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Objectives: This review of systematic reviews evaluated the effectiveness and safety of the preemptive use of anti-inflammatory and analgesic drugs in the management of postoperative pain, edema, and trismus in oral surgery. Materials and methods: The databases searched included the Cochrane Library, MEDLINE, EMBASE, Epistemonikos, Scopus, Web of Science, and Virtual Health Library, up to March 2023. Pairs of reviewers independently selected the studies, extracted the data, and rated their methodological quality using the AMSTAR-2 tool. Results: All of the 19 studies reviewed had at least two critical methodological flaws. Third molar surgery was the most common procedure ( n = 15) and the oral route the most frequent approach ( n = 14). The use of betamethasone (10, 20, and 60 mg), dexamethasone (4 and 8 mg), methylprednisolone (16, 20, 40, 60, 80, and 125 mg), and prednisolone (10 and 20 mg) by different routes and likewise of celecoxib (200 mg), diclofenac (25, 30, 50, 75, and 100 mg), etoricoxib (120 mg), ibuprofen (400 and 600 mg), ketorolac (30 mg), meloxicam (7.5, 10, and 15 mg), nimesulide (100 mg), and rofecoxib (50 mg) administered by oral, intramuscular, and intravenous routes were found to reduce pain, edema, and trismus in patients undergoing third molar surgery. Data on adverse effects were poorly reported. Conclusion: Further randomized clinical trials should be conducted to confirm these findings, given the wide variety of drugs, doses, and routes of administration used., 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 Pimenta, Takahashi, Barberato-Filho, McClung, Moraes, de Souza and Bergamaschi.)

This review of systematic reviews of randomized clinical trials summarized the available evidence regarding the effectiveness and safety of interventions to treat depression and/or anxiety in people with type 1 and type 2 diabetes. The sources of information searched were the Cochrane Library, MEDLINE, EMBASE, Web of Science and LILACS, until up to December 1st, 2022. The interventions were compared with placebo, active control or usual care. The measured primary outcomes were improvement in depression and anxiety remission, reduction of diabetes-specific emotional distress; and improvement in quality of life. Two reviewers, independently, selected the reviews, extracted their data, and assessed their methodological quality using AMSTAR-2. A narrative synthesis of the findings was performed, according to the type of intervention and type of diabetes. Thirteen systematic reviews that included 28,307 participants were analyzed. The reviews had at least one critical methodological flaw. Cognitive Behavioral Therapy improved the mainly depression, glycemic values (n = 5 reviews) and anxiety (n = 1), in adults and elderly with diabetes. Collaborative care (n = 2) and health education (n = 1) improved depression and glycemic values, in adults with diabetes. Pharmacological treatment (n = 2) improved depression outcomes only. The quality of the evidence was low to moderate, when reported. The interventions reported in literature and mainly the Cognitive Behavioral Therapy can be effective to treat people with diabetes and depression; however, some findings must be confirmed. This study can guide patients, their caregivers and health professionals in making decisions concerning the use of these interventions in the mental healthcare of people with diabetes. Protocol Registration: PROSPERO (CRD42021224587)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Franquez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Recent changes in the epidemiology of meningococcal have been reported and meningococcal group W (MenW) has become the third most prevalent group isolated in Brazil in the last 10 years. In this study we have developed a conjugate vaccine for MenW using a modified reductive amination conjugation method through a covalent linkage between periodate-oxidized MenW non-O-acetylated polysaccharide and hydrazide-activated monomeric tetanus toxoid. Process control of bulks was done by physicochemical analysis including polysaccharide and protein quantification, high performance liquid chromatography - size exclusion chromatography, capillary electrophoresis, and hydrogen nuclear magnetic resonance. Conjugate bulks were best produced with concentration of polysaccharide twice as high as protein, at room temperature, and pH approximately 6.0. A scaled-up bulk (100 mg scale) was formulated and inoculated intramuscularly in mice in a dose-response study (0.1, 0.5, 1.0 and 10.0 µg of polysaccharide/dose). The immunogenicity of conjugate bulks was determined by serum bactericidal assay and ELISA assays of serum from immunized mice. ELISA and SBA titers revealed high titers of IgG and demonstrated the functionality of the antibodies produced in all doses studied 15 days after the third dose. However, significant differences were observed among them by ELISA. In conclusion, this study established the best conditions to produce MenW conjugate bulks and showed the efficacy of the obtained conjugate bulk in induce a good immune response in mice. Further experiments will need to be done to scale up the conjugation reaction and then allow the use of this conjugate in clinical trials., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The inclusion of race/skin color in Health Information Systems makes it possible to measure health inequities. Brazil and South Africa correspond to countries marked by profound inequalities, multiracial constituted that suffered from the historical process of colonization, and had racism legitimized as a structuring model of state development. The objective is to compare the information systems of Brazil and South Africa regarding the configuration and implementation of the item race/skin color. This is a qualitative, descriptive study, based on the content analysis proposed by Bardin. A survey on race/skin color was carried out in health department documents and ministerial sites in both countries. The collected material was processed and analyzed utilizing the IRAMUTEQ R software, version 0.7 alpha 2, with a test × 2 > 3.80 (p < 0.05), and by the TABNET application version 4.14 and Excel software, version 2016. In Brazil and Africa South, several health information systems did not include race/skin color. In both countries, health information systems were boosted in the mid-1990s. In Brazil, of the systems that provide data by race/skin color, the inclusion occurred after claims by the black movement. In South Africa, through the creation of the respective systems. The historical configuration of the question of race/skin color in both countries was guided by political and ideological references. In multiracial and unequal countries, race/skin color is a central political category to promote health equity.

