Incidência de obstrução em cateteres periféricos intravenosos em adultos e fatores relacionados / Incidence of obstruction in peripheral intravenous catheters in adults and related factors / Incidencia de obstrucción en catéteres intravenosos periféricos en adultos y factores relacionados

Objetivo: analisar a incidência e os fatores relacionados à obstrução de cateter intravenoso periférico em adultos hospitalizados. Método: uma coorte prospectiva, realizada a partir da observação de 203 cateteres, entre fevereiro de 2019 e maio de 2020, em hospital público e de ensino brasileiro. Foram consideradas variáveis clínicas e do cateter. Os dados foram analisados descritivamente e por estatística inferencial. Resultados: o tempo de permanência variou entre um a 15 dias e a obstrução ocorreu em 7,5% das observações. Houve aumento do risco de obstrução em relação ao sexo (RR=0,49 / p=0,186), à idade (RR=1,20/ p=0,732), aos cateteres de maior calibre (RR=0,53/ p=0,250), à inserção no dorso da mão até antebraço (RR=2,33/ p=0,114) e ao tempo do cateter in situ (RR=033/ p=0,433). Conclusão: O cuidado diário e observação do cateter intravenoso periférico são importantes para minimizar o surgimento de complicações locais e sistêmicas e manter a patência do dispositivo.

Objective: to analyze the incidence and factors related to peripheral intravenous catheter obstruction in hospitalized adults. Method: a prospective cohort, based on the observation of 203 catheters, between February 2019 and May 2020, in a Brazilian public teaching hospital. Clinical and catheter variables were taken into account. The data was analyzed descriptively and using inferential statistics. Results: the length of stay ranged from one to 15 days and obstruction occurred in 7.5% of the observations. There was an increased obstruction risk in relation to gender (RR=0.49 / p=0.186), age (RR=1.20/ p=0.732), larger catheters (RR=0.53/ p=0.250), insertion in the back of the hand up to the forearm (RR=2.33/ p=0.114) and the time length the catheter was in situ (RR=033/ p=0.433). Conclusion: Daily care and observation of the peripheral intravenous catheter is important to minimize the appearance of local and systemic complications and maintain the patency of the device.

Objetivo: analizar la incidencia y los factores relacionados con la obstrucción del catéter intravenoso periférico en adultos hospitalizados. Método: cohorte prospectiva, realizada mediante la observación de 203 catéteres, entre febrero de 2019 y mayo de 2020, en un hospital escuela público brasileño. Se consideraron variables clínicas y del catéter. Los datos se analizaron de forma descriptiva y mediante estadística inferencial. Resultados: el tiempo de permanencia varió entre uno y 15 días y la obstrucción ocurrió en el 7,5% de las observaciones. Hubo mayor riesgo de obstrucción en relación con el sexo (RR=0,49 / p=0,186), la edad (RR=1,20 / p=0,732), los catéteres de mayor calibre (RR=0,53 / p= 0,250), la inserción en el dorso de la mano hasta el antebrazo (RR=2,33/ p=0,114) y el tiempo del catéter in situ (RR=033/ p=0,433). Conclusión: el cuidado diario y la observación del catéter intravenoso periférico son importantes para minimizar la aparición de complicaciones locales y sistémicas y mantener la permeabilidad del dispositivo.

Studying Orthodontic Tooth Movement in Mice.

Orthodontic tooth movement (OTM) represents a dynamic process in which the alveolar bone undergoes resorption at compression sites and deposition at tension sites, orchestrated by osteoclasts and osteoblasts, respectively. This mechanism serves as a valuable model for studying various aspects of bone adaptation, including root resorption and the cellular response to mechanical force stimuli. The protocol outlined here offers a straightforward approach to investigate OTM, establishing 0.35 N as the optimal force in a mouse model employing a nickel-titanium (NiTi) coil spring. Utilizing micro-computed tomography analysis, we quantified OTM by assessing the discrepancy in the linear distance at the cement-enamel junction. The evaluation also included an analysis of orthodontic-induced inflammatory root resorption, assessing parameters such as root mineral density and the percentage of root volume per total volume. This comprehensive protocol contributes to advancing our understanding of bone remodeling processes and enhancing the ability to develop effective orthodontic treatment strategies.

