Self-mutilation: a systematic review.

Self-mutilation lesions can represent a clinical diagnosis challenge for healthcare professionals, as patients do not admit to self-mutilation. This leads to failed diagnoses due to the similarity of this condition to other diseases. Searches on the subject were carried out at the PubMed, Periódicos Capes, Scopus, Science Direct and WoS databases, according to the following inclusion criteria: articles in English, Portuguese or Spanish, published from 2018 to June 2023, encompassing case reports, case series and literature reviews. Men are slight more affected by self-mutilation injuries, also presenting the most serious lesions. Self-mutilation injuries are reported globally, mostly in the Asian and American continents. Clinical presentations are varied, but morphology is, in most cases, associated to the form/instrument used for self-mutilation. Greater evidence of diagnosed mental disorders in women and underreporting of these cases in men due to low demands for specialized treatment are noted. A higher prevalence of self-mutilation lesions was verified for men, affecting a wide age range, with the highest number of cases in the USA. The most affected body areas are arms and external genitalia, mostly due to knife use. An association between self-mutilation injuries and mental disorders is clear, with most cases being previously undiagnosed.

Development and validation of an LC-ESI-QTOF-MS method to measure cefepime in the plasma and peritoneal fluid of rats using microdialysis: Application in a pilot pharmacokinetic study.

Cefepime (CEF) is a cephalosporin and can be administered in secondary peritonitis together with metronidazole to treat sepsis. This study aimed to develop and validate an LC-ESI-QTOF-MS method for the quantification of cefepime in the plasma and peritoneal microdialysate of healthy Wistar rats. Chromatographic separation was performed using a CLC-ODS C18 column (250 × 4.6 mm), a C18 pre-column (4 mm, 5 µm) and isocratic elution. Gallic acid was used as the internal standard. The mobile phase consisted of (A) ultrapure water (pH adjusted to 3.5) and (B) acetonitrile (80:20, v/v) at 0.8 ml/min. Quantification was performed using a mass spectrometer with electrospray ionization in positive mode to monitor ions with m/z 481.1322 (CEF) and m/z 171.0288 (IS). The method was validated for selectivity, precision, accuracy, linearity, stability, lower limit of quantification, carryover, recovery and matrix effect. Calibration was done in the ranges 1-40 and 1-100 µg/ml for the peritoneal microdialysate and plasma, respectively. Plasma extraction recovery ranged from 93.9 to 99.9%. The technique was validated and successfully applied in a pilot pharmacokinetic study for estimating the free concentration of CEF in the peritoneal microdialysate of rats for the first time.

Four almost unexplored species of Brazilian Connarus (Connaraceae): Chemical composition by ESI-QTof-MS/MS-GNPS and a pharmacologic potential.

INTRODUCTION: Species of Connaraceae are globally used in traditional medicines. However, several of these have not been studied regarding their chemical composition, and some are even at risk of extinction without proper studies. Therefore, the chemical composition and pharmacological potential of Connarus blanchetii Planch., Connarus nodosus Baker, Connarus regnellii G. Schellenb., and Connarus suberosus Planch., which were previously unknown, were analyzed. OBJECTIVE: This work aims to investigate the pharmacological potential of these four Connarus species. The chemical composition of different extracts was determined by high-resolution mass spectrometry (HRMS), with subsequent analysis by the GNPS platform and competitive fragmentation modeling (CFM). MATERIALS AND METHODS: Leaf extracts (C. blanchetii, C. nodosus, C. regnellii, and C. suberosus) and bark extracts (C. regnellii and C. suberosus) were obtained by decoction, infusion, and maceration. LC/HRMS data were submitted to the GNPS platform and evaluated using CFM in order to confirm the structures. RESULTS: The HRMS-GNPS/CFM analysis indicated the presence of 23 compounds that were mainly identified as phenolic derivatives from quercetin and myricetin, of which 21 are unedited in the Connarus genus. Thus, from the analyses performed, we can identify different compounds with pharmacological potential, as well as the most suitable forms of extraction. CONCLUSION: Using HRMS-GNPS/CFM, 21 unpublished compounds were identified in the studied species. Therefore, our combination of data analysis techniques can be used to determine their chemical composition.

