Placenta Accreta Spectrum Disorders - The Impact of the Creation of a Multidisciplinary Team on Maternal Outcomes in Portugal / Patologia do espectro do acretismo placentário - O impacto da criação de uma equipa multidisciplinar nos desfechos maternos em Portugal

Abstract Objective To describe a cohort of placenta accreta spectrum (PAS) cases from a tertiary care institution and compare the maternal outcomes before and after the creation of a multidisciplinary team (MDT). Methods Retrospective study using hospital databases. Identification of PAS cases with pathological confirmation between 2010 and 2021. Division in two groups: standard care (SC) group - 2010-2014; and MDT group - 2015-2021. Descriptive analysis of their characteristics and maternal outcomes. Results During the study period, there were 53 cases of PAS (24 - SC group; 29 - MDT group). Standard care group: 1 placenta increta and 3 percreta; 12.5% (3/24) had antenatal suspicion; 4 cases had a peripartum hysterectomy - one planned due to antenatal suspicion of PAS; 3 due to postpartum hemorrhage. Mean estimated blood loss (EBL) was 2,469 mL; transfusion of packed red blood cells (PRBC) in 25% (6/24) - median 7.5 units. Multidisciplinary team group: 4 cases of placenta increta and 3 percreta. The rate of antenatal suspicion was 24.1% (7/29); 9 hysterectomies were performed, 7 planned due to antenatal suspicion of PAS, 1 after intrapartum diagnosis of PAS and 1 after uterine rupture following a second trimester termination of pregnancy. The mean EBL was 1,250 mL, with transfusion of PRBC in 37.9% (11/29) - median 2 units. Conclusion After the creation of the MDT, there was a reduction in the mean EBL and in the median number of PRBC units transfused, despite the higher number of invasive PAS disorders.

Resumo Objetivo Descrever uma coorte de casos do espectro do acretismo placentário (PAS) de uma instituição terciária e comparar os resultados maternos antes e depois da criação de uma equipa multidisciplinar (MDT). Métodos Estudo retrospectivo utilizando bancos de dados hospitalares. Identificação de casos de PAS com confirmação patológica entre 2010 e 2021. Divisão em dois grupos: grupo Standard Care (SC) - 2010-2014; e grupo MDT - 2015-2021. Análise descritiva de suas características e desfechos maternos. Resultados Durante o período do estudo, houve 53 casos de PAS (24 - grupo SC; 29 - grupo MDT). Grupo Standard Care: 1 placenta increta e 3 percretas; 12,5% (3/24) tiveram suspeita anteparto; 4 casos tiveram histerectomia periparto - uma eletiva devido à suspeita anteparto de PAS; 3 devido a hemorragia pós-parto. A média de perda hemática estimada (EBL) foi de 2.469 mL; transfusão de concentrado eritrocitário (PRBC) em 25% (6/24) - mediana 7,5 unidades. Equipa multidisciplinar: 4 casos de placenta increta e 3 percretas. A taxa de suspeita anteparto foi de 24,1% (7/29); foram realizadas 9 histerectomias, 7 eletivas por suspeita anteparto de PAS, 1 após diagnóstico intraparto de PAS e 1 após rotura uterina após interrupção da gravidez no segundo trimestre. A EBL média foi de 1.250 mL, com transfusão de PRBC em 37,9% (11/29) - mediana de 2 unidades. Conclusão Após a criação da MDT, houve redução na média de EBL e na mediana do número de unidades de PRBC transfundidas, apesar do maior número de PAS invasivos.

Nursing assistance systematization: understanding the care implementation process

Introduction: the Systematization of Nursing Care is one of the main tools for the development and organization of services for nursing professionals, its application guides the planning of individualized care and focuses on the specific needs of each individual. Objective: the study's general purpose is to analyze primary health nursing care in light of the basic human needs theory. Methods: this is a descriptive study with a qualitative approach, developed in the city of Rio Branco, Acre, Brazil, with nurses from the Basic Family Health Units. As a method for organization and interpretation, we opted for the content analysis proposed by Bardin. Results: the Systematization of Nursing Care is perceived by nurses as an instrument for organizing care, but in practice, they think it is focused on assistance directed to the use of ministerial protocols. In this context, it was also evidenced that they focus on aid for health problems and complaints, indicating the anamnesis as a phase of the implemented nursing process with the other stages focused on the diagnosis of the disease and specific interventions. Conclusion: our findings showed that professionals in primary health care end up directing their care only to momentary complaints, failing to broaden their look as a whole. In this way, assistance occurs in a fragmented way, failing to meet the real needs of the population.

