Ischemic heart disease-related mortality in Brazil, 2006 to 2020. A study of multiple causes of death.

CONTEXT: Both the aging of the population and the increase in noncommunicable diseases may influence the progression and outcomes culminating in death, changing the evolution of ischemic heart diseases (IHDs) and their associated causes. Using the multiple causes of death method could help understand the magnitude of these relationships and enable better targeting of investments in health. OBJECTIVES: To evaluate the mortality from IHD in Brazil between 2006 and 2020 using the method of multiple causes and identify differences in the distribution pattern of IHD mortality by sex and geographic region. METHODS: Based on information extracted from death certificates (DCs) obtained from the database of the Department of Informatics of the Unified Health System (DATASUS), we used the multiple causes method to analyze the causes of death associated with IHD when IHD was defined as the underlying cause of death (UC) and the causes of death listed as the UC when IHD was recorded in any other lines of the DC, from 2006 to 2020, in Brazil. Subsequently, the proportion of these causes of death and differences between sexes and geographic regions were evaluated, with statistical relevance analyzed using the chi-square test, and the dependence between factors illustrated using stacked bar charts and small-world network graphs. RESULTS: When IHD was listed as the UC of death, the most frequent associated causes of death were, in descending order of frequency, acute myocardial infarction (AMI), arterial hypertension (AH), chronic ischemic heart disease (CHID), heart failure (HF), and diabetes mellitus (DM). When IHD was mentioned in any line of the DC, the most frequent UCs of death were AMI followed by DM, CIHD, chronic obstructive pulmonary disease (COPD), stroke, dyslipidemia, and, in the year 2020, COVID-19. The most frequent cause of death in women were DM as the UC and associated cause of death, AH as the UC, and CIHD and Alzheimer's disease as associated causes of death, while the most frequent causes of death in men were substance dependence as the UC and associated cause of death, and cancer as an associated cause of death. The most frequent causes of death were DM and stroke in the North and Northeast, dyslipidemia and obesity in the Midwest, Alzheimer's disease in the South and Southeast, and atherosclerotic heart disease (AHD) and COPD in the South. CONCLUSIONS: Several diseases - including AMI, AH, CIHD, HF, and DM - were the most frequent associated causes of death when IHD was recorded as the UC. In contrast, AMI, DM, CIHD, COPD, and stroke were the most frequent UCs when IHD was listed as an associated cause of death. The degree of these associations varied between sexes and geographic regions.

Structure-activity relationship study of antitrypanosomal analogues of gibbilimbol B using multivariate analysis and computation-aided drug design.

Gibbilimbol B and analogues were isolated from the Brazilian plant Piper malacophyllum and displayed activity against trypomastigote forms of Trypanosoma cruzi as well as reduced toxicity against NCTC cells. These results stimulated the preparation of a series of 24 chemically related analogues to study the potential of these compounds against T. cruzi trypomastigotes and explore structure-activity relationships. Initially, 12 compounds were planned, maintaining the same extension of the linear side chain of gibbilimbol B and unsaturation on the C-4 position but changing the functional groups - ester and amide - and variating the substituent at the p-position in the aromatic ring. Other 12 compounds were prepared using a branched side chain containing an ethyl group at the C-2 position. Overall, these structurally-related analogues demonstrated promising activity against trypomastigote forms (EC50 < 20 µM) and no mammalian cytotoxicity to fibroblasts (CC50 > 200 µM). Using multivariate statistics and machine learning analysis, aspects associated with structure/activity were related to their three-dimensional structure and, mainly, to the substituents on the aromatic ring. Obtained results suggested that the presence of t-butyl or nitro groups at p-position with appropriate side chains causes an alteration in the electron topological state, Van der Waals volumes, surface areas, and polarizabilities of tested compounds which seem to be essential for biological activity against T. cruzi parasites.

Women with functional constipation have a worse ability to relax their pelvic floor muscle: A cross sectional study.

