First report of the association between Wolbachia and Cotesia flavipes (Hymenoptera: Braconidae): effect on life history parameters of the parasitoid.

The symbiosis between microorganisms and host arthropods can cause biological, physiological, and reproductive changes in the host population. The present study aimed to survey facultative symbionts of the genera Wolbachia, Arsenophonus, Cardinium, Rickettsia, and Nosema in Cotesia flavipes (Cameron) (Hymenoptera: Braconidae) and Diatraea saccharalis (Fabricius) (Lepidoptera: Crambidae) in the laboratory and evaluate the influence of infection on the fitness of these hosts. For this purpose, 16S rDNA primers were used to detect these facultative symbionts in the host species, and the hosts' biological and morphological features were evaluated for changes resulting from the infection caused by these microorganisms. The bacterial symbionts studied herein were not detected in the D. saccharalis samples analysed, but the endosymbiont Wolbachia was detected in C. flavipes and altered the biological and morphological aspects of this parasitoid insect. The results of this study may help to elucidate the role of Wolbachia in maintaining the quality of populations/lineages of C. flavipes.

Gender Disparities in the Academic Performance of Neurology Residents in Portugal.

Implicit bias has been linked to gender disparities in medical careers, impacting not only access to leadership positions but also early career opportunities. We aimed to evaluate if there were differences in the assessment of Neurology residents according to gender. We collected publicly available grades and rankings of two major evaluations that residents are submitted to, one at the beginning and another at the end of the neurology residency program, the National Board Exam and neurology examination, respectively. The National Board Examination is a multiple-choice gender-blinded evaluation, while the neurology examination is an oral gender-unblinded evaluation. We found that 36.5% of women and 21.6% of men were in the first quartile of the National Board Examination ranking, which reflects a similar representation among top classifications when assessed through a gender-blinded examination. On the other hand, the percentage of men who were in the top classification of NE, a gender-unblinded evaluation, was more than twice as high compared to women (37.8% vs 18.3%, p < 0.05). The findings of the present study may imply that there could be a disparity in women's career progression among neurology residents in Portugal, although the recruitment seems balanced between genders.

Detection of Arsenophonus in Glycaspis brimblecombei (Hemiptera: Aphalaridae) populations in Brazil.

Eucalyptus is the most intensively managed tree genus in the world. Different factors, including damage by insect pests, affect its growth and productivity. Among these pests is Glycaspis brimblecombei Moore (Hemiptera: Aphalaridae), an exotic insect of Australian origin. The evolutionary success of this insect depends on symbiotic associations with microorganisms. The influence of these microorganisms on insect pests and their natural enemies is important for integrated management tactics. Within this context, this work aimed to detect Arsenophonus in populations of G. brimblecombei in Brazil. Eucalyptus branches infested with G. brimblecombei nymphs were collected in commercial eucalyptus plantations in six Brazilian states. Specimens of this pest were sampled soon after emergence and frozen for molecular analysis. The genomic DNA of G. brimblecombei adults from each population was extracted and used to detect the endosymbiont Arsenophonus by polymerase chain reaction (PCR) employing specific primers that target its 23 S rRNA gene. This endosymbiont was identified in all of the studied G. brimblecombei populations. This is the first report on the association between Arsenophonus and G. brimblecombei in Brazil.

Adjunctive Statin Therapy in Patients with Covid-19: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: The efficacy and safety of adjunctive statin therapy in hospitalized patients with coronavirus disease 2019 (Covid-19) remains uncertain. METHODS: We systematically searched Medline, Embase, Cochrane, and ClinicalTrials.gov databases from inception to late April 2024 for randomized controlled trials (RCTs) comparing statin versus no statin use in patients hospitalized with Covid-19. We pooled risk ratios (RRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) applying a random-effects model. R version 4.3.1 was used for statistical analyses. RESULTS: We included 7 RCTs comprising 4,262 patients, of whom 2,645 (62%) were randomized to receive statin therapy. Compared with no statin, statin use significantly reduced case-fatality rate (RR 0.88; 95% CI 0.80-0.98; I2 = 0%). In a time-to-event analysis, we found similar results (HR 0.86; 95% CI 0.75-0.99; I2 = 0%). Statin use also significantly reduced World Health Organization (WHO) scale at 14 days (mean difference -0.27; 95% CI -0.54 to -0.01; I2 = 0%). There was no statistically significant difference between the two groups in length of hospital stay, elevation of liver enzymes, and C-reactive protein levels. CONCLUSIONS: In patients hospitalized with Covid-19, statins significantly reduced case-fatality rate and WHO scale score. REGISTRATION: A prospective register was recorded in International Prospective Register of Systematic Reviews (PROSPERO) with the number CRD42023479007.

