Exploring microalgal and cyanobacterial metabolites with antiprotozoal activity against Leishmania and Trypanosoma parasites.

Neglected tropical diseases (NTD) like Leishmaniasis and trypanosomiasis affect millions of people annually, while currently used antiprotozoal drugs have serious side effects. Drug research based on natural products has shown that microalgae and cyanobacteria are a promising platform of biochemically active compounds with antiprotozoal activity. These unicellular photosynthetic organisms are rich in polyunsaturated fatty acids, pigments including phycocyanin, chlorophylls and carotenoids, polyphenols, bioactive peptides, terpenes, alkaloids, which have proven antioxidant, antimicrobial, antiviral, antiplasmodial and antiprotozoal properties. This review provides up-to-date information regarding ongoing studies on substances synthesized by microalgae and cyanobacteria with notable activity against Leishmania spp., Trypanosoma cruzi, and Trypanosoma brucei, the causative agents of Leishmaniasis, Chagas disease, and human African trypanosomiasis, respectively. Extracts of several freshwater or marine microalgae have been tested on different strains of Leishmania and Trypanosoma parasites. For instance, ethanolic extract of Chlamydomonas reinhardtii and Tetraselmis suecica have biological activity against T. cruzi, due to their high content of carotenoids, chlorophylls, phenolic compounds and flavonoids that are associated with trypanocidal activity. Halophilic Dunaliella salina showed moderate antileishmanial activity that may be attributed to the high ß-carotene content in this microalga. Peptides such as almiramides, dragonamides, and herbamide that are biosynthesized by marine cyanobacteria Lyngbya majuscula were found to have increased activity in micromolar scale IC50 against L. donovani, T. Cruzi, and T. brucei parasites. The cyanobacterial peptides symplocamide and venturamide isolated from Symploca and Oscillatoria species, respectively, and the alkaloid nostocarbonile isolated from Nostoc have shown promising antiprotozoal properties and are being explored for pharmaceutical and medicinal purposes. The discovery of new molecules from microalgae and cyanobacteria with therapeutic potential against Leishmaniasis and trypanosomiasis may address an urgent medical need: effective and safe treatments of NTDs.

Feasibility of extended ultrasound examination of the fetal brain between 24 and 37 weeks' gestation in low-risk pregnancies.

OBJECTIVES: To assess the feasibility of identifying fetal brain structures and anatomic landmarks included in the anterior complex (AC) and posterior complex (PC), as well as the proximal hemisphere (PH). METHODS: This was a prospective observational multicenter study of healthy pregnant women evaluated by ultrasound screening at 24 to 36 + 6 weeks' gestation. Six physicians performed transabdominal ultrasound, to obtain the planes required to visualize the AC, PC, and PH. Blind analysis by an expert and non-expert operator in fetal neurosonography was used to assess the structures included in each plane view. RESULTS: In the population studied (n=366), structure detection rates for AC were over 95 %, with an agreement of 96 % when comparing expert and non-expert examiners. Visualization of the corpus callosum crossing the midline was detected in over 97 and 96 % of cases for the AC and PC, respectively, with an agreement of over 96 %. The PH plane, particularly through the posterior access via the mastoid fontanelle, enabled visualization of the proximal anatomical structures in almost 95 % of cases. Detection of the corpus callosum through the AC and PC, both proximal/distal germinal matrix (AC) and proximal Sylvian fissure through the anterior access (PH) in the 24-25 + 6, 26-31 + 6 and 32-36 + 6 weeks' gestation groups were successful in over 96 % of cases with high level of agreement. CONCLUSIONS: Inclusion of AC, PC, and PH later in pregnancy proves feasible with a high level of agreement between both expert and non-expert operators.

Cervical cancer screening, treatment and prophylaxis in Brazil: Current and future perspectives for cervical cancer elimination.

As a middle-income country, Brazil has one of the largest public health systems worldwide, which deals with free and universal access to health care. Regarding cervical cancer, the country possesses a large infrastructure for the screening of premalignant and malignant lesions, but yet based on old technology, having Papanicolaou as the major screening method, followed by colposcopy and treatment. Also, large disparities in access are present, which makes effectiveness of screening and treatment in different regions of the country highly unequal. In this review, we describe and evaluate the current screening, treatment and prophylactic (HPV vaccination) strategies to combat cervical cancer in Brazil, and discuss potential incorporation of more recent technologies in these areas in the country to pave its way toward cervical cancer elimination.

Covid-19 in Brazil in 2020: impact on deaths from cancer and cardiovascular diseases.

OBJECTIVE: To analyze the impact of the covid-19 pandemic on mortality from cancer and cardiovascular diseases (CVD) as underlying cause and comorbidity in Brazil and Brazilian regions in 2020. METHODS: We used the 2019 and 2020 databases of the Mortality Information System (SIM) to analyze deaths occurring between March and December of each year that had cancer or CVD as the underlying cause or comorbidity. Deaths from covid-19 in 2020 were also analyzed. To estimate the Standardized Mortality Ratio (SMR) and the excess of deaths, 2019 data were considered as standard. RESULTS: Between March and December 2020, there were 181,377 deaths from cancer and 291,375 deaths from cardiovascular diseases in Brazil, indicating reduction rates of 9.7% and 8.8%, respectively, compared to the same period of the previous year. The pattern was maintained in the five Brazilian regions, with lower variation for cancer (-8.4% in the South to -10.9% in the Midwest). For CVD, the variation was greater, from -2.2% in the North to -10.5 in the Southeast and South. In the same period of 2020, these diseases were classified as comorbidities in 18,133 deaths from cancer and 188,204 deaths from cardiovascular diseases, indicating a proportional excess compared to data from 2019, of 82.1% and 77.9%, respectively. This excess was most significant in the Northern Region, with a ratio of 2.5 between observed and expected deaths for the two conditions studied. CONCLUSIONS: Excess deaths from cancer and CVD as comorbidities in 2020 may indicate that covid-19 had an important impact among patients with these conditions.

