Influence of Host Plants and Tending Ants on the Cuticular Hydrocarbon Profile of a Generalist Myrmecophilous Caterpillar.

In myrmecophilous organisms, which live in symbiosis with ants, cuticular hydrocarbons (CHCs) play a pivotal role in interspecific communication and defense against chemical-oriented predators. Although these interactions form complex information webs, little is known about the influence of biotic environmental factors on the CHC profiles of myrmecophiles. Here, we analyzed the effect of different host plants and tending ants on the larval CHC profile of Synargis calyce (Lepidoptera: Riodinidae), a polyphagous species with facultative myrmecophily. Groups of caterpillars were fed individually with three host plant species (without tending ants), and with two tending ant species. Through gas chromatography analysis, we compared the cuticular profiles of treatments and found a high similarity between plants and caterpillars (65-82%), but a low similarity between caterpillars and their tending ants (30 - 25%). Cluster analysis showed that caterpillars, ants, and plants form distinct groups, indicating that S. calyce caterpillars have their own chemical profile. These results are similar to those observed for Lycaenidae caterpillars indicating that there is functional convergence in the chemical strategies used by myrmecophilous caterpillar species with similar ecology. Also, the results suggest that the cuticular compounds of S. calyce are primarily influenced by their host plants rather than their tending ants. Thus, we propose that these caterpillars present a trade-off between camouflage and directly informing their presence to ants, maintaining their unique chemical profile, though slightly affected by biotic environmental factors.

Analysis of the costs of the basic care line for sickle cell disease in Brazilian children under 5 years of age

ABSTRACT Objective: To evaluate and estimate the cost of basic care in sickle cell disease (SCD) for patients under five years of age, within the scope of the Unified Health System (SUS) and to discuss the costs related to possible complications of the disease from the literature. Methods: The main management and conduct recommendations in the SCD up to five years of age, with healthy and baseline health status, were extracted from the Basic Guidelines of the Care Line in the SCD of the Ministry of Health. Systematic data regarding costs of medicines were extracted from the Medicine Market Regulation Chamber. The SUS Table of Procedures, Medicines and Orthotics, Prosthetics and Auxiliary Means of Movement Management System was the guide for the values of complementary exams, as well as for medical consultations. The values applied to calculate the vaccination schedule were extracted from the Pan American Health Organization, adopting the perspective of the SUS-paying costs. Results: The total cost obtained for basic care of SCD in children up to five years of age, including the use of antibiotic prophylaxis, immunizations and the performance of transcranial Doppler ultrasound in the prevention and early detection of cerebrovascular accidents was, on average, $1020.96. Conclusion: The cost-effectiveness of prophylaxis in SCD, up to five years of age, exceeds the expenses resulting from hospitalizations due to complications of the disease. The study of expenses associated with SCD could be used to establish public policies, improve prevention strategies and treat the symptoms and complications of the disease.

Deep Learning in Colorectal Cancer Classification: A Scoping Review.

Colorectal cancer (CRC) is one of the most common cancers worldwide, and its diagnosis and classification remain challenging for pathologists and imaging specialists. The use of artificial intelligence (AI) technology, specifically deep learning, has emerged as a potential solution to improve the accuracy and speed of classification while maintaining the quality of care. In this scoping review, we aimed to explore the utilization of deep learning for the classification of different types of colorectal cancer. We searched five databases and selected 45 studies that met our inclusion criteria. Our results show that deep learning models have been used to classify colorectal cancer using various types of data, with histopathology and endoscopy images being the most common. The majority of studies used CNN as their classification model. Our findings provide an overview of the current state of research on deep learning in the classification of colorectal cancer.

The importance of the temporomandibular joint in the differential diagnosis of primary headaches and recurrent primary headaches / A importância da articulação temporomandibular no diagnóstico diferencial de cefaleias primárias e cefaleias primárias recorrentes

Introduction: he present article aims to popularize the temporomandibular disorder as a possible diagnosis when the phisician is facing a primary headache that was first thought to be a migraine headache or tension type headache, specially when they are not responsible to the treatment. Methodology:This study focused on the clinical manifestation of the headache caused by temporomandibular disorder, with data searched in the National Library of Medicine, Scielo and PubMed libraries, from 2002 to 2022; also the 3rd edition of the International Classification of Headache Disorders (2018) and the Continuum Headache (2021). The aspects of the clinical manifestation chosen for comparison were location of the pain, type of pain, crisis duration, improvement and worsening factors and associated symptoms. Results:27 articles were found and 3 were included and used to create a table comparing migraine, tension type and TMD headache. Some manifestations were similar, like bilateral location of headache (tension type and TMD headache) and many manifestations were distinct, like the type of pain (pulsatile for migraine, tight for tension type and rigidity or stabbing for TMD headache). In face of these results, it is clear that there are many aspects of the differential diagnosis between these three types of headache that can be investigated so that we can distinguish them. This study also reiterates the need for further studies regarding this topic. Conclusion:It is very reasonable to consider TMD headache as a first diagnosis when the complaint is a primary headache, as much as it is reasonable to consider this diagnosis when the refractoriness is the complaint. Also, considering the TMD as a trigger to the other headaches.

