Beyond the Off-Label: A Systematic Review of What We Know About Clozapine Use for Children.

Introduction: It is essential not to delay behavior management and control for aggression, violence, and impulsive behavior in young people. Clozapine has been widely used in adolescents and adults to manage violence and aggression in Schizophrenia. However, there are limited data on the use of clozapine in children, and no systematic review has addressed its use in this population. Objective and Methods: To better understand the conditions under which clozapine is used as a therapeutic alternative for nonschizophrenic diagnoses and to assess the current evidence supporting its prescription to children, a systematic review was conducted. The review followed PRISMA guidelines and was registered in PROSPERO under the ID CRD42024537707. Results: The review identified that all the studies used clozapine to address externalizing behavior, particularly aggressive behavior, and found positive outcomes supporting its use for treating children with treatment-resistant aggression. The studies also found that clozapine was well-tolerated in all cases. However, the studies were limited and mainly consisted of open trials without a control group. Conclusion: Further high-quality research is needed to establish precise guidelines for using clozapine in children.

Congenital Clubfoot: Difficulties in Maintaining the Use of the Dennis-Brown Orthosis by Caregivers.

Objective This study aimed to identify the main difficulties faced by the family when a child with congenital clubfoot (CC) uses the Dennis-Brown orthosis. Method This study interviewed via Google Forms caregivers of children treated from 2015 to 2018 regarding their difficulties in orthosis use. Results The answers revealed that orthosis-related difficulties are independent of the child's gender, age, or affected side. We noted that 41.7% of the respondents reported some difficulty, especially the child's irritation when using the orthosis (93.3%). Conclusion The main factor in CC relapses is poor adherence to orthosis use. As a result, studying factors causing or increasing the probability of interrupting orthosis use is significant in creating strategies to facilitate their use, potentially reducing CC recurrence.

Relationship Between Chronic Obstructive Pulmonary Disease and Osteoporosis: A Scoping Review.

INTRODUCTION: Potential associations between Chronic Obstructive Pulmonary Disease (COPD) and osteoporosis have been studied, but areas of uncertainty remain. OBJECTIVE: This scoping review aimed to identify the published evidence on the epidemiological relationships between COPD and osteoporosis. METHODS: Experimental and observational evidence evaluating relationships between COPD and osteoporosis on epidemiology, clinical manifestations, risk factors (RFs), therapeutic management and quality of life (QoL) was searched on PubMed and Embase (until May 2023). The studies were categorized according to their objectives and characteristics. Data were analyzed using descriptive statistics. RESULTS: Ninety-nine studies were selected, namely 33 (33%) reporting epidemiologic measures, 11 (11%) clinical manifestations, 74 (75%) RFs (45 ones, of which body mass index [BMI; n = 22 studies], corticosteroids' use [n = 20], and COPD severity [n = 15] were the most studied), 7 (7%) therapeutic management, and 3 (3%) QoL. Twenty-seven (27.6%) studies evaluated ≥2 domains. Most studies followed a cross-sectional design (n = 37; 37.4%). Eighty-nine studies (90%) assessed patients with COPD at baseline and studied its relationship with osteoporosis. CONCLUSION: There are well-established features linking COPD and osteoporosis, including shared RFs, such as smoking, elderly, physical inactivity, or low BMI. Others deserve clarification, including the impact of COPD severity, or the use of inhaled corticosteroids on the incidence of osteoporosis and fractures, as well as the value of performing routine imaging tests, or prescribing anti-resorptive medications in COPD to prevent osteoporotic-related outcomes. QoL studies are also lacking. Investigating such issues is needed to propose clinical guidelines for managing osteoporosis in patients with COPD.

Congenital Clubfoot: Difficulties in Maintaining the Use of the Dennis-Brown Orthosis by Caregivers / Pé torto congênito: Dificuldades na manutenção do uso da órtese de Dennis-Brown pelos cuidadores

Abstract Objective This study aimed to identify the main difficulties faced by the family when a child with congenital clubfoot (CC) uses the Dennis-Brown orthosis. Method This study interviewed via Google Forms caregivers of children treated from 2015 to 2018 regarding their difficulties in orthosis use. Results The answers revealed that orthosis-related difficulties are independent of the child's gender, age, or affected side. We noted that 41.7% of the respondents reported some difficulty, especially the child's irritation when using the orthosis (93.3%). Conclusion The main factor in CC relapses is poor adherence to orthosis use. As a result, studying factors causing or increasing the probability of interrupting orthosis use is significant in creating strategies to facilitate their use, potentially reducing CC recurrence.

