First record of mercury concentrations and stable isotopes (13C & 15N) in albacore (Thunnus alalunga) from the Western Equatorial Atlantic Ocean.

This paper reports the first record of total mercury (THg) concentrations in albacore (Thunnus alalunga), one of the main tuna species caught from the Western Equatorial Atlantic Ocean and presents a preliminary comparison with other regions and tuna species. Mean, standard deviation and range of concentrations in T. alalunga (515 ± 145 ng g-1 ww; 294-930 ng g-1 ww) with 92 % being of methyl-Hg, are higher than in albacore from other Atlantic Ocean subregions despite their smaller body size. These concentrations are similar to those from the Pacific and Indian oceans, but lower than in the Mediterranean. Compared to other sympatric tuna species, concentrations are higher than those in T. albacares and similar to T. obesus. These results are discussed considering the potential differences in stable isotope values (13C and 15N) of T. alalunga populations from multiple oceanic areas and compared to other tuna species worldwide.

Can species guilds act as hubs for energy transfer in macrophyte meadows of Amazonian floodplain lakes?

Aquatic macrophytes are the main autochthonous component of primary production in the Amazon Basin. Floating meadows of these plants support habitats with highly diverse animal communities. Fishes inhabiting these habitats have been assumed to use a broad range of food items and compose a particular food web. We employed carbon (δ13C) and nitrogen (δ15N) stable isotope analysis to draw the trophic structure of these habitats and to trace the energy flow by its trophic levels. Fishes and other animals from 18 independent macrophyte meadows of a floodplain lake of the Solimões River (Amazonia, Brazil) were analyzed. The food web of macrophyte meadows consists of four trophic levels above autotrophic sources. In general, primary consumers exhibited a broader range of food sources than the upper trophic levels. Some fish species depended on a large number of food sources and at the same time are consumed by several predators. The energy transfer from one trophic level to the next was then mainly accomplished by these species concentrating a high-energy flux and acting as hubs in the food web. The broad range of δ13C values observed indicates that the organisms living in the macrophyte meadows utilize a great diversity of autotrophic sources.

Stress distribution on teeth restored with veneers using various incisal preparation designs: A 3D finite element analysis study.

STATEMENT OF PROBLEM: The type of veneer preparation is often chosen according to the patient's tooth structure and occlusion. Taking biomechanics into account in this decision-making process provides the clinician with more technical information on how to improve the clinical longevity of restorations. However, biomechanical analyses of veneer preparation designs are sparse. PURPOSE: The purpose of this 3-dimensional (3D) finite element analysis with microcomputed tomography (µCT) data obtained from realistic models was to assess the influence of different preparations for ceramic and composite resin veneers on restoration and resin layer stress distribution. MATERIAL AND METHODS: Four replicas of a central incisor were printed and prepared for laminate veneers with 4 different incisal edge designs: shoulder (SH), palatal chamfer (PC), palatal chamfer and oblique fracture involving the distal angle (OF-PC), and palatal chamfer involving horizontal incisal fracture (IF-PC). After fabrication and cementation of the veneers, the restored replicas were assessed with µCT, and 3D finite element models were built. A 100-N load was applied on the palatal surface at 60 and 125 degrees relative to the longitudinal axis. Maximum principal stress and stress distribution on the veneers, cement layer, and tooth structure were calculated and analyzed. RESULTS: The SH preparation exhibited better stress distribution than the PC preparation, and the cement layer and the veneer were subjected to lower stress. The IF-PC preparation had better stress distribution than the OF-PC. The shoulder and IF-PC showed higher stress on laminate veneers, but lower stress on the cement layer. Ceramic veneers exhibited lower stress than composite resin veneers. CONCLUSIONS: The different incisal preparations for laminate veneers influenced stress distribution on restorations and on the resin cement layer. The shoulder type preparation showed better stress distribution and the composite resin veneers showed unfavorable results compared with the ceramic veneers.

