Morbidity trend and space-time clusters of COVID-19 occurrence in children and adolescents

Abstract Objective: To analyze the morbidity trend and space-time distribution clusters of confirmed COVID-19 cases in children and adolescents. Method: An ecological study of COVID-19 cases confirmed in the Information System from 2020 to 2022 in the age group from 0 to 19 years old, residents in Mato Grosso municipalities, Brazilian Midwest region. A trend analysis of the monthly morbidity rate of cases/100,000 inhabitants was used, following Prais-Winsten's regression. A space-time distribution of the Bayesian incidence rate per 100,000 inhabitants was performed, in addition to a space-time scan to identify high-risk clusters. Results: Of all 79,592 COVID-19 cases studied, 51.6% were in females and 44.21% in people aged 15-19 years old. The mean monthly rate was 265.87 cases per 100,000 inhabitants, with a stationary trend in the period analyzed (Monthly Percentage Variation [MPV]) = 12.15; CI95%[MPV]: -0.73;26.70). The morbidity rate due to COVID-19 was higher in the female gender (283.14/ 100,000 inhabitants) and in the age group from 15 to 19 years old (485.90/100,000 inhabitants). An increasing trend was observed with a greater monthly time variation of 14.42% (CI95%[MPV]: 1.28;29.28)] among those aged from 10 to 14 years old. The primary cluster, which was also the one with the highest Relative Risk (RR = 5,16, p-value = 0.001), included 19 municipalities located in the North health macro-region. Conclusion: The findings indicated a monthly stationary trend in the study population, an increase in the age group from 10 to 14 years old, and areas at a higher risk for the disease in the North health macro-region of the state.

Morbidity trend and space-time clusters of COVID-19 occurrence in children and adolescents.

OBJECTIVE: To analyze the morbidity trend and space-time distribution clusters of confirmed COVID-19 cases in children and adolescents. METHOD: An ecological study of COVID-19 cases confirmed in the Information System from 2020 to 2022 in the age group from 0 to 19 years old, residents in Mato Grosso municipalities, Brazilian Midwest region. A trend analysis of the monthly morbidity rate of cases/100,000 inhabitants was used, following Prais-Winsten's regression. A space-time distribution of the Bayesian incidence rate per 100,000 inhabitants was performed, in addition to a space-time scan to identify high-risk clusters. RESULTS: Of all 79,592 COVID-19 cases studied, 51.6% were in females and 44.21% in people aged 15-19 years old. The mean monthly rate was 265.87 cases per 100,000 inhabitants, with a stationary trend in the period analyzed (Monthly Percentage Variation [MPV]) = 12.15; CI95%[MPV]: -0.73;26.70). The morbidity rate due to COVID-19 was higher in the female gender (283.14/100,000 inhabitants) and in the age group from 15 to 19 years old (485.90/100,000 inhabitants). An increasing trend was observed with a greater monthly time variation of 14.42% (CI95%[MPV]: 1.28;29.28)] among those aged from 10 to 14 years old. The primary cluster, which was also the one with the highest Relative Risk (RR = 5,16, p-value = 0.001), included 19 municipalities located in the North health macro-region. CONCLUSION: The findings indicated a monthly stationary trend in the study population, an increase in the age group from 10 to 14 years old, and areas at a higher risk for the disease in the North health macro-region of the state.

Calcineurin inhibitors in the management of recurrent miscarriage and recurrent implantation failure: Systematic review and meta-analysis.

