Comparative analysis of the degree of patient satisfaction after breast-conserving surgery with or without oncoplastic surgery: systematic review and meta-analysis.

Introduction: Conservative surgery is the gold standard for the treatment of single and small tumors and, combined with the concept of oncoplastic tumors, brings good aesthetic results while maintaining cancer safety. The objective was to comparatively analyze the degree of satisfaction of patients undergoing breast conserving surgery (BCS), with and without oncoplastic surgery (OPS) using level II OPS techniques. Methods: Review with a search in the databases MEDLINE (by PubMed), EMBASE, Clinical Trials, Scopus, Web of Science, BVS and Oppen gray. The meta-analysis of random effects was performed using the Der Simonian-Laird method considering the odds ratio (OR) with a 95% confidence interval (95% CI). Results: There was no statistically significant difference in the aesthetic outcome between women who underwent OPS and BCS (OR 0.90; 95% CI 0.62-1.30). The staging (OR 1.93; 95% CI 0.97-3.84; I 2 = 15.83%); tumor location [central (OR 1.28; 95% CI 0.06-27.49; I 2 = 17.63%); lower (OR 0.75; 95% CI 0.21-2.65; I 2 = 2.21%); superior (OR 0.67; 95% CI 0.26-1.74; I 2 = 0.00%] and tumor size (OR 8.73; 95% CI -11.82-29.28; I 2 = 93.18%) showed no association with the type of BCS performed, with or without OPS. The degree of satisfaction remains even in cases of extreme oncoplasty. Conclusion: The level of patient satisfaction in relation to BCS was similar to that of the group undergoing OPS, highlighting that OPS allows the patient's satisfaction rate to be maintained even in the case of large or multicentric tumors.

Systematic review to evaluate accuracy studies of the diagnostic criteria for periodontitis in pregnant women.

The diversity of criteria used in the diagnosis of periodontitis in pregnant women makes it difficult to define and compare the disease. Using a systematic review, this study evaluated the accuracy of criteria for diagnosing periodontitis in pregnant women. Searches were carried out in the databases: Medline/PubMed, Embase, Scopus, Web of Science, SciELO, Lilacs, ProQuest, and CINAHL. Validation studies of the criteria used for diagnosing periodontitis met the inclusion criteria. The study steps were performed by three independent reviewers. A qualitative synthesis of the included articles was carried out and the quality methodological analysis using the QUADAS-2 instrument. The assessment of the quality of the evidence was obtained through the GRADE tool. A total of 592 records were identified, of which only 6 made up this systematic review. The included studies analyzed different criteria for diagnosing periodontitis, evaluating 3,005 pregnant women. The criteria selected as a test presented results equivalent to the performance of those recognized as the gold standard. The self-reported criteria were of lower diagnostic accuracy. A major limitation of this review was the small number of primary studies that evaluated clinical diagnosis of periodontitis in pregnant women, which was highly heterogeneous, making it impossible to carry out accuracy meta-analysis and additional analyzes. There is a lack of consensus on the criteria for the diagnosis of periodontitis, with great variability in the accuracy and prevalence of the disease in pregnant women.

The effect of antireaction medications on the association between periodontitis and leprosy reactions: An important methodological issue in periodontal medicine.

BACKGROUND: The treatment of leprosy reactions (LRs) involves thalidomide, corticosteroids, and other immunomodulatory medications. This study evaluated the effect of these treatments on the association between periodontitis and LRs, as well as factors associated with LRs. METHODS: This case-control study was conducted on 283 individuals followed at a leprosy outpatient clinic in Brazil. The case group was comprised of 158 individuals presenting type 1 or type 2 LRs, and the control group of 125 leprosy individuals without reactions. A complete oral examination was performed to diagnose periodontitis, the independent variable. Antireaction medication used was collected from medical records, and participants were classified according to the use of prednisone and/or thalidomide, time of use, or non-use of medication. Socioeconomic-demographic, clinical, and lifestyle covariables were collected by interview. Unconditional logistic regression analysis by subgroups evaluated the effect of antireaction medication on the association between periodontitis and LRs, estimating the odds ratio with a 95% confidence interval (OR; 95% CI). RESULTS: A relationship between periodontitis and LRs was observed only in the subgroup using the association prednisone and thalidomide: ORadjusted = 0.32; 95% CI = 0.11-0.95. Conversely, more severe periodontal clinical parameters were observed in cases versus controls. Several socioeconomic, health conditions, and lifestyle factors were associated with the presence of LRs. CONCLUSIONS: Although periodontal disease indicators were worse among the cases, the findings showed a negative relationship between periodontitis and LRs in individuals receiving associated prednisone and thalidomide. These medications appear to influence the inflammatory cascade between diseases, modifying and masking the manifestations of periodontitis.