Introdução: o presente artigo tem como objetivo popularizar a disfunção temporomandibular como um possível diagnóstico quando o médico se depara com uma cefaleia primária que inicialmente se pensava ser uma enxaqueca ou cefaleia do tipo tensional, principalmente quando não são responsáveis ​​pelo tratamento. Metodologia:Este estudo teve como foco a manifestação clínica da cefaleia causada pela disfunção temporomandibular, com dados pesquisados ​​nas bibliotecas National Library of Medicine, Scielo e PubMed, de 2002 a 2022; também a 3ª edição da Classificação Internacional de Cefaleias (2018) e da Cefaleia Contínua (2021). Os aspectos da manifestação clínica escolhidos para comparação foram localização da dor, tipo de dor, duração da crise, fatores de melhora e piora e sintomas associados. Resultados: foram encontrados 27 artigos e 3 foram incluídos e utilizados para criar uma tabela comparando enxaqueca, tipo tensional e cefaleia por DTM. Algumas manifestações foram semelhantes, como localização bilateral da cefaleia (tipo tensional e cefaléia por DTM) e muitas manifestações foram distintas, como o tipo de dor (pulsátil para enxaqueca, tensa para tipo tensional e rigidez ou pontada para cefaléia por DTM). Diante desses resultados, fica claro que existem muitos aspectos do diagnóstico diferencial entre esses três tipos de cefaleia que podem ser investigados para que possamos distingui-los. Este estudo também reitera a necessidade de mais estudos sobre esse tema. Conclusão: É muito razoável considerar a cefaleia por DTM como primeiro diagnóstico quando a queixa é uma cefaleia primária, assim como é razoável considerar este diagnóstico quando a refratariedade é a queixa. Além disso, considerar a DTM como gatilho para as demais dores de cabeça.

Hiperpigmentação Mucocutânea Associada à Terapia de Hidroxiureia em Paciente com Trombocitemia Essencial: Relato de Caso / Mucocutaneous Hyperpigmentation Associated with Hydroxyurea Therapy in a Patient with Essential Thrombocythemia: Case Report

Introdução: A hiperpigmentação mucocutânea é uma condição dermatológica que pode estar relacionada a tratamentos quimioterápicos, a exemplo das terapias com uso de hidroxiureia (HU). A HU é um fármaco citostático de amplo uso nas doenças mieloproliferativas e compõe a principal linha de tratamento da trombocitemia essencial (TE). O presente estudo tem por objetivo relatar um caso raro de hiperpigmentação mucocutânea em um paciente com TE. Relato do caso: Paciente do sexo masculino, 68 anos de idade, 89 kg, com diagnóstico de TE, em uso de HU 2 g/dia. Com três meses de terapia, apresentou lesões hiperpigmentadas de coloração acastanhadas em pele das mãos e mucosa oral (língua). Em decisão partilhada com o médico-assistente, o paciente optou pela continuação do uso do medicamento. Após seis anos de acompanhamento, as lesões mantêm-se estáveis. Conclusão: A hiperpigmentação mucocutânea associada à terapia com HU é um evento benigno secundário ao uso do fármaco e não exige a interrupção de uso, porém, sua retirada, ou redução das doses, geralmente leva à diminuição ou ao desaparecimento das lesões.

Introduction: Mucocutaneous hyperpigmentation is a dermatological condition that may be related to chemotherapy treatments, such as therapies using hydroxyurea (HU). HU is a cytostatic drug widely used in myeloproliferative diseases and is the main line of treatment for essential thrombocythemia (ET). The present study aims to report a rare case of mucocutaneous hyperpigmentation in a patient with ET. Case report: Male patient, 68 years old, 89 kg, diagnosed with ET using HU 2 g/day. After three months of therapy, he presented hyperpigmented brownish-colored lesions on the hands and oral cavity (tongue). In a decision shared with the assistant physician, the patient chose to continue using the drug. After six years of follow-up, the lesions remain stable. Conclusion: Mucocutaneous hyperpigmentation associated with HU therapy is a benign event secondary to the use of the drug and does not require discontinuation of use, however, its withdrawal or dose reduction usually leads to the reduction or disappearance of the lesions

Introducción: La hiperpigmentación mucocutánea es una condición dermatológica que puede estar relacionada con tratamientos de quimioterapia, como las terapias con hidroxiurea (HU). La HU es un fármaco citostático ampliamente utilizado en enfermedades mieloproliferativas y es la principal línea de tratamiento de la trombocitemia esencial (TE). El presente estudio tiene como objetivo reportar un caso raro de hiperpigmentación mucocutánea en un paciente con TE. Informe del caso: Paciente masculino de 68 años, 89 kg, diagnosticado de TE mediante HU 2 g/día. A los tres meses de tratamiento presenta lesiones hiperpigmentadas de color pardusco en manos y cavidad oral (lengua). En una decisión compartida con el médico asistente, el paciente optó por continuar usando el medicamento. Tras seis años de seguimiento, las lesiones se mantienen estables. Conclusión: La hiperpigmentación mucocutánea asociada a la terapia con HU es un evento benigno secundario al uso del fármaco y no requiere la suspensión de su uso, sin embargo, su retirada o reducción de dosis suele conducir a la reducción o desaparición de las lesiones.

