Convergence of Accelerated Brain Volume Decline in Normal Aging and Alzheimer's Disease Pathology.

Background: Age represents the largest risk factor for Alzheimer's disease (AD) but is typically treated as a covariate. Still, there are similarities between brain regions affected in AD and those showing accelerated decline in normal aging, suggesting that the distinction between the two might fall on a spectrum. Objective: Our goal was to identify regions showing accelerated atrophy across the brain and investigate whether these overlapped with regions involved in AD or where related to amyloid. Methods: We used a longitudinal sample of 137 healthy older adults from the Alzheimer's Disease Neuroimaging Initiative (ADNI), who underwent magnetic resonance imaging (MRI). In addition, a total of 79 participants also had longitudinal positron emission tomography (PET) data. We computed linear-mixed effects models for brain regions declining faster than the average to investigate variability in the rate of change. Results: 23 regions displayed a 0.5 standard deviation (SD) above average decline over 2 years. Of these, 52% overlapped with regions showing similar decline in a matched AD sample. Beyond this, the left precuneus, right superior frontal, transverse temporal, and superior temporal sulcus showed accelerated decline. Lastly, atrophy in the precuneus was associated with increased amyloid load. Conclusions: Accelerated decline in normal aging might contribute to the detection of early signs of AD among healthy individuals.

Blended Psychological Interventions for Emotional Disorders in Youth: Acceptability and Intention to Use in a Sample of Portuguese Psychologists.

INTRODUCTION: The rise of mental health problems in youth highlights the need for accessible and cost-effective psychological interventions. Blended interventions, which combine face-to-face and online sessions, can be an adequate response to the increase in demands for youth mental health services. Although this can be a promising approach, effective dissemination depends on the professionals´ acceptance. OBJECTIVES: This study aimed to explore the acceptability of and intention to use blended interventions by psychologists working with children with emotional disorders and to examine their predictors, including previous knowledge, expectancies (i.e., performance expectancy, effort expectancy, social influence, and facilitating conditions), and attitudes toward evidence-based practices. METHODS: The sample consisted of 76 Portuguese psychologists (Mage = 37.26 years, SD = 10.47; 92.1% female) working in youth mental health services. The participants completed an online protocol to evaluate the different dimensions included in the study. RESULTS: The results showed that most participants demonstrated moderate to high acceptability of blended psychological interventions for emotional disorders in youth and intend to use them in the future. Regression analysis showed that performance expectancy and positive attitudes toward evidence-based practices were significant predictors of acceptance of blended interventions and that social influence was a significant predictor of both acceptance of and intention to use blended interventions. CONCLUSION: These results emphasize the importance of sharing the findings of blended interventions, changing professionals' attitudes toward evidencebased practices, and collaborating more closely with organizations and institutions to advance standards that encourage the adoption of this intervention format.

Clean-label products: Factors affecting liking and acceptability by Portuguese older adults.

Consumers are preferring more "natural" foods, made of "healthier" and "familiar" components - the "clean-label" trend. As the population ages, understanding the older adult consumer segment becomes increasingly important. This study aims to identify the factors influencing the acceptability and liking of clean-label products in older adults living in the community. A convenience sample of 100 older adults was used for this cross-sectional study. Socio-demographic data, health status, independence level, lifestyle characteristics, nutritional status, and food and nutrient intake data were collected. The acceptability and liking for clean-label products comprised two parts: Sensory analysis with overall liking evaluation of three pairs of products, using a 9-point hedonic scale and free comments; Willingness to eat and preference assessment of nine pairs of products using the Food Action scale and a simple preference test. The participants were 80% female with a mean age of 75 years old. The overall liking for clean-label versions of cookies and mayonnaise was lower than for traditional versions. However, participants were more willing to eat the clean-label versions of products, particularly ham and yogurt. Most of the participants would prefer buying the clean-label version of all nine pairs of products, especially for ham, loaf bread, sausages, and yogurt. In sum, older adults living in the community exhibit a lower liking but, a greater willingness to eat and a higher preference for buying clean-label products. Older adults who favor clean-label products have higher levels of education and are reported to have a more adequate diet.

Study protocol for a randomized controlled trial testing the efficacy of Emotion Detectives In-Out: a blended version of the unified protocol for transdiagnostic treatment of emotional disorders in Portuguese children.

BACKGROUND: Childhood emotional disorders (EDs; i.e., anxiety and depressive disorders) are currently a public health concern. Their high prevalence, long-term effects, and profound influence on the lives of children and families highlight the need to identify and treat these disorders as early and effectively as possible. This clinical trial will examine the efficacy of a blended version (i.e., combining face-to-face and online sessions into one treatment protocol) of the Unified Protocol for Children (the "Emotion Detectives In-Out" program). This program is a manualized cognitive-behavioral therapy for the transdiagnostic treatment of EDs in children aged 7 to 12 years that aims to reduce the intensity and frequency of strong and aversive emotional experiences by helping children learn how to confront those emotions and respond to them in more adaptive ways. METHODS: This study is designed as a multicenter equivalence randomized controlled parallel-group two-arm trial comparing the Emotion Detectives In-Out program with an evidenced-based group intervention for children with anxiety disorders (the Coping Cat program). Participants will be children aged between 7 and 12 years with an anxiety disorder or with clinically significant anxiety symptoms as well as one of their parents or a legal representative. A minimum sample size of 138 children (69 per group) is needed to test whether the efficacy of the proposed intervention is equivalent to that of the well-established Coping Cat intervention. DISCUSSION: We expect Emotion Detectives In-Out to be a feasible and efficacious alternative intervention for treating children's EDs by allowing for a greater increase in children's access to care. A blended format is expected to overcome common barriers to treatment (e.g., parents´ lack of time to attend regular sessions) and make the intervention more accessible to families. TRIAL REGISTRATION: The clinical trial is registered at ClinicalTrials.gov (Identifier: NCT05747131, date assigned February 28, 2023).