Religious coping methods predict depression and quality of life among end-stage renal disease patients undergoing hemodialysis: a cross-sectional study.

BACKGROUND: Poor quality of life (QOL) and a high prevalence of depression have been identified among end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). We aimed to evaluate the associations between religious/spiritual (R/S) coping methods and both QOL and depression among ESRD patients undergoing hemodialysis (HD). METHODS: The sample included 161 ESRD patients over 18 years of age who had been undergoing HD for more than 3 months. R/S coping methods were assessed using the Religious Coping Questionnaire (RCOPE). The RCOPE generates scores (from 1 to 5) for positive and negative R/S coping methods. The higher the score, the more frequent the use of that coping method. Depression was evaluated using the 20-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). Scores on the CES-D range from 0 to 60. A cutoff of 18 was used to define depression. QOL was evaluated using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36); this survey was used to generate scores for the eight dimensions of QOL, which can vary from 0 (worst) to 100 (best). RESULTS: We identified a depression prevalence of 27.3%. Positive R/S coping scores were higher among non-depressed than depressed patients (2.98 vs. 2.77; p = 0.037). Positive R/S coping scores were negatively correlated with depression scores (r = -0.200; p = 0.012) and were an independent protective factor for depression (OR = 0.13; CI 95% = 0.02-0.91; p = 0.039). Regarding QOL, a positive correlation was identified between positive R/S coping scores and scores related to general health (r = 0.171; p = 0.030) and vitality (r = 0.183; p = 0.019), and an inverse correlation was identified between negative R/S coping scores and scores in the social functioning (r = -0.191; p = 0.015) and mental health (r = -0.214; p = 0.006) dimensions. In addition, positive R/S coping scores were an independent predictor of higher scores in the bodily pain (ß = 14.401; p = 0.048) and vitality (ß = 12.580; p = 0.022) dimensions. In contrast, negative R/S coping scores independently predicted lower social functioning scores (ß = -21.158; p = 0.017). CONCLUSIONS: Our results provide further evidence suggesting that R/S coping methods may be associated with QOL and depression among HD patients. In our opinion, the use of religious resources should be encouraged among HD patients, and psycho-spiritual interventions should be attempted to target religious struggles (negative R/S coping) in patients undergoing HD.

Prevention and Treatment of Anemia in Infants through Supplementation, Assessing the Effectiveness of Using Iron Once or Twice Weekly.

BACKGROUND: The objective of this study was to compare the effect of once weekly iron supplementation (IS) versus twice weekly, on hemoglobin (Hb) levels and anemia prevalence. METHODS: In this cluster-randomized clinical trial study, we evaluated infants aged 6-18 months. Length of intervention: 16 weeks. Infants were cluster randomized to either 25 mg elemental iron once weekly (Group-A) or twice weekly (Group-B). Primary outcome variables were change in Hb concentration and anemia prevalence. Two biochemical evaluations were performed to determine Hb concentrations, before and after intervention. RESULTS: For Group-A, at baseline, mean Hb concentration was 10.8 ± 1.18 g/dl and after intervention 11.2 ± 1.07 g/dl,p = 0.12; anemia prevalence was 52.5% at baseline and 37.5% after intervention,p = 0.18; Group-B, mean baseline Hb was 10.7 ± 1.04 g/dl, and 11.3 ± 0.91 g/dl after intervention,p = 0.002; anemia prevalence reduced from 57.9 to 36.8%. CONCLUSIONS: Both once and twice weekly IS increased mean Hb concentration; however, twice weekly supplementation provided more significant results.

Characterization of Tn3000, a Transposon Responsible for blaNDM-1 Dissemination among Enterobacteriaceae in Brazil, Nepal, Morocco, and India.

