Effects of Hibiscus sabdariffa supplementation on metabolism and bladder in obese rats.

PURPOSE: Hibiscus sabdariffa (HS) extract has several health benefits and anti-obesogenic effects. The aim of the present study was to assess whether the medicinal properties attributable to HS would prevent or mitigate bladder changes induced by obesity in an experimental model. METHODS: Forty-eight male Wistar rats were submitted to one of four different dietary interventions (12 animals each): G1, standard diet and water (controls); G2, standard diet and HS tea; G3, a palatable high-fat diet and water; and G4, high-fat diet diet and HS tea. The animals were monitored for body weight, feed, and water and tea intake, according to the allocated group. After 16 weeks, the animals were euthanized, and the levels of creatinine, inflammatory cytokines, testosterone, cholesterol, triglycerides, and electrolytes were evaluated. In addition, histopathological analysis of the animals' bladder was performed. RESULTS: Groups receiving HS (G2 and G4) showed decreased levels of the pro-inflammatory cytokine interleukin-1α. HS tea was able to reduce low-density lipoprotein and triglyceride levels in the G2 group compared to other groups. Only in the G3 there was a significant increase in the body weight when it was compared the 12th and 16th weeks. Leptin was shown to be elevated in the groups that received a high-fat diet. There was a significant decrease in the muscle fibers thickness and in the total collagen count in G4 bladder when compared with G1 and G3. CONCLUSIONS: HS has an anti-inflammatory role, can reverse hyperlipidemia in rats, and reduced deleterious effects of obesity on these animals' bladder.

Derivation and external validation of predictive models for invasive mechanical ventilation in intensive care unit patients with COVID-19.

BACKGROUND: This study aimed to develop prognostic models for predicting the need for invasive mechanical ventilation (IMV) in intensive care unit (ICU) patients with COVID-19 and compare their performance with the Respiratory rate-OXygenation (ROX) index. METHODS: A retrospective cohort study was conducted using data collected between March 2020 and August 2021 at three hospitals in Rio de Janeiro, Brazil. ICU patients aged 18 years and older with a diagnosis of COVID-19 were screened. The exclusion criteria were patients who received IMV within the first 24 h of ICU admission, pregnancy, clinical decision for minimal end-of-life care and missing primary outcome data. Clinical and laboratory variables were collected. Multiple logistic regression analysis was performed to select predictor variables. Models were based on the lowest Akaike Information Criteria (AIC) and lowest AIC with significant p values. Assessment of predictive performance was done for discrimination and calibration. Areas under the curves (AUC)s were compared using DeLong's algorithm. Models were validated externally using an international database. RESULTS: Of 656 patients screened, 346 patients were included; 155 required IMV (44.8%), 191 did not (55.2%), and 207 patients were male (59.8%). According to the lowest AIC, arterial hypertension, diabetes mellitus, obesity, Sequential Organ Failure Assessment (SOFA) score, heart rate, respiratory rate, peripheral oxygen saturation (SpO2), temperature, respiratory effort signals, and leukocytes were identified as predictors of IMV at hospital admission. According to AIC with significant p values, SOFA score, SpO2, and respiratory effort signals were the best predictors of IMV; odds ratios (95% confidence interval): 1.46 (1.07-2.05), 0.81 (0.72-0.90), 9.13 (3.29-28.67), respectively. The ROX index at admission was lower in the IMV group than in the non-IMV group (7.3 [5.2-9.8] versus 9.6 [6.8-12.9], p < 0.001, respectively). In the external validation population, the area under the curve (AUC) of the ROX index was 0.683 (accuracy 63%), the AIC model showed an AUC of 0.703 (accuracy 69%), and the lowest AIC model with significant p values had an AUC of 0.725 (accuracy 79%). CONCLUSIONS: In the development population of ICU patients with COVID-19, SOFA score, SpO2, and respiratory effort signals predicted the need for IMV better than the ROX index. In the external validation population, although the AUCs did not differ significantly, the accuracy was higher when using SOFA score, SpO2, and respiratory effort signals compared to the ROX index. This suggests that these variables may be more useful in predicting the need for IMV in ICU patients with COVID-19. GOV IDENTIFIER: NCT05663528.

