Do social protection programmes affect the burden of breast and cervical cancer? A systematic review.

Background: Socioeconomic conditions are strongly associated with breast and cervical cancer incidence and mortality patterns; therefore, social protection programmes (SPPs) might impact these cancers. This study aimed to evaluate the effect of SPPs on breast and cervical cancer outcomes and their risk/protective factors. Methods: Five databases were searched for articles that assessed participation in PPS and the incidence, survival, mortality (primary outcomes), screening, staging at diagnosis and risk/protective factors (secondary outcomes) for these cancers. Only peer-reviewed quantitative studies of women receiving SPPs compared to eligible women not receiving benefits were included. Independent reviewers selected articles, assessed eligibility, extracted data, and assessed the risk of bias. A harvest plot represents the included studies and shows the direction of effect, sample size and risk of bias. Findings: Of 17,080 documents retrieved, 43 studies were included in the review. No studies evaluated the primary outcomes. They all examined the relationship between SPPs and screening, as well as risk and protective factors. The harvest plot showed that in lower risk of bias studies, participants of SPPs had lower weight and fertility, were older at sexual debut, and breastfed their infants for longer. Interpretation: No studies have yet assessed the effect of SPPs on breast and cervical cancer incidence, survival, or mortality; nevertheless, the existing evidence suggests positive impacts on risk and protective factors.

From images to insights: a neuroradiologist's practical guide on white matter fiber tract anatomy and DTI patterns for pre-surgical planning.

INTRODUCTION: Diffusion tensor imaging (DTI) is a valuable non-invasive imaging modality for mapping white matter tracts and assessing microstructural integrity, and can be used as a "biomarker" in diagnosis, differentiation, and therapeutic monitoring. Although it has gained clinical importance as a marker of neuropathology, limitations in its interpretation underscore the need for caution. METHODS: This review provides an overview of the principles and clinical applicability of DTI. We focus on major white matter fiber bundles, detailing their normal anatomy and pathological DTI patterns, with emphasis on tracts routinely requested in our neurosurgical department in the preoperative context (uncinate fasciculus, arcuate fasciculus, pyramidal pathway, optic radiation, and dentatorubrothalamic tract). RESULTS: We guide neuroradiologists and neurosurgeons in defining volumes of interest for mapping individual tracts and demonstrating their 3D reconstructions. The intricate trajectories of white matter tracts pose a challenge for accurate fiber orientation recording, with each bundle exhibiting specific characteristics. Tracts adjacent to brain lesions are categorized as displaced, edematous, infiltrated, or disrupted, illustrated with clinical cases of brain neoplasms. To improve structured reporting, we propose a checklist of topics for inclusion in imaging evaluations and MRI reports. CONCLUSION: DTI is emerging as a powerful tool for assessing microstructural changes in brain disorders, despite some challenges in standardization and interpretation. This review serves an educational purpose by providing guidance for fiber monitoring and interpretation of pathological patterns observed in clinical cases, highlighting the importance and potential pitfalls of DTI in neuroradiology and surgical planning.

Towards a neurocognitive profile in familial cerebral cavernous malformations.

BACKGROUND: Familial cerebral cavernous malformations (FCCM) is a rare autosomal dominant disease, characterized by vascular malformations that can lead to macro and microhemorrhages. The neurocognitive impact of FCCM is still underrecognized. METHODS: We report the clinical, neurocognitive, imaging and genetic data of a three generation family with FCCM. RESULTS: A 63-year-old man (proband) had progressive memory impairment since the last year. Neurologic exam was unremarkable. Brain MRI showed multiple large cavernomas (mainly in the pons, left temporal, and right temporo-parietal) and scattered microhemorrhages. Neuropsychological assessment mainly revealed left frontal and right temporo-parietal dysfunction. A 41-year-old daughter, presented with headache, vertigo and memory complaints in the last 2 years. Neurological examination revealed left central facial paralysis. Brain MRI showed two small right parietal and internal capsule cavernomas, as well as microhemorrhages. Neuropsychological assessment showed moderate temporal neocortical left dysfunction. A 34-year-old daughter had recurrent headache and memory complaints, with unremarkable neurological exam. Brain MRI revealed two large cavernomas (left fronto-orbitary and inferior temporal), with few microhemorrhages. Neuropsychological assessment was normal. A granddaughter had mild headaches and a small right cerebellar cavernoma, without microhemorrhages. Neuropsychological assessment showed mild temporal neocortical left dysfunction. A nonsense variant, c.55C > T; p.R19* generating a premature stop codon in CCM2 gene shared by all affected family members was identified. CONCLUSIONS: Neuropsychological evaluation showed that memory complaints and cognitive impairment could be an important unrecognized finding in FCCM. Its pathophysiological mechanisms are still unknown but the role of recurrent microhemorrhages could provide an interesting hypothesis.