Intervention Program Dropout Among Perpetrators of Intimate Partner Violence: A Meta-Analysis of Correlated Variables.

Dropout in perpetrator intervention programs (PIPs) is extensively documented in the literature, yet findings across various studies exhibit global inconsistency. This meta-analysis aimed to identify dropout rates among individuals attending PIPs and examine sociodemographic, violence-related, intrapersonal, interpersonal, and external variables related to dropout. A search was conducted across six databases, encompassing studies published between 2010 and 2022 in English, Spanish, or Portuguese. Thirty manuscripts, comprising data from 31 independent samples, were included. Dropout rates varied from 9% to 67%. Bivariate analysis results indicated that younger age (OR = 0.69), non-White ethnicity (OR = 1.54), unemployment (OR = 1.78), offender typology other than family only (OR = 2.45), substance abuse (OR = 1.78), presenting a personality disorder (OR = 1.21), engaging in problematic leisure activities (OR = 1.28), possessing a greater criminal history (OR = 1.47), and experiencing more adversity in childhood (OR = 1.44) were significantly correlated with dropout. Additionally, the inclusion of motivational strategies in treatment (OR = 0.44) significantly decreased the likelihood of dropout. Results from multivariate analyses revealed that younger age (OR = 0.63), presenting a personality disorder (OR = 1.73), and experiencing more adversity in childhood (OR = 2.16) were significantly associated with dropout. Notably, intimate partner violence characteristics established a significant negative relation with dropout (OR = 0.59). Findings indicate that variables associated with dropout align with those related to general and intimate partner violence recidivism, suggesting that individuals requiring more intensive intervention are those who derive less benefit from it.

The Factorial Structure, Psychometric Properties and Sensitivity to Change of the Distress Tolerance Scale for Children with Emotional Disorders.

BACKGROUND: The Distress Tolerance Scale (DTS) was adapted for American and Chinese youth, but never for European youth. Moreover, the factor structures found in these previous studies were not consistent. METHODS: The DTS was adapted for Portuguese children and then validated among 153 children aged 6-13 years with emotional disorders. A confirmatory factor analysis (CFA) was conducted; the DTS reliability and validity were analyzed, and sex and age differences were explored. A sub-sample of children who received a transdiagnostic CBT (Unified Protocol for Children) was used to analyze the DTS's sensitivity to therapeutic change. RESULTS: The five tested models (based on previous studies) exhibited adequate fit in the CFA. However, the model previously reported for use in American children with emotional disorders was selected as the most appropriate. The DTS demonstrated adequate psychometric properties, and its validity was established through significant negative associations with measures of anxiety, depression and negative affect, as well as positive associations with positive affect. Age and sex differences were discussed. The DTS scores significantly increased from pre- to post-treatment, demonstrating sensitivity to therapeutic change. CONCLUSIONS: The DTS is a suitable and useful measure for assessing children's distress tolerance and to assess the efficacy of CBT.

Impactos do TDAH à Adolescência: Revisão Sistemática de Literatura / Impacts of ADHD on Adolescence: Systematic Literature Review

RESUMO: Transtorno do Déficit de Atenção com Hiperatividade (TDAH) é um transtorno do neurodesenvolvimento caracterizado por níveis prejudiciais de desatenção e/ou hiperatividade-impulsividade. Foram investigados resultados obtidos em pesquisas sobre impactos do TDAH ao adolescente e foi utilizada a recomendação PRISMA 2020. As bases de dados consultadas foram: APA PsycNet, Lilacs, Medline, PubMed Central, Scorpus, SciELO, a partir dos seguintes descritores: Transtorno do Déficit de Atenção e Hiperatividade, TDAH, Attention Deficit Hyperactivity Disorder, ADHD e Adolescente, Adolescentes, Adolescência, Adolescent, Teenager e Adolescence. Os critérios de inclusão foram: artigos publicados em periódicos entre janeiro de 2001 e janeiro de 2021, em português e inglês, completos e disponíveis online, estudos empíricos, revisados por pares, terem adolescentes como participantes e apresentarem no título, resumo ou corpo do texto os descritores referidos. Os dados foram tratados e organizados conforme check list (recomendação PRISMA 2020). Análises estatísticas descritivas foram realizadas com o Excel 2019. Para apresentar os resultados, utilizaram-se o fluxograma PRISMA, quadro e figuras. Incluíram-se 68 artigos que apontaram variedade de impactos negativos ao desenvolvimento do adolescente nas áreas sociais/relacionais, comportamentais, biológicas, neurológicas, cognitivas, psicológicas e psicopatológicas. Possível limitação desta revisão pode ser a não inclusão de artigos em outros idiomas, além do inglês e português. Os resultados sugerem multidimensionalidade dos impactos do TDAH ao adolescente, requerendo abordagem pluridimensional para evitar cronicidade, reduzindo seus efeitos ao desenvolvimento.

