The association between vitamin-D deficiency and fecal incontinence.

BACKGROUND: Vitamin-D is essential for musculoskeletal health. We aimed to determine whether patients with fecal incontinence (FI): (1) are more likely to have vitamin-D deficiency and, (2) have higher rates of comorbid medical conditions. METHODS: We examined 18- to 90-year-old subjects who had 25-hydroxy vitamin-D levels, and no vitamin-D supplementation within 3 months of testing, in a large, single-institutional electronic health records dataset, between 2017 and 2022. Cox proportional hazards survival analysis was used to assess association of vitamin-D deficiency on FI. KEY RESULTS: Of 100,111 unique individuals tested for serum 25-hydroxy vitamin-D, 1205 (1.2%) had an established diagnosis of FI. Most patients with FI were female (75.9% vs. 68.7%, p = 0.0255), Caucasian (66.3% vs. 52%, p = 0.0001), and older (64.2 vs. 53.8, p < 0.0001). Smoking (6.56% vs. 2.64%, p = 0.0001) and GI comorbidities, including constipation (44.9% vs. 9.17%, p = 0.0001), irritable bowel syndrome (20.91% vs. 3.72%, p = 0.0001), and diarrhea (28.55% vs. 5.2%, p = 0.0001) were more common among FI patients. Charlson Comorbidity Index score was significantly higher in patients with FI (5.5 vs. 2.7, p < 0.0001). Significantly higher proportions of patients with FI had vitamin-D deficiency (7.14% vs. 4.45%, p < 0.0001). Moreover, after propensity-score matching, rate of new FI diagnosis was higher in patients with vitamin-D deficiency; HR 1.9 (95% CI [1.14-3.15]), p = 0.0131. CONCLUSION & INFERENCES: Patients with FI had higher rates of vitamin-D deficiency along with increased overall morbidity. Future research is needed to determine whether increased rate of FI in patients with vitamin-D deficiency is related to frailty associated with increased medical morbidities.

Trends and Challenges in the Mental Health of University Students with Disabilities: A Systematic Review.

This systematic review examines mental health in university students with disabilities, focusing on increasing prevalence and associated challenges. Following the PRISMA protocol for study selection and analysis, it aims to analyze problem prevalence and risk factors, explore support strategies and available resources, and identify gaps and areas for improvement in care and access to mental health services for disabled university students. This review includes 16 articles that met the established criteria. The findings reveal higher mental health issue prevalence in these students compared to non-disabled peers, highlighting the need for specific, tailored interventions. Improvement areas in general inclusion measures to prevent high-risk situations and intervention responses to discomfort and existing mental health problems are discussed. The importance of a holistic approach to ensure their overall well-being and academic success in an inclusive educational environment is emphasized.

Atletas de Taekwondo apresentam desequilíbrio muscular entre os músculos flexores e extensores do joelho: achados preliminares / Taekwondo athletes have muscle imbalance between knee flexors and extensions: preliminary findings / Los atletas de Taekwondo presentan un desequilibrio muscular entre los flexores y los extensores de la rodilla: hallazgos preliminares

Durante a prática de taekwondo com movimentos repetitivos, sistematizados e com certa sobrecarga de treino, o indivíduo pode gerar possíveis adaptações orgânicas que resultam em problemas posturais com grandes chances de desencadear desequilíbrio muscular. Objetivo: Verificar a presença de desequilíbrio entre os grupos musculares agonistas e antagonistas da articulação do joelho e entre membros dominantes e não dominantes de praticantes de taekwondo por meio da dinamometria isocinética. Método: Estudo transversal, observacional e descritivo realizado com nove praticantes de taekwondo do sexo masculino. Utilizou-se um dinamômetro isocinético para investigar o pico de torque, pico de torque por peso corporal, trabalho total, potência média, relação agonista/antagonista e índice de fadiga. Os dados dos membros dominante e não dominante foram comparados por meio do teste t-student para amostras pareadas. Foram calculados o intervalo de confiança de 95% da diferença média, o tamanho de efeito e o poder das análises. Resultados: Os músculos extensores dos membros dominante e não dominante apresentaram diferença média significante de 15,49 Nm (IC95% 7,27; 23,70; p=0,002) para pico de torque e de 22,64% (IC95% 11,83; 33,46; p=0,001) para pico de torque por peso corporal a 60°/s, representando tamanho de efeito médio. Conclusão: Os atletas de taekwondo apresentaram maior pico de torque e maior pico de torque por peso corporal dos músculos extensores do joelho a 60º/s no lado dominante. A relação agonista/ antagonista foi inferior a 60% e mais da metade dos atletas apresentaram uma diferença maior que 10% no pico de torque flexor no lado não dominante.