In vitro and ex vivo anti-Pythium insidiosum potential of ozonated sunflower oil.

This study sought to evaluate the in vitro and ex vivo susceptibility of Pythium insidiosum to ozonized sunflower oil (OSO) and verify the morphological alterations of OSO-exposed hyphae. Susceptibility assays were performed according to the broth microdilution protocol M38-A2/CLSI, and the minimal inhibitory (MIC) and minimal oomicidal (MOC) concentrations were also determined. Non-ozonated sunflower oil (SO) was used as the oil control. Additionally, kunkers from equine pythiosis were exposed to OSO. Damages caused by OSO and SO on P. insidiosum hyphae ultrastructure were verified using scanning electron microscopy. The MIC range for OSO was 7000 to 437.5 mg/mL, and the values for SO were higher, ranging from 56000 to 14000 mg/mL. The MOC was equal to MIC for both oil formulations. The OSO fully inhibited the oomycete growth from kunkers, although there was P. insidiosum growth in the kunker control in 24 h of incubation. The SEM analyses showed that both OSO and SO caused morphological alterations in P. insidiosum hyphae, highlighting the presence of cavitation along the hyphae with loss of continuity of the cell wall, which was more evident in the OSO-treated hyphae. The OSO had the best oomicidal activity, leading us to believe that our findings may support future research containing this formulation to be applied in integrative medicine protocols to control pythiosis in animals and humans.

Characterisation of an area of coexistent visceral and cutaneous leishmaniasis transmission in the State of Piauí, Brazil

BACKGROUND In Brazil, transmission of visceral and cutaneous leishmaniasis has expanded geographically over the last decades, with both clinical forms occurring simultaneously in the same area. OBJECTIVES This study characterised the clinical, spatial, and temporal distribution, and performed entomological surveillance and natural infection analysis of a leishmaniasis-endemic area. METHODS In order to characterise the risk of leishmaniasis transmission in Altos, Piauí, we described the clinical and socio-demographic variables and the spatial and temporal distribution of cases of American visceral leishmaniasis (AVL) and American cutaneous leishmaniasis (ACL) cases and identified potential phlebotomine vectors. FINDINGS The urban area concentrated almost 54% of ACL and 86.8% of AVL cases. The temporal and spatial distribution of AVL and ACL cases in Altos show a reduction in the number of risk areas, but the presence of permanent disease transmission foci is observed especially in the urban area. 3,808 phlebotomine specimens were captured, with Lutzomyia longipalpis as the most frequent species (98.45%). Of the 35 females assessed for natural infection, one specimen of Lu. longipalpis tested positive for the presence of Leishmania infantum and Leishmania braziliensis DNA. MAIN CONCLUSION Our results indicate the presence of risk areas for ACL and AVL in the municipality of Altos and highlight the importance of entomological surveillance to further understand a possible role of Lu. longipalpis in ACL transmission.

