Swallowing Safety after Remote sub-total Esophagectomy: How Important is Tongue Pressure?

The factors related to oropharyngeal dysphagia after remote esophagectomy (greater than five months) remain unclear. This study aimed to assess patient perception of dysphagia, maximum anterior isometric pressure (MAIP), maximum posterior isometric pressure (MPIP), lingual swallowing pressure (LSP) and radiographic physiological components of the oral and pharyngeal phases of swallowing in patients who are post remote sub-total esophagectomy (SE). Patient perception of dysphagia was assessed using the Eating Assessment Tool (EAT-10). MAIP, MPIP, and LSP were measured using the Iowa Oral Performance Instrument. Videofluoroscopy was used to assess the physiologic components of swallowing with the Modified Barium Swallow Impairment Profile (MBSImP) and the Penetration-Aspiration Scale (PAS). Ten patients were included in the study (53.2% male; mean age 54.5 ± 18.0). The mean postoperative time was 30 months (range, 5.0-72 months). Seven patients had elevated EAT-10 scores (> 3). All patients demonstrated impaired oropharyngeal swallowing on at least three MBSImP components (range 3-12) and two patients aspirated (PAS 8). There was a significant difference in MAIP values when comparing patients with normal versus impaired laryngeal elevation and epiglottic movement (p < 0.001). MPIP values were significantly different in patients with normal versus impaired epiglottic movement as well as normal versus elevated PAS scores (p < 0.001). Decreased lingual pressure and physiological changes in swallowing coexist after SE. Our results indicate that the decrease in tongue strength may be one of the factors related to unsafe swallow. The assessment of lingual pressure provides diagnostic value and should be incorporated as part of a comprehensive assessment in this population.

Neuroinflammation in Glioblastoma: The Role of the Microenvironment in Tumour Progression.

Glioblastoma (GBM) stands as the most aggressive and lethal among the main types of primary brain tumors. It exhibits malignant growth, infiltrating the brain tissue, and displaying resistance toward treatment. GBM is a complex disease characterized by high degrees of heterogeneity. During tumour growth, microglia and astrocytes, among other cells, infiltrate the tumour microenvironment and contribute extensively to gliomagenesis. Tumour-associated macrophages (TAMs), either of peripheral origin or representing brain-intrinsic microglia, are the most numerous nonneoplastic populations in the tumour microenvironment in GBM. The complex heterogeneous nature of GBM cells is facilitated by the local inflammatory tumour microenvironment, which mostly induces tumour aggressiveness and drug resistance. The immunosuppressive tumour microenvironment of GBM provides multiple pathways for tumour immune evasion, contributing to tumour progression. Additionally, TAMs and astrocytes can contribute to tumour progression through the release of cytokines and activation of signalling pathways. In this review, we summarize the role of the microenvironment in GBM progression, focusing on neuroinflammation. These recent advancements in research of the microenvironment hold the potential to offer a promising approach to the treatment of GBM in the coming times.

Incidence, risk factors, and outcomes of second neoplasms in patients with acute promyelocytic leukemia: the PETHEMA-PALG experience.

The most important challenges in acute promyelocytic leukemia (APL) is preventing early death and reducing long-term events, such as second neoplasms (s-NPLs). We performed a retrospective analysis of 2670 unselected APL patients, treated with PETHEMA "chemotherapy based" and "chemotherapy free" protocols. Only de novo APL patients who achieved complete remission (CR) and completed the three consolidation cycles were enrolled into the analysis. Out of 2670 APL patients, there were 118 (4.4%) who developed s-NPLs with the median latency period (between first CR and diagnosis of s-NPL) of 48.0 months (range 2.8-231.1): 43.3 (range: 2.8-113.9) for s-MDS/AML and 61.7 (range: 7.1-231.1) for solid tumour. The 5-year CI of all s-NPLs was of 4.43% and 10 years of 7.92%. Among s-NPLs, there were 58 cases of s-MDS/AML, 3 cases of other hematological neoplasms, 57 solid tumours and 1 non-identified neoplasm. The most frequent solid tumour was colorectal, lung and breast cancer. Overall, the 2-year OS from diagnosis of s-NPLs was 40.6%, with a median OS of 11.1 months. Multivariate analysis identified age of 35 years (hazard ratio = 0.2584; p < 0.0001) as an independent prognostic factor for s-NPLs. There were no significant differences in CI of s-NPLs at 5 years between chemotherapy-based vs chemotherapy-free regimens (hazard ratio = 1.09; p = 0.932). Larger series with longer follow-up are required to confirm the potential impact of ATO+ATRA regimens to reduce the incidence of s-NPLs after front-line therapy for APL.

Antimicrobial potential of linear low-density polyethylene food packaging with Ag nanoparticles in different carriers (Silica and Hydroxyapatite).

Silver nanoparticles incorporation into polymeric packaging aims to prevent microbiological contamination in food products, thus ensuring superior food safety and preservation. In this context, this study aimed to verify the antimicrobial efficacy of linear low-density polyethylene (LLDPE) films incorporated with silver nanoparticles (AgNPs) dispersed in silica (SiO2) and hydroxyapatite (HAP) carriers at different concentrations. AgNPs + carriers polymer films were characterized at 0.2, 0.4, and 0.6% concentrations using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), field emission gun-scanning electron microscope (FEG-SEM), thermogravimetric analyzer (TGA), differential scanning calorimetry (DSC), and migration in acidic and non-acidic simulants. Antimicrobial action was investigated on Gram-positive Staphylococcus aureus, Gram-negative Escherichia coli, and the Penicillium expansum and Fusarium solani fungi with antimicrobial activity by direct contact test and bacterial imaging by scanning electron microscopy. AgNPs addition to the LLDPE matrix did not interfere with the films' chemical and thermal properties and presented no significant migration to the external medium. For antimicrobial action, silver nanoparticles showed, in most concentrations, an inhibition percentage higher than 90% on all microorganisms studied, regardless of the carrier. However, a greater inhibitory action on S. aureus and between carriers was found, making hydroxyapatite more effective. The results indicated that nanostructured films with AgNPs + hydroxyapatite showed more promising antimicrobial action on microorganisms than AgNPs + silica, making hydroxyapatite with silver nanoparticle potentially useful in food packaging, improving safety and maintaining quality.