Resumo Objetivo Identificar as principais dificuldades apresentadas pela família durante o uso da órtese de Dennis-Brown. Método Esse estudo foi realizado com os responsáveis por pacientes tratados no período de 2015-2018, os quais responderam a um formulário com perguntas sobre a criança por google forms quanto às dificuldades no uso da órtese. Resultado Com as respostas obtidas, identificamos que as dificuldades com a órtese independem do sexo, idade ou lado afetado na criança. Foi possível identificar que 41,7% dos pacientes que fizeram o uso da órtese apresentaram algum tipo de dificuldade, sendo a principal dificuldade a irritação da criança (93,3%). Conclusão Sabendo que o principal fator de recidivas do PTC é a má aderência ao uso das órteses, o estudo de fatores que causam ou aumentam a probabilidade da interrupção do seu uso se torna um importante aliado para a criação de estratégias para facilitar o uso da órtese, assim possivelmente diminuindo a recidiva da doença.

Clinical Pharmacology of Vinpocetine: Properties Revisited and Introduction of a Population Pharmacokinetic Model for Its Metabolite, Apovincaminic Acid (AVA).

This paper examines the use of vinpocetine in the context of clinical pharmacology. The main and active metabolite of vinpocetine is apovincaminic acid (AVA). Due to the scarce information in the literature on AVA pharmacokinetics, we propose a population pharmacokinetic (PopPK) model for AVA based on a study in healthy volunteers with three different formulations of vinpocetine. The suggested PopPK model (and simulations) could be helpful in ensuring the more effective and safer use of the vinpocetine in the future given the increasing range of suggested indications for its use.

Prevalence of migraine in patients with fibromyalgia / Prevalência de enxaqueca em pacientes com fibromialgia

Objective: To evaluate the prevalence of migraine in patients with fibromyalgia and the impacts of these comorbidities on the daily life of patients. Methods: Questionnaires were applied to fibromyalgia patients. The questionnaires were applied through a Google forms application link and in person, printed. We used FIQ, PHQ-9, and ID migraine. And for patients with a positive ID migraine, we applied the Midas subsequently. Results: Seventy fibromyalgia patients were recruited, age of 47.31 ± 14.5 years. Sixty-five (92.86%) were female and 5 (7.14%) were male. We obtained a prevalence of 60% (n = 42) of migraine associated with fibromyalgia. Among the analyzed variables, severity of depression (p = 0.007), aggregate severity of depression (p = 0.004), and impact of fibromyalgia (p = 0.008) were significantly associated. Among the migraine patients, the vast majority, 34/42 (80.95%), were classified as having severe disability. Conclusion: There is a high prevalence of migraine in patients with fibromyalgia that has an associated impact on patients' lives, which makes clinical and psychosocial management of these patients necessary.

Objetivo: Avaliar a prevalência de enxaqueca em pacientes com fibromialgia e os impactos dessas comorbidades no cotidiano dos pacientes. Métodos: Questionários foram aplicados a pacientes com fibromialgia. Os questionários foram aplicados por meio de link de aplicativo Google Forms e presencialmente, impressos. Usamos FIQ, PHQ-9 e enxaqueca ID. E para pacientes com enxaqueca ID positiva, aplicamos o Midas posteriormente. Resultados: Foram recrutados 70 pacientes com fibromialgia, idade de 47,31 ± 14,5 anos. Sessenta e cinco (92,86%) eram do sexo feminino e 5 (7,14%) do sexo masculino. Obtivemos uma prevalência de 60% (n = 42) de enxaqueca associada à fibromialgia. Entre as variáveis ​​analisadas, a gravidade da depressão (p = 0,007), a gravidade agregada da depressão (p = 0,004) e o impacto da fibromialgia (p = 0,008) foram significativamente associadas. Entre os pacientes com enxaqueca, a grande maioria, 34/42 (80,95%), foi classificada como portadora de incapacidade grave. Conclusão: Existe uma elevada prevalência de enxaqueca em pacientes com fibromialgia que tem impacto associado na vida dos pacientes, o que torna necessário o manejo clínico e psicossocial destes pacientes.

Estudiar - Análisis de la producción científica en periódicos brasileños / Estudar - análise da produção científica em periódicos brasileiros / Studying - analysis of scientific production in brazilian journals

Estudar é um comportamento essencial para todos os alunos, pois, potencialmente, permite aprender qualquer conteúdo. O presente estudo teve como objetivo analisar a produção da comunidade científica, divulgada em periódicos brasileiros, sobre o estudar. Nas bases de dados SciELO e PePSIC foram inseridas palavras de busca, que resultou em 82 estudos selecionados. As informações obtidas dizem respeito aos autores, instituições, área de conhecimento, abordagem teórica e tipo de pesquisa. Dentre os resultados, destacam-se: crescimento das publicações a partir de 2004; predomínio de poucos grupos de pesquisa; pouca participação da área da Educação; dominância da Psicologia Cognitiva; predomínio de pesquisas descritivas; utilização de instrumentos padronizados; predomínio do Ensino Superior e utilização da sala de aula como setting. Discute-se sobre a necessidade de mais pesquisas de intervenção, além da maior participação dos professores que deveriam ser os principais participantes envolvidos nas pesquisas.