Genetic description of VanD phenotype vanA genotype in vancomycin-resistant Enterococcus faecium isolates from a Bone Marrow Transplantation Unit.

BACKGROUND: Vancomycin-resistant Enterococcus faecium (VREfm) is an important agent of hospital-acquired infection. VanA phenotype is characterized by resistance to high levels of vancomycin and teicoplanin and is encoded by the vanA gene, whereas VanD phenotype is characterized by resistance to vancomycin and susceptibility or intermediate resistance to teicoplanin; however, some isolates carry a VanD phenotype with a vanA genotype, but there are many gaps in the knowledge about the genetic mechanisms behind this pattern. OBJECTIVE: To characterize the genetic structure, clonality, and mobile genetic elements of VRE isolates that display a VanD-vanA phenotype. RESULTS: All vanA VRE-fm isolates displayed minimum inhibitory concentration (MIC) for vancomycin > 32µg/mL and intermediate or susceptible MIC range for teicoplanin (8-16µg/mL). The isolates were not clonal, and whole-genome sequencing analysis showed that they belonged to five different STs (ST478, ST412, ST792, ST896, and ST1393). The absence of some van complex genes were observed in three isolates: Ef5 lacked vanY and vanZ, Ef2 lacked vanY, and Ef9 lacked orf1 and orf2; moreover, another three isolates had inverted positions of orf1, orf2, vanR, and vanS genes. IS1542 was observed in all isolates, whereas IS1216 in only five. Moreover, presence of other hypothetical protein-encoding genes located downstream the vanZ gene were observed in six isolates. CONCLUSION: VRE isolates can display some phenotypes associated to vanA genotype, including VanA and VanB, as well as VanD; however, further studies are needed to understand the exact role of genetic variability, rearrangement of the transposon Tn1546, and presence of insertion elements in isolates with this profile.

Evaluation of eleven immunochromatographic assays for SARS-CoV-2 detection: investigating the dengue cross-reaction

ABSTRACT COVID-19 disease is spread worldwide and diagnostic techniques have been studied in order to contain the pandemic. Immunochromatographic (IC) assays are feasible and a low-cost alternative especially in low and middle-income countries, which lack structure to perform certain diagnostic techniques. Here we evaluate the sensitivity and specificity of eleven different IC tests in 145 serum samples from confirmed cases of COVID-19 using RT-PCR and 100 negative serum samples from blood donors collected in February 2019. We also evaluated the cross-reactivity with dengue using 20 serum samples from patients with confirmed diagnosis for dengue collected in early 2019 through four different tests. We found high sensitivity (92%), specificity (100%) and an almost perfect agreement (Kappa 0.92) of IC assay, especially when we evaluated IgG and IgM combined after 10 days from the onset of symptoms with RT-PCR. However, we detected cross-reactivity between dengue and COVID-19 mainly with IgM antibodies (5 to 20% of cross-reaction) and demonstrated the need for better studies about diagnostic techniques for these diseases.

Relação entre o medo da COVID-19 e a sobrecarga física e mental de profissionais de saúde que realizam atendimento contínuo de pacientes durante a pandemia do novo coronavírus / Relationship between fear of COVID-19 and physical and mental burden of health professionals in the continuous care of patients during new coronavirus pandemic

Introdução: A pandemia da doença por coronavírus 19 (COVID-19) contribui para a exacerbação do estresse e sofrimento dos profissionais de saúde. Objetivo: Avaliar a relação entre o medo da COVID-19 e a sobrecarga física e mental dos profissionais de saúde em atendimento contínuo de pacientes durante a pandemia de COVID-19 em duas cidades da região do Campo das Vertentes no estado de Minas Gerais. Material e Métodos: Foi realizado um estudo descritivo transversal com 77 profissionais de saúde (32 (14) anos; 67,5% do gênero feminino) que estavam em atendimento contínuo durante a pandemia de COVID-19. Dados sociodemográficos e profissionais foram coletados e o medo foi avaliado pela Escala de Medo da COVID-19 (EMC-19), sintomas depressivos pelo Patient Health Questionnaire-9 (PHQ-9) e síndrome de Burnout pelo Maslach Burnout Inventory ­ Human Services Survey (MBI-HSS). Resultados: O escore total da EMC-19 se correlacionou com a carga horária de trabalho semanal (ρ= 0,395; p<0,001), o PHQ-9 (ρ= 0,332; p= 0,003) e as dimensões exaustão emocional (ρ= 0,253; p= 0,026), despersonalização (ρ= 0,243; p= 0,033) e baixa realização pessoal (ρ= -0,389; p<0,001) do MBI-HSS. No modelo de regressão linear ajustado para potenciais fatores confundidores, a EMC-19 continuou significativamente associada com a baixa realização pessoal apresentando coeficiente de determinação ajustado de 0,372 (p<0,001). Conclusão: O medo da COVID-19 nos profissionais de saúde em atendimento contínuo de pacientes durante a pandemia de COVID-19 nas duas cidades da região do Campo das Vertentes no estado de Minas Gerais se relacionou com sintomas depressivos e as características da síndrome de Burnout de exaustão emocional, despersonalização e baixa realização pessoal.