Contributions of human cultures to biodiversity and ecosystem conservation.

The expansion of globalized industrial societies is causing global warming, ecosystem degradation, and species and language extinctions worldwide. Mainstream conservation efforts still focus on nature protection strategies to revert this crisis, often overlooking the essential roles of Indigenous Peoples and Local Communities (IP&LC) in protecting biodiversity and ecosystems globally. Here we assess the scientific literature to identify relationships between biodiversity (including ecosystem diversity) and cultural diversity, and investigate how these connections may affect conservation outcomes in tropical lowland South America. Our assessment reveals a network of interactions and feedbacks between biodiversity and diverse IP&LC, suggesting interconnectedness and interdependencies from which multiple benefits to nature and societies emerge. We illustrate our findings with five case studies of successful conservation models, described as consolidated or promising 'social-ecological hope spots', that show how engagement with IP&LC of various cultures may be the best hope for biodiversity and ecosystem conservation, particularly when aligned with science and technology. In light of these five inspiring cases, we argue that conservation science and policies need to recognize that protecting and promoting both biological and cultural diversities can provide additional co-benefits and solutions to maintain ecosystems resilient in the face of global changes.

G6PDH as a key immunometabolic and redox trigger in arthropods.

The enzyme glucose-6-phosphate dehydrogenase (G6PDH) plays crucial roles in glucose homeostasis and the pentose phosphate pathway (PPP), being also involved in redox metabolism. The PPP is an important metabolic pathway that produces ribose and nicotinamide adenine dinucleotide phosphate (NADPH), which are essential for several physiologic and biochemical processes, such as the synthesis of fatty acids and nucleic acids. As a rate-limiting step in PPP, G6PDH is a highly conserved enzyme and its deficiency can lead to severe consequences for the organism, in particular for cell growth. Insufficient G6PDH activity can lead to cell growth arrest, impaired embryonic development, as well as a reduction in insulin sensitivity, inflammation, diabetes, and hypertension. While research on G6PDH and PPP has historically focused on mammalian models, particularly human disorders, recent studies have shed light on the regulation of this enzyme in arthropods, where new functions were discovered. This review will discuss the role of arthropod G6PDH in regulating redox homeostasis and immunometabolism and explore potential avenues for further research on this enzyme in various metabolic adaptations.

Intentional creation of carbon-rich dark earth soils in the Amazon.

Fertile soil known as Amazonian dark earth is central to the debate over the size and ecological impact of ancient human populations in the Amazon. Dark earth is typically associated with human occupation, but it is uncertain whether it was created intentionally. Dark earth may also be a substantial carbon sink, but its spatial extent and carbon inventory are unknown. We demonstrate spatial and compositional similarities between ancient and modern dark earth and document modern Indigenous practices that enrich soil, which we use to propose a model for the formation of ancient dark earth. This comparison suggests that ancient Amazonians managed soil to improve fertility and increase crop productivity. These practices also sequestered and stored carbon in the soil for centuries, and we show that some ancient sites contain as much carbon as the above-ground rainforest biomass. Our results demonstrate the intentional creation of dark earth and highlight the value of Indigenous knowledge for sustainable rainforest management.

Incidence of hospital acquired pressure injury in critically ill patients with COVID-19 in prone position admitted to the intensive care unit.

Critical patients have conditions that may favor the occurrence of hospital-acquired pressure injury (HAPI). The objective of this study was to identify the incidence and factors associated with the occurrence of HAPI in patients with coronavirus disease 2019 admitted to the intensive care unit (ICU) who used the prone position. Retrospective cohort study carried out in an ICU of a tertiary university hospital. Two hundred four patients with positive real-time polymerase chain reactions were evaluated, of which 84 were placed in the prone position. All patients were sedated and submitted to invasive mechanical ventilation. Of the prone patients, 52 (62%) developed some type of HAPI during hospitalization. The main place of occurrence of HAPI was the sacral region, followed by the gluteus and thorax. Of the patients who developed HAPI, 26 (50%) had this event in places possibly associated with the prone position. The factors associated with the occurrence of HAPI in patients prone to coronavirus disease 2019 were the Braden Scale and the length of stay in the ICU. The incidence of HAPI in prone patients was extremely high (62%), which denotes the need to implement protocols in order to prevent the occurrence of these events.