INCIDENTALLY VS. NON-INCIDENTALLY DIAGNOSED PAPILLARY THYROID CARCINOMA: ARE THERE DIFFERENCES?

Thyroid carcinoma (TC) incidence increased over the past 50 years. The explanation for this is not consensual. OBJECTIVE: Compare incidental vs. non-incidental TC (ITC vs. NITC) regarding demographic, clinical, histological data and 5-year clinical outcomes. DESIGN: Retrospective analysis of 225 papillary TC (PTC) cases that completed a 5-year follow-up. METHODS: Created 2 groups: ITC (including the incidentalomas) and NITC (cases of palpable or visible nodules or with thyroid compressive complaints). RESULTS: Included 225 PTC (122 were ITC). There were 95 women in ITC and 78 in NITC. ITC patients were significantly older (53.3±14.8 vs 47.2±17.7, p=0.006). Groups had no differences in family history of TC. ITC mean tumour size was smaller (19.1±9.2 vs 28.6±16.2, p<0.01). Tumours >20mm comprised 36.1% of ITC and 58.2% of NITC. We found no differences in tumour multifocality, histological thyroiditis, aggressive PTC subtypes, capsule or lymph-vascular invasion and gross extrathyroidal extension. There were no differences regarding the number of patients submitted to RAI or in RAI activity. pTMN staging showed higher prevalence of T3a and T4 cases (p<0.01), and M1 status (p=0.025) in NITC. There were no differences in the rates of persistence of disease. Logistic regression showed that the diagnostic modality had no impact on the 5-year clinical outcome. CONCLUSIONS: ITC patients were older and had smaller tumours. NITC showed no worst histological features or 5-year clinical outcome. Approximately, one third of ITC had diameters >20mm. As even large tumours can be ITC, overdiagnosis can be the most likely cause for the TC increasing incidence.

Unveiling the Narratives of Portuguese Professionals Engaged with Domestic Violence Victims: Persistent Challenges and Novel COVID-19 Impacts.

Domestic violence remains a complex and challenging issue, particularly for professionals engaged in providing support to victims. The occurrence of emergency situations, such as the COVID-19 pandemic, further exacerbates the difficulties faced by these practitioners. This study aims to explore the lived experiences of professionals working with domestic violence victims, with a specific focus on the primary challenges encountered during interventions. It also aims to identify key guidelines that could enhance their practices. Twenty-four professionals from the domestic violence victim support in Portugal participated in this qualitative research. Through semi-structured interviews and thematic analysis, the study identified a range of challenges professionals confront in their intervention efforts. These challenges encompassed various aspects of the intervention process, vulnerabilities observed in victims, and the existing support system. Furthermore, the study uncovered specific challenges posed by the COVID-19 pandemic. Alongside these challenges, the research highlighted a set of recommendations designed to refine intervention strategies and promote better professional adaptation. The findings underscore the array of challenges that professionals grapple with, impacting both their strategies for intervention and their overall well-being. Thus, the development of effective intervention methodologies for professionals and organizations emerges as a crucial endeavor, essential for assisting domestic violence victims in their daily lives and enhancing preparedness for potential future crises.

Excessive weight in pregnant women increases the chance of diagnosing periodontitis combined with tooth loss.