Introduction: The coronavirus disease 19 (COVID-19) pandemic contributes to the exacerbation of stress and suffering of health professionals. Objective: To evaluate the relationship between fear of COVID-19 and physical and mental burden of health professionals in the continuous care of patients during COVID-19 pandemic in two cities in the Campo das Vertentes region in the state of Minas Gerais. Material and Methods: A descriptive cross-sectional study was carried out with 77 health professionals (32 (14) years; 67.5% female) who were in continuous care during COVID-19 pandemic. Sociodemographic and professional data were collected and the fear of COVID-19 was taken from the Fear of COVID-19 Scale (FCV-19S), depressive symptoms by the Patient Health Questionnaire-9 (PHQ-9) and Burnout syndrome by the Maslach Burnout Inventory ­ Human Services Research (MBI-HSS). Results: The total score of FCV-19S correlated with the weekly workload (ρ= 0.395; p<0.001), the PHQ-9 (ρ= 0.332; p= 0.003) and the emotional exhaustion (ρ= 0.253; p= 0.026), depersonalization (ρ= 0.243; p= 0.033) and low sense of personal accomplishment (ρ= -0.389; p<0.001) dimensions of the MBI-HSS. In the linear regression model adjusted for potential confounders, the FCV-19S continued significantly associated with low sense of personal accomplishment and presented adjusted coefficient of determination of 0.372 (p<0.001). Conclusion: The fear of COVID-19 of health professionals in the continuous care of patients during COVID-19 pandemic in two cities in the Campo das Vertentes region in the state of Minas Gerais was related to depressive symptoms and as characteristics of the Burnout syndrome of emotional exhaustion, depersonalization and with low sense of personal accomplishment.

Clinical Evaluation of Intravascular Blood Irradiation with Laser, Photobiomodulation, and Photodynamic Therapy in Cancer Patients with Mucositis.

Objective: To assess the clinical application of intravascular laser irradiation of blood (ILIB), photodynamic therapy (PDT), and photobiomodulation therapy (PBM-T) in mucositis in cancer patients. Background: PBM-T and PDT are used for the management of oral mucositis (OM) and there are no studies associating intravascular laser irradiation of blood (ILIB) for this purpose. Materials and methods: Thirty-six patients were allocated by convenience into three groups according to the established therapy: PDT+PBM-T (n = 10); PDT+PBM-T+ILIB (n = 10), and ILIB (n = 16). PDT was performed with the photosensitizer curcumin and irradiation of the oral cavity with blue light-emitting diode (LED) (power 1200 mW and wavelength 468 nm). PBM-T was performed using low-intensity laser (power 100 mW, wavelength 660 nm, and spot energy 1 J) at 26 points of the oral cavity. ILIB was applied with a bracelet on the radial artery using the low-intensity laser (100 mW of power, 660 nm wavelength, and 30 J of total energy). All therapies were performed weekly for 5 weeks. The results of the OM degrees were analyzed using the Wilcoxon test. Results: There was a significant reduction in the degrees of OM after treatment with PDT+PBM-T (p = 0.0117), PDT+PBM-T+ILIB (p = 0.0277), and ILIB (p = 0.0277). Conclusions: It was concluded that ILIB, PDT, and PBM-T reduced the severity of mucositis and prevented its onset. Clinical Trial Registration number: RBR-54XS25.

The Role of IgM-Enriched Immunoglobulin (Pentaglobin) in Septic Patients with Hematological Disease.

Background: Patients with hematological disease are 15 times more likely to develop sepsis than the general population. The patient with hematological disease and, mainly, those undergoing hematopoietic stem cell transplantation (HSCT), develop a severe secondary humoral immunodeficiency, with low serum levels of IgM, which may take more than a year to be restored. Materials and Methods: This is a retrospective, controlled and observational study that analyzed 51 patients with underlying hematological disease, who were diagnosed with sepsis or septic shock during the study period, to evaluate whether IgM-rich Ig replacement decreases the 30-day mortality. Results: Of the 51 patients, 35 patients received IgM-rich immunoglobulin (group A) and 16 (31%) received conventional therapy. Eleven (69%) patients in the control group were alive after 30 days compared to 11 (34%) patients in the intervention group, p= 0.013. Conclusion: There are no apparent benefits in the use of IgM-rich immunoglobulin in septic patients with hematological disease.

Germline and Somatic mutations in postmenopausal breast cancer patients.