Specific behaviors during auditory fear conditioning and postsynaptic expression of AMPA receptors in the basolateral amygdala predict interindividual differences in fear generalization in male rats.

Auditory fear conditioning in rats is a widely used method to study learning, memory, and emotional responding. Despite procedural standardizations and optimizations, there is substantial interindividual variability in fear expression during test, notably in terms of fear expressed toward the testing context alone. To better understand which factors could explain this variation between subjects, we here explored whether behavior during training and expression of AMPA receptors (AMPARs) after long-term memory formation in the amygdala could predict freezing during test. We studied outbred male rats and found strong variation in fear generalization to a different context. Hierarchical clustering of these data identified two distinct groups of subjects that independently correlated with a specific pattern of behaviors expressed during initial training (i.e., rearing and freezing). The extent of fear generalization correlated positively with postsynaptic expression of GluA1-containing AMPA receptors in the basolateral nucleus of the amygdala. Our data thus identify candidate behavioral and molecular predictors of fear generalization that may inform our understanding of some anxiety-related disorders, such as posttraumatic stress disorder (PTSD), that are characterized by overgeneralized fear.

Mitochondrial and Redox Changes in Periodontitis and Type 2 Diabetes Human Blood Mononuclear Cells.

Periodontitis (PDT) and type 2 diabetes (T2D) have demonstrated a bidirectional relationship and imbalanced oxidative stress linked to mitochondrial dysfunction. Therefore, we investigated mitochondrial and redox (de)regulation in peripheral blood mononuclear cells (PBMCs) in comorbid T2D-PDT, compared to PDT, T2D patients, and control individuals. PBMCs were analyzed for mitochondrial respiration, reactive oxygen species, antioxidant proteins, and expression of Nrf2-target genes. PDT and T2D-PDT patients exhibited altered periodontal clinical markers, while T2D and T2D-PDT patients displayed increased blood HbA1c. Decreased oxygen consumption and ATP production were observed in the PDT patient's PBMCs. PDT and T2D-PDT PBMCs also evidenced increased H2O2 levels and reduced catalase levels (also detected in T2D patients), whereas a compromised glutathione cycle was observed in T2D-PDT patients. PBMCs from both T2D or T2D-PDT patients showed increased Nrf2 protein levels, enhanced GCL activity and GCL-catalytic subunit protein levels, and maintained GCLc, GST, and HO-1 mRNA levels. In contrast, the expressions of Nrf2-target genes were significantly diminished in the PDT patient's PBMCs. Decreased SOD1 and GST mRNA levels were also observed in CD3+CD8+-lymphocytes derived from PDT and T2D-PDT patients. In conclusion, PBMCs from T2D-PDT patients showed major redox changes, while mononuclear cells from PDT patients showed mitochondrial deregulation and reduced expression of Nrf2-target genes.

Effect of methylene blue on hemodynamic response in the early phase of septic shock: A case series.

RATIONALE: Methylene blue (MB) has been used to increase blood pressure in septic shock, acting on the activity of guanylate cyclase and nitric oxide synthase. PATIENCE CONCERNS: The aim of this study is to demonstrate the benefit of MB in early phase of septic shock.Diagnoses: We report 6 cases of patients with septic shock with up to 72 hours of evolution. INTERVENTIONS: We used MB after fluid replacement, use of norepinephrine and vasopressin. Patients received a loading dose of MB and maintenance for 48 hours. OUTCOMES: All patients presented a reduction in the dose of vasopressors and lactate levels soon after the administration of the loading dose of MB, an effect that was maintained with the maintenance dose for 48 hours. Interleukin 6 and interleukin 8 were elevated at the beginning of the septic condition, with a progressive and marked reduction after the beginning of MB infusion, demonstrating a role of MB in reducing the inflammatory activity. LESSONS: This case series suggests that MB used early in the treatment of septic shock may be useful in reducing vasopressor dose and lactate levels. Further studies are still required to further validate these findings.