From Ovarian Hyperstimulation to the Discovery of a Liver Nodule.

Ovarian hyperstimulation syndrome (OHSS) is a complication of ovulation induction. Deep vein thrombosis (DVT) can occur as a consequence of this syndrome, but it is an infrequent event. The authors describe the case of a woman who became pregnant after ovulation induction and developed severe OHSS and, subsequently, DVT of the right brachiocephalic trunk, internal and external jugular veins, and right subclavian vein. Thrombophilia studies were positive, revealing the presence of four mutations. The pregnancy was bichorionic and biamniotic twins and, during the course of the pregnancy, she developed severe cholestasis. In the follow-up of this situation, she underwent abdominal ultrasound which revealed the presence of liver nodules. Three years after delivery, the patient remains anticoagulated and under surveillance of liver nodules by annual MRI.

Estimation of human age using machine learning on panoramic radiographs for Brazilian patients.

This paper addresses a relevant problem in Forensic Sciences by integrating radiological techniques with advanced machine learning methodologies to create a non-invasive, efficient, and less examiner-dependent approach to age estimation. Our study includes a new dataset of 12,827 dental panoramic X-ray images representing the Brazilian population, covering an age range from 2.25 to 96.50 years. To analyze these exams, we employed a model adapted from InceptionV4, enhanced with data augmentation techniques. The proposed approach achieved robust and reliable results, with a Test Mean Absolute Error of 3.1 years and an R-squared value of 95.5%. Professional radiologists have validated that our model focuses on critical features for age assessment used in odontology, such as pulp chamber dimensions and stages of permanent teeth calcification. Importantly, the model also relies on anatomical information from the mandible, maxillary sinus, and vertebrae, which enables it to perform well even in edentulous cases. This study demonstrates the significant potential of machine learning to revolutionize age estimation in Forensic Science, offering a more accurate, efficient, and universally applicable solution.

Spinocerebellar Ataxias: Phenotypic Spectrum of PolyQ versus Non-Repeat Expansion Forms.

Spinocerebellar ataxias (SCA) are most frequently due to (CAG)n (coding for polyglutamine, polyQ) expansions and, less so, to expansion of other oligonucleotide repeats (non-polyQ) or other type of variants (non-repeat expansion SCA). In this study we compared polyQ and non-repeat expansion SCA, in a cohort of patients with hereditary ataxia followed at a tertiary hospital. From a prospective study, 88 patients (51 families) with SCA were selected, 74 (40 families) of whom genetically diagnosed. Thirty-eight patients (51.4%, 19 families) were confirmed as having a polyQ (no other repeat-expansions were identified) and 36 (48.6%, 21 families) a non-repeat expansion SCA. Median age-at-onset was 39.5 [30.0-45.5] for polyQ and 7.0 years [1.00-21.50] for non-repeat expansion SCA. PolyQ SCA were associated with cerebellar onset, and non-repeat expansion forms with non-cerebellar onset. Time to diagnosis was longer for non-repeat expansion SCA. The most common polyQ SCA were Machado-Joseph disease (MJD/SCA3) (73.7%) and SCA2 (15.8%); whereas in non-repeat expansion SCA ATX-CACNA1A (14.3%), ATP1A3-related ataxia, ATX-ITPR1, ATX/HSP-KCNA2, and ATX-PRKCG (9.5% each) predominated. Disease duration (up to inclusion) was significantly higher in non-repeat expansion SCA, but the difference in SARA score was not statistically significant. Cerebellar peduncles and pons atrophy were more common in polyQ ataxias, as was axonal neuropathy. SCA had a wide range of genetic etiology, age-at-onset and presentation. Proportion of polyQ and non-repeat expansion SCA was similar; the latter had a higher genetic heterogeneity. While polyQ ataxias were typically linked to cerebellar onset in adulthood, non-repeat expansion forms associated with early onset and non-cerebellar presentations.

The protective and destructive critical processes of female labor in small-scale fishing in coast Pernambuco, Brazil. / Processos críticos protetores e destrutivos no trabalho das pescadoras artesanais do litoral Pernambucano, Brasil.