ABSTRACT: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by harmful levels of inattention and/or hyperactivity-impulsivity. Results obtained from research on the impact of ADHD on adolescents were investigated and the PRISMA 2020 recommendation was used. The databases consulted: were APA PsycNet, Lilacs, Medline, PubMed Central, Scorpus, SciELO, from the following descriptors: Transtorno do Déficit de Atenção e Hiperatividade, TDAH, Attention Deficit Hyperactivity Disorder, ADHD and Adolescente, Adolescentes, Adolescência, Adolescent, Teenager and Adolescence. The inclusion criteria were: articles published in journals between January 2001 and January 2021, in Portuguese and English, complete and available online, empirical studies, peer reviewed, with adolescents as participants and presenting in the title, abstract or body of the text the referred descriptors. The data were processed and organized according to the check list (PRISMA 2020 recommendation). Descriptive statistical analyzes were performed using Excel 2019. The PRISMA flowchart, table and figures were used to present the results. Sixty-eight articles were included that pointed to a variety of negative impacts on adolescent development in the social/relational, behavioral, biological, neurological, cognitive, psychological and psychopathological areas. A possible limitation of this review may be the non-inclusion of articles in languages other than English and Portuguese. The results suggest the multidimensionality of the impacts of ADHD on adolescents, requiring a multidimensional approach to avoid chronicity, reducing its effects on development.

Astrocytoma Mimicking Herpetic Meningoencephalitis: The Role of Non-Invasive Multimodal Monitoring in Neurointensivism.

Neuromonitoring is a critical tool for emergency rooms and intensive care units to promptly identify and treat brain injuries. The case report of a patient with status epilepticus necessitating orotracheal intubation and intravenous lorazepam administration is presented. A pattern of epileptiform activity was detected in the left temporal region, and intravenous Acyclovir was administered based on the diagnostic hypothesis of herpetic meningoencephalitis. The neurointensivist opted for multimodal non-invasive bedside neuromonitoring due to the complexity of the patient's condition. A Brain4care (B4C) non-invasive intracranial compliance monitor was utilized alongside the assessment of an optic nerve sheath diameter (ONSD) and transcranial Doppler (TCD). Based on the collected data, a diagnosis of intracranial hypertension (ICH) was made and a treatment plan was developed. After the neurosurgery team's evaluation, a stereotaxic biopsy of the temporal lesion revealed a grade 2 diffuse astrocytoma, and an urgent total resection was performed. Research suggests that monitoring patients in a dedicated neurologic intensive care unit (Neuro ICU) can lead to improved outcomes and shorter hospital stays. In addition to being useful for patients with a primary brain injury, neuromonitoring may also be advantageous for those at risk of cerebral hemodynamic impairment. Lastly, it is essential to note that neuromonitoring technologies are non-invasive, less expensive, safe, and bedside-accessible approaches with significant diagnostic and monitoring potential for patients at risk of brain abnormalities. Multimodal neuromonitoring is a vital tool in critical care units for the identification and management of acute brain trauma as well as for patients at risk of cerebral hemodynamic impairment.

Effect of seasonality on the leaf phenology and physiology of Byrsonima species (Malpighiaceae)

Introduction: Defined seasonality in savanna species can stimulate physiological responses that maximize photosynthetic metabolism and productivity. However, those physiological responses are also linked to the phenological status of the whole plant, including leaf phenophases. Objective: To study how physiological traits influence phenophase timing among congeneric and co-occurring savanna species. Methods: We evaluated the leaf phenology and physiological traits of populations of Byrsonima intermedia, B. coccolobifolia, and B. verbascifolia. Physiological measurements were performed at the onset of the dry and rainy seasons and again late in the season. Results: B. intermedia and B. coccolobifolia were classified as brevideciduous and B. verbascifolia as evergreen. The maximum quantum yield for B. intermedia and B. coccolobifolia were lowest during the dry season. At the onset of the dry period, the highest chloroplastidic pigment levels were observed, which decreased as the season advanced, total chlorophyll/carotenoid ratios were lowest, and carotenoid contents were highest. We detected low starch content values at the start of the rainy season, coinciding with the resumption of plant growth. Two months into this season, the leaves were at their peak structural and functional maturity, with high water-soluble polysaccharide values and photosynthetic rates, and were storing large amounts of starch. Conclusions: Physiological and leaf phenological strategies of the Byrsonima species were related to drought resistance and acclimatization to the seasonality of savanna water resources. The oscillations of the parameters quantified during the year indicated a strong relationship with water seasonality and with the phenological status of the leaves.

Introducción: La marcada estacionalidad en las especies de sabana puede estimular respuestas fisiológicas que maximicen el metabolismo fotosintético y la productividad. Sin embargo, esas respuestas fisiológicas están vinculadas al estado fenológico de toda la planta, incluidas las fenofases de las hojas. Objetivo: Estudiar cómo los rasgos fisiológicos influyen en el tiempo de la fenofase entre especies de sabana congenéricas y concurrentes. Métodos: Evaluamos la fenología y características fisiológicas de poblaciones de Byrsonima intermedia, B. coccolobifolia y B. verbascifolia. Las mediciones fisiológicas se realizaron al inicio de la estación seca y lluviosa, y de nuevo al final de la estación. Resultados: B. intermedia y B. coccolobifolia se clasificaron como brevicaducifolias y B. verbascifolia como perennifolias. El rendimiento cuántico máximo para B. intermedia y B. coccolobifolia fueron más bajos durante la época seca. Al inicio del período seco, se observaron niveles de pigmentos cloroplastídicos más altos, aunque los niveles de clorofila disminuyeron a medida que avanzaba la estación seca, las proporciones clorofila/carotenoides totales fueron más bajas y los contenidos de carotenoides más altos. Detectamos valores bajos de contenido de almidón al inicio de la época lluviosa, que coincide con la reanudación del crecimiento de la planta. A dos meses de esta época, las hojas estaban en su máxima madurez estructural y funcional, con altos valores de polisacáridos solubles en agua y tasas fotosintéticas, y almacenaban grandes cantidades de almidón. Conclusiones: Las estrategias fisiológicas y fenológicas de las hojas de las especies de Byrsonima estaban relacionadas con la resistencia a la sequía y la aclimatación a la estacionalidad de los recursos hídricos de la sabana. Las oscilaciones de los parámetros cuantificados durante el año indicaron una fuerte relación con la estacionalidad hídrica y con los estados fenológicos de las hojas.