BACKGROUND: Excess weight (EW), especially in women of childbearing age, those who are pregnant, as well as postpartum, is a problem worldwide. Fat accumulation deregulates the inflammatory response, contributing to the development of health problems, such as periodontitis. This study investigated the association between EW and periodontitis during pregnancy. METHODS: A cross-sectional, multicenter study involved 1745 postpartum women in Brazil. Socioeconomic-demographic data, gestational history, lifestyle behavior, and general and oral health conditions were obtained. Pre-pregnancy body mass index (BMI) was collected from medical records with EW being the exposure. Both tooth loss and clinical attachment level (CAL) were evaluated, and the presence of periodontitis was the outcome. Logistic regression, odds ratio (OR) and 95% confidence interval (95% CI), and quantile regression, beta coefficient and 95% CI, estimated the association between EW (BMI) and periodontitis and its combined effect with tooth loss ≥3, as dichotomous and continuous variables (CAL and tooth loss), with 5% significance level. RESULTS: The EW was 27.7% prevalent and periodontitis was 11.7%. There was a positive association between EW and periodontitis: ORadjusted:1.39; 95% CI:1.01;1.92 and between EW and periodontitis combined with tooth loss ≥3: ORadjusted:1.73; 95% CI:1.36;2.20. The adjusted association between EW and periodontitis as continuous variables was also positive, showing that for each unit of increased BMI, there was an elevation in the mean CAL (p = 0.04) and tooth loss (p < 0.01), with statistical significance. CONCLUSIONS: There was a moderate association between EW and periodontitis during pregnancy, with an even greater association of pregnant women with EW presenting periodontitis combined with tooth loss.

The accuracy of self-reported family history in glaucoma in Brazil.

PURPOSE: To evaluate the accuracy of a positive self-reported glaucoma family history. MATERIAL AND METHODS: Cross-sectional study. Each subject was asked if they had a first-degree relative diagnosed with glaucoma. If their answer was affirmative, the relative was invited to attend on ophthalmic evaluation and underwent complementary exams to confirm or exclude the glaucoma diagnosis. Only one relative was included per subject. RESULTS: We included 204 subjects in the study (102 subjects and their respective relatives). The accuracy of family history of glaucoma was 76.96% of the cases. In the univariable analysis, subjects with college degree had 2.34 [(P = 0.010; 95% confidence interval (CI) 1.18-4.63)], with higher family income 3.72 (P = 0.003; 95% CI 1.57-8.85) and those with health insurance 3.42 (P = 0.001; 95% CI 1.67-6.98) more chances to have a true positive family history for glaucoma. In the multivariable logistic regression analysis, none of the variables presented significant association. CONCLUSION: Around 24% of patients may not provide reliable information about family history for glaucoma. When asking about a glaucoma family history, clinicians should consider the real accuracy of this self-reported data.

Lists of potentially inappropriate medications for older people in primary care: a systematic review of health outcomes.

This study is a systematic literature review of the association between lists of potentially inappropriate medications (PIM) in clinical practice and health outcomes of older adults followed up in primary health care. For this purpose, the PRISMA protocol was used to systematize the search for articles in the PubMed, Web of Science, Scopus, Cochrane Central, LIVIVO and LILACS databases, in addition to the gray literature. Studies with randomized clinical trials were selected, using explicit criteria (lists) for the identification and management of PIM in prescriptions of older patients in primary care. Of the 2,400 articles found, six were used for data extraction. The interventions resulted in significant reductions in the number of PIM and adverse drug events and, consequently, in potentially inappropriate prescriptions (PIP) in polymedicated older adults. However, there were no significant effects of the interventions on negative clinical outcomes, such as emergency room visits, hospitalizations and death, or on improving the health status of the older adults. The use of PIM lists promotes adequate medication prescriptions for older adults in primary health care, but further studies are needed to determine the impact of reducing PIM on primary clinical outcomes.

Nursing management of catheter-related non-infectious complications of PD: Your questions answered.