This study aims to analyze the protective and destructive critical processes of 34 water women in the municipalities of Cabo de Santo de Agostinho and Ipojuca, Pernambuco, Brazil, from February/21 to August/22. The work process stages were systematized by the work flowchart, and we employed Breilh's critical processes matrix to organize the data. The destructive processes identified in the general domain were injustice and socio-environmental vulnerability, such as the economic development model, the Suape Industrial Port Complex, the 2019 oil spill crime disaster, the COVID-19 pandemic, and the difficult access to public policies; in the particular domain: overloads and extended working hours, use of rudimentary equipment and tools, and unequal gender, class, and race relationships; in the singular domain: physical and mental illnesses and deaths. The protective processes identified in the general domain were sustainable development objectives, public health, and social assistance policies; in the particular domain, group work and processing, consumption for subsistence; in the singular domain, fishing as a therapeutic, pleasurable, and sharing process. The study highlighted the central issues of the water women and the need to establish public policies targeting their care.

Objetivou-se analisar os processos críticos, protetores e destrutivos do trabalho de 34 mulheres das águas nos municípios de Cabo de Santo de Agostinho e Ipojuca (PE), de fevereiro de 2021 a agosto de 2022. As etapas do processo de trabalho foram sistematizadas pelo fluxograma do trabalho e organizadas na matriz de processos críticos de Breilh. Os processos destrutivos, no domínio geral, foram: injustiça e vulnerabilização socioambiental como modelo de desenvolvimento econômico, o Complexo Industrial Portuário de Suape, o desastre-crime de petróleo ocorrido em 2019, a pandemia de COVID-19 e dificuldade de acesso às políticas públicas; no particular: jornadas e sobrecargas de trabalho, uso de equipamentos e ferramentas rudimentares e relações desiguais de gênero, classe e raça; no singular: adoecimentos físicos, mentais e mortes. Os processos protetores, no domínio geral: os objetivos de desenvolvimento sustentável, políticas públicas de saúde e assistência social; no particular: trabalho e beneficiamento em grupo, consumo para subsistência; no singular: a pesca como processo terapêutico, prazeroso e de partilha. O estudo destacou os problemas centrais das mulheres das águas e a necessidade do estabelecimento de políticas públicas voltadas ao seu cuidado.

Physicochemical Properties, Antioxidant Activity, and High-Performance Thin-Layer Chromatography Profiling of Propolis Samples from Western Australia.

This study reports on the physicochemical and antioxidant properties of propolis samples from various regions across Western Australia and identifies some phenolic constituents using high-performance thin-layer chromatography (HPTLC). Total phenolic content (TPC) was determined using a modified Folin-Ciocalteu assay, and antioxidant activity was investigated with the Ferric Reducing Antioxidant Power (FRAP) assay and also visualised and semi-quantified by HPTLC-DPPH analysis. TPC values ranged from 9.26 to 59.3 mg gallic acid equivalent/g of raw propolis and FRAP assay data from 4.34 to 53.8 mmol Fe2+ mmol/kg of raw propolis, although some of these variations might be related to differences in extraction yields obtained with 70% ethanol. The presence of luteolin, taxifolin, naringenin, and 4-hydroxyphenylacetic acid was confirmed based on a comprehensive, validated matching approach against an HPTLC-derived database. The findings of the study highlight the importance of future research on the chemical composition and bioactivity of Western Australian propolis.

The rising incidence of feline and cat-transmitted sporotrichosis in Latin America.

INTRODUCTION: Sporotrichosis is a subcutaneous mycosis caused by different species of thermodimorphic fungi belonging to the genus Sporothrix. These fungi may affect a wide range of warm-blooded animals, including humans, dogs and, mainly, cats. METHODS: In this article, we conducted a narrative literature review about the status of feline and cat-transmitted sporotrichosis in Latin American countries, with emphasis on Brazil. RESULTS: From a global perspective, Latin America is one of the main foci of human and feline sporotrichosis. In humans, the disease has been reported in several countries, with endemic transmission occurring in Brazil, Colombia, Costa Rica, Guatemala, Mexico and Uruguay. Sporothrix brasiliensis is the most common species identified in human cases in Brazil, whereas Sporothrix schenckii predominates in other countries. CONCLUSION: Domestic cats are the main source of infection in the zoonotic transmission cycle of sporotrichosis in Latin America. Cases of feline sporotrichosis have been reported in several countries, including Argentina, Brazil, Chile, Colombia, Mexico, Panama, Paraguay and Peru.

