Topiramate treatment during adolescence induces short and long-term alterations in the reproductive system of female rats.

Topiramate (TPM) is an antiepileptic drug used for treating epilepsy in children, and migraine in teenagers. In this context, preclinical studies with adult female rats observed reproductive system abnormalities following treatment with TPM. Additionally, exposure to endocrine disruptors during developmental plasticity periods, such as childhood and adolescence, may influence characteristics in the adult individual. This study evaluated whether treatment with TPM during developmental periods influences the reproductive system of female rats either immediately or in adult life. Female Wistar rats were treated with TPM (41 mg/Kg/day) by oral gavage from postnatal day (PND) 16-28, or PND 28-50, which correspond to childhood and adolescence, respectively, and euthanized either 24 h after the final administration or during adulthood. Treatment with TPM during adolescence induced short-term increase in uterus and ovary weights and reduction in endometrial stroma thickness. Adult animals treated during adolescence displayed reduced primordial ovarian follicles' numbers, and increased primary and pre-antral ovarian follicles' numbers. Treatment during childhood induced no short or long-term differences. These results indicate TPM treatment during adolescence is capable of inducing short and long-term alterations on the reproductive system of female Wistar rats.

Immediate effects of photobiomodulation on saliva production. / Efeitos imediatos da fotobiomodulação na produção de saliva.

PURPOSE: To verify the immediate effects of photobiomodulation on the production of salivary flow and the correlation of demographic, anthropometric and medication use data. METHODS: The study included 100 healthy individuals, aged between 18 and 76 years (mean 27.2 years), randomly split into an experimental group and a placebo group. Assessments of anthropometric measurements, self-perception of saliva production and sialometry were performed. Next, LASER irradiation was carried out at an infrared wavelength (808 nanometers) with 100 milliwatts (mw) of power at five intraoral points: on the sublingual glands and bilaterally on the submandibular and parotid glands, at doses of 9, 18 and 24 joules (J). Sialometry was repeated after each application. The control group received the same procedures with placebo equipment. RESULTS: There was a statistical association in the self-perception of reduced saliva in the experimental group for the 24J dose and in sialometry and in the reduction in salivary flow for the 18J and 24J doses and an increase to 9J, in both groups. There was no association when comparing the experimental and placebo groups. Multiple multinomial regression analysis revealed that the reduction or increase in salivary flow is independent of demographic, anthropometric and medication use variables. CONCLUSION: The bioinhibitory action of photobiomodulation on healthy salivary glands occurred at a dose of 18J and 24J, while the biostimulant action happened at a dose of 9J, regardless of demographic, anthropometric variables and medication use. The self-perception of reduced salivary flow occurred at 24J.

OBJETIVO: Verificar os efeitos imediatos da fotobiomodulação na produção do fluxo salivar e a correlação dos dados demográficos, antropométricos e de uso de medicamentos. MÉTODO: Participaram do estudo 100 indivíduos saudáveis, com idade entre 18 e 76 anos (média 27,2 anos), divididos de forma randomizada em grupo experimental e grupo placebo. Foram realizadas as avaliações das medidas antropométricas, autopercepção da produção de saliva e a sialometria. Na sequência, realizou-se a irradiação do LASER no comprimento de onda infravermelho (808 nanômetros) com 100 miliwatts (mw) de potência em cinco pontos intraorais: nas glândulas sublingual e bilateralmente nas submandibulares e parótidas, nas doses 9, 18 e 24 joules (J). A sialometria foi repetida após cada aplicação. O grupo controle recebeu os mesmos procedimentos com equipamento placebo. RESULTADOS: Houve associação estatística na autopercepção de redução da saliva no grupo experimental para a dose de 24J e na sialometria e na redução do fluxo salivar para as doses 18J e 24J e aumento para 9J, em ambos os grupos. Não houve associação quando comparado entre os grupos experimental e placebo. A análise de regressão multinomial múltipla revelou que a redução ou o aumento do fluxo salivar independe das variáveis demográficas, antropométricas e uso de medicamentos. CONCLUSÃO: A ação bioinibitória da fotobiomodulação sobre as glândulas salivares saudáveis ocorreu em dose de 18J e 24J, já ação bioestimulante na dose 9J, independe das variáveis demográficas, antropométricas e uso de medicamentos. A autopercepção da redução do fluxo salivar ocorreu em 24J.

Vascular dysfunction programmed in male rats by topiramate during peripubertal period.