Recurrent miscarriage (RM) affects up to 2.5% of couples of reproductive age. Up to 10% of couples using assisted reproductive technology experience recurrent implantation failure (RIF). Immunosuppressive drugs, such as calcineurin inhibitors (CNIs), has been proposed for RM and RIF management. This systematic review and meta-analysis (SRMA) aimed to evaluate the efficacy and safety of CNIs in RM and RIF treatment. We searched in the three databases. Review Manager 5.4.1 was used for statistical analysis. This review included 8 studies involving 1042 women (485 women in the CNIs group and 557 women in the control group). CNI treatment (cyclosporine [CsA] and tacrolimus [TAC]) increases live birth rate (LBR, odds ratio [OR]: 2.52; 95% confidence interval [CI]: 1.93-3.28, p < 0.00001) and clinical pregnancy rate (OR: 2.25; 95% CI: 1.54-4.40, p < 0.0001) and decreases miscarriage rate (OR: 0.45 95% CI: 0.32-0.63, p < 0.00001) when compared to the control. Side effects and obstetric and neonatal complications was similar in both groups. In conclusion, CNIs increased LBR in women with RM and RIF but there is a moderate risk of bias. Subgroup analysis revealed that CNIs improved LBR in women with RM with a low risk of bias. However, in women with RIF, with moderate to high risk of bias. The use of CsA and TAC, in low doses and for a short period, for managing reproductive failures in women seems to be safe, not causing serious side effects nor increasing the risk of obstetric and neonatal complications.

Pharmaceutical-contaminated irrigation water: implications for ornamental plant production and phytoremediation using enrofloxacin-accumulating species.

Enrofloxacin (Enro) has been widely encountered in natural water sources, and that water is often used for irrigation in crop production systems. Due to its phytotoxicity and accumulation in plant tissues, the presence of Enro in water used for crop irrigation may represent economical and toxicological concerns. Here, we irrigated two ornamental plant species (Zantedeschia rehmannii Engl. and Spathiphyllum wallisii Regel.) with water artificially contaminated with the antimicrobial enrofloxacin (Enro; 0, 5, 10, 100, and 1000 µg L-1) to evaluate its effects on ornamental plant production, as well as its accumulation and distribution among different plant organs (roots, leaves, bulbs, and flower stems), and examined the economic and environmental safety of commercializing plants produced under conditions of pharmaceutical contamination. The presence of Enro in irrigation water was not found to disrupt plant growth (biomass) or flower production. Both species accumulated Enro, with its internal concentrations distributed as the following: roots > leaves > bulbs > flower stems. In addition to plant tolerance, the content of Enro in plant organs indicated that both Z. rehmannii and S. wallisii could be safety produced under Enro-contaminated conditions and would not significantly contribute to contaminant transfer. The high capacity of those plants to accumulate Enro in their tissues, associated with their tolerance to it, indicates them for use in Enro-phytoremediation programs.

Lymph node microcalcifications after neoadjuvant chemotherapy: A therapeutic response marker.

Lymph node microcalcifications are rare events, and when they are accompanied by neoplasia, they usually seem to be associated with a metastatic condition. We present a case of a patient with breast cancer and lymph node microcalcifications undergoing neoadjuvant chemotherapy (NCT). A change in the calcification pattern towards becoming coarse was observed. Calcification represented a marker of axillary disease, and it was resected after NCT. This is the first report of a patient with lymph node microcalcification undergoing NCT. We observed a change in the calcification format, which facilitated lymph node sentinel identification. Pathological evaluation indicated metastatic disease.

Cell therapies for spinal cord injury: a review of the clinical trials and cell-type therapeutic potential.

Spinal cord injury (SCI) is an as yet untreatable neuropathology that causes severe dysfunction and disability. Cell-based therapies hold neuroregenerative and neuroprotective potential, but, although being studied in SCI patients for more than two decades, long-term efficacy and safety remain unproven, and which cell types result in higher neurological and functional recovery remains under debate. In a comprehensive scoping review of 142 reports and registries of SCI cell-based clinical trials, we addressed the current therapeutical trends and critically analysed the strengths and limitations of the studies. Schwann cells, olfactory ensheathing cells (OECs), macrophages and various types of stem cells have been tested, as well as combinations of these and other cells. A comparative analysis between the reported outcomes of each cell type was performed, according to gold-standard efficacy outcome measures like the ASIA impairment scale, motor and sensory scores. Most of the trials were in the early phases of clinical development (phase I/II), involved patients with complete chronic injuries of traumatic aetiology and did not display a randomized comparative control arm. Bone marrow stem cells and OECs were the most commonly tested cells, while open surgery and injection were the main methods of delivering cells into the spinal cord or submeningeal spaces. Transplantation of support cells, such as OECs and Schwann cells, resulted in the highest ASIA Impairment Scale (AIS) grade conversion rates (improvements in ∼40% of transplanted patients), which surpassed the spontaneous improvement rate expected for complete chronic SCI patients within 1 year post-injury (5-20%). Some stem cells, such as peripheral blood-isolated and neural stem cells, offer potential for improving patient recovery. Complementary treatments, particularly post-transplantation rehabilitation regimes, may contribute highly to neurological and functional recovery. However, unbiased comparisons between the tested therapies are difficult to draw, given the great heterogeneity of the design and outcome measures used in the SCI cell-based clinical trials and how these are reported. It is therefore crucial to standardize these trials when aiming for higher value clinical evidence-based conclusions.