In vitro evaluation against Leishmania amazonensis and Leishmania chagasi of medicinal plant species of interest to the Unified Health System.

Leishmaniasis is a disease of public health relevance that demands new therapeutic alternatives due to the toxicity of conventional treatments. In this study, 27 plants of interest to the Unified Health System (SUS) were evaluated for cytotoxicity in macrophages, leishmanicidal activity and production of nitric oxide (NO). None of the species demonstrated cytotoxicity to macrophages (CC50 >100 µg/mL). Extracts from Chenopodium ambrosioides, Equisetum arvense, Maytenus ilicifolia showed greater efficacy in inducing the death of Leishmania amazonensis amastigotes with IC50 of 68.4, 82.3, 75.7 µg/mL, respectively. The species Cynara scolymus, Punica granatum and Passiflora alata were the most effective in inducing an increase in the indirect concentration of NO (41.31, 29.30 and 28.86 µM, respectively) in cultures of macrophages infected with L. amazonensis. Furthermore, Punica granatum was also the most effective species in inducing an increase in NO in macrophages infected by Leishmania chagasi (19.90 µM). The results obtained so far support the continuation of studies, with the possibility of developing safer and more effective treatments for leishmaniasis, using natural products. The identification of plants that stimulate the production of NO in macrophages infected by Leishmania opens doors for more detailed investigations of the mechanism of action of these natural products.

Long term cognitive dysfunction among critical care survivors: associated factors and quality of life-a multicenter cohort study.

OBJECTIVES: To identify the prevalence and associated factors of cognitive dysfunction, 1 year after ICU discharge, among adult patients, and it´s relation with quality of life. METHODS: Multicenter, prospective cohort study including ICUs of 10 tertiary hospitals in Brazil, between May 2014 and December 2018. The patients included were 452 adult ICU survivors (median age 60; 47.6% women) with an ICU stay greater than 72 h. RESULTS: At 12 months after ICU discharge, a Montreal Cognitive Assessment (tMOCA) telephone score of less than 12 was defined as cognitive dysfunction. At 12 months, of the 452 ICU survivors who completed the cognitive evaluation 216 (47.8%) had cognitive dysfunction. In multivariable analyses, the factors associated with long-term (1-year) cognitive dysfunction were older age (Prevalence Ratio-PR = 1.44, P < 0.001), absence of higher education (PR = 2.81, P = 0.005), higher comorbidities on admission (PR = 1.089; P = 0.004) and delirium (PR = 1.13, P < 0.001). Health-related Quality of life (HRQoL), assessed by the mental and physical dimensions of the SF-12v2, was significantly better in patients without cognitive dysfunction (Mental SF-12v2 Mean difference = 2.54; CI 95%, - 4.80/- 0.28; p = 0.028 and Physical SF-12v2 Mean difference = - 2.85; CI 95%, - 5.20/- 0.50; P = 0.018). CONCLUSIONS: Delirium was found to be the main modifiable predictor of long-term cognitive dysfunction in ICU survivors. Higher education consistently reduced the probability of having long-term cognitive dysfunction. Cognitive dysfunction significantly influenced patients' quality of life, leading us to emphasize the importance of cognitive reserve for long-term prognosis after ICU discharge.