During taekwondo practice with the repetitive motions, systematized and with certain training overload, the person can generate possible organic adaptations that result in postural problems with a great chances of triggering muscle imbalance. Objective: To verify the presence of imbalance between agonist and antagonist muscle groups of knee joint and between dominant and non-dominant limbs through isokinetic dynamometry. Methods: Cross-sectional, observational and descriptive study realized with nine male taekwondo practitioners. An isokinetic dynamometer was used to investigate the peak torque, peak torque by body weight, total work, average power, agonist/antagonist ratio and fatigue index. Data from the dominant and non-dominant limbs were compared by t-student test for pared samples. The 95% confidence interval of the mean difference, the effect size and the power of analyses power were calculated. Results: The extensor muscles of the dominant and non-dominant limbs showed mean difference of 15,49 Nm (IC95% 7,27; 23,70; p=0,002) for peak torque and of 22,64% (IC95% 11,83; 33,46; p=0,001) for peak torque by body weight at 60°/s, representing average effect size. Conclusion: The taekwondo athletes had higher peak torque and higher peak torque by body weight of the knee extensors muscles in the dominant side. The agonist/ antagonist ratio was less than 60% and more than half of the athletes showed a difference greater than 10% in the peak flexor torque on the non-dominant side.

Durante la práctica de taekwondo con los movimientos repetitivos, sistematizados y con cierta sobrecarga de entrenamiento, la persona puede generar posibles adaptaciones orgánicas que deriven en problemas posturales con grandes posibilidades de desencadenar desequilibrios musculares. Objetivo: Verificar la presencia de desequilibrio entre grupos musculares agonistas y antagonistas de la articulación de la rodilla y entre miembros dominantes y no dominantes mediante dinamometría isocinética. Métodos: Estudio transversal, observacional y descriptivo realizado con nueve practicantes masculinos de taekwondo. Se utilizó un dinamómetro isocinético para investigar el par máximo, el par máximo por peso corporal, el trabajo total, la potencia media, la relación agonista/antagonista y el índice de fatiga. Los datos de las extremidades dominantes y no dominantes se compararon mediante la prueba t- student para muestras de pared. Se calcularon el intervalo de confianza del 95% de la diferencia media, el tamaño del efecto y la potencia de los análisis. Resultados: Los músculos extensores de los miembros dominantes y no dominantes mostraron una diferencia media de 15,49 Nm (IC95% 7,27; 23,70; p=0,002) para el par máximo y de 22,64% (IC95% 11,83; 33,46; p=0,001) para el par máximo por peso corporal a 60°/s, lo que representa el tamaño medio del efecto. Conclusiones: Los atletas de taekwondo presentaron un mayor par máximo y un mayor par máximo por peso corporal de los músculos extensores de la rodilla en el lado dominante. La relación agonista/antagonista fue inferior al 60% y más de la mitad de los atletas mostraron una diferencia superior al 10% en el pico de par flexor en el lado no dominante.

Comparative Effectiveness of Manual Therapy Interventions on Pain and Pressure Pain Threshold in Patients With Myofascial Trigger Points: A Network Meta-analysis.

OBJECTIVES: Myofascial trigger points (MTPs) are one of the most important causes of musculoskeletal pain. Evidence has suggested a positive effect of manual therapy in the treatment of MTPs. However, a comprehensive review comparing the effect of different manual therapy techniques are lacking. Thus, we conducted a network meta-analysis of randomized controlled trials to determine the type of manual therapy technique that has the greatest positive influence in patients with MTPs. MATERIALS AND METHODS: PubMed, Web of Science, Cochrane Library, and Scopus databases were searched to identify direct and indirect evidence comparing the effectiveness of different types of manual therapy interventions on pain intensity and pressure pain threshold (PPT) in patients with MTPs. Risk of bias was assessed using the Cochrane RoB2 tool. A pairwise meta-analysis for direct and indirect comparisons between intervention and control/nonintervention groups was carried out. RESULTS: A total of 37 studies were eligible for analysis. Combined interventions had the highest effect size for pain (-1.40; 95% CI, -2.34, -0.47), and the highest probability to be the best intervention and the highest Surface Under the Cumulative Ranking (64.7% and 87.9%, respectively). Afferent reduction techniques, understood as the interventions aimed to restore muscle spindles helping to dictate sarcomere length and tone in MTPs, had the highest effect size for PPT (0.93; 95% CI, 0.47, 1.39), and the highest probability to be the best intervention and the highest Surface Under the Cumulative Ranking (34.7% and 71.2%, respectively). The results were consistent in sensitivity analyses, with minimal inconsistencies between direct and indirect results. DISCUSSION: Manual therapy interventions should be considered an effective strategy for pain and PPT in patients with MTPs. The results suggest that among the different manual therapy modalities, combined and afferent reduction techniques are the most effective for pain and PPT, respectively.