Estudiar es un comportamiento esencial a todos los alumnos, pues, potencialmente, permite aprender cualquier contenido. En el presente estudio se tuvo como objetivo analizar la producción de la comunidad científica, relatada en periódicos brasileños, sobre el estudiar. Se utilizaron palabras de búsqueda, que se insirió en los bancos de datos de SciELO y PePSIC, se seleccionaron 82 estudios. Se obtuvo, entre otras, informaciones sobre autores, instituciones, área de conocimiento, abordaje teórico, tipo de investigación. Entre los resultados, se destacan: crecimiento de las publicaciones a partir de 2004; predominio de pocos grupos de investigación; poca participación del área de la Educación; dominancia de la Psicología Cognitiva; predominio de investigaciones descriptivas; utilización de instrumentos normatizados; predominio de la Enseñanza Universitaria y utilización de la sala de clase como setting. Se discute sobre la necesidad de más intervención, además de más participación de los profesores que deberían ser los principales participantes involucrados en las investigaciones.

Studying is an essential behavior for all students, as it potentially allows them to learn any content. This study aimed to analyze the production of the scientific community, published in Brazilian journals, about studying. Search words were inserted in the SciELO and PePSIC databases, which resulted in 82 selected studies. The information obtained concerns the authors, institutions, area of ​​knowledge, theoretical approach, and type of research. Among the results, the following stand out: an increase in the number of publications since 2004; predominance of few research groups; little participation from the Education area; predominance of Cognitive Psychology; predominance of descriptive research; use of standardized instruments; predominance of Higher Education and the use of the classroom as a setting. It discusses the need for more intervention research, in addition to the greater participation of teachers who should be the main participants involved in the research.

Soybean meal particle size for pigs during the nursery phase / Tamanho da partícula do farelo de soja em suínos no período de creche

This study evaluated the effect of soybean meal (SBM) particle size on nutrient digestibility and the growth performance of nursery piglets. Sixty-three piglets (BW = 6.86 kg ± 0.56; 23 d of age) were distributed in a randomized block design (by initial weight and sex) with 3 dietary treatments: diets with 1,017 µm (unground); 585 µm; and 411µm SBM, with 7 replicates of 3 piglets each. All diets were offered ad libitum in mash form, formulated differently according to three growing phases: (1) with 20% of SBM, from 23 to 32 d of age; (2) with 25% of SBM, from 32 to 44 d of age, and (3) with 30% of SBM, from 44 to 63 d of age. For the first 21 d, pigs fed diets with a medium particle size of SBM (585mm) had better average weight gain and feed/gain ratio (P<0.05). The average feed intake, average body weight gain, and feed/gain ratio from 44 to 63 d improved (P<0.05) with increasing SBM particle sizes, and the average live weight for the overall period increased with coarser SBM (P<0.05). There was a marginally improvement (P < 0.1) on digestible energy as particle size of SBM decreased; although, no differences (P > 0.05) in the coefficients of apparent digestibility of dry matter and crude protein for the assessed SBM particle sizes were observed. It was concluded that the grinding of dietary SBM is not required for piglets during the nursery phase.

O objetivo deste estudo foi avaliar o efeito do tamanho da partícula do farelo de soja (FS) sobre o desempenho e digestibilidade de leitões no período de creche. 63 leitões (6,86 kg ± 0,56; 23 dias de idade) foram distribuídos aleatoriamente em um delineamento de blocos casualizados (peso inicial e sexo) entre os tratamentos. As dietas experimentais foram produzidas a partir de diferentes tamanhos médios de partículas do FS moídos ou não: 1,017 µm (sem moer), 585 µm (moído em peneira de 10 mm), e 411µm (moído em peneira de 3 mm), totalizando três tratamentos com sete repetições de três animais cada. Todas as dietas foram fornecidas na forma farelada e ad libitum, sendo divididas em três fases: 1) com 20% de FS, dos 23 a 32 dias de idade; 2) com 25% de FS, dos 32 a 44 dias de idade; e 3) com 30% de FS, dos 44 a 62 dias de idade. Nos primeiros 21 dias de experimento, os animais consumindo a dieta com o tamanho médio (585 µm) das partículas do FS apresentaram melhores resultados para o ganho de peso médio e conversão alimentar. No período seguinte (44 a 63 d), houve (P<0.05) aumento do consumo de ração médio, do ganho do peso médio e melhor conversão alimentar dos leitões conforme o aumento do tamanho da partícula de FS incluída na ração. Consequentemente, ao final do experimento houve melhora linear do peso vivo médio dos animais com o aumento do tamanho do FS consumido. Foi observado melhora marginalmente significativa (P < 0.1) da energia digestível conforme a redução no tamanho do FS, entretanto, não houve diferença (P > 0.05) no coeficiente de digestibilidade aparente da matéria seca e da proteína bruta dos animais entre os diferentes tamanhos do FS. Em conclusão, de acordo com as condições deste estudo, não se faz necessária a moagem do farelo de soja para leitões no período de creche.