A review from the last seven years (August 2016-July 2023) of questions posted to the International Society for Peritoneal Dialysis (ISPD) website "Questions about PD" by nurses and physicians from around the world revealed that 19 of the questions were associated with optimal approaches for preventing, assessing, and managing issues related to PD catheter non-infectious complications. Our review focused on responses to these questions whereby existing best practice recommendations were considered, if available, relevant literature was cited and differences in international practices discussed. We combined similar questions, revised both the original questions and responses for clarity, as well as updated the references to these questions. PD catheter non-infectious complications can often be prevented or, with early detection, the potential severity of the complication can be minimized. We suggest that the PD nurse is key to educating the patient on PD about PD catheter non-infectious complications, promptly recognize a specific complication and bring that complication to the attention of the Home Dialysis Team. The questions posted to the ISPD website highlight the need for more education and resources for PD nurses worldwide on the important topic of non-infectious complications related to PD catheters, thereby enabling us to prevent such complications as PD catheter malfunction, peri-catheter leakage and infusion or drain pain, as well as recognize and resolve these issues promptly when they do arise, thus allowing patients to extend their time on PD therapy and enhance their quality of life whilst on PD.

Gastric outlet obstruction in an 11-year-old girl: A case report.

Pyloric stenosis commonly affects infants and rarely causes gastric outlet obstruction in adolescents and older children. We present the case of an 11-year-old girl with a 2-month history of recurrent postprandial vomiting and weight loss. On physical examination, the patient presented with abdominal distension. Upper gastrointestinal endoscopy revealed a very small pyloric orifice through which the endoscope could not be advanced. Abdominal ultrasonography and a computed tomography confirmed pylorus thickening. She underwent Heineke-Mikulicz pyloroplasty with symptom resolution.

Case report: Introduction of an Ahmed valve implant tube into the ciliary sulcus using a guide-wire.

BACKGROUND: Glaucoma is a progressive optic neuropathy and it is the main cause of irreversible blindness worldwide. Intraocular pressure (IOP) is the only modifiable one and trabeculectomy is commonly considered the surgical "gold standard" to decrease IOP. In particular cases, other kind of surgeries, as the Ahmed Glaucoma Valve (AGV) implant, are a reliable alternative. Usually, the silicone tube of AGV surgery is inserted into the anterior chamber. Sometimes it is necessary to place the AGV silicone tube in the ciliary sulcus, especially in cases of endothelial decompensation. This surgical procedure is not always easy to perform. CASE PRESENTATION: This article describes and presents a technique for inserting the AGV tube into the posterior chamber using a guide-wire, in a total of 12 cases are reported. This procedure has been mostly applied in a group of pseudophakic patients who need AGV placement to control elevated IOP. In exceptional situations, this procedure was applied in pseudophakic patients previously with AGV tube implanted in the anterior chamber and with loss of endothelial cells or in phakic patients with previously implanted AGV anterior chamber tube, simultaneously to cataract surgery. CONCLUSION: The purpose of these cases presentations attended at our service is to demonstrate the passage of the AGV silicone tube was performed with the aid of a guide wire.

Biological Activity of 6,7-Dehydroxyroyleanone and Derivatives Obtained from Plectranthus aliciae (Codd) A.J.Paton.

The Plectranthus genus (Lamiaceae) is known to be rich in abietane diterpenes. The bioactive 6,7-dehydroxyroyleanone (DHR, 1) was previously isolated from Plectranthus madagascariensis var. madagascariensis and var. aliciae. This study aimed to explore the occurrence of DHR, 1, in P. aliciae and the potential bioactivities of new semisynthetic derivatives from DHR, 1. Several extraction methods were evaluated, and the hydrodistillation, using a Clevenger apparatus, afforded the highest yield (77.8 mg/g of 1 in the essential oil). Three new acyl derivatives (2-4) were successfully prepared from 1 (yields of 86-95%). Compounds 1-4 showed antioxidant activity, antibacterial effects, potent cytotoxic activity against several cell lines, and enhanced anti-inflammatory activity that surpassed dexamethasone (positive control). These findings encourage further exploration of derivatives 2-4 for potential mechanisms of antitumoral, antioxidant, and anti-inflammatory capabilities, studying both safety and efficacy.