The whitefly, Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae), is one of the most important agricultural pests and virus vectors worldwide. Bemisia tabaci is considered a complex of cryptic species with at least 44 species. Among them, the species Middle East-Asia Minor 1 (MEAM1, formerly B biotype) and Mediterranean (MED, formerly Q biotype) are the most important, and they have attained global status. In Brazil, MEAM1 was first reported in the 1990s and is currently the predominant species in the country, meanwhile, MED was recently reported in the South and Southeast regions and was found to be mainly associated with ornamental plants. Currently, an increasing problem in the management of whitefly infestations in greenhouses associated with bell pepper was observed in São Paulo State, Brazil. The whiteflies were collected and identified based on a microsatellite locus (primer pair BEM23F and BEM23R) and the mitochondrial cytochrome oxidase I gene followed by restriction fragment length polymorphism analysis and sequencing. We observed that MED was the predominant species collected on bell pepper, but it was also found on tomato, cucumber, eggplant, and weeds grown in greenhouses. In open field, we found MED on tomatoes, bell peppers, and eggplants. In addition, MED was identified in Goiás State in association with ornamental plants. The begomovirus Tomato severe rugose virus and the crinivirus Tomato chlorosis virus was detected on bell pepper and tomato, respectively. Only MED specimens were found associated with the virus-infected plants. Moreover, we also investigated the endosymbionts present in the MED whiteflies. The collected populations of B. tabaci MED harbored a diversity of secondary endosymbionts, with Hamiltonella (H) found predominantly in 89 specimens of the 129 tested. These results represent a new concern for Brazilian agriculture, especially for the management of the newly introduced whitefly MED species, which must be implemented to limit the spreading and establishment of this pest in different crops in this country.

Assessing how much management of agricultural landscapes, in addition to protected areas, can offset biodiversity erosion in the tropics is a central issue for conservation that still requires cross-taxonomic and landscape-scale studies. We measured the effects of Amazonia deforestation and subsequent land-use intensification in 6 agricultural areas (landscape scale), where we sampled plants and 4 animal groups (birds, earthworms, fruit flies, and moths). We assessed land-use intensification with a synthetic index based on landscape metrics (total area and relative percentages of land uses, edge density, mean patch density and diversity, and fractal structures at 5 dates from 1990 to 2007). Species richness decreased consistently as agricultural intensification increased despite slight differences in the responses of sampled groups. Globally, in moderately deforested landscapes species richness was relatively stable, and there was a clear threshold in biodiversity loss midway along the intensification gradient, mainly linked to a drop in forest cover and quality. Our results suggest anthropogenic landscapes with high-quality forest covering >40 % of the surface area may prevent biodiversity loss in Amazonia., (© 2018 Society for Conservation Biology.)

High temperature is known to cause some instability in polysaccharide-protein conjugated vaccines and studies under stress conditions may be useful in determining whether short-term accidental exposure to undesired conditions can compromise product quality. In this study, we examined the structural stability of three industrial batches of Brazilian Meningococcal C conjugate bulk (MPCT) incubated at 4, 37, and 55 °C for 5 weeks. The effect of exposure to the storage temperatures was monitored by HPLC-SEC, CZE, CD and NMR techniques. The immunological significance of any physicochemical changes observed in MPCT was determined by SBA and ELISA assays of serum from immunized mice. Fluorescence emission spectra at 4 and 37 °C were similar among all samples and compatible with the native fold of the carrier protein. Fluorescence spectra of MPCT stored at 55 °C decreased in intensity and had a significant red-shift, indicating conformational changes. Far-UV CD spectra revealed a trend toward loss of structural conformation as storage temperature was increased to 55 °C. The NMR data showed modified signal intensity of the aromatic and aliphatic residues, mainly for samples incubated at 55 °C, suggesting a partial loss of tertiary structure. About 50% free saccharide content was found in bulks stored at 55 °C, but no difference was observed in the IgG or SBA titers. The present study showed physicochemical methods alone are insufficient to predict the biological activity of a MPCT conjugate vaccine without extensive validation against immunological data. However, they provide a sensitive means of detecting changes induced in a vaccine exposed to adverse environmental condition.

