Prevalence and risk factors of Burnout syndrome among intensive care unit members during the second wave of COVID-19: a single-center study.

OBJECTIVE: To evaluate the prevalence of burnout among the intensive care unit team of a university hospital after the second wave of COVID-19 and identify the key factors associated with its development. METHODS: This single-center study included 395 employees from a multidisciplinary team. The participants completed a questionnaire based on the Maslach Burnout Inventory. Multivariate analysis was used to identify the factors associated with burnout. RESULTS: Of 395 participants, 220 responded to the questionnaire (response rate: 56%). The prevalence of Burnout syndrome, defined as a severe score in at least one dimension, was 64.5% (142/220). Emotional distress was the most prevalent dimension, with a severe score affecting 50.5% (111/220) of the participants, followed by depersonalization at 39.1% (86/220). Only 5.9% (13/220) had severe scores in all three dimensions. Multivariate analysis revealed that being a physician was significantly associated with severe burnout symptoms in at least one dimension (odds ratio (OR), 1.32; 95% confidence interval (95%CI): 1.57-9.05; p=0.003). Additionally, having two or more jobs was associated with burnout in the three dimensions (OR=1.65; 95%CI=1.39-19.59; p=0.01). CONCLUSION: This study highlights the alarming prevalence of burnout among intensive care unit teams, particularly among physicians, following the second wave of COVID-19. This emphasizes the need for targeted interventions and support systems to mitigate burnout and reduce its negative impact on healthcare professionals' well-being and patient care.

COVID-19 pandemic and suicidal behavior in adults: systematic review of observational studies.

OBJECTIVE: To analyze the scientific evidence on the impact of the COVID-19 pandemic on suicidal behavior in adults. METHOD: Systematic review, conducted from June to October 2022, in the following databases: MEDLINE/PubMed, Virtual Health Library, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, PsycINFO, Web of Science, Scopus, Science Direct and Google Scholar. The selection, data extraction and assessment of methodological quality were carried out using the Methodological Index for Non-randomized Studies tool. Considering that most of the studies evaluated had significant methodological differences, it was decided to carry out a qualitative synthesis of the data. RESULTS: A total of 2112 articles were found, from which eight articles were selected that analyzed the impact of the COVID-19 pandemic on suicidal behavior in adults. CONCLUSION: The COVID-19 pandemic has influenced the suicidal behavior in adults worldwide, especially when related to race, gender, age, religion, socioeconomic, family and legal issues, and pre-existing mental disorders, leading to a greater propensity for suicidal act.

Anxiety Evolution among Healthcare Workers-A Prospective Study Two Years after the Onset of the COVID-19 Pandemic Including Occupational and Psychoemotional Variables.

Background and objectives: Although previous research has found a high prevalence of anxiety during the COVID-19 pandemic among healthcare workers, longitudinal studies on post-pandemic anxiety and predictor variables have been less abundant. To examine the evolution of anxiety in healthcare workers from the beginning of the pandemic until one and a half years later, analyzing the influence of occupational and psychosocial variables, as well as their possible predictors. Materials and Methods: This was a prospective longitudinal design with three periods of data collection: (1) between 5 May and 21 June 2020, (2) six months after the end of the state of alarm (January-March 2021), and (3) one year after this second assessment (April-July 2022), in which generalized anxiety (GAD-7) was evaluated, as well as occupational and psycho-emotional variables (i.e., social support, self-efficacy, resilience, and cognitive fusion) in healthcare workers in direct contact with COVID-19 patients in Spain. Results: A high prevalence of anxiety was found, with a clear decrease over time. Associations were found between anxiety and certain sociodemographic and work variables (i.e., years of experience, p = 0.046; COVID-19 symptoms, p = 0.001; availability of PPE, p = 0.002; workload, p < 0.001; family contagion concern, p = 0.009). Anxiety maintained negative relationships with social support (p < 0.001), self-efficacy (p < 0.001), and resilience (p < 0.001) and positive associations with cognitive fusion (p < 0.001). Cognitive fusion seemed to be a clear predictor of anxiety. Conclusions: Our findings suggest that social support, self-efficacy, and resilience act as buffers for anxiety, whilst cognitive fusion was found to be a clear risk factor for anxiety. It is important to emphasize the risk role played by cognitive fusion on HCWs as a clear risk factor for stressful work events. The findings emphasize the need to implement specific interventions to promote the mental well-being of healthcare workers, particularly in crisis contexts such as the COVID-19 pandemic.

Oxidized Bacterial Cellulose Membranes Immobilized with Papain for Dressing Applications: Physicochemical and In Vitro Biological Properties.