Nematicidal Activity of Phytochemicals against the Root-Lesion Nematode Pratylenchus penetrans.

Plant-parasitic nematodes (PPNs) are highly damaging pests responsible for heavy losses in worldwide productivity in a significant number of important plant crops. Common pest management strategies rely on the use of synthetic chemical nematicides, which have led to serious concerns regarding their impacts on human health and the environment. Plant natural products, or phytochemicals, can provide a good source of agents for sustainable control of PPNs, due to their intrinsic characteristics such as higher biodegradability, generally low toxicity for mammals, and lower bioaccumulation in the environment. In this work, the nematicidal activity of 39 phytochemicals was determined against the root-lesion nematode (RLN) Pratylenchus penetrans using standard direct and indirect contact methodologies. Overall, the RLN was tolerant to the tested phytochemicals at the highest concentration, 2 mg/mL, seldom reaching full mortality. However, high activities were obtained for benzaldehyde, carvacrol, 3-octanol, and thymol, in comparison to other phytochemicals or the synthetic nematicide oxamyl. These phytochemicals were seen to damage nematode internal tissues but not its cuticle shape. Also, the environmental and (eco)toxicological parameters reported for these compounds suggest lower toxicity and higher safety of use than oxamyl. These compounds appear to be good candidates for the development of biopesticides for a more sustainable pest management strategy.

Effectiveness and safety of lenvatinib in a series of advanced well-differentiated thyroid carcinomas from a single tertiary cancer center and literature review.

BACKGROUND: Treatment of advanced differentiated thyroid carcinoma (DTC) remains a challenge as 25-50% of patients with locally invasive or distant metastatic disease become refractory to radioiodine (RAI) therapy. Tyrosine kinase inhibitors (TKI) are increasingly used in this setting. The SELECT trial demonstrated that lenvatinib, a multikinase inhibitor, significantly improved progression free survival (PFS) compared to placebo. Our aim was to report the effectiveness and safety of lenvatinib in our series of patients with advanced DTC. METHODS: A total of 25 patients with advanced DTC followed at a single tertiary center from January of 2016 to January of 2022 were retrospectively reviewed. RESULTS: Patients were treated with a mean daily dose of lenvatinib of 16.9 mg for a mean of 9.1 months. Median estimated PFS was 31.3 months. One patient achieved complete response. The objective response rate (ORR) was 40% and the disease control rate was 84%. The mean change in summed longest diameter of target lesions from baseline to nadir was -36.9%. Lenvatinib prolonged the tumor volume doubling time in 86.7% patients. Interestingly, we found that patients treated with a lower dose of lenvatinib (<16.9 mg daily) had a significantly higher PFS and ORR than patients treated with higher dosages (>16.9 mg). Adverse events were frequently reported. CONCLUSIONS: Our results confirm the effectiveness of lenvatinib in the management of patients with advanced DTC and support the need to adjust the dosage of lenvatinib to patient´s performance status and comorbidities.

Chemical Characterization and Biological Properties Assessment of Euphorbia resinifera and Euphorbia officinarum Moroccan Propolis.

Although the plants of the genus Euphorbia are largely exploited by therapists in Morocco, the composition and antibacterial activities of propolis from these plants are still unknown. To address this gap, this study aimed to characterize the pollen type, the volatile compounds, and the phenolic and mineral profiles of three Euphorbia propolis samples collected in Morocco and evaluate their antimicrobial activities. The minimum inhibitory concentration of the propolis samples was determined by the microdilution method, and the anti-adherence activity was evaluated by the crystal violet assay. The examination of anti-quorum-sensing proprieties was performed using the biosensor Chromobacterium violaceum CV026. Pollen analysis revealed that Euphorbia resinifera pollen dominated in the P1 sample (58%), while E. officinarum pollen dominated in the P2 and P3 samples (44%). The volatile compounds were primarily composed of monoterpene hydrocarbons, constituting 35% in P1 and 31% in P2, with α-pinene being the major component in both cases, at 16% in P1 and 15% in P2. Calcium (Ca) was the predominant mineral element in both E. resinifera (P1) and E. officinarum (P2 and P3) propolis samples. Higher levels of phenols, flavonoids and dihydroflavonoids were detected in the E. officinarum P2 sample. The minimum inhibitory concentration (MIC) value ranged from 50 to 450 µL/mL against Gram-positive and Gram-negative bacteria. Euphorbia propolis displayed the ability to inhibit quorum sensing in the biosensor C. violaceum CV026 and disrupted bacterial biofilm formation, including that of resistant bacterial pathogens. In summary, the current study evidences the potential use of E. officinarum propolis (P2 and P3) to combat important features of resistant pathogenic bacteria, such as quorum sensing and biofilm formation.