Cognitive evaluation in Parkinson's disease: applying the Movement Disorder Society recommendations in a population with a low level of formal education.

BACKGROUND: The diagnosis of cognitive disorders in Parkinson disease (PD) can be very challenging. Aiming at establishing uniform and reliable diagnostic procedures, the International Parkinson's Disease and Movement Disorder Society (MDS) commissioned task forces to delineate diagnostic criteria for mild cognitive impairment (MCI) and dementia in PD. OBJECTIVES: To investigate the applicability of the MDS recommendations for cognitive evaluation in a Brazilian sample of patients with PD with low levels of formal education. METHODS: A total of 41 patients with PD were subjected to a comprehensive neuropsychological evaluation based on tests proposed by the MDS, which included the Mini-Mental State Examination, the Mattis Dementia Rating Scale (MDRS), the Trail Making Test (TMT) parts A and B, in addition to language and memory skills assessment. Neuropsychiatric and daily functioning features were also evaluated. Spearman correlation analyses were used to evaluate the association between the scores obtained in the cognitive scales and demographic/clinical variables. RESULTS: Although none of the participants had a formal diagnosis of dementia, 50% presented some degree of cognitive impairment when considering the results of the MDRS. Of note, a noticeable number of patients was not able to complete the full neuropsychological assessment. The TMT part B was the most difficult task, being completed by only 22 participants (54%). As expected, the greater the educational level, the better the performance on the cognitive tests. Better motor function was also associated with better scores in cognition. CONCLUSIONS: Adopting strict inclusion/exclusion criteria and a comprehensive clinical evaluation, we found remarkable limitations for the MDS recommendations when individuals with low educational levels are considered. A revision of the current guidelines is necessary considering differences among populations, especially related to formal education.

ANTECEDENTES: O diagnóstico de distúrbios cognitivos na doença de Parkinson (DP) pode ser muito desafiador. Com o objetivo de estabelecer procedimentos diagnósticos uniformes e confiáveis, a Sociedade Internacional da Doença de Parkinson e Distúrbios do Movimento (MDS, na sigla em inglês) encomendou forças-tarefa para delinear critérios diagnósticos para comprometimento cognitivo leve (CCL) e demência na DP. OBJETIVOS: Investigar a aplicabilidade das recomendações da MDS para avaliação cognitiva em uma amostra brasileira de pacientes com DP de baixa escolaridade. MéTODOS: Um total de 41 pacientes com DP foram submetidos a uma avaliação neuropsicológica abrangente com base nos testes propostos pela MDS, que incluiu o Miniexame do Estado Mental, a Escala de Avaliação de Demência de Mattis (MDRS, na sigla em inglês), o teste de trilhas (TMT, na sigla em inglês) partes A e B, além da avaliação das habilidades de linguagem e memória. Características neuropsiquiátricas e de funcionamento diário também foram avaliadas. Análises de correlação de Spearman foram utilizadas para avaliar a associação entre os escores obtidos nas escalas cognitivas e variáveis demográficas/clínicas. RESULTADOS: Apesar de nenhum dos participantes ter diagnóstico formal de demência, 50% apresentaram algum grau de comprometimento cognitivo ao levar em consideração os resultados da MDRS. Vale ressaltar que um número notável de pacientes não conseguiu completar a avaliação neuropsicológica completa. A parte B do TMT foi a tarefa mais difícil, sendo realizada por apenas 22 participantes (54%). Como esperado, quanto maior o nível educacional, melhor o desempenho nos testes cognitivos. Melhor função motora também foi associada a melhores escores em cognição. CONCLUSõES: Adotando critérios rígidos de inclusão/exclusão e uma avaliação clínica abrangente, encontramos limitações marcantes para as recomendações da MDS quando considerados indivíduos com baixa escolaridade. É necessária uma revisão das diretrizes atuais considerando as diferenças entre as populações, principalmente relacionadas ao nível educacional.

Psychometric validation of the MIND Youth Questionnaire (MY-Q) to assess quality of life in Spanish patients with type 1 diabetes between 12 and 25 years old.