Acquisition of resistance to ceftazidime-avibactam during infection treatment in Pseudomonas aeruginosa through D179Y mutation in one of two blaKPC-2 gene copies without losing carbapenem resistance.

Ceftazidime/Avibactam (CAZ/AVI) is frequently used to treat KPC-producing Pseudomonas aeruginosa (KPC-PA) and Enterobacterales. CAZ/AVI resistance is driven by several mechanisms. In P. aeruginosa this mainly occurs through alteration of AmpC, porins, and/or efflux pump overexpression, whereas in Enterobacterales it frequently occurs through D179Y substitution in the active site of KPC enzyme. This aminoacid change abolishes AVI binding to the KPC active site, hence inhibition is impaired. However, this substitution also decreases KPC-mediated resistance to carbapenems ("see-saw" effect). The goal of this work was to characterize the in vivo acquisition of CAZ/AVI resistance through D179Y substitution in a KPC-PA isolated from a hospitalized patient after CAZ/AVI treatment. Two KPC-PA isolates were obtained. The first isolate, PA-1, was obtained before CAZ/AVI treatment and was susceptible to CAZ/AVI. The second isolate, PA-2, was obtained after CAZ/AVI treatment and exhibited high-level CAZ/AVI resistance. Characterization of isolates PA-1 and PA-2 was performed through short and long-read whole genome sequencing analysis. The hybrid assembly showed that PA-1 and PA-2A had a single plasmid of 54,030 bp, named pPA-1 and pPA-2 respectively. Each plasmid harbored two copies of the bla KPC-containing Tn4401b transposon. However, while pPA-1 carried two copies of bla KPC-2, pPA-2 had one copy of bla KPC-2 and one copy of bla KPC-33, the allele with the D179Y substitution. Interestingly, isolate PA-2 did not exhibit the "see-saw" effect. The bla KPC-33 allele was detected only through hybrid assembly using a long-read-first approach. The present work describes a KPC-PA isolate harboring a plasmid-borne CAZ/AVI resistance mechanism based on two copies of bla KPC-2-Tn4401b and D179Y mutation in one of them, that is not associated with loss of resistance to carbapenems. These findings highlight the usefulness of a fine-tuned combined analysis of short and long-read data to detect similar emerging resistance mechanisms.

Health-related quality of life among women aging with and without HIV in Peru.

BACKGROUND: Studies have shown that women aging with HIV have significantly lower health-related quality of life (HRQoL) compared to women without HIV. However, no studies have examined this issue in Latin America and the Caribbean. We aimed to explore HRQoL measured by the 36-Item Short Form Health Survey (SF-36) among women aging with and without HIV in Peru. MATERIALS AND METHODS: We conducted a cross-sectional study at a large HIV-clinic in Peru. Outcomes of the SF-36 were evaluated, exploring the relationship between physical activity (International Physical Activity Questionnaire), sociodemographic factors (ethnicity, alcohol/tobacco use, age, BMI) and clinical data (AIDS progression, treatment duration, CD4+ cell count and viral load, years since HIV diagnosis) with HRQoL using regression analysis. Statistical significance was set with a two-tailed p-value <0.05. RESULTS: We enrolled 427 women (175 HIV-infected) with mean age of 54±8 years. From the SF-36 individual domains: physical functioning, role limitations due to physical and emotional health, and emotional wellbeing were significantly lower for HIV-infected women. Summary component scores were lower for the HIV-subset for both physical (45.8 vs 47.3) and mental (45.1 vs 45.8) components, although they did not achieve statistical significance. Regression analysis of the HIV-infected women revealed that the physical component score was significantly associated with physical activity, ethnicity, and chronic comorbidities while the mental component was significantly associated with physical activity, employment, and CD4+ cell count. CONCLUSION: In our study, HIV-infected women scored lower in both physical and mental component scores. Important determinants for each component included CD4+ cell count as an assessment of HIV severity for the mental component, and ethnicity, reflecting socio-cultural factors, for the physical component. These results reveal the importance of a holistic approach to addressing HRQoL in this population. Better understanding of these factors will help shape future policies and interventions to improve HRQoL of women aging with HIV.

Arbuscular mycorrhizal fungi community in coffee agroforestry, consortium and monoculture systems.

Understanding the effects of different production systems on arbuscular mycorrhizal fungi (AMF) can help to interpret interactions between their components and to define management strategies. As a result, our study was conducted on soils under three coffee production systems (one homogeneous and two heterogeneous) and in a native forest located in the Bahia state, Brazil. This study aimed to answer the following questions: 1) Does the organization and management of the coffee production system affect the occurrence and diversity of AMF?; and 2) Is the seasonality effect similar between systems? To do so, soil samples (0-10 cm depth) were collected at two times of the year (rainy and dry). Number of spores (NS) and average richness did not show differences between the systems, only between seasons. There was a reduction in NS in the dry season (1.4 and 2.7 spores g-1 soil) in relation to the rainy season (3.8 to 12.5 spores g-1 soil). The influence of coffee production systems was observed in the presence and absence of some AMF species. The AMF community was shown to be related to the plant species composition of the system, which was reflected in the dissimilarity of heterogeneous systems in relation to the coffee monoculture system.