Effect of Wendler glottoplasty on voice and quality of life of transgender women.

OBJECTIVE: To investigate the effect of Wendler glottoplasty on voice feminization, voice quality and voice-related quality of life. METHODS: Prospective interventional cohort of transgender women submitted to Wendler glottoplasty. Acoustic analysis of the voice included assessment of fundamental frequency, maximum phonation time formant frequencies (F1 and F2), frequency range, jitter and shimmer. Voice quality was blindly assessed through GRBAS scale. Voice-related quality of life was measured using the Trans Woman Voice Questionnaire and the self-perceived femininity of the voice. RESULTS: A total of 7 patients were included. The mean age was 35.4 years, and the mean postoperative follow-up time was 13.7 months. There was a mean increase of 47.9 ±â€¯46.6 Hz (p = 0.023) in sustained/e/F0 and a mean increase of 24.6 ±â€¯27.5 Hz (p = 0.029) in speaking F0 after glottoplasty. There was no statistical significance in the pre- and postoperative comparison of maximum phonation time, formant frequencies, frequency range, jitter, shimmer, and grade, roughness, breathiness, asthenia, and strain scale. Trans Woman Voice Questionnaire decreased following surgery from 98.3 ±â€¯9.2 to 54.1 ±â€¯25.0 (p = 0.007) and mean self-perceived femininity of the voice increased from 2.8 ±â€¯1.8 to 7.7 ±â€¯2.4 (p = 0.008). One patient (14%) presented a postoperative granuloma and there was 1 (14%) premature suture dehiscence. CONCLUSION: Glottoplasty is safe and effective for feminizing the voice of transgender women. There was an increase in fundamental frequency, without aggravating other acoustic parameters or voice quality. Voice-related quality of life improved after surgery.

Professores de ensino médio, características do sono e sinais de burnout: revisão integrativa / High school teachers, sleep characteristics and burnout signs: integrative review / Profesores de secundaria, características del sueño y signos del burnout: revisión integradora

Objetivo: identificar estudos que avaliaram alterações do sono e Burnout em professores de ensino médio. Método: revisão integrativa, com busca de artigos em português, inglês e espanhol, publicados nas bases de dados National Library of Medicine (PubMed), Biblioteca Virtual em Saúde (BVS), Scopus, Web of Science e EBSCOHOST, utilizando os descritores Sleep, Burnout Psychological e School Teachers, e seus sinônimos. A busca e seleção de evidências científicas foi realizada por três revisores, de forma simultânea. Resultados: foram selecionados três artigos que avaliaram sono e Burnout para docentes, realizados no continente europeu (66,7%) e Estados Unidos, publicados a partir de 2018, que utilizaram três instrumentos distintos para avaliação de variáveis relacionadas ao sono e Burnout. Conclusão: Esgotamento, fadiga, carga de trabalho, comprometimento excessivo, podem ser fontes geradoras de alterações de sono e presença de Burnout na profissão docente, justificando a implementação de programas que promovam a promoção da saúde dessa classe. (AU).

Objective: identifing studies that evaluated sleep disorders and burnout in high school teachers. Method: integrative review, with search for articles in Portuguese, English and Spanish, published in the National Library of Medicine (PubMed), the Virtual Health Library (VHL), Scopus, Web of Science and EBSCOHOST databases, using the descriptors Sleep, Burnout, Psychological and School Teachers, and their synonyms. The search and selection of scientific evidence was carried out by three reviewers, simultaneously. Results: three articles were selected that evaluated sleep and Burnout for teachers, carried out in the European continent (66.7%) and the United States, published from 2018 onwards, which used three different instruments to assess variables related to sleep and Burnout. Conclusion: Exhaustion, fatigue, workload, excessive commitment, can be sources of sleep alterations and the presence of Burnout in the teaching profession, justifying the implementation of programs that promote the health promotion of this class. (AU).