A Review on the use of Synthetic and Recombinant Antigens for the Immunodiagnosis of Tegumentary Leishmaniasis.

Improving the diagnostic technology used to detect tegumentary leishmaniasis (TL) is essential in view of it being a widespread, often neglected tropical disease with cases reported from the southern United States to northern Argentina. Recombinant proteins, recombinant multiepitope proteins, and synthetic peptides have been extensively researched and used in disease diagnosis. One of the benefits of applying these antigens is a measurable increase in sensitivity and specificity, which improves test accuracy. The present review aims to describe the antigens and their diagnostic effectiveness. With that in mind, a bibliographic survey was conducted on the PudMed platform using the search terms "tegumentary leishmaniasis" AND "diagno", revealing that recombinant proteins have been described and evaluated for their value in TL diagnosis since the 1990s. However, there was a spike in the number of publications using all of the antigens between 2013 and 2022, confirming an expansion in research efforts to improve diagnosis. Moreover, all of the studies involving different antigens had promising results, including improved sensitivity and specificity. These data recognize the importance of doing research with new technologies focused on developing quick, more effective diagnostic kits as early diagnosis facilitates treatment.

Trophic ecology of sympatric sea turtles in the tropical Atlantic coast of Brazil.

The Tropical Atlantic coast of Brazil is a hotspot area for multiple sea turtle species at all life stages. The multiple nearshore reefs and beaches, oceanic islands, and the only atoll in the south Atlantic Ocean, are suitable for year-round foraging, migration corridors, and nesting activities of five sea turtle species. Still, relatively few studies have assessed trophic niche among sympatric sea turtles which can provide a better understanding of how closely related species compete/partition the available resources. Using multiple biogeochemical tracers (i.e., nitrogen (δ15N) and carbon (δ13C) stable isotopes, and mercury (Hg)), we disentangled the trophic niches of four sea turtle species - the green turtle (Chelonia mydas), the loggerhead turtle (Caretta), the hawksbill turtle (Eretmochelys imbricata), and the olive ridley turtle (Lepidochelys olivacea) - co-occurring in nesting and foraging habitats along the northeastern coast of Brazil. We found interspecific differences in isotopic and contamination niches, as well as intraspecific niche variation associated with life stage. Differences in the estimation niche models associated to life-stage in C. caretta support the notion of ontogenetic shift in habitat and diet composition previously reported for this species. Oceanic habitat signatures were observed in juvenile green turtles and adult olive turtles, while nearshore habitat signatures were observed in adult hawksbill turtles.

Geochemical fractionation of trace metals and ecological risk assessment of surface sediments in Sepetiba Bay, Brazil.

The Sepetiba Bay (Southeast Brazil) is a known Cd- and Zn-contaminated site that received spills of a large slag pile leachate from a Zn smelter. With important harbors, Sepetiba Bay demands periodic dredging operations which affect the mobility of the metals. The main goal of this work was to assess metal mobility in sediments and its associated toxicity in a fictive dredging area, to evaluate the risks of the operation. To achieve this goal, 18 superficial sediment samples were collected and characterized for pH and Eh. Sediments were analyzed for grain size, organic carbon, and total nitrogen, and metal mobility was evaluated with a sequential extraction procedure, proposed by the European Community Bureau of Reference (BCR). The results demonstrate that Cd and Zn are mainly associated with the exchangeable fraction (mean concentrations 1.4 mg kg-1 and 149.4 mg kg-1, respectively) and reducible fractions (mean concentrations 0.3 mg kg-1 and 65.5 mg kg-1, respectively), while Fe, Cr, Cu, Ni, and Al were associated with the residual fraction. Metals in the residual fraction are probably associated with the mineral lattice of the sediment and should not represent an environmental risk for the biota. The application of the enrichment factor and three risk assessment indexes (Risk Assessment Code, Risky Pollution Index, and Bioavailability Risk Assessment Index) show that the sediments are considerably enriched in metals that constitute a relevant risk for the sediment biota. In the case of dredging operations, Cd and Zn should be released to the overlying waters and be available to organisms, threatening the whole ecosystem. The proposed approach was shown to be much more precise than what is frequently presented in the Environmental Impact Assessments that only consider the threshold limits of the legislation.