Uso de agrotóxicos em canaviais de Pernambuco e danos à saúde do trabalhador / Use of pesticides in Pernambuco sugarcane fields and damage to workers' health

RESUMO O presente estudo teve por objetivo analisar a exposição aos agrotóxicos e os danos à saúde dos trabalhadores das plantações de cana-de-açúcar em Pernambuco. Trata-se de pesquisa participante desenvolvida em territórios rurais de cinco municípios com forte expressão em área plantada de cana-de-açúcar. Os dados primários foram produzidos em oficinas com trabalhadores rurais para construção de diagnóstico rural participativo, analisados mediante condensação de significados e interpretados à luz do referencial teórico da epidemiologia crítico latino-americana. Os resultados estão apresentados em três seções: i) Fluxograma do trabalho nas plantações de cana-de-açúcar; ii) Exposição aos agrotóxicos utilizados nas lavouras; iii) Danos à saúde do trabalhador. Conclui-se que a exposição permanente aos agrotóxicos envolve o trabalho nas plantações de cana-de-açúcar e emerge de um construto histórico e socioambiental, em que se encontram subsumidos os modos de vida dos territórios sob o domínio do agronegócio canavieiro. Recomendam-se políticas públicas de fomento à agricultura familiar com diversificação, escoamento e distribuição da produção agroecológica, além do fortalecimento da Atenção Primária à Saúde e de ações integradas de vigilância epidemiológica, sanitária, ambiental e do trabalhador.

ABSTRACT This study aims to analyze exposure to pesticides and harm to the health of workers on sugarcane plantations in Pernambuco. This participatory research was conducted in rural territories of five municipalities with a strong presence in sugarcane-planted areas. The primary data were produced in workshops with rural workers to construct a participatory rural diagnosis, analyzed through condensation of meanings, and interpreted in light of the theoretical framework of Latin American critical epidemiology. The results are presented in three sections: i) Flowchart of work on sugarcane plantations; ii) Exposure to pesticides used on crops; iii) Harm to worker's health. We conclude that permanent exposure to pesticides involves working on sugarcane plantations and emerges from a historical and socio-environmental construct in which the ways of life of the territories under the control of sugarcane agribusiness are subsumed. Public policies are recommended to promote family farming with diversification, flow, distribution of agroecological production, and strengthening primary health care and integrated epidemiological, health, environmental, and worker surveillance actions.

O mar que habita em mim: estratégias de comunicação sobre o trabalho da pesca artesanal de mulheres das águas / The sea that lives in me: communication strategies about the artisanal fishing work of women from the Waters / El mar que habita en mí: estrategias de comunicación sobre el trabajo pesquero artesanal de las mujeres de las aguas

As pescadoras artesanais do litoral de Pernambuco enfrentam os impactos das indústrias, do derramamento de petróleo e da pandemia de covid-19, conformando uma sindemia que agrava as vulnerabilidades socioe-conômicas, ambientais e sanitárias. Objetivou-se demonstrar que estratégias de comunicação e divulgação científica, como a cartilha "Saúde das mulheres das águas" e o documentário O mar que habita em mim, são importantes por promoverem a democratização do conhecimento. Trata-se de pesquisa-ação do tipo etnográfica para identificar aspectos do trabalho e da vida. Participaram 34 pescadoras, mediante grupos focais, oficina de fluxograma laboral, vivência do trabalho da pesca, análise e produção de estratégias. Esses materiais demonstram a relação saúde doença no trabalho da pesca enfatizando narrativas sobre deter-minação social da saúde. As estratégias comunicativas provocaram interesse da sociedade, promoveram debate e contribuíram para a consciência de profissionais/gestores de saúde sobre os povos das águas e as situações nos territórios.

Artisanal fisherwomen of Pernambuco face the impacts of the industries, of an oil spill and of the covid-19 pandemic, forming a syndemic that aggravates socioeconomic, environmental and health vulnerabilities. The objective was to demonstrate that scientific communication and dissemination strategies, such as the booklet "Saúde das mulheres das águas" and the documentary O mar que habita em mim, promote knowledge. This is an ethnographic type of action research to identify aspects of work and life. A total of 34 artisanal fisherwomen participated, in focus groups, labor flowchart workshop, experience of fishing work, analysis and production of strategies. These materials demonstrate the health disease relationship in fishing work, emphasizing the narratives of the fisherwomen about the social determination of their health. The communicative strategies provoked society's interests, promoted the debate and contributed to the awareness of professionals and health managers about the health of water's people and situations in the territories.