The knowledge of prescription and the pharmacological role in temporomandibular disorders for dental surgeons: literature review / O conhecimento da prescrição e o papel farmacológico em disfunção temporomandibular para os cirurgiões-dentistas: revisão de literatura

ABSTRACT BACKGROUND AND OBJECTIVES: The temporomandibular disorder (TMD) is an anatomical-functional disorder that affects the muscles of chewing, the temporomandibular joint (TMJ) or both structures. It is one of the most common orofacial pain of non-dental origin with a prevalence of 5% to 7% of the population, being considered a public's health problem. The main symptom of TMD is pain and, when chronic, it affects the quality of life. The drug classes that are commonly used in this condition are antidepressants, anticonvulsants and muscle relaxants that modulate symptomatology in these subjects. The aim of this study was to review the literature about main drugs used to control TMD, its mechanisms of action and effectiveness as well as the possible causes of TMD. CONTENTS: Literature was searched in the following databases: Pubmed, Scielo and Lilacs with a time sample from 2010 to 2021. As inclusion parameter, were selected literatures review and systematic articles, randomized clinical cases, placebo-controlled and double-blind studies with the TMD theme, considering pharmacological treatments aspects. As exclusion parameter, articles in which the outcome was not the TMD, congress abstracts and personal opinions were rejected. After the articles' selection, reading of titles and abstracts, 09 articles were selected, consisting of reviews and clinical studies relevant to the subject. CONCLUSION: The pharmacological approach has demonstrated its positive effects in the management of TMD-related chronic pain, with more effective results when associated with other therapies, due to its multifactorial characteristic.

RESUMO JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibular (DTM) é uma desordem anátomo-funcional que afeta os músculos da mastigação, da articulação temporomandibular (ATM) ou ambas as estruturas. E uma das dores orofaciais mais comuns de origem não dentária, com prevalência de 5% a 7% da população, sendo considerada um problema de saúde pública. O principal sintoma da DTM é a dor que, quando crônica, afeta a qualidade de vida. As classes de fármacos mais comumente empregadas nessa condição são os antidepressivos, anticonvulsivantes e relaxantes musculares, que modulam os sintomas nesses pacientes. O objetivo deste estudo foi revisar a literatura acerca dos principais fármacos utilizados no controle da DTM, seus mecanismos de ação e eficácia, bem como as suas possíveis causas. CONTEÚDO: Buscou-se na literatura artigos científicos nas bases de dados: Pubmed, Scielo e Lilacs, com a amostra temporal de 2010 a 2021. Como parâmetro de inclusão, foram selecionados artigos de revisão de literatura e sistemática, casos clínicos randomizados, estudos placebo-controlados e estudos duplo-cegos com a temática DTM, considerando aspectos do tratamento farmacológico. Como parâmetro de exclusão, artigos em que o desfecho não era a DTM, resumos em congressos e opiniões pessoais foram rejeitados. Após a seleção dos artigos, leitura de títulos e resumos, 9 artigos foram selecionados, consistindo em revisões e estudos clínicos pertinentes ao assunto. CONCLUSÃO: A abordagem farmacológica demonstrou efeitos positivos no manejo da dor crônica em DTM, tendo resultados mais eficazes quando associada a outras terapias, em virtude de sua característica multifatorial.

Estresse ocupacional em nutricionistas atuantes na área de alimentação coletiva / Occupational stress in nutritionists working in the área of colletctive food / Estrés laboral em nutricionistas que trabajan em el área de alimentación colectiva

Objetivo: identificar o nível de estresse ocupacional de nutricionistas atuantes na alimentação coletiva. Método: estudo transversal e quantitativo realizado com nutricionistas da área de alimentação coletiva, de ambos os sexos. Os dados foram obtidos por meio da aplicação de questionário online, auto preenchido pelo voluntário. Resultados: verificou-se nível moderado e alto de estresse nos nutricionistas estudados. Esses resultados são preocupantes, sendo necessário ações aliadas a programas de prevenção. Os principais estressores são: deficiência nos treinamentos e pouca perspectiva de crescimento na carreira. A variável estresse apresentou associação estatística com as variáveis filhos (p=0,0152) e renda mensal (p=0,0387). Conclusão: torna-se fundamental consolidar ações de intervenções visando prevenir e minimizar tal resultado, por meio de ações de orientação no processo de formação ao ingressar na organização bem como no desenvolvimento de habilidades de enfrentamento.

Objective: to identify the level of occupational stress of nutritionists working in collective feeding. Method: cross-sectional and quantitative study carried out with nutritionists in the área of collective feeding, of both sex. Data were obtained through the application of an online questionnaire, self-completed by the volunteer. Results: moderate and high levels of stress were found in the nutritionists studied. These results are worrying, requiring actions combined with prevention programs. The main stressors are: deficiency in training and little prospecto f career growth. The stress variable showed a statistical association with the child variables (p=0.0152) and monthly income (p=0.0387). Conclusion: it becomes essential to consolidate intervention actions aimed at preventing and minimizing this result, through guidance actions in the training process when joining the organization as well as in the development of coping skills.