Maquinarias de guerra e mortes juvenis nas periferias do Ceará / War machines and juvenile deaths in the peripheries of Ceará

O objetivo deste artigo é problematizar como maquinarias de guerra em territorialidades periferizadas operam na produção de juventudes matáveis no bojo da intensificação da violência letal no Brasil, tomando a cidade de Fortaleza como exemplo empírico e as noções de necropolítica e políticas de inimizade, de Achille Mbembe, como operadores conceituais. Num primeiro momento, traz reflexões teóricas sobre essa própria tecnologia de gestão e produção da morte. Num segundo momento, analisa-se como "maquinarias de guerra" engendram "zonas de morte", sendo a articulação entre disciplinamento, regulação biopolítica e produção/gestão de um "fazer morrer" característica da ocupação colonial na atualidade. Com isso, apontamos como o recrudescimento da violência letal nas margens urbanas expressa sua condição de colônias contemporâneas, em que processos de racialização maximizam a precarização de corpos juvenis negros, sob o fundamento da perpetuação de relações de inimizade.

The aims of this article is to discuss the war strategies in peripheral territorialities, operating in the production of new non-intense forms of lethal violence in Brazil, taking the city of Fortaleza as an empirical example and uses Achille Mbembe's notion of necropolitics as the main conceptual operator. At first, brings theoretical reflections from the dialogs that Mbembe weaves with Foucault, Agamben, Arendt and Fanon. Secondly, parses as "war machines" engender "death zones, being the link between discipline, biopolitical production and regulation/management of a "do die" feature of colonial occupation today. With this, we point out how the escalation of deadly violence in the urban margins expressed your condition of contemporary colonies, in which racionalitation processes maximize precariousness of black youth bodies, under the foundation of perpetuation of enmity.

Testers in supersweet corn lines / Avaliação de testadores em linhagens de milho superdoce

ABSTRACT: The purpose of this study was to evaluate the discriminatory capacity of tester lines for tropical corn lines converted to supersweet shrunken (sh2) gene, for the development of hybrids adapted to tropical conditions. Lines were used as female parents in crosses with three testers: open-pollinated mixed variety; supersweet line L4; supersweet commercial hybrid Tropical Plus. Four trials were carried out to evaluate topcrosses in Maringá - PR e Sabáudia - PR, Brazil in the main growing season of 2015/16. The following traits were evaluated: total ear weight (TEW, in kg), commercial ear weight (CEW, in kg) and total soluble solids (TSS, in °Brix). The GCA estimates for TEW and CEW were highest for L4. The lines Balu-114 and UEM-25 were selected based on the effects of g ̂ ifor the traits studied and should be used in the establishment of base populations for the breeding of superior lines. The s ̂ ijvalue for TEW was highest for cross BALU-182 x Tropical, while for CEW was the highest value for cross BALU-94 x Mista.

RESUMO: O presente trabalho teve como objetivo avaliar o desempenho de testadores quanto à capacidade de discriminação de linhagens tropicais convertidas à superdoce, por meio da incorporação do gene shrunken (sh2), visando a produção de híbridos adaptados às condições tropicais. As linhagens utilizadas como parentais femininos foram os testadores: variedade de polinização aberta Mista; linhagem superdoce L4; híbrido comercial superdoce Tropical Plus. Os quatro experimentos foram conduzidos em Maringá - PR e Sabáudia - PR, na safra verão de 2015/16. As características avaliadas foram: Peso de espigas totais (PET, em kg), Peso de espigas comerciais (PEC, em kg) e sólidos solúveis totais (SST, em ºBrix). A linhagem L4 foi o testador que mais proporcionou efeito de heterose. As maiores estimativas de CGC para PET e PEC foram obtidas por L4. As linhagens Balu-114 e UEM-25 foram selecionados com base nos efeitos de g ̂ i para as características estudadas e deverão ser utilizados na formação de populações base para a extração de linhagens superiores. O cruzamento BALU-182 x Tropical apresentou o maior valor de s ̂ ijpara PET, enquanto o cruzamento BALU-94 x Mista obteve o melhor valor para PEC.

Morphological characterization and taxonomic key of tadpoles (Amphibia: Anura) from the northern region of the Atlantic Forest / Caracterização morfológica e chave taxonômica de girinos (Amphibia: Anura) da região norte da Mata Atlântica

Abstract: Although anuran tadpoles are widely distributed and abundant in tropical aquatic habitats, there is a lack of taxonomic keys for the Atlantic Forest. Herein, we developed a dichotomous key for identifying the tadpoles for all species with known larval phase and already recorded in the Atlantic Forest north of the São Francisco River. We analyzed discrete characteristics of 1,042 tadpoles encompassing 63 species of 28 genera from 32 localities. The user-friendly key includes illustration and pictures, and it is a significant step towards improving our knowledge of tadpoles of the Atlantic Forest.