Short-term effects of the COVID-19 pandemic on cancer screening, diagnosis and treatment procedures in Brazil: a descriptive study, 2019-2020. / Efeitos de curto prazo da pandemia de COVID-19 na realização de procedimentos de rastreamento, investigação diagnóstica e tratamento do câncer no Brasil: estudo descritivo, 2019-2020.

OBJECTIVE: To analyze the short-term effects of the COVID-19 pandemic on cancer screening, diagnosis and treatment in Brazil. METHODS: This was a descriptive study using data from the Outpatient and Hospital Information Systems, and the Cancer Information System. Monthly percentage variation of cancer screening, diagnosis and treatment procedures in 2019 and 2020 was calculated, as well as waiting time for cervical and breast cancer tests. RESULTS: In 2020 cytopathology tests fell by 3,767,686 (-44.6%), screening mammograms fell by 1,624,056 (-42.6%), biopsies fell by 257,697 (-35.3%), cancer surgery fell by 25,172 (-15.7%), and radiotherapy procedures fell by 552 (-0.7%), compared to 2019. Time intervals for performing cervical and breast cancer screening exams were little affected. CONCLUSION: Cancer control actions were impacted by the pandemic, making it necessary to devise strategies to mitigate the effects of possible delays in diagnosis and treatment.

Covid-19 in Brazil in 2020: impact on deaths from cancer and cardiovascular diseases / Covid-19 no Brasil em 2020: impacto nas mortes por câncer e doenças cardiovasculares

ABSTRACT OBJECTIVE To analyze the impact of the covid-19 pandemic on mortality from cancer and cardiovascular diseases (CVD) as underlying cause and comorbidity in Brazil and Brazilian regions in 2020. METHODS We used the 2019 and 2020 databases of the Mortality Information System (SIM) to analyze deaths occurring between March and December of each year that had cancer or CVD as the underlying cause or comorbidity. Deaths from covid-19 in 2020 were also analyzed. To estimate the Standardized Mortality Ratio (SMR) and the excess of deaths, 2019 data were considered as standard. RESULTS Between March and December 2020, there were 181,377 deaths from cancer and 291,375 deaths from cardiovascular diseases in Brazil, indicating reduction rates of 9.7% and 8.8%, respectively, compared to the same period of the previous year. The pattern was maintained in the five Brazilian regions, with lower variation for cancer (-8.4% in the South to -10.9% in the Midwest). For CVD, the variation was greater, from -2.2% in the North to -10.5 in the Southeast and South. In the same period of 2020, these diseases were classified as comorbidities in 18,133 deaths from cancer and 188,204 deaths from cardiovascular diseases, indicating a proportional excess compared to data from 2019, of 82.1% and 77.9%, respectively. This excess was most significant in the Northern Region, with a ratio of 2.5 between observed and expected deaths for the two conditions studied. CONCLUSIONS Excess deaths from cancer and CVD as comorbidities in 2020 may indicate that covid-19 had an important impact among patients with these conditions.

RESUMO OBJETIVO Analisar o impacto da pandemia de covid-19 sobre a mortalidade por câncer e por doenças cardiovasculares (DCV) como causa básica e comorbidade no Brasil e em suas regiões em 2020. MÉTODOS Foram utilizadas as bases de dados de 2019 e 2020 do Sistema de Informações de Mortalidade (SIM), analisando os óbitos ocorridos entre março e dezembro de cada ano que tiveram o câncer e as DCV como causa básica ou como comorbidade. Também foram analisados os óbitos por covid-19 em 2020. Para o cálculo da Razão de Mortalidade Padronizada (RMP) e estimativa do excesso de mortes, os dados de 2019 foram considerados como padrão. RESULTADOS Entre março e dezembro de 2020 ocorreram no Brasil 181.377 mortes por câncer e 291.375 mortes por doenças cardiovasculares, indicando redução de 9,7% e de 8,8%, respectivamente, em relação ao mesmo período do ano anterior. O padrão foi mantido nas cinco regiões brasileiras, com menor variação para o câncer (-8,4% na Região Sul a -10,9% na Região Centro-Oeste). Para as DCV houve uma maior variação, de -2,2% na Região Norte até -10,5 nas regiões Sudeste e Sul. No mesmo período de 2020, essas enfermidades foram classificadas como comorbidade em 18.133 óbitos por câncer e 188.204 óbitos por doenças cardiovasculares, indicando um excesso proporcional, se comparado aos dados de 2019, de 82,1% e 77,9%, respectivamente. Esse excesso foi mais expressivo na Região Norte, com razão de 2,5 entre mortes observadas e esperadas, para as duas condições estudadas. CONCLUSÕES O excesso de óbitos por câncer e DCV como comorbidade em 2020 pode indicar que a covid-19 teve um importante impacto entre pacientes portadores dessas condições.