AIM: The present study evaluated whether topiramate (TPM) treatment during the peripubertal period affects vascular parameters of male rats and whether oxidative stress plays a role in these changes. MAIN METHODS: Rats were treated with TPM (41 mg/kg/day, gavage) or vehicle (CTR group) from the postnatal day (PND) 28 to 50. At PND 51 and 120 the rats were evaluated for: thoracic aorta reactivity to phenylephrine, in the presence (Endo+) or absence of endothelium (Endo-), to acetylcholine and to sodium nitroprusside (SNP), aortic thickness and endothelial nitric oxide synthase (eNOS) expression. In serum were analyzed: the antioxidant capacity by ferric reducing antioxidant power assay; endogenous antioxidant reduced glutathione, and superoxide anion. Results were expressed as mean ± s.e.m., differences when p < 0.05. STATISTICS: Two-way ANOVA (and Tukey's) or Student t-test. KEY FINDINGS: At PND 51, the contraction induced by phenylephrine in Endo+ ring was higher in TPM when compared to CTR. At PND 120, the aortic sensitivity to acetylcholine in TPM rats was reduced in comparison with CTR. The aortic eNOs expression and the aortic thickness were similar between the groups. At PND 51 and 120, TPM group presented a decrease in antioxidants when compared to CTR groups and at PND 120, in TPM group the superoxide anion was increased. SIGNIFICANCE: Taken together, the treatment of rats with TPM during peripubertal period promoted permanent impairment of endothelial function probably mediated by oxidative stress.

Streptococcus pyogenes Lineage ST62/emm87: The International Spread of This Potentially Invasive Lineage.

Streptococcus pyogenes is known to be associated with a variety of infections, from pharyngitis to necrotizing fasciitis (flesh-eating disease). S. pyogenes of the ST62/emm87 lineage is recognized as one of the most frequently isolated lineages of invasive infections caused by this bacterium, which may be involved in hospital outbreaks and cluster infections. Despite this, comparative genomic and phylogenomic studies have not yet been carried out for this lineage. Thus, its virulence and antimicrobial susceptibility profiles are mostly unknown, as are the genetic relationships and evolutionary traits involving this lineage. Previously, a strain of S. pyogenes ST62/emm87 (37-97) was characterized in our lab for its ability to generate antibiotic-persistent cells, and therapeutic failure in severe invasive infections caused by this bacterial species is well-reported in the scientific literature. In this work, we analyzed genomic and phylogenomic characteristics and evaluated the virulence and resistance profiles of ST62/emm87 S. pyogenes from Brazil and international sources. Here we show that strains that form this lineage (ST62/emm87) are internationally spread, involved in invasive outbreaks, and share important virulence profiles with the most common emm types of S. pyogenes, such as emm1, emm3, emm12, and emm69, which are associated with most invasive infections caused by this bacterial species in the USA and Europe. Accordingly, the continued increase of ST62/emm87 in severe S. pyogenes diseases should not be underestimated.

Detection of sensitivity and vestigiality of presumptive tests for swabbed blood stains.

It is a common practice in forensic casework to use presumptive tests for blood stains before DNA extraction and testing. Stains are usually swabbed and then the swabs are sent for analysis. The Kastle-Meyer (KM) and Leucomalachite green (LMG) presumptive tests for blood are widely used, and their sensitivities have been thoroughly tested in the literature in solution and directly on stains, but not on swabbed stains to mimic casework. In this study, the sensitivity of the KM and LMG tests was tested on eight blood dilutions on cotton fabric and ceramic tile that were stained and subsequently swabbed. Both tests showed sensitivity up to 1:5000, which is slightly lower than reported values in solution or directly on stain but still highly effective in most cases. Stains were also cleaned with common agents, then swabbed and re-tested. Stained ceramic tiles cleaned with soap/water or bleach gave mixed positive and negative results for the 1:10 dilution, presumably due to variance in how thoroughly each investigator cleaned the stain, and other dilutions were undetectable after cleaning. The LMG test gave false positives for bleach cleaned stains, due to reagent reactivity with bleach. Surprisingly, blood was detectible up to the 1:100 dilution with both tests on stained cotton fabric that was cleaned in a washing machine with detergent and dried. Ultimately the KM and LMG presumptive tests remain effective tools for swabbed blood stains, and their practicality for cleaned stains is dependent on material containing the stain, cleaning agent and processing.

Protein restriction during peripubertal period impairs endothelial aortic function in adult male Wistar rats.