Body Adiposity Index as a Predictor of Body Fat in an Oldest Old and Independent Cohort of Brazilian Older Adults.

BACKGROUND: Anthropometry and body mass index (BMI) do not assess body composition or its distribution in older adults; thus, individuals may have different fat percentages but similar BMI values. The body adiposity index (BAI) was recently proposed as a feasible and inexpensive method for estimating the percentage of body fat based on measurements of hip circumference and height. The present study evaluated whether BAI and BMI are useful alternatives to dual-energy X-ray absorptiometry (DXA), which is rarely used in clinical practice, for predicting body fat in independent long-lived older adults. METHODS: In this cross-sectional study, we used DXA to calculate the percentage of body fat, which was compared with BAI and BMI values. We performed Pearson correlation analyses and used Cronbach's alpha, described by Bland and Altman, to compare the reliability between the indexes. RESULTS: Among 157 evaluated individuals (73.2% women, mean age 87±3.57 years), men had a lower percentage of total fat, as assessed by DXA, and lower BAI indices than women. The correlation between BAI and DXA was moderate (r=0.59 for men and r=0.67 for women, p<0.001). We confirmed the reliability based on Cronbach's alpha coefficients of 0.67 in men and 0.77 in women. We also observed that the BAI was strongly positively correlated with BMI in both men and women. CONCLUSION: The BAI, used in combination with BMI, can be an alternative to DXA for the assessment of body fat in the oldest old in clinical practice, mainly women, and can be used to add information to BMI.

Upper motor neuron signs in primary lateral sclerosis and hereditary spastic paraplegia.

INTRODUCTION/AIMS: The frequency and distribution of upper motor neuron (UMN) signs in primary lateral sclerosis (PLS) are unknown. We aimed to study the spectrum of UMN signs in PLS and compare it with hereditary spastic paraplegia (HSP). METHODS: We retrospectively analyzed the frequency of different UMN signs, including hyperreflexia (limbs and jaw), limb and tongue spasticity, Babinski, and Hoffman signs, in PLS patients at first observation and compared this respect to onset region and symptom duration. We also compared PLS versus HSP patients. RESULTS: We included 34 PLS and 20 HSP patients, with a median symptom duration at first visit of 3.0 (interquartile range, IQR = 4.0) and 19.0 (IQR = 22.0) years, respectively. In PLS patients, hyperreflexia of upper (UL) (88.2%) and lower (LL) (91.2%) limbs, and LL spasticity (79.4%) were the most common findings. Spasticity of LL was significantly (p = .012) more frequent in LL-spinal onset subgroup, tongue spasticity in bulbar-onset subgroup (p = .021), and Hoffman sign in UL-spinal onset subgroup (p = .024). The PLS subgroup with shorter disease duration had a higher frequency of abnormal jaw jerk reflex (p = .037). Compared with HSP, PLS patients had a higher frequency of UL hyperreflexia (88.2% vs. 42.1%, p < .001) and UL spasticity (44.1% vs. 0.0%, p < .001). Asymmetric distribution of UMN signs was present in PLS and not in HSP. DISCUSSION: In PLS, UL UMN signs are nearly always present and UMN sign distribution appears to be associated with onset region. At first observation, bulbar involvement, asymmetrical distribution of UMN signs and UL spasticity may indicate PLS versus HSP.