Surface Treatment of Dental Mini-Sized Implants and Screws: A Systematic Review with Meta-Analysis.

Miniscrews are devices that allow for absolute skeletal anchorage. However, their use has a higher failure rate (10-30%) than dental implants (10%). To overcome these flaws, chemical and/or mechanical treatment of the surface of miniscrews has been suggested. There is no consensus in the current literature about which of these methods is the gold standard; thus, our objective was to carry out a systematic review and meta-analysis of the literature on surface treatments of miniscrews. The review protocol was registered (PROSPERO CRD42023408011) and is in accordance with the PRISMA guidelines. A bibliographic search was carried out on PubMed via MEDLINE, Cochrane Library, Embase and Web of Science. The initial search of the databases yielded 1684 results, with 98 studies included in the review, with one article originating from the search in the bibliographic references of the included studies. The results of this systematic review show that the protocols of miniscrew surface treatments, such as acid-etching; sandblasting, large-grit and acid-etching; photofunctionalization with ultraviolet light; and photobiomodulation, can increase stability and the success of orthodontic treatment. The meta-analysis revealed that the treatment with the highest removal torque is SLA, followed by acid-etching. On the other hand, techniques such as oxidative anodization, anodization with pre-calcification and heat treatment, as well as deposition of chemical compounds, require further investigation to confirm their effectiveness.

Nutritional risk and morbidity and mortality in intensive care unit patients with Coronavirus disease 2019.

INTRODUCTION: The Coronavirus disease 2019 (COVID-19) spread rapidly, with 37 million cases and more than 699,000 deaths. Among intensive care unit (ICU) patients with COVID-19, a high incidence of acute kidney injury (AKI) has been observed, ranging from 50 to 80%; furthermore, 85.9% were calculated to have high nutritional risk, which doubled their odds of death. The aim of the present study was to evaluate possible associations between nutritional risk, acute kidney injury, and morbidity and mortality in patients with COVID-19 admitted to an ICU. METHODS: Retrospective cohort study of adult and older-adult patients hospitalized for >24 h in an ICU. The exposure was diagnosis of COVID-19, while the outcomes were mortality, acute kidney injury, dialysis, mechanical ventilation, and vasopressor use. The association of nutritional risk with outcomes was evaluated. The sample consisted of two secondary datasets. Individuals aged <18 years, those with dialytic chronic kidney disease, pregnant women, and those diagnosed with brain death were excluded. RESULTS: The sample consisted of 192 patients: 101 in the exposure group (positive for COVID-19) and 91 in the control group (no COVID-19 diagnosis). The COVID-19 and non-COVID-19 groups differed significantly in the variables weight, body mass index (BMI), nutritional risk, mNUTRIC-S score, and length of ICU stay. Our results suggest that the optimal mNUTRIC-S score cutoff to predict nutritional risk is <5 points. CONCLUSION: COVID-19 has a significant impact on patients' kidney function, increasing the incidence of AKI and the likelihood of death. Nutritional risk is a major factor in the mortality of patients with COVID-19. Therefore, use of the mNUTRIC-S scale could contribute to assessment of prognosis in this patient population.

Coriander (Coriandrum sativum L.) from Alentejo (South Portugal)-Ethnobotany and Potential Industrial Use.