INTRODUCTION: Functional intestinal constipation (FIC) has a high prevalence worldwide. It is higher in adult and elderly women, and in those with alterations in the pelvic floor muscle (PFM) structure and function. OBJECTIVE: The primary aim of this study was to characterize PFM function, including tone, of women with and without FIC. The secondary aim was to assess and compare the general and symptom-related quality of life (QoL) between participants with and without FIC and its correlation with the assessed PFM function. METHODS: This was a cross-sectional observational study, the outcomes were assessed using vaginal palpation, vaginal manometry and validated questionnaires: the Pelvic Floor Impact Questionnaire Short Form 7 (PFIQ-7), the Pelvic Floor Distress inventory (PFDI-20), and the Short-Form Health Survey (SF-36). This study included 60 women, 30 with FIC and 30 without FIC. The mean age of women with FIC was 48.2 years (standard deviation [SD] 12.22) and 51 years (SD 13.47) for those without FIC. Both groups were overweight. There was a significant difference between groups in the bowel domain of the PFIQ-7 (p = 0.016) and in the anal dysfunction domain of the PFDI-20 (p < 0.001), being higher in those women with FIC. Women with FIC presented a significantly worse ability to voluntarily relax their PFM (38.3%) than those without FIC (11.7%; p = 0.008). participants without FIC presented higher values of maximum voluntary contraction (MVC) assessed by vaginal manometry compared to participants without FIC (p = 0.008). PFM tone was not different between groups. CONCLUSION: Women with FIC have more difficulty in relaxing their PFM and lower MVC values than women without FIC. FIC negatively impacts women's symptom-related QoL. The main contribution of this study was to reavel the difficulty of the participants with FIC to relax their PFM. This finding is important to guide clinical decision making for an adequate treatment program direct to women with FIC.

Comparative morphofunctional analysis of axial skeleton excluding the skull of primates based on the anatomical, radiographic, and tomographic description of the black-striped capuchin (Sapajus libidinosus Spix, 1823).

Comparative anatomy the basis for studies of evolution, and radiographic and tomographic aspects, as auxiliary methods in the investigation of anatomical particularities, reinforce evolutionary research. Therefore, the aim of this study was to describe the vertebrae, sternum, and ribs of the capuchin monkey (Sapajus libidinosus) by means of anatomical dissection and radiographic and tomographic images. To this purpose, four cadavers were used in the anatomical analysis and five living animals for the imaging exams. The bones were described and compared with data from other primates species found in literature. Student's t-test for independent samples was performed. The vertebral column of the comprises seven cervical, 13 or 14 thoracic, five or six lumbar, two or three sacral, and 23 or 24 caudal vertebrae. The atlas is characterized by three foramina on the wing. The seventh cervical vertebra had a transverse foramen in one specimen. The anticlinal vertebra is always the penultimate thoracic one, the ninth pair of ribs is always the last sternal pair, and the last two are buoyant. The sternal was composed of five or six sternebrae. The lumbar vertebrae showed a bifurcated spinous process. Three different sacral morphologies were observed. The structures identified macroscopically could be well determined through radiographic and tomographic images. S. libidinosus presented anatomical characteristics more similar to those of man and of platirrinos monkeys. The knowledge obtained by macroscopic anatomy and tomographic and radiological exams contributes significantly to comparative evolutionary studies.

Do different protocols affect the success rate or bond strength of glass-ceramics repaired with composite resin? A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Intraoral repair techniques prevent unnecessary replacement of ceramic restorations, thereby increasing the survival rate. However, adhesion between ceramics and the composite resin is challenging and how different protocols influence adhesion is unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to analyze the influence of different protocols on repairing glass-ceramic surfaces with composite resins. MATERIAL AND METHODS: PubMed, Scopus, ISI Web of Science, and Embase electronic databases were searched to select studies comparing bond strength values or survival rates of glass-ceramic repaired with composite resins using different surface treatment protocols. No publication year or language restriction was applied. Data sets were extracted from all included studies, and the mean differences calculated. A 95% confidence interval was calculated by using the random effect model (Rev Man 5.4). RESULTS: The search identified 5037 studies, and 165 were assessed for eligibility. Finally, 123 in vitro studies were included in the systematic review and 48 in the meta-analysis. Considering different glass-ceramics, bond strength tests, and aged or not aged specimens, 37 meta-analyses found the effect of repair protocols: only adhesive, silane plus adhesive alone or preceded by hydrofluoric (HF) acid, airborne-particle abrasion (APA) with Al2O3 particles, silica-coated APA (SCAPA), diamond rotary instrument (DRI), and laser irradiation (LI). CONCLUSIONS: For feldspathic porcelain, HF acid, APA, SCAPA, or DRI improved the repair micromechanical retention; applying silane is essential to HF-conditioned surfaces but the use of adhesive is optional when silane is applied. Results for leucite and lithium disilicate were inconclusive in terms of suggesting a treatment other than HF acid plus silane and adhesive applications.