Resumo: Embora os girinos de anuros sejam amplamente distribuídos e abundantes em habitats aquáticos tropicais, não há chaves taxonômicas suficientes para as espécies da Mata Atlântica. Aqui, desenvolvemos uma chave dicotômica para identificar os girinos de todas as espécies com fase larval conhecida e já registradas nesse bioma, ao norte do rio São Francisco. Nós analisamos características discretas de 1.042 girinos pertencentes a 63 espécies (28 gêneros) de 32 localidades. Esta chave de identificação inclui ilustrações e imagens, sendo um passo significativo para um melhor conhecimento dos girinos da Mata Atlântica.

Characterization of suicidal behavior among children in a depressive episode: case series study / Caracterização do comportamento suicida em crianças em episódio depressivo: estudo de série de casos

Abstract Introduction Child suicidal behavior is related to specific childhood variations, constituting risk factors, including predisposing factors, internal factors, and environmental factors. Objective To characterize suicidal behavior among children aged 5 to 12 years diagnosed with a depressive episode. Methods Fifteen participants, aged 5 to 12, were assessed at a child and adolescent mental health center in Belo Horizonte, state of Minas Gerais, Brazil. All participants had a history of suicide attempt and were in a depressive episode at the time of assessment. Results Vulnerabilities related to the children themselves were self-harm, aggression, loss of an important family figure, sexual abuse, sexuality disorders, use of alcohol or other drugs, and ill-treatment. Factors of family structure and dynamics found were psychiatric illness in family members, family conflict or violence, abandonment or rejection, history of suicidal behavior in family, parents users of alcohol and other drugs, and separated parents. Factors related to school were bullying, school difficulties/delays, high school performance, bad behavior, physical aggression, school dropout, and aggressiveness. The main methods used in suicide attempts were injury by sharp or blunt objects and intentional self-poisoning. Conclusions Psychiatric comorbidities and a previous history of disturbances in the family and at school are important factors to consider with relation to suicidal behavior by children with depressive episodes.

Resumo Introdução O comportamento suicida infantil está relacionado com vicissitudes específicas da infância, representadas por fatores de risco, incluindo fatores predisponentes, internos e ambientais. Objetivo Caracterizar o comportamento suicida em crianças de 5 a 12 anos com diagnóstico de episódio depressivo. Métodos Quinze participantes, com idades entre 5 e 12 anos, foram avaliados em um centro de saúde mental da infância e adolescência de Belo Horizonte, MG, Brasil. Todos os participantes tinham histórico de tentativa de suicídio e estavam em um episódio depressivo no momento da avaliação. Resultados As vulnerabilidades relacionadas às próprias crianças foram automutilação, agressão, perda de uma figura familiar importante, abuso sexual, distúrbios da sexualidade, uso de álcool ou outras drogas e maus-tratos. Em relação a estrutura e dinâmica familiar, foram encontrados fatores como doença psiquiátrica na família, conflito ou violência familiar, abandono ou rejeição, histórico de comportamento suicida na família, pais usuários de álcool e outras drogas e pais separados. Os fatores relacionados à escola foram assédio moral, dificuldades/atrasos escolares, bom desempenho escolar, mau comportamento, agressão física, abandono escolar e agressividade. Os principais métodos utilizados nas tentativas de suicídio foram lesões por objetos pontiagudos ou contundentes e autoenvenenamento intencional. Conclusão As comorbidades psiquiátricas e o histórico prévio de distúrbios na família e na escola são fatores importantes a serem considerados em relação ao comportamento suicida em crianças com episódios depressivos.

Clinical and epidemiological aspects of microcephaly in the state of Piauí, northeastern Brazil, 2015-20166 / Aspectos clínicos e epidemiológicos da microcefalia no Estado do Piauí, Nordeste do Brasil, 2015-2016

Abstract Objectives: To describe aspects of the microcephaly epidemic in the state of Piauí. Methods: All cases of congenital microcephaly confirmed in the state between 2015 and 2016 were included (n = 100). Investigation forms of the Regional Reference Center for Microcephaly were reviewed. Discarded cases (n = 63) were used as a comparison group. Results: In October, November, and December 2015 incidence rates reached 4.46, 6.33 and 3.86/1000 live births, respectively; 44 cases were reported in the state capital. Among the mothers of confirmed and discarded cases, the frequency of skin rash during pregnancy was 50/97 (51.5%) and 8/51 (15.7%), respectively (p < 0.001); 33 confirmed cases (35.9%) had a head circumference z-score between −2 and −3, 23 (25%) between −3 and −4, and 8 (8.7%) had a z-score of less than −4. Head computer tomography scans revealed calcifications in 78/95 (82.1%) cases. Lissencephaly, hydrocephalus and agenesis of the corpus callosum were also frequently observed. Ophthalmic findings included retinal pigment epithelium rarefaction and atrophy. Absence of otoacoustic emissions was observed in 21/70 cases. One newborn also presented lower limb muscle atrophy. There were no significant differences in vaccination rates for influenza, diphtheria-tetanus-acellular pertussis, and hepatitis B in either group. Conclusions: The state of Piauí, like others in the northeastern region, faced an epidemic of congenital microcephaly between 2015 and 2016, presumably related to congenital Zika virus infection, more intense in the capital. Current challenges include the improvement of vector control, basic research, scaling-up of diagnostic tools for pre-natal screening of Zika virus, vaccines, and health care for affected children.