Pescadoras artesanales de pernambucano enfrentan impactos de industrias, derrame de petróleo y la pandemia de covid-19, formando una sindemia que agrava vulnerabilidades socioeconómicas, ambientales y de salud. El objetivo fue demostrar que las estrategias de comunicación y divulgación científica, como el folleto "'Salud das mujeres das aguas" y el documentario El mar que habita en mí, democratizan el conocimiento. Tiene abordaje de investigación-acción, etnográfica, para identificar aspectos del trabajo y la vida. Participaron 34 pescadoras en grupos focales, taller del flujo de trabajo, vivencia del trabajo en la pesca, análisis y elaboración de estrategias. Estos materiales demuestran la relación salud enfermedad en el trabajo pesquero, enfatizando narrativas sobre la determinación social de la salud. Las estrategias comu-nicativas despertaron el interés de la sociedad, promovieron el debate y contribuyeron a la sensibilización de los profesionales/gestores de la salud sobre los pueblos de las aguas y las situaciones de los territorios.

Engineering the Mechanical Stability of a Therapeutic Affibody/PD-L1 Complex by Anchor Point Selection.

Protein-protein complexes can vary in mechanical stability depending on the direction from which force is applied. Here we investigated the anisotropic mechanical stability of a molecular complex between a therapeutic non-immunoglobulin scaffold called Affibody and the extracellular domain of the immune checkpoint protein PD-L1. We used a combination of single-molecule AFM force spectroscopy (AFM-SMFS) with bioorthogonal clickable peptide handles, shear stress bead adhesion assays, molecular modeling, and steered molecular dynamics (SMD) simulations to understand the pulling point dependency of mechanostability of the Affibody:(PD-L1) complex. We observed diverse mechanical responses depending on the anchor point. For example, pulling from residue #22 on Affibody generated an intermediate unfolding event attributed to partial unfolding of PD-L1, while pulling from Affibody's N-terminus generated force-activated catch bond behavior. We found that pulling from residue #22 or #47 on Affibody generated the highest rupture forces, with the complex breaking at up to ~ 190 pN under loading rates of ~104-105 pN/sec, representing a ~4-fold increase in mechanostability as compared with low force N-terminal pulling. SMD simulations provided consistent tendencies in rupture forces, and through visualization of force propagation networks provided mechanistic insights. These results demonstrate how mechanostability of therapeutic protein-protein interfaces can be controlled by informed selection of anchor points within molecules, with implications for optimal bioconjugation strategies in drug delivery vehicles.

Antioxidant Activity, Physicochemical and Sensory Properties of Stingless Bee Honey from Australia.

This study reports on the physicochemical and sensory attributes, total phenolic content, and antioxidant activity of 36 honey samples produced by two different stingless bee species (Tetragonula carbonaria and Tetragonula hockingsi) from Australia. The findings reveal moisture content across all samples ranges from 24.9% to 30.8% (w/w), electrical conductivity from 1.02 to 2.15 mS/cm, pH levels between 3.57 and 6.54, soluble solids from 69.2 to 75.1 °Brix, trehalulose concentrations from 6.20 to 38.2 g/100 g, fructose levels from 7.79 to 33.4 g/100 g, and glucose content from 3.36 to 26.8 g/100 g. Sucrose was undetectable in all investigated samples. In a sensory analysis involving 30 participants, Australian stingless bee honey was perceived as having a more pronounced sourness compared with New Zealand Manuka honey. The study reveals considerable variability in the composition of Australian stingless bee honey, influenced by factors such as floral availability, geographical origin, and time of harvest. It also demonstrates the presence of phenolic compounds and antioxidant activity in stingless bee honey, underlining their potential as a natural source of antioxidants. All investigated samples contain trehalulose, which supports the findings of other recent studies that propose this unusual disaccharide as a marker compound of stingless bee honey.

Nursing Intervention to Prevent and Manage Delirium in Critically Ill Patients: A Scoping Review.