Objetivo: identificar el nivel de estrés laboral de nutricionistas que trabajan en alimentación colectiva. Método: estudio transversal y cuantitativo realizado con nutricionistas del área de alimentación colectiva, de ambos sexos. Los datos se obtuvieron mediante la aplicación de un cuestionario em línea, autocompletado por el voluntario. Resultados: se encontraron niveles moderados y altos de estrés em los nutricionistas estudiados. Estos resultados son preocupantes, requiriendo acciones combinadas con programas de prevención. Los principales factores de estrés son: deficiencia em la formación y pocas perspectivas de crecimiento profesional. La variable estrés mostro asociación estadística com las variables hijo (p=0,0152) e ingresso mensual (p=0,0387). Conclusión: se hace imprescindible consolidar acciones de intervención encaminadas a prevenir y minimizar este resultado, a través de acciones de orientación en el proceso de formación al ingresso a la organización así como em el desarrollo de habilidades de afrontamiento.

Surgical treatment of rectal cancer: prospective cohort study about good oncologic results and low rates of abdominoperineal excision / Tratamento cirúrgico do câncer retal: estudo coorte prospectivo com bons resultados oncológicos e baixas taxas de amputação abdominoperineal

ABSTRACT Objectives: the purpose of this study was to evaluate the outcome of rectal cancer surgery, in a unit adopting the principles of total mesorectal excision (TME) with a high restorative procedure rate and with a low rate of abdominoperineal excision (APE). Methods: we enrolles patients with extraperitoneal rectal cancer undergoing TME or TME+APE. Patients with mid rectal tumors underwent TME, and patients with tumors of the lower rectum and no criteria for APE underwent TME and intersphincteric resection. Those in which the intersphincteric space was invaded and in those with a free distal margin less than 1cm or a tumor free radial margin were unattainable underwent APE or extralevator abdominoperineal excision (ELAPE). We assessed local recurrence rates, overall survival and involvement of the radial margin. Results: sixty (89.6%) patients underwent TME and seven (10.4%) TME + APE, of which five underwent ELAPE. The local recurrence, in pacientes undergoing TME+LAR, was 3.3% and in patients undergoing APE, 14.3%. The local recurrence rate (p=0.286) or the distant recurrence rate (p=1.000) was similar between groups. There was no involvement of radial margins. Survival after 120 months was similar (p=0.239). Conclusion: rectal malignancies, including those located in the low rectum, may be surgically treated with a low rate of APE without compromising oncological principles and with a low local recurrence rates.

RESUMO Objetivos: o objetivo deste estudo foi avaliar os resultados da cirurgia do câncer de reto, em uma unidade que adota os princípios da excisão total do mesorreto (ETM) com baixa taxa de amputação abdominoperineal (AAP). Métodos: os pacientes com câncer retal extraperitoneal foram submetidos a ETM ou ETM com amputação abdominoperianeal. Pacientes com tumores de reto médio foram submetidos a EMT e pacientes com tumores de reto inferior e sem critérios para AAP foram submetidos a EMT e ressecção interesfincteriana. Aqueles em que o espaço interesfincteriano foi invadido e naqueles com margem distal livre menor que 1cm ou margem radial livre de tumor foram inatingíveis foram submetidos a AAP ou excisão abdominoperineal extraelevadora (ELAPE). Avaliamos as taxas de recorrência local, sobrevida global e envolvimento da margem radial. Resultados: sessenta (89,6%) pacientes realizaram ETM e sete (10,4%) ETM + AAP, dos quais cinco realizaram ELAPE. A recidiva local, em pacientes submetidos a ETM com ressecção anterior baixa, foi de 3,3% e em pacientes submetidos a AAP, 14,3%. A taxa de recorrência local (p=0,286) ou a taxa de recorrência à distância (p=1,000) foi semelhante entre os grupos. Não houve envolvimento das margens radiais. A sobrevida após 120 meses foi semelhante (p=0,239). Conclusão: as neoplasias malignas retais, incluindo aquelas localizadas no reto baixo, podem ser tratadas cirurgicamente com baixo índice de AAP, sem comprometer os princípios oncológicos e com baixo índice de recorrência local.

Nasosinusal Endoscopic Anatomy and Physiology

The present article focuses on the analysis of the nasal cavity's anatomy succinctly and descriptively. This essay was carried out through a bibliographic review, directed to the detailed anatomy of the nasal cavity, and the structures that form its sinuses. We have identified the need formore studies directed to the related anatomical area so that the improved knowledge of this region ensures a nasoendoscopic treatment with better effectiveness and no complications.

Envelhecimento e poética de atenção às formas de vida / Aging and poetics of attention to life forms / Envejecimiento y poética de atención a las formas de vida

Este artigo discute a possibilidade de uma poética de cuidado e atenção às formas de vida em uma instituição de longa permanência para idosos. O texto ancora-se em uma etnografia que ocorreu em um abrigo para idosos, realizada por meio de observação participante, entrevistas e acompanhamento da vida cotidiana. Durante o trabalho de campo, uma das atividades centrais era um Círculo de Leitura promovido pela instituição. Ao acompanhar essas atividades, a literatura provocava os afetos e memórias dos participantes e constituiu uma forma de cuidado e produção de saúde. Nesse contexto, ler e rememorar também era produzir saúde. Procurando analisar as vivências no Círculo de Leitura, o texto indaga o que pode a literatura e quais experiências provocam. A busca é por entender como a literatura afeta os idosos.(AU)

This article discusses the potential of poetics of care in a long-term care facility for older persons. The text is anchored in an ethnography conducted in a care home using participant observation, interviews, and accompanying day-to-day life in the home. One the central activities during field work were reading circles organized by the home. It was observed that the literature triggered affects and memories among the participants and constituted a form of care and production of health. Within this context, reading and reminiscing also produce health. Analyzing the experiences of the reading circles, the text explores the potential of literature and the experiences provoked by reading, seeking to understand how it affected the residents.(AU)