Collapse of scallop Nodipecten nodosus production in the tropical Southeast Brazil as a possible consequence of global warming and water pollution.

Mollusc rearing is a relevant global socioeconomic activity. However, this activity has faced severe problems in the last years in southeast Brazil. The mariculture scallop production dropped from 51,2 tons in 2016 to 10,2 tons in 2022 in the Baia da Ilha Grande (BIG; Rio de Janeiro). However, the possible causes of this collapse are unknown. This study aimed to analyze decadal trends of water quality in Nodipecten nodosus spat and adult production in BIG. We also performed physical-chemical and biological water quality analyses of three scallop farms and two nearby locations at BIG in 2022 to evaluate possible environmental stressors and risks. Scallop spat production dropped drastically in the last five years (2018-2022: mean ± stdev: 0.47 ± 0.45 million). Spat production was higher in colder waters and during peaks of Chlorophyll a in the last 13 years. Reduction of Chlorophyll a coincided with decreasing spat production in the last five years. Warmer periods (>27 °C) of the year may hamper scallop development. Counts of potentially pathogenic bacteria (Vibrios) and Escherichia coli were significantly higher in warmer periods which may further reduce scallop productivity. Shotgun metagenomics of seawater samples from the five studied corroborated these culture-based counts. Vibrios and fecal indicator bacteria metagenomic sequences were abundant across the entire study area throughout 2022. The results of this study suggest the collapse of scallop mariculture is the result of a synergistic negative effect of global warming and poor seawater quality.

The Paraíba do Sul River Basin and its coastal area as a study model of the mercury cycle: A meta-analytical review of three decades of research.

The Paraíba do Sul River (PSR) Basin is a crucial drainage basin in Southeast Brazil, being the most industrialized and densely populated region in the country. Over the last three decades, the basin has been the subject of numerous studies due to its long history of mercury (Hg) contamination. This makes the PSR Basin an excellent model to evaluate Hg cycling, which is a priority for signatory countries of the Minamata Convention, which includes Brazil. This review compiled data on Hg from five environmental compartments (animals, plants, sediment, suspended particulate matter (SPM), and water), three different sectors (upper, middle, and lower) and five different ecosystems (reservoir, mangrove, fluvial, estuarine, and coastal) from 60 published studies, aiming to understand the Hg cycling through meta-analyses. The highest concentrations of Hg were observed in the upper and middle sectors of the basin, which are areas with high industrialization and urbanization levels. Among the evaluated ecosystems, hydropower reservoirs showed the highest medians and were also frequent in the upper and middle portions of the PSR basin. Over the years, all environmental compartments showed a decline in Hg concentrations due to the implementation of federal and state environmental policies. The main source of Hg for the basin was Hg-rich soils from past activities (such as artisanal small-scale gold mining and the use of organomercurial fungicides in sugarcane plantations). These results can assist decision-makers in the management of the basin's ecosystems and can also be used to evaluate the effectiveness of implementing the Minamata Convention in the region.

Metal concentrations in the whole blood of farmers in southeast Brazil.