Protein restriction during early phases of body development, such as intrauterine life can favor the development of vascular disorders. However, it is not known if peripubertal protein restriction can favor vascular dysfunction in adulthood. The present study aimed to evaluated whether a protein restriction diet during peripubertal period favors endothelial dysfunction in adulthood. Male Wistar rats from postnatal day (PND) 30 until 60 received a diet with either 23% protein (CTR group) or with 4% protein (LP group). At PND 120, the thoracic aorta reactivity to phenylephrine, acetylcholine, and sodium nitroprusside was evaluated in the presence or absence of: endothelium, indomethacin, apocynin and tempol. The maximum response (Rmax) and pD2 (-log of the concentration of the drug that causes 50% of the Rmax) were calculated. The lipid peroxidation and catalase activity were also evaluated in the aorta. The data were analyzed by ANOVA (one or two-ways and Tukey's) or independent t-test; the results were expressed as mean ± S.E.M., p < 0.05. The Rmax to phenylephrine in aortic rings with endothelium were increased in LP rats when compared with the Rmax in CTR rats. Apocynin and tempol reduced Rmax to phenylephrine in LP aortic rings but not in CTR. The aortic response to the vasodilators was similar between the groups. Aortic catalase activity was lower and lipid peroxidation was greater in LP compared to CTR rats. Therefore, protein restriction during the peripubertal period causes endothelial dysfunction in adulthood through a mechanism related to oxidative stress.

Topiramate treatment during the peripubertal period does not alter aortic endothelial function in female Wistar rats.

AIMS: This study aimed to evaluate the short- and long-term adverse effects of blood pressure (BP), vascular endothelial function, and estrogen receptor (ERα and ERß) modulation on endothelial function in female Wistar rats treated with topiramate (TPM), an antiepileptic drug, during the peripubertal period. MATERIALS AND METHODS: Female Wistar rats were treated with TPM (41 mg/kg) or water (CTR group) by gavage from postnatal day (PND) 28 to 50 (peripubertal phase). At the end of the treatment, the TPM and CTR rats were divided into two groups and evaluated after 24 h or from PND 85 (adulthood). The rats were evaluated for: thoracic aorta reactivity to phenylephrine (Phenyl), acetylcholine (ACh), and sodium nitroprusside (SNP); aortic ring reactivity after ERα and ERß antagonism; and BP. KEY FINDINGS: It was observed that vascular response to Phenyl, ACh, and SNP was similar between TPM and CTR rats in the short- and long-term evaluations. In addition, the ER antagonism did not interfere with aortic contraction or relaxation in either TPM or CTR. SIGNIFICANCE: Taken together, the results show that TPM treatment during the peripubertal period does not alter aortic endothelial function and its estrogen modulation via classic ER in female Wistar rats, suggesting that TPM treatment in this period is safe for the vascular system.

Analysis of DNA methylation markers for tissue identification in individuals with different clinical phenotypes.

Deoxyribonucleic acid (DNA) methylation patterns can be used to identify the type of tissue or body fluid found at a crime scene. However, tissue-related methylation levels have not been analyzed in individuals with different illnesses and medical conditions in forensic-specific studies. The primary goal of this study was to investigate if certain clinical phenotypes can alter the methylation levels of CpG sites in genes involved in tissue typing. Four studies with focus on DNA methylation analysis on individuals with different clinical conditions were selected from the Gene Expression Omnibus database. Then, a list of 137 CpG sites was compiled for further investigation. Statistical tests were performed to compare the beta-values results obtained for the control groups and the individuals affected by medical conditions. For each study, CpG sites that presented significant statistical differences between patients and control group were identified and it was possible to notice that DNA methylation levels can be affected in sites with potential forensic use. Although the observed DNA methylation variation (less than 10% difference) in this study would likely not cause any issues in body fluid identification, the results are important to show that this type of analysis should be taken into consideration when investigating and further validating body fluid markers. The CpG sites identified in this study should be further investigated by future studies on body fluids identification, and due to the significant difference in methylation levels in samples from affected individuals, caution must be taken before including these sites in tissue identification investigations.

Parents' Willingness to Vaccinate Children for COVID-19: Conspiracy Theories, Information Sources, and Perceived Responsibility.

Understanding parental decision-making about vaccinating their children for COVID-19 is essential to promoting uptake. We conducted an online survey between April 23-May 3, 2021, among a national sample of U.S. adults to assess parental willingness to vaccinate their child(ren). We also examined associations between parental intentions to VACCINATE their children for COVID-19 and conspiracy theory beliefs, trusted information sources, trust in public authorities, and perceptions regarding the responsibility to be vaccinated. Of 257 parents of children under 18 years that responded, 48.2% reported that they would vaccinate their children, 25.7% were unsure, and 26.1% said they would not vaccinate. After adjusting for covariates, each one-point increase in the Vaccine Conspiracy Beliefs Scale was associated with 25% lower odds of parents intending to vaccinate their children compared to those who did not intend to (adjusted odds ratio (AOR) = 0.75, 95% confidence interval (CI): 0.64-0.88). Parents that perceived an individual and societal responsibility to be vaccinated were more likely to report that they intended to vaccinate their children compared to those that did not intend to vaccinate their children (AOR = 5.65, 95% CI: 2.37-13.44). Findings suggest that interventions should focus on combatting conspiracy beliefs, promoting accurate and trusted information sources, and creating social norms emphasizing shared responsibility for vaccination.