Effects of Vitamin D Supplementation on Inflammation, Colonic Cell Kinetics, and Microbiota in Colitis: A Review.

Vitamin D is widely known to regulate bone health, but there is increasing evidence that it may also ameliorate colitis through inflammation, cell proliferation and apoptosis, and the microbiota. The purpose of this review is to systematically examine the mechanisms by which vitamin D reduces colitis. PubMed and Web of Science were searched for articles published between 2008 and 2019 using key words such as "vitamin D," "colitis," "inflammatory bowel disease," "inflammation," "apoptosis," "cell proliferation," and "gut bacteria". Retrieved articles were further narrowed and it was determined whether their title and abstracts contained terminology pertaining to vitamin D in relation to colitis in human clinical trials, animal studies, and cell culture/biopsy studies, as well as selecting the best match sorting option in relation to the research question. In total, 30 studies met the established criteria. Studies consistently reported results showing that vitamin D supplementation can downregulate inflammatory pathways of COX-2, TNF-α, NF-κB, and MAPK, modify cell kinetics, and alter gut microbiome, all of which contribute to an improved state of colitis. Although vitamin D and vitamin D analogs have demonstrated positive effects against colitis, more randomized, controlled human clinical trials are needed to determine the value of vitamin D as a therapeutic agent in the treatment of colitis.

Effectiveness of transcutaneous tibial nerve stimulation at two different thresholds for overactive bladder symptoms in older women: a randomized controlled clinical trial.

OBJECTIVES: To compare the effectiveness of transcutaneous tibial nerve stimulation (TTNS) at two different current amplitude thresholds (sensory and motor) in terms of urinary habit, symptoms and the degree of discomfort of overactive bladder (OAB) in older women. STUDY DESIGN: This is a randomized, controlled, 3-arm blinded trial. One hundred and one patients attending secondary care with OAB were randomized into one of three groups: group 1, TTNS sensitivity threshold (n = 39); group 2, TTNS motor threshold (n = 33); and control group 3 (n = 29). MAIN OUTCOME MEASURES: Participants allocated to groups 1 and 2 had 8 sessions of TTNS for 30 min, twice a week. Group 3 received no intervention. The results measured were the symptoms of overactive bladder (ICIQ-OAB, overall score), bother scales (to indicate the impact of individual symptoms for the patient) and urinary habit (3-day bladder diary). A blind assessor measured outcomes at baseline and 5 weeks after randomization. RESULTS: After five weeks, a statistically significant difference between group 3 (control) and group 1 (TTNS sensitivity threshold) and group 2 (TTNS motor threshold) was observed in the intergroup analysis, but no difference in the outcomes analyzed was detected between the two groups receiving intervention (groups 1 and 2). CONCLUSION: TTNS is effective in the treatment of OAB in older women, with no difference between the sensitivity and motor thresholds. CLINICAL TRIAL REGISTRATION NUMBER: Registro Brasileiros de Ensaios Clínicos (RBR-39DZ5V).

Global health, global surgery and mass casualties: II. Mass casualty centre resources, equipment and implementation.

Trauma/stroke centres optimise acute 24/7/365 surgical/critical care in high-income countries (HICs). Concepts from low-income and middle-income countries (LMICs) offer additional cost-effective healthcare strategies for limited-resource settings when combined with the trauma/stroke centre concept. Mass casualty centres (MCCs) integrate resources for both routine and emergency care-from prevention to acute care to rehabilitation. Integration of the various healthcare systems-governmental, non-governmental and military-is key to avoid both duplication and gaps. With input from LMIC and HIC personnel of various backgrounds-trauma and subspecialty surgery, nursing, information technology and telemedicine, and healthcare administration-creative solutions to the challenges of expanding care (both daily and disaster) are developed. MCCs are evolving initially in Chile and Pakistan. Technologies for cost-effective healthcare in LMICs include smartphone apps (enhance prehospital care) to electronic data collection and analysis (quality improvement) to telemedicine and drones/robots (support of remote regions and resource optimisation during both daily care and disasters) to resilient, mobile medical/surgical facilities (eg, battery-operated CT scanners). The co-ordination of personnel (within LMICs, and between LMICs and HICs) and the integration of cost-effective advanced technology are features of MCCs. Providing quality, cost-effective care 24/7/365 to the 5 billion who lack it presently makes MCCs an appealing means to achieve the healthcare-related United Nations Sustainable Development Goals for 2030.