In this study, we measured Ni, Co, Cd, and Pb concentrations in the whole blood of farmers from southeast Brazil to address the factors influencing human exposure in this population. The factors included smoking, alcohol consumption, aging, body composition, gender, and feeding preferences, which were measured through carbon and nitrogen isotopic composition. We also calculated and compared the reference values (RVs) of the measured elements to evaluate ongoing exposure levels. We observed the influence of lifestyle habits on metal exposure; Cd levels were statistically higher in smokers, and alcohol consumption affected only Pb concentrations, with an association also observed with the frequency of alcohol ingestion. The metal levels were positively associated with both isotope values, indicating that feeding may be the dominant source of these elements in this population. We also observed the effect of endogenous sources measured through age, as increased Pb concentrations in both genders and higher Cd levels in older women, which is related to bone, kidney, and liver accumulation. The body mass index was negatively associated with Ni, Co, and Cd in women and positively in men. The negative associations may indicate that body fat may act as a reservoir for metals, reducing their availability in the blood in individuals with higher body mass and possibly influencing the assessment of exposure levels. The evaluated population presented elevated RVs for all elements: Ni 36, Co 3.3, Cd 16, and Pb 149 µg L-1. These values point to higher exposure in this population compared to other studies in Brazil and worldwide. These results emphasize an urgent need for monitoring programs for toxic substances in Brazil and evaluating possible health effects, given the ongoing environmental exposure associated with endogenous exposure and lifestyle habits that promote higher metal levels in this population.

Machine learning sheds light on physical-chemical and biological parameters leading to Abrolhos coral reef microbialization.

Microbes play a central role in coral reef health. However, the relative importance of physical-chemical and biological processes in the control of microbial biomass are unknown. Here, we applied machine learning to analyze a large dataset of biological, physical, and chemical parameters (N = 665 coral reef seawater samples) to understand the factors that modulate microbial abundance in the water of Abrolhos reefs, the largest and richest coral reefs of the Southwest Atlantic. Random Forest (RF) and Boosted Regression Tree (BRT) models indicated that hydrodynamic forcing, Dissolved Organic Carbon (DOC), and Total Nitrogen (TN) were the most important predictors of microbial abundance. The possible cumulative effects of higher temperatures, longer seawater residence time, higher nutrient concentration, and lower coral and fish biomass observed in coastal reefs resulted in higher microbial abundance, potentially impacting coral resilience against stressors.

Assessment of Human Health Risk of Metal(Loid) Content in Brazilian Sardine Along the Southwestern Atlantic.

The Brazilian sardine (Sardinella aurita) is an important food resource found in the subtropical Southwestern Atlantic Continental Shelf (CSSWA), but limited information about its metal(loid) concentrations is available, restricting effective risk assessment by its consumption. On this research, we hypothesized that S. aurita presents different metal(loid) concentrations within a latitudinal gradient in the CSSWA (northern and southern sectors). We also assessed the S. aurita consumption contamination risk in both sectors of the CSSWA. The results indicated that S. aurita might present different chemical and contamination profiles between the observed sectors, with highlights to As, Cr, and Fe at greater levels than the safety limits established by regulatory agencies. Such finds could be explained by urbanization, industrialization, continental and oceanographic processes along the CSSWA, corroborating our hypothesis for most observed metals(loid). On the other hand, our risk assessment analysis of metal(loid) concentrations did not indicate hazards for human consumption.

Land-use changes in Amazon and Atlantic rainforests modify organic matter and black carbon compositions transported from land to the coastal ocean.