AIM: Validate in Spanish the Monitoring Individual Needs in Diabetes Youth Questionnaire (MY-Q), a multi-dimensional self-report HRQoL questionnaire designed for paediatric diabetes care. DESIGN AND METHODS: After translation, 209 patients diagnosed with type 1 diabetes, between 12 and 25 years old were assessed. The patients belonged to 12 hospitals in Spain. RESULTS: Exploratory factor analysis including one-factor up to seven-factor solutions were tested. The three-factor solution (Negative Impact of Diabetes, Empowerment and Control of Diabetes and Worries) was the most parsimonious model with adequate fit: χ2(723)=568.856 (p<0.001), CFI=0.913, RMSEA=0.072 [0.064, 0.080], SRMR=0.075. The three-factor solution and the grouping of the items followed a clear rationale. Cronbach's alpha was 0.816 for Negative Impact, 0.700 for Empowerment and Control and 0.795 for Worries. The study of the relationship between the MY-Q dimensions and socio-demographics variables show a relationship between age and the MY-Q: F(6,410)=10.873 (p<0.001), η2=0.137. Participants younger than 14 years old showed greater scores on Empowerment and Control when compared to participants between 14 and 17 years old (p=0.021); statistically significant differences were found for the participants 18 years old or older, who showed lower levels of Worries than the younger patients. Concurrent validity found that the dimension of Negative Impact of Diabetes was positively related to WHO-5, and the PedsQL Diabetes Module. CONCLUSION: The Spanish version of the MY-Q to measure HRQoL in patients with type 1 diabetes between the ages of 12 and 25, has adequate psychometric properties and conceptual and semantic equivalence with the original version in Dutch.

Cognitive evaluation in Parkinson's disease: applying the Movement Disorder Society recommendations in a population with a low level of formal education / Avaliação cognitiva na doença de Parkinson: aplicando as recomendações da Movement Disorder Society em uma população de baixa escolaridade

Abstract Background The diagnosis of cognitive disorders in Parkinson disease (PD) can be very challenging. Aiming at establishing uniform and reliable diagnostic procedures, the International Parkinson's Disease and Movement Disorder Society (MDS) commissioned task forces to delineate diagnostic criteria for mild cognitive impairment (MCI) and dementia in PD. Objectives To investigate the applicability of the MDS recommendations for cognitive evaluation in a Brazilian sample of patients with PD with low levels of formal education. Methods A total of 41 patients with PD were subjected to a comprehensive neuropsychological evaluation based on tests proposed by the MDS, which included the Mini-Mental State Examination, the Mattis Dementia Rating Scale (MDRS), the Trail Making Test (TMT) parts A and B, in addition to language and memory skills assessment. Neuropsychiatric and daily functioning features were also evaluated. Spearman correlation analyses were used to evaluate the association between the scores obtained in the cognitive scales and demographic/clinical variables. Results Although none of the participants had a formal diagnosis of dementia, 50% presented some degree of cognitive impairment when considering the results of the MDRS. Of note, a noticeable number of patients was not able to complete the full neuropsychological assessment. The TMT part B was the most difficult task, being completed by only 22 participants (54%). As expected, the greater the educational level, the better the performance on the cognitive tests. Better motor function was also associated with better scores in cognition. Conclusions Adopting strict inclusion/exclusion criteria and a comprehensive clinical evaluation, we found remarkable limitations for the MDS recommendations when individuals with low educational levels are considered. A revision of the current guidelines is necessary considering differences among populations, especially related to formal education.

Resumo Antecedentes O diagnóstico de distúrbios cognitivos na doença de Parkinson (DP) pode ser muito desafiador. Com o objetivo de estabelecer procedimentos diagnósticos uniformes e confiáveis, a Sociedade Internacional da Doença de Parkinson e Distúrbios do Movimento (MDS, na sigla em inglês) encomendou forças-tarefa para delinear critérios diagnósticos para comprometimento cognitivo leve (CCL) e demência na DP. Objetivos Investigar a aplicabilidade das recomendações da MDS para avaliação cognitiva em uma amostra brasileira de pacientes com DP de baixa escolaridade. Métodos Um total de 41 pacientes com DP foram submetidos a uma avaliação neuropsicológica abrangente com base nos testes propostos pela MDS, que incluiu o Miniexame do Estado Mental, a Escala de Avaliação de Demência de Mattis (MDRS, na sigla em inglês), o teste de trilhas (TMT, na sigla em inglês) partes A e B, além da avaliação das habilidades de linguagem e memória. Características neuropsiquiátricas e de funcionamento diário também foram avaliadas. Análises de correlação de Spearman foram utilizadas para avaliar a associação entre os escores obtidos nas escalas cognitivas e variáveis demográficas/clínicas. Resultados Apesar de nenhum dos participantes ter diagnóstico formal de demência, 50% apresentaram algum grau de comprometimento cognitivo ao levar em consideração os resultados da MDRS. Vale ressaltar que um número notável de pacientes não conseguiu completar a avaliação neuropsicológica completa. A parte B do TMT foi a tarefa mais difícil, sendo realizada por apenas 22 participantes (54%). Como esperado, quanto maior o nível educacional, melhor o desempenho nos testes cognitivos. Melhor função motora também foi associada a melhores escores em cognição. Conclusões Adotando critérios rígidos de inclusão/exclusão e uma avaliação clínica abrangente, encontramos limitações marcantes para as recomendações da MDS quando considerados indivíduos com baixa escolaridade. É necessária uma revisão das diretrizes atuais considerando as diferenças entre as populações, principalmente relacionadas ao nível educacional.