Leishmania (Leishmania) infantum DNA detection in Nyssomyia neivai in Vale do Ribeira, Paraná, Brazil

BACKGROUND The incidence of visceral leishmaniasis (VL) has increased in the Southern region of Brazil in recent years, especially in the State of Paraná. New species have been suggested with potential to act as vector in VL endemic areas. OBJECTIVES Identify the Leishmania species in sand fly specimens collected from 2016 to 2018 in the municipality of Itaperuçu, Vale do Ribeira, Paraná, Brazil. METHODS Light traps were used for collections and for the analysis of sand fly were used the multiplex polymerase chain reaction (PCR) methodology and subsequent sequencing. FINDINGS Among the collected specimens, 88.62% were attributed to the species Nyssomyia neivai, which were grouped into 176 pools. Three positive pools were detected: two with Leishmania (Viannia) braziliensis and one with L. (Leishmania) infantum. The positivity rate for the parasite was 0.25% based on the presence of at least one infected insect in the pool. MAIN CONCLUSIONS The detection of L. infantum in Ny. neivai draws attention due to its abundance and anthropophily in the State of Paraná. Moreover, this finding is considered as an alert and suggests that the vector competence of Ny. neivai and the criteria for its incrimination should be carried out, given its wide distribution in southern of Brazil.

Efferocytosis is restricted by axon guidance molecule EphA4 via ERK/Stat6/MERTK signaling following brain injury.

BACKGROUND: Efferocytosis is a process that removes apoptotic cells and cellular debris. Clearance of these cells alleviates neuroinflammation, prevents the release of inflammatory molecules, and promotes the production of anti-inflammatory cytokines to help maintain tissue homeostasis. The underlying mechanisms by which this occurs in the brain after injury remain ill-defined. METHODS: We used GFP bone marrow chimeric knockout (KO) mice to demonstrate that the axon guidance molecule EphA4 receptor tyrosine kinase is involved in suppressing MERTK in the brain to restrict efferocytosis of resident microglia and peripheral-derived monocyte/macrophages. RESULTS: Single-cell RNAseq identified MERTK expression, the primary receptor involved in efferocytosis, on monocytes, microglia, and a subset of astrocytes in the damaged cortex following brain injury. Loss of EphA4 on infiltrating GFP-expressing immune cells improved functional outcome concomitant with enhanced efferocytosis and overall protein expression of p-MERTK, p-ERK, and p-Stat6. The percentage of GFP+ monocyte/macrophages and resident microglia engulfing NeuN+ or TUNEL+ cells was significantly higher in KO chimeric mice. Importantly, mRNA expression of Mertk and its cognate ligand Gas6 was significantly elevated in these mice compared to the wild-type. Analysis of cell-specific expression showed that p-ERK and p-Stat6 co-localized with MERTK-expressing GFP + cells in the peri-lesional area of the cortex following brain injury. Using an in vitro efferocytosis assay, co-culturing pHrodo-labeled apoptotic Jurkat cells and bone marrow (BM)-derived macrophages, we demonstrate that efferocytosis efficiency and mRNA expression of Mertk and Gas6 was enhanced in the absence of EphA4. Selective inhibitors of ERK and Stat6 attenuated this effect, confirming that EphA4 suppresses monocyte/macrophage efferocytosis via inhibition of the ERK/Stat6 pathway. CONCLUSIONS: Our findings implicate the ERK/Stat6/MERTK axis as a novel regulator of apoptotic debris clearance in brain injury that is restricted by peripheral myeloid-derived EphA4 to prevent the resolution of inflammation.

A suggestive approach for assessing item quality, usability and validity of Automatic Item Generation.

Automatic Item Generation (AIG) refers to the process of using cognitive models to generate test items using computer modules. It is a new but rapidly evolving research area where cognitive and psychometric theory are combined into digital framework. However, assessment of the item quality, usability and validity of AIG relative to traditional item development methods lacks clarification. This paper takes a top-down strong theory approach to evaluate AIG in medical education. Two studies were conducted: Study I-participants with different levels of clinical knowledge and item writing experience developed medical test items both manually and through AIG. Both item types were compared in terms of quality and usability (efficiency and learnability); Study II-Automatically generated items were included in a summative exam in the content area of surgery. A psychometric analysis based on Item Response Theory inspected the validity and quality of the AIG-items. Items generated by AIG presented quality, evidences of validity and were adequate for testing student's knowledge. The time spent developing the contents for item generation (cognitive models) and the number of items generated did not vary considering the participants' item writing experience or clinical knowledge. AIG produces numerous high-quality items in a fast, economical and easy to learn process, even for inexperienced and without clinical training item writers. Medical schools may benefit from a substantial improvement in cost-efficiency in developing test items by using AIG. Item writing flaws can be significantly reduced thanks to the application of AIG's models, thus generating test items capable of accurately gauging students' knowledge.