Assessment of Gualaxo do Norte River water quality (Minas Gerais, Brazil) affected by the dam breach of Fundão utilizing exploratory multivariate techniques.

At the end of 2015, the Fundão dam belonging to the Samarco S.A. mining company was ruptured, releasing a flood of mud into the Gualaxo do Norte River, which advanced into the Doce River. The aim of the present study was to apply exploratory multivariate approaches to water quality data obtained during sampling campaigns at the Gualaxo do Norte River during the dry and rainy seasons, between July 2016 and June 2017. A total of 27 locations along the river were sampled, covering unaffected areas and regions influenced by the tailings waste from the dam. Determinations of chemical, physical, and microbiological water quality parameters were performed. Application of principal component analysis (PCA) resulted in the first two components together explaining 39.49% and 37.91% of the total variance for the dry and rainy season data, respectively. In both cases, the PCA groups were related to variables such as turbidity and total solids, which both presented higher values in regions affected by the mud flow. These results are in agreement with those obtained by the Kohonen neural network method, where two-dimensional maps confirmed the samples according to the affected and unaffected area by the disaster.

Teste de força máxima de preensão palmar em pessoas idosas longevas do sudeste brasileiro: definição de pontos de corte / Maximum handgrip strength test in long-lived elderly people from southeastern Brazil: definition of cutoff points

Resumo Objetivo Definir pontos de corte para os valores do teste de força máxima de preensão palmar (FMPP) em pessoas idosas longevas. Método Estudo transversal com amostra de pessoas idosas longevas, octogenárias e nonagenárias, saudáveis e independentes funcionais (grupo robusto) e frágeis (grupo frágil). O teste de FMPP foi realizado em triplicata, sendo considerado o maior valor obtido. Os valores de sensibilidade, especificidade e os pontos de corte foram calculados por meio da Curva Característica de Operação do Receptor (ROC). Foram utilizados os pontos de corte brasileiros e os do Consenso Europeu de Sarcopenia para estudo da comparação. Resultados Foram avaliadas 121 pessoas idosas, com idade média de 84,5±5,3 anos, 65 (53,7%) do sexo feminino, sendo 46 (38%) do grupo frágil e 75 (62%) do grupo robusto. Foram encontrados os pontos de corte para FMPP de 27 kgf para homens e 19 kgf para mulheres. Os valores de sensibilidade e especificidade para os pontos de corte masculinos foram 94,44 e 65,79, respectivamente. Para o sexo feminino foram de 85,71 e 67,57. A partir desses pontos de corte, 23 (38,3%) pessoas idosas do grupo robusto foram classificadas com força inadequada, e, portanto, com provável sarcopenia, ao passo que, de acordo com os pontos de corte brasileiros e europeus, o número é de 35 (44,3%) e 14 (33,3%), respectivamente. Conclusão O estudo definiu pontos de corte para a população longeva e mostrou que os pontos de corte definidos até o momento para a população idosa brasileira não se mostraram adequados para longevos.