This research consolidates our group's advances in developing a therapeutic dressing with innovative enzymatic debridement, focusing on the physicochemical and in vitro biological properties of papain immobilized in wet oxidized bacterial cellulose (OxBC-Papain) dressing. OxBC membranes were produced with Komagataeibacter hansenii oxidized with NaIO4, and papain was immobilized on them. They were characterized in terms of enzyme stability (over 100 days), absorption capacity, water vapor transmission (WVT), hemocompatibility, cytotoxicity, and cell adhesion. The OxBC-Papain membrane showed 68.5% proteolytic activity after 100 days, demonstrating the benefit of using the OxBC wet membrane for papain stability. It had a WVT rate of 678 g/m2·24 h and cell viability of 99% and 86% for L929 and HaCat cells, respectively. The membranes exhibited non-hemolytic behavior and maintained 26% clotting capacity after 1 h. The wet OxBC-Papain membrane shows significant potential as a natural biomolecule-based therapeutic dressing for wound care, offering efficient debridement, moisture maintenance, exudate absorption, gas exchange, and hemostasis without cytotoxic effects or cell adhesion to the dressing. Further research, especially using in vivo models, is needed to assess its efficacy in inducing epithelialization. This study advances stomatherapy knowledge, providing a cost-effective solution for enzymatic debridement in healthcare.

The Similarity Degree of the Anthropometric and Body Composition Variables of Brazilian and Mozambican Schoolchildren: A New Approach Using the Smoothed Jaccard Index Surface.

BACKGROUND/OBJECTIVES: Brazil and Mozambique face similar socioeconomic challenges, including common indicators of undernutrition and overnutrition among children. This study evaluated the similarity degree of the anthropometric and body composition variables of Brazilian and Mozambican children by using the Jaccard index. METHODS: A total of 1831 children of both genders aged 7-10 years from three Brazilian cities (Recife, Vitoria de Santo Antao, and Lagoa do Carro) and three Mozambican cities (Maputo, Boane, and Inhambane) participated in this study. Anthropometric (height, body mass, and waist circumference) and body composition (body fat percentage [%BF], lean mass, and fat mass) variables were measured and the Smoothed Jaccard Index Surface (SJIS) was used to evaluate the similarity degree. RESULTS: Brazilian children were taller and heavier and had a higher %BF and fat mass than Mozambican children. Children living in urban areas were taller than those living in rural zones in both countries. Brazilian and Mozambican children showed high similarity only between %BF and lean mass. Children from Recife and Maputo had high similarities among waist circumference, body mass, fat mass, height, and %BF. Finally, a high SJIS degree was observed among height and %BF for schoolchildren from rural and urban zones. CONCLUSION: Brazilian and Mozambican children exhibit differences in growth characteristics but a high degree of similarity when children from rural and urban zones are compared.

Rheumatoid meningitis: a case series report and review of modern therapeutic schemes and outcome.

INTRODUCTION: Rheumatoid meningitis (RM) is an extremely rare extra-articular complication of rheumatoid arthritis (RA), with approximately 165 cases reported world-wide. RM exhibits a broad range of symptoms, with stroke-like episodes and seizures being the most common manifestations. The primary differential diagnoses include vascular and infectious diseases. The influence of immunomodulatory medications on the pathophysiology of RM remains unclear. There are no consensus guidelines on therapeutic regimen. METHODS: We present four patients with prior history of RA that developed different neurological syndromes in correlation to radiological leptomeningitis. Clinical presentations, comorbid conditions, supplementary diagnostic assessments, treatments, and prognosis are provided. A literature review of recent immunosuppressive management in RM patients was performed. RESULTS: Three patients presented to hospital with recurrent focal seizures. Only two suffered meningism, reporting headache and fever. Magnetic resonance imaging (MRI) showed different grades of leptomeningitis across all cases. Notably, three cases demonstrated bilateral involvement extending to the pachymeninges. Two patients exhibited pronounced CSF mononuclear inflammation while extended microbiological evaluations yielded negative results. Two patients required biopsy for confirmation. The initiation of immunosuppressive therapy marked a turning point for three patients who previously exhibited progressive deterioration. Mortality was absent in all cases. CONCLUSIONS: Our experience remarks the elusive nature of RM. Rigorous exclusionary diagnostics are imperative to differentiate RM from mimicking conditions. Clinical manifestations oscillate between transient episodes and progressive neurological impairments, punctuated by frequent epileptic seizures. In scenarios where clinical worsening persists or where clinical and radiological evaluations are inconclusive, aggressive immunosuppressive therapy is recommended.

Headache and Associated Psychological Variables in Intensive Care Unit Nurses during the COVID-19 Pandemic: A Prospective Study.