This study assessed black carbon (BC) dynamics, concentrations, and the organic matter (OM) isotopic carbon composition in northeastern South America drainage basin coastal sediments. Paraíba do Sul (PSR; Atlantic Rainforest, Brazil) coastal sediments displayed more 13C-enriched values (-22.6 ± 1.3 ‰ [n = 13]) than Amazon and Sinnamary (Amazon Rainforest in French Guiana and Brazil) sediments (-25.0 ± 3.1 ‰ [n = 14] and - 26.1 ± 1.0 ‰ [n = 6], respectively), indicating that local land-use basin changes have altered the OM composition, i.e., from natural C3 plant to C4 plants contributions. BC contents normalized to total organic carbon (TOC) content were 0.32 ± 0.24 (n = 8), 0.73 ± 0.67 (n = 6), and 0.95 ± 0.74 (n = 13) mg g-1 TOC for Amazon, Sinnamary and PSR samples, respectively, with BC sources appearing to differ according to different drainage basin vegetation covers. With increasing distance from the river mouths, BC contents exhibited different trends between the coastal zones, with values increasing for the PSR and decreasing values for the Amazon samples. BC distribution in Sinnamary coastal sediments did not display specific patterns. Regarding the Amazon coastal zone, BC contents decreased while the B6CA:B5CA ratios did not show a pattern, which could indicate that BC in the area originates from river transport (aged BC) and that the hydrophobic component of dissolved BC is removed. The BC content mostly increased in the PSR coastal zone, while the B6CA:B5CA ratios were not altered for the entire gradient, indicating the BC stability and possible atmospheric deposition of soot. Our findings indicate that different sources, transformation processes, and hydrological conditions affect BC contents within coastal zones. Continuous land cover changes in both the Amazon and Atlantic Rainforests may result in large-scale marine carbon cycling impacts.

Effect of implementing care protocols on acute ischemic stroke outcomes: a systematic review.

BACKGROUND: Implementing stroke care protocols has intended to provide better care quality, favor early functional recovery, and achieving long-term results for the rehabilitation of the patient. OBJECTIVE: To analyze the effect of implementing care protocols on the outcomes of acute ischemic stroke. METHODS: Primary studies published from 2011 to 2020 and which met the following criteria were included: population should be people with acute ischemic stroke; studies should present results on the outcomes of using protocols in the therapeutic approach to acute ischemic stroke. The bibliographic search was carried out in June 2020 in 7 databases. The article selection was conducted by two independent reviewers and the results were narratively synthesized. RESULTS: A total of 11,226 publications were retrieved in the databases, of which 30 were included in the study. After implementing the protocol, 70.8% of the publications found an increase in the rate of performing reperfusion therapy, such as thrombolysis and thrombectomy; 45.5% identified an improvement in the clinical prognosis of the patient; and 25.0% of the studies identified a decrease in the length of hospital stay. Out of 19 studies that addressed the rate of symptomatic intracranial hemorrhage, 2 (10.5%) identified a decrease. A decrease in mortality was mentioned in 3 (25.0%) articles out of 12 that evaluated this outcome. CONCLUSIONS: We have identified the importance of implementing protocols in increasing the performance of reperfusion therapies, and a good functional outcome with improved prognosis after discharge. However, there is still a need to invest in reducing post-thrombolysis complications and mortality.

ANTECEDENTES: A implementação de protocolos de acidente vascular cerebral (AVC) visa proporcionar uma melhor qualidade da assistência, favorecer a recuperação funcional precoce e alcançar resultados para a reabilitação do paciente. OBJETIVO: Analisar o efeito da implantação de protocolos nos desfechos do AVC isquêmico agudo. MéTODOS: Foram incluídos estudos primários publicados entre 2011 e 2020 e que atendiam aos seguintes critérios: população deveria ser constituída de pessoas com AVC isquêmico agudo; apresentar resultados sobre os desfechos do uso de protocolos na abordagem terapêutica ao AVC isquêmico agudo. A busca bibliográfica foi realizada em junho de 2020 em 7 bases de dados. A seleção dos artigos foi feita por dois revisores independentes e a síntese dos resultados foi feita de forma narrativa. RESULTADOS: Foram recuperadas 11.226 publicações, das quais 30 foram incluídas no estudo. Após a implementação do protocolo, 70,8% das publicações constataram aumento na taxa de realização de terapia de reperfusão, como a trombólise e a trombectomia; 45,5% identificaram melhora no prognóstico clínico do paciente; e 25,0% dos estudos identificaram diminuição no tempo de internação hospitalar. De 19 estudos que abordaram a taxa de hemorragia intracraniana sintomática, 2 (10,5%) identificaram diminuição nesta taxa. A diminuição da mortalidade foi citada em 3 (25,0%) artigos de 12 que avaliaram tal desfecho. CONCLUSõES: Identificou-se a importância da implantação de protocolos no aumento da realização das terapias de reperfusão, e ao bom desfecho funcional com melhora do prognóstico após a alta. No entanto, ainda há que se investir na diminuição das complicações pós trombólise e da mortalidade.