Unusual Microsatellite-Instable Mixed Neuroendocrine and Non-neuroendocrine Neoplasm: A Clinicopathological Inspection and Literature Review.

BACKGROUND: Mixed neuroendocrine and non-endocrine neoplasms (MiNENs) are challenging to diagnose and manage clinically. The current understanding of MiNENs' pathobiology, molecular mechanisms, and management is incomplete. Though microsatellite instability (MSI) is known to impact carcinogenesis, reports examining MSI mechanisms for MiNENs are rare. METHODS: We report an unusual colonic MSI-MiNEN uncovered in an 89-year-old woman and the review of the literature. RESULTS: Pathologic inspection revealed a high-grade carcinoma composed of tumor cells with neuroendocrine histologic traits and immunophenotype intermixed with mucin-containing signet ring-like cells arranged in nested and micronodular patterns. Loss of MLH1 and PMS2 mismatch repair proteins was detected in tumor cells. INSM1 immunostaining highlighted about 50% of the tumour, further reinforcing the MiNEN diagnosis. Next-generation sequencing identified multiple carcinogenic mutations. Because of the advanced stage of the tumor and its adhesion to the adjacent organs, surgical resection was aborted; immunotherapy was initiated. The tumor is in remission 30 months following initiation of treatment, and the patient remains asymptomatic. CONCLUSION: This unique MSI MiNEN was characterized by its immunohistochemical and molecular signatures and illustrated how correctly diagnosing MSI can strongly improve a patient's outcomes.

Oomicidal activity of polypyrrole nanoparticles against Pythium insidiosum.

This study evaluated in-vitro action of a new molecule, the polypyrrole nanoparticles (Ppy-NP), against Pythium insidiosum isolates using M38-A2/CLSI; the minimal inhibitory (MIC) and minimal oomicidal (MOC) concentrations were also determined. Additionally, changes in the hyphae wall of P. insidiosum CBS 575.85 treated with Ppy-NP were evaluated by scanning electron microscopy (SEM). The MIC100 and MOC for all isolates ranged from 8 to 32 µg mL-1, and the MIC90 and MIC50 were 16 µg mL-1. The SEM showed structural damage to the hyphae of P. insidisoum treated with Ppy-NP, as hyphae surfaces with less turgidity were found, thereby showing scaling and ruptures compared to the control (untreated hyphae). Our findings highlighted the anti-P. insidiosum properties of Ppy-NP proved to be a promising candidate for research using pythiosis experimental models.

Prototheca bovis in goats: Experimental mastitis and treatment with polypyrrole.

Prototheca bovis has been associated with several cases of mastitis in cattle but no record of intramammary infections has been reported in goats. This infection does not respond to available treatments and the disposal recommendation of affected animals cause great damage to the dairy industry. Alternatives for dealing with infections caused by Prototheca spp. are required worldwide. In vitro results suggest polypyrrole as promising molecule for combating this alga, because an algaecide effect was observed on tested Prototheca spp. isolates. Thus, this study evaluated goats as an experimental model for intramammary infection by P. bovis and a protocol for treating these animals with an intramammary polypyrrole solution. The possibility of P. bovis promoting an intramammary infection in goats was experimentally proven, demonstrating this species as an important model for studies involving algae mastitis. Furthermore, polypyrrole reduced the counts of Prototheca sp. in the analyzed samples, showing potential to fight this microorganism also in vivo. The results obtained in this study demonstrate the ability of P. bovis to colonize breast tissue in lactating goats and the highly soluble molecule of polypyrrole has potential use for the treatment of protothecosis.