(1) Background: Headaches in health professionals have been studied over the years. This has become even more relevant during the COVID-19 pandemic, due to their link with the use of masks, being female or working in highly complex units. However, their association with different personality traits has not been studied in healthcare workers (HCWs). The aim of this study was to assess the prevalence and evolution of headaches throughout the pandemic in Intensive Care Unit (ICU) nurses and to analyze their association with sociodemographic, occupational and personality variables as well as with other symptoms. (2) Methods: This was an observational, descriptive, longitudinal, prospective study with two periods of data collection (at the end of the containment phase and six months thereafter). A non-probabilistic convenience sampling was performed (n = 131). (3) Results: A high percentage of ICU nurses reported headaches during the first (71%) or second (79.4%) time point; more than half of the sample (58.8%) reported headaches over time (chronic headache). Although a higher prevalence of headaches was observed in women at both assessment points, no significant gender-related relationships were observed for headaches maintained across the two time points. Regarding the symptoms and personality variables, positive relationships were found between headaches and anxiety (p = 0.005), insomnia (p = 0.030) and emotional exhaustion (p = 0.022), and a negative relationship was found between headaches and hardiness (p = 0.031). (4) Conclusions: Our study highlights the importance of assessing occupational, psychological and emotional aspects in order to decrease the prevalence of headaches and thus improve the quality of the work life of nurses in such demanding environments as the ICU.

Post-Pandemic Insomnia in Healthcare Workers: A Prospective Study including Sociodemographic, Occupational and Psychosocial Variables.

Background/Objectives: Previous research points to the prevalence of insomnia during the COVID-19 pandemic among healthcare workers (HCWs). However, longitudinal studies on its evolution, including the post-pandemic stage, are less abundant, with a special lack of research about possible psychosocial risk factors. The aim of the current study is to analyze the evolution of insomnia in Spanish HCWs from the beginning of the pandemic until two years later, examining the influence of sociodemographic, occupational and psychosocial variables. Methods: This was a prospective longitudinal design with three data collection periods in which insomnia was assessed using the Insomnia Severity Index (ISI), in addition to sociodemographic, occupational and psychosocial (i.e., social support, self-efficacy, resilience and cognitive fusion) variables in HCWs (n = 216) who were in direct contact with COVID-19 patients. Results: High scores were observed for insomnia, with a clear decrease throughout the periods studied (F = 30.198, p < 0.001). An association was observed between insomnia and certain sociodemographic and occupational variables (i.e., work category, p = 0.001; availability of Personal Protective Equipment (PPE), p < 0.001; workload, p < 0.001; worry about self or family contagion, p = 0.002, p = 0.003, respectively). Insomnia had negative relationships with social support (p = 0.014), self-efficacy (p < 0.001) and resilience (p < 0.001) and positive relationships with cognitive fusion (p < 0.001). Interaction effects between the evolution of insomnia and social support from friends (p = 0.024, ƞ2 = 0.34) and between the evolution of insomnia and cognitive fusion (p = 0.047; ƞ2 = 0.25) were found. Conclusions: Social support, self-efficacy and resilience act as buffers for insomnia. Cognitive fusion acts as a clear precipitator of insomnia as well as directly influencing its evolution. Social support from friends also affects the evolution of insomnia. Within the specific circumstances of the COVID-19 pandemic, a long-term effect of social support from friends and a short-term effect of cognitive fusion on the evolution of insomnia was observed. The findings emphasize the need to implement specific interventions to promote the mental well-being of HCWs, particularly in crisis contexts that involve an increase in occupational stress, emphasizing the role of certain psychosocial variables as protective factors.

Establishment of a laboratory colony of Pressatia choti (Diptera: Psychodidae), a suspected vector of Leishmania braziliensis.

BACKGROUND: Pressatia choti is a common sand fly found in the Atlantic Forest of Brazil, which is suspected to be involved in the transmission of Leishmania braziliensis. Herein, we aimed to establish a Pr. choti laboratory colony. METHODS: Wild-caught female sand flies were blood fed on hamsters and maintained under controlled conditions (temperature: 26 °C; relative humidity: 70%). RESULTS: Of the 301 collected female sandflies, 288 were identified as Pr. choti. The life cycle duration ranged from 31 to 56 days. CONCLUSIONS: We successfully established a Pr. choti colony, whose biological parameters were similar to those of other neotropical sand flies.

Efeito do monitoramento telefônico de Intervenções Breves para uso de álcool entre gestantes: ensaio clínico randomizado / Effect of telephone monitoring of Brief Interventions for alcohol use among pregnant women: a randomized clinical trial / Efecto del seguimiento telefónico de Intervenciones Breves para el consumo de alcohol en mujeres embarazadas: un ensayo clínico aleatorizado