In Enterobacteriaceae, the blaNDM genes have been found in many different genetic contexts, and a wide diversity of plasmid scaffolds bearing those genes has been found. In August 2013, we identified NDM-1-producing Escherichia coli and Enterobacter hormaechei strains from a single rectal swab sample from a patient hospitalized in Rio de Janeiro, Brazil, who had no history of travel abroad. Complete DNA sequencing using the Illumina platform and annotation of the two plasmids harboring the blaNDM-1 gene, one from each strain, showed that they belonged to incompatibility groups IncFIIK and IncX3 and harbored a novel transposon named Tn3000. Similar genetic structures have been identified among other isolates in Brazil but also on plasmids from other continents. Our findings suggest that the blaNDM-1 gene may be transmitted by Tn3000 in different parts of the world.

Volaemic status and dyspepsia in end-stage renal disease patients.

AIM: Studies in animals show a relationship between extracellular volume and gastrointestinal motility. End-stage renal disease (ESRD) patients present fluid overload and frequent dyspeptic symptoms. We looked for an association between volaemic status and dyspepsia among ESRD patients undergoing haemodialysis (HD). METHODS: We studied 155 ESRD patients on HD. Their volaemic status was evaluated using bioimpedance analysis. Fluid overload (FO) in litres and relative fluid overload (rFO) in percentage were calculated. rFO > 15% was classified as hypervolaemia. Dyspepsia was assessed through the Porto Alegre Dyspeptic Symptoms Questionnaire (PADYQ). PADYQ scores equal to or greater than 6 classified patients as dyspeptic. Characteristics of patients with and without dyspepsia were compared. Pearson's test was used to test the correlation between continuous variables. Multivariate linear and logistic regressions were performed to test FO as predictor of dyspepsia score and the presence of dyspepsia. RESULTS: There were 64 (41.2%) patients with dyspepsia. Dyspeptics presented higher FO (2.5 ± 1.8 L vs 1.0 ± 1.8 L; P < 0.001) and higher rFO (16 ± 9.9% vs 4.8 ± 12.0%; P < 0.001). Dyspepsia score was positively correlated with FO (r = 0.300; P < 0.001) and with rFO (r = 0.256; P = 0.001). There were more patients with hypervolaemia among dyspeptics compared to non-dyspeptics (65.6% vs 17.6%; P < 0.001). FO was an independent predictor of dyspepsia score (b = 1.036; P < 0.001) and the presence of dyspepsia (OR = 2.00, 95% CI = 1.55-2.50; P < 0.001). CONCLUSION: Hypervolaemia is associated with dyspepsia among ESRD patients on HD.

Acute kidney injury in an intensive care unit of a general hospital with emergency room specializing in trauma: an observational prospective study.

BACKGROUND: Acute kidney injury (AKI) is common among intensive care unit (ICU) patients and is associated with high mortality. Type of ICU, category of admission diagnosis, and socioeconomic characteristics of the region can impact AKI outcomes. We aimed to determine incidence, associated factors and mortality of AKI among trauma and non-trauma patients in a general ICU from a low-income area. METHODS: We studied 279 consecutive patients in an ICU during a follow-up of one year. Patients with less than 24-hour stay in the ICU and with chronic kidney disease were excluded. AKI was classified according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria in three stages. Comparisons were performed by the Student-t and Mann-Whitney tests for continuous variables, respectively with and without normal distribution. Comparisons of frequencies were carried out by the Fisher test. Multivariate logistic regression was used to test variables as predictors for AKI and death. RESULTS: Admission categories were proportionally divided into 51.6% of non-trauma diagnosis and 48.4% of trauma cases. Most trauma cases involved brain injury (79.5%). The overall incidence of AKI was 32.9%, distributed among the three stages: 33.7% stage 1, 29.4% stage 2 and 36.9% stage-3. Patients who developed AKI were older, had more diabetes, stayed longer in the ICU, presented higher APACHE II and more often needed mechanical ventilation and use of vasopressors. In comparison with non-trauma cases, trauma patients had a greater prevalence of males, higher APACHE II score, higher urine output, and younger age. There was no difference concerning development of AKI and crude mortality between trauma and non-trauma patients. Age, presence of diabetes, APACHE score and use of vasopressors were independent predictors for AKI, and AKI increased the risk of death ten-fold (OR = 14.51; CI 95% = 7.94-26.61; p < 0.001). CONCLUSIONS: There was a high incidence of AKI in this study. AKI was strongly associated with mortality both among trauma and non-trauma patients. Trauma cases, especially brain injury due to traffic accidents involving motorized two-wheeled vehicles, should be seen as an important preventable cause of AKI.