A cisheteronormatividade e a diversidade dos arranjos familiares: considerações à Terapia de Família Sistêmica / Cisheteronormativity and the diversity of family arrangements: considerations for Systemic Family Therapy / Cisheteronormatividad y diversidad de arreglos familiares: consideraciones para la Terapia de Família Sistêmica

INTRODUÇÃO: Neste artigo, buscamos articular questões referentes à Terapia de Família Sistêmica (TFS), estudos de sexualidade e gênero, perspectiva decolonial e interseccionalidade. Expomos como podemos pensar a partir destas problematizações as experiências familiares de pessoas que se situam no avesso ou nas margens da cisheteronormatividade e discutir sobre a diversidade que compõe a família, para além de uma visão restritiva deste termo. OBJETIVO: Fazer uma crítica construtiva à TFS, apontando o apagamento que esta disciplina possui em relação às vivências de pessoas LGBTQIAP+ (lésbicas, gays, transexuais e travestis, queer, intersexo, assexuais, pansexuais e demais orientações sexuais e identidades de gênero). METODOLOGIA: O artigo possui caráter ensaístico e sustentado em um material empírico oriundo de entrevistas de caráter biográfico/trajetórias de vida. Propomos aqui a perspectiva queer e decolonial, aliada à interseccionalidade como estratégia de análise de histórias de vida a fim de compreender os arranjos familiares de mulheres lésbicas, bissexuais e pansexuais. RESULTADOS: As entrevistadas demonstraram múltiplas realidades, baseando-se tanto em vivências de violência quanto de aceitação em suas famílias de origem, focando suas jornadas na construção de laços de apoio com suas famílias escolhidas, criando relações de irmandade entre amigas. CONCLUSÕES: A TFS poderia ampliar seu olhar e escrita sobre a população LGBTQIAP+, utilizando-se da decolonialidade/perspectiva queer e interseccionalidade como potente guia de análise das relações familiares, visto que as histórias de vida dessas mulheres concentram-se em lidar com discriminações e desafios associados aos seus diversos marcadores sociais da diferença.

INTRODUCTION: In this essay, the following themes will be analyzed: Systemic Family Therapy (SFT), sexuality and gender studies, women, and intersectionality. We expose how these themes combine in the family experiences of people who are on the other side or the margins of cisheteronormativity and discuss the diversity that makes up the family, beyond a restrictive view of this term. OBJECTIVE: Make a constructive criticism of TFS, pointing out the erasure that this discipline has in relation to the experiences of LGBTQIAP+ people (lesbians, gays, transsexuals and transvestites, queer, intersex, asexual, pansexual, and other sexual orientations and gender identities). We propose intersectionality as a strategy for analyzing life stories to understand the family arrangements of lesbian, bisexual and pansexuals women. METHODOLOGY: This essay is based on empirical material from biographical interviews/life trajectories. We propose here intersectionality as a strategy for analyzing life stories to understand the family arrangements of lesbian, bisexual and pansexual women. RESULTS: The interviewees demonstrated multiple realities, based on both experiences of violence and acceptance in their families of origin. And focusing their journeys on building supportive bonds with their chosen families, creating sisterhood relationships between friends. CONCLUSIONS: TFS could broaden its view and writing about the LGBTQIAP+ population, using intersectionality as a powerful guide for analyzing family relationships. Since these women's life stories focus on dealing with discrimination and challenges associated with their various social markers of difference.

INTRODUCCIÓN: En este artículo se analizan los siguientes temas: Terapia Familiar Sistémica (TFS), estudios de sexualidad y género, mujer e interseccionalidad. Exponemos cómo estos temas se conjugan en las experiencias familiares de personas que están del otro lado o en los márgenes de la cisheteronormatividad y discutimos la diversidad que conforma la familia, más allá de una visión restrictiva de este término. OBJETIVO: Hacer una crítica constructiva a TFS, señalando la borradura que tiene esta disciplina en relación a las vivencias de las personas LGBTQIAP+ (lesbianas, gays, transexuales y travestidos, queer, intersex, asexual, pansexual y otras orientaciones sexuales e identidades de género). METODOLOGÍA: El artículo tiene carácter ensayístico y se basa en material empírico de entrevistas de carácter biográfico/trayectorias de vida. Proponemos aquí la interseccionalidad como estrategia de análisis de las historias de vida para comprender los arreglos familiares de mujeres lesbianas, bisexuales y pansexuales. RESULTADOS: Los entrevistados evidenciaron múltiples realidades, basadas tanto en experiencias de violencia como de aceptación en sus familias de origen. Y enfocando sus viajes en construir lazos de apoyo con sus familias elegidas, creando relaciones de hermandad entre amigos. CONCLUSIONES: TFS podría ampliar su visión y escritura sobre la población LGBTQIAP+, utilizando la interseccionalidad como una poderosa guía para analizar las relaciones familiares. Dado que las historias de vida de estas mujeres se centran en lidiar con la discriminación y los desafíos asociados con sus diversos marcadores sociales de diferencia.