Abstract Objective To define cut-off points for the values ​​of the Maximum Handgrip Strength (MGS) test in long-lived elderly people. Method Cross-sectional study with a sample of long-lived elderly people, octogenarians and nonagenarians, healthy and functionally independent (robust group) and frail (fragile group). The MHS test was performed in triplicate, with the highest value obtained being considered. Sensitivity, specificity and cut-off values ​​were calculated using the Receiver Operating Characteristic Curve (ROC). The Brazilian cut-off points and those of the European Consensus on Sarcopenia were used for the comparison study. Results 121 elderly people were evaluated, with a mean age of 84.5±5.3 years, 65 (53.7%) female, 46 (38%) from the frail group and 75 (62%) from the robust group. Cut-off points for MHS of 27 kgf for men and 19 kgf for women were found. Sensitivity and specificity values ​​for men's cutoffs were 94.44 and 65.79, respectively. For woman, they were 85.71 and 67.57. Based on these cutoff points, 23 (38.3%) individuals from the robust group were classified as having competitive strength, and therefore with probable sarcopenia, while according to the Brazilian and European cutoff points, the number is 35 (44.3%) and 14 (33.3%). Conclusion The study defined cut-off points for the oldest-old population and showed that the cut-off points defined so far for the Brazilian elderly population were not adequate for the oldest-old.

Is the Pilates method efficient to cause changes in the body composition of healthy individuals? A systematic review.

BACKGROUND: The Pilates Method has become more popular as an option for physical activity, also among healthy individuals, who seek a better quality of life and also an improve in body composition. This paper is a systematic review of the literature on the effectiveness of Pilates in the body composition of healthy individuals. METHODS: A systematic review of the literature was carried out using the PEDro, Cochrane Library, Medline and Pubmed databases; the inclusion and exclusion criteria were applied and the final studies were evaluated using the PEDro checklists. To ensure methodological quality, all steps were performed by two examiners and when discrepancies appeared, these were resolved by a third reviewer. RESULTS: Nine studies, published between 2004 and 2019, met the inclusion criteria. Six articles showed some improvement in relation to body composition, such as increased skeletal muscle mass and decrease in body fat mass and of these, when evaluated by the PEDro scale, only one obtained good methodological quality. CONCLUSION: This systematic review shows that the influence of Pilates on the body composition of healthy individuals is still uncertain due to the controversial results and the scarcity of studies with this public. The lack of studies with excellent methodological quality can be considered one of the factors that prevent a statement.

Efficacy of Voice Therapy With Acapella Choice ® Device in Subjects With Vocal Fatigue Delivered Via Telepractice.

PURPOSE: The present study aimed at assessing the effectiveness of remote voice therapy (telepractice) implemented with Acapella Choice device in subjects with vocal fatigue. METHODS: Thirty participants with vocal fatigue were randomly assigned to one of two treatment groups: (1) voice treatment with acapella Choice device plus vocal hygiene program (n=15), and (2) voice treatment with Water resistance therapy plus vocal hygiene program (n=15). Laryngoscopic assessment was conducted in all subjects to confirm diagnosis. Before and after voice therapy, participants underwent self-assessment of voice. Vocal Fatigue Index (VFI), Voice Handicap Index (VHI), and Vocal tract discomfort scale (VTDS) were used. Treatment period included six voice therapy sessions within 3 weeks, with a frequency of two therapy sessions per week. Each session lasted 30 minutes. For both groups, exercises consisted of a sequence of nine phonatory tasks performed with Acapella Choice (experimental group) and WRT (control group). Comparison for all variables were performed between experimental group and control group. RESULTS: Significant improvements were found when comparing Pre and Post measures for both groups. No significant differences were found when comparing Acapella Choice group and WRT group. CONCLUSION: Remote physiologic voice therapy with Acapella Choice device and water resistance therapy seem to be both effective to improve voice in subjects diagnosed with vocal fatigue. No differences should be expected between these therapeutic protocols when treating patients with vocal fatigue. Moreover, both are effective at reducing tiredness of voice, voice avoidance, physical discomfort associated with voicing, subjective perception of sensory discomfort in throat, and reduction of physical, emotional, and functional impact of voice problems.

Evaluating aquatic macrophytes for removing erythromycin from contaminated water: floating or submerged?