Objetivo: identificar estudios que evaluaron alteraciones del sueño y Burnout en docentes de enseñanza media. Método: revisión integradora, búsqueda de artículos en portugués, inglés y español, publicados en las bases de datos de la Biblioteca Nacional de Medicina (PubMed), Biblioteca Virtual en Salud (BVS), Scopus, Web of Science y EBSCOHOST, utilizando los descriptores Sueño, Burnout Psicológico y Escolar Maestros, y sus sinónimos. La búsqueda y selección de evidencia científica fue realizada por tres revisores, simultáneamente. Resultados: se seleccionaron tres artículos que evaluaron el sueño y el Burnout para docentes, realizados en el continente europeo (66,7%) y Estados Unidos, publicados a partir de 2018, que utilizaron tres instrumentos diferentes para evaluar variables relacionadas con el sueño y el Burnout. Conclusión: El agotamiento, la fatiga, la carga de trabajo, el compromiso excesivo, pueden ser fuentes de alteraciones del sueño y la presencia de Burnout en la profesión docente, justificando la implementación de programas que promuevan la promoción de la salud de esta classe. (AU).

Effect of Wendler glottoplasty on voice and quality of life of transgender women

Abstract Objective: To investigate the effect of Wendler glottoplasty on voice feminization, voice quality and voice-related quality of life. Methods: Prospective interventional cohort of transgender women submitted to Wendler glottoplasty. Acoustic analysis of the voice included assessment of fundamental frequency, maximum phonation time formant frequencies (F1 and F2), frequency range, jitter and shimmer. Voice quality was blindly assessed through GRBAS scale. Voice-related quality of life was measured using the Trans Woman Voice Questionnaire and the self-perceived femininity of the voice. Results: A total of 7 patients were included. The mean age was 35.4 years, and the mean postoperative follow-up time was 13.7 months. There was a mean increase of 47.9 ± 46.6 Hz (p = 0.023) in sustained/e/F0 and a mean increase of 24.6 ± 27.5 Hz (p = 0.029) in speaking F0 after glottoplasty. There was no statistical significance in the pre- and postoperative comparison of maximum phonation time, formant frequencies, frequency range, jitter, shimmer, and grade, roughness, breathiness, asthenia, and strain scale. Trans Woman Voice Questionnaire decreased following surgery from 98.3 ± 9.2 to 54.1 ± 25.0 (p = 0.007) and mean self-perceived femininity of the voice increased from 2.8 ± 1.8 to 7.7 ± 2.4 (p = 0.008). One patient (14%) presented a postoperative granuloma and there was 1 (14%) premature suture dehiscence. Conclusion: Glottoplasty is safe and effective for feminizing the voice of transgender women. There was an increase in fundamental frequency, without aggravating other acoustic parameters or voice quality. Voice-related quality of life improved after surgery.

Ophthalmological findings in patients suspected with COVID-19 at a tertiary hospital in Pernambuco, Brazil / Achados oftalmológicos em pacientes com suspeita de COVID-19 atendidos na triagem do HC-UFPE

ABSTRACT Purpose: This study evaluated the frequency of the most common ophthalmological, neurological, and systemic findings in symptomatic patients seen at a COVID-19 screening service at Hospital das Clínicas - Universidade Federal de Pernambuco. Methods: A total of 104 patients under clinical suspicion of SARS-CoV-2 infection underwent medical evaluation through an ophthalmological and systemic symptoms survey. All participants selected for the study underwent COVID-19 RT-PCR testing. Results: The mean age was 38.8 years, with 44.23% between 31 and 40 years old, 68.27% female, and 31.73% male. The most common symptoms in patients with a positive RT-PCR test were cough (69.23%), fever (42.3%), hyposmia (38.46%), myalgia (38.46%), and ageusia (30.77%). In the positive group, 34.61% presented with ophthalmological symptoms: burning (19.23%), eye pain (11.54%), foreign body sensation (7.7%), hyperemia (7.7%), and tearing (3.84%). Conclusions: Systemic clinical features were characteristic of upper respiratory infection, but neurological findings of hyposmia and anosmia proved to be important markers for suspicion of SARS-CoV-2 infection. Ophthalmic symptoms in patients with COVID-19 were similar to those observed in other viral conditions and may precede systemic conditions. A high rate of self-medication was observed for general symptoms compared with ophthalmological conditions.