Standard Operating Procedure validity on intramuscular vaccine administration in adults: a methodological study / Validación del Procedimiento Operativo Estándar sobre administración intramuscular de vacunas en adultos: estudio metodológico / Validação de Procedimento Operacional Padrão sobre administração intramuscular de vacina em adultos: estudo metodológico

ABSTRACT Objective: to validate a Standard Operating Procedure on the intramuscular vaccine administration technique in adults using high frequency vibration associated with cryotherapy. Methods: a literature review on intramuscular vaccination practice using a vibration device associated with cryotherapy. Then, a form was created to validate the instrument, detailing the items that were assessed by judges following recommendations in the literature. Judges' answers were assessed using the Content Validity Index, with items whose index was greater than or equal to 0.80 being validated. Results: twenty-five nurses participated in validity, identifying judges' opinion regarding item relevance, clarity and accuracy. Judges validated the instrument, according to the values that remained between 0.88 and 1.0. Conclusions: the instrument developed and validated is a tool capable of guaranteeing safety and standardizing immunization practice in vaccine rooms.

RESUMEN Objetivo: validar un Procedimiento Operativo Estándar sobre la técnica de administración de vacunas intramusculares en adultos mediante vibración de alta frecuencia asociada a crioterapia. Métodos: revisión de la literatura sobre la práctica de la vacunación intramuscular mediante un dispositivo de vibración asociado a la crioterapia. Luego, se elaboró un formulario para validar el instrumento, detallando los ítems que fueron evaluados por los jueces siguiendo las recomendaciones de la literatura. Las respuestas de los jueces fueron evaluadas mediante el Índice de Validez de Contenido, siendo validados los ítems cuyo índice fuera mayor o igual a 0,80. Resultados: 25 enfermeros participaron de la validación, captando la opinión de los jueces sobre la pertinencia, claridad y precisión de los ítems. Los jueces validaron el instrumento según los valores, que se mantuvieron entre 0,88 y 1,0. Conclusiones: el instrumento desarrollado y validado es una herramienta capaz de garantizar la seguridad y estandarizar la práctica de inmunización en salas de vacunas.

RESUMO Objetivo: validar um Procedimento Operacional Padrão sobre a técnica de administração de vacinas pela via intramuscular em adultos utilizando vibração em alta frequência associada à crioterapia. Métodos: revisão de literatura sobre a prática de vacinação intramuscular utilizando dispositivo de vibração associado à crioterapia. Em seguida, elaborou-se um formulário para validação do instrumento, com detalhamento dos itens que foram avaliados por juízes seguindo recomendações da literatura. As respostas dos juízes foram avaliadas pelo Índice de Validade de Conteúdo, sendo validados os itens cujo índice foi maior ou igual a 0,80. Resultados: 25 enfermeiros participaram da validação, captando o parecer dos juízes quanto à relevância, clareza e precisão dos itens. Os juízes validaram o instrumento segundo os valores, que permaneceram entre 0,88 e 1,0. Conclusões: o instrumento desenvolvido e validado é uma ferramenta capaz de garantir a segurança e padronizar a prática de imunização nas salas de vacina.

Quebra do silêncio em grupo on-line de enfrentamento ao abuso sexual infantil / Rompiendo el silencio en un grupo online que enfrenta abuso sexual infantil / Breaking the silence in a group on-line facing child sexual abuse

RESUMO O presente artigo apresenta um recorte dos dados coletados em entrevistas durante pesquisa etnográfica on-line acerca da exposição das vivências de vítimas de violência sexual em grupo no Facebook intitulado 'Luta contra o abuso sexual infantil'. Entendemos que os relatos funcionam como uma possibilidade de quebra do pacto de silêncio e se constituem como o início da elaboração do trauma psíquico. As interações no grupo foram registradas em diário de campo durante o período de quatro meses de acompanhamento e os dados aprofundados em dez entrevistas semiestruturadas com participantes contactadas por meio de convite postado no grupo. As entrevistas aconteceram por vídeochamada e perguntavam sobre o sentido que elas produzem ao utilizar o grupo, refletindo sobre a possibilidade de ultrapassar a condição de vítimas. Verifica-se que o uso da plataforma surge como uma possibilidade de fazer algo que ajude outras vítimas, seja por meio do compartilhamento de histórias ou do fornecimento de informações que auxiliem a romper com o ciclo abusivo. Observa-se que cada vítima lida de forma única com o evento traumático, enfrentando impactos psíquicos da agressão e do momento de revelação permeado pela dinâmica familiar e pela assimetria de poder. Desta forma, fica evidenciada a necessidade de uma escuta qualificada que viabilize a reconstrução subjetiva facilitada por um processo de elaboração do ocorrido.