Efeitos de curto prazo da pandemia de COVID-19 na realização de procedimentos de rastreamento, investigação diagnóstica e tratamento do câncer no Brasil: estudo descritivo, 2019-2020 / Efectos a corto plazo de la pandemia COVID-19 en la realización de procedimientos de rastreo, investigación diagnóstica y tratamiento del cáncer en Brasil: estudio descriptivo, 2019-2020 / Short-term effects of the COVID-19 pandemic on cancer screening, diagnosis and treatment procedures in Brazil: a descriptive study, 2019-2020

Objetivo: Analisar efeitos de curto prazo da pandemia de COVID-19 no rastreamento, investigação diagnóstica e tratamento de câncer no Brasil. Métodos: Estudo descritivo, utilizando-se dados do Sistema de Informações Ambulatoriais e do Sistema de Informações Hospitalares, e Sistema de Informação do Câncer. Calculou-se a variação percentual mensal de procedimentos de rastreamento, diagnóstico e tratamento de câncer, em 2019 e 2020, além do tempo esperado para realização dos exames relacionados aos cânceres do colo do útero e de mama. Resultados: Em 2020, houve redução de 3.767.686 (-44,6%) exames citopatológicos, 1.624.056 (-42,6%) mamografias, 257.697 (-35,3%) biópsias, 25.172 cirurgias oncológicas (-15,7%) e 552 (-0,7%) procedimentos de radioterapia, comparando-se a 2019. Os intervalos de tempo para realização de exames de rastreamento de câncer do colo uterino e mama foram pouco afetados. Conclusão: Ações de controle do câncer foram afetadas pela pandemia, sendo necessárias estratégias para mitigar efeitos dos atrasos no diagnóstico e tratamento.

Objetivo: Analizar los efectos a corto plazo de la pandemia por COVID-19 en rastreo, diagnóstico y tratamiento de cáncer en Brasil. Métodos: Estudio descriptivo utilizando datos del Sistemas de Información Ambulatoria y Hospitalaria del SUS y Sistema de Información del Cáncer. Se calculó la variación porcentual mensual en procedimientos de rastreo, diagnóstico y tratamiento de cáncer para 2019 y 2020, y el tiempo para realizar exámenes de cánceres de cérvix y mama. Resultados: En 2020 hubo reducción de 3.767.686 (-44,6%) en exámenes citopatológicos, 1.624.056 (-42,6%) en mamografías, 257.697 (-35,3%) en biopsias, 25.172 (-15,7%) en cirugías oncológicas y 552 (-0,7%) en radioterapia en comparación con 2019. Tiempos de los exámenes de rastreo para los cánceres de cérvix y de mama se vieron poco afectados. Conclusión: Acciones de control del cáncer se vieron impactadas por la pandemia, por lo que fue necesario diseñar estrategias para mitigar los efectos de posibles retrasos en diagnóstico y tratamiento.

Objective: To analyze the short-term effects of the COVID-19 pandemic on cancer screening, diagnosis and treatment in Brazil. Methods: This was a descriptive study using data from the Outpatient and Hospital Information Systems, and the Cancer Information System. Monthly percentage variation of cancer screening, diagnosis and treatment procedures in 2019 and 2020 was calculated, as well as waiting time for cervical and breast cancer tests. Results: In 2020 cytopathology tests fell by 3,767,686 (-44.6%), screening mammograms fell by 1,624,056 (-42.6%), biopsies fell by 257,697 (-35.3%), cancer surgery fell by 25,172 (-15.7%), and radiotherapy procedures fell by 552 (-0.7%), compared to 2019. Time intervals for performing cervical and breast cancer screening exams were little affected. Conclusion: Cancer control actions were impacted by the pandemic, making it necessary to devise strategies to mitigate the effects of possible delays in diagnosis and treatment.

Rethinking Cervical Cancer Screening in Brazil Post COVID-19: A Global Opportunity to Adopt Higher Impact Strategies.

The World Health Organization global call to eliminate cervical cancer encourages countries to consider introducing or improving cervical cancer screening programs. Brazil's Unified Health System (SUS) is among the world's largest public health systems offering free cytology testing, follow-up colposcopy, and treatment. Yet, health care networks across the country have unequal infrastructure, human resources, equipment, and supplies resulting in uneven program performance and large disparities in cervical cancer incidence and mortality. An effective screening program needs multiple strategies feasible for each community's reality, facilitating coverage and follow-up adherence. Prioritizing those at highest risk with tests that better stratify risk will limit inefficiencies, improving program impact across different resource settings. Highly sensitive human papillomavirus (HPV)-DNA testing performs better than cytology and, with self-collection closer to homes and workplaces, improves access, even in remote regions. Molecular triage strategies like HPV genotyping can identify from the same self-collected sample, those at highest risk requiring follow-up. If proven acceptable, affordable, cost-effective, and efficient in the Brazilian context, these strategies would increase coverage while removing the need for speculum exams for routine screening and reducing follow-up visits. SUS could implement a nationwide organized program that accommodates heterogenous settings across Brazil, informing a variety of screening programs worldwide.

