA was not detected in saliva samples in low-density infections compared with the detection in blood samples. ddPCR showed increased sensitivity for detecting Plasmodium in the blood and swabs (99% in blood, 73% in saliva, and 59% in swabs). Notably, ddPCR detected more mixed infections in the blood (15%), saliva (9%), and swabs (18%) than qPCR. Our data showed that the differences between ddPCR and qPCR were the result of a higher number of P. falciparum infections detected by ddPCR. Overall, there was a moderate correlation between parasite densities estimated by the different methods in the blood. Our findings highlight the possibility of using non-invasive sample collection methods for malaria diagnosis by targeting multicopy sequences combined with highly sensitive molecular methods., Competing Interests: The reviewer JL-J declared a shared affiliation with the authors GC, DA, LC, CF, TN at the time of the review. 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 Costa, Alvarenga, Aguiar, Louzada, Pereira, de Oliveira, Fonseca Júnior, Carvalho, Ferreira Alves de Brito and Nóbrega de Sousa.)

Background and Purpose: Acute Respiratory Distress Syndrome (ADRS) due to coronavirus disease 2019 (COVID-19) has been associated with muscle fatigue, corticospinal pathways dysfunction, and mortality. High-Definition transcranial Direct Current Stimulation (HD-tDCS) may be used to attenuate clinical impairment in these patients. The HD-RECOVERY randomized clinical trial was conducted to evaluate the efficacy and safety of HD-tDCS with respiratory rehabilitation in patients with moderate to severe ARDS due to COVID-19., Methods: Fifty-six critically ill patients were randomized 1:1 to active (n = 28) or sham (n = 28) HD-tDCS (twice a day, 30-min, 3-mA) plus respiratory rehabilitation for up to 10 days or until intensive care unit discharge. The primary outcome was ventilator-free days during the first 28 days, defined as the number of days free from mechanical ventilation. Furthermore, secondary outcomes such as delirium, organ failure, hospital length of stay and adverse effects were investigated., Results: Active HD-tDCS induced more ventilator-free days compared to sham HD-tDCS. Patients in the active group vs in the sham group experienced lower organ dysfunction, delirium, and length of stay rates over time. In addition, positive clinical response was higher in the active vs sham group. There was no significant difference in the prespecified secondary outcomes at 5 days. Adverse events were similar between groups., Conclusions: Among patients with COVID-19 and moderate to severe ARDS, use of active HD-tDCS compared with sham HD-tDCS plus respiratory rehabilitation resulted in a statistically significant increase in the number of ventilator-free days over 28 days. HD-tDCS combined with concurrent rehabilitation therapy is a safe, feasible, potentially add-on intervention, and further trials should examine HD-tDCS efficacy in a larger sample of patients with COVID-19 and severe hypoxemia., Competing Interests: Declaration of competing interest The City University of New York holds patents on brain stimulation with MB as inventor. MB has equity in Soterix Medical Inc. MB consults, received grants, assigned inventions, and/or serves on the SAB of SafeToddles, Boston Scientific, GlaxoSmithKline, Biophysics, Mecta, Lumenis, Halo Neuroscience, Google-X, i-Lumen, Humm, Allergan (Abbvie), Apple. AD is an employee and has equity in Soterix Medical Inc., (Copyright © 2022. Published by Elsevier Inc.)

Introduction: Artemisinin-based combination therapies (ACTs) are recommended first-line antimalarials for uncomplicated Plasmodium falciparum malaria. Pharmacokinetic/pharmacodynamic variation associated with ACT drugs and their effect is documented. It is accepted to an extent that inter-individual variation is genetically driven, and should be explored for optimized antimalarial use., Areas Covered: We provide an update on the pharmacogenetics of ACT antimalarial disposition. Beyond presently used antimalarials, we also refer to information available for the most notable next-generation drugs under development. The bibliographic approach was based on multiple Boolean searches on PubMed covering all recent publications since our previous review., Expert Opinion: The last 10 years have witnessed an increase in our knowledge of ACT pharmacogenetics, including the first clear examples of its contribution as an exacerbating factor for drug-drug interactions. This knowledge gap is still large and is likely to widen as a new wave of antimalarial drug is looming, with few studies addressing their pharmacogenetics. Clinically useful pharmacogenetic markers are still not available, in particular, from an individual precision medicine perspective. A better understanding of the genetic makeup of target populations can be valuable for aiding decisions on mass drug administration implementation concerning region-specific antimalarial drug and dosage options.