RESUMEN. El presente artículo presenta una compilación de los datos recolectados durante la investigación etnográfica online realizada acerca de la exposición de las vivencias de víctimas de violencia sexual en el grupo de Facebook intitulado 'Lucha contra el abuso infantil'. Entendemos que los relatos funcionan como una posibilidad de romper el pacto de silencio y constituyen el inicio de la elaboración del trauma psíquico. Las interacciones en el grupo se registraron en un diario de campo durante el período de cuatro meses de seguimiento y los datos se profundizaron en diez entrevistas semiestructuradas con participantes contactados a través de una invitación publicada en el grupo. Las entrevistas se realizaron mediante videollamada y se preguntaron sobre el sentido que producen al utilizar el grupo, reflexionando sobre la posibilidad de superar la condición de víctimas. Verifícase que el uso de la plataforma surge como una posibilidad para hacer algo que ayude a otras víctimas, sea por medio de compartir historias o a través del suministro de informaciones que auxilien a romper el ciclo abusivo. Obsérvase que cada víctima lida de forma única con el evento traumático, enfrentando impactos psíquicos de agresión y del momento de revelación permeado por la dinámica familiar y por la asimetría de poder. De esta manera, se evidencia la necesidad de una escucha cualificada que posibilite una reconstrucción subjetiva facilitada por un proceso de elaboración de lo ocurrido.

ABSTRACT This article presents an excerpt of the data collected in interviews during online ethnographic research about the disclosure of the experiences of victims of sexual violence in a Facebook group entitled 'Fight against child sexual abuse'. This study considered the research's understanding that the reports function as a possible way of breaking the pact of silence and become the basis for the beginning of the psychic trauma elaboration. Interactions in the group were recorded in a field diary during the four-month follow-up period. The data were further analyzed in ten semi-structured interviews with participants contacted through an invitation posted in the group. The interviews were conducted by video call and asked about the meaning they produce when using the group, reflecting on the possibility of overcoming the condition of victims. The use of the platform emerges as a possibility to do something that helps other victims, either by sharing stories or providing information that helps break the abusive cycle. It is observed that each victim deals uniquely with the traumatic event, facing the psychic impacts of the aggression and the moment of disclosure permeated by the family dynamics and power asymmetry. Thus, the need for qualified listening is evident, which enables a subjective reconstruction facilitated by elaborating on what happened.

Immunotherapy in Head and Neck Cancer When, How, and Why?

Head and neck cancer (HNC) is one of the most common cancers worldwide. Alcohol and tobacco consumption, besides viral infections, are the main risk factors associated with this cancer. When diagnosed in advanced stages, HNC patients present a higher probability of recurrence or metastasising. The complexity of therapeutic options and post-treatment surveillance is associated with poor prognosis and reduced overall survival (OS). This review aims to explore immunotherapy (immune checkpoint inhibitors (ICI), therapeutic vaccines, and oncolytic viruses) in HNC patients' treatment, and to explore when, how, and why patients can benefit from it. The monotherapy with ICI or in combination with chemotherapy (QT) shows the most promising results. Compared to standard therapy, ICI are able to increase OS and patients' quality of life. QT in combination with ICI demonstrates significant response rates and considerable long-term clinical benefits. However, the toxicity associated with this approach is still a hurdle to overcome. In parallel, the therapeutic vaccines directed to the Human Papilloma Virus are also efficient in increasing the antitumour response, inducing cellular and humoral immunity. Although these results demonstrate clinical benefits compared to standard therapy, it is also important to unravel the resistance mechanisms in order to predict the clinical benefit of immunotherapy.