El objetivo de este artículo es discutir la posibilidad de una poética de cuidado y atención a las formas de vida en una institución de larga permanencia para ancianos. El texto está anclado en una etnografía que ocurrió en un asilo para ancianos, realizada por medio de observación participante, entrevistas y acompañamiento de la vida cotidiana. Durante el trabajo de campo, una de las actividades centrales era un círculo de lectura promovido por la institución. Al acompañar esas actividades, la literatura provocaba los afectos y memorias de los participantes y se constituyó como forma de cuidado y producción de salud. En ese contexto, leer y rememorar también era producir salud. Buscando analizar las vivencias en el círculo de lectura, el texto indaga lo que puede la literatura y cuáles son las experiencias que provoca. La búsqueda es entender de qué forma la literatura afectaba a los ancianos.(AU)

Jugular Foramen's Paraganglioma in a Patient with Von Hippel-Lindau Disease: Case Report

Glomus jugular tumors, also known as paragangliomas (PGLs), are rare and related to several clinical syndromes described. These are located in the carotid body, the jugular glomus, the tympanic glomus and the vagal glomus. The symptoms are directly related to the site of involvement and infiltration. These lesions have slow growth, are generally benign and hypervascularized, have a peak incidence between the age of 30 to 50 years old; however, when associated with hereditary syndromes, they tend to occur a decade earlier. Several familial hereditary syndromes are associated with PGLs, including Von Hippel- Lindau disease (VHL) in< 10% of the cases. The diagnosis and staging of PGLs are based on imaging and functional exams (bone window computed tomography [CT] with a "ground moth" pattern and magnetic resonance imaging (MRI) with a "salt and pepper" pattern). The cerebral angiography is a prerequisite in patients with extremely vascularized lesions, whose preoperative embolization is necessary. The histopathological finding of cell clusters called "Zellballen" is a characteristic of PGLs. Regarding the jugular foramen, the combination of two or three surgical approaches may be necessary: (1) lateral group, approaches through themastoid; (2) posterior group, through the retrosigmoid access and its variants; and (3) anterior group, centered on the tympanic and petrous bone. In the present paper, we report a case of PGL of the jugular foramen operated on a young female patientwho underwent a surgery with a diagnosis ofVonHippel-Lindau Disease (VHL) at the Neurosurgery Service of the Hospital Heliópolis, São Paulo, state of São Paulo, Brazil in 2018, by the lateral and posterior combined route.

Avaliação da fala pré-tratamento e pós-tratamento fonoaudiológico associado ao biofeedback ultrassonográfico de língua e de prótese bucomaxilofacial no câncer de cavidade oral / Evaluation of speech before and after speech therapy associated with ultrasound biofeedback of tongue and bucomaxillofacial prosthesis in oral cavity cancer

RESUMO As próteses bucomaxilofaciais (PBMF) têm como objetivo a reabilitação oral de pacientes com mutilações decorrentes de cirurgias de câncer de boca. Como parte dessa reabilitação oral, a terapia fonoaudiológica associada ao biofeedback ultrassonográfico da língua possibilita melhor precisão da produção de fala. O presente estudo teve por objetivo caracterizar a produção de fala de um indivíduo com histórico de múltiplas cirurgias oncológicas que levaram à glossectomia total, com auxílio de um dispositivo individualizado de acrílico, idealizado a partir da parceria Odonto-Fonoaudiologia da instituição e confeccionado por especialista em PBMF e terapia fonoaudiológica, utilizando o biofeedback visual com ultrassonografia. O indivíduo era homem, 45 anos, professor aposentado com histórico de carcinoma epidermóide de língua com episódios de recidiva. Como tratamento oncológico, foram realizadas diversas cirurgias associadas à radioterapia, ao longo de sete anos. O tratamento oncológico culminou com a glossectomia total e instalação de osteorradionecrose de mandíbula. O tratamento desta sequela da radioterapia também exigiu múltiplas abordagens cirúrgicas, com perda de grande parte da mandíbula, levando ao severo comprometimento das funções de deglutição e fala. Durante o atendimento multiprofissional da equipe Odonto-Fonoaudiologia de um hospital universitário, foi idealizada a confecção de um dispositivo individualizado de acrílico, objetivando melhorar a inteligibilidade da fala do paciente. Tal dispositivo foi confeccionado por dentista especialista em PBMF e ajustado em conjunto com a equipe de Fonoaudiologia. Com o dispositivo de acrílico adaptado, o indivíduo iniciou a terapia fonoaudiológica associada ao biofeedback, por meio da ultrassonografia de língua, com o objetivo de promover o refinamento da produção de fala dos fones fricativos [s] e [∫]. Ao comparar a avaliação pré-terapia e pós-terapia, foi possível identificar, após a análise das falas por juízes, melhora quanto à Porcentagem de Consoantes Corretas, de moderadamente severa para levemente moderada, bem como a inteligibilidade de fala, de insuficiente para regular. O dispositivo individualizado com a terapia fonoaudiológica associada ao biofeedback produziram resultados de fala satisfatórios, considerando-se a gravidade do caso e o elevado grau de mutilação do paciente.