Diagnóstico da infecção pelo Toxoplasma gondii em gestantes de fronteira brasileira, Foz do Iguaçu / Diagnosis of Toxoplasma gondii infection in pregnant women from the Brazilian border, Foz do Iguaçu

Resumo Introdução: O Toxoplasma gondii, parasito intracelular obrigatório, é o agente etiológico da toxoplasmose, a qual acomete cerca de um terço da população mundial. Objetivo: Analisar a frequência da infecção por Toxoplasma gondii em gestantes em Foz do Iguaçu e verificar possíveis fatores de associação a infecção. Método: Foi realizado um estudo transversal retrospectivo (dados de 2017) que avaliou exames sorológicos, pesquisa de anticorpos IgG e IgM para T. gondii durante a gestação e possíveis fatores de associação a infecção, a partir das fichas de pré-natal das gestantes em unidades de saúde, Foz do Iguaçu/PR. O teste do χ2 para tendência foi utilizado para análise dos dados e, o odds ratio (OR) para estimar a chance de associação entre as variáveis. Resultados: Das 1.000 fichas de pré-natal analisadas, 78,1% apresentaram registro de sorologia para T. gondii, das quais, 34,0% eram imunes ao T. gondii, 3,9% apresentaram anticorpos IgG e IgM e 66,0% eram suscetíveis. A maioria das gestantes iniciaram o pré-natal no primeiro trimestre 467 (60,0%). Houve predominância de gestantes com mais de uma gestação 200 (44,0% — p=0,00001), brasileiras 259 (35,1% — p=0,0112), idade >41 anos 7 (63,6%), ensino médio completo 125 (37,8% — p<0,05) e de cor da pele branca 140 (38,5% — p=0,0164). Conclusões: Os fatores associados a frequência da infecção nas gestantes devem ser considerados durante o pré-natal para a prevenção da infecção.

Abstract Background: The Toxoplasma gondii, an obligatory intracellular parasite, is the etiological agent of toxoplasmosis, which affects approximately one third of the world's population. Objective: To analyze the frequency of Toxoplasma gondii infection in pregnant women in Foz do Iguaçu and possible factors associated with the infection. Method: A retrospective cross-sectional study (2017 data) was carried out, which evaluated serological tests, IgG and IgM antibodies for T. gondii during pregnancy and possible factors associated the infection, based on the prenatal records of pregnant women in health units, Foz do Iguaçu/PR. The χ2 test for trend was used for data analysis, and the odds ratio (OR) to estimate the chance of association between variables. Results: Of the 1,000 prenatal records analyzed, 781 (78.1%) had serology records for T. gondii, of which 265 (34.0%) were immune to T. gondii, 31 (3.9%) had IgG and IgM antibodies, and 516 (66.0%) were susceptible. Most pregnant women started prenatal care in the first trimester 467 (60.0%). There was a predominance of pregnant women with more than one pregnancy 200 (44.0% — p=0.00001), Brazilian 259 (35.1% — p=0.0112), aged >41 years old 7 (63.6%), complete high school 125 (37.8% — p<0.05), and of white skin color 140 (38.5% — p=0.0164). Conclusions: An average frequency of infection was identified among pregnant women. The associated factors evidenced should be considered during prenatal care, along with educational actions to prevent infection.

Case report: Arteriovenous graft for hemodialysis using abdominal vessels.

The improvement of dialysis therapy and clinical support has increased the life expectancy of patients with end stage renal disease (ESRD) over the last years. However, in Brazil, the renal transplant rate cannot follow this growth. This fact, in association with the unavailability of adequate healthcare services in the country, substantially enlarges the use of dual lumen catheters and, consequently, access-related complications. The result is a high rate of patients with access failure, which brings a challenge: how to maintain dialysis in this group? This case report describes a non-conventional surgical approach to create a definite access using abdominal vessels, in an end stage vascular access patient.

High frequency of increased triclosan MIC among CC5 MRSA and risk of misclassification of the SCCmec into types.