Moving towards a strategy to accelerate cervical cancer elimination in a high-burden city-Lessons learned from the Amazon city of Manaus, Brazil.

The World Health Organization Call to Eliminate Cervical Cancer resonates in cities like Manaus, Brazil, where the burden is among the world's highest. Manaus has offered free cytology-based screening since 1990 and HPV immunization since 2013, but the public system is constrained by many challenges and performance is not well-defined. We obtained cervical cancer prevention activities within Manaus public health records for 2019 to evaluate immunization and screening coverage, screening by region and neighborhood, and the annual Pink October screening campaign. We estimated that among girls and boys age 14-18, 85.9% and 64.9% had 1+ doses of HPV vaccine, higher than rates for age 9-13 (73.4% and 43.3%, respectively). Of the 90,209 cytology tests performed, 24.9% were outside the target age and the remaining 72,230 corresponded to 40.1% of the target population (one-third of women age 25-64). The East zone had highest screening coverage (49.1%), highest high-grade cytology rate (2.5%) and lowest estimated cancers (38.1/100,000) compared with the South zone (32.9%, 1.8% and 48.5/100,000, respectively). Largest neighborhoods had fewer per capita screening locations, resulting in lower coverage. During October, some clinics successfully achieved higher screening volumes and high-grade cytology rates (up to 15.4%). Although we found evidence of some follow-up within 10 months post-screening for 51/70 women (72.9%) with high-grade or worse cytology, only 18 had complete work-up confirmed. Manaus has successfully initiated HPV vaccination, forecasting substantial cervical cancer reductions by 2050. With concerted efforts during campaigns, some clinics improved screening coverage and reached high-risk women. Screening campaigns in community locations in high-risk neighborhoods using self-collected HPV testing can achieve widespread coverage. Simplifying triage and treatment with fewer visits closer to communities would greatly improve follow-up and program effectiveness. Achieving WHO Cervical Cancer Elimination goals in high-burden cities will require major reforms for screening and simpler follow-up and treatment.

General anaesthesia versus other types of anaesthesia in patients undergoing surgery for treatment of cutaneous melanoma: a systematic review and meta-analysis.

General and local anaesthetics alter tumour behaviour in experimental models. Objectives: To investigate the relationship between general anaesthesia and recurrence or survival in patients who received surgery for malignant melanoma. A meta-analysis was performed based on a comprehensive literature search. Controlled and observational studies of patients undergoing surgery for melanoma under general anaesthesia, compared with other types of anaesthesia, were included. The primary outcomes were overall survival and disease-free survival. The secondary outcomes included cancer-specific survival, cost analysis, and adverse events. Risk of bias was assessed. Individual study information was summarized. The meta-analysis was performed using a random-effects model. The GRADE approach was used to summarise the certainty of evidence. Eight studies were included (n = 5,832). The use of general anaesthesia was not associated with any statistical difference in overall survival (p = 0.087; 1 NRS; n= 104; very low certainty of evidence) or disease-free survival (HR: 1.266; 95% CI: 0.904-1.773; p = 0.169; 1 NRS; n = 281; very low certainty of evidence). However, general anaesthesia was associated with worse melanoma-specific survival (HR: 1.46; 95% CI: 1.22-1.68: p < 0.00001; 3 NRS; n = 4654; low certainty of evidence). Three studies reported increased intraoperative costs associated with the use of general anaesthesia (3 NRT; n = 513; very low certainty of evidence). No study adequately reported other primary or secondary outcomes. General anaesthesia may reduce melanoma-specific survival in patients undergoing surgery for treatment of cutaneous melanoma. We are uncertain whether general anaesthesia impacts the other reported outcomes.

Two-phase orthodontic treatment of two different types of tooth transposition in the same patient.

Orthodontic treatment is thoroughly planned considering the patient's facial and dental characteristics, the main complaint, treatment time and the orthodontist's experience. Transposition is a form of ectopia, in which two adjacent teeth exchange positions in the dental arch. Transposition can be partial or complete. This article reports the treatment of a female patient with two kinds of tooth transposition managed in the mixed and permanent dentitions. A girl, aged eight years and three months, came to routine paediatric consultation with an ectopic permanent mandibular left lateral incisor in the mixed dentition. Radiographic analysis indicated partial transposition of the permanent mandibular left lateral incisor and canine (Md.L2.C), and development of a complete tooth transposition between the permanent maxillary right first pre-molar and canine (Mx.C.P1). The patient was treated in two phases. The first, in the mixed dentition, and the second, in the permanent dentition with a three-year follow-up between them. These challenging treatment approaches are described in detail, including the mechanics used. The key points of this treatment were early diagnosis of the ectopic mandibular lateral incisor, use of light forces and interphase patient follow-up. These determined the best time to start the second treatment phase, enabling achievement of aesthetic and functional outcomes, and the results remained stable one year after the end of orthodontic treatment.

Semi-quantitative determination of ash element content for freeze-dried, defatted, sulfated and pyrolysed biomass of Scenedesmus sp.