ABSTRACT The oral maxillofacial prostheses (PBMF) aim the oral rehabilitation of patients with mutilations resulting from oral cancer surgery. The oral rehabilitation was composed of speech therapy associated with ultrasound biofeedback of the tongue, which allows better precision in speech production. The present study aims to characterize the speech production of an individual with a history of multiple oncological surgeries with total glossectomy with the aid of an individualized acrylic device, designed based on the partnership between Dentistry and Speech Therapy and made by a prosthetic dentist, undergoing therapy and speech therapy with visual biofeedback by ultrasound. The individual is a 45-year-old man, retired teacher with a history of tongue squamous cell carcinoma with episodes of recurrence. The cancer treatment was performed by several surgeries associated with radiotherapy over seven years. This treatment resulted in total glossectomy and the presence of osteoradionecrosis (ORN) of the mandible. The sequel to radiotherapy also required multiple surgical approaches with loss of a large part of the jaw, causing severe impairment of swallowing and speech functions. During the multidisciplinary care provided by the Dentistry and Speech Therapy team at a university hospital. The creation of an individualized acrylic device was conceived, aiming to improve the speech intelligibility of the patient. This device was made by a prosthetic dentist and adjusted together with the Speech Therapy team. With the adapted acrylic device, the individual started speech therapy associated with biofeedback by means of tongue ultrasound with the aim of promoting the refinement of the speech production of the fricative headphones [s] and [∫]. When comparing the pre-therapy and post-therapy assessment (after the analysis of the speeches by judges) it was possible to identify an improvement in the Percentage of Consonants Correct (PCC) from moderately-severe to slightly-moderate, as well as speech intelligibility from insufficient to regulate. The individualized device with speech therapy associated with biofeedback produced satisfactory speech results, considering the severity of the case and the high degree of mutilation of the patient.

Perspectivas de vida e de viver de pessoas em tratamento hemodialítico / Life and living outlook of people in hemodialitic treatment

Objetivo: compreender a perspectiva de vida e de viver de pessoas em tratamento hemodialítico. Método:pesquisa qualitativa com embasamento fenomenológico de Martin Heidegger, realizada com 15 pessoas em tratamento hemodialítico, em um hospital geral do Sul de Minas Gerais. Utilizou-se um roteiro para caracterização dos participantes e a entrevista gravada. Para elucidar o fenômeno, desenvolveram-se as etapas da trajetória fenomenológica utilizando-se o existencialismo. Resultado: à luz de Heidegger foram apreendidas três categorias que emergiram das unidades de significado: A pessoa em tratamento hemodialítico: enfrentamentos; o convívio social: limitações e desafios; Ente doente: possibilidades e perspectiva de vida. O Ser desvelou dificuldade em relação à limitação da doença e do tratamento, uma vez que as escolhas transpassam a sua vontade; a importância dos familiares e profissionais de saúde na superação da dependência e na valorização como Ser social; e a expectativa de futuro está relacionada à realização do transplante renal.Considerações finais:foi possível compreender a vivência da pessoa em tratamento hemodialítico enquanto um Ser-aí, Ser-no-mundo e Ser-para-os-outros,assinalando as vertentes do homem como projeto, sua intencionalidade, potencialidades e factibilidade perante os fenômenos doença, tratamento e vida.

Objective: to comprehend the prospect of life and living of people on hemodialysis. Method: qualitative research with phenomenological basis of Martin Heidegger, conducted with 15 people on hemodialysis, in a general hospital in the south of Minas Gerais, Brazil. A script was used to characterize the participants and the recorded interview. To elucidate the phenomenon, the steps of the phenomenological trajectory were developed using existentialism. Results: in view of Heidegger three categories emerged from the meaning units: The person on hemodialysis treatment: confrontations; social life: limitations and challenges; sick entity: possibilities and life perspective. The Being revealed difficulty in limiting the disease and treatment, since the choices go beyond his will; the importance of families and health professionals in overcoming dependence and appreciation as a social Being; and the expectation of the future is related to kidney transplantation. Final Considerations: it was possible to comprehend the vivency of the person undergoing hemodialysis treatment while an Being-there, Being-in-the-world and Being-to-others, remarking the strands of man as a project, a intentionality, potentialities and feasibility before the phenomenons disease, treatment and life

Risk factors for post-liver transplant biliary complications in the absence of arterial complications / Fatores de risco para complicações biliares pós-transplante hepático na ausência de complicações arteriais

ABSTRACT Background - Biliary complications (BC) represent the most frequent complication after liver transplantation, up to 34% of cases. Aim: To identify modifiable risk factors to biliary complications after liver transplantation, essential to decrease morbidity. Method: Clinical data, anatomical characteristics of recipient and donors, and transplant operation features of 306 transplants with full arterial patency were collected to identify risk factors associated with BC. Results: BC occurred in 22.9% after 126 days (median) post-transplantation. In univariate analyses group 1 (without BC, n=236) and group 2 patients (with BC, n=70) did not differ on their general characteristics. BC were related to recipient age under 40y (p=0.029), CMV infection (p=0.021), biliary disease as transplant indication (p=0.018), lower pre-transplant INR (p=0.009), and bile duct diameter <3 mm (p=0.033). CMV infections occurred sooner in patients with postoperative biliary complications vs. control (p=0.07). In a multivariate analysis, only CMV infection, lower INR, and shorter bile duct diameter correlated with BC. Positive CMV antigenemia correlated with biliary complications, even when titers lied below the treatment threshold. Conclusions: Biliary complications after liver transplantation correlated with low recipient INR before operation, bile duct diameter <3 mm, and positive antigenemia for CMV or disease manifestation. As the only modifiable risk factor, routine preemptive CMV inhibition is suggested to diminish biliary morbidity after liver transplant.