Resumo Objetivos: Descrever os aspectos da epidemia de microcefalia no Estado do Piauí. Métodos: Foram incluídos todos os casos de microcefalia congênita confirmados no estado entre 2015-2016 (n = 100). Os formulários de investigação do Centro Regional de Referência em Microcefalia foram analisados. Os casos descartados (n = 63) foram usados como grupo de comparação. Resultados: Em outubro, novembro e dezembro de 2015, as taxas de incidência atingiram 4,46, 6,33 e 3,86/1.000 nascidos vivos, respectivamente; 44 casos foram relatados na capital do estado. Entre as mães de casos confirmados e descartados, a frequência de erupção cutânea durante a gravidez foi 50/97 (51,5%) e 8/51 (15,7%), respectivamente (p < 0,001); 33 casos confirmados (35,9%) apresentaram um escore z de perímetro cefálico entre -2 e -3, 23 (25%) entre -3 e -4 e 8 (8,7%) apresentaram escore z inferior a -4. As tomografias computadorizadas cerebrais revelaram calcificações em 78/95 (82,1%) dos casos. Lisencefalia, hidrocefalia e agenesia do corpo caloso também foram observadas com mais frequência. Os achados oftalmológicos incluíram rarefação e atrofia do epitélio pigmentar da retina. Foram observadas ausência de emissões otoacústicas em 21/70 casos. Um recém-nascido também apresentou atrofia muscular dos membros inferiores. Não houve diferenças significativas nas taxas de vacinação para gripe, vacina difteria tétano e coqueluche acelular e hepatite B em qualquer grupo. Conclusões: O Estado do Piauí, como outros na região Nordeste, enfrentou, entre 2015 e 2016, uma epidemia de microcefalia congênita, supostamente relacionada à infecção congênita pelo vírus Zika, mais intensa na capital. Os desafios atuais incluem melhora do controle de vetores, pesquisa básica, ampliação de ferramentas de diagnóstico para exame pré-natal do vírus Zika, vacinas e cuidados de saúde para crianças afetadas.

Blood-brain barrier transport and neuroprotective potential of blackberry-digested polyphenols: an in vitro study.

PURPOSE: Epidemiological and intervention studies have attempted to link the health effects of a diet rich in fruits and vegetables with the consumption of polyphenols and their impact in neurodegenerative diseases. Studies have shown that polyphenols can cross the intestinal barrier and reach concentrations in the bloodstream able to exert effects in vivo. However, the effective uptake of polyphenols into the brain is still regarded with some reservations. Here we describe a combination of approaches to examine the putative transport of blackberry-digested polyphenols (BDP) across the blood-brain barrier (BBB) and ultimate evaluation of their neuroprotective effects. METHODS: BDP was obtained by in vitro digestion of blackberry extract and BDP major aglycones (hBDP) were obtained by enzymatic hydrolysis. Chemical characterization and BBB transport of extracts were evaluated by LC-MSn. BBB transport and cytoprotection of both extracts was assessed in HBMEC monolayers. Neuroprotective potential of BDP was assessed in NT2-derived 3D co-cultures of neurons and astrocytes and in primary mouse cerebellar granule cells. BDP-modulated genes were evaluated by microarray analysis. RESULTS: Components from BDP and hBDP were shown to be transported across the BBB. Physiologically relevant concentrations of both extracts were cytoprotective at endothelial level and BDP was neuroprotective in primary neurons and in an advanced 3D cell model. The major canonical pathways involved in the neuroprotective effect of BDP were unveiled, including mTOR signaling and the unfolded protein response pathway. Genes such as ASNS and ATF5 emerged as novel BDP-modulated targets. CONCLUSIONS: BBB transport of BDP and hBDP components reinforces the health benefits of a diet rich in polyphenols in neurodegenerative disorders. Our results suggest some novel pathways and genes that may be involved in the neuroprotective mechanism of the BDP polyphenol components.

Clinical and epidemiological aspects of microcephaly in the state of Piauí, northeastern Brazil, 2015-2016.