Dyspepsia is Associated with Low Protein and Caloric Intake among End-Stage Renal Disease Patients.

BACKGROUND: Dyspepsia is highly prevalent and easily assessed in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) and is not a traditional predictor of malnutrition. We sought to establish an association between dyspeptic symptoms and nutritional status in ESRD patients undergoing maintenance HD. METHODS: We studied 106 ESRD patients on HD. Dyspepsia was assessed through the Porto Alegre Dyspeptic Symptoms Questionnaire (PADYQ). Scores equal to or greater than 6 classified patients as dyspeptic. Nutritional status was evaluated using serum chemistry, total body mass, muscle mass, and dietary intake. Nutritional status was compared between dyspeptic and non-dyspeptic patients. The association of PADYQ scores and the presence of dyspepsia with nutritional variables were tested. Multivariate analysis was performed to test dyspepsia as an independent predictor for dietary intake. RESULTS: There were 41 (38.7 %) dyspeptics. Protein intake (g/kg/day) and calorie intake (kcal/kg/day) were lower among dyspeptics compared to non-dyspeptics, 1.0 ± 0.5 vs 1.3 ± 0.5 (p = 0.01) and 23.0 ± 9.2 vs 27.4 ± 10.0 (p = 0.02), respectively. More dyspeptics than non-dyspeptics presenting protein-energy wasting based on protein and calorie intake, 41.4 vs 15.3 % (p = 0.01) and 68.2 vs 38.4 % (p = 0.02), respectively. PAQYQ score was negatively correlated with protein intake (r = - 0.20; p = 0.03) and calorie intake (r = - 0.19; p = 0.04). Dyspepsia was able to predict protein (b = - 0.26; p = 0.01) and calorie (b = - 4.42; p = 0.02) intake. CONCLUSIONS: Dyspepsia is associated with low protein and calorie intake. Screening of dyspeptic symptoms can be routinely performed aiming to improve HD patients' nutritional status.

Distribution of phoretic mites and lice in Pseudolynchia canariensis living on pigeons and the relationship with seasonality, carrier sex, plumage coloration and age of definitive hosts.

Among the parasites, some groups that have a limited capacity for locomotion, such as mites and lice, the transmission is challenging to win. These ectoparasites disperse through direct contact between hosts or, in some cases, through phoresy. However, these processes are not well-documented in detail because they are difficult to observe and quantify. In the present study, the patterns of distribution of skin mites and phoretic lice on hippoboscid louse fly Pseudolynchia canariensis sampled from Columba livia were evaluated. The analyzed pigeons were juveniles and adults, with three distinct plumage colors: blue checker, spread, or wild type, and were caught over 24 months. A total of 1,381 hippoboscid flies were collected on 377 hosts. The plumage color did not influence the infestation patterns of louse flies on juvenile and adult pigeons, nor did it influence the infestation patterns of skin mites and phoretic lice on the hippoboscid flies. However, the environmental temperature was directly related to higher prevalence, mean infestation intensity, and phoretic species richness on P. canariensis during the hottest seasons. Furthermore, a higher abundance of phoretic mite eggs, including embryonated eggs, was observed in females of P. canariensis in all seasons.