OBJECTIVES: In breast cancer (BC) patients, the frequency of germline BRCA mutations (gBRCA) may vary according to the ethnic background, age, and family history of cancer. Phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) is the second most common somatic mutated gene in BC; however, the association of mutations in both genes with cancer has not been thoroughly investigated. Thus, our aims were to investigate gBRCA mutation frequency in a cohort of postmenopausal Brazilian BC patients and the association of gBRCA1/BRCA2 and PIK3CA somatic mutations. METHODS: Forty-nine postmenopausal (>55 years) and forty-one young (≤35 years) BC patients were included in this study. The postmenopausal group included patients who reported a positive family history of cancer. For these patients, gBRCA1/BRCA2 were sequenced using next-generation sequencing (NGS) or Sanger sequencing. Data for gBRCA in young patients were already available from a previous study. DNA from formalin-fixed, paraffin-embedded (FFPE) tumors was obtained from 27 postmenopausal and 41 young patients for analyzing exons 9 and 20 of PIK3CA. The association between gBRCA1/BRCA2 and somatic mutations in PIK3CA was investigated. RESULTS: The overall frequency of gBRCA1/BRCA2 among the 49 postmenopausal patients was 10.2%. The frequencies of somatic mutations in PIK3CA in the postmenopausal and young patients were 37% and 17%, respectively (ns). The most common PIK3CA mutation was found to be E454A. Nonsense and frameshift mutations, which may counteract the oncogenic potential of PIK3CA were also detected. Regardless of age, 25% of BRCA1/BRCA2 mutation carriers and non-carriers , each, had PIK3CA somatic mutations. CONCLUSIONS: Data obtained indicate that BRCA1/BRCA2 gene testing may be considered for postmenopausal patients with BC who have a family history of cancer. Although some of them are not considered pathogenic, somatic variants of PIK3CA are frequently observed in BC patients, especially in postmenopausal patients.

ROUX-IN-Y GASTROJEJUNAL BYPASS: WHICH ANESTHETIC TECHNIQUE HAS BEST RESULTS?

BACKGROUND: Nausea and vomiting groups x moments. As the number of bariatric operations increases, there is a greater interest in knowledge, experience and skills in the operative and anesthetic management of obese people. Anesthetic recovery is an important point in the therapeutic approach and less adverse effects delaying discharge of these patients are necessary to be kept in mind by the surgical team. AIM: To compare anesthetic-analgesic techniques in the opioid-sparing era through epidural administration of local anesthetic associated with low-dose morphine vs. clonidine and analyze the impact of analgesia on the effectiveness of postoperative recovery by comparing these two techniques. METHODS: Randomized, double-blind clinical trial with 66 patients candidates for Roux-en-Y gastrojejunal bypass divided into two groups: morphine group and clonidine group. Multimodal analgesia included epidural anesthesia with 0.375% ropivacaine 20 ml at the eighth thoracic vertebra with the association of morphine (morphine group) at a dose of 15 mcg / kg or clonidine (clonidine group) at a dose of 1 mcg / kg. RESULTS: The groups were homogeneous and statistical significance was found when analyzing the difference in pain between them in the first postoperative period. The pain was higher in the clonidine group, as in this period, analgesic rescue was also better in this group. In the other times, there was no significance in the differences regarding pain and rescue. The return of intestinal motility in the morphine group was earlier in the first postoperative period. Nausea, vomiting and hospital discharge did not show significant differences between groups. CONCLUSION: Epidural anesthesia with low-dose morphine allowed less pain during the entire hospital stay, with a positive impact on patient recovery.

Roux-in-y gastrojejunal bypass: which anesthetic technique has best results? / Bypass gastrojejunal em y-de-roux: que técnica anestésica apresenta melhores resultados?

ABSTRACT Background: As the number of bariatric operations increases, there is a greater interest in knowledge, experience and skills in the operative and anesthetic management of obese people. Anesthetic recovery is an important point in the therapeutic approach and less adverse effects delaying discharge of these patients are necessary to be kept in mind by the surgical team. Aim: To compare anesthetic-analgesic techniques in the opioid-sparing era through epidural administration of local anesthetic associated with low-dose morphine vs. clonidine and analyze the impact of analgesia on the effectiveness of postoperative recovery by comparing these two techniques. Methods: Randomized, double-blind clinical trial with 66 patients candidates for Roux-en-Y gastrojejunal bypass divided into two groups: morphine group and clonidine group. Multimodal analgesia included epidural anesthesia with 0.375% ropivacaine 20 ml at the eighth thoracic vertebra with the association of morphine (morphine group) at a dose of 15 mcg / kg or clonidine (clonidine group) at a dose of 1 mcg / kg. Results: The groups were homogeneous and statistical significance was found when analyzing the difference in pain between them in the first postoperative period. The pain was higher in the clonidine group, as in this period, analgesic rescue was also better in this group. In the other times, there was no significance in the differences regarding pain and rescue. The return of intestinal motility in the morphine group was earlier in the first postoperative period. Nausea, vomiting and hospital discharge did not show significant differences between groups. Conclusion: Epidural anesthesia with low-dose morphine allowed less pain during the entire hospital stay, with a positive impact on patient recovery.