Global decrease in blood lead concentrations due to the removal of leaded gasoline.

Lead (Pb) is a chemical element with extreme toxicity that is classified as one of the ten chemicals of most significant concern to human health. The main problem involving Pb is its use as a fuel additive (tetraethyllead - TEL) at a global level, which raised the atmospheric Pb concentrations. It is estimated that between 80 and 90% of the atmospheric Pb in large cities came from the use of TEL, and as a consequence, it was also the main source responsible for human exposure to the element. Therefore, this work aimed to evaluate, through a systematic review, the blood concentrations of Pb in scientific articles published in the first two decades of the 2000s to compare the global and regional trends of each continent over time. Our data show the importance of removing TEL in decreasing human exposure to Pb worldwide. We observed exponentially decreasing blood Pb concentrations over the years after additive removal on all continents, resulting in a global trend which TEL's use was the major process governing human exposure worldwide. In addition, the results also showed that, despite the removal of Pb additives lowering levels of human blood Pb, the general population remains exposed to the element through exogenous and endogenous sources. The exhaust Pb particles were deposited into the environment in proportion to the traffic flows, and the legacy of Pb in the environment requires novel primary prevention remedy to curtail exposure.

Trace metal concentration along the Brazilian coast: An assessment of the influence of the Doce River plume.

The Fundão Dam rupture released tons of iron ore tailings into the environment. This study analyzes the long-term impacts and provides a possible scenario of Doce River (DR) plume dispersion. For this, water and surface sediment were collected in November 2019 along three Brazilian states to determine metal concentrations and δ13C and δ15N compositions. The δ13Csediment values of the DR plume showed a dispersion pattern mainly to the north but also in areas closer to the south of the DR mouth. Furthermore, the most negative values of δ13C and δ15N were observed in mud, followed by suspended particulate matter, sediment and the dissolved fraction, indicating that geological matrices are involved in the transport of organic matter coupled to metals to the ocean and pointing to the DR as the main source of metals in the region. Thus, this study highlights the need for continuous studies to monitor the environmental and biological conditions in these areas.

Fate and Trophic Transfer of Rare Earth Elements in a Tropical Estuarine Food Web.

We sampled abiotic and food web components in an impacted estuarine system to assess the transfer and fate of rare earth elements (REE). REE (based on dry weight) were measured in sediments, suspended particulate matter (SPM), and organisms from different trophic levels. The highest ∑REE concentrations were measured in sediments (180 ± 4.24 mg kg-1) and SPM (163 ± 12.6 mg kg-1). Phytoplankton (45.7 ± 5.31 mg kg-1), periphyton (51.6 ± 1.81 mg kg-1), and zooplankton (68.5 ± 1.27 mg kg-1) are the major sources of exposure and transfer of REE to the food web. REE concentrations were several orders of magnitude lower in bivalves, crustaceans, and fish (6.01 ± 0.11, 1.22 ± 0.18, and 0.059 ± 0.003 mg kg-1, respectively) than in plankton. The ∑REE declined as a function of the trophic position, as determined by functional feeding groups and δ15N, indicating that REE were subject to trophic dilution. Our study suggests that the consumption of seafood is unlikely to be an important source of REE for humans. However, given the numerous sources of dietary introduction of REE, they should be monitored for a possible harmful cumulative effect. This study provides new key information on REE's baseline concentrations and trophic transfers and patterns.

Brumadinho dam collapse induces changes in the microbiome and the antibiotic resistance of the Paraopeba River (Minas Gerais, Brazil).