Social adaptability and substance abuse: predictors of depression among hemodialysis patients?

BACKGROUND: Several aspects linked to social are involved in the onset of depressive feelings. We aimed to find out if social adaptability and substance abuse predict depression among end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). METHODS: We included 145 ESRD patients undergoing HD. Social adaptability was estimated by the Social Adaptability Index (SAI). Substance abuse was defined according to SAI. We screened for depression by applying the 20-item version of the Center for Epidemiologic Studies Depression Scale. A score ≥ 24 classified the patients as depressed. Comparisons between depressed and non-depressed patients were carried out and logistic regression was performed to test gender, age, total SAI, SAI without the substance abuse item, only the substance abuse score and substance abuse as a categorical variable (yes/no) as predictors of depression. RESULTS: There were 36 (24.8%) depressed patients. There were no differences regarding demographic and laboratory data between the depressed and non-depressed patients. Mean SAI among depressed and non-depressed patients was, respectively, 6.1 ± 1.6 vs. 6.2 ± 1.9 (p=0.901). The percentage of patients with or without substance abuse among depressed patients was, respectively, 13.8% vs. 13.9% (p=1.000). Gender, age, total SAI, SAI without the substance abuse item, only the substance abuse score and substance abuse as a categorical variable did not predict depression. CONCLUSIONS: Social adaptability and substance abuse did not predict depression in HD patients. We propose that aspects related to socioeconomic status not comprised in SAI items should be ruled out as predictors of depression.

Dyspepsia and gastric emptying in end-stage renal disease patients on hemodialysis.

BACKGROUND: Dyspepsia is common among end-stage renal disease (ESRD) patients and its association with delayed gastric emptying is not well established. We assessed the association of dyspepsia with gastric emptying time in ESRD patients undergoing hemodialysis (HD). METHODS: Dyspepsia was assessed through the Porto Alegre Dyspeptic Symptoms Questionnaire (PADYQ). PADYQ's scores ≥ 6 classified participants as dyspeptic. The octanoic acid breath test using ¹³carbon was employed to assess the gastric emptying time. Based on the test, time in minutes to metabolize the first half of the ¹³carbon in the test meal (t1/2) was calculated. Association of dyspepsia with gastric emptying time was tested by the correlation between PADYQ scores and t1/2, and also by comparing t1/2 between dyspeptics and non-dyspeptics. RESULTS: There were 34 (68.0%) dyspeptic patients. Dyspepsia score was positively correlated with t1/2 (r = 0.366; p = 0.009). Dyspeptics had longer t1/2 compared to non-dyspeptics, respectively, 238.0 ± 92.9 versus 185.5 ± 45.5 minutes (p = 0.042). CONCLUSIONS: Delayed gastric emptying was associated with dyspepsia. Prokinetic medications could have a role in preventing or relieving dyspeptic symptoms among HD patients. Future research in larger samples is necessary to confirm this association.

Community of arthropod ectoparasites of two species of Turdus Linnaeus, 1758 (Passeriformes: Turdidae) in southern Rio Grande do Sul, Brazil.

This study was aimed at describing the community of arthropod ectoparasites associated with sympatric populations of Turdus amaurochalinus and Turdus rufiventris and analyzing the aggregation patterns of the chewing lice species, during reproductive and nonreproductive periods, of both Turdus species in three areas of the Atlantic forest in southern Rio Grande do Sul state (RS), Brazil. Altogether, we captured 36 specimens of T. amaurochalinus and 53 specimens of T. rufiventris. We identified two families of chewing lice, Menoponidae and Philopteridae, with Myrsidea and Brueelia as the most prevalent and abundant on both host birds. The lowest aggregation levels of chewing lice Myrsidea and Brueelia occurred during the reproductive period of both host species, suggesting a reproductive synchronization and a dispersion period. The most prevalent feather mite on T. amaurochalinus was Proctophyllodes weigoldi, and on T. rufiventris, Trouessartia serrana. Analges sp. and Pteronyssoides sp. were not observed on T. rufiventris. We identified three species of ticks; Ixodes auritulus was the most prevalent and abundant on the birds. Ornithoica vicina was the only hippoboscid fly collected, and only on T. amaurochalinus. The richness of ectoparasites was greater on T. amaurochalinus than on T. rufiventris. For T. amaurochalinus, the mean richness was lesser in winter compared to spring and autumn; however, we observed no variation in the mean richness of ectoparasites for T. rufiventris during the same seasons.