Avaliação da composição química de um óleo de copaíba (Copaifera spp) e seu efeito em células-tronco mesenquimais / Evaluation of the chemical composition of a copaiba oil (Copaifera spp) and its effect on mesenchymal stem cells

A oleorresina obtida de copaíferas é amplamente utilizada na medicina tradicional brasileira. Este estudo avaliou a composição química por Cromatografia Gasosa (CG) e o efeito da oleorresina de Copaifera officinalis em células-tronco. Para isso as células foram tratadas com a oleorresina nas concentrações de 0,5, 20, 110, 140, 170 ou 200 µg/ml por 24h. A avaliação por CG identificou os sesquiterpenos ß-cariofileno, trans-α-bergamoteno e óxido de cariofileno II como os compostos majoritários da oleorresina. As menores concentrações de oleorresina utilizadas apresentaram resultados semelhantes ao grupo controle e as maiores concentrações diminuíram significativamente a viabilidade celular e apresentaram maior citotoxicidade. Como conclusão, os principais componentes encontrados na oleorresina de copaíba foram os sesquiterpenos e as baixas concentrações testadas não foram citotóxicas. O aumento das concentrações de oleorresina de copaíba promoveu diminuição da viabilidade celular e aumento dos efeitos citotóxicos nas células-tronco. Embora a oleorresina de copaíba tenha uso etnofarmacológico na cicatrização, este estudo demonstrou efeito citotóxico em células-tronco, as quais estão relacionadas ao processo de regeneração corpóreo. Portanto, deve-se ter cuidado com a dosagem de oleorresina a ser utilizada, uma vez que este estudo in vitro mostrou citotoxicidade e um impacto negativo na viabilidade das células-tronco nas mais altas concentrações testadas. [au]

Oleoresinobtained from Copaifera trees is extensively used in Brazilian traditional medicine. This study hasevaluated the chemical composition and effect of Copaifera officinalisoleoresin on stem cells. The oleoresin was analyzed by Gas Chromatography (GC) and the cells were treated with the oleoresin at concentrations of 0.5, 20, 110, 140, 170 or 200 µg/ml for 24h for cellular tests. GC identified the sesquiterpenes beta-caryophyllene, trans-alpha-bergamotene, and caryophyllene oxide II as the main compounds in oleoresin. The cell viability and cytotoxicity assays showed the lowest concentrations of oleoresin used presented similar results to the control group and the higher concentrations tested significantly decreased cell viability and increased cytotoxicity. In a conclusion, the main components found in copaiba oleoresin were sesquiterpenes and the low tested concentrations were not cytotoxic. The increased concentrations of copaiba oleoresin promoted a decrease in cell viability and an increase of cytotoxicity in the stem cells. Although copaiba oleoresin has ethnopharmacology use in healing, this study showed toxicity in stem cells, which are related to the corporeal regeneration process. Therefore, caution must be taken with the dosage of the oleoresin to be used since this in vitro study showed cytotoxicity and a negative impact on stem cell viability at the higher tested concentrations. [au]

A Pilot Randomized Controlled Clinical Trial Comparing Piezo Versus Conventional Rotary Surgery for Removal of Impacted Mandibular Third Molars.

BACKGROUND: The extraction of impacted mandibular third molars is a frequent dental surgery, interfering with patients' quality of life. Ultrasonic surgery is an alternative to osteotomy with conventional rotary instruments. This study compares postoperative signals and symptoms after extracting impacted mandibular third molars using ultrasonic surgery or conventional rotary osteotomy. METHODS: A pilot randomized controlled clinical trial was conducted. Thirty patients were randomly divided into the test group (ultrasonic technique) and a control group (conventional rotatory technique). All surgeries were timed. Swelling parameters, trismus and paraesthesia were evaluated on the day of surgery and the third, fifth and seventh postoperative days. Intraoperative bleeding was evaluated during surgery. Postoperative pain was evaluated daily by the patient through a visual analogue scale and the number of ingested analgesics. RESULTS: Pain, swelling and trismus present beneficial results with the ultrasonic technique but without statistical significance. Intraoperative bleeding was significantly lower with ultrasonic surgery (t(28) = 3.258; p = 0.003). Operating time was significantly higher in extractions involving osteotomy and cutting crown and roots either with the conventional technique (p = 0.020) or ultrasonic technique (p = 0.039). Regardless of the surgical difficulty, no statistically significant results were detected between techniques regarding the procedure duration. CONCLUSIONS: The beneficial postoperative signs and symptoms make ultrasonic surgery a favourable therapeutic option, especially when the integrity of noble anatomical structures is the most important risk factor. Further studies with larger samples are needed to support the use of piezosurgery as a valid option for impacted mandibular third molar extraction.