BACKGROUND: Energy demand by mankind has become one of the most important aspects of our society. A promising technology that seeks to provide part of the energy demand and to obtain high-value products is the thermochemical conversion of microalgae biomass. Inorganic species presented in microalgae biomass may act as catalysts for thermochemical reactions and are responsible for notorious ash-related issues during thermochemical decomposition. RESULTS: In this study, the freeze-dried biomass of Scenedesmus sp. was used to evaluate the lipid extraction methodology regarding a sonication bath as pretreatment technique for cell disruption followed by vortex mixing and n-hexane as solvent. It is also presented the lipid and amino acid profiles for Scenedesmus sp. The freeze-dried biomass was pyrolysed through a TGA (thermogravimetric analysis), with heating rates of 20 °C/min, from 100 to 650 °C. The ash and sulfated ash contents were accurately determined by combustion of biomass in a muffle furnace. The element component of ashes of the freeze-dried, defatted, pyrolysed and sulfated biomasses was determined by means of scanning electron microscope (SEM) fitted with energy dispersive spectroscopy (EDS). The lipid content obtained for Scenedesmus sp. dry biomass was 16.72% (± 0.03). The content of the sulfated ash obtained was 17.81 ± 0.15%. The SEM-EDS technique identified different mineral compounds in ashes, allowing to quantify Mg, P, S, K, Ca, Fe, Co and Br, as well as oxides. CONCLUSION: The results suggest a possible strategy to evaluate in a semi-quantitative manner the ash composition of freeze-dryed, defatted, sulfated and pyrolysed biomass of Scenedesmus sp. and its feasibility in using Scenedesmus sp. biomass in different thermochemical conversion strategies to achieve processes with positive energy ratio, representing potential use both environmental and energetically.

Feasibility and agreement of including anterior-posterior complexes and landmarks of the proximal hemisphere into basic examination of the fetal brain: A prospective study.

OBJECTIVE: To assess the feasibility of identifying structures included in anterior complex (AC) and posterior complex (PC), as well as a series of anatomic landmarks that could help to demonstrate the integrity of the cerebral proximal hemisphere (PH). METHODS: This was a prospective observational multicenter study of healthy pregnant women attending routine ultrasound screening at 20 + 0 to 33 + 6 weeks' gestation. Six physicians performed transabdominal (TA) ultrasound, in order to obtain the planes required to visualize the AC, PC, and PH. Blind analysis by a nonexpert and two experts in fetal neurosonography was used to assess the structures included in each plane view. RESULTS: In the population studied (n = 747), detection of the structure rates for AC, PC, and proximal hemisphere was of 94%, 93%, and 96%, respectively, with an agreement of 97%, 94%, and 98% when comparing an expert and a nonexpert in fetal brain examiner. Detection of structures in the proximal hemisphere was significantly higher when observed through the proximal hemisphere plane rather than the transventricular plane. CONCLUSION: Our results suggest that inclusion of AC and PC complexes visualization, as well as real-time access to the proximal hemisphere, is feasible and could improve the prenatal detection of fetal cerebral anomalies.

New Insights into the Anterior Complex.

OBJECTIVE: To introduce visualization of the germinal matrix (GM), external angle of the frontal horn, and periventricular white matter while evaluating the anterior complex (AC) during basic ultrasound assessment of the fetal brain. CASE PRESENTATIONS: This is a retrospective observational study of healthy women with singleton pregnancies, with no increased risk of fetal central nervous system anomalies, attending routine ultrasound screening at 20-32 weeks' gestation. Seventeen cases are presented in which an abnormal aspect of the GM or external angle of the frontal horn or periventricular white matter on AC evaluation has allowed a prenatal diagnosis of peri-intraventricular hemorrhage, subependymal cysts, connatal cysts, periventricular venous hemorrhagic infarction, and white matter injury. CONCLUSION: An extended AC evaluation could significantly improve the -diagnosis of hemorrhagic/cystic/hypoxic-ischemic lesions during the performance of a basic ultrasound study of the fetal brain.

Breast Cancer Quality of Life and Health-state Utility at a Brazilian Reference Public Cancer Center.

Objectives: To evaluate health-related-quality-of-life and derive health-state-utility (HSU) from breast cancer patients, before and after routine therapy at a Brazilian reference public cancer center.Methods: In a prospective cohort study, a consecutive sample of outpatients newly diagnosed with breast cancer was submitted to two interviews (baseline, 6-month) to complete EQ-5D-3L/VAS and EORTC-QLQ-C30/BR23 questionnaires. Demographic and clinical information was reviewed from medical records.Results: For 196 patients, EQ-5D domains of pain/discomfort and anxiety/depression were mainly affected, but partially improved overtime, while mobility/usual activities/self-care worsened after therapy. EORTC-QLQ-C30/BR23 scales mostly affected were emotional functioning, insomnia, pain, sexual enjoyment and future self-health perspective at baseline, while financial difficulties, insomnia, fatigue and therapy side-effects at follow-up. Overtime mean scores were 71.4 (95%CI68.5-74.4) and 76.1 (95%CI73.3-78.8) for EQ-5D-VAS, and 0.712 (95%CI0.686-0.737) and 0.732 (95%CI0.707-0.757) for HSU. HSU was 0.689 (95%CI0.648-0.730) in stages III-IV, and 0.692 (95%CI0.652-0.731) under two/three chemotherapy regimens.Conclusion: In a context of impairments in emotional functioning, sexual enjoyment, symptoms burden, and poor future self-health perspective, breast cancer produced a mean HSU of 0.712. After routine care, there was a small improvement in quality of life, with lower HSU particularly in advanced disease and multiple chemotherapy regimens.