Introdução: a Sistematização da Assistência de Enfermagem é uma das principais ferramentas para o desenvolvimento e organização dos serviços dos profissionais da enfermagem, a aplicação da mesma orienta quanto ao planejamento de uma assistência individualizada e com foco nas necessidades específicas de cada indivíduo. Objetivo: analisar a assistência de enfermagem na atenção primaria à saúde à luz da teoria das necessidades humanas básicas. Método: trata-se de um estudo descritivo de abordagem qualitativa. A pesquisa foi desenvolvida no município de Rio Branco, com profissionais enfermeiros das Unidades Básicas de Saúde da Família. Como método para a organização e interpretação optou-se pela análise de conteúdo proposta por Bardin. Resultados: a Sistematização da Assistência de Enfermagem (SAE) é percebida pelos profissionais enfermeiros como um instrumento de organização do cuidado, porém estes na prática acabam achando que a SAE está voltada para a assistência direcionada ao uso de protocolos ministeriais. Nesse contexto, evidenciou-se ainda que estes focam a assistência em problemas de saúde e as queixas, indicando a anamnese como fase do processo de enfermagem implementado, sendo as demais etapas voltadas para diagnóstico da doença e intervenções pontuais. Conclusão: evidenciou que os profissionais na atenção primária à saúde acabam direcionando seus cuidados apenas para as queixas momentâneas, deixando de ampliar o olhar para o mesmo como um todo. Desse modo, a assistência ocorre de modo fragmentado, deixando de atender as necessidades reais da população

Cardiovascular risk factors during pregnancy impact the postpartum cardiac and vascular reverse remodeling.

Pregnant women with cardiovascular risk (CVR) factors are highly prone to develop cardiovascular disease later in life. Thus, recent guidelines suggest extending the follow-up period to 1 yr after delivery. We aimed to evaluate cardiovascular remodeling during pregnancy and determine which CVR factors and potential biomarkers predict postpartum cardiac and vascular reverse remodeling (RR). Our study included a prospective cohort of 76 healthy and 54 obese and/or hypertensive and/or with gestational diabetes pregnant women who underwent transthoracic echocardiography, pulse-wave velocity (PWV), and blood collection at the 1st trimester (1T) and 3rd trimester (3T) of pregnancy as well as at the 1st/6th/12th mo after delivery. Generalized linear mixed-effects models was used to evaluate the extent of RR and its potential predictors. Pregnant women develop cardiac hypertrophy, as confirmed by a significant increase in left ventricular mass (LVM). Moreover, ventricular filling pressure (E/e') and atrial volume increased significantly during gestation. Significant regression of left ventricular (LV) volume, LVM, and filling pressures was observed as soon as 1 mo postpartum. The LV global longitudinal strain worsened slightly and recovered at 6 mo postpartum. PWV decreased significantly from 1T to 3T and normalized at 1 mo postpartum. We found that arterial hypertension, smoking habits, and obesity were independent predictors of increased LVM during pregnancy and postpartum. High C-reactive protein (CRP) and low ST2/IL33-receptor levels are potential circulatory biomarkers of worse LVM regression. Arterial hypertension, age, and gestational diabetes positively correlated with PWV. Altogether, our findings pinpoint arterial hypertension as a critical risk factor for worse RR and CRP, and ST2/IL33 receptors as potential biomarkers of postpartum hypertrophy reversal.NEW & NOTEWORTHY This study describes the impact of cardiovascular risk factors (CVR) in pregnancy-induced remodeling and postpartum reverse remodeling (up to 1 yr) by applying advanced statistic methods (multivariate generalized linear mixed-effects models) to a prospective cohort of pregnant women. Aiming to extrapolate to pathological conditions, this invaluable "human model" allowed us to demonstrate that arterial hypertension is a critical CVR for worse RR and that ST2/IL33-receptors and CRP are potential biomarkers of postpartum hypertrophy reversal.

The preventive and therapeutic effects of anthocyanins on colorectal cancer: A comprehensive review based on up-to-date experimental studies.

Colorectal cancer (CRC) is the second most lethal and the third most diagnosed type of cancer worldwide. More than 75% of CRC cases are sporadic and lifestyle-related. Risk factors include diet, physical inactivity, genetics, smoking, alcohol, changes in the intestinal microbiota, and inflammation-related diseases such as obesity, diabetes, and inflammatory bowel diseases. The limits of conventional treatments (surgery, chemotherapy, radiotherapy), as demonstrated by the side effects and resistance of many CRC patients, are making professionals search for new chemopreventive alternatives. In this context, diets rich in fruits and vegetables or plant-based products, which contain high levels of phytochemicals, have been postulated as complementary therapeutic options. Anthocyanins, phenolic pigments responsible for the vivid colors of most red, purple, and blue fruits and vegetables, have been shown protective effects on CRC. Berries, grapes, Brazilian fruits, and vegetables such as black rice and purple sweet potato are examples of products rich in anthocyanins, which have been able to reduce cancer development by modulating signaling pathways associated with CRC. Therefore, this review has as main objective to present and discuss the potential preventive and therapeutic effects of anthocyanins present in fruits and vegetables, in plant extracts, or in their pure form on CRC, taking into account up-to-date experimental studies (2017-2023). Additionally, a highlight is given towards the mechanisms of action of anthocyanins on CRC.