RESUMO Objetivo: Avaliar a frequência dos sintomas oftalmológicos, neurológicos e sistêmicos mais comuns em pacientes sintomáticos atendidos no serviço de triagem de COVID-19 do Hospital das Clínicas da UFPE. Métodos: Cento e quatro pacientes com suspeita clínica de infecção por Sars-Cov-2 foram submetidos a avaliação médica e aplicação de questionário sobre a sintomatologia oftalmológica, neurológica e sistêmica. Todos os participantes do estudo tiveram exame de RT-PCR para COVID-19 solicitado. Resultados: A média de idade foi de 38,8 anos, com 44,23% entre 31 e 40 anos. Mulheres corresponderam a 68,27% dos atendimentos e homens a 31,73%. Os sintomas mais frequentes nos pacientes com RT-PCR positivo foram: tosse (69,23%), febre (42,3%), mialgia (38,46%), hiposmia (38,46%), e ageusia (30,77%). Neste grupo, os sintomas oftalmológicos estiveram presentes em 34,61%, sendo: ardor (19,23%), dor ocular (11,54%), sensação de corpo estranho (7,7%), hiperemia (7,7%) e lacrimejamento (3,84%) os mais encontrados. Conclusões: O quadro clínico sistêmico foi característico de infecção respiratória alta, porém os achados neurológicos de hiposmia e anosmia mostraram-se importantes marcadores para a suspeição dos casos de infecção por COVID-19. Os sintomas oftalmológicos dos pacientes com COVID-19 foram semelhantes aos presentes em outros quadros virais, podendo preceder o quadro sistêmico. Houve uma alta taxa de automedicação para os sintomas gerais quando comparado ao quadro oftalmológico.

Deficiency of Acetyl-CoA Carboxylase Impairs Digestion, Lipid Synthesis, and Reproduction in the Kissing Bug Rhodnius prolixus.

Rhodnius prolixus is a hematophagous insect, vector of Chagas disease. After feeding, as blood is slowly digested, amino acids are used as substrates to fuel lipid synthesis, and adult females accumulate lipids in the fat body and produce eggs. In order to evaluate the importance of de novo fatty acid synthesis for this insect metabolism, we generated acetyl-CoA carboxylase (ACC) deficient insects. The knockdown (AccKD) females had delayed blood digestion and a shorter lifespan. Their fat bodies showed reduced de novo lipogenesis activity, did not accumulate triacylglycerol during the days after blood meal, and had smaller lipid droplets. At 10 days after feeding, there was a general decrease in the amounts of neutral lipids and phospholipids in the fat body. In the hemolymph, no difference was observed in lipid composition at 5 days after blood meal, but at day ten, there was an increase in hydrocarbon content and a decrease in phospholipids. Total protein concentration and amino acid composition were not affected. The AccKD females laid 60% fewer eggs than the control ones, and only 7% hatched (89% for control), although their total protein and triacylglycerol contents were not different. Scanning electron microscopy of the egg surface showed that chorion (eggshell) from the eggs laid by the AccKD insects had an altered ultrastructural pattern when compared to control ones. These results show that ACC has a central role in R. prolixus nutrient homeostasis, and its appropriate activity is important to digestion, lipid synthesis and storage, and reproductive success.

Ophthalmological findings in patients suspected with COVID-19 at a tertiary hospital in Pernambuco, Brazil.

PURPOSE: This study evaluated the frequency of the most common ophthalmological, neurological, and systemic findings in symptomatic patients seen at a COVID-19 screening service at Hospital das Clínicas - Universidade Federal de Pernambuco. METHODS: A total of 104 patients under clinical suspicion of SARS-CoV-2 infection underwent medical evaluation through an ophthalmological and systemic symptoms survey. All participants selected for the study underwent COVID-19 RT-PCR testing. RESULTS: The mean age was 38.8 years, with 44.23% between 31 and 40 years old, 68.27% female, and 31.73% male. The most common symptoms in patients with a positive RT-PCR test were cough (69.23%), fever (42.3%), hyposmia (38.46%), myalgia (38.46%), and ageusia (30.77%). In the positive group, 34.61% presented with ophthalmological symptoms: burning (19.23%), eye pain (11.54%), foreign body sensation (7.7%), hyperemia (7.7%), and tearing (3.84%). CONCLUSIONS: Systemic clinical features were characteristic of upper respiratory infection, but neurological findings of hyposmia and anosmia proved to be important markers for suspicion of SARS-CoV-2 infection. Ophthalmic symptoms in patients with COVID-19 were similar to those observed in other viral conditions and may precede systemic conditions. A high rate of self-medication was observed for general symptoms compared with ophthalmological conditions.