Daily and Weekly Iron Supplementations are Effective in Increasing Hemoglobin and Reducing Anemia in Infants.

OBJECTIVE: The objective of this study was to evaluate the effect of daily and weekly iron supplementation compared with control on hemoglobin values and anemia prevalence in infants. METHODS: In this cluster-randomized study, we evaluated infants aged 12-24 months (n = 210) from three public daycare centers, during 4 months. Intervention-group A was allocated 25 mg elemental iron once weekly; intervention-group B received 12.5 mg elemental iron once daily; control-group C received 0.5 ml of a natural color additive. Hemoglobin was assessed before and after intervention. RESULTS: Baseline mean hemoglobin was 8.81 ± 0.89 g/dl (group A), 9.70 ± 1.56 g/dl (group B) and 10.96 ± 0.92 g/dl (group C); after intervention, mean hemoglobin was 10.03 ± 0.78 g/dl (p < 0.0001), 10.65 ± 0.97 g/dl (p < 0.0001) and 11.30 ± 0.80 g/dl (p = 0.0034) for groups A, B and C, respectively. Anemia prevalence was as follows: group A, 100% at baseline and 83.3% at end of study, p = 0.0001; group, B 75.0% and 41.7%, p = 0.0002; group C, 50.0% and 37.5%, p = 0.182. CONCLUSIONS: Weekly and daily iron supplementation were effective in increasing hemoglobin levels and reducing anemia in infants.

Quality of life among women with sexual dysfunction undergoing hemodialysis: a cross-sectional observational study.

BACKGROUND: Sexual function among women undergoing hemodialysis (HD) is under-studied and there is no consensus about the effect of sexual dysfunction (SD) on their quality of life (QoL). We aimed to determine the prevalence of SD and to compare QoL between women undergoing maintenance HD with and without SD. METHODS: We included female end-stage renal disease (ESRD) patients undergoing HD during June 2011 in the only renal unit in the north of Ceará state, northeastern Brazil. The criteria for inclusion were age between 18 and 55, at least three months on dialysis and being sexually active. Women using antidepressant medication were excluded. We used the Female Sexual Function Index (FSFI), which evaluates six domains of sexual function, including desire, arousal, lubrication, orgasm, satisfaction and pain. The patients were classified as presenting SD if the total FSFI score was less than 26. For QoL evaluation, we used the validated Brazilian version of SF-36. This is a widely used 36-item questionnaire covering eight dimensions of QoL. Demographic data, time on dialysis, underlying etiology of ESRD, and laboratory measures were assessed in unit records. RESULTS: Of a total of 58 women, 46 (79.3%) presented SD. There were lower scores related to physical functioning (48.2 vs. 71.2; p = 0.007), bodily pain (45 vs. 67.5; p = 0.010), vitality (52.1 vs. 69.1; p = 0.026) and social functioning (57.2 vs. 76.1; p = 0.034) among women with SD compared to women without SD. Physical functioning and role-physical presented positive linear correlation with FSFI scores, respectively, r = 0.322 (p = 0.013) and r = 0.345 (p = 0.007). CONCLUSION: The prevalence of SD among women on HD is very high, reaching nearly 80%. Women on HD with SD had worse QoL, especially physical aspects of QoL, when compared to women without SD. Therefore, approaches aiming to improve QoL among women undergoing HD should be considered.