Resumo Objetivo: testar se o monitoramento por telefone acrescenta efeito à aplicação de Intervenções Breves para o uso de álcool entre gestantes. Metodologia: trata-se de ensaio clínico controlado e randomizado, aberto, paralelo, com dois braços. Os dados foram coletados na atenção primária à saúde de São Carlos e Centro de Referência de Saúde da Mulher em Ibaté (São Paulo, Brasil). Foram rastreadas gestantes que consumiram qualquer quantidade de álcool na gestação. Após, foram alocadas aleatoriamente em dois grupos. O grupo controle recebeu apenas uma intervenção breve; o grupo experimental recebeu uma intervenção breve e foi monitorado semanalmente por telefone nas duas semanas posteriores à intervenção. Utilizou-se programa estatístico para realização de estatísticas descritivas e inferencial (Teste de Wilcoxon). Resultados: Houve redução do consumo nos dois grupos. Porém, apenas no grupo experimental em que foi implementado intervenção com monitoramento, houve abstinência de todo o grupo (AUDIT-C: p-valor=0,011; T-ACE: p-valor=0,010). Conclusões: Intervenções breves associadas a monitoramento telefônico durante a gestação se mostraram efetivas para a cessação do consumo de álcool. O monitoramento contínuo após intervenções breves melhora as taxas de abstinência de álcool. Registro Brasileiro de Ensaios Clínicos: RBR-4y4k7w.

Abstract Objective: to test whether telephone monitoring adds effect to the application of Brief Interventions for alcohol use among pregnant women. Methodology: this is a controlled and randomized clinical trial, open, parallel, with two arms. Data were collected in primary health care in São Carlos and Reference Center for Women's Health in Ibaté (São Paulo, Brazil). Pregnant women who consumed any amount of alcohol during pregnancy were tracked. Afterwards, they were randomly allocated into two groups. The control group received only a brief intervention; the experimental group received a brief intervention and were monitored weekly by telephone for two weeks after the intervention. A statistical program was used to perform descriptive and inferential statistics (Wilcoxon Test). Results: There was a reduction in consumption in both groups. However, only in the experimental group in which the intervention with monitoring was implemented, there was abstinence in the entire group (AUDIT-C: p-value=0.011; T-ACE: p-value=0.010). Conclusions: Brief interventions associated with telephone monitoring during pregnancy proved to be effective in stopping alcohol consumption. Continuous monitoring after brief interventions improves alcohol abstinence rates. Brazilian Registry of Clinical Trials: RBR-4y4k7w.

Resumen Objetivo: comprobar si el seguimiento telefónico agrega efecto a la aplicación de Intervenciones Breves para el uso de alcohol entre las mujeres embarazadas. Metodología: se trata de un ensayo clínico controlado y aleatorizado, abierto, paralelo, de dos brazos. Los datos fueron recolectados en la atención primaria de salud en São Carlos y el Centro de Referencia para la Salud de la Mujer en Ibaté (São Paulo, Brasil). Se realizó un seguimiento de las mujeres embarazadas que consumieron cualquier cantidad de alcohol durante el embarazo. Posteriormente, fueron distribuidos aleatoriamente en dos grupos. El grupo de control recibió solo una breve intervención; el grupo experimental recibió una intervención breve y fue monitoreado semanalmente por teléfono durante dos semanas después de la intervención. Se utilizó un programa estadístico para realizar estadísticas descriptivas e inferenciales (Test de Wilcoxon). Resultados: Hubo una reducción en el consumo en ambos grupos. Sin embargo, solo en el grupo experimental en el que se implementó la intervención con seguimiento, hubo abstinencia en todo el grupo (AUDIT-C: p-valor=0,011; T-ACE: p-valor=0,010). Conclusiones: Las intervenciones breves asociadas al seguimiento telefónico durante el embarazo demostraron ser efectivas para detener el consumo de alcohol. El seguimiento continuo después de intervenciones breves mejora las tasas de abstinencia de alcohol. Registro Brasileño de Ensayos Clínicos: RBR-4y4k7w.

Increasing community prevalence of extended-spectrum beta-lactamase-producing Escherichia coli in urine is associated with increasing district-level antibiotic consumption.

This study aimed to analyze ESBL-producing Escherichia coli prevalence in urine samples collected between 2011-2019 in Curitiba, a large city in Brazil, and relating it to antibiotic consumption and sanitary conditions. This is a longitudinal study correlating prevalence of ESBL-producing E. coli isolates from urine samples with district-level antibiotic consumption and sociodemographic data during 2011-2019. E. coli isolates were tested for antibiotic susceptibility and ESBL by an automated method. Statistical analysis applied linear regressions, pooled ordinary least squares, and fixed effects models for districts or years. The Chow and Hausman tests indicated that the fixed effects model for individual districts fitted best. Chi-square test was used for qualitative variables (statistical significance was set when P < 0.05). Among the 886 535 urine sample cultures, 9.9% of isolates were ESBL-producing E. coli. Their prevalence increased from 4.7% in 2012 to 19.3% in 2019 (P < 0.0001; R2 = 0.922). This progressive increase correlated with age (P = 0.007; R2 = 0.8725) and male gender (P < 0.001) and increased antibiotic consumption (P = 0.0386; R2 = 0.47). The fixed effects model showed that district influences ESBL prevalence and that antibiotic consumption explains 20%-30% of this variation, with an increase of one defined daily dose accounting for an increase of 0.02084 percentage points of ESBL. The increasing prevalence of ESBL-producing E. coli can, to a considerable extent, be explained by increasing antibiotic consumption.