Relação do etilismo e do nível de atividade física com fatores de risco para doenças cardiovasculares em estudantes universitários / Relationship between alcohol consumption and physical activity level with risk factors for cardiovascular diseases in college students / Relación del consumo de alcohol y el nivel de actividad física con los factores de riesgo de enfermedades cardiovasculares en estudiantes universitarios

O consumo de bebidas alcoólicas, principalmente em jovens, acarreta uma série de efeitos negativos no sistema cardiovascular. Tal uso exacerbado e precoce pode predispor à calcificações coronarianas, aumento na pressão arterial, arritmias cardíacas e insuficiências coronarianas à longo prazo. Em contrapartida, a prática de atividades físicas é uma grande aliada na saúde cardiovascular. Assim, objetiva-se com o presente estudo associar o consumo de bebidas alcoólicas e a prática de atividade física com fatores de risco para doenças cardiovasculares em estudantes universitários. É um estudo observacional transversal. Foram coletados dados de consumo de bebidas alcoólicas (questionário AUDIT), nível de atividade física (IPAQ), índice de massa corporal (IMC), circunferência de cintura (CC), relação cintura quadril (RCQ), pressão arterial sistêmica e histórico de tabagismo. A comparação entre os grupos realizada pelo teste t-Student ou Mann-Whitney. A correlação entre as variáveis pelo Coeficiente de Spearman. Dessa forma, os resultados encontrados foram que os estudantes universitários que consumiam bebida alcóolica e que tiveram risco de dependência (n=40) tiveram maior IMC (Δ=+1,18kg/m2, p=0,049), CC (Δ=+5,77cm, p=0,005) e RCQ (Δ=+0,003, p=0,027). O score da dieta (Δ=+6,39, p=0,056) do grupo ativo foi maior em relação ao sedentário. Houve correlação direta do score do questionário AUDIT com tabagismo (p<0,001), IMC (p=0,010), CC (p=0,005), RCQ (0,045) e atividade física vigorosa (p=0,027) e, desta com tabagismo (p=0,021). Com o estudo, foi perceptível que há alto consumo de bebidas alcoólicas entre os estudantes universitários, mas, baixo o risco de dependência ao álcool. Os estudantes que são etilistas e com risco de dependência tem maiores valores para parâmetros de obesidade incluindo a RCQ que está diretamente relacionada com evento cardiovascular.

The consumption of alcoholic beverages, especially among young people, has a series of negative effects on the cardiovascular system. Such exacerbated and early use may predispose to coronary calcification, increased blood pressure, cardiac arrhythmias, and long-term coronary insufficiency. On the other hand, the practice of physical activities is a great ally in cardiovascular health. Thus, this study aims to associate the consumption of alcoholic beverages and the practice of physical activity with risk factors for cardiovascular diseases in college students. This is a cross-sectional observational study. We collected data on alcohol consumption (AUDIT questionnaire), physical activity level (IPAQ), body mass index (BMI), waist circumference (WC), waist- to-hip ratio (WHR), systemic blood pressure, and smoking history. The comparison between groups was done by the t-Student or Mann-Whitney test. The correlation between variables was done by Spearman's Coefficient. Thus, the results found were that college students who consumed alcoholic beverages and had a risk of addiction (n=40) had higher BMI (Δ= +1.18kg/m2, p=0.049), WC (Δ=+5.77cm, p=0.005) and WHR (Δ=+0.003, p=0.027). The diet score (Δ=+6.39, p=0.056) of the active group was higher compared to the sedentary group. There was direct correlation of AUDIT questionnaire score with smoking (p<0.001), BMI (p=0.010), WC (p=0.005), WHR (0.045) and vigorous physical activity (p=0.027) and, of this with smoking (p=0.021). With the study, it was noticeable that there is high alcohol consumption among college students, but, low risk of alcohol dependence. Students who are alcohol drinkers and at risk of addiction have higher values for obesity parameters including WHR which is directly related to cardiovascular event. KEYWORDS: Alcohol Consumption in College; Physical Exercise; Heart Disease; Risk Factors; Students.

El consumo de bebidas alcohólicas, especialmente entre los jóvenes, tiene una serie de efectos negativos sobre el sistema cardiovascular. Este consumo exacerbado y precoz puede predisponer a la calcificación coronaria, aumento de la presión arterial, arritmias cardiacas e insuficiencia coronaria a largo plazo. Por otro lado, la práctica de actividades físicas es un gran aliado en la salud cardiovascular. Así, este estudio pretende asociar el consumo de bebidas alcohólicas y la práctica de actividad física con factores de riesgo de enfermedades cardiovasculares en estudiantes universitarios. Se trata de un estudio observacional transversal. Se recogieron datos sobre el consumo de alcohol (cuestionario AUDIT), el nivel de actividad física (IPAQ), el índice de masa corporal (IMC), el perímetro de cintura (CC), la relación cintura-cadera (RCC), la presión arterial sistémica y los antecedentes de tabaquismo. La comparación entre los grupos se realizó mediante la prueba t-Student o Mann-Whitney. La correlación entre las variables por el Coeficiente de Spearman. Así, los resultados encontrados fueron que los universitarios que consumían bebidas alcohólicas y tenían riesgo de dependencia (n=40) presentaban mayor IMC (Δ= +1,18kg/m2, p=0,049), CC (Δ=+5,77cm, p=0,005) y RH (Δ=+0,003, p=0,027). La puntuación de la dieta (Δ=+6,39, p=0,056) del grupo activo fue mayor en comparación con el grupo sedentario. Hubo correlación directa de la puntuación del cuestionario AUDIT con el tabaquismo (p<0,001), el IMC (p=0,010), la CC (p=0,005), el RH (0,045) y la actividad física vigorosa (p=0,027) y, de ésta, con el tabaquismo (p=0,021). Con el estudio, se notó que hay alto consumo de bebidas alcohólicas entre los universitarios, pero, bajo riesgo de dependencia del alcohol. Los estudiantes bebedores de alcohol y con riesgo de dependencia presentan valores más elevados en los parámetros de obesidad, incluyendo el WHR que está directamente relacionado con el evento cardiovascular.