Marijuana, Ondansetron, and Promethazine Are Perceived as Most Effective Treatments for Gastrointestinal Nausea.

BACKGROUND: Many anti-nausea treatments are available for chronic gastrointestinal syndromes, but data on efficacy and comparative effectiveness are sparse. AIMS: To conduct a sectional survey study of patients with chronic nausea to assess comparative effectiveness of commonly used anti-nausea treatments. METHODS: Outpatients at a single center presenting for gastroenterology evaluation were asked to rate anti-nausea efficacy on a scale of 0 (no efficacy) to 5 (very effective) of 29 commonly used anti-nausea treatments and provide other information about their symptoms. Additional information was collected from the patients' chart. The primary outcome was to determine which treatments were better or worse than average using a t test. The secondary outcome was to assess differential response by individual patient characteristics using multiple linear regression. RESULTS: One hundred and fifty-three patients completed the survey. The mean efficacy score of all anti-nausea treatments evaluated was 1.73. After adjustment, three treatments had scores statically higher than the mean, including marijuana (2.75, p < 0.0001), ondansetron (2.64, p < 0.0001), and promethazine (2.46, p < 0.0001). Several treatments, including many neuromodulators, complementary and alternative treatments, erythromycin, and diphenhydramine had scores statistically below average. Patients with more severe nausea responded better to marijuana (p = 0.036) and diphenhydramine (p < 0.001) and less so to metoclopramide (p = 0.020). There was otherwise no significant differential response by age, gender, nausea localization, underlying gastrointestinal cause of nausea, and GCSI. CONCLUSIONS: When treating nausea in patients with chronic gastrointestinal syndromes, clinicians may consider trying higher performing treatments first, and forgoing lower performing treatments. Further prospective research is needed, particularly with respect to highly effective treatments.

Transcutaneous tibial nerve stimulation versus parasacral stimulation in the treatment of overactive bladder in elderly people: a triple-blinded randomized controlled trial.

OBJECTIVES: To evaluate the effect of transcutaneous tibial nerve stimulation (TTNS) and transcutaneous parasacral stimulation on the treatment of overactive bladder (OAB) in elderly people and to compare the final results between groups. METHODS: Fifty female volunteers, mean age 68.62 (±5.9) years, were randomly allocated into two groups: those receiving TTNS (G1, N=25) and those receiving transcutaneous parasacral stimulation (G2, N=25). The primary outcome was the International Consultation on Incontinence Questionnaire (ICIQ-OAB) score, and secondary outcomes were the International Consultation on Incontinence Questionnaire - short form (ICIQ-SF) score and 3-day bladder diary measurements. Volunteers were assessed before and after the treatment. Clinical Trials (ReBeC): RBR-9Q7J7Y. RESULTS: Both groups' symptoms improved as measured by the ICIQ-OAB (G1 = <0.001; G2 = <0.001) and ICIQ-SF (G1 = <0.001; G2 = <0.001). In the 3-day bladder diary assessments after treatment, G1 showed a reduced number of nocturia (p<0.001), urgency (p<0.001) and urge urinary incontinence episodes (p<0.001), whereas G2 showed only a reduced number of nocturia episodes (p<0.001). No difference between groups was found. CONCLUSION: Both of the proposed treatments were effective in the improvement of OAB symptoms, but TTNS showed a reduction in a greater number of symptoms as measured by the 3-day bladder diary. No differences were found between groups.

Transcutaneous tibial nerve stimulation versus parasacral stimulation in the treatment of overactive bladder in elderly people: a triple-blinded randomized controlled trial

OBJECTIVES: To evaluate the effect of transcutaneous tibial nerve stimulation (TTNS) and transcutaneous parasacral stimulation on the treatment of overactive bladder (OAB) in elderly people and to compare the final results between groups. METHODS: Fifty female volunteers, mean age 68.62 (±5.9) years, were randomly allocated into two groups: those receiving TTNS (G1, N=25) and those receiving transcutaneous parasacral stimulation (G2, N=25). The primary outcome was the International Consultation on Incontinence Questionnaire (ICIQ-OAB) score, and secondary outcomes were the International Consultation on Incontinence Questionnaire - short form (ICIQ-SF) score and 3-day bladder diary measurements. Volunteers were assessed before and after the treatment. Clinical Trials (ReBeC): RBR-9Q7J7Y. RESULTS: Both groups' symptoms improved as measured by the ICIQ-OAB (G1 = <0.001; G2 = <0.001) and ICIQ-SF (G1 = <0.001; G2 = <0.001). In the 3-day bladder diary assessments after treatment, G1 showed a reduced number of nocturia (p<0.001), urgency (p<0.001) and urge urinary incontinence episodes (p<0.001), whereas G2 showed only a reduced number of nocturia episodes (p<0.001). No difference between groups was found. CONCLUSION: Both of the proposed treatments were effective in the improvement of OAB symptoms, but TTNS showed a reduction in a greater number of symptoms as measured by the 3-day bladder diary. No differences were found between groups.