Water contamination by antibiotics is an emerging global problem, with impacts on both public health and the environment. Erythromycin has been encountered in bodies of water throughout the world, which demands the development of efficient remediation technologies. We investigated the physiological responses and phytoremediation capacity of four species of aquatic macrophytes, two floating (Salvinia molesta and Lemna minor) and two submerged (Myriophyllum aquaticum and Rotala rotundifolia). The plants were exposed to relevant environmental concentrations of erythromycin (0 and 1.7 µg l-1) in artificially contaminated water for seven days. Physiological evaluations evidenced the ability of that antibiotic to promote oxidative events in those plants, such as the activation of antioxidant enzymes (ascorbate peroxidase and/or catalase). S. molesta exposed to erythromycin demonstrated accumulations of hydrogen peroxide and oxidative damage (lipid peroxidation) that was reflected in growth reductions. The erythromycin removal efficiency of floating plants varied from 9 to 12%, while submerged species varied from 31 to 44%. As such, submerged macrophyte species demonstrated the most efficient removal of erythromycin from contaminated waters, and are therefore more indicated for antibiotic phytoremediation projects.

For the very first time, the capacities of floating and submerged plant species used for removing erythromycin from contaminated water were compared. Moreover, plant physiological responses were related to their phytoremediation capacity. Our results promise to have direct impacts on plant and environmental science as well as in toxicology since they will contribute to a better understanding of the effects of antibiotics in plants and indicate species for better performance of phytoremediation programs aiming to reclaim the antibiotic erythromycin.

Phytoremediation by ornamental plants: a beautiful and ecological alternative.

Phytoremediation is an eco-friendly and economical technology in which plants are used for the removal of contaminants presents in the urban and rural environment. One of the challenges of the technique is the proper destination of the biomass of plants. In this context, the use of ornamental plants in areas under contamination treatment improves landscape, serving as a tourist option and source of income with high added value. In addition to their high stress tolerance, rapid growth, high biomass production, and good root development, ornamental species are not intended for animal and human food consumption, avoiding the introduction of contaminants into the food web in addition to improving the environments with aesthetic value. Furthermore, ornamental plants provide multiple ecosystem services, and promote human well-being, while contributing to the conservation of biodiversity. In this review, we summarized the main uses of ornamental plants in phytoremediation of contaminated soil, air, and water. We discuss the potential use of ornamental plants in constructed buffer strips aiming to mitigate the contamination of agricultural lands occurring in the vicinity of sources of contaminants. Moreover, we underlie the ecological and health benefits of the use of ornamental plants in urban and rural landscape projects. This study is expected to draw attention to a promising decontamination technology combined with the beautification of urban and rural areas as well as a possible alternative source of income and diversification in horticultural production.

Descrição do seguimento farmacoterapêutico de pacientes com hanseníase em município hiperendêmico do estado de Mato Grosso / Pharmacotherapy follow-up of patients with leprosy in a hyperendemic city in the state of Mato Grosso

Introdução: A hanseníase é uma doença crônica, infectocontagiosa e considerada um problema de saúde pública no Brasil. O objetivo deste estudo foi descrever o seguimento farmacoterapêutico de pacientes com diagnóstico de hanseníase. Métodos: Estudo descritivo, com pacientes com hanseníase multibacilar do município de Rondonópolis, Mato Grosso. O seguimento farmacoterapêutico foi realizado a partir de uma versão adaptada do Método Dáder. Para análise de dados aplicou-se a estatística descritiva e o teste Qui-quadrado de Pearson.Resultados: Uma frequência de 95,6% dos participantes apresentou problemas relacionados aos medicamentos, 59,1% apresentaram 3 ou mais problemas, os mais frequentes foram administração errada do medicamento e interação medicamento/nutriente. A inefetividade não quantitativa foi o resultado negativo associado ao medicamento mais evidenciado. Os indivíduos acompanhados em um serviço especializado apresentaram menor número de problemas relacionados aos medicamentos quando comparados àqueles da Estratégia Saúde da Família (p = 0,027).Conclusão: A maioria dos pacientes acompanhados apresentou problemas relacionados ao uso de medicamentos. O método Dáder possibilitou realizar o seguimento farmacoterapêutico de indivíduos com hanseníase.