OBJECTIVES: To describe aspects of the microcephaly epidemic in the state of Piauí. METHODS: All cases of congenital microcephaly confirmed in the state between 2015 and 2016 were included (n=100). Investigation forms of the Regional Reference Center for Microcephaly were reviewed. Discarded cases (n=63) were used as a comparison group. RESULTS: In October, November, and December 2015 incidence rates reached 4.46, 6.33 and 3.86/1000 live births, respectively; 44 cases were reported in the state capital. Among the mothers of confirmed and discarded cases, the frequency of skin rash during pregnancy was 50/97 (51.5%) and 8/51 (15.7%), respectively (p<0.001); 33 confirmed cases (35.9%) had a head circumference z-score between -2 and -3, 23 (25%) between -3 and -4, and 8 (8.7%) had a z-score of less than -4. Head computer tomography scans revealed calcifications in 78/95 (82.1%) cases. Lissencephaly, hydrocephalus and agenesis of the corpus callosum were also frequently observed. Ophthalmic findings included retinal pigment epithelium rarefaction and atrophy. Absence of otoacoustic emissions was observed in 21/70 cases. One newborn also presented lower limb muscle atrophy. There were no significant differences in vaccination rates for influenza, diphtheria-tetanus-acellular pertussis, and hepatitis B in either group. CONCLUSIONS: The state of Piauí, like others in the northeastern region, faced an epidemic of congenital microcephaly between 2015 and 2016, presumably related to congenital Zika virus infection, more intense in the capital. Current challenges include the improvement of vector control, basic research, scaling-up of diagnostic tools for pre-natal screening of Zika virus, vaccines, and health care for affected children.

Characterization of suicidal behavior among children in a depressive episode: case series study.

INTRODUCTION: Child suicidal behavior is related to specific childhood variations, constituting risk factors, including predisposing factors, internal factors, and environmental factors. OBJECTIVE: To characterize suicidal behavior among children aged 5 to 12 years diagnosed with a depressive episode. METHODS: Fifteen participants, aged 5 to 12, were assessed at a child and adolescent mental health center in Belo Horizonte, state of Minas Gerais, Brazil. All participants had a history of suicide attempt and were in a depressive episode at the time of assessment. RESULTS: Vulnerabilities related to the children themselves were self-harm, aggression, loss of an important family figure, sexual abuse, sexuality disorders, use of alcohol or other drugs, and ill-treatment. Factors of family structure and dynamics found were psychiatric illness in family members, family conflict or violence, abandonment or rejection, history of suicidal behavior in family, parents users of alcohol and other drugs, and separated parents. Factors related to school were bullying, school difficulties/delays, high school performance, bad behavior, physical aggression, school dropout, and aggressiveness. The main methods used in suicide attempts were injury by sharp or blunt objects and intentional self-poisoning. CONCLUSIONS: Psychiatric comorbidities and a previous history of disturbances in the family and at school are important factors to consider with relation to suicidal behavior by children with depressive episodes.

SIBLINGS AFFECTED BY ECTRODACTYLY-ECTODERMAL DYSPLASIA AND CLEFT LIP/PALATE (EEC) SYNDROME PRESENTING NORMAL PARENTS: GERMLINE MOSAICISM? / IRMÃOS AFETADOS PELA SÍNDROME DE ECTRODACTILIA, DISPLASIA ECTODÉRMICA E FISSURA LABIOPALATAL (EEC) COM PAIS HÍGIDOS: MOSAICISMO GERMINATIVO?

OBJECTIVE: EEC is an acronym for an autosomal dominant syndrome clinically characterized by ectrodactyly (E), ectodermal dysplasia (E) and cleft lip/palate (C). Our aim was to describe a rare case of siblings affected by ectrodactyly, ectodermal dysplasia and cleft lip/palate (EEC) syndrome presenting normal parents. CASE DESCRIPTION: The patient was the third son of young and healthy parents. The parents did not present any minor or major anomaly of hands, feet or skin, hair and teeth. The couple had a previous history of two children with hands and feet malformations similar to the present patient. The first was a stillborn, and the second one a preterm infant that died in the first days after birth due to the consequences of prematurity. After birth, the patient presented respiratory distress with need of endotracheal intubation and mechanic ventilation. At physical examination, there were cleft lip/palate, hands and feet ectrodactyly, with absence of the second and third fingers in both hands, and reduction defects affecting mainly the second toes. The child presented pneumothorax and cardiorespiratory arrest and died at 1 month and 26 days. COMMENTS: Herein we described a case of siblings with EEC syndrome, indicative of a germline mosaicism. In the literature review, there was the description of only three similar reports. The present case strengthens the possibility that germline mosaicism may be a more common inheritance mechanism than previously thought in cases of EEC syndrome.