Inhibition of protein translational machinery in triple-negative breast cancer as a promising therapeutic strategy.

Y-box binding protein-1 (YB-1) is a proto-oncogenic protein associated with protein translation regulation. It plays a crucial role in the development and progression of triple-negative breast cancer (TNBC). In this study, we describe a promising approach to inhibit YB-1 using SU056, a small-molecule inhibitor. SU056 physically interacts with YB-1 and reduces its expression, which helps to restrain the progression of TNBC. Proteome profiling analysis indicates that the inhibition of YB-1 by SU056 can alter the proteins that regulate protein translation, an essential process for cancer cell growth. Preclinical studies on human cells, mice, and patient-derived xenograft tumor models show the effectiveness of SU056. Moreover, toxicological studies have shown that SU056 treatment and dosing are well tolerated without any adverse effects. Overall, our study provides a strong foundation for the further development of SU056 as a potential treatment option for patients with TNBC by targeting YB-1.

Factors associated with concurrent alcohol, tobacco and illicit drug use: 2019 National School-Based Health Survey. / Fatores associados ao policonsumo de álcool, tabaco e drogas ilícitas: Pesquisa Nacional de Saúde do Escolar 2019.

The aim of this study was to analyze the factors associated with concurrent alcohol, tobacco and illicit drug use among Brazilian schoolchildren aged 13-17. We conducted a cross-sectional study using data from the 2019 National School-Based Health Survey. The outcome was use of the three substances during the last 30 days. Hierarchical multiple logistic regression was carried out with independent variables grouped into four blocks: sociodemographic characteristics; family context; behavioral aspects; and stressors. Variables with p<0.05 were retained in the final model. The prevalence of concurrent substance use was 3.3%. Being male, living in the Midwest, South and Southeast, skipping school without parent permission, parents not knowing what their children do in their free time, having parents who smoke, having experienced physical aggression from parents, feeling that life is not worth living, trying drinking and illicit drugs before the age of 13, and having friends who drink alcohol, smoke and use drugs in their presence remained associated with the outcome in the final model. The findings reveal high prevalence of concurrent alcohol, cigarette and illicit drug use among adolescents and that poly use is associated with sociodemographic, family, and behavioral factors and stressors.

Objetivou-se analisar os fatores associados ao policonsumo de álcool, tabaco e drogas ilícitas, entre adolescentes escolares brasileiros de 13 a 17 anos. Estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar (2019). A variável desfecho foi o relato de consumo das três substâncias nos últimos 30 dias. As variáveis independentes foram agrupadas em quatro blocos: características sociodemográficas; contexto familiar; situações estressoras; aspectos comportamentais. Foi realizada análise de regressão logística múltipla hierarquizada, permanecendo no modelo final as variáveis com p<0,05. A prevalência de policonsumo em adolescentes escolares foi 3,3%. No modelo final, sexo masculino, morar na região Centro-Oeste, Sul e Sudeste, faltar a escola sem permissão, pais não saberem o que fazem no tempo livre, ter pais fumantes, sofrer agressão física pelos pais, sentir que a vida não vale a pena ser vivida, experimentar bebida alcoólica e drogas ilícitas antes dos 13 anos, ter amigos que bebem bebida alcoólica, fumam e usam drogas na sua presença permaneceram associados ao desfecho. Os dados mostram alta prevalência de policonsumo de três substâncias entre adolescentes e sua associação a fatores sociodemográficos, familiares, comportamentais e a eventos estressantes.

Potential effects of the discharge of wastewater treatment plant (WWTP) effluents in benthic communities: evidence from three distinct WWTP systems.

Wastewater treatment plant (WWTP) effluents can be sources of environmental contamination. In this study, we aimed to understand whether effluents of three different WWTPs may have ecological effects in riverine recipient ecosystems. To achieve this, we assessed benthic phytobenthos and macroinvertebrate communities at three different locations relative to the effluent discharge: immediately upstream, immediately downstream and 500-m downstream the effluent discharge. Two approaches were employed: the ecological status classification as defined in the Water Framework Directive (WFD) based on biological indicators; constrained multivariate analysis to disentangle the environmental drivers (physicochemical variables and contaminants, namely metals, polycyclic aromatic hydrocarbons, pharmaceuticals, and personal care products) of ecological changes across the study sites. The results showed inconsistencies between the WFD approach and the multivariate approach, as well as between the responses of macroinvertebrates and diatoms. The WWTP effluents impacted benthic communities in a single case: macroinvertebrates were negatively affected by one of the WWTP effluents, likely by the transported pharmaceuticals (other stressors are essentially homogeneous among sites). Given the findings and the scarcity of consistent evidence on ecological impacts that WWTP effluents may have in recipient ecosystems, further research is needed towards more sustainable regulation and linked environmental protection measures.