Revisão sistemática dos efeitos alimentares e econômicos de programas de alimentação do trabalhador / Systematic review of nutritional and food effects of workers' food programs

Introdução. Vários países têm programas direcionados à alimentação dos trabalhadores, visando melhoria das condições nutricionais da força de trabalho, associada ao aumento da produtividade no trabalho. O Programa de Alimentação do Trabalhador (PAT) brasileiro foi criado em 1976, incluindo incentivo às empresas para participação na iniciativa, a partir de dedução de despesas com alimentação no imposto de renda devido. O programa também impulsionou o crescimento do setor de alimentação no país, inicialmente a partir da inserção de restaurantes dentro das empresas (entre década de 1970 até final da década de 1980) e, a partir dos anos 1990, há adoção dos modelos de fornecimento de refeições e alimentação via convênio ou voucher. Consequentemente, o objetivo da tese foi conduzir uma revisão sistemática sobre os efeitos alimentares e econômicos advindos de programas de alimentação do trabalhador em diferentes países. Métodos. A presente investigação constitui estudo observacional baseado em revisão sistemática de literatura. A revisão sistemática foi baseada em busca de literatura em três bases de dados (PubMed/MedLine, Scielo e Google Scholar), guiada pela estratégia PECOS (acrônimo para Population, Exposition, Comparator, Outcomes e Study design), sendo registrada na plataforma PROSPERO (CRD42020195934). Resultados. A partir de revisão sistemática de literatura, verificou-se que a maior parte dos estudos sobre programas de alimentação do trabalhador concentra-se no Brasil, em vista da existência do programa na maior parte do país desde a década de 1970. Vários estudos apontam efeitos potencialmente deletérios do programa sobre estado nutricional dos trabalhadores, em vista da ausência de diretrizes nutricionais na distribuição do benefício. Avaliação de programas para alimentação de trabalhadores em outros países, como Estados Unidos e África do Sul, apresentaram efeitos bastante diferenciados, considerando diferenças nos propósitos dos programas. Conclusão. A presente tese buscou preencher uma lacuna na literatura quanto aos efeitos nutricionais e econômicos de programas de alimentação direcionados a trabalhadores em diferentes países. Os resultados apontam para necessidade de ações de apoio aos trabalhadores em termos de educação nutricional, considerando-se os efeitos potencialmente deletérios dos programas sobre estado nutricional dos trabalhadores.

Introduction. Diverse countries present food programs directed towards workers to foster improvements in nutritional conditions of labor force, associated to improvements in work productivity. The Brazilian Workers' Food Program (Programa de Alimentação do Trabalhador, PAT) was established in 1976, including incentive to enterprises for participation in the initiative through deduction of food expenditures from income taxes. The program also encouraged the growth in the Brazilian food sector, initially through inclusion of restaurants and cafeterias in enterprises (between 1970s and 1980s) and, after the beginning of the 1990s, adoption of models based on supply of meals, covenants, and vouchers. Consequently, the objective of the study was to conduct a systematic review of food and economic effects from workers' food programs in different countries. Methods. The present investigation comprises an observational study based on systematic literature review. The systematic review of literature was based on literature search in three datasets (PubMed/MedLine, Scielo and Google Scholar), guided by PECOS strategy (acronym for Population, Exposition, Comparator, Outcomes e Study design), being registered in the PROSPERO platform (CRD42020195934). Results. The systematic literature review identified that major part of studies on workers' food programs concentrates in Brazil, given the establishment and continuity of the program since the 1970s. Various studies pointed to potentially negative effects of the program on workers' nutritional status, considering the absence of nutritional guidelines in the distribution of the assistance. Workers' food programs in other countries, like United States and South Africa, presented diverse effects, considering differences in the purposes of the programs. Conclusion. The present dissertation proposed to fulfill a gap in the literature referring to the nutritional and economic effects of food programs directed to workers in diverse countries. The results suggest the need to activities to support workers' nutritional education, considering the potentially negative effects of programs on workers' nutritional status.

A experiência estética como facilitadora de grupos na saúde mental / The aesthetic experience as a facilitator of mental health groups

A experiência estética pode ser compreendida como uma vivência que emerge na intencionalidade homem e mundo por meio de expressões artísticas e sensíveis, recebidas de forma mobilizadoras à percepção. O objetivo deste artigo foi compreender como essa experiência foi significada por participantes do Grupo Comunitário de Saúde Mental, que tem como premissa a atenção à experiência cotidiana, entre elas, a experiência vivida com elementos estéticos como filmes, músicas, entre outros. O corpus formou-se pela observação participante por dois anos e seis meses e por nove entrevistas abertas, baseado no referencial teórico metodológico da Fenomenologia. A experiência estética proporcionou uma forma de religar a pessoa e o mundo em uma unicidade criativa, a partir da exploração do potencial simbólico de elementos disponíveis na cultura, bem como favoreceu a constituição de encontros, de reciprocidade e de surpresas na relação com o outro, fortalecendo a dimensão comunitária da atividade.

Worst spasticity in patients post-stroke associated with MNSOD ALA16VAL polymorphism and interleukin-1ß.

The MnSOD Ala16Val single nucleotide polymorphism (SNP) has shown to be associated to risk factors of several metabolic and vascular diseases. However, little is known about interaction between MnSOD Ala16Val SNP in stroke, a frequent neurologic disease that involves clinic manifestations such as motor deficits and spasticity. In this sense, we decided to investigate the relationship between MnSOD Ala16Val SNP with spasticity in stroke and also its influence on interleukin levels, BDNF, and glycolipid parameters. Eighty post-stroke subjects and 80 healthy controls were investigated. We showed a higher spasticity, levels of total cholesterol, LDL, IL-1ß, IL-6, and INF-γ in VV post-stroke group. Interesting, we found a correlation between IL-1ß levels and spasticity in VV post-stroke. Triglycerides, glucose levels and caspases (1 and 3) activation were significantly higher, as well as BDNF levels were lower in VV and AV post-stroke. DNA damage was higher in post-stroke group. Thus, we can suggest that the V allele has a worse glycolipid profile, which would facilitate changes in neurovascular homeostasis. These events associated with an increase in inflammatory markers and a reduction in BDNF can contribute with the stroke and a worse clinical evolution in relation to spasticity in patients with VV genotype.