Spray drying microencapsulation of betalain rich extracts from Escontria chiotilla and Stenocereus queretaroensis fruits using cactus mucilage.

In this work the capacity of Opuntia ficus indica mucilage as a wall agent in the microencapsulation of Escontria chiotilla and Stenocereus queretaroensis pulp and skin pigments through a spray drying process was studied. The acidified mucilage was used as an extracting medium for betalains present in the skin of these fruits. The shear-thinning behavior of the mucilage-betalain solutions was suitable for spray drying, wherein microcapsules with smooth and spherical morphologies were observed by SEM and characterized by FTIR. Additionally, microcapsules of mucilage achieved the retention of betalains at more than 90% after three months of storage. The colors obtained from the redissolution of the powders from skin and pulp samples do not present significant differences; therefore, the use of skin fruits can be a source of colorants, taking advantage of waste from other processes, promoting a culture of the use of environmentally-friendly technologies.

Efetividade da Musicoterapia na Redução da Ansiedade de Pacientes Oncológicos: Revisão Sistemática / Effectiveness of Music Therapy in Reducing Anxiety in Cancer Patients: Systematic Review / Efectividad de la Musicoterapia en la Reducción de la Ansiedad en Pacientes con Cáncer: Revisión Sistemática

Introdução: O câncer é uma doença que envolve extenso sofrimento emocional, físico e social, o que favorece o aparecimento de diversas morbidades, incluindo ansiedade. Terapias complementares, como a musicoterapia, têm sido estudadas como alternativas para a abordagem da ansiedade. Objetivo: Revisar sistematicamente os estudos e determinar a efetividade da musicoterapia na redução da ansiedade de pacientes oncológicos. Método: A pesquisa foi realizada em seis bases de dados incluindo MEDLINE/PubMed, SciELO, Scopus, CINAHL, Cochrane e Web of Science, sem restrição de data, sexo, etnia ou tipos de câncer. Foram incluídos somente ensaios clínicos randomizados que avaliaram a ansiedade como um dos desfechos, bem como os que utilizaram a musicoterapia como intervenção e que envolveram amostra com indivíduos adultos diagnosticados com câncer. Foram excluídos os estudos em que a musicoterapia não foi realizada por um profissional especializado, não foi proposto grupo controle, não foi disponibilizado o estudo na integra, associaram pacientes com outras doenças além do câncer e incluíram no grupo experimental outra intervenção além da música. Resultado: Foram encontrados 1.909 estudos, sendo oito elegíveis. A maioria dos estudos demonstrou benefícios da musicoterapia na ansiedade. Conclusão:A musicoterapia é efetiva na redução da ansiedade de pessoas com câncer. No entanto, mais estudos com novas tecnologias e mais detalhes sobre a intervenção são necessários para a confirmação dos resultados.

Introduction: Cancer is a disease that involves extensive emotional, physical and social suffering, which favors the appearance of various morbidities, including anxiety. Complementary therapies, such as music therapy, have been studied as alternatives to an approach to anxiety. Objective: To conduct a systematic review of the literature and determine the effectiveness of music therapy to reduce anxiety of oncologic patients. Method: The research was conducted in six databases including MEDLINE/PubMed, SciELO, Scopus, CINAHL, Cochrane and Web of Science without restriction of date, gender, ethnicity or cancer types. It were included only randomized controlled trials that evaluated anxiety as one of the outcomes, as well as those using music therapy as an intervention, involving a sample with adult individuals diagnosed with cancer. The exclusion criteria were studies where music therapy was not performed by a skilled professional, without control group, studies not fully available, that associated patients with diseases other than cancer and which included in the experimental group another intervention instead of music. Result: A total of 1909 studies were found, of which eight were eligible. The majority of the studies have demonstrated benefits of music therapy for anxiety. Conclusion: Music therapy is effective in reducing the anxiety of people with cancer. However, more studies with new methodologies and further details about the intervention are necessary to confirm the results.