Relationship of protein, calcium and vitamin D consumption with body composition and fractures in oldest-old independent people.

BACKGROUND & AIM: Some studies state that the protein intake has a protective effect against bone mass loss, while others show that the combination of low calcium intake and high protein consumption increases the risk of fractures. Perhaps this phenomenon is also altered by the consumption of vitamin D after the age 80 years. This study aimed to identify if there is an association of protein, calcium and vitamin D intake with body composition and fractures in community dwelling 80 years or older independent people. METHODS: This is a cross-sectional observational analytic study. We invited community dwelling 80 years or older independent people, with chronic diseases under control, according to the scientific guidelines. The food intake was obtained through a one-day food record (FR) and Avanutri software (4.1 version) was used to calculate the intake of total calories, calcium, protein, and other food nutrients. The body composition and bone densitometry were evaluated by whole-body Dual Energy X-ray Absorptiometry (DXA). The morphometric vertebral fractures were assessed through conventional X-ray of the vertebral, level T4 to L4, on side face position - semi quantitative technique. RESULTS: One hundred and fifty-nine 80 years or older independent people, mean age 87.0 ± 3.9 years old were studied. The mean calcium intake was 834.6 ± 374.7 mg/day and vitamin D was 6.1 ± 24.3 µg/day, in both cases they were complemented by supplements to reach the recommendations. The mean protein intake was 72.9 ± 26.8 g/day, we found that 48.4% had low muscle mass; there was a frequency of 45.3% of osteoporosis; and vertebral fractures in 24.7% of them. The estimates of the logistic regression model with the outcome variable obesity and low muscle mass with reference to "low muscle mass" showed that the 80 years or older independent people who have a fracture are more likely to be obese with low muscle mass compared to those with only low muscle mass. CONCLUSION: In the studied population of 80 years or older independent people, we observed that among all the nutrients studied, only dietary protein per g/kg/day was associated with body composition and bone mineral density, but not with fracture, although the elderly who have fracture are more likely to be obese with low muscle mass compared to those not obese with low muscle mass. More studies about nutrients intakes and its relationship with muscle and bone health in this population is necessary.

Qualificação do(a) enfermeiro(a) que participa do processo de doação de órgãos na morte encefálica / Qualifications of nurses involved in the process of organ donation during brain death / Cualificación de la enfermera que participa en el proceso de donación de órganos en muerte encefálica

INTRODUÇÃO: O processo de doação de órgãos e tecidos é complexo, e se define como um conjunto de ações e procedimentos que visam a transformar um potencial doador de órgãos em um doador efetivo. Observa-se que o(a) enfermeiro(a) é presente em todas as etapas do processo de doação de órgãos, sendo assim, essencial para efetivação da doação. OBJETIVO: Conhecer a qualificação do(a) enfermeiro(a) no processo de doação de órgãos relatando como os artigos científicos abordam o tema. MÉTODO: Trata-se de um estudo bibliográfico, descritivo, tipo revisão integrativa de literatura, que contempla a análise de artigos científicos que dão suporte para a tomada de decisão e a melhoria da prática clínica, que possibilita a composição do conceito de um determinado assunto, além de apontar lacunas do conhecimento que precisam ser preenchidas com a realização de novos estudos. Incluindo artigos disponíveis integralmente, no idioma português, publicados de 2017 a 2021. RESULTADOS: A amostra foi composta por 11 artigos, ambos com nível de evidencia VI, que após leitura, foram definidos duas categorias para a discussão do tema em questão. Sendo elas: Atribuições do(a) enfermeiro(a) no processo de doação de órgãos e A Qualificação do profissional de Enfermagem frente ao processo de doação de órgãos. CONSIDERAÇÕES FINAIS: Baseado nos estudos dos artigos previamente citados conclui-se que há um déficit na formação acadêmica do profissional enfermeiro(a) relacionado ao processo de doação de órgãos em pacientes diagnosticados com morte encefálica (AU).