RESUMO Racional: Com o aumento do número de operações bariátricas torna-se maior o interesse pelo conhecimento, experiência e habilidades no manejo operatório e anestésico de obesos. A recuperação anestésica é ponto importante na abordagem terapêutica e menos efeitos adversos que retardem a alta são necessários estar em mente da equipe cirúrgica. Objetivo: Comparar técnicas anestésico-analgésicas na era poupadora de opioides através da administração epidural de anestésico local associado à morfina em baixa dose vs. à clonidina e analisar o impacto da analgesia na efetividade da recuperação pós-operatória comparando as duas técnicas. Métodos: Ensaio clínico randomizado e duplo-cego com 66 pacientes candidatos ao bypass gastrojejunal em Y-de-Roux divididos em dois grupos: grupo morfina e grupo clonidina. A analgesia multimodal incluiu na anestesia epidural com ropivacaína 0,375% 20 ml na altura da oitava vértebra torácica a associação de morfina (grupo morfina) em dose de 15 mcg/kg ou de clonidina (grupo clonidina) na dose 1 mcg/kg. Resultados: Os grupos se mostraram homogêneos e foi encontrada significância estatística ao analisar a diferença da dor entre eles no primeiro pós operatório. A dor foi superior no grupo clonidina, como também neste período o resgate analgésico foi melhor neste grupo. Nos demais tempos não houve significância nas diferenças quanto à dor e resgate. O retorno da motilidade intestinal no grupo morfina foi mais precoce no primeiro pós-operatório. Náuseas, vômitos e a alta hospitalar não apresentaram diferenças significativas entre os grupos. Conclusão: A anestesia epidural com morfina em baixa dose permitiu menor dor durante todo internamento com impacto positivo em relação a recuperação dos pacientes.

Effects of cumulative school soccer matches separated by 24-h or 48-h intervals on physical recovery status of U-19 players / Efeitos de partidas consecutivas de futebol escolar com intervalos de 24 e 48 horas no estado de recuperação física de jogadores Sub-19

Abstract This study aimed to evaluate the effects of cumulative school soccer matches separated by 24-h or 48-h intervals on the recovery status of U-19 players. Thirty-four school athletes (17.6 ± 1.1 years) who played in an U-19 school soccer competition (composed of one group with four teams and another group with three teams, followed by semifinals and final) were examined before three matches, which lasted 70 min. Seventeen athletes had a 24-h rest interval between each match (GGG group), while 18 athletes had a 48-h rest interval between the second and third matches (GG48hG group). Total Quality Recovery, countermovement jump, 10-m sprint, and maximum lumbar isometric strength were measured. The internal load of each match was calculated by the product of the session Rating of Perceived Exertion and match time. There was a 22% reduction in Total Quality Recovery (p< 0.001) and 12% in 10-m sprint performance (p< 0.001) before the third match in the GGG group, while the GG48hG group showed no changes for the same variables (p> 0.05). The countermovement jump decreased before the second match in both groups (GGG= 12% and GG48hG= 10%; p< 0.001), with no difference between groups (p> 0.05). In addition, both groups showed no changes in the isometric strength or the internal load match over the games (p> 0.05). Despite not providing complete muscle recovery, a 48-h interval between the second and third matches seems to have minimized the reduction of muscle performance due to consecutive matches.

Resumo Este estudo teve como objetivo avaliar os efeitos de partidas consecutivas de futebol escolar com intervalos de 24 e 48 horas no estado de recuperação física de jogadores Sub-19. Foram avaliados 35 homens (17,6±1,1 anos) atletas escolares sub-19. Durante a competição, foram realizados três jogos de 70-min de duração. Dezessete atletas tiveram intervalo de 24h entre cada jogo (grupo GGG). Dezoito atletas tiveram intervalo de 48 h entre o 2º e o 3º jogo (grupo GG48hG). Antes de cada jogo foram medidas a Qualidade Total de Recuperação, altura do salto com contra movimento, velocidade no sprint de 10-m, e força máxima isométrica lombar máxima. A carga interna do jogo foi calculada pelo produto da percepção subjetiva do esforço da sessão e tempo de cada jogo. Houve uma redução de 22% na qualidade total de recuperação (p <0,001) e de 12% no desempenho de sprint de 10 m (p <0,001) antes da terceira partida no grupo GGG, enquanto o grupo GG48hG não apresentou alterações para as mesmas variáveis (p> 0,05). O salto com contra movimento diminuiu antes da segunda partida em ambos os grupos (GGG = 12% e GG48hG = 10%; p <0,001), sem diferença entre os grupos (p> 0,05). Em adição, ambos os grupos não apresentaram alterações na força isométrica e na carga interna ao longo dos jogos (p> 0,05). Apesar de não proporcionar uma completa recuperação muscular, 48 h de intervalo entre o segundo e o terceiro jogo parece ter minimizado o efeito de jogos consecutivos na redução do desempenho.