Prosodic Differences in the Voices of Transgender and Cisgender Women: Self-Perception of Voice - An Auditory and Acoustic Analysis.

INTRODUCTION: The voice is an important parameter for identifying the speaker's gender. Transgender people seek to adapt their bodies to gender identity, and transgender women have greater difficulties in achieving vocal acceptance. In this context, the evaluation of the various parameters of the voice of transgender and cisgender women is essential to make it possible to propose appropriate intervention measures. OBJECTIVES: To identify the differences in vocal characteristics of transgender and cisgender women. METHODS: An sectional study was conducted. The sample comprised 20 transgender women and 20 cisgender women who underwent evaluation of acoustic parameters, emotional prosody, self-perception, and perception of gender by lay listeners. RESULTS: The vocal characteristics of transgender and cisgender women differ in terms of the following parameters: f0, glottal noise excitation (GNE), vocal intensity, speech range profile (SRP), the first three formants of the vowel /a/, and in terms of emotional prosody, including duration and melodic contour. Higher values ​​were mostly found in the cisgender population, except for noise level and vocal intensity. In addition, in most cases lay listeners identified the voices of transgender women as belonging to the male gender. There was a negative correlation between vocal dissatisfaction and f0 among transgender women. CONCLUSIONS: Even though they perform vocal adjustments, the voices of transgender women are different from cisgender women in terms of acoustic parameters, vocal extension, and emotional prosody including duration and melodic contour. These differences have repercussions on the perception of gender by listeners.

Effect of methylene blue on hemodynamic and metabolic response in septic shock patients.

INTRODUCTION: Septic shock is a lethal disease responsible for a large proportion of deaths in the Intensive Care Unit (ICU), even with therapy centered on fluid resuscitation, use of vasopressors and empirical antibiotic therapy applied within the first hour of diagnosis. Considering the multifactorial pathophysiology of septic shock and the mechanism of action of vasopressors, some patients may not respond adequately, which can lead to the maintenance of vasodilatation, hypotension and increased morbidity, and mortality. This protocol aims to verify whether the use of methylene blue in septic patients with an early diagnosis can contribute to an earlier resolution of a shock compared to standard treatment. METHODS AND ANALYSIS: This is a study protocol for a single-center randomized clinical trial design in an ICU of a tertiary university hospital. In this study, we intend to include 64 patients aged between 18 and 80 years with a diagnosis of septic shock, of any etiology, with up to 72 hours of evolution after volume restoration, using norepinephrine at a dose ≥0.2 µg/kg/min and vasopressin at a dose of 0.04 IU/min. After the initial approach, we will randomize patients into two groups, standard care, and standard care plus methylene blue. The sample size was calculated in order to show 30% differences in septic shock resolution between groups. The Research Ethics Committee approved the study, and all patients included will sign an informed consent form (Clinical registration: RBR-96584w4).

Desafios da sífilis congénita na atenção primária à saúde em Alagoas, Brasil, 2009-2018 / Desafíos de la sífilis congénita en la atención primaria de salud en Alagoas, Brasil, 2009-2018 / Challenges of congenital syphilis in primary health care in Alagoas, Brazil, 2009-2018