Influence of sex on the timing of coronary angiography and the prescription of antiplatelet therapy in patients with nonST-segment elevation myocardial infarction. / Impacto del sexo en los tiempos de cateterismo y en el uso de pretratamiento antiagregante plaquetario en pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST).

OBJECTIVES: To assess differences in the clinical management of nonST-segment elevation myocardial infarction (NSTEMI), including in-hospital events, according to biological sex. MATERIAL AND METHODS: Prospective observational multicenter study of patients diagnosed with NSTEMI and atherosclerosis who underwent coronary angiography. RESULTS: We enrolled 1020 patients in April and May 2022; 240 (23.5%) were women. Women were older than men on average (72.6 vs 66.5 years, P .001), and more women were frail (17.1% vs 5.6%, P .001). No difference was observed in pretreatment with any P2Y12 inhibitor (prescribed in 68.8% of women vs 70.2% of men, P = .67); however, more women than men were prescribed clopidogrel (56% vs 44%, P = .009). Women prescribed clopidogrel were more often under the age of 75 years and not frail. Coronary angiography was performed within 24 hours less corooften in women (29.8% vs 36.9%, P = .03) even when high risk was recognized. Frailty was independently associated with deferring coronary angiography in the adjusted analysis; biological sex by itself was not related. The frequency and type of revascularization were the same in both sexes, and there were no differences in in-hospital cardiovascular events. CONCLUSION: Women were more often prescribed less potent antithrombotic therapy than men. Frailty, but not sex, correlated independently with deferral of coronary angiography. However, we detected no differences in the frequency of coronary revascularization or in-hospital events according to sex.

OBJETIVO: Evaluar las diferencias en el manejo clínico y eventos intrahospitalarios en una cohorte de pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST) en función del sexo. METODO: Estudio observacional, prospectivo y multicéntrico que incluyó pacientes consecutivos con diagnóstico de SCASEST sometidos a coronariografía con enfermedad ateroesclerótica responsable. RESULTADOS: Entre abril y mayo de 2022 se incluyeron 1.020 pacientes; de ellos, 240 eran mujeres (23,5%). En comparación con los hombres, las mujeres fueron mayores (72,6 años vs 66,5 años; p 0,001) y más frágiles (17,1% vs 5,6%; p 0,001). No hubo diferencias en el pretratamiento con un inhibidor del receptor P2Y12 (68,8% vs 70,2%, p = 0,67), aunque las mujeres recibieron más pretratamiento con clopidogrel (56% vs 44%, p = 0,009), principalmente aquellas de edad 75 años y sin fragilidad. En las mujeres se realizaron menos coronariografías precoces (# 24 h) (29,8% vs 36,9%; p = 0,03) a pesar de presentar la misma indicación (criterios de alto riesgo). En el análisis ajustado, la fragilidad, pero no el sexo, se asoció de forma independiente con la realización de una coronariografía diferida. La tasa y el tipo de revascularización fue igual en ambos sexos, y no hubo diferencias en los eventos cardiovasculares intrahospitalarios. CONCLUSIONES: Las mujeres recibieron con mayor frecuencia un tratamiento antitrombótico menos potente. La fragilidad y no el sexo se asoció con la realización de coronariografía diferida. Sin embargo, no hubo diferencias en la tasa de revascularización coronaria ni en los eventos intrahospitalarios en función del sexo.

Contextual and individual factors associated with traumatic dental injuries in deprived 12-year-old schoolchildren: A cohort study.

AIM: Traumatic dental injuries (TDIs) among children and adolescents have been acknowledged as of public health concern worldwide. The aim of the study was to assess the relationship between contextual and individual characteristics and TDIs in 12-year-old schoolchildren. MATERIALS AND METHODS: A cohort study was conducted with 355 schoolchildren living in deprived communities in the city of Manaus, Brazil. Contextual factors (place of residence and socio-economic indicators) and individual characteristics, including sex, family income, parents/guardians years of schooling, overjet and open bite (Dental Aesthetic Index), self-esteem (Rosenberg Self-Esteem Scale), sense of coherence (Sense of Coherence Scale), oral health beliefs, social support (Social Support Appraisals) were assessed at baseline. TDIs were measured at baseline and at 2-year follow-up using the O'Brien Index. Data were analysed through confirmatory factor analysis and structural equation modeling. RESULTS: The baseline prevalence of TDIs was 17.6% and the incidence of TDIs at 2-year follow-up was 26.8%. Better psychosocial status had a direct protective effect on the incidence of TDIs (ß = -.184). Better contextual characteristics (ß = -.135) and greater overjet (ß = -.203) were directly associated with poor psychosocial status. Higher schooling of parents/guardians directly predicted better psychosocial status (ß = .154). Psychosocial status mediated the relationship of greater overjet (ß = .036), contextual factors (ß = .024) and parental/guardian schooling (ß = -.027) with TDIs. CONCLUSIONS: Contextual factors and individual characteristics predicted TDIs. Psychosocial status was a relevant individual attribute in the causal network of TDIs, due to the direct effect on the incidence of TDIs as well as a mediator on the influence of contextual factors, overjet and parents/guardians schooling on the incidence of TDIs.