In this work, we present the in vitro schistosomicidal activity evaluation of the most active dichloromethane fraction (FDm) (ED50=83.5μg/mL) and of a mixture of the major alkaloids ((-)-cassine/(-)-spectaline, C/E) (ED50=37.4μg/mL) from the flowers of Senna spectabilis against adult worms and cercariae. We also demonstrate other toxic effects including paralysis of the adult worms, inhibition of the secretory activity, tegument lesions and cercaricidal activity. In the association test of Praziquantel (PZQ)-C/E, we observed up to 80% mortality of Schistosoma mansoni in comparison to PZQ monotherapy. Due to the diversity of the toxic effects, the schistosomicidal activity of C/E is likely a result of a multitarget mechanism involving the tegument, secretory system and neuromotor action., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Betulinic acid (BA) is a pentacyclic triterpene that can be isolated from many medicinal plants around the world. The aim of this study was to evaluate the genotoxic potential of BA and its effect on the genotoxicity induced by different mutagens in V79 cells using the cytokinesis-block micronucleus assay. Different BA concentrations were combined with methyl methanesulfonate (MMS), doxorubicin (DXR), camptothecin (CPT), and etoposide (VP-16). The frequencies of micronuclei in cultures treated with different BA concentrations did not differ from those of the negative control. Treatment with BA and MMS resulted in lower micronucleus frequencies than those observed for cultures treated with MMS alone. On the other hand, a significant increase in micronucleus frequencies was observed in cultures treated with BA combined with DXR or VP-16 when compared to these mutagens alone. The results showed no effect of BA on CPT-induced genotoxicity. Therefore, BA was not genotoxic under the present experimental conditions and exerted a different influence on the genotoxicity induced by different mutagens. The modulatory effect of BA depends on the type of mutagen and concentrations used.

Several outbreaks caused by Neisseria meningitidis group C have been occurred in different regions of Brazil. A conjugate vaccine for Neisseria meningitidis was produced by chemical linkage between periodate-oxidized meningococcal C polysaccharide and hydrazide-activated monomeric tetanus toxoid via a modified reductive amination conjugation method. Vaccine safety and immunogenicity tested in Phase I and II trials showed satisfactory results. Before starting Phase III trials, vaccine production was scaled up to obtain industrial lots under Good Manufacture Practices (GMP). Comparative analysis between data obtained from industrial and pilot scales of the meningococcal C conjugate bulk showed similar execution times in the scaling up production process without significant losses or alterations in the quality attributes of purified compounds. In conclusion, scale up was considered satisfactory and the Brazilian meningococcal conjugate vaccine production aiming to perform Phase III trials is feasible., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

This study evaluated patients' knowledge on the risk of venous thromboembolism (VTE) associated with combined oral contraceptives (COCs) and their perception of this risk when it is presented as a relative risk (RR), absolute risk (AbR) or attributable risk (AR). This was a cross-sectional study involving 159 users or potential users of COCs. The participants answered a self-administered questionnaire in which the risk of VTE associated with COCs was presented as RR, AbR and AR. The degree of concern expressed regarding this risk and the women's changes of opinion when the information was communicated through a different risk model were evaluated. Most of the women (67.9%) expressed concern when the risk was presented as an RR. Conversely, they showed no concern when the risk was presented as an AbR (14.5%) or AR (10.7%). A significant number of women changed their opinion regarding their level of concern when the risk was presented as an AbR or AR (p < 0.001). In conclusion, concerns about thrombotic complications from the use of combined hormonal contraception is reduced when incidence rather than relative risk is presented. Presentation of thrombosis complications in terms of incidence rather than RR may improve communication of side effects during counseling for combined hormonal contraception initiation.

Introduction: Although coronary heart disease in users of combined oral contraceptives (COCs) is rare, one of the principal risk factors for its occurrence is dyslipidemia., Objective: To evaluate the prevalence of dyslipidemia in women wishing to use COCs, and its association with known clinical risk factors in order to evaluate the need to determine the lipid profile in this population., Study Design: Cross-sectional study involving 516 women aged 18-40 years, 54% nulligravid, who wished to use COCs and presented no contraindications. Dyslipidemia was classified according to the National Cholesterol Educational Project Adult Treatment Panel III guidelines, which define levels of total cholesterol ≥ 200 mg/dL, high-density lipoprotein cholesterol <40 mg/dL, triglycerides >150 mg/dL, and low-density lipoprotein cholesterol ≥ 160 mg/dL as an abnormal lipid profile. The lipid profile was determined, and the association between clinical risk factors and the presence of dyslipidemia was evaluated by the chi-squared test and logistic regression. The receiver operating characteristic curve was constructed to compare body mass index (BMI) and smoking relevance for dyslipidemia., Results: The prevalence of dyslipidemia was 33.9%. Smoking and BMI were significantly associated with the presence of dyslipidemia, with sensitivity of 31.3-54% and specificity of 41.9-67.7% for diagnosis of dyslipidemia, respectively., Conclusion: The high prevalence of dyslipidemia could justify lipid profile evaluation before prescribing a COC. BMI and smoking represent modest predictive markers for the presence of dyslipidemia in candidates for the use of combined oral contraceptives., (Copyright © 2013 Elsevier Inc. All rights reserved.)