[The Health Effects and Anesthetic Management for Patients Using E-Cigarettes and Heat-Not-Burn Tobacco Products: A Narrative Review]. / Consequências Fisiopatológicas e Abordagem Anestésica em Doentes Consumidores de Cigarros Eletrónicos e Produtos de Tabaco Aquecido: Revisão Narrativa.

INTRODUCTION: The implementation of policies aimed at promoting smoking cessation led to a decrease in the use of tobacco. There has been an increase in the use of systems such as electronic nicotine delivery systems and electronic non-nicotine delivery systems - also known as electronic cigarettes, and heat-not-burn tobacco products. The aim of this review is to describe the pathophysiological implications of these devices and their perioperative impact. MATERIAL AND METHODS: A literature search was carried out by the authors to identify studies published in English on PubMed and MEDLINE between 2007 and 2021, and using the terms 'vaping', 'electronic nicotine delivery systems', 'heated tobacco products', 'IQOS' and 'anesthesia'. A total of 654 articles were found, and the most relevant ones were selected. RESULTS: There is currently insufficient information available regarding the perioperative implications of electronic cigarettes and heat not-burn tobacco products. These devices release potentially harmful substances - such as nicotine - that have a negative impact on the health of consumers. These substances affect the cardiovascular, respiratory and immune systems, and can interact with multiple drugs, which can affect the anesthetic management. The users of these devices are also at a higher risk of explosion injuries and cancer. A number of interventions that may improve the perioperative management of these patients are suggested. CONCLUSION: Awareness of the potential harmful effects of these devices, and their perioperative implications, is essential, as it enables the implementation of interventions to minimize the risks and improve patient outcomes.

Introdução: A implementação de medidas políticas para a cessação tabágica levou à diminuição do consumo de tabaco. Contudo, em contrapartida, tem-se verificado um aumento do consumo de sistemas eletrónicos de administração de nicotina e sistemas eletrónicos sem nicotina, também conhecidos como cigarros eletrónicos, e produtos de tabaco aquecido. O objetivo deste trabalho é rever as implicações fisiopatológicas da utilização destes dispositivos e as suas implicações no peri-operatório. Material e Métodos: A pesquisa na literatura foi efetuada pelos autores, identificando artigos de língua inglesa nas plataformas de pesquisa PubMed e MEDLINE, entre os anos 2007 e 2021, e usando os termos 'vaping', 'electronic nicotine delivery systems', 'heated tobacco products', 'IQOS' e 'anesthesia'. Foram obtidas 654 publicações, tendo sido selecionados as mais pertinentes. Resultados: Existe atualmente pouca informação relativamente às implicações peri-operatórias da utilização dos cigarros eletrónicos e dos produtos de tabaco aquecido. Estes sistemas libertam várias substâncias potencialmente nocivas, incluindo nicotina, com implicações negativas para a saúde dos consumidores. Interferem com o sistema cardiovascular, respiratório e imunológico e apresentam várias interações farmacológicas, com influência na abordagem anestésica. Verifica-se ainda um risco acrescido de lesões causadas por explosão do dispositivo e desenvolvimento de neoplasias. São sugeridas medidas para otimizar a abordagem destes doentes. Conclusão: O conhecimento sobre os potenciais efeitos deletérios da utilização destes dispositivos, assim como as suas implicações peri-operatórias, é fundamental e permite adotar medidas que minimizem riscos e melhorem a evolução destes doentes.