Germline and Somatic mutations in postmenopausal breast cancer patients

OBJECTIVES: In breast cancer (BC) patients, the frequency of germline BRCA mutations (gBRCA) may vary according to the ethnic background, age, and family history of cancer. Phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) is the second most common somatic mutated gene in BC; however, the association of mutations in both genes with cancer has not been thoroughly investigated. Thus, our aims were to investigate gBRCA mutation frequency in a cohort of postmenopausal Brazilian BC patients and the association of gBRCA1/BRCA2 and PIK3CA somatic mutations. METHODS: Forty-nine postmenopausal (>55 years) and forty-one young (≤35 years) BC patients were included in this study. The postmenopausal group included patients who reported a positive family history of cancer. For these patients, gBRCA1/BRCA2 were sequenced using next-generation sequencing (NGS) or Sanger sequencing. Data for gBRCA in young patients were already available from a previous study. DNA from formalin-fixed, paraffin-embedded (FFPE) tumors was obtained from 27 postmenopausal and 41 young patients for analyzing exons 9 and 20 of PIK3CA. The association between gBRCA1/BRCA2 and somatic mutations in PIK3CA was investigated. RESULTS: The overall frequency of gBRCA1/BRCA2 among the 49 postmenopausal patients was 10.2%. The frequencies of somatic mutations in PIK3CA in the postmenopausal and young patients were 37% and 17%, respectively (ns). The most common PIK3CA mutation was found to be E454A. Nonsense and frameshift mutations, which may counteract the oncogenic potential of PIK3CA were also detected. Regardless of age, 25% of BRCA1/BRCA2 mutation carriers and non-carriers , each, had PIK3CA somatic mutations. CONCLUSIONS: Data obtained indicate that BRCA1/BRCA2 gene testing may be considered for postmenopausal patients with BC who have a family history of cancer. Although some of them are not considered pathogenic, somatic variants of PIK3CA are frequently observed in BC patients, especially in postmenopausal patients.

Critical success factors for implementation of an incident learning system in radiation oncology department.

AIM: The aim of this study was to analyze critical success factors (CSFs) for implementation of an incident learning system (ILS) in a radiation oncology department (ROD) and evaluate the perception of the staff members along this process. BACKGROUND: Implementing an ILS is a way to leverage learning from incidents and is a tool for improving patient safety, consisting of a cycle of reporting and analyzing events as well as taking preventive actions. ILS implementation is challenging, requiring specific resources and cultural changes. MATERIALS AND METHODS: An ILS was designed and implemented based on the CSF identified in the literature review. Before starting the ILS implementation, a structured survey was applied to assess dimensions of patient safety culture. After the period of implementation (7 months), the survey was applied again and compared with the initial assessment, and interviews were performed with staff members to evaluate the overall satisfaction with ILS and CSFs. RESULTS: Statistically significant improvements were observed in 5 dimensions (12 totals) of the safety culture survey, considering time points before and after the ILS implementation. According to interviewees, "Facilitating committee", "Efficient data collection", "Focus on improvement", "Just culture" and "Feedback to users" were the most relevant CSFs. CONCLUSIONS: The ILS designed and implemented at ROD was perceived as an important tool to support quality and safety initiatives, promoting the improvement in safety culture. The ILS implementation critical success factors were identified and have shown good agreement between the results of the literature and the users' practical perception.

Treatment of Acute Lymphoid Leukemia Refractory to Classic First-Line and Rescue Protocols.

Acute Lymphoblastic Leukemia is a very aggressive malignant disorder of lymphoid cells in adults, with recurrence (30 to 60% of the cases) after the initial treatment. Until this moment, there is no gold standard therapy for the treatment of adult patients with acute relapsed/refractory lymphoblastic leukemia. In this case report, we describe two cases of relapsed leukemia: one of lymphocytic leukemia B and one of trilineage leukemia, which presented a satisfactory response to treatment with Bortezomib associated with Vincristine, Dexamethasone, and Bendamustine.

Hematopoietic Stem Cell Transplantation Without the Use of Blood Components by the Patient's Choice: Experience of 2 Brazilian Centers.

Hematopoietic stem cell transplantation (HSCT) has been used to treat many malignant and nonmalignant hematologic conditions; however, the use of HSCT in patients who refuse blood transfusions has rarely been described in the literature, and no data have been published concerning haploidentical HSCT without the use of blood products. The aim of this study is to describe the experience of a Brazilian group in performing 21 HSCTs without the use of blood components in the first 100 days after transplantation, which is the period corresponding to the greatest risk of toxicity for this procedure. We developed 21 HSCTs without transfusion support in 19 patients admitted to 2 Brazilian transplantation centers. The patients were subjected to stem cell mobilization and different conditioning regimens. No mortality related to the procedure occurred among the transplant recipients. The global survival rate after 100 days, which is the period related to the immediate toxicity of HSCT, was 94.7%, and the median duration of follow-up was 980 days, with an overall survival rate of 68.4%. Thus, refusal of blood transfusion is not an absolute contraindication for HSCT. This therapy is feasible in specific situations when the patient clearly expresses a desire to avoid blood transfusions and when favorable clinical conditions are achievable with strict, specialized medical monitoring.