AZGP1 deficiency promotes angiogenesis in prostate cancer.

BACKGROUND: Loss of AZGP1 expression is a biomarker associated with progression to castration resistance, development of metastasis, and poor disease-specific survival in prostate cancer. However, high expression of AZGP1 cells in prostate cancer has been reported to increase proliferation and invasion. The exact role of AZGP1 in prostate cancer progression remains elusive. METHOD: AZGP1 knockout and overexpressing prostate cancer cells were generated using a lentiviral system. The effects of AZGP1 under- or over-expression in prostate cancer cells were evaluated by in vitro cell proliferation, migration, and invasion assays. Heterozygous AZGP1± mice were obtained from European Mouse Mutant Archive (EMMA), and prostate tissues from homozygous knockout male mice were collected at 2, 6 and 10 months for histological analysis. In vivo xenografts generated from AZGP1 under- or over-expressing prostate cancer cells were used to determine the role of AZGP1 in prostate cancer tumor growth, and subsequent proteomics analysis was conducted to elucidate the mechanisms of AZGP1 action in prostate cancer progression. AZGP1 expression and microvessel density were measured in human prostate cancer samples on a tissue microarray of 215 independent patient samples. RESULT: Neither the knockout nor overexpression of AZGP1 exhibited significant effects on prostate cancer cell proliferation, clonal growth, migration, or invasion in vitro. The prostates of AZGP1-/- mice initially appeared to have grossly normal morphology; however, we observed fibrosis in the periglandular stroma and higher blood vessel density in the mouse prostate by 6 months. In PC3 and DU145 mouse xenografts, over-expression of AZGP1 did not affect tumor growth. Instead, these tumors displayed decreased microvessel density compared to xenografts derived from PC3 and DU145 control cells, suggesting that AZGP1 functions to inhibit angiogenesis in prostate cancer. Proteomics profiling further indicated that, compared to control xenografts, AZGP1 overexpressing PC3 xenografts are enriched with angiogenesis pathway proteins, including YWHAZ, EPHA2, SERPINE1, and PDCD6, MMP9, GPX1, HSPB1, COL18A1, RNH1, and ANXA1. In vitro functional studies show that AZGP1 inhibits human umbilical vein endothelial cell proliferation, migration, tubular formation and branching. Additionally, tumor microarray analysis shows that AZGP1 expression is negatively correlated with blood vessel density in human prostate cancer tissues. CONCLUSION: AZGP1 is a negative regulator of angiogenesis, such that loss of AZGP1 promotes angiogenesis in prostate cancer. AZGP1 likely exerts heterotypical effects on cells in the tumor microenvironment, such as stromal and endothelial cells. This study sheds light on the anti-angiogenic characteristics of AZGP1 in the prostate and provides a rationale to target AZGP1 to inhibit prostate cancer progression.

Validation of the Equidyn protocol for evaluation of dynamic balance in older adults through a smartphone application.

BACKGROUND: Different tasks and proxy measurements have been employed to evaluate dynamic balance in older individuals. However, due to inherent limitations, results from most evaluations could hardly be taken as valid measurements of dynamic balance. RESEARCH QUESTION: Is the Equidyn smartphone application-based protocol valid and sensitive for assessment of dynamic balance in older adults? METHODS: Dynamic balance was evaluated in 52 physically active individuals, age range 60-80 years (M = 69.36). The dynamic tasks were one-leg sway either in the mediolateral (ML) or anteroposterior (AP) direction while supported on the contralateral leg, and cyclic sit-to-stand with a narrow support base. These tasks were performed under standardized movement amplitude and rhythm. Outcomes were correlated with unipedal quiet standing. A smartphone was attached to the trunk backside, and a custom-made application (Equidyn) was employed to provide guidance throughout evaluation, timed beeps to pace the movements, and three-dimensional trunk acceleration measurement for balance evaluation. RESULTS: Our data showed (a) that both ML and AP leg sway tasks were sensitive to aging and to direction of leg sway movements; (b) referenced to quiet unipedal stance, moderate/strong correlations for the ML/AP leg sway tasks and moderate correlations for the sit-to-stand task; and (c) moderate/strong correlations between the ML and AP leg sway tasks, and moderate correlations between the sit-to-stand and the two unipedal dynamic tasks in the ML acceleration direction. SIGNIFICANCE: The current results support the conclusion that the Equidyn protocol is a sensitive and valid tool to evaluate dynamic balance in healthy older individuals. The protocol tasks standardized in amplitude and rhythm favor their reproducibility and trunk acceleration data interpretation. As the whole assessment is made through a smartphone application, this dynamic balance evaluation could be made in a low-cost simple way both in the laboratory and clinical settings.