INTRODUCTION: The organ and tissue donation process is complex, and is defined as a set of actions and procedures aimed at transforming a potential organ donor into an effective donor. It is observed that the nurse is present in all stages of the organ donation process, thus being essential for the effective donation. OBJECTIVE: To know the qualification of nurses in the process of organ donation, reporting how scientific articles address the topic. METHOD: This is a bibliographic, descriptive, integrative literature review type study, which includes the analysis of scientific articles that support decision-making and the improvement of clinical practice, which enables the composition of the concept of a given subject. in addition to pointing out knowledge gaps that need to be filled with new studies.11 Including articles available in full, in Portuguese, published from 2017 to 2021. RESULTS: The sample consisted of 11 articles, both with evidence level VI , which after reading, two categories were defined for the discussion of the topic in question. They are: Attributions of the nurse in the organ donation process and The Qualification of the Nursing professional in the face of the organ donation process. FINAL CONSIDERATIONS: Based on the studies of the previously cited articles, it is concluded that there is a deficit in the academic training of professional nurses related to the process of organ donation in patients diagnosed with brain death (AU).

INTRODUCCIÓN: El proceso de donación de órganos y tejidos es complejo, y se define como un conjunto de acciones y procedimientos encaminados a transformar a un potencial donante de órganos en un donante efectivo. Se observa que el enfermero está presente en todas las etapas del proceso de donación de órganos, siendo así fundamental para la donación efectiva. OBJETIVO: Conocer la calificación de los enfermeros en el proceso de donación de órganos, relatando cómo los artículos científicos abordan el tema. MÉTODO: Se trata de un estudio de tipo revisión bibliográfica, descriptivo, integrador de la literatura, que incluye el análisis de artículos científicos que apoyen la toma de decisiones y la mejora de la práctica clínica, que posibilite la composición del concepto de un determinado tema, además de señalando vacíos de conocimiento que necesitan ser llenados con nuevos estudios.11 Incluyendo artículos disponibles en su totalidad, en portugués, publicados entre 2017 y 2021. RESULTADOS: La muestra consistió en 11 artículos, ambos con nivel de evidencia VI, que después de la lectura, dos categorías fueron definidos para la discusión del tema en cuestión. Son: Atribuciones del enfermero en el proceso de donación de órganos y La Habilitación del profesional de Enfermería frente al proceso de donación de órganos. CONSIDERACIONES FINALES: Con base en los estudios de los artículos citados anteriormente, se concluye que existe un déficit en la formación académica de los profesionales de enfermería relacionados con el proceso de donación de órganos en pacientes con diagnóstico de muerte encefálica (AU).

Recommendations from the Brazilian Society of Anesthesiology (SBA) for difficult airway management in adults

Abstract Difficult airway management represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report with updated recommendations for the management of difficult airway in adults. These recommendations were developed based on the consensus of a group of expert anesthesiologists, aiming to provide strategies for managing difficulties during tracheal intubation. They are based on evidence published in international guidelines and opinions of experts. The report underlines the essential steps for proper difficult airway management, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and maintaining arterial oxygenation. Additional strategies for using advanced tools, such as video laryngoscopy, flexible bronchoscopy, and supraglottic devices, are discussed. The report considers recent advances in understanding crisis management, and the implementation seeks to further patient safety and improve clinical outcomes. The recommendations are outlined to be uncomplicated and easy to implement. The report underscores the importance of ongoing education, training in realistic simulations, and familiarity with the latest technologies available.

Recommendations from the Brazilian Society of Anesthesiology (SBA) for difficult airway management in adults.

Difficult airway management represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report with updated recommendations for the management of difficult airway in adults. These recommendations were developed based on the consensus of a group of expert anesthesiologists, aiming to provide strategies for managing difficulties during tracheal intubation. They are based on evidence published in international guidelines and opinions of experts. The report underlines the essential steps for proper difficult airway management, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and maintaining arterial oxygenation. Additional strategies for using advanced tools, such as video laryngoscopy, flexible bronchoscopy, and supraglottic devices, are discussed. The report considers recent advances in understanding crisis management, and the implementation seeks to further patient safety and improve clinical outcomes. The recommendations are outlined to be uncomplicated and easy to implement. The report underscores the importance of ongoing education, training in realistic simulations, and familiarity with the latest technologies available.