The rupture of the Córrego do Feijão dam in Brumadinho (January 25, 2019) caused serious damage to the Paraopeba River and compromised the quality of its waters for human consumption. However, the possible effects of the dam collapse on the river microbiome and its antibiotic resistance profiles are unknown. The present study aims to analyse the possible shifts in microbial diversity and enhancement of antibiotic resistance in the Paraopeba River. To this end, two sampling campaigns (February and May 2019) were performed to obtain water across the entire Paraopeba River (eight sampling locations: Moeda, Brumadinho, Igarapé, Juatuba, Varginha, Angueretá, Retiro Baixo and Três Marias; ~464 km). This sampling scheme enabled determining the effects of the disaster on the river microbiome. Total DNA and microbial isolation were performed with these water samples. The 16S rRNA-based microbiome analyses (n = 24; 2.05 million 16S rRNA reads) showed changes in microbial diversity immediately after the disaster with the presence of metal-indicating bacteria (Acinetobacter, Bacillus, Novosphingobium, and Sediminibacterium). Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) identification of bacterial isolates (n = 170) also disclosed possible indicators of faecal contamination across the Paraopeba (Cloacibacterium, Bacteroides, Feaecalibacterium, Bifidobacterium, Citrobacter, Enterobacter, Enterococcus and Escherichia). Antibiotic resistance increased significantly to ampicillin, ampicillin/sulbactam, amoxicillin/clavulanate, ceftriaxone, and cefalotin among isolates obtained in May after the disaster. The effects of toxic mud on microbiomes were felt at all points sampled up to Anguereta. The ore mud may have exacerbated the growth of different antibiotic-resistant, metal-resistant, and faecal-indicating bacteria in the Paraopeba River.

Patient-related outcomes of conventional impression making versus intraoral scanning for prosthetic rehabilitation: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Intraoral scanning has been reported to be preferred by patients over conventional impression making. Nevertheless, information regarding patient-related outcomes for conventional impression making and digital scanning is sparse. PURPOSE: The purpose of this systematic review and meta-analysis was to analyze patient-related outcomes of intraoral scanning and conventional impression methods. The primary outcomes evaluated were patient preference and satisfaction, and the secondary outcomes discomfort, nausea, unpleasant taste, breathing difficulty, pain, and anxiety. MATERIAL AND METHODS: Electronic and manual searches were performed for clinical trials that evaluated patient-related outcomes for intraoral scanning and conventional impression making for prosthetic rehabilitation. The Cochrane Collaboration risk of bias tool and Newcastle-Ottawa scale were used to assess the quality of the studies. Random-effects models using mean difference were used for meta-analyses. Heterogeneity was assessed using the Cochran Q test and I2 statistics (α=.05). RESULTS: The search strategy identified 1626 articles, and 11 studies were included in the meta-analyses. Patients preferred intraoral scanning to conventional impression making. The mean difference for patient preference was 15.02 (95% confidence interval of 8.33 - 21.73; P<.001). Discomfort, absence of nausea, absence of unpleasant taste, and absence of breathing difficulty were also significantly different (P<.05). CONCLUSIONS: Intraoral scanning is a suitable alternative to conventional impression procedures, promoting less discomfort for patients sensitive to taste, nausea, and breathing difficulty than when conventional impression making techniques are used.

Evaluating total mercury and methylmercury biomagnification using stable isotopes of carbon and nitrogen in fish from the Madeira River basin, Brazilian Amazon.