Use of iron-fortified rice reduces anemia in infants.

Food fortification is advocated to tackle iron deficiency in anemic populations. Our objective was to evaluate the impact of iron-fortified rice (Ultrarice(®)) weekly on hemoglobin and anemia levels compared with standard rice (control). This cluster-randomized study deals with infants (10-23 months) from two public child day care centers in Brazil, n = 216, in an 18 week intervention. The intervention group received individual portions of fortified rice (50 g) provided 56.4 mg elemental/Fe. For intervention center: baseline mean hemoglobin was 11.44 ± 1.07 g/dl, and after intervention 11.67 ± 0.96 g/dl, p < 0.029; for control: baseline mean hemoglobin value was 11.35 ± 4.01 g/dl, and after intervention 11.36 ± 2.10 g/dl, p = 0.986. Anemia prevalence for intervention center was 31.25% at baseline, and 18.75% at end of study, p = 0.045; for control 43.50% were anemic at baseline, and 37.1% at the end of study, p = 0.22. Number Needed to Treat was 7. Iron-fortified rice was effective in increasing hemoglobin levels and reducing anemia in infants.

Shockwave Therapy Plus Eccentric Exercises Versus Isolated Eccentric Exercises for Achilles Insertional Tendinopathy: A Double-Blinded Randomized Clinical Trial.

BACKGROUND: There remains a lack of consensus regarding the treatment of Achilles insertional tendinopathy. The condition is typically treated with eccentric exercises despite the absence of satisfactory and sustained results. Shockwave therapy was presented as an alternative, but there is a paucity of literature, with good outcomes, supporting its use. The purpose of the present single-center, double-blinded, placebo-controlled, randomized trial was to determine if the use of shockwave therapy in combination with eccentric exercises improves pain and function in patients with Achilles insertional tendinopathy. METHODS: A total of 119 patients with Achilles insertional tendinopathy were evaluated and enrolled in the study from February 2017 to February 2019. Patients were allocated to 1 of 2 treatment groups, eccentric exercises with extracorporeal shockwave therapy (SWT group) and eccentric exercises with sham shockwave therapy (control group). Three sessions of radial shockwaves (or sham treatment) were performed every 2 weeks and eccentric exercises were undertaken for 3 months. The primary outcome was the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) at 24 weeks. Secondary outcomes included the visual analogue scale, algometry, the Foot and Ankle Outcome Score, and the 12-Item Short Form Health Survey. RESULTS: Both groups showed significant improvement during the study period; however, there were no between-group differences in any of the outcomes (all p >0.05). At the 24-week evaluation, the SWT group exhibited a mean VISA-A of 63.2 (95% confidence interval, 8.0) compared with 62.3 (95% confidence interval, 6.9) in the control group (p = 0.876). There was a higher rate of failure (38.3%) but a lower rate of recurrence (17.0%) in the SWT group compared with the control group (11.5% and 34.6%, respectively; p = 0.002 and p = 0.047). There were no complications reported for either group. CONCLUSIONS: Extracorporeal shockwave therapy does not potentiate the effects of eccentric strengthening in the management of Achilles insertional tendinopathy. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Parametric evaluation of impedance curve in radiofrequency ablation: A quantitative description of the asymmetry and dynamic variation of impedance in bovine ex vivo model.

Radiofrequency ablation (RFA) is a treatment for liver tumors with advantages over the traditional treatment of surgical resection. This procedure has the shortest recovery time in early stage tumors. The objective of this study is to parameterize the impedance curve of the RFA procedure in an ex vivo model by defining seven parameters (t1/2, tminimum, tend, Zinitial, Z1/2, Zminimum and Zend). Based on these parameters, three performance indices are defined: one to identify the magnitude of impedance curve asymmetry (δ), one Drop ratio (DR) describing the percentage of impedance decrease until the minimum impedance point is reached, and Ascent Ratio (AR) describing the magnitude of increase in impedance from the minimum impedance point to its maximum point. Fifty ablations were performed in a bovine ex vivo model to measure and evaluate the proposed parameters and performance index. The results show that the groups had an average δ of 29.02%, DR of 22.41%, and AR of 545.33% for RFA without the use of saline or deionized solutions. The saline solution and deionized water-cooled groups indicated the correlation of performance indices δ, DR, and AR with the obtained final ablation volume. Therefore, by controlling these parameters and indices, lower recurrence is achieved.