BACKGROUND: Typing of staphylococcal cassette chromosome mec (SCCmec) elements is commonly used for studies on the molecular epidemiology of MRSA. OBJECTIVES: To perform an investigation centred on uncovering the reasons for misclassification of MRSA clonal complex 5 (CC5) SCCmec type II clinical isolates in our laboratory. METHODS: MRSA isolates from CC5 were subjected to WGS and SCCmec typing. RESULTS: This investigation led to the discovery that the classification failure was due to an insertion of IS1272 carrying the fabI gene on a transposable element (TnSha1) that confers increased MIC to the biocide triclosan. Genomic analysis revealed that fabI was present in 25% of the CC5 MRSA isolates sampled. The frequency of TnSha1 in our collection was much higher than that observed among publicly available genomes (0.8%; n = 24/3142 CC5 genomes). Phylogenetic analyses revealed that genomes in different CC5 clades carry TnSha1 inserted in different integration sites, suggesting that this transposon has entered CC5 MRSA genomes on multiple occasions. In at least two genotypes, ST5-SCCmecII-t539 and ST5-SCCmecII-t2666, TnSha1 seems to have entered prior to their divergence. CONCLUSIONS: Our work highlights an important misclassification problem of SCCmecII in isolates harbouring TnSha1 when Boye's method is used for typing, which could have important implications for molecular epidemiology of MRSA. The importance of increased-MIC phenotype is still a matter of controversy that deserves more study given the widespread use of triclosan in many countries. Our results suggest expanding prevalence that may indicate strong selection for this phenotype.

Anti-Restriction Gene Homologs Are Highly Represented in Methicillin-Resistant and Multidrug-Resistant Staphylococcus aureus ST239 and ST398: Implications for Resistance Gene Acquisitions.

Multidrug resistance is commonly acquired by transferring DNA from one bacterium to another. However, the mechanisms that enhance the acquisitions of foreign genes are poorly understood, as well as the dynamics of their transmission between hosts in different environments. Here, genomic approaches were applied to evaluate the enrichment of the S. aureus chromosome with resistance traits in groups of genomes with or without anti-restriction genes and to analyze some evolutionary aspects of these acquisitions. Furthermore, the role played by an anti-restriction gene in improving multiresistance in MRSA was investigated by molecular cloning. A strong association was observed between the presence of anti-restriction gene homologs and patterns of multidrug resistance. Human isolates, mainly ST239-SCCmecIII, carry ardA-H1, and from animal sources, mainly CC398, carry ardA-H2. Increased DNA transfer was observed for clones that express the ardA-H1 allele, corroborating its role in promoting gene transfer. In addition, ardA-H1 was expressed in the dsDNA format in the BMB9393 strain. The evolution of successful multidrug-resistant MRSA lineages of the ST239 and ST398 was initiated not only by the entry of the mec cassette but also by the acquisition of anti-restriction gene homologs. Understanding the mechanisms that affect DNA transfer may provide new tools to control the spread of drug resistance.

Intrauterine and Lactational Exposure to Paracetamol: Cardiometabolic Evaluation in Adult Female and Male Offspring.

ABSTRACT: Paracetamol (PAR) is the most common over-the-counter drug recommended by physicians for treatment of pain and fever during gestation. This drug is not teratogenic, being considered safe for fetus; however, PAR crosses the blood-placental barrier. Considering that, the present study aimed to evaluate the vascular and metabolic safety of PAR exposure during intrauterine and neonatal development in adult male and female-exposed offspring. Wistar female rats were gavaged, with PAR (350 mg/kg/d), from gestational day 6-21 or from gestational day 6 until postnatal day 21. Control dams received water by gavage at the same periods. The male and female offspring were evaluated at adulthood (80 days of life). The thoracic aorta reactivity to acetylcholine, sodium nitroprusside, and phenylephrine was evaluated in male and female adult offspring. It was observed that aortic relaxation was similar between the PAR and control offspring. In addition, the contraction to phenylephrine was similar between the groups. Further, the insulin sensitivity, adipose tissue deposition and blood pressure were not different between PAR and control adult offspring. These results suggest that the protocol of PAR exposure used in the present study did not program vascular and metabolic alterations that would contribute to the development of cardiometabolic diseases in adult life, being safe for the exposed offspring.

Anthelmintic resistance of gastrointestinal nematodes in sheep grazing in irrigated and dry areas in the semiarid region of northeastern Brazil.