Introduction: Leprosy is a chronic, infectious, and contagious disease considered a public health problem in Brazil. The objective of this study was to describe the pharmacotherapy follow-up of patients diagnosed with leprosy. Methods: We conducted a descriptive study of patients with multibacillary leprosy in the city of Rondonópolis, state of Mato Grosso, Brazil. Pharmacotherapy follow-up was conducted based on an adapted version of the Dáder method. Data were analyzed using descriptive statistics and Pearson's chi-square test. Results: Drug-related problems (DRP) were reported in 95.6% of patients, among whom 59.1% had 3 or more problems DRPs. The most common DRPs were incorrect drug administration and drug-nutrient interaction. Nonquantitative ineffectiveness was the most common drug-related negative outcome. Patients monitored in a leprosy treatment center had fewer DRPs than those monitored by a Family Health Strategy team (p = 0.027). Conclusion: Most patients had DRPs. The Dáder method allowed pharmacotherapy follow-up of patients with leprosy.

Cuidado ao paciente com delirium na unidade de terapia intensiva: o olhar do enfermeiro / Care for patients with delirium in the intensive care unit: the nurse's view

Objetivo:analisar o cuidado ao paciente com delirium na Unidade de Terapia Intensiva através do olhar do enfermeiro. Metodologia: estudo qualitativo, exploratório e descritivo, realizado em duas UTI adulto de um hospitalar público, Bahia, Brasil. Participaram do estudo 12 enfermeiros que atenderam aos critérios de inclusão. Os dados foram coletados através de entrevista semiestruturada e analisados por meio da análise de conteúdo. Resultados: os resultados foram organizados em categorias os quais revelam que os aspectos do cuidado ao paciente com delirium envolvem atuar, perante aprevenção do delirium, o uso de instrumentos para sua identificação, as intervenções para o cuidado direcionado ao paciente e as facilidades e dificuldades do enfermeiro no cuidado ao paciente com delirium em UTI.Conclusão: o cuidado ao paciente com delirium envolve medidas de prevenção,uso de instrumentos para a sua identificação e ações farmacológicas e não farmacológicas parao seu tratamento. Ademais, o cenário de atuação revela facilidades e dificuldades relacionadas à aproximação com a temática, estando o suporte fornecido pelo serviço de saúde para sua atuação, como desfavorável e o conhecimento, como facilitador/dificultador para o manejo do delirium

Objective: to analyze the care for patients with delirium in the Intensive Care Unit through the eyes of the nurse. Methodology: qualitative, exploratory, and descriptive study carried out in two adult ICUs of a public hospital in Bahia, Brazil. Twelve nurses who met the inclusion criteria participated in the study. Data were collected through semi-structured interviews and analyzed using content analysis. Results: the results were organized into categories which reveal that the aspects of care for patients with delirium involve acting before the prevention of delirium, the use of instruments for its identification, the interventions for the care directed to the patient, and the facilities and difficultiesof nurses in the care of patients with delirium in the ICU. Conclusion: care for patients with delirium involves preventive measures, the use of instruments for its identification, and pharmacological and non-pharmacological actions for its treatment. Also, the performance scenario reveals facilities and difficulties related to approaching the theme, with the support provided by the health service for its performance, as unfavorable and knowledge, as a facilitator/hindrance for the management of delirium

Radiomic analysis of MRI to Predict Sustained Complete Response after Radiofrequency Ablation in Patients with Hepatocellular Carcinoma - A Pilot Study.