Effects of Oral Magnesium Supplementation on Vascular Function: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

INTRODUCTION: The effects of magnesium (Mg) supplementation on vascular function have been evaluated in some randomized controlled trials (RCT) but their results are conflicting. AIM: A systematic review and meta-analysis were conducted to summarize the effects of oral Mg supplementation on vascular function in RCT. METHODS: The databases MEDLINE (PubMed), Embase, Web of Science and Cochrane Library were accessed from inception to May 27, 2019. Intergroup differences (treatment vs. control group) related to changes in flow-mediated dilation (FMD) and pulse wave velocity (PWV), expressed as mean and standard deviation, were used to evaluate the effect of Mg supplementation on these outcomes. The results of the meta-analysis were expressed using a random-effects model. The heterogeneity between studies was evaluated using the I2 statistic. RESULTS: The oral supplementation of Mg had no significant effect on FMD (mean difference 2.13; 95% CI - 0.56, 4.82; p = 0.12) and PWV (mean difference - 0.54, 95% CI - 1.45, 0.36, p = 0.24). Heterogeneity for both outcomes (FMD and PWV) was high (I2 = 99%, p < 0.001). However, in subgroup analyses, oral Mg significantly improved FMD in studies longer than 6 months, in unhealthy subjects, in individuals older than 50 years, or in those with body mass index (BMI) ≥ 25 kg/m2. The reduced number of RCT and the heterogeneity among them were the main limitations. CONCLUSIONS: This meta-analysis suggest that oral Mg supplementation may improve endothelial function when conducted at least for 6 months and in unhealthy, overweight or older individuals. Registration number: PROSPERO CRD42019111462.

Artificial Neural Networks for Filling Missing Streamflow Data in Rio do Carmo Basin, Minas Gerais, Brazil

Abstract Adequate availability of data directly influences the quality of hydrological studies. In this sense, procedures for filling gaps of observations are often applied in order to improve the length of hydrological series. One technique that can be used is the Artificial Neural Network (ANN), which process information from input data creating an output. This study aims to evaluate the application of ANN to fill missing data from monthly average streamflow series at Rio do Carmo Basin in the state of Minas Gerais, Brazil. A 26-years series (from 1989 to 2012) was used for ANN modelling while the two proceeding years, 2013 and 2014, were used to simulate failures pursuant to evaluating the performance of the ANN. The ANN construction was performed by the software WEKA that uses the multilayer perceptron model with sigmoidal activation functions. Four types of ANN were generated: five attributes and two (MLP1) or five (MLP2) neurons; and with three attributes and one (MLP3) or three (MLP4) neurons. The best-fit model to ANN was the MLP1, verified by Pearson correlation coefficients (0.9824), and coefficient of determination r² (0.9646). The model used five attributes, four input data (year, month, streamflow data from Acaiaca and Fazenda Paraíso stations) and one output data (streamflow from Fazenda Oriente station), that considered the temporal variation of streamflow. Hence, the utilization of the ANN generated by the WEKA was adequate and can be considered a simple approach, not requiring great computational programming knowledge.

Presença de critérios diagnósticos de sepse na admissão e sua relação com as características clínicas e desfecho em pacientes diagnosticados com sepse / Presence of sepsis criteria on admission and its relationship to clinical characteristics and outcomes in patients diagnosed with sepsis

A sepse é definida como a resposta inflamatória desrregulada do hospedeiro àuma infecção, sendo considerada um problema de saúde pública mundialmente. Elapode ser classificada de acordo com o local da aquisição da infecção em adquirida na comunidade ou adquirida no hospital, cada uma com características distintas, no entanto, a definição para a sepse de origem comunitária é divergente na literatura e neste estudo optou-se por classificar os pacientes em dois grupos: pacientes sem critérios para o diagnóstico sepse no momento da admissão e pacientes com critérios para o diagnóstico de sepse no momento da admissão. O objetivo deste estudo foi caracterizar e analisar os contrastes nas hospitalizações entre pacientes sem e com critérios diagnósticos de sepse no momento da admissão em doishospitais de grande porte do interior do estado de São Paulo. Trata-se de estudo quantitativoque foi desenvolvido por meio da revisão dos prontuáriosde todos os pacientes com idade superior a 18 anos, diagnosticados com sepse e internados nas duas instituições, no período de janeiro a dezembro de 2018. Foram analisadas variáveis sociodemográficas e clínicas relacionadas à sepse. A população do estudo foi de 385 prontuários de pacientes, sendo que 326 não apresentavam critério e 59 (15,3%) apresentavam critério de sepse no momento da admissão. Observou-se predominância do sexo masculino e de pacientes com idade inferior a 60 anos, no entanto, não há associação do sexo ou da idade com a presença de critério de sepse no momento da admissão. Pacientes com critério de sepse na admissão apresentavam mais comprometimento dos parâmetros laboratoriais e clínicos do que os pacientes sem critério. O desfecho da internação (óbito ou alta hospitalar) não foi associado à presença de critério de sepse no momento da admissão, porém, o tempo de internação hospitalar foi menor nos pacientes com critério do que nos sem critério. Na análise conjunta da população do estudo, observou-se que a idade inferior a 60 anos e a internação para tratamento cirúrgico associaram-se à alta hospitalar. Assim, conclui-se que, em comparação com os pacientes sem critérios para o diagnóstico de sepse na admissão, os pacientes com critério apresentaram mais sinais de disfunção orgânica no momento da admissão emenor tempo de internação na terapia intensiva, além disso, a presença ou não de critérios para o diagnóstico de sepse no momento da admissão não está associada ao desfecho da internação