Outbreak of equine pythiosis in a southeastern region of Brazil: Environmental isolation and phylogeny.

Pythiosis is a disease caused by the oomycete Pythium insidiosum, mainly reported in equines, dogs and humans and directly transmitted through contaminant zoospores in aquatic environments. We report the first outbreak of equine pythiosis in five equines. Wound samples were submitted for diagnostic testing including mycological culture and nested PCR. Treatment approaches consisted of conventional and alternative therapies. Microbiological analyses were performed using water samples from the riverbanks close to where the animals had grazed. All animals were positive for P. insidiosum cultures, and two animals responded successfully to alternative therapy (ozone therapy). After culture and molecular analysis of environmental samples, the presence of P. insidiosum in one section of the Tietê River was confirmed through a 99% sequence identity. Phylogenetic analyses using the cytochrome oxidase II gene showed that the animal isolates clustered in clade I and the environmental isolates clustered in clade III. Although the environmental and wound isolates belonged to different genetic clades, we concluded that the Tietê River is an important source of infection by P. insidiosum and that research concerning environmental isolation of P. insidiosum from rivers and lakes should be strongly facilitated in Brazil.

Psychological recovery after critical illness and stay in hospital ICU / Recuperação psicológica após adoecimento grave e internação em UTI / Recuperación psicológica después de una enfermedad grave y admisión en la UCI

The effects of critical illness and hospitalization in intensive care units (ICU) have been associated with the presence of negative psychological consequences. This study explores the experiences of sick people who were admitted to an ICU, seeking to know its repercussions on the self. In-depth qualitative interviews and participant observations were carried out with two people since their ICU admission until at least six months after discharge from the unit. Data was analyzed following an adaptation of the clinical qualitative method within a longitudinal frame and interpreted with Winnicott's psychoanalytic perspective. This research managed to describe participants' lived experiences and the ways they affected their psychic organization. To the interviewed, these experiences configured threshold situations which promoted a process of psychic disintegration. Psychological recovery, then, depends on the articulation of lived experiences, and is supported by facilitating intersubjective relationships that promote the expression of personal potentialities.(AU)

Os efeitos do adoecimento crítico e da hospitalização em Unidade de Terapia Intensiva (UTI) têm sido associados a consequências psicológicas negativas. Este estudo investiga as experiências de pessoas adoecidas que foram internadas em UTI, buscando compreender suas repercussões no self. Foram realizadas entrevistas qualitativas em profundidade e observações participantes com duas pessoas, desde a admissão na UTI até, no mínimo, seis meses após a alta. Os dados foram analisados seguindo uma adaptação do método clínico qualitativo, em um enquadre longitudinal, e interpretados a partir da perspectiva psicoanalítica winnicottiana. A pesquisa descreveu as experiências vividas pelos participantes e a forma como elas afetaram sua organização psíquica. Para os entrevistados, essas experiências se configuraram como situações limite, que estimularam um processo de desintegração psíquica. A recuperação psicológica, por sua vez, depende da articulação das experiências vividas, e é sustentada por relações intersubjetivas facilitadoras que promovem a expressão de potencialidades pessoais.(AU)

Los efectos de una enfermad grave y de la hospitalización en Unidades de Cuidados Intensivos (UCI) se asocian a consecuencias psicológicas negativas. Este estudio abordó las experiencias de personas enfermas hospitalizadas en UCI, con el fin de comprender sus repercusiones en el self. Se realizaron entrevistas cualitativas a profundidad y observaciones participantes con dos personas, desde la admisión en la UCI hasta, por lo menos, seis meses después de haber dado el alta el paciente. Los datos se analizaron de acuerdo con una adaptación del método clínico cualitativo, en un marco longitudinal, y para su interpretación se aplicó la perspectiva psicoanalítica winnicottiana. La investigación describió las experiencias de los participantes y la forma como estas han afectado sus organizaciones psíquicas. Según los entrevistados, las experiencias se configuraron como situaciones límite, las cuales han promovido un proceso de desintegración psíquica. La recuperación psicológica dependió de la articulación de las experiencias vividas y estuvo sostenida por relaciones intersubjetivas facilitadoras, las cuales promovieron la expresión de potencialidades personales.(AU)

Practical protocol of the food allergy committee of the seicap on open oral food challenges to nuts.

Food allergy is rising rapidly among children, and allergy to nuts is one of the most prevalent allergies among them. The category "nuts and seeds" include several plant foods from different botanical families, very different from each other. It is not uncommon to detect co-sensitization to different nuts. However, true co-allergy is less frequent. Up to 80% of patients with positive skin prick tests or specific IgE without true history of reaction who avoid certain nuts, might tolerate them in an Oral Food Challenge (OFC). Although molecular diagnostic techniques help to improve nut allergy diagnosis, OFC still remains the gold standard. For this reason, after reviewing the current bibliography and the recommendations of different allergy societies on standardization of open OFC, the Food Allergy Committee of the Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP) food allergy working group proposed a unified protocol to undertake these OFC, which include preliminary recommendations, unification of total dose, number of doses and interval between doses. Additionally, this group offers an interactive table to facilitate calculation of doses specific to each nut under study.