OBJECTIVES: To investigate whether quantitative textural features, extracted from pretreatment MRI, can predict sustained complete response to radiofrequency ablation (RFA) in patients with hepatocellular carcinoma (HCC). METHODS: In this IRB-approved study, patients were selected from a maintained six-year database of consecutive patients who underwent both pretreatment MRI imaging with a probable or definitive imaging diagnosis of HCC (LI-RADS 4 or 5) and loco-regional treatment with RFA. An experienced radiologist manually segmented the hepatic nodules in MRI arterial and equilibrium phases to obtain the volume of interest (VOI) for extraction of 107 quantitative textural features, including shape and first- and second-order features. Statistical analysis was performed to evaluate associations between textural features and complete response. RESULTS: The study consisted of 34 patients with 51 treated hepatic nodules. Sustained complete response was achieved by 6 patients (4 with single nodule and 2 with multiple nodules). Of the 107 features from the arterial and equilibrium phases, 20 (18%) and 25 (23%) achieved AUC >0.7, respectively. The three best performing features were found in the equilibrium phase: Dependence Non-Uniformity Normalized and Dependence Variance (both GLDM class, with AUC of 0.78 and 0.76, respectively) and Maximum Probability (GLCM class, AUC of 0.76). CONCLUSIONS: This pilot study demonstrates that a radiomic analysis of pre-treatment MRI might be useful in identifying patients with HCC who are most likely to have a sustained complete response to RFA. Second-order features (GLDM and GLCM) extracted from equilibrium phase obtained highest discriminatory performance.

Supraperiosteal application of hyaluronic acid with cannula: Is it possible?

INTRODUCTION: The aging process occurs in all anatomical layers of the face; therefore, rejuvenation should not be limited to the dermic signs of aging (Aesthet Surg J. 2018;38:73) The treatment with fillers in strategic points can reconstruct young anatomy, providing natural results (Aesthet Surg J. 2018;38:73). There are two instruments used for facial application of hyaluronic acid: cannula and needle. Both of them have advantages and disadvantages. OBJECTIVE: In this study, we aim to compare the limitations of application with cannula by cutaneous ultrasound when compared to the needle by ultrasound, since some injectors suggest that one of the disadvantages would be the inability to reach certain application plans (periosteum). MATERIALS AND METHODS: A 52-year-old female patient was treated with 22 mg/ml hyaluronic acid (Juvéderm® Voluma), guided by high-frequency ultrasound (LogicE device, Logic brand (GE Healthcare), with high-frequency linear probe (L8-L18i-RS). The left hemiface was treated with a 27G needle and the right hemiface with a 5 cm 22G cannula (SoftFil®). CONCLUSION: This study proved that, in the malar/zygomatic and the chin region, it is possible the cannula and needle reached the supraperiosteal region. In the temporal region, the cannula did not reach the supraperiosteal plane.

A topical formulation containing quercetin-loaded microcapsules protects against oxidative and inflammatory skin alterations triggered by UVB irradiation: enhancement of activity by microencapsulation.

Ultraviolet B (UVB) irradiation causes free radical production, increase inflammation and oxidative stress, thus, supporting the use of antioxidants by topical administration as therapeutic approaches. Quercetin (QC) is a flavonoid with antioxidant activity, however, high liposolubility makes it difficult to remain in the viable skin layer. Thus, this study evaluated whether microencapsulation of QC would enhance its activity in comparison with the same dose of free QC (non-active dose) and unloaded-microcapsules added in formulation for topical administration in a mouse model of UVB irradiation targeting the skin. Topical formulation containing Quercetin-loaded microcapsules (TFcQCMC) presents physico-chemical (colour, consistence, phase separation and pH) and functional antioxidant stability at 4 °C, room temperature and 40 °C for 6 months. TFcQCMC inhibited the UVB-triggered depletion of antioxidants observed by GSH (reduced glutathione), ability to reduce iron, ability to scavenge 2,2'-azinobis radical and catalase activity. TFcQCMC also inhibited markers of oxidation (lipid hydroperoxides and superoxide anion production). Concerning inflammation, TFcQCMC reduced the production of inflammatory cytokines, matrix metalloproteinase-9 activity, skin edoema, collagen fibre damage, myeloperoxidase activity/neutrophil recruitment, mast cell and sunburn cell counts. The pharmacological activity of TFcQCMC was not shared by the same pharmaceutical form containing the same dose of free QC or unloaded control microcapsules.