Sepsis is defined as the host's deregulated inflammatory response to an infection and is considered a public health problem worldwide. It can be classified according to the place of acquisition of infection in community-acquired or hospital-acquired infection, each with distinct characteristics; however, the definition for community-based sepsis is divergent in the literature and in this study we opted for classify patients into two groups: patients without criteria for sepsis diagnosis at admission and patients with criteria for sepsis diagnosis at admission. The aim of this study was to characterize and analyze the contrasts in hospitalizations between patients without and with sepsis diagnostic criteria at the time of admission in two large hospitals in the interior of the state of São Paulo. This is a quantitative study that was developed by reviewing the medical records of all patients aged over 18 years, diagnosed with sepsis and hospitalized in both institutions, from January to December 2018. We analyzed sociodemographic and clinical variables related to sepsis. The study population was 385 patient records, of which 326 had no criteria and 59 (15.3%) had sepsis criteria at the time of admission. There was a predominance of males and patients younger than 60 years; however, there is no association of gender or age with the presence of sepsis criteria at the time of admission. Patients with sepsis criteria on admission had more impairment of laboratory and clinical parameters than patients without criteria. The outcome of hospitalization (death or hospital discharge) was not associated with the presence of sepsis criteria at admission; however, the length of hospital stay was shorter in patients with criteria than in those without criteria. In the joint analysis of the study population, it was observed that the age below 60 years and hospitalization for surgical treatment were associated with hospital discharge. Thus, it can be concluded that, compared to patients without criteria for the diagnosis of sepsis on admission, patients with criteria presented more signs of organ dysfunction upon admission and shorter Intensive Care Units stay, in addition to the presence or not of the criteria for diagnosis of sepsis at admission are not associated with the outcome of the hospitalization

Ansiedade de responsáveis por pacientes com deficiência frente ao atendimento odontológico dos seus filhos / Anxiety in care givers of children with disabilities about their dental care

A ansiedade do responsável pode ser um fator determinante na ansiedade infantil durante a prática odontológica, levando a criança a apresentar comportamentos não colaborativos. Objetivou-se identificar a ansiedade dos responsáveis de pacientes com deficiência ­ Grupo 1 (G1) - atendidos na FOUFRJ, diante do tratamento odontológico de seus filhos, sua relação com Traço e Estado de ansiedade e com o comportamento na consulta, comparando com responsáveis de pacientes sem deficiência ­ Grupo 2 (G2). 128 responsáveis (64 do G1 e 64 do G2) responderam a 3 questionários: 2 validados (Escala de Ansiedade Odontológica (DAS) e Inventário de Ansiedade Traço/Estado) e o terceiro criado pela autora para coleta de dados pessoais e relacionados a percepção de ansiedade frente ao atendimento odontológico do filho (Kappa = 0,96). A maioria do G1 (93,79%) e do G2 (90,63%) era do sexo feminino, com média de idade similar. O comportamento negativo foi mais frequente no G1 com 31,2% contra 9,49% no G2 (p=0,002, Qui²). Ansiedade na 1ª consulta foi relatada em 54,7% no G1 e 48,4% no G2, tendo essa persistindo nas consultas posteriores em 20% do G1, no qual teve médias de DAS (p=0,002) e Estado (p=0,001) maiores nos mais ansiosos; e em 19,6% do G2, com maiores média de Estado (p=0,02) nos mais ansiosos. O comportamento ruim não foi relacionado a maiores valores DAS, Traço ou Estado, mas, nos que permanecem ansiosos, 63,6% das crianças tiveram comportamento ruim no G1 contra 15,4% no G2 (p=0,033). Responsáveis por pacientes com e sem deficiência apresentam ansiedade odontológica semelhante, no entanto a presença de um comportamento ruim está relacionada a ansiedade de responsáveis apenas no grupo dos pacientes com deficiência. (AU)

The caregiver's anxiety can be a determining factor in childhood anxiety during dental practice, leading the child to exhibit non-collaborative behaviors. The objective of this study was to identify the anxiety of those caregivers of patients with disabilities - Group 1 (G1) - treated at the School of Dentistry of the Federal University of Rio de Janeiro, about their children's dental treatment, the relationship with Trait and State anxiety, and with the behavior at the appointment, comparing it with caregivers of non-disabled patients - Group 2 (G2). 128 guardians (64 from G1 and 64 from G2) answered three questionnaires: two validated (Dental Anxiety Scale (DAS) and State-Trait Anxiety Inventory) and the third created by the author to collect personal and related data about the perception of anxiety regarding the child's dental care (Kappa = 0.96). The majority of G1 (93.79%) and G2 (90.63%) were female, with a similar mean age. The negative behavior was more frequent in G1 with 31.2% against 9.49% in G2 (p = 0.002, Qui²). Anxiety in the first visit was reported in 54.7% in G1 and 48.4% in G2, persisting in subsequent visits in 20% of G1, in which the mean DAS (p = 0.002) and State (p = 0.001) was higher in the more anxious; and in 19.6% of G2, with the highest mean State (p = 0.02) in the most anxious. The bad behavior was not related to higher DAS, Trait or State values, but in those who remain anxious, 63.6% of the children had a bad behavior in G1 versus 15.4% in G2 (p = 0.033). Caregivers for patients with and without disabilities have similar dental anxiety; however, the presence of a bad behavior is related to the anxiety of the parents of patients with disabilities. (AU)