Prevalência e Autoconhecimento de Indicadores de Inflamação Sugestivos de Doença Periodontal em Militares / Prevalence And Self-Knowledge Of Indicators Of Inflammation Suggestive of Periodontal Disease In Military Personne

O objetivo deste estudo foi identificar a prevalência e o autoconhecimento para indicadores de inflamação sugestivos de doença periodontal em militares de ambos os sexos. Os militares foram recrutados para realização de um censo odontológico para toda a população do Centro de Instrução Almirante Wandenkolk (CIAW) da Marinha do Brasil, totalizando 409 voluntários. Foram formados dois grupos para posterior análise: Grupo 1- contendo exclusivamente mulheres e Grupo 2- contendo exclusivamente homens. Foram realizados 409 exames clínicos e analisados 409 questionários. Os resultados demonstraram que, quanto aos participantes militares, 40,1% foram do sexo feminino e 59,9%, do sexo masculino; 87% faziam uso do fio dental, desses 56% usavam diariamente; 77% apresentaram frequência de escovação de três vezes ao dia ou mais; 74,3% relataram que visitam regularmente o dentista, e a proporção de mulheres que frequenta regularmente o dentista superou significativamente a proporção de homens que o fizeram (I.C. 95%; p < 0,001); 61,6% afirmaram conhecer a doença periodontal. A avaliação profissional verificou a presença de indicadores de inflamação sugestivos de doença periodontal em 45,2% participantes, desses 37% eram do gênero feminino e 63%, do gênero masculino, não sendo observada diferença estatística entre os gêneros (I.C. 95%; p = 0,2248). Concluiu-se que a prevalência de indicadores de inflamação sugestivos de doença periodontal encontrada foi de 45,2%; o autoconhecimento dos militares sobre doença periodontal foi baixo, apenas 19%; dessa forma foi verificada diferença estatística entre o conhecimento das mulheres e dos homens; e observou-se que a maioria dos participantes estava dentro da frequência correta para consulta de retorno ao dentista.

The objective of this study was to identify the prevalence and self-recognition for indicators of inflammation suggestive of periodontal disease in military personnel of both genders. The military personnel was recruited to conduct a dental census for the entire population of the Admiral Wandenkolk Training Center of the Brazilian Navy, totaling 409 volunteers. Two groups were formed for further analysis: Group 1- containing exclusively women and Group 2- containing exclusively men. A total of 409 clinical examinations were performed and the questionnaires were analyzed. The results showed that, regarding the military participants, 40.1% were female and 59.9% were male; 87% used dental floss, of which 56% used it daily; 77% brushed three times a day or more; 74.3% reported that they visited the dentist regularly, and the proportion of women who regularly visited the dentist significantly exceeded the proportion of men who did (C.I. 95%; p<0.001); 61.6% said they knew about periodontal disease. The professional evaluation verified the presence of inflammation indicators suggestive of periodontal disease in 45.2% of the participants, of which 37% were female and 63% were male, with no statistical difference between genders (95% CI, p=0.2248). The prevalence of inflammation indicators suggestive of periodontal disease was 45.2%; the self-knowledge of the military about the periodontal disease was low, only 19%; thus a statistical difference was found between the knowledge of females and males; and it was observed that most participants were within the correct frequency for return visits to the dentist.

Antiproliferative effects and main molecular mechanisms of Brazilian native fruits and their by-products on lung cancer.

Lung Cancer (LC) is an emergent disease widespread globally. Compared to other types of cancer, LC has one of the lowest survival rates (18%). As some risk factors associated with the development of lung carcinogenesis are still unavoidable, researchers have been trying to find efficient and safe alternatives that can help prevent LC or even attenuate its rapid evolution after diagnosis. Studies with natural products promise to offer biological effects against several types of cancers, including LC. The uncountable types of plant matrices dispersed in nature, or even their extracts, contain a powerful composition of bioactive compounds with promising biological effects on LC. The biomes in Brazil are examples of regions with a great biodiversity of bioactive compounds-rich fruits. Therefore, this review aimed to present the potential anticancer effect of Brazilian native fruits, their fractions, and by-products on LC through the elucidation of the main molecular mechanisms involved. The Brazilian plant matrices discussed here (açaí, achiote, araticum, camu camu, cocoa, jaboticaba, genipap, guarana, and pequi) showed promising evidence by inducing cellular apoptosis, reducing cancer cell viability and tumor growth, and regulating cell cycle.

Signaling pathways and the potential anticarcinogenic effect of native Brazilian fruits on breast cancer.

Breast cancer (BC) is the type of cancer with the highest incidence and mortality rates in women worldwide. Despite its well-established risk factors, BC is following an epidemiological pattern, similar to obesity and other western pandemics, associated to demographic and environmental factors. Food and specific bioactive compounds have been evidenced as key factors in BC status attenuation. Native Brazilian fruits and derived products are rich sources of bioactive compounds, which exert valuable antioxidant, anti-inflammatory, and anticancer effects. Therefore, the aim of this review is to evidence the potential of Brazilian fruits in BC by revealing some of the mechanisms underlaying the anticancer effects of their respective bioactive compounds. The interventions investigated here generally show promising evidence, reducing tumor growth or cancer cell viability, and regulating the cell cycle. Native Brazilian fruits, such as açaí, cocoa, guarana, passionfruit, and pineapple have been associated with the regulation of BC-related molecular biomarkers.

Brazilian tucumã-do-Amazonas (Astrocaryum aculeatum) and tucumã-do-Pará (Astrocaryum vulgare) fruits: bioactive composition, health benefits, and technological potential.