Introducción: El cáncer es una enfermedad que implica extensión emocional, física y social, lo que favorece la aparición de diversas morbilidades, incluida la ansiedad. Las terapias complementarias, como la musicoterapia, se han estudiado como alternativas al enfoque de la ansiedad. Objetivo: Revisar la literatura sobre la efectividad de la musicoterapia para el tratamiento de pacientes con trastornos de ansiedad y cáncer. Método:La investigación se realizó en seis bases de datos, incluyendo MEDLINE/PubMed, SciELO, Scopus, CINAHL, Cochrane y Web of Science, sin restricciones de fecha, género, etnia o tipos de cáncer. Se incluyeron solo ensayos controlados aleatorios de estudios que evaluaron la ansiedad como uno de los resultados, así como el uso de la musicoterapia como una intervención y la participación de una muestra con individuos adultos diagnosticados con cáncer. Los estudios en los que la musicoterapia no fue realizada por un profesional especializado, no se propuso un grupo de control, no se disponía de un estudio completo, se asociaron pacientes con enfermedades distintas al cáncer y se incluyó otra intervención además de la música en el grupo experimental. Resultados: Se encontraron 1.909 estudios, de los cuales ocho fueron elegibles. La mayoría de los estudios han demostrado los beneficios de la musicoterapia en la ansiedad. Conclusión: Esta revisión sistemática concluyó que la musicoterapia es efectiva para reducir la ansiedad de las personas con cáncer. Sin embargo, se necesitan más estudios con nuevas tecnologías y más detalles sobre la intervención para confirmar los resultados.

Cross-infection control in clinical training: Development of a device for storing a composite resin in restorative dentistry.

This study presented a biosafety device for the hygienic storage of composite resin during restorative procedures in teaching clinics, RESTAURASAFE, and to compare the color stability, surface hardness, and degree of conversion of the composite resin made with the proposed device to those of conventionally made resins. Esthet-X HD composite was manipulated directly from the syringe, fractionated doses, dappen dish or RESTAURASAFE. Disc-shaped specimens were immersed in artificial saliva and coffee for 60 days and the color stability and the Vickers surface hardness were evaluated during 60 days. Degree of conversion was assessed after immersing specimens in saliva (baseline). The surface morphology analysis of composite resin has taken by scanning electron microscopy (SEM). The data were evaluated statistically by repeated measures ANOVA (α=.05). No difference of color stability was observed for saliva and coffee regardless of storing devices. The resin manipulated directly from the syringe presented lower hardness, and fractionated doses presented lower degree of conversion than the RESTAURASAFE. SEM analysis showed that after artificial aging in coffee for 60 days, the specimens prepared with fractionated doses of resin displayed the fewest changes in surface morphology, followed by those prepared with the RESTAURASAFE. We conclude that RESTAURASAFE allows to obtain similar color stability, higher hardness, and degree of conversion of the composite in comparison to the other storing devices.

Antioxidant enzymes, hematology and histology of spleen in Nile tilapia fed supplemented diet with natural extracts challenged with Aeromonas hydrophila.

This study investigated the effects of dietary supplementation with the extrats of propolis and Aloe barbadensis (aloe) on the antioxydant enzime activity, hematology and histology of the spleen of Nile tilapia challenged with Aeromonas hydrophila. Seventy two juvenile Nile tilapia were divided in four treatments and three replicates and fed extract mixture for 15 days: fish fed supplemented diet with 1% of the mixture of extracts of propolis and aloe (1:1) injected with phosphate-buffered saline (PBS); fish fed suplemented diet with 1% of the mixture of extracts of propolis and aloe (1:1) injected with the A. hydrophila, fish fed supplemented diet with the mixture of propolis extracts and aloe, injected with PBS and injected with A. hydrophila. The influence of the supplementation of propolis and Aloe extracts on the immunomodulation in tilapias was observed by the evaluation of the survival of the animals after challenge with A. hydrophila. Non-supplemented fish had a 44.5% survival rate and those supplemented with 1% of the mixture of extracts showed 55.6% survival 7 days after challenge. The supplemented animals also showed a significant increase in the number of lymphocytes in the evaluation of the blood parameters and, consequently, in the histopathological evaluation, presented greater presence of centers of melanomacrophages. In addition, the activity of the antioxidant enzymes glutathione reductase (GR) in the spleen presented a significant difference in fish supplemented with 1% of the extracts mixture, being superior in the animals injected with PBS when compared to those challenged with A. hydrophila.

Iron supplementation in mouse expands cellular innate defences in spleen and defers lethal malaria infection.

The co-endemicity of malnutrition, erythrocytopathies, transmissible diseases and iron-deficiency contribute to the prevalence of chronic anaemia in many populations of the developing world. Although iron dietary supplementation is applied or recommended in at risk populations, its use is controversial due to undesirable outcomes, particularly regarding the response to infections, including highly prevalent malaria. We hypothesized that a boosted oxidative stress due to iron supplementation have a similar impact on malaria to that of hereditary anaemias, enhancing innate response and conditioning tissues to prevent damage during infection. Thus, we have analysed antioxidant and innate responses against lethal Plasmodium yoelii during the first five days of infection in an iron-supplemented mouse. This murine model showed high iron concentration in plasma with upregulated expression of hemoxygenase-1. The sustained homeostasis after this extrinsic iron conditioning, delayed parasitemia growth that, once installed, developed without anaemia. This protection was not conferred by the intrinsic iron overload of hereditary hemochromatosis. Upon iron-supplementation, a large increase of the macrophages/dendritic cells ratio and the antigen presenting cells was observed in the mouse spleen, independently of malaria infection. Complementary, malaria promoted the splenic B and T CD4 cells activation. Our results show that the iron supplementation in mice prepares host tissues for oxidative-stress and induces unspecific cellular immune responses, which could be seen as an advantage to promote early defences against malaria infection.