Análise do impacto econômico do absenteísmo em um hospital público durante a pandemia de COVID-19 / Analysis of the economic impact of absenteeism in a public hospital during the COVID-19 pandemic

Com a pandemia da COVID-19, uma grande quantidade dos profissionais da saúde adoeceu e se afastou do trabalho. Este estudo objetivou estimar o custo desses afastamentos em um hospital público brasileiro e ajudou a identificar as falhas nos processos de trabalho que levaram ao absenteísmo. É uma avaliação econômica parcial, descritiva, retrospectiva, quantitativa, com dados coletados de prontuários médicos, sobre os custos diretos dos afastamentos. A amostra foi de 793 servidores e 2.166 registros de atestados médicos, de março a dezembro de 2020. Observou-se que: o custo total dos afastamentos foi de R$ 2.603.017,95. As doenças virais representaram o maior custo, seguidas dos problemas relacionados à saúde mental. Os técnicos de enfermagem foram os profissionais que causaram o maior impacto nos afastamentos (27,21%). Portanto, a pesquisa gerou indicadores importantes para nortear os gestores na alocação de recursos e na tomada de decisões durante a pandemia da COVID-19.

With the COVID-19 pandemic, a large number of healthcare professionals became ill and were away from work. This study aimed to estimate the cost of these absences in a Brazilian public hospital and helped to identify the flaws in work processes that led to absenteeism. It is a partial, descriptive, retrospective, quantitative economic evaluation, with data collected from medical records, on the direct costs of sick leave. The sample consisted of 793 employees and 2.166 medical certificate records, from March to December 2020. It was observed that: the total cost of leaves was R$ 2.603.017,95. Viral diseases represented the highest cost, followed by problems related to mental health. Nursing technicians were the professionals who caused the greatest impact on sick leave (27.21%). Therefore, the research generated important indicators to guide managers in resource allocation and decision-making during the COVID-19 pandemic.

Evaluation of 3D-Printed Dog Teeth for Pre-clinical Training of Endodontic Therapy in Veterinary Dentistry.

Artificial teeth in dental training have become a valuable tool for students to gain hands-on experience in a safe and controlled environment. This training method allows students to practice various dental procedures and develop their skills without putting patients at risk. Artificial teeth can be used to simulate dental conditions, allowing students to gain experience in dealing with various situations and techniques. Although previous studies in human dentistry have demonstrated the feasibility of using 3D-printed teeth for teaching endodontic procedures such as root canal therapy, similar research has yet to be conducted in the veterinary field. This study aimed to assess the feasibility of creating 3D-printed teeth from an adult dog skull and validate their use as an alternative training tool for root canal therapy in this species. For this, cone beam computed tomography images from a medium-sized dog skull were used to replicate its teeth using a digital 3D printing system. Then, artificial mandibular first molar teeth and a 24-question survey were sent to specialized veterinary dentistry practitioners in Brazil to assess their perception of the model's characteristics during endodontic treatment. In conclusion, it was feasible to create 3D-printed models of dog teeth with high accuracy for the endodontic system. Despite the differences in the properties of the two materials between natural and artificial teeth, it was possible to use the artificial tooth as a training device for conventional endodontic treatment in dogs. The reliability level for the survey was reported as good, displaying a reliability coefficient above 0.86.

European Academy of Neurology guidelines on the treatment of cluster headache.

BACKGROUND AND PURPOSE: Cluster headache is a relatively rare, disabling primary headache disorder with a major impact on patients' quality of life. This work presents evidence-based recommendations for the treatment of cluster headache derived from a systematic review of the literature and consensus among a panel of experts. METHODS: The databases PubMed (Medline), Science Citation Index, and Cochrane Library were screened for studies on the efficacy of interventions (last access July 2022). The findings in these studies were evaluated according to the recommendations of the European Academy of Neurology, and the level of evidence was established using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). RECOMMENDATIONS: For the acute treatment of cluster headache attacks, there is a strong recommendation for oxygen (100%) with a flow of at least 12 L/min over 15 min and 6 mg subcutaneous sumatriptan. Prophylaxis of cluster headache attacks with verapamil at a daily dose of at least 240 mg (maximum dose depends on efficacy and tolerability) is recommended. Corticosteroids are efficacious in cluster headache. To reach an effect, the use of at least 100 mg prednisone (or equivalent corticosteroid) given orally or at up to 500 mg iv per day over 5 days is recommended. Lithium, topiramate, and galcanezumab (only for episodic cluster headache) are recommended as alternative treatments. Noninvasive vagus nerve stimulation is efficacious in episodic but not chronic cluster headache. Greater occipital nerve block is recommended, but electrical stimulation of the greater occipital nerve is not recommended due to the side effect profile.