Perfil de termorregulaçâo e desfecho clínico em pacientes críticos com sepse / Thermoregulation profile and clinical outcome in critical patients with sepsis

Resumo Objetivo: descrever o perfil da temperatura corporal (TC) e o desfecho em pacientes com sepse atendidos em uma Unidade de Terapia Intensiva (UTI). Método: estudo retrospectivo, descritivo e exploratório. Incluíram-se pacientes maiores de 18 anos, diagnosticados com sepse grave ou choque séptico no período de janeiro a dezembro 2012, atendidos em uma UTI de um hospital púbico. Foram levantadas variáveis sociodemográficas, clínicas e o desfecho. Para a avaliação da TC, consideraram-se todas as medidas registradas durante a internação, aferidas na região axilar por termômetro digital acoplado ao monitor multiparamétrico. Adicionalmente, propuseram-se cenários comparativos entre o número de episódios de febre ou hipotermia nas 24 horas após a internação e nas 24 horas prévias ao desfecho. Os dados foram coletados nos prontuários físicos e eletrônicos. Resultados: foram incluídos 105 pacientes, com predominância de maiores de 60 anos, sexo masculino e cor branca. O desfecho clínico para 26 (24,8 %) foi a alta e para 79 (75,2 %), o óbito. Foram observadas 8778 verificações da TC, sendo a hipotermia mais frequente no grupo óbito (p = 0,00). No grupo alta, as medidas dentro da normalidade foram mais frequentes (p = 0,00). Entre os cenários propostos, houve diferenças estatisticamente significantes entre os grupos quando ocorreram dois ou mais episódios de febre nas 24 horas prévias ao desfecho. Conclusão: a descrição do perfil de termorregulação em pacientes sépticos mostrou que a TC é um indicador complementar capaz de auxiliar a equipe na prática clínica com intuito de propiciar melhores desfechos.

Resumen Objetivo: describir el perfil de la temperatura corporal (TC) y el desenlace en pacientes con sepsis asistidos en una unidad de cuidado intensivo (UCI). Método: estudio retrospectivo, descriptivo y exploratorio. Se incluyeron pacientes mayores de 18 años, diagnosticados con sepsis grave o shock séptico en el periodo de enero a diciembre de 2012, asistidos en una uci de un hospital púbico. Se construyeron variables sociodemográficas, clínicas y de desenlace. Para la evaluación de la TC se consideraron todas las medidas registradas durante la hospitalización, tomadas en la región axilar con termómetro digital acoplado al monitor multiparamétrico. Adicionalmente, se propusieron escenarios comparativos entre el número de episodios de fiebre o hipotermia en las 24 horas después del ingreso y el número de estos las 24 horas previas al desenlace. Los datos fueron recolectados de registros médicos físicos y electrónicos. Resultados: se incluyeron 105 pacientes, con predominio de mayores de 60 años, sexo masculino y color blanco. El resultado clínico para 26 pacientes (24,8 %) fue el alta y para 79 (75,2 %) la muerte. Se observaron 8778 verificaciones de TC, siendo la hipotermia más frecuente en el grupo de muerte (p = 0,00). En el grupo de alta, las medidas dentro de la normalidad fueron más frecuentes (p = 0,00). Entre los escenarios propuestos hubo diferencia estadísticamente significativa entre los grupos cuando ocurrieron dos o más episodios de fiebre en las 24 horas anteriores al desenlace. Conclusión: la descripción del perfil de termorregulación en pacientes sépticos mostró que la TC es un indicador complementario capaz de auxiliar al equipo en la práctica clínica con el objetivo de propiciar mejores resultados.

Abstract Objective: to describe the body temperature profile (TC) and the outcome in patients with sepsis assisted in an intensive care unit (UCI). Method: retrospective, descriptive and exploratory study. Patients over the age of 18 were included, diagnosed with severe sepsis or septic shock in the period from January to December 2012, assisted in an UCI of a public hospital. Sociodemographic, clinical and outcome variables were built. For the evaluation of the TC, all measures recorded during hospitalization were considered, taken in the axillary region by digital thermometer coupled to the multiparametric monitor. In addition, comparative scenarios were proposed between the number of episodes of fever or hypothermia in the 24 hours after internment and the number of these 24 hours prior to the outcome. The data were collected from physical and electronic medical records. Results: 105 patients were included, predominantly over 60 years old, male and white. Clinical outcome for 26 patients (24.8 %) was to be discharged, and for 79 (75.2 %) it was death. 8778 TC verifications were observed, being hypothermia the most frequent in the death group (p = 0.00). In the discharge group, measurements within normality were more frequent (p = 0.00). Among the proposed scenarios, there was statistically significant difference between the groups when two or more episodes of fever occurred in the 24 hours prior to the outcome. Conclusion: the description of the thermoregulation profile in septic patients showed that the TC is a complementary indicator capable of assisting the team in the clinical practice in order to promote better results.