Translation into Brazilian Portuguese and Cultural Adaptation of the Component Scores Definition from the Modified Barium Swallow Impairment Profile (MBSImPTM). / Tradução para o português brasileiro e adaptação cultural da Definição de Pontuações de Componentes (Component Scores Definition) pertencentes ao Modified Barium Swallow Impairment Profile ­ MBSImP(™).

PURPOSE: Translate into Brazilian Portuguese and culturally adapt the component scores definition from the Modified Barium Swallow Impairment Profile - MBSImP videofluoroscopy protocol. METHODS: This study was conducted based on international guidelines for creation, translation and transcultural adaptation according to domestic publications for the validation of international speech-language pathology tests. A specialist committee was convened with two otorhinolaryngologists and three speech-language pathologists familiar with videofluoroscopy examinations. Translation into Brazilian Portuguese was carried out by two otorhinolaryngologists with subsequent back translation performed independently by two U.S.-born translators. The final Brazilian Portuguese version was written by speech-language pathologists after revision of translations and back translations resolved semantic, idiomatic, conceptual, linguistic and contextual inconsistencies. This version was tested by committee members, who assessed subjects with no disease, with head and neck cancer and with mild cognitive impairment. RESULTS: Translation of the component scores definition from MBSImP was performed independently and translators agreed on a final version. The MBSImP protocol was renamed "Martin-Harris scale for swallowing videofluoroscopy". Some terms were adapted for the final Brazilian Portuguese version. Use of the translated protocol did not reveal any deviations from the original. CONCLUSION: Translation of the MBSImP fragment into Brazilian Portuguese was consistent with the original version. Approval from specialist committee members refined the protocol adaptation, allowing precise concepts to be accurately translated.

OBJETIVO: Traduzir para o português brasileiro e adaptar culturalmente a definição dos componentes e pontuação (Component Scores Definition) pertencentes ao protocolo para videofluoroscopia Modified Barium Swallow Impairment ­ MBSImPTM. MÉTODO: Esse estudo foi desenvolvido com base nas recomendações internacionais para elaboração, tradução e adaptação transcultural em consonância com publicações nacionais para validação de testes internacionais em Fonoaudiologia. Foi formado um comitê de especialistas, composto por dois médicos otorrinolaringologistas e três fonoaudiólogas conhecedoras do exame de videofluoroscopia. A tradução para o português brasileiro foi realizada por dois otorrinolaringologistas com retrotradução de forma independente por dois nativos norte-americanos. A versão final em português brasileiro foi elaborada pelas fonoaudiólogas certificadas após a revisão das traduções e das retrotraduções com resolução de discrepâncias semânticas, idiomáticas, conceituais, linguísticas e contextuais. Essa versão foi testada pelas fonoaudiólogas membros do Comitê, que avaliaram indivíduos saudáveis, com Câncer de Cabeça e Pescoço e Comprometimento Cognitivo Leve. RESULTADOS: A tradução da definição dos componentes e pontuação do MBSImP foi realizada de forma independente e os tradutores chegaram a um consenso para a versão final. O protocolo original Modified Barium Swallow Impairment, foi traduzido para "Escala Martin-Harris para videofluoroscopia da deglutição". Na versão final em português brasileiro alguns termos foram adaptados. A aplicação do protocolo traduzido não apresentou discrepâncias em relação ao protocolo original. CONCLUSÃO: A tradução do excerto do protocolo MBSImP para o português brasileiro foi compatível com a versão original. A certificação de membros do comitê favoreceu a adaptação do material, permitindo a adaptação conceitual.

Treatment-free remission in patients with chronic myeloid leukemia: recommendations of the LALNET expert panel.

Tyrosine kinase inhibitors (TKIs) have dramatically changed the survival of chronic myeloid leukemia (CML) patients, and treatment-free remission (TFR) has recently emerged as a new goal of CML treatment. The aim of this work was to develop recommendations for TKI discontinuation in Latin America (LA), outside of clinical trials. A working group of CML experts from LA discussed 22 questions regarding TFR and reached a consensus for TFR recommendations in the region. TFR is indicated in patients in first chronic phase, with typical BCR-ABL transcripts, under TKI treatment of a minimum of 5 years, in sustained deep molecular response (DMR; molecular response 4.5 [MR4.5]) for 2 years. Sustained DMR must be demonstrated on at least 4 international reporting scale quantitative polymerase chain reaction (PCR) tests, separated by at least 3 months, in the immediate prior 2 years. After second-line therapy, TFR is indicated in previously intolerant, not resistant, patients. Molecular monitoring is recommended monthly for the first 6 months, every 2 to 3 months from months 7 to 12, and every 3 months during the second year, indefinitely. Treatment should be reintroduced if major molecular response is lost. Monitoring of withdrawal syndrome, glucose levels, and lipid profile is recommended after discontinuation. After TKI reintroduction, molecular monitoring is indicated every 2 to 3 months until MR4.0 achievement; later, every 3 to 6 months. For the TFR attempt, having standardized and reliable BCR-ABL PCR tests is mandatory. These recommendations will be useful for safe discontinuation in daily practice and will benefit patients who wish to stop treatment in emergent regions, in particular, with TKI-related chronic adverse events.

Prospecting Biomarkers for Diagnostic and Therapeutic Approaches in Pythiosis.