Safety Evaluation of Fluoride Content in Tea Infusions Consumed in the Azores-a Volcanic Region with Water Springs naturally Enriched in Fluoride.

Tea is the second most commonly consumed beverage in the world. It is well recognized that the consumption of tea in high quantities can promote the development of fluorosis. The main objective of this study is to estimate the exposure to fluoride in the Azores through drinking tea prepared with water from different volcanic locations, by i) investigating the fluoride (F) content of various commercial brands of tea (Camellia sinensis) marketed in Azores and ii) comparing tea releasing rates of F according to brewing time, considering the fluoride concentration in the different types of water used for the infusion. Fluoride contents were determined by ion-selective electrode in 30 samples of drinking water from three different locations and in 450 samples of tea (black and green tea) from three different brands. Fluoride concentration in water ranged from 0.29 to 1.56 ppm (Porto Formoso and Sete Cidades village, respectively). Fluoride concentrations increased with brewing time, reaching the highest values in the Azorean black and green tea infusions. For all the studied brands, a negative correlation was found between tea fluoride contents and the pH of the water used to prepare the infusion. Fluoride concentration in infusions was significantly associated with the background fluoride concentration in drinking water. Since the fluoride concentration in groundwater varies accordingly to the geological conditions and tea consumption can contribute to fluoride intake, it is important to define the limits for tea consumption, particularly in fluoride-rich areas. Graphical Abstract Fluoride concentrations in black and green tea for 3 minutes of brewing time and, association between fluoride concentration and pH with brewing time.

Abordaje de la ansiedad en pacientes diagnosticados de cáncer / Treatmet of anxiety in patients with cancer

Objetivo: El diagnóstico de cáncer puede ser considerado como un potente estresor que puede provocar reacciones emocionales e incluso trastornos emocionales como por ejemplo, trastornos de ansiedad, del estado de ánimo o trastornos adaptativos. Dada la elevada frecuencia de patología ansiosa en pacientes con diagnóstico de cáncer, nuestro objetivo es revisar la eficacia de los tratamientos psicológicos utilizados para el abordaje de la sintomatología ansiosa en pacientes con cáncer. Método: Se ha realizado una búsqueda bibliográfica en la base de datos PubMed mediante los términos: . Se analizaron artículos científicos publicados desde febrero de 2007 hasta febrero de 2016, con pacientes oncológicos como población diana. Resultados: Se han analizado un total de 40 artículos, con homogeneidad en cuanto a diagnóstico, tipo de cáncer y sexo (mayoritariamente mujeres). 34 de los artículos demuestran ser efectivos en la reducción de la ansiedad. Las más utilizadas fueron el mindfulness, los enfoques cognitivo-conductuales y la relajación. Las terapias complementarias han demostrado resultados variables. Técnicas como el yoga fueron ineficaces. Conclusiones: Existen múltiples opciones no farmacológicas para lograr una reducción de la ansiedad en pacientes oncológicos. La mayoría de técnicas evaluadas demuestran eficacia para reducir la ansiedad e incluso conseguir otros beneficios como la reducción de sintomatología depresiva asociado al nuevo diagnóstico de cáncer o asociado a las intervenciones relacionadas con el cáncer

Objective: The diagnosis of cancer can be considered as a high stressor which produce emotional reactions and emotional disorders like anxiety disorder, mood disorder or adjustment disorder. Given the high frequency of anxious symptoms in patients with diagnosis of cancer, our objective is to review the effectiveness of the psychological treatments used to approach the anxiety in cancer patients. Method: We performed a bibliographic review in PubMed database with the terms: . We analyzed scientific articles published since February 2007 to February 2016 with a sample of cancer patients. Results: We analyzed 40 articles with homogeneity in terms of diagnosis, kind of cancer and sex (most common females). 34 of them demonstrated to be effective in reduction of anxiety (the most used were mindfulness, cognitive behavioral approaches and relaxation). The complementary therapies have demonstrated variable results. Techniques like yoga were ineffective. Conclusion: There are multiple non farmacological options to reduce the anxiety in oncological patients. Most of techniques studied shown to be effectiveness in reduction of anxiety and achieve other benefits as reduction of depressive symptoms associated with a new diagnosis of cancer or associated with medical interventions