Latin America has a wide range of native plants spread through its territory. The palms of the Astrocaryum genus are examples of crops occurring in Central and South America, including the large plant life in Brazil. Although not very well known, the Astrocaryum spp. possess edible and non-edible fractions with potential technological and medicinal uses, as evidenced by recent research. Two native Brazilian fruits, tucumã-do-Amazonas (Astrocaryum aculeatum) and tucumã-do-Pará (Astrocaryum vulgare), typically found in the north and northeast of the country, respectively, stand out for their high antioxidant capacity and rich content in bioactive compounds, mainly carotenoids and phenolic compounds. Accordingly, experimental studies indicate their potential to prevent and treat inflammatory and oxidative stress-related conditions, including cancer. The tucumã plants have also been suggested as tools in the industry, for example for biofuel production, activated carbon technology, and as alternative packaging. Considering the importance of bringing light to underestimated yet culturally relevant native crops with potential benefits for small and large communities, this review aims to present and discuss the characteristics, bioactive composition, health effects, and technological potential of tucumã-do-Amazonas and tucumã-do-Pará fruits.

Urinary cotinine assessment of maternal smoking and environmental tobacco smoke exposure status and its associations with perinatal outcomes: a cross-sectional birth study.

Tobacco consumption and environmental tobacco smoke (ETS) exposure remains an important public health concern. Pregnant women require particular attention as active and passive smoking during pregnancy are associated with multiple adverse perinatal outcomes. This study aimed to biochemically validate self-reported smoking and ETS exposure status among pregnant women, to more precisely ascertain its association with adverse perinatal outcomes. Data refers to 595 pregnant women who sought prenatal care in a public hospital in Porto, Portugal. A standard questionnaire on smoking and ETS-related variables was completed. Urinary cotinine (UC) concentrations were assessed by solid-phase competitive ELISA, in maternal urine samples collected on the day of delivery. The results showed that the optimal UC cut-off value to distinguish smokers from non-smokers and within non-smokers those who were exposed to ETS from those non-exposed in the third trimester of pregnancy was 74.1 ng/mL (sensitivity and specificity of 96.7% and 98.0%, respectively) and 1.6 ng/mL (sensitivity of 66.2% and specificity of 75.7%, respectively). The agreement between maternal self-reported and UC-based smoking status was very good (κ=0.919, p<0.001), but much lower for ETS exposure (κ=0.386, p<0.001). Maternal active smoking in the third trimester of pregnancy was associated with a significant decrease in birth weight, length and head circumference of 157.66 g (95% CI: -245.81, -69.52; p<0.001), 0.78 cm (95% CI: -1.22, -0.34; p=0.001) and 0.39 cm (95% CI: -0.70, -0.07; p=0.016), respectively. Maternal ETS exposure in the third trimester of pregnancy was associated with a non-significant increase in birth weight of 38.37 g (95% CI: -28.91, 105.64; p=0.263). Furthermore, maternal smoking cessation was associated with the increase of approximately 172 g in birth weight (95% CI: 50.00, 293.19). As such, there is an urgent need for increased public health awareness campaigns to encourage smoking cessation during pregnancy, in order to improve perinatal outcomes.

Chemoprevention with a tea from hawthorn (Crataegus oxyacantha) leaves and flowers attenuates colitis in rats by reducing inflammation and oxidative stress.

The purpose of the study was to determine the effects of a tea from the leaves and flowers of Crataegus oxyacantha in rats with colitis. Colitis was induced by administration of 2,4,6-trinitrobenzene sulfonic acid. Hawthorn tea (HT) (100 mg/kg) was given via gavage for 21 days and the mesalamine drug (100 mg/kg) was administrated during the period of disease onset. HT was rich in total phenolic compounds (16.5%), flavonoids (1.8%), and proanthocyanidins (1.5%); vitexin-2-O-rhamnoside was the main compound detected. Mesalamine and the HT diminished the length of the lesions formed in the colon, in addition to reducing the levels of myeloperoxidase and interleukin-1ß. Mesalamine was able to significantly reverse the body weight loss, while HT improved the activity of glutathione reductase and catalase. Histological scoring was not changed by the interventions, but it was highly correlated with the necrotic area. HT given at 100 mg/kg can be effective against colitis.

Breast and cervical cancer mortality in the western Amazon: A time series study between 1980 and 2014.

ABSTRACT: Among the main types of neoplasms in the female population, breast and cervical cancers are the most important due to their high morbidity and mortality rates. The mortality has been proportionally higher in developing countries. Analysis of the trend of cancer mortality in Brazil revealed a considerable difference in the pattern of deaths between the regions.To analyze the trend of mortality due to breast and cervical cancers in women.Retrospective study of a series of death cases, using secondary data from the mortality information system (SIM) of the Ministry of Health. The deaths were identified as the underlying cause of breast and cervical cancers, including malignant neoplasms of the uterus without other specifications, occurring from 1980 to 2014. Thus, the annual standardized age-specific mortality rates by the world population were applied. For trend analysis, regression models were utilized in which the mortality rates were considered dependent variables and years the independent variable. Polynomial regression models and a Prais-Winsten regression model were adopted.Cervical cancer presented a mortality rate ranging from 2.15 to 10.69 per 100,000 women from 1980 to 2014, with a tendency for stability.Breast cancer mortality rate varied from 3.81 to 11.47 per 100,000 women from 1981 to 2014, indicating a growing trend.There is a significant increase in the mortality rate for breast cancer and stability of cervical cancers in the State of Acre from 1980 to 2014, evidencing a concern in their care and monitoring. Above all, guaranteed access, especially to the population of women at social risk, and the search for effective screening should be emphasized in the formation of the care line and the Health Care Network in the State of Acre.