The isotopic signatures of carbon in primary consumer fish species in the Madeira River basin (Western Amazon) follow a pattern, with basal species feeding mainly on C3 (e.g., vascular plants and phytoplankton). In this study with 196 specimens of 19 fish species and six trophic guilds, significant differences were found between the two main groups of primary consumers (herbivores and detritivores) in the Madeira River basin. The mercury and δ15N data indicated that the fish specimens collected in Puruzinho and Cuniã Lakes provided greater trophic magnification factors (TMFs) for this metal than those found in the corresponding rivers. In relation to total mercury (0.09-2.07 µg g-1) and methylmercury (0.05-1.91 µg g-1) concentrations, the piscivorous/carnivorous species exceeded the values recommended by the World Health Organization, with a [MeHg:THg] ratio of about 80%. Preventive and educational practices should be adopted to reduce the possible toxic effects of Hg in the riverside population, for whom fish constitutes the main protein source. Also, biomonitoring of the fish species in the Madeira River should be conducted on an ongoing basis to detect possible alterations in mercury concentrations.

Effect of implementing care protocols on acute ischemic stroke outcomes: a systematic review / Efeito da implementação de protocolos nos desfechos do AVC isquêmico agudo: revisão sistemática

Abstract Background Implementing stroke care protocols has intended to provide better care quality, favor early functional recovery, and achieving long-term results for the rehabilitation of the patient. Objective To analyze the effect of implementing care protocols on the outcomes of acute ischemic stroke. Methods Primary studies published from 2011 to 2020 and which met the following criteria were included: population should be people with acute ischemic stroke; studies should present results on the outcomes of using protocols in the therapeutic approach to acute ischemic stroke. The bibliographic search was carried out in June 2020 in 7 databases. The article selection was conducted by two independent reviewers and the results were narratively synthesized. Results A total of 11,226 publications were retrieved in the databases, of which 30 were included in the study. After implementing the protocol, 70.8% of the publications found an increase in the rate of performing reperfusion therapy, such as thrombolysis and thrombectomy; 45.5% identified an improvement in the clinical prognosis of the patient; and 25.0% of the studies identified a decrease in the length of hospital stay. Out of 19 studies that addressed the rate of symptomatic intracranial hemorrhage, 2 (10.5%) identified a decrease. A decrease in mortality was mentioned in 3 (25.0%) articles out of 12 that evaluated this outcome. Conclusions We have identified the importance of implementing protocols in increasing the performance of reperfusion therapies, and a good functional outcome with improved prognosis after discharge. However, there is still a need to invest in reducing post-thrombolysis complications and mortality.

Resumo Antecedentes A implementação de protocolos de acidente vascular cerebral (AVC) visa proporcionar uma melhor qualidade da assistência, favorecer a recuperação funcional precoce e alcançar resultados para a reabilitação do paciente. Objetivo Analisar o efeito da implantação de protocolos nos desfechos do AVC isquêmico agudo. Métodos Foram incluídos estudos primários publicados entre 2011 e 2020 e que atendiam aos seguintes critérios: população deveria ser constituída de pessoas com AVC isquêmico agudo; apresentar resultados sobre os desfechos do uso de protocolos na abordagem terapêutica ao AVC isquêmico agudo. A busca bibliográfica foi realizada em junho de 2020 em 7 bases de dados. A seleção dos artigos foi feita por dois revisores independentes e a síntese dos resultados foi feita de forma narrativa. Resultados Foram recuperadas 11.226 publicações, das quais 30 foram incluídas no estudo. Após a implementação do protocolo, 70,8% das publicações constataram aumento na taxa de realização de terapia de reperfusão, como a trombólise e a trombectomia; 45,5% identificaram melhora no prognóstico clínico do paciente; e 25,0% dos estudos identificaram diminuição no tempo de internação hospitalar. De 19 estudos que abordaram a taxa de hemorragia intracraniana sintomática, 2 (10,5%) identificaram diminuição nesta taxa. A diminuição da mortalidade foi citada em 3 (25,0%) artigos de 12 que avaliaram tal desfecho. Conclusões Identificou-se a importância da implantação de protocolos no aumento da realização das terapias de reperfusão, e ao bom desfecho funcional com melhora do prognóstico após a alta. No entanto, ainda há que se investir na diminuição das complicações pós trombólise e da mortalidade.