Extra-buccal surgical access for canine removal included in mandibular symphysis: case report / Acesso cirúrgico extra-bucal para remoção de canino incluso em sínfise mandibular: relato de caso

ABSTRACT Included teeth are all the dental elements that arrive the normal time of its eruption, remains immersed within the tissues. Usually found when missing a tooth, or on routine radiographic examinations. In the presence of included teeth, it is necessary to define the best treatment approach, whether it is surgical, through exodontia, or by orthodontic tracings. Inclusive canines, in the symphysis region and near the base of the mandible, are rare and make the use of orthodontic traction techniques contraindicated. Presence of teeth in the intraosseous ectopic position can cause injuries, such as alveolodentary ankylosis, calcium metamorphosis of the pulp and aseptic pulp necrosis, among others. Anamnesis, physical examination (intra- and extraoral) and radiographic examinations such as panoramic, periapical, computed tomography, and occlusal radiographs should be performed to make the diagnosis adequate. In general, the success of the treatment depends on the age of the patient and the position of the canines at the time of the surgical procedure. The objective of this work is the extraction of a lower canine with extra-oral access in an outpatient clinical setting under local anesthesia.

RESUMO Dentes inclusos são todos os elementos dentários que chegada a época normal de seu irrompimento, permanece imerso no interior dos tecidos. Geralmente encontrados quando se observa ausência de algum dente, ou em exames radiográficos de rotina. Na presença de dentes inclusos, deve-se definir qual a melhor abordagem de tratamento, se é cirúrgica, através de exodontias, ou por tracionamentos ortodônticos. Caninos inclusos, em região de sínfise e próximos à base da mandíbula, são raros e fazem com que o uso de técnicas do tipo tracionamento ortodôntico sejam contra-indicadas. Presença de dentes em posição ectópica intraósseos podem causar injúrias, como anquilose alveolodentária, metamorfose cálcica da polpa e necrose pulpar asséptica, dentre outros. Para que o diagnóstico seja adequado, deve-se realizar, anamnese, exame físico (intra e extraoral) e exames radiográficos como panorâmicas, periapicais, tomografias computadorizadas e radiografias oclusais. Em geral, o sucesso do tratamento depende da idade do paciente e da posição dos caninos no momento do procedimento cirúrgico. O objetivo deste trabalho relata a extração de um canino inferior com acesso extra-oral em ambiente clínico ambulatorial sob anestesia local.

Risco cardiovascular pelo escore de Framingham em serviços de cardiologia de uma cidade de médio porte de Minas Gerais / Cardiovascular risk by the Framingham score in cardiology services of a medium-sized city of Minas Gerais

Objetivo. Estratificar os pacientes de serviços ambulatoriais de cardiologia através do escore de Framingham, para subsidiar o planejamento de futuras intervenções. Métodos. Trata-se de um corte transversal realizado em serviços de cardiologia de centro público ambulatorial e consultório particular de cidade de médio porte de Minas Gerais. A amostragem foi aleatória, com 329 prontuários, de pacientes acima de 30 anos, com dados suficientes. Os dados foram utilizados para cálculo do risco cardiovascular dos pacientes a partir da aplicação do escore, com posterior processamento de dados em softwares estatísticos. Resultados. A idade dos participantes variou de 30 a 74 anos, 54,7% eram do sexo feminino e 74,8% foram atendidos no serviço público de saúde. Dentre os pacientes, 48% tinham valores de HDL inferiores a 45mg/ dL e 36,5% apresentaram LDL inferior a 100mg/dL. 22,5% dos pacientes eram tabagistas e 37,1% diabéticos. 46,2% dos pacientes tiveram valores sistólicos acima de 139mmHg e 61,7% tinham valores diastólicos abaixo de 85mmHg. Em 43,8% dos prontuários analisados o risco encontrado era baixo, em 36,5% era moderado, em 19,8% era alto. O risco médio da população foi de 13,4%. Conclusão. Na população estudada, a respeito dos fatores de risco cardiovascular que compõem o Escore de Framingham, destacam-se o DM, HAS, LDL-c e tabagismo como principais contribuintes da definição do risco. Os resultados encontrados a partir do estudo são importantes para o planejamento de futuras intervenções, principalmente na atenção primária a fim de prevenir o surgimento e implementar o controle de tais fatores. (AU)

Objectives. Stratify outpatient cardiology services patients through the Framingham score to assist the planning of future interventions. Methods. This is a cross-sectional study performed in cardiology services from an outpatient public center and a private clinic of a medium-sized city of Minas Gerais. The sampling was random, with 329 medical records, of patients over the age of 30 years, with sufficient data. The data were used to calculate the cardiovascular risk of patients through the application of the score, with subsequent data processing in statistical software. Results. The age of the participants ranged from 30 to 74 years, 54.7% were female and 74.8% were treated in the public health service. Among the patients, 48% had HDL-c values lower than 45mg/dL and 36.5% had LDL-c below 100mg/dL. 22.5% of the patients were smokers and 37.1% diabetics. 46.2% of the patients had systolic values greater or equal to 139mmHg and 61.7% had diastolic values less or equal to 85mmHg. In 43.8% of the analyzed medical records, the risk was found low, in 36.5% it was moderate, in 19.8% it was high. The average risk of the population was 13.4%. Conclusion. In the studied population, regarding the cardiovascular risk factors that compose the Framingham Score, DM, systemic arterial hypertension, LDL-c and smoking stand out as the main contributors to risk definition. The results found in the study are important for the planning of future interventions, especially in primary care in order to prevent the appearance and implement the control of such factors. (AU)