IL-6 and IL-10 in the serum and exfoliated cervical cells of patients infected with high-risk human papillomavirus.

Persistent infection by high-risk human papillomavirus (HR-HPV) is the main cause of cervical cancer and its precursor lesions. While some cytokines help immune cells in virus clearance, others contribute to the persistence of infection and neoplastic progression. Here, the levels of interferon (IFN)-γ, tumor necrosis factor (TNF)-α, interleukin (IL)-10, IL-6, IL-4, and IL-2 were quantified in the serum and exfoliated cervical cells (ECCs) of patients with HR-HPV, and the presence of IL-6+ cells was investigated in uterine cervix biopsies. Cytokine levels in the serum and ECCs of 26 HR-HPV DNA-positive patients and 18 HPV DNA-negative patients were measured using flow cytometry. Fifteen uterine cervix biopsy samples embedded in paraffin were subjected to immunohistochemical analysis for the detection of IL-6+ cells. HR-HPV-positive patients showed increased IL-6 and IL-10 in the ECCs and serum, respectively. Compared with HPV DNA-positive patients, HPV DNA-negative patients had higher levels of IL-6 in ECCs. Patients with multiple infections of HPV had higher levels of IL-6 in their ECCs than those with a single infection. Immunostaining of uterine cervix biopsy samples revealed no differences in IL-6 expression between the different classes of histopathological lesions. However, differences were observed in the expression levels of IL-6 and IL-10 at the systemic and local levels in HR-HPV-positive patients without cervical lesions. Considering the functional characteristics of these cytokines, it can be inferred that such patients are prone to persistent HPV infection.

Polyphenols from food by-products: An alternative or complementary therapy to IBD conventional treatments.

Inflammatory bowel diseases (IBD) are illnesses characterized by chronic intestinal inflammation and microbial dysbiosis that have emerged as a public health challenge worldwide. It comprises two main conditions: Crohn's disease and ulcerative colitis. Currently, conventional therapy to treat IBD are not free from side effects, such as liver and kidney toxicity, drug resistance, and allergic reactions. In view of this, there is growing research for alternative and complementary therapies that, in addition to acting in the prevention or the control of the disease, do not compromise the quality of life and health of individuals. In this sense, a growing body of evidence has confirmed the benefits of natural phenolic compounds in intestinal health. Phenolic compounds or polyphenols are molecules widely distributed throughout the plant kingdom (flowers, vegetables, leaves, and fruits), including plant materials remaining of the handling and food industrial processing, referred to in the scientific literature as by-products, food waste, or bagasse. Since by-products are low-cost, abundant, easily accessible, safe, and rich in bioactive compounds, it becomes an exciting option to extract, concentrate or isolate phenolic compounds to be posteriorly applied in the therapeutic approach of IBD. In this article, we have reviewed the main phenolic compounds present in various plants and by-products that have shown beneficial and/or promising effects in experimental pre-clinical, clinical, and in vitro research with IBD. In addition, we have mentioned and suggested several plants and by-products originated and produced in Latin America that could be part of future research as good sources of specific phenolic compounds to be applied in the prevention and development of alternative treatments for IBD. This review may offer a valuable reference for studies related to IBD administering phenolic compounds from natural, cheap, and easily accessible raw and undervalued materials.

Review on the potential application of non-phenolic compounds from native Latin American food byproducts in inflammatory bowel diseases.

Inflammatory bowel diseases (IBDs), mainly Crohn's disease and ulcerative colitis, are high-prevalent chronic gastrointestinal disorders that may cause an important reduction in life quality. Such diseases are characterized by their immune-mediated inflammatory, oxidative and dysbiotic events, which can lead to important symptoms in patients, such as abdominal pain, bloody diarrhea and body weicght loss. In the last years, alternative natural options have been postulated for the prevention or treatment of IBDs, since common drug therapy may not be well accepted due to recurrent adverse effects and/or partial efficacy. Among those new natural products, agro-industrial byproducts, such as the peel and seed of foods, are emerging as cheap and pro-ecological options, as they are rich in bioactive compounds, such as polyphenols, but also in non-phenolic compounds, like unsaturated fatty acids, dietary fibers and prebiotics, carotenoids, bioactive peptides, and vitamins. In that sense, Latin America is rich in little explored native fruits and vegetables, from which great amounts of byproducts can be produced. Studies have shown that the byproducts from Latin American vegetables, such as passion-fruit (Passiflora edulis), pineapple (Ananas comosus) and pumpkin (Cucurbita spp.), for example, could represent interesting tools against IBDs, judging by the results of in vitro and animal studies. Therefore, the aim of this review is to discuss the potential role of non-phenolic compounds from native Latin American food byproducts in the prevention or treatment of IBDs, by highlighting their anti-inflammatory, anti-oxidative and/or anti-dysbiotic effects.