This study aimed to determine the AR of gastrointestinal nematodes (GIN) to commercial drugs in sheep flocks naturally infected, grazing in irrigated (IA) and dry (DA) areas of the semiarid region in northeastern Brazil. Fecal egg count reduction tests (FECRT) were performed at 10 farms. From each flock, 36 adult sheep were selected and divided into five groups (G1 (0.08% ivermectin), G2 (10% albendazole), G3 (5% levamisole), G4 (1% moxidectin), G5 (10% closantel) and one control group, G6). All the commercial drugs were found to reduce the number of eggs per gram of feces (EPG). Resistance to ivermectin (37.1%), albendazole (52.1%), and levamisole (52.0%) was detected at all the farms, but nematodes proved to be susceptible to moxidectin (87.9%) and closantel (83.9%). The overall average efficacy of the commercial drugs was significantly higher (P < 0.05) in DA (49.2%), where moxidectin (90.4%) showed high effectiveness. The presence of the parasite Haemonchus contortus predominated at all the farms. The variables irrigated area (P = 0.002), intensive breeding (P = 0.018), uncovered enclosures (P = 0.05), cultivated (P = 0.043) and native/cultivated (P = 0.007) pastures, and rotational grazing (P = 0.013) were significantly associated with GIN infection; irrigated area (P = 0.009), semi-intensive breeding (P = 0.05), rotational grazing (P = 0.045), cultivated (P = 0.021) and native/cultivated (P = 0.04) pastures, and estimated weighing of animals (P = 0.002) were significantly associated with AR. Therefore, improved management practices and strategic deworming must be implemented to prevent the development of AR.

Impacto da introdução da angioembolização para o tratamento não operatório do trauma esplênico contuso grau III e IV no Hospital João XXIII, Belo Horizonte / Brasil / Impact of the introduction of angioembolization on nonoperative management of blunt splenic trauma grades III and IV at Hospital João XXIII - Belo Horizonte/Brazil

Objetivo: Comparar o sucesso do tratamento não operatório da lesão esplênica contusa graus III e IV, antes e após a introdução da angioembolização como método adjuvante. Métodos: Os dados foram coletados do prontuário eletrônico de pacientes com lesões esplênicas contusas graus III e IV (exceto hematoma subcapsular), segundo classificação da AAST (American Association for Surgery of Trauma), submetidos ao tratamento não operatório no Hospital João XXIII no período de janeiro/2014 a julho/2017. Os dados foram comparados a uma série de casos dessas mesmas lesões entre novembro/2004 e dezembro/2013 na mesma instituição, quando a angioembolização não era utilizada. O nível de significância do estudo foi 5% e seu desfecho foi a falha do tratamento não operatório. As análises foram feitas nos software R3.6.3 e MINITAB versão 14. Resultados: Entre novembro/2004 e dezembro/2013, foram estudados 389 pacientes em tratamento conservador, sendo 332 (82,8%) com lesão esplênica contusa grau III e 67 (17,2%) grau IV, havendo falha no tratamento (necessidade de esplenectomia) em 36 (11%) com lesão grau III e 22 (33%) com lesão grau IV. No período de janeiro/2014 a julho/2017, quando da disponibilidade da angioembolização, 195 pacientes foram submetidos a tratamento conservador, sendo 110 (56,4%) com lesão esplênica contusa grau III e 85 (43,6%) grau IV. Desses, houve falha no tratamento em 4 (3,6%) com lesão grau III e 6 (7%) com lesão grau IV. Conclusão: O tratamento não operatório do trauma esplênico contuso associado à angioembolização apresentou redução, com significância estatística, da necessidade de esplenectomia nas lesões esplênicas graus III e IV.

Objective: Compare the success of non-operative treatment of blunt splenic injury grades III and IV, before and after the introduction of angioembolization. Methods: Data collected from electronic medical reports of patients presenting blunt splenic injury (BSI) grades III and IV (subcapsular hematoma was not included), according to AAST (American Association for Surgery of Trauma) classification and undergoing nonoperative management at Hospital João XXII from January 2014 to July 2017. Data was compared to a case series of these nonoperative injuries from November 2004 to December 2013 at the same institution, when angioembolization was not used. The study level of significance was 5% and outcome was failure of non-operative treatment. Analyses were made using the software R3.6.3 and MINITAB version 14. Results: From November/2004 to December/2013, 389 patients undergoing conservative treatment were studied, 332 (82,8%) of which presented with blunt splenic injury grade III and 67 (17,2%) had lesions grade IV, treatment failure (need for splenectomy) occurred in 36 (11%) patients with injury grade III and 22 (33%) with grade IV. From January/2014 to July/2017, when angioembolization was available, 195 patients underwent conservative treatment, 110 (56,4%) with blunt splenic injury grade III and 85 (43,6%) with grade IV. In this group, treatment failed in 4 (3,6%) with injury grade III and 6 (7%) grade IV. Conclusion: Nonoperative management of blunt splenic trauma associated with angioembolization is associated with a reduction in splenectomy in splenic injuries grades III and IV.