RESUMO Racional: Complicações biliares (CB) são os eventos adversos mais frequentes após o transplante de fígado, ocorrendo em até 34% dos procedimentos. Objetivo: Identificar fatores de risco modificáveis para o aparecimento de complicações biliares após transplantes de fígado, essenciais para diminuir morbidade. Método: Investigação dos dados clínicos, características anatômicas de receptores e doadores e informações sobre a operação de 306 transplantes com artéria hepática pérvia, para identificar fatores de risco associados ao aparecimento de CB. Resultados: CB ocorreu em 22,9% após 126 dias (mediana) do transplante. Em análise univariada pacientes do grupo 1 (sem CB, n=236) e grupo 2 (com CB, n=70) não diferiram em suas características gerais. CB esteve relacionada à idade do receptor menor que 40 anos (p=0,029), infecção pelo citomegalovírus (CMV, p=0,021), doença biliar como indicação ao transplante (p=0,018), RNI pré-transplante mais baixo (p=0,009) e diâmetro do ducto biliar <3 mm (p=0,033). Infecções pelo CMV ocorreram mais precocemente em pacientes com CB (p=0,07). Na análise multivariada, somente infecção por ele, INR mais baixo e menor diâmetro do ducto biliar mantiveram correlação com CB. Antigenemia positiva para CMV correlacionou com CB mesmo em títulos inferiores ao cutoff para tratamento. Conclusões: CB após transplante hepático esteve relacionada com menores RNI do receptor antes da operação, diâmetro do ducto biliar <3 mm e antigenemia ou manifestação clínica positiva para CMV. Como único fator de risco evitável, tratamento preemptivo para inibição do CMV é sugerido para diminuir morbidade biliar após o transplante.

Origin of the Sao Paulo Yellow Fever epidemic of 2017-2018 revealed through molecular epidemiological analysis of fatal cases

The largest outbreak of yellow fever of the 21st century in the Americas began in 2016, with intense circulation in the southeastern states of Brazil, particularly in sylvatic environments near densely populated areas including the metropolitan region of São Paulo city (MRSP) during 2017­2018. Herein, we describe the origin and molecular epidemiology of yellow fever virus (YFV) during this outbreak inferred from 36 full genome sequences taken from individuals who died following infection with zoonotic YFV. Our analysis revealed that these deaths were due to three genetic variants of sylvatic YFV that belong the South American I genotype and that were related to viruses previously isolated in 2017 from other locations in Brazil (Minas Gerais, Espírito Santo, Bahia and Rio de Janeiro states). Each variant represented an independent virus introduction into the MRSP. Phylogeographic and geopositioning analyses suggested that the virus moved around the peri-urban area without detectable human-to-human transmission, and towards the Atlantic rain forest causing human spill-over in nearby cities, yet in the absence of sustained viral transmission in the urban environment.

Valor del ultrasonido en el diagnóstico de los tumores del saco lagrimal / Value of the ultrasound in the diagnosis of lacrimal sac tumor

RESUMEN Los tumores del saco lagrimal son extremadamente raros, y el benigno primario más común es el papiloma escamoso. Clínicamente se manifiestan como una zona de tumefacción en la región cantal medial, asociado a epifora y dacriocistitis crónica-recurrente. Dentro de las pruebas de imagen recomendadas están: dacriocistografía, tomografía computarizada, resonancia magnética y dacrioescintifotografía. Sin embargo, muy pocos sugieren el uso del ultrasonido. Se presenta el caso de un papiloma mixto del saco lagrimal diagnosticado por ultrasonido. Se trata de una paciente femenina de 39 años, quien fue remitida por cuadros repetidos de dacriocistitis derecha en los últimos 3 años. En consulta se constató celulitis preseptal ipsolateral, por lo que se indicó antibiótico-terapia, y se logró la remisión de los signos inflamatorios agudos, pero persistió el aumento del volumen cantal medial derecho. La vía lagrimal se exploró y se comprobó que estaba obstruida. Se realizó ultrasonido, donde el saco lagrimal derecho apareció ocupado por una masa ecogénica, que se extendía al conducto lacrimonasal y mostraba ligera vascularidad. Seguidamente se hizo tomografía computarizada, y se confirmaron los hallazgos ecográficos, pero sin lograr delimitar la lesión intrasaco descrita, aún tras la administración de contraste yodado endovenoso. Se sugirió dacriocistitis crónica derecha, secundaria al tumor intrasaco de aspecto benigno, probable papiloma, por lo que se efectuó cirugía y examen histopatológico que ratificaron dicho diagnóstico. En conclusión, el ultrasonido del saco lagrimal es un método complementario de gran valor, que en algunos casos hará el diagnóstico, y en otros brindará información que optimizará la decisión de quienes serían tributarios a estudios más complejos(AU)

ABSTRACT Lacrimal sac tumors are extremely rare, and the most common benign primary is squamous papilloma. Clinically, they manifest as a zone of swelling in the medial canthal region, associated with epiphora and chronic-recurrent dacryocystitis. Among the recommended imaging tests are dacryostography, computed tomography, magnetic resonance imaging, and dacryoscintifotography. However, very few suggest the use of ultrasound. The case of a mixed papilloma of the lacrimal sac diagnosed by ultrasound is presented. This is a 39-year-old female patient, who was referred for repeated cases of right dacryocystitis in the last three years. In consultation, ipsolateral preseptal cellulitis was found, for which antibiotic therapy was indicated, and the remission of acute inflammatory signs was achieved, but the increase in right medial canthal volume persisted. The lacrimal duct was explored and found to be obstructed. Ultrasound was performed, where the right lacrimal sac appeared occupied by an echogenic mass, which extended to the lacrimal duct and showed slight vascularity. Subsequently, computed tomography was performed, and the ultrasound findings were confirmed, but without defining the described intrasaccal lesion, even after administration of intravenous iodinated contrast. It was suggested chronic right dacryocystitis, secondary to apparently benign intrasaccal tumor, probable papilloma, so surgery and histopathological examination were performed, which that ratified the diagnosis. In conclusion, ultrasound of the lacrimal sac is a complementary method of great value, which in some cases will make the diagnosis, while in others it will provide information that will optimize the decision of those who would be candidate to more complex studies(AU)