Análise de mortalidade perinatal na Região Metropolitana da Grande Vitória, Espírito Santo, Brasil / Analysis of perinatal mortality in the Greater Vitória Metropolitan Region, Espirito Santo, Brazil

Introdução: A taxa de mortalidade perinatal é um importante indicador na hora de avaliar as condições de saúde materno infantil, afinal dizem muito a respeito das condições de saúde e da assistência que vem sendo prestada a população. Através desses números é possível identificar aspectos relacionados à saúde reprodutiva e à qualidade da assistência ofertada durante o pré-natal, o parto e ao recém-nascido e assim, traçar metas e desenvolver novas políticas, capazes de garantir melhor qualidade de vida para mãe e filho. Objetivo: Analisar a mortalidade perinatal na Região Metropolitana da Grande Vitória, Espírito Santo, ES, Brasil. Método: Trata-se de um estudo ecológico e descritivo, com abordagem quantitativa, realizado nos municípios da Região Metropolitana da Grande Vitória (RGMV) do Estado do Espírito Santo. A população do estudo será constituída dos óbitos perinatais (fetais e neonatais precoce) e dos óbitos infantis (pós-neonatal e neonatal-tardio). Resultado: No período de 2008 a 2017, a taxa de mortalidade perinatal no estado do Espirito Santo foi de 15,81:1000 nascimentos. Dentre os municípios que fazem parte da Região Metropolitana da Grande Vitoria, o município de Vitoria apresentou menor taxa de mortalidade, correspondendo a 11,50:1000 nascimentos e Fundão apresentou a maior taxa com 19,60:1000 nascimentos. Entre os municípios estudados, a taxa de mortalidade perinatal não apresentou diferença significante. Conclusão: A taxa de mortalidade perinatal na Região Metropolitana da Grande Vitoria no Estado do Espírito Santo não apresentou evolução significativa, os óbitos no período perinatal representam a grande parte do número de casos, sendo o município de Vitoria o com menor número de óbitos.

Introduction: Perinatal mortality is an important indicator when it comes to assessing maternal and child health conditions. It specifies health conditions and the assistance that has been provided to the population. Through these numbers, it is possible to identify aspects related to reproductive health and quality of care offered during prenatal care, childbirth and the newborn and thus, set goals and develop new policies, capable of guaranteeing a better quality of life for mothers and children. Objective: To analyze perinatal mortality in the Região Metropolitana da Grande Vitória, Espírito Santo, Brazil. Method: Ecological and descriptive study, with a quantitative approach, carried out in the municipalities of the Região Metropolitana da Grande Vitória (Greater Vitória Metropolitan Region) of the State of Espírito Santo, Brazil. It consists of perinatal deaths (fetal and early neonatal) and infant deaths (post-neonatal and late-neonatal). Results: In the period from 2008 to 2017, perinatal mortality rate in the state of Espirito Santo was 15.81/1000 births. Among the municipalities that are part of the Região Metropolitana da Grande Vitória, the municipality of Vitoria had the lowest mortality rate, corresponding to 11.50/1000 births and Fundão had the highest rate with 19.60/1000 births. Among the municipalities studied, the perinatal mortality rate was not statistically significant. Conclusion: The perinatal mortality rate in the Região Metropolitana da Grande Vitória, in the State of Espirito Santo, Brazil, did not show a significant evolution. However, deaths in the perinatal period represent a large part of the number of cases, with the municipality of Vitoria having the lowest number of deaths.

Risco e transmissão da Leishmaniose Visceral associada à prevalência da doença em Teresina-Piauí / Risk and transmission of Visceral Leishmaniasis associated with the prevalence of the disease in Teresina-Piauí

Identificar o risco de transmissão da Leishmaniose Visceral associada as condições de saneamento e à prevalência da doença em Teresina-Piauí. O estudo configura-se em pesquisa documental descritiva quantitativa, com dados extraídos do Sistema Nacional de Informação de Agravos e Notificação (SINAN/DATASUS), Sistema Nacional de Informações sobre Saneamento (SNIS) e do Centro de Zoonoses da cidade de Teresina. Segundo os dados do SINAN/DATASUS, foram registrados 345 casos de LV no município de Teresina, entre o período de 2013 a 2018. O ano que apresentou o maior número de casos foi 2013 (20%) e o menor 2018 (10,14%). Quanto à variável sexo, os indivíduos do sexo masculino foram os mais acometidos (70,14%), apresentou a maior ocorrência em indivíduos residentes da zona rural (90,72%) e de cor parda (90,43%). Em relação à LVC em Teresina, no período estudado o Centro de Zoonoses coletou 42.065 amostras de sangue, sendo que 67,07% delas foi sororreagente ao Teste Rápido e 32,93% sororreagentes ao Teste ELISA. Observou-se nos períodos de menor número de notificações da doença, houve um melhor abastecimento de água, esgoto e coleta de resíduos. Dessa forma foi possível perceber que a Leishmaniose visceral humana e canina relaciona-se com as questões sanitárias, uma vez que a falta de saneamento adequado contribui para a maior proliferação do vetor e por consequência aumento na quantidade de casos de Leishmaniose Visceral. Conclui-se que quantidade de casos de Leishmaniose Visceral Humana e Canina evoluiu de forma semelhante, levantando o risco de transmissão da doença no meio urbano.