Conhecimento de adolescentes sobre vacinas: uma revisão integrativa / Knowledge of adolescents on vaccines: an integrating review / Conocimiento de adolescentes sobre las vacunas: una revisión integrativa

Objetivo: analisar as produções científicas acerca do conhecimento dos adolescentes sobre vacinas. Métodos:revisão integrativa que utilizou as bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval Sistem on-line (MEDLINE) e Bases de Dados de Enfermagem (BDENF). Os descritores foram utilizados com a seguinte equação de busca: "Conhecimento" and "Adolescentes" and "Vacinas". Incluíram-se artigos científicos do tipo original, publicados de 2010 a 2017, com adolescentes, nos idiomas português, espanhol e inglês, disponíveis on-line na íntegra e de modo gratuito; excluíram-se artigos incompletos, teses, dissertações e monografias. Resultados: as seis produções científicas analisadas revelaram conhecimento escasso acerca das práticas de imunização e déficit de conhecimento sobre vacinas entre os adolescentes. Conclusão: o nível de conhecimento dos adolescentes sobre vacinas é insatisfatório, representando um fator que pode ocasionar diminuição da cobertura vacinal e aumentar a vulnerabilidade desses indivíduos as doenças imunopreveníveis

Objective: to analyze the scientific productions about adolescents' knowledge about vaccines. Methods: integrative review that used the databases: Latin American and Caribbean Literature in Health Sciences (LILACS), Medical Literature Analysis and Online Retrieval System (MEDLINE) and Nursing Databases (BDENF). The descriptors were used with the following search equation: "Knowledge" and "Adolescents" and "Vaccines". Scientific articles of the original type, published from 2010 to 2017, were included with adolescents, in the Portuguese, Spanish and English languages, available on-line in full and free of charge; we excluded articles that did not have complete text available online, theses, dissertations and monographs. Results: the six scientific productions analyzed revealed scarce knowledge about immunization practices and knowledge deficits on vaccines among adolescents. Conclusion: adolescents' level of knowledge about vaccines is unsatisfactory, representing a factor that may lead to a decrease in vaccination coverage and increase the vulnerability of these individuals to immunopreventable diseases

Objetivo: analizar producciones científicas sobre el conocimiento de los adolescentes sobre las vacunas. Métodos: revisión integradora que utilizó las bases de datos: Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Análisis de Literatura Médica y Sistema de Recuperación en línea (MEDLINE) y Bases de Datos de Enfermería (BDENF). Los descriptores se utilizaron con la siguiente ecuación de búsqueda: "Conocimiento" y "Adolescentes" y "Vacunas". Se incluyeron artículos científicos originales, publicados de 2010 a 2017, con adolescentes, en portugués, español e inglés, disponibles en línea de forma completa y gratuita; artículos incompletos, tesis, disertaciones y monografías fueron excluidos. Resultados: las seis producciones científicas analizadas revelaron poco conocimiento sobre las prácticas de inmunización y la falta de conocimiento sobre las vacunas entre los adolescentes. Conclusión: el nivel de conocimiento de los adolescentes sobre las vacunas es insatisfactorio, lo que representa un factor que puede causar una disminución en la cobertura de vacunación y aumentar la vulnerabilidad de estos individuos a las enfermedades prevenibles por vacunación

Proposta de termo de consentimento livre e esclarecido em endodontia regenerativa / Proposed of informed consent in regenerative endodontics

O termo de consentimento livre e esclarecido (TCLE) refere-se ao documento responsável por esclarecer ao paciente o seu diagnóstico, as modalidades de tratamento disponíveis, o prognóstico e os eventuais riscos passíveis de ocorrência em detrimento da realização de um determinado tratamento. Deve ser instituído em todas as especialidades clínicas, principalmente para casos complexos, uma vez que nestas situações busca-se manter dentes com prognósticos duvidosos na cavidade bucal. Uma situação desafiadora na Endodontia compreende o tratamento de dentes necróticos com ápices incompletamente formados. Por anos, estes casos foram tratados por meio das técnicas de apicificação, todavia, por não permitirem o desenvolvimento da raiz em espessura e comprimento, apresentavam considerável índice de fratura radicular. Diante dessas limitações, uma modalidade contemporânea de tratamento foi proposta, a Endodontia Regenerativa (ER), capaz de permitir o término do desenvolvimento radicular e fechamento apical, com resultados mais promissores. Por tratar-se de um tratamento relativamente recente, a elaboração de um termo de consentimento livre e esclarecido para estas situações clínicas faz-se necessária, com vistas a resguardar o profissional e o paciente. Assim, o presente trabalho teve como objetivos revisar a literatura quanto à importância da elaboração de um TCLE para pacientes tratados por meio da técnica de ER, bem como sugerir um modelo de documento. É relevante que o Cirurgião-dentista elabore e aplique o TCLE para pacientes que serão submetidos à ER, devendo incluir neste documento todas as informações referentes ao tratamento, para que em casos de questionamentos ético-judiciais, o mesmo o auxilie na comprovação da adequada conduta profissional

Sequence-based autosomal STR characterization in four US populations using PowerSeq™ Auto/Y system.