Pythiosis, whose etiological agent is the oomycete Pythium insidiosum, is a life-threatening disease that occurs mainly in tropical and subtropical countries, affecting several animal species. It is frequently found in horses in Brazil and humans in Thailand. The disease is difficult to diagnose because the pathogen's hyphae are often misdiagnosed as mucoromycete fungi in histological sections. Additionally, there is no specific antigen to use for rapid diagnosis, the availability of which could improve the prognosis in different animal species. In this scenario, we investigated which P. insidiosum antigens are recognized by circulating antibodies in horses and humans with pythiosis from Brazil and Thailand, respectively, using 2D immunoblotting followed by mass spectrometry for the identification of antigens. We identified 23 protein spots, 14 recognized by pooled serum from horses and humans. Seven antigens were commonly recognized by both species, such as the heat-shock cognate 70 KDa protein, the heat-shock 70 KDa protein, glucan 1,3-beta-glucosidase, fructose-bisphosphate aldolase, serine/threonine-protein phosphatase, aconitate hydratase, and 14-3-3 protein epsilon. These results demonstrate that there are common antigens recognized by the immune responses of horses and humans, and these antigens may be studied as biomarkers for improving diagnosis and treatment.

Changes in epidemiology and clinical practice in IgE-mediated Allergy in children.

In the last decades, allergic diseases have increased exponentially and although pediatric asthma prevalence is stabilizing, it is estimated around 10% in Spain. Not the same with food allergy and anaphylaxis which are clearly increasing, becoming a significant public health problem. Taking into account epidemiological trends, the European Academy of Allergy and Clinical Immunology (EAACI) estimates that in less than 15 years more than half of the European population will suffer from some type of allergic disorder. The advances in diagnostic methods in food allergy, especially component resolved diagnosis, allow us to know the patient's sensitization profile and explain possible cross reactivity, anticipate potential risk of food trangressions, and prescribe correct avoidance diet in each patient. Thus, the development of molecular biology and nanotechnology have led to the appearance of new technologies (microarrays) which facilitate the study, specially of the polysensitized patients, allowing allergen immunotherapy (AIT) to be more personalized. The latest advances in the use of biologics are having an impact, not only in disease evolution, but also in quality of life.

Juventudes, trabalho e cultura em tempos de racionalidade neoliberal / Youths, work and culture in neoliberal rationality times

Resumo O presente artigo se debruça sobre a temática das juventudes enquanto importante categoria social, inscrita em um contexto de diversidade social interessada, em especial, nos grupos que mais sofrem com os efeitos da exclusão e da desigualdade. Temos que a expansão da lógica do atual modo social de produção capitalista e suas respostas diante das crises, como o neoliberalismo e a reestruturação das relações de trabalho, por exemplo, resultaram em mutações acerca do trabalho e das sociabilidades no mundo contemporâneo. Compreende-se, então, que a racionalidade neoliberal interfere diretamente na relação entre juventudes, trabalho e cultura e o presente texto apresenta análise crítica sobre como esse contexto interfere nos/as jovens trabalhadores/as da cultura. O trabalho no campo cultural se apresenta como possibilidade factível e também como potencializador para a essência criativa, novas subjetividades e formas de ser e estar no mundo, ao mesmo tempo em que enfrenta e reproduz os desafios da precarização e flexibilização e o próprio desemprego ou não trabalho como parte deste processo. Na terapia ocupacional se faz essencial investigar como a desigualdade, a exclusão e a exploração, intrínsecos ao capitalismo e à racionalidade neoliberal, interferem e alteram as ocupações, as atividades humanas e os cotidianos, sobretudo daqueles que mais vivenciam seus efeitos.

Abstract This article focuses on the theme of youth as an important social category, in a context of social diversity especially interested in the groups that suffer most the effects of exclusion and inequality. The expanded logic of the current social mode of capitalist production and its responses to crises such as neoliberalism and the restructuring of labor relations has resulted in mutations about work and sociability in the contemporary world. It is understood, then, that neoliberal rationality directly interferes in the relation between youths, work and culture and the present essay presents a critical analysis on how this context interferes in the young cultural workers. In the cultural field, labor is a feasible possibility and also enhances the creative essence, new subjectivities and ways of being and being in the world, at the time it faces and reproduces the challenges of precarious work and flexibilization and unemployment or not working as part of this process. In occupational therapy, it is essential to investigate how inequality, exclusion and exploitation intrinsic to capitalism and neoliberal rationality interferes and alters occupations, human activities and daily life, especially of those who most experience its effects.

Short communication: Recombinant mammary serum amyloid A3 as a potential strategy for preventing intramammary infections in dairy cows at dryoff.

Mammary serum amyloid A3 (M-SAA3) has shown potential in stimulating innate immunity during intramammary infections, at calving and at dryoff. In this study, we produced recombinant caprine M-SAA3 to test its ability to reduce intramammary infections with Staphylococcus aureus, Streptococcus uberis, Streptococcus dysgalactiae, and Escherichia coli, which are all common mastitis-producing pathogens. Recombinant production of M-SAA3 (followed by lipopolysaccharide removal to avoid lipopolysaccharide-nonspecific stimulation of the immune system) was successfully achieved. Mammary serum amyloid A3 stimulated the expression of IL-8 in a dose-dependent manner in primary mammary cultures. Although a direct killing effect on Staph. aureus by M-SAA3 was not detected, this acute phase protein was able to reduce Staph. aureus, Strep. uberis, and Strep. dysgalactiae infections by up to 50% and induced a reduction in E. coli counts of 67%. In general, the best concentration of caprine M-SAA3 for inhibiting infections was the lowest concentration tested (10 µg/mL), although higher concentrations (up to 160 µg/mL) increased its antimicrobial potential against some pathogens.