Abordaje global del paciente con pie diabético: Una revisión / Global approach to the patient with diabetic foot: A review

RESUMEN El artículo de revisión destaca la importancia de la planta del pie en la deambulación y su adaptación a las necesidades humanas. Se enfoca en el pie diabético (PD), definido por signos, síntomas o úlceras en el pie debido a complicaciones crónicas de la diabetes. El PD afecta a alrededor del 25% de los pacientes con diabetes mellitus (DM), con úlceras que pueden derivar en infecciones graves y riesgo de amputación. El manejo del PD es complejo y requiere un enfoque multidisciplinar. Este artículo propone un "Sistema de Evaluación y Tratamiento del Pie Diabético", aplicable en diversos entornos clínicos, que clasifica las úlceras según su profundidad e infección y ofrece guías claras para su tratamiento. Se discuten también la epidemiología de la neuropatía diabética (ND), destacando su alta prevalencia y morbilidad, y la necesidad de un diagnóstico y tratamiento adecuados. Se analiza en detalle la neuropatía de Charcot, una complicación severa del PD, incluyendo sus causas y métodos diagnósticos. Además, se enfatiza la importancia del enfoque multidisciplinar en el tratamiento de las úlceras del PD para reducir amputaciones y mejorar la calidad de vida de los pacientes. También se abordan las infecciones del PD y la antibioticoterapia, recomendando el uso de antibióticos adecuados según la gravedad de la infección y la realización de cultivos microbiológicos precisos. Finalmente, se presenta una visión global del manejo del PD, destacando la importancia de un enfoque multidisciplinar y proponiendo un sistema de evaluación y tratamiento eficaz que puede ser implementado en diversos contextos clínicos.

ABSTRACT The review article highlights the importance of the sole of the foot in ambulation and its adaptation to human needs. It focuses on diabetic foot (DF), defined by signs, symptoms, or ulcers on the foot due to chronic complications of diabetes. DF affects approximately 25 % of patients with diabetes mellitus (DM), with ulcers that can lead to severe infections and risk of amputation. Managing DF is complex and requires a multidisciplinary approach. This article proposes a "Diabetic Foot Evaluation and Treatment System," applicable in various clinical settings, which classifies ulcers according to their depth and infection and provides clear treatment guidelines. The epidemiology of diabetic neuropathy (DN) is also discussed, highlighting its high prevalence and morbidity, and the need for adequate diagnosis and treatment. The article provides a detailed analysis of Charcot neuropathy, a severe complication of DF, including its causes and diagnostic methods. Furthermore, the importance of a multidisciplinary approach in the treatment of DF ulcers is emphasized to reduce amputations and improve patients' quality of life. DF infections and antibiotic therapy are also addressed, recommending the use of appropriate antibiotics according to the severity of the infection and the performance of precise microbiological cultures. Finally, a comprehensive view of DF management is presented, highlighting the importance of a multidisciplinary approach and proposing an effective evaluation and treatment system that can be implemented in various clinical contexts.

Fetal Programming Influence on Microbiome Diversity and Ruminal and Cecal Epithelium in Beef Cattle.

We explored the influence of maternal nutritional strategies on the development of the rumen and cecum in offspring. Additionally, we investigated the potential repercussions of prenatal nutrition on the rumen and fecal microbiota composition, utilizing metagenomic 16S techniques, to understand the effects of fetal programming (FP) in Nellore cattle. A total of 63 bulls submitted to different prenatal nutrition strategies, namely, non-programming (NP), partial programming (PP), and complete programming (CP), were evaluated. The rumen epithelium was methodically evaluated based on the presence of rumenitis and structural irregularities. The assessment of cecum lesions was conducted post-evisceration, whereby all thoroughly cleaned ceca were methodically evaluated. Samples from 15 animals of rumen fluid at slaughter and feces during the finishing phase were collected, respectively. All DNA extraction were carried out using the Macherey Nagel NucleoSpin Tissue®, and 16S sequencing was conducted using the V4 primers on the MiSeq platform. Within the ruminal ecosystem, an estimated range of 90 to 130 distinct amplicon sequence variants was discerned, as distributed across 45,000 to 70,000 sequencing reads. Our metagenomic exploration unveils microbial communities that distinctly mirror gastrointestinal tract microenvironments and dietary influences. In sum, this comprehensive study advances our comprehension of FP, highlighting the interplay of maternal nutrition, gastrointestinal development, and microbial communities, contributing significantly to the fields of animal science.