Coriander is a medicinal and aromatic plant (MAP) traditionally cultivated and used in Alentejo, Portugal. However, few publications are available about its ethnobotanical applications. Four independent ethnobotanical surveys were carried out: throughout the region (2002-2003), in three villages (2013), and in city markets (2007 and 2022). Coriander was the most common fresh cultivated MAP (75% of the total area) and also the most representative MAP fresh herb in city markets. The leaves, mostly, were used fresh or frozen or transformed in piso. Some of the recipes have agro-industrial potential, such as piso and aromatized olive oil. Coriander essential oils (EOs) were isolated by hydrodistillation from aerial parts with inflorescence emergence (APIs) and from fruits, and fatty acids (FA) by solvent extraction from the fruits. Gas chromatography and gas chromatography-mass spectrometry analysis showed EOs dominated by n-decanal (21-24%), 2-trans-decenal (12-18%) and n-nonane (10-17%) in APIs, and linalool dominance (73-78%) in the fruits. Petroselinic acid (32-55%) was the dominant fatty acid. A literature survey on conventional and nonconventional extraction techniques showed a constancy in the dominant compounds isolated, highlighted piso as a home-made green-extraction procedure, but also reflected the relevance of coriander as a MAP with diverse industrial potential uses.

Targeting circulating labile heme as a defense strategy against malaria.

Severe presentations of malaria emerge as Plasmodium (P.) spp. parasites invade and lyse red blood cells (RBC), producing extracellular hemoglobin (HB), from which labile heme is released. Here, we tested whether scavenging of extracellular HB and/or labile heme, by haptoglobin (HP) and/or hemopexin (HPX), respectively, counter the pathogenesis of severe presentations of malaria. We found that circulating labile heme is an independent risk factor for cerebral and non-cerebral presentations of severe P. falciparum malaria in children. Labile heme was negatively correlated with circulating HP and HPX, which were, however, not risk factors for severe P. falciparum malaria. Genetic Hp and/or Hpx deletion in mice led to labile heme accumulation in plasma and kidneys, upon Plasmodium infection This was associated with higher incidence of mortality and acute kidney injury (AKI) in ageing but not adult Plasmodium-infected mice, and was corroborated by an inverse correlation between heme and HPX with serological markers of AKI in P. falciparum malaria. In conclusion, HP and HPX act in an age-dependent manner to prevent the pathogenesis of severe presentation of malaria in mice and presumably in humans.

Scheimpflug-Based Corneal Biomechanical Analysis As A Predictor of Glaucoma in Eyes With High Myopia.

Purpose: To address if corneal biomechanical behavior has a predictive value for the presence of glaucomatous optical neuropathy in eyes with high myopia. Patients and Methods: This observational cross-sectional study included 209 eyes from 108 consecutive patients, divided into four groups: high myopia and primary open-angle glaucoma (POAG) - HMG, n = 53; high myopia without POAG - HMNG, n = 53; non-myopic with POAG - POAG, n = 50; non-myopic and non-POAG- NMNG, n = 53. Biomechanical assessment was made through a Scheimpflug-camera-based technology. Receiver operating characteristic curves were made for the discrimination between groups. Multivariable logistic regression models were performed to address the predictive value of corneal biomechanics for the presence of glaucoma. Results: Areas Under the Receiver Operating Characteristic (AUROCs) above 0.6 were found in 6 parameters applied to discriminate between HMG and HMNG and six parameters to discriminate between POAG and NMNG. The biomechanical models with the highest power of prediction for the presence of glaucoma included 5 parameters with an AUROC of 0.947 for eyes with high myopia and 6 parameters with an AUROC of 0.857 for non-myopic eyes. In the final model, including all eyes, and adjusted for the presence of high myopia, the highest power of prediction for the presence of glaucoma was achieved including eight biomechanical parameters, with an AUROC of 0.917. Conclusion: Corneal biomechanics demonstrated differences in eyes with glaucoma and mainly in myopic eyes. A biomechanical model based on multivariable logistic regression analysis and adjusted for high myopia was built, with an overall probability of 91.7% for the correct prediction of glaucomatous damage.