An efficient functional magnetic resonance imaging data reduction strategy using neighborhood preserving embedding algorithm.

High dimensionality data have become common in neuroimaging fields, especially group-level functional magnetic resonance imaging (fMRI) datasets. fMRI connectivity analysis is a widely used, powerful technique for studying functional brain networks to probe underlying mechanisms of brain function and neuropsychological disorders. However, data-driven technique like independent components analysis (ICA), can yield unstable and inconsistent results, confounding the true effects of interest and hindering the understanding of brain functionality and connectivity. A key contributing factor to this instability is the information loss that occurs during fMRI data reduction. Data reduction of high dimensionality fMRI data in the temporal domain to identify the important information within group datasets is necessary for such analyses and is crucial to ensure the accuracy and stability of the outputs. In this study, we describe an fMRI data reduction strategy based on an adapted neighborhood preserving embedding (NPE) algorithm. Both simulated and real data results indicate that, compared with the widely used data reduction method, principal component analysis, the NPE-based data reduction method (a) shows superior performance on efficient data reduction, while enhancing group-level information, (b) develops a unique stratagem for selecting components based on an adjacency graph of eigenvectors, (c) generates more reliable and reproducible brain networks under different model orders when the outputs of NPE are used for ICA, (d) is more sensitive to revealing task-evoked activation for task fMRI, and (e) is extremely attractive and powerful for the increasingly popular fast fMRI and very large datasets.

The Attitudes of Brazilian Breast Surgeons on Axillary Management in Early Breast Cancer-10 Years after the ACOSOG Z0011 Trial First Publication.

PURPOSE: To evaluate the impact of the ACOSOG Z0011 trial on axillary breast cancer surgery management in Brazil following publication of that study (2010) and again in 2020. PATIENTS AND METHODS: A survey of members of the Brazilian Society of Mastology. RESULTS: Of 1627 breast surgeons, 799 (49.1%) completed and returned the questionnaire. For patients with the Z11 inclusion criteria, following detection of a positive sentinel lymph node (SLN), axillary dissection (AD) was recommended by 99.2% of respondents before publication of the study, 47.5% in 2010 and 18.5% in 2020 (p < 0.001). In breast-conserving surgery, if there were micro-metastases, 2.6% would perform AD, 30.3% axillary radiotherapy, and 67.1% no additional axillary treatment, while with macro-metastases, these proportions were 21.3%, 52.2%, and 26.5%, respectively. In cases of mastectomy and of nodal extracapsular extension, 43.4% and 36% of surgeons, respectively, recommended AD. For clinically negative axilla and suspicious findings at ultrasonography, 69% of the surgeons would apply the Z11 approach. Most applied the Z11 criteria in cases of younger patients (83.6%) and triple-negative and/or HER2 positive tumors (74%). AD was significantly more likely to be recommended by surgeons who did not work in academic institutes, who worked in locations other than capital cities, who were not board-certified, and who were ≥ 50 years old. CONCLUSIONS: This survey revealed substantial changes in axillary surgery management in cN0/pathologically positive SLN, particularly following publication of the updated Z11 results and other similar studies. A better education environment and long-term follow-up were factors associated with the incorporation of Z11-related changes in practice.

Anatomy applied to image diagnosis of the hind limb in the black-striped capuchin (Sapajus libidinosus Spix, 1823).