Sex steroid hormones and epilepsy: Effects of hormonal replacement therapy on seizure frequency of postmenopausal women with epilepsy-A systematic review.

BACKGROUND AND PURPOSE: Hormonal replacement therapy (HRT) is used for symptomatic treatment of menopause. Some evidence suggests a proconvulsant effect of estrogen and an anticonvulsant role of progesterone. Thus, the use of exogenous sex steroid hormones might influence the course of epilepsy in peri- and postmenopausal women with epilepsy (WWE). We conducted a systematic review on the impact of HRT on the frequency of seizures of WWE. METHODS: PubMed and Scopus were searched for articles published from inception until August 2022. Abstracts from the past 5 years from the European Academy of Neurology and European Epilepsy Congresses were also reviewed. Article reference lists were screened, and relevant articles were retrieved for consultation. Interventional and observational studies on WWE and animal models of estrogen deficiency were included. Critical appraisal was performed using the revised Cochrane risk-of-bias tool for randomized trials and ROBINS-E tool. RESULTS: Of 497 articles screened, 13 studies were included, including three human studies. One cross-sectional study showed a decrease in seizure frequency in WWE using combined HRT, a case-control study showed an increase in comparison with controls, and a randomized clinical trial found a dose-dependent increase in seizure frequency in women with focal epilepsy taking combined HRT. Ten studies addressing the impact of HRT in rat models were also included, which showed conflicting results. CONCLUSIONS: There is scarce evidence of the impact of HRT in WWE. Further studies should evaluate the harmful potential, and prospective registries are needed for monitoring this population.

Inclusion of men in health services and educational activities: the fathers' perceptions.

OBJECTIVE: To learn about the perception of fathers regarding their inclusion in health services and/or educational activities. METHOD: Qualitative, exploratory, and descriptive study addressing 22 fathers participating in a group of pregnant women in Rio Grande, RS, Brazil. Data were collected through semi-structured interviews and analyzed using the content analysis technique. RESULTS: The following categories emerged from the participants' reports: fathers' perceptions regarding their presence in health services and fathers' perceptions regarding their participation in the group of pregnant women. Additionally, they provided contributions and suggestions regarding their experiences with the group's meetings. CONCLUSION: The participants felt excluded from the services, which shows that health intervention strategies need to be (re)constructed to implement actions that include fathers as active participants in care, so they recognize the importance of their role in healthy human development.

Bacterial Microbiota from Lab-Reared and Field-Captured Anopheles darlingi Midgut and Salivary Gland.

Anopheles darlingi is a major malaria vector in the Amazon region and, like other vectors, harbors a community of microorganisms with which it shares a network of interactions. Here, we describe the diversity and bacterial composition from the midguts and salivary glands of lab-reared and field-captured An. darlingi using metagenome sequencing of the 16S rRNA gene. The libraries were built using the amplification of the region V3-V4 16S rRNA gene. The bacterial community from the salivary glands was more diverse and richer than the community from the midguts. However, the salivary glands and midguts only showed dissimilarities in beta diversity between lab-reared mosquitoes. Despite that, intra-variability was observed in the samples. Acinetobacter and Pseudomonas were dominant in the tissues of lab-reared mosquitoes. Sequences of Wolbachia and Asaia were both found in the tissue of lab-reared mosquitoes; however, only Asaia was found in field-captured An. darlingi, but in low abundance. This is the first report on the characterization of microbiota composition from the salivary glands of An. darlingi from lab-reared and field-captured individuals. This study can provide invaluable insights for future investigations regarding mosquito development and interaction between mosquito microbiota and Plasmodium sp.