Delirium is an acute neuropsychiatric syndrome of multifactorial etiology with a high incidence in people admitted to intensive care units. In addition to reversible impairment of cognitive processes, it may be associated with changes in thinking and perception. If, in the past, it was considered an expected complication of severe disease, nowadays, delirium is associated with a poor short-term and long-term prognosis. Knowing that its prevention and early identification can reduce morbidity, mortality, and health costs, it is vital to investigate nursing interventions focused on delirium in critically ill patients. This study aimed to identify nursing interventions in the prevention and management of delirium in critically ill adults. The method used to answer the research question was a scoping review. The literature search was performed in the Medline (via PubMed), CINAHL (via EBSCOhost), Scopus, Web of Science, and JBI databases. The final sample included 15 articles. Several categories of non-pharmacological interventions were identified, addressing the modifiable risk factors that contribute to the development of delirium, and for which nurses have a privileged position in their minimization. No drug agent can, by itself, prevent or treat delirium. However, psychoactive drugs are justified to control hyperactive behaviors through cautious use. Early diagnosis, prevention, or treatment can reduce symptoms and improve the individual's quality of life. Therefore, nursing professionals must ensure harmonious coordination between non-pharmacological and pharmacological strategies.

Hereditary transthyretin amyloidosis: a myriad of factors that influence phenotypic variability.

Hereditary transthyretin-related amyloidosis (ATTRv amyloidosis) is a rare and progressively debilitating disease characterized by the deposition of transthyretin (TTR) amyloid fibrils in various organs and tissues, most commonly in the heart and peripheral nerves. This pathological deposition can lead to significant organ dysfunction and, ultimately, organ failure. ATTRv amyloidosis exhibits a broad range of clinical presentations, from purely neurological symptoms to purely cardiac manifestations, as well as mixed phenotypes which result from both neurological and cardiac implications. This wide phenotypical spectrum realistically challenges disease diagnosis and prognosis, especially in individuals without or with an unknown family history. Multiple factors are thought to contribute to this variability, including genetic, epigenetic, and even environmental influences. Understanding these factors is crucial, as they can significantly affect disease expression and progression. This review aims to summarize each of these contributing factors, to help elucidate the current knowledge on the phenotypical variability of ATTRv amyloidosis.

Effectiveness of a home-based pulmonary rehabilitation maintenance programme: the Rehab2Life study protocol.

Pulmonary rehabilitation (PR) is the bedrock of non-pharmacological treatment for people with COPD. Nonetheless, it is well described in the literature that unless the patient changes his behaviour, the benefits of PR programmes will decline in six to twelve months after finishing the programme. Therefore, maintenance programmes can address the problem of PR programmes' effect loss over time.Community care units can provide multidisciplinary care in the current Portuguese primary health care context. These units have an interdisciplinary team that aims to develop competencies in COPD patients to self-manage the disease.This study aims to test the effectiveness of a 12-month home-based PR programme (Rehab2Life) compared to usual care through a single-blind randomised controlled trial with two parallel groups. The Rehab2Life programme includes two distinct phases. The first is an 8-week PR programme delivered to both groups, and the second is a PR maintenance programme delivered to the intervention group after the initial eight weeks. The control group receive the usual care and regular appointments. The primary outcome is functional capacity, and secondary outcomes are dyspnea, Health-Related Quality of Life (HRQoL), number of exacerbations, symptoms burden, anxiety and depression symptoms, and physical activity.We expect to observe that the home-based PR programme brings clinically relevant benefits to the participants at the end of the first eight weeks and that, at 12 months after the maintenance phase of the programme, benefits are less dissipated than in the control group. We expect to identify the characteristics of the patients who benefit the most from home-based programmes.The trial was registered on 7 April 2022 at ClinicalTrials.gov (NCT05315505).

Understanding the municipal-level design and adaptation of pay-for-performance schemes across two states of Brazil.