The forensic science community is poised to utilize modern advances in massively parallel sequencing (MPS) technologies to better characterize biological samples with higher resolution. A critical component towards the advancement of forensic DNA analysis with these technologies is a comprehensive understanding of the diversity and population distribution of sequence-based short tandem repeat (STR) alleles. Here we analyzed 786 samples of individuals from different population groups, including four of the mostly commonly encountered in forensic casework in the USA. DNA samples were amplified with the PowerSeq™ Auto/Y System Prototype Kit (Promega Corp.), and sequencing was performed on an Illumina® MiSeq instrument. Sequence data were analyzed using a bioinformatics processing tool, Altius. For additional data analysis and profile comparison, capillary electrophoresis (CE) size-based STR genotypes were generated for a subset of individuals, and where possible, also with a second commercially available MPS STR assay. Autosomal STR loci were analyzed and frequencies were calculated based on sequence composition. Also, population genetics studies were performed, with Hardy-Weinberg equilibrium, polymorphic information content (PIC), and observed and expected heterozygosity all assessed. Overall, sequence-based allelic variants of the repeat region were observed in 20 out of 22 different STR loci commonly used in forensic DNA genotyping, with the highest number of sequence variation observed at locus D12S391. The highest increase in allelic diversity and in PIC through sequence-based genotyping was observed at loci D3S1358 and D8S1179. Such detailed sequence analysis, as the one performed in the present study, is important to help understand the diversity of sequence-based STR alleles across different populations and to demonstrate how such allelic variation can improve statistics used for forensic casework.

Atividade física como fator protetor para o extremo baixo peso em idosos assistidos por uma operadora de saúde / Physical activity as a protective factor for extreme low weight in elderly assisted by a health care operator

Objetivo: Investigar a influência de fatores relacionados aos aspectos multidimensionais do envelhecimento em um grupo de idosos com baixo peso assistidos pelo setor privado de saúde. Métodos: Estudo transversal conduzido com 243 idosos com índice de massa corpórea <23 kg/m², todos assistidos por uma operadora de planos de saúde, no município de São Paulo, SP, Brasil, alocados em dois grupos: baixo peso e extremo baixo peso. Para a coleta dos dados empregou-se inquérito contendo informações relacionadas aos aspectos multidimensionais do envelhecimento. Os dados obtidos foram submetidos a análise descritiva das variáveis, com posterior análise comparativa através dos testes t Student e Qui-Quadrado ou exato de Fisher, quando necessário. Para variáveis com significância estatística, aplicou-se regressão logística e calculou-se as Odds Ratio, com intervalo de confiança de 95%. Resultados: Observou-se que, a idade avançada (p=0,044), dificuldade de mobilidade (p=0,011) e baixos níveis de atividade física (p=0.021) influenciam significativamente os idosos em estado nutricional de extremo baixo peso. Por meio do modelo de regressão logística, verificou-se que para cada uma hora de atividade física praticada pelos idosos deste grupo, os riscos de evolução para extremo baixo peso diminuem em até 14%. Conclusão: A pratica regular e orientada de atividade física praticada por idosos com algum grau de déficit nutricional é capaz de prevenir e/ou retardar desfechos indesejados em grupos susceptíveis.

Objective: Investigate the influence of factors related to multidimensional aspects of aging in a group of elderly assisted by the private health sector. Methods: Cross-sectional study conducted with 243 elders with a body mass index <23 kg/m² assisted by a health plan in the city of São Paulo, SP, Brazil, with them being allocated into two groups: low weight and extreme low weight. For data collection, a survey developed by the researchers themselves containing information related to multidimensional aspects of aging was employed. The obtained data were submitted to a descriptive analysis of the variables and a subsequent comparative analysis through Student's t-distribution, Chi-squared or Fisher's exact tests, when necessary. For variables with statistical significance, logistic regression was applied and the odds ratio, with a 95% confidence interval, was calculated. Results: It was observed that advanced age (p=0.044), mobility difficulty (p=0.011) and low levels of physical activity (p=0.021) significantly influence the elderly in extremely low weight nutritional status. Moreover, through the logistic regression model, it was found that, for this group, every hour of physical activity practiced by underweight elders, the risks of evolution to an extreme low weight status decrease by up to 14%. Conclusion: The regular and oriented practice of physical activity by the elderly with some degree of nutritional deficit is able to prevent and/or delay unwanted outcomes in susceptible groups.