Physical and pulmonary capacities of individuals with severe coronavirus disease after hospital discharge: A preliminary cross-sectional study based on cluster analysis.

OBJECTIVE: This study aimed to analyze the physical and pulmonary capacities of hospitalized patients with severe coronavirus disease and its correlation with the time of hospitalization and complications involved. METHODS: A total of 54 patients, aged ≥18 years of both sexes, were evaluated 2-4 months after hospital discharge in São Paulo, Brazil. The physical characteristics analyzed were muscle strength, balance, flexibility, and pulmonary function. The K-means cluster algorithm was used to identify patients with similar physical and pulmonary capacities, related to the time of hospitalization. RESULTS: Two clusters were derived using the K-means algorithm. Patients allocated in cluster 1 had fewer days of hospitalization, intensive care, and intubation than those in cluster 2, which reflected a better physical performance, strength, balance, and pulmonary condition, even 2-4 months after discharge. Days of hospitalization were inversely related to muscle strength, physical performance, and lung function: hand grip D (r=-0.28, p=0.04), Short Physical Performance Battery score (r=-0.28, p=0.03), and forced vital capacity (r=-0.29, p=0.03). CONCLUSION: Patients with a longer hospitalization time and complications progressed with greater loss of physical and pulmonary capacities.

Synthesis, chemical characterization and DNA interaction study of new diclofenac and ibuprofen zinc (II)-nicotinamide ternary complexes as cyclooxygenase inhibitor prototypes.

In the search for new drugs, strategies such as bioisosterism have been evidenced, in which the modification of molecules is already known to be active. Thus, metal complexes of known drugs have been highlighted, with examples of significant improvements in therapeutic efficacy. In this way, this work aimed at the synthesis of new zinc complexes with nonsteroidal anti-inflammatory drugs (NSAIDs), as well as the chemical characterization and the previous toxicity by cytotoxicity with Artemia salina, and evaluating the ability of these compounds to interact with DNA. As result, two new zinc II ternary complexes containing the NSAIDs diclofenac (Diclof) and ibuprofen (Ibup) and nicotinamide neutral linker (Nic) were obtained by the two-step solvent metal-ligand complexation method. Molecular structures were determined by NMR, FTIR, HR-MS, UV-Vis and X-ray diffraction, which demonstrated that both complexes are binuclear systems of general formula [Zn2(R-COO-)4(Nic)2]. Plasmidial DNA breakdown capacities were evaluated by producing single and double breaks (DNA FII and FIII) from plasmid incubation with complex solutions in the concentration range 0 to 400 µmol·L-1 in experiments with the presence and absence of light. Both experiments did not show significant differences (P ≤ 0.05) in induced DNA cleavage activity between the maximum study concentrations (400 µmol·L-1) and the negative controls for both complexes. The types of complex 1 and 2 interactions with the secondary DNA structure were determined by titrating a CT-DNA solution with complex solutions and monitored by circular dichroism spectrometry. The results showed that both complexes interact with the grooves of the secondary structure of CT-DNA by electrostatic attraction, but without evidence of alteration in the primary structure. Acute toxicity tests against Artemia salina showed that both complexes did not produce lethality >10% of the population up to a maximum concentration of 1200 µg·mL-1 within an exposure interval of 24 h. Thus, two new compounds were synthesized, characterized and had their previous toxicities determined. These compounds are promising new drugs, with the next step being evaluations of their activity.