The design of complex health systems interventions, such as pay for performance (P4P), can be critical to determining such programmes' success. In P4P programmes, the design of financial incentives is crucial in shaping how these programmes work. However, the design of such schemes is usually homogenous across providers within a given scheme. Consequently, there is a limited understanding of the strengths and weaknesses of P4P design elements from the implementers' perspective. This study takes advantage of the unique context of Brazil, where municipalities adapted the federal incentive design, resulting in variations in incentive design across municipalities. The study aims to understand why municipalities in Brazil chose certain P4P design features, the associated challenges and the local adaptations made to address problems in scheme design. This study was a multiple case study design relying on qualitative data from 20 municipalities from two states in Northeastern Brazil. We conducted two key informant interviews with municipal-level stakeholders and focus group discussions with primary care providers. We also reviewed municipal Primary Care Access and Quality laws in each municipality. We found substantial variation in the design choices made by municipalities regarding 'who was incentivized', the 'payment size' and 'frequency'. Design choices affected relationships within municipalities and within teams. Challenges were chiefly associated with fairness relating to 'who received the incentive', 'what is incentivized' and the 'incentive size'. Adaptations were made to improve fairness, mostly in response to pressure from the healthcare workers. The significant variation in design choices across municipalities and providers' response to them highlights the importance of considering local context in the design and implementation of P4P schemes and ensuring flexibility to accommodate local preferences and emerging needs. Attention is needed to ensure that the choice of 'who is incentivized' and the 'size of incentives' are inclusive and fair and the allocation and 'use of funds' are transparent.

The effect of temperature on the boundary conditions of West Nile virus circulation in Europe.

West Nile virus (WNV) is a vector-borne flavivirus that causes an increasing number of human and equine West Nile fever cases in Europe. While the virus has been present in the Mediterranean basin and the Balkans since the 1960s, recent years have witnessed its northward expansion, with the first human cases reported in Germany in 2018 and the Netherlands in 2020. WNV transmission and amplification within mosquitoes are temperature-dependent. This study applies a mathematical modelling approach to assess the conditions under which WNV circulation occurs based on the proportion of mosquito bites on WNV-competent birds (dilution), vector-host ratios, mosquito season length and the observed daily temperature data. We modelled five distinct European regions where previous WNV circulation has been observed within the Netherlands, Germany, Spain, Italy, and Greece. We observed that the number of days in which the basic reproduction number (R0) is above one, increased over the last 40 years in all five regions. In the Netherlands, the number of days in which the R0 is above one, is 70% lower than in Spain. The temperature in Greece, Spain and Italy allowed for circulation under low vector-host ratios, and at a high dilution. On the other hand in the Netherlands and Germany, given the observed daily temperature, the thresholds for circulation requires a lower dilution and higher vector-host ratios. For the Netherlands, a short window of introductions between late May and mid-June would result in detectable outbreaks. Our findings revealed that the temperate maritime climate of the Netherlands allows WNV circulation primarily during warmer summers, and only under high vector-host ratios. This research contributes valuable insights into the dynamic relationship between temperature, vector properties, and WNV transmission, offering guidance for proactive strategies in addressing this emerging health threat in Europe.

Characterisation of Patients With Chronic Obstructive Pulmonary Disease (COPD) From an Urban Municipality in the Northern Region of Portugal: A Cross-Sectional Study.

Background Pulmonary rehabilitation (PR) is formally indicated to all COPD patients in groups B and E. It positively impacts dyspnoea, health-related quality of life and exercise tolerance, reducing admissions among people with chronic obstructive pulmonary disease (COPD) who have had a recent exacerbation and symptoms of anxiety and depression. There is limited access to PR programmes in Portugal, partially due to insufficient resources or referrals. This study aims to characterise COPD patients and assess whether they have criteria for PR programmes. Data from this study may provide strategic information for healthcare organisations to differentiate and innovate their response to COPD patients. Methodology A cross-sectional study was conducted in an urban municipality in the northern region of Portugal. The sample was randomly extracted from the national primary electronic health records. The sample size (n = 339) was determined considering the population of COPD patients in this region (N = 2818), a 95% confidence level and a margin of error of 5%. Results In this population, the prevalence of COPD is 1.8%. Furthermore, in this sample, 40% (n = 136) of people diagnosed with COPD have a formal indication to participate in PR programmes, although only 14.2% (n = 48) of these patients had access to PR. Conclusion COPD is probably underdiagnosed in this Portuguese region. Most COPD patients have eligibility criteria to be offered PR programmes, although most of them do not benefit from this vital treatment. Investing in community and home-based programmes may increase PR access, reducing acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admissions.