OBJETIVO: EEC é um acrônimo para uma síndrome autossômica dominante caracterizada clinicamente por ectrodactilia (E), displasia ectodérmica efissura labiopalatal (C). Nosso objetivo foi relatar um caso raro de irmãos afetados pela síndrome de ectrodactilia, displasia ectodérmica efissura labiopalatal (EEC) com pais hígidos. DESCRIÇÃO DO CASO: O paciente era o terceiro filho de pais jovens e hígidos, os quais não apresentavam nenhuma anomalia menor ou maior de mãos e pés ou anomalias de pele, cabelos e dentes. O casal tinha história prévia de duas crianças com malformação de mãos e pés, similar à do paciente. O primeiro foi natimorto e o segundo, prematuro, falecendo nos primeiros dias de vida, pelas consequências da prematuridade. Após o nascimento, o paciente apresentou desconforto respiratório, com necessidade de intubação orotraqueal e ventilação mecânica. No exame físico, verificaram-se a presença de fissura labiopalatal e ectrodactilia de mãos e pés, com ausência do segundo e terceiro dedos em ambas as mãos e defeitos de redução acometendo principalmente o segundo dedo dos pés. A criança apresentou pneumotórax e parada cardiorrespiratória, morrendo com 1 mês e 26 dias de vida. COMENTÁRIOS: Descrevemos aqui um caso de irmãos com síndrome EEC, indicativo de mosaicismo germinativo. Na revisão da literatura, observaram-se apenas três relatos similares. Este caso reforça a possibilidade do mosaicismo germinativo ser um mecanismo de herança mais comum do que se acreditava previamente para casos da síndrome EEC.

Irmãos afetados pela síndrome de ectrodactilia, displasia ectodérmica e fissura labiopalatal (eec) com pais hígidos: mosaicismo germinativo? / Siblings affected by ectrodactyly-ectodermal dysplasia and cleft lip/palate (eec) syndrome presenting normal parents: germline mosaicism?

RESUMO Objetivo: EEC é um acrônimo para uma síndrome autossômica dominante caracterizada clinicamente por ectrodactilia (E), displasia ectodérmica efissura labiopalatal (C). Nosso objetivo foi relatar um caso raro de irmãos afetados pela síndrome de ectrodactilia, displasia ectodérmica efissura labiopalatal (EEC) com pais hígidos. Descrição do caso: O paciente era o terceiro filho de pais jovens e hígidos, os quais não apresentavam nenhuma anomalia menor ou maior de mãos e pés ou anomalias de pele, cabelos e dentes. O casal tinha história prévia de duas crianças com malformação de mãos e pés, similar à do paciente. O primeiro foi natimorto e o segundo, prematuro, falecendo nos primeiros dias de vida, pelas consequências da prematuridade. Após o nascimento, o paciente apresentou desconforto respiratório, com necessidade de intubação orotraqueal e ventilação mecânica. No exame físico, verificaram-se a presença de fissura labiopalatal e ectrodactilia de mãos e pés, com ausência do segundo e terceiro dedos em ambas as mãos e defeitos de redução acometendo principalmente o segundo dedo dos pés. A criança apresentou pneumotórax e parada cardiorrespiratória, morrendo com 1 mês e 26 dias de vida. Comentários: Descrevemos aqui um caso de irmãos com síndrome EEC, indicativo de mosaicismo germinativo. Na revisão da literatura, observaram-se apenas três relatos similares. Este caso reforça a possibilidade do mosaicismo germinativo ser um mecanismo de herança mais comum do que se acreditava previamente para casos da síndrome EEC.

ABSTRACT Objective: EEC is an acronym for an autosomal dominant syndrome clinically characterized by ectrodactyly (E), ectodermal dysplasia (E) and cleft lip/palate (C). Our aim was to describe a rare case of siblings affected by ectrodactyly, ectodermal dysplasia and cleft lip/palate (EEC) syndrome presenting normal parents. Case description: The patient was the third son of young and healthy parents. The parents did not present any minor or major anomaly of hands, feet or skin, hair and teeth. The couple had a previous history of two children with hands and feet malformations similar to the present patient. The first was a stillborn, and the second one a preterm infant that died in the first days after birth due to the consequences of prematurity. After birth, the patient presented respiratory distress with need of endotracheal intubation and mechanic ventilation. At physical examination, there were cleft lip/palate, hands and feet ectrodactyly, with absence of the second and third fingers in both hands, and reduction defects affecting mainly the second toes. The child presented pneumothorax and cardiorespiratory arrest and died at 1 month and 26 days. Comments: Herein we described a case of siblings with EEC syndrome, indicative of a germline mosaicism. In the literature review, there was the description of only three similar reports. The present case strengthens the possibility that germline mosaicism may be a more common inheritance mechanism than previously thought in cases of EEC syndrome.

Discontinuity Detection in the Shield Metal Arc Welding Process.

This work proposes a new methodology for the detection of discontinuities in the weld bead applied in Shielded Metal Arc Welding (SMAW) processes. The detection system is based on two sensors-a microphone and piezoelectric-that acquire acoustic emissions generated during the welding. The feature vectors extracted from the sensor dataset are used to construct classifier models. The approaches based on Artificial Neural Network (ANN) and Support Vector Machine (SVM) classifiers are able to identify with a high accuracy the three proposed weld bead classes: desirable weld bead, shrinkage cavity and burn through discontinuities. Experimental results illustrate the system's high accuracy, greater than 90% for each class. A novel Hierarchical Support Vector Machine (HSVM) structure is proposed to make feasible the use of this system in industrial environments. This approach presented 96.6% overall accuracy. Given the simplicity of the equipment involved, this system can be applied in the metal transformation industries.