The objective of this study is to identify the risk of transmission of Visceral Leishmaniasis (VL) associated with sanitation conditions and the prevalence of the disease in Teresina, Piauí. This was a quantitative, descriptive, documentary research study, with data extracted from the National Notifiable Diseases Information System (SINAN/DATASUS), National Sanitation Information System (NSIS), and the Center for Zoonoses of the city of Teresina. According to data from SINAN/DATASUS, 345 VL cases were registered in the city of Teresina, during the period of 2013 to 2018. The year with the highest number of cases was 2013 (20%) and the lowest in 2018 (10.14%). As for the gender variable, male individuals were the most affected (70.14%), and the highest occurrence was among rural residents (90.72%) and mixed-race individuals (90.43%). Regarding canine VL (CVL) in Teresina, during the study period, the Zoonoses Center collected 42,065 blood samples, 67.07% of which were seroreactive to the Rapid Test and 32.93% were seroreactive to the ELISA Test. In periods with fewer notifications of the disease, a better supply of water, sewage, and waste collection were observed. Thus, it is possible to see that human and canine visceral leishmaniasis are related to health issues, since the lack of adequate sanitation contributes to a greater proliferation of the vector and, consequently, an increase in the number of cases of VL. It is concluded that the number of cases of Human and Canine Visceral Leishmaniasis evolved in a similar way, raising the risk of disease transmission in urban areas.

Extraction of Flavonoids From Natural Sources Using Modern Techniques.

Flavonoids are one of the main groups of polyphenols found in natural products. Traditional flavonoid extraction techniques are being replaced by advanced techniques to reduce energy and solvent consumption, increase efficiency and selectivity, to meet increased market demand and environmental regulations. Advanced technologies, such as microwaves, ultrasound, pressurized liquids, supercritical fluids, and electric fields, are alternatives currently being used. These modern techniques are generally faster, more environmentally friendly, and with higher automation levels compared to conventional extraction techniques. This review will discuss the different methods available for flavonoid extraction from natural sources and the main parameters involved (temperature, solvent, sample quantity, extraction time, among others). Recent trends and their industrial importance are also discussed in detail, providing insight into their potential. Thus, this paper seeks to review the innovations of compound extraction techniques, presenting in each of them their advantages and disadvantages, trying to offer a broader scope in the understanding of flavonoid extraction from different plant matrices.

Tecnologia educativa para adolescentes: construção e validação de álbum seriado sobre sífilis adquirida / Educational technology for adolescents: construction and validation of an acquired syphilis flip chart / Tecnología educativa para adolescentes: construcción y validación de álbum ilustrado sobre sífilis adquirida

Objetivo: Construir e validar um álbum seriado sobre sífilis adquirida a ser utilizado como estratégia educativa para adolescentes. Métodos: Trata-se de um estudo do tipo metodológico realizado em Recife, Pernambuco, no período de novembro de 2018 a abril de 2019. Obtiveram-se dados provenientes de 22 juízes especialistas para validação de aparência e conteúdo do álbum seriado e de 40 adolescentes de uma escola pública, os quais avaliaram o álbum quanto à aparência. Analisou-se a validade de conteúdo considerando: o Item ­ Level Content Validity Index (I-CVI); a concordância entre os juízes, por meio do coeficiente de correlação intraclasse (ICC); e a validade de aparência, usando o Suitability Assessment of Materials (SAM). Utilizou-se o software Statistical Package for the Social Sciences (SPSS) para análise. Resultados: O álbum seriado possui 20 páginas e contém orientações sobre a sífilis adquirida. A média do I-CVI foi de 0,97 pelos juízes especialistas; constatando-se como excelente nível de concordância entre as respostas. A partir do formulário o SAM, o álbum foi julgado como superior, obtendo uma média de 80,99% entre os juízes, sendo recomendada sua utilização pelo público ao qual se destina. Houve unanimidade pelos adolescentes na aprovação do material, julgando ser claro, de fácil compreensão e relevante. Conclusão: O álbum seriado foi construído e validado em seu conteúdo e aparência por juízes e, quanto à aparência, pelo público-alvo, podendo ser utilizado com adolescentes no ambiente escolar ou em outras realidades.

Objective: To construct and validate an acquired syphilis flip chart to be used as an educational strategy for adolescents. Methods: This methodological study was carried out in Recife, Pernambuco, from November 2018 to April 2019. Data were collected from 22 expert judges to validate the appearance and content of the flip chart and 40 adolescents from a public school who evaluated the album for appearance. The content validity was analyzed using the Item ­ Level Content Validity Index (I-CVI) and agreement between the judges using the Intraclass Correlation Coefficient (ICC). The appearance validity was analyzed using the Suitability Assessment of Materials (SAM). The Statistical Package for the Social Sciences (SPSS) software was used for analysis. Results: The flip chart has 20 pages and contains guidelines on acquired syphilis. The mean I-CVI measured by the expert judges was 0.97, with an excellent level of agreement between the responses. According to the SAM form, the flip chart met superior criteria, with a mean score of 80.99% among the judges, and its use was recommended by the target audience. The adolescents unanimously approved the material, believing it to be clear, easy to understand and relevant. Conclusion: The flip chart was constructed, and judges validated its content and appearance and the target audience validated its appearance. It can be used with adolescents in the school environment or in other realities.