This prospective observational study was designed to determine the percentage of hysterectomies avoided following insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) in perimenopausal women with uterine fibroids and a prior indication for surgery. The study also compared the progress of patients using the LNG-IUS with those submitted to hysterectomy, with particular emphasis on the patient's satisfaction with treatment. Sixty perimenopausal patients with uterine fibroids and excessive bleeding referred for hysterectomy were included. After counseling on the possibility of non-surgical treatment, 39 patients opted to use an LNG-IUS while 21 opted for hysterectomy. Continuation of LNG-IUS use and the patient's satisfaction with the chosen procedure were assessed. A secondary analysis evaluated hemoglobin levels, clinical complications, bleeding patterns and uterine volume at ultrasonography over time. After 24 months of follow-up, four of the patients who had opted to use an LNG-IUS were submitted to surgery, while 35 continued using the device, thus avoiding hysterectomy in 89.5% of cases. LNG-IUS users were more satisfied with treatment (p = 0.02) compared to those submitted to hysterectomy. In conclusion, the use of the LNG-IUS enables the number of hysterectomies to be reduced in women with uterine fibroids and is associated with greater satisfaction compared to surgical treatment.

Background: Natural antioxidants present in common foods and beverages have drawn great attention to cancer prevention due to its health benefits, remarkable lack of toxicity and side effects. Copaifera langsdorffii, known as "copaiba", "capaiva", or "pau-de-óleo", belongs to the Leguminosae family and occurs in fields and grasslands in the northern and northeastern parts of Brazil. Biological studies of Copaifera corroborate its widespread use by the population. This paper describes the effects of C. langsdorffii leaves hydroalcoholic extract on the 1,2-dimethylhydrazine (DMH)-induced DNA damage and aberrant crypt foci (ACF) in the colon of male Wistar rats., Methods: The hydroalcoholic extract of C. langsdorffii was administered to rats by gavage at daily doses of 20, 40 and 80 mg/kg body weight. To evaluate DNA damage by the comet assay, animals received the C. langsdorffii extract for seven days and a single subcutaneous injection (sc) of 1,2-dimethylhydrazine (DMH) at a dose of 40 mg/kg on day 7. Animals were sacrificed 4 h after injection of DMH, to assess DNA damage. For the ACF assay, animals were acclimatized for one week (week 1) and then treated with the C. langsdorffii extract five times a week for four weeks (weeks 2 to 5). The rats received sc injections of DMH (40 mg/kg) on days 2 and 5 of weeks 2 and 3, to induce ACF. Animals were euthanized at week 5; i.e., four weeks after the first DMH treatment., Results: Animals treated with different doses of the C. langsdorffii extract combined with DMH had significantly lower frequency of DNA damage as compared with the positive control (animals treated with DMH only). The percentage of reduction in the frequency of DNA damage ranged from 14.30% to 38.8%. The groups treated with 40 and 80 mg/kg C. langsdorffii extract during and after DMH treatment presented significantly lower numbers of ACF and aberrant crypts compared with the control., Conclusion: The C. langsdorffii extract significantly reduced the extent of DNA damage and ACF induced by DMH, suggesting that the extract has a protective effect against colon carcinogenesis.

Artepillin C (3,5-diprenyl-p-coumaric acid) is one of the major phenolic compounds found in Brazilian green propolis, as well as in its botanical source, Baccharis dracunculifolia DC (Asteraceae). The present study evaluated the possible genotoxic and protective activities of artepillin C, in vitro, using methyl methanesulfonate (MMS) as a positive control, by comet and micronucleus assays. The cultures of Chinese hamster lung fibroblasts (V79 cells) were treated with different concentrations of artepillin C (2.5, 5.0, 10.0, and 20 μM). In antigenotoxicity assessment, the 3 concentrations of artepillin C (2.5, 5.0, and 10.0 μM) were associated with MMS (200 μM-comet assay and 400 μM-micronucleus assay). A statistically significant increase in the DNA damage and micronucleus frequencies was observed in the culture treated with the highest concentration of the artepillin C in comparison to the control group. All concentrations of artepillin C showed protective activity in relation to MMS-induced genotoxicity, which may be due to its antioxidant properties.