Resumo Introdução: A sífilis é um agravo sexual causado pela bactéria Treponema pallidum, podendo causar defeitos congênitos quando há transmissão vertical da grávida infectada para seu concepto. No Brasil e no estado de Alagoas, caracteriza-se como problema de saúde pública a ser controlado, principalmente na Atenção Primária à Saúde que conta com a Estratégia Saúde da Família para o diagnóstico e o tratamento da sífilis na gestação, prevenindo os casos congênitos. Objetivo: Analisar as correlações entre a cobertura da Estratégia Saúde da Família e os indicadores da Sífilis Congênita no estado de Alagoas, Brasil, entre 2009 e 2018. Método: Trata-se de um estudo transversal retrospectivo com dados secundários do Ministério da Saúde sobre os indicadores de Sífilis Congênita e cobertura da Estratégia Saúde da Família em Alagoas. Utilizou-se o software Statistical Package for the Social Sciences -versão 25 e as correlações foram consideradas significantes com p-valor < 0,05. Resultados: Entre 2009-2018, notificou-se 3.407 casos de Sífilis Congênita em Alagoas e 73,6% das gestantes realizam o pré-natal. Contudo, observou-se que o momento do diagnóstico da sífilis materna não ocorreu durante o pré-natal; o tratamento materno não foi realizado ou realizado de forma inadequada; e apenas 9% das parcerias sexuais das gestantes foram tratadas. Conclusão: Em Alagoas, existem lacunas para o diagnóstico oportuno e o tratamento efetivo da sífilis na gestação, mesmo com a disponibilidade de insumos e protocolos assistenciais.

Resumen Introducción: La sífilis es un delito sexual causado por la bacteria Treponema pallidum, que puede causar defectos de nacimiento cuando hay transmisión vertical de la mujer embarazada infectada a su hijo. En Brasil y en el estado de Alagoas, es un problema de salud pública que debe ser controlado, especialmente en la Atención Primaria de Salud que se apoya en la Estrategia de Salud de la Familia para el diagnóstico y tratamiento de la sífilis en el embarazo, previniendo así los casos congénitos. Objetivo: Analizar las correlaciones entre la cobertura de la Estrategia de Salud de la Familia y los indicadores de Sífilis Congénita en el estado de Alagoas, Brasil, entre 2009 y 2018. Método: Se trata de un estudio transversal retrospectivo con datos secundarios del Ministerio de Salud sobre los indicadores de Sífilis Congénita y la cobertura de la Estrategia de Salud de la Familia en Alagoas. Se utilizó el software Statistical Package for the Social Sciences - versión 25 y las correlaciones se consideraron significativas con un valor p < 0,05. Resultados: Entre 2009-2018 se notificaron 3.407 casos de Sífilis Congénita en Alagoas y el 73,6% de las embarazadas realizaron control prenatal. Sin embargo, se observó que el momento del diagnóstico de la sífilis materna no se produjo durante la atención prenatal; el tratamiento materno no se realizó o se realizó de forma inadecuada; y sólo el 9% de las parejas sexuales de las embarazadas recibieron tratamiento. Conclusión: En Alagoas, existen lagunas para el diagnóstico oportuno y el tratamiento eficaz de la sífilis en el embarazo, incluso con la disponibilidad de insumos y protocolos de atención.

Comparison of coach-athlete perceptions on internal and external training loads in trained cyclists.

ABSTRACTThe aim was to compare the rating of perceived exertion (RPE), duration and session-RPE (S-RPE) prescribed by the coaches to those perceived by the cyclists in training sessions. The classification of RPE, duration and S-RPE of 14 male road cycling and mountain biking athletes were compared with the planned values of five coaches. The results revealed no differences for average RPE (P = 0.586), duration (P = 0.717) and S-RPE (P = 0.738) between coaches and cyclists. When comparing the three categories of effort, the results of the intensity of training sessions designed to be easy were perceived as significantly harder by cyclists compared to coaches (3.0 [2.0] vs. 2.0 [0.0] a.u.; P = 0.013). In addition, the correlations between coaches and cyclists on RPE (r = 0.73), duration (r = 0.95) and S-RPE (r = 0.87) were large, almost perfect and very large (P < 0.0001) respectively. In conclusion, our results indicate a mismatch between coaches (prescription) and cyclists (perception) of easy RPE training sessions, where the cyclists perceived the session harder. However, the S-RPE can be used to prescribe and quantifying the internal training load of trained cyclists.