Objetivo: Construir y validar un álbum ilustrado sobre la sífilis adquirida para utilizarla como estrategia educativa para adolescentes. Métodos: Se trata de un estudio del tipo metodológico realizado en Recife, Pernambuco, en el período entre noviembre de 2018 y abril de 2019. Se recogieron datos de 22 jueces especialistas para la validación de la apariencia y del contenido del álbum ilustrado y de 40 adolescentes de una escuela pública los cuales evaluaron la apariencia del álbum. Se analizó la validez del contenido considerándose el Item ­ Level Content Validity Index (I-CVI); la concordancia entre jueces a través del coeficiente de correlación intraclase (ICC); y la validez de la apariencia usando el Suitability Assessment of Materials (SAM). Se utilizó el software Statistical Package for the Social Sciences (SPSS) para el análisis. Resultados: El álbum ilustrado tiene 20 páginas y orientaciones sobre la sífilis adquirida. La media del I-CVI ha sido de 0,97 de parte de los jueces especialistas, constatándose como excelente nivel de concordancia entre las respuestas. El álbum ha sido considerado como superior por el formulario SAM con una media del 80,99% entre los jueces y la recomendación de su utilización por el público de destino. Hubo unanimidad de los adolescentes para la aprobación del material considerándolo claro, de fácil comprensión y relevante. Conclusión: El álbum ilustrado ha sido construido e validado por jueces por su contenido y apariencia y solo por la apariencia por el público investigado y puede ser utilizado con adolescentes en su entorno escolar o en otras realidades.

Oncogenic high-risk human papillomavirus in patients with full denture.

Human Papillomavirus (HPV) has considerable tropism for epithelial and mucosal tissues and can therefore be found in several anatomical sites, including the oral cavity. This study aimed to investigate the presence of HPV-DNA and the most frequent viral types in patients using full dentures, compare to patients not using full dentures and to associate its presence with socio-epidemiological and behavioral factors. The study consisted of 90 patients with or without full dentures at the time of collection, treated at a public dental clinic. The samples were obtained by exfoliating the oral cavity, and analyzed for HPV-DNA using the nested PCR with PGMY09/11 (450-bp), and general primers GP5+/GP6+ (150-bp). Genotyping was performed by specific-type PCR to HPV 6, 11, 16, 18, 31, 33, and 45; and Restriction Fragment Length Polymorphism (RFLP). Pearson's Chi-square test (x 2 ) or Fisher's exact test were applied and significant variables in these tests were analyzed by multinomial logistic regression analysis to estimate odds ratio (OR). HPV-DNA was detected in 27.7% of samples and, among those obtained from patients using full dentures, positivity for HPV-DNA was 41.9% (p = 0.025). The most frequent viral types were low-risk HPV 6 and 11, and high-risk HPV 31 and 45. Patients who used full dentures had an odds ratio of 2.1 to be positive for HPV DNA. Our results indicate the need for periodic dental follow-up of patients with full dentures in order to preserve the basic conditions of oral health, and also to monitor the appearance of lesions with malignant potential.

Hypertensive Disorders during Pregnancy and Risk of Bronchopulmonary Dysplasia in Very Preterm Infants.

INTRODUCTION: It is not yet fully known whether hypertensive disorders (HTD) during pregnancy impose an increased risk of development of bronchopulmonary dysplasia (BPD) in preterm newborn infants. OBJECTIVE: To test the hypothesis that preeclampsia and other HTD are associated with the development of BPD in preterm infants. MATERIALS AND METHODS: Data on mothers and preterm infants with gestational age 24 to 30 weeks were prospectively analyzed in 11 Portuguese level III centers. Statistical analysis was performed using IBM SPSS statistics 23. RESULTS: A total of 494 preterm infants from 410 mothers were enrolled, and 119 (28%) of the 425 babies, still alive at 36 weeks, developed BPD. The association between chronic arterial hypertension, chronic arterial hypertension with superimposed preeclampsia, and gestational hypertension in mothers and BPD in preterm infants was not significant (p = 0.115; p = 0.248; p = 0.060, respectively). The association between preeclampsia-eclampsia and BPD was significant (p = 0.007). The multivariate analysis revealed an association between preeclampsia-eclampsia and BPD (odds ratio [OR] = 4.6; 95% confidence interval [CI] 1.529-13.819; p = 0.007) and a protective effect for BPD when preeclampsia occurred superimposed on chronic arterial hypertension in mothers (OR = 0.077; 95%CI 0.009-0.632; p = 0.017). CONCLUSION: The results of this study support the association of preeclampsia in mothers with BPD in preterm babies and suggest that chronic hypertension may be protective for preterm babies.