The knowledge of anatomy and imaging exams emerges as an important tool in the study of evolutionary processes of a species, in the elaboration of diagnosis, and the successful choice of the appropriate clinical and surgical procedures. Therefore, this study aims to describe the osteology of the hind limb of Sapajus libidinosus by means of gross, radiographic, and tomographic images. Four cadavers were used in the macroscopic analysis and five animals for the imaging exams, of which four were eventually euthanized and added to the macroscopic study. For imaging exams, they were kept anesthetized. All bones of the hind limb were documented, their structures were described, and compared with data in the literature from human and nonhuman primates. We have performed Student's t test for independent samples. There was no statistical difference between the sexes regarding the length of the hind limb bones. The coxal bone was largely well described using imaging methods. A small penile bone was present at the tip of the penis and it could be identified by all analysis methods. The femur, as well as the tibia and fibula, were not well portrayed in their proximal and distal epiphyses by radiography (Rx). However, they were well identified on tomography. No third trochanter was observed in the femur and the patella had a triangular shape. All the structures described by gross anatomy of the tarsus and metatarsus could be identified by Rx and tomography. More subtle structures, such as the popliteal notch on the tibia, and the gluteal tuberosity pectineal line and facies aspera on the coxal bone, were not identified by medical imaging. S. libidinosus presented anatomical characteristics that were similar to those of larger New World and Old World monkeys, including man. This suggests it's value as an experimental model for studies in recent primates.

Osteology applied to image diagnosis of the forelimb of the black-striped capuchin (Sapajus libidinosus Spix, 1823).

Macroscopic bone analysis and evaluation through imaging methods are essential in the recognition of natural and altered structures. Therefore, this study aimed at describing the osteology the thoracic limb of Sapajus libidinosus in bone pieces, identifying them in radiographic and tomographic images. For this, four cadavers were used in the macroscopic analysis and five animals for the imaging exams, of which four were euthanized and added to the macroscopic stage. For imaging exams, the animals were kept anesthetized. All bones were documented, structures described, and compared with literature data from human and nonhuman primates. There was no statistical difference between males and females regarding the length of the forelimb bones. Most of the bone structures of the scapula were well identified in the imaging methods, being more restricted in the ventrodorsal projection. The clavicle presented very limited visualization. The humerus, as well as the radius and ulna, were not well portrayed in their proximal and distal epiphyses by radiography. However, they were well identified on tomography. All structures described in the macroscopic image of the carpal and metacarpal bones could be identified through radiography and tomography, and the radiographic examination of this region is an excellent method for identifying fractures. The glenoid notch of the scapula was not visualized by any imaging method. S. libidinosus presented anatomical characteristics more similar to those of neotropical primates and man, being a great indicator of an experimental model for studies in these species.

Stochastic Petri net model describing the relationship between reported maternal and congenital syphilis cases in Brazil.

INTRODUCTION: Syphilis is a sexually transmitted disease (STD) caused by Treponema pallidum subspecies pallidum. In 2016, it was declared an epidemic in Brazil due to its high morbidity and mortality rates, mainly in cases of maternal syphilis (MS) and congenital syphilis (CS) with unfavorable outcomes. This paper aimed to mathematically describe the relationship between MS and CS cases reported in Brazil over the interval from 2010 to 2020, considering the likelihood of diagnosis and effective and timely maternal treatment during prenatal care, thus supporting the decision-making and coordination of syphilis response efforts. METHODS: The model used in this paper was based on stochastic Petri net (SPN) theory. Three different regressions, including linear, polynomial, and logistic regression, were used to obtain the weights of an SPN model. To validate the model, we ran 100 independent simulations for each probability of an untreated MS case leading to CS case (PUMLC) and performed a statistical t-test to reinforce the results reported herein. RESULTS: According to our analysis, the model for predicting congenital syphilis cases consistently achieved an average accuracy of 93% or more for all tested probabilities of an untreated MS case leading to CS case. CONCLUSIONS: The SPN approach proved to be suitable for explaining the Notifiable Diseases Information System (SINAN) dataset using the range of 75-95% for the probability of an untreated MS case leading to a CS case (PUMLC). In addition, the model's predictive power can help plan actions to fight against the disease.