Análise de forças de movimentação e características físico-químicas em alinhadores ortodônticos: avanços tecnológicos e considerações críticas / Analysis of motion forces and physicochemical characteristics in orthodontic aligners: technological advances and critical considerations

O avanço tecnológico revolucionou a prática odontológica, com os alinhadores ortodônticos emergindo como uma escolha altamente popular entre pacientes que buscam tratamentos estéticos e confortáveis. No entanto, apesar de sua crescente demanda, permanecem questões cruciais relacionadas à eficácia e análise dimensional desses dispositivos. Este artigo oferece uma análise abrangente das características químicas, físicas e mecânicas dos alinhadores ortodônticos, iluminando a influência vital do processo de termoformação e da espessura nas propriedades desses materiais. Compreender profundamente essas características é essencial para aprimorar a eficácia e a durabilidade dos alinhadores ortodônticos, contribuindo, assim, para o sucesso e a evolução dos tratamentos ortodônticos modernos. Neste estudo, exploraremos: 1) as propriedades químicas dos materiais e como elas afetam a biocompatibilidade e a resistência à degradação; 2) as características físicas, incluindo textura de superfície, transparência e sua influência na adaptação bucal e no conforto do paciente; 3) as propriedades mecânicas, como flexibilidade e rigidez, e como essas características afetam a distribuição de forças de movimentação dentária; 4) a influência do processo de termoformação na precisão e reprodutibilidade dos alinhadores, bem como sua relação com a qualidade do tratamento; 5) a análise crítica da espessura dos alinhadores e seu papel na capacidade de aplicar forças adequadas para a movimentação dentária. Ao abordar esses aspectos, este artigo visa oferecer uma visão holística das complexidades envolvidas na fabricação e uso de alinhadores ortodônticos. Esperamos que esta revisão contribua para uma compreensão mais profunda desses dispositivos e promova avanços significativos na ortodontia, beneficiando tanto os profissionais quanto os pacientes.

Technological advancement has revolutionized dental practice, with orthodontic aligners emerging as a trendy choice among patients seeking aesthetic and comfortable treatments. However, despite their growing demand, crucial questions remain regarding these devices' effectiveness and dimensional analysis. This article offers a comprehensive analysis of the chemical, physical, and mechanical characteristics of orthodontic aligners, illuminating the vital influence of the thermoforming process and thickness on the properties of these materials. Understanding these characteristics in depth is essential to improving the effectiveness and durability of orthodontic aligners, thus contributing to the success and evolution of modern orthodontic treatments. In this study, we will explore 1) the chemical properties of materials and how these properties affect biocompatibility and resistance to degradation; 2) the physical characteristics, including surface texture, transparency and their influence on oral adaptation and patient comfort; 3) mechanical properties, such as flexibility and stiffness, and how these characteristics affect the distribution of tooth movement forces; 4) the influence of the thermoforming process on the precision and reproducibility of the aligners, as well as its relationship with the quality of the treatment; 5) critical analysis of aligner thickness and its role in the ability to apply adequate forces for tooth movement. By addressing these aspects, this article aims to offer a holistic view of the complexities involved in manufacturing and using orthodontic aligners. We hope this review will contribute to a deeper understanding of these devices and promote significant advances in orthodontics, benefiting professionals and patients.

Stereoselective Electrochemical Synthesis of E-Tetrasubstituted Haloalkenyl Chalcogenides.

Herein, we describe an electrochemical method for the synthesis of haloalkenyl chalcogenides from internal alkynes using hydrobromic and hydrochloric acids as halogenating agents, with the sole byproduct being hydrogen gas. This e-halochalcogenation protocol generates electrophilic chalcogenium species under mild conditions in a simple, undivided cell setup, enabling the synthesis of 25 examples of chloro- and bromovinyl selenides and sulfides with yields ranging from 10% to 94%, predominantly as the E-isomer. The synthetic utility of the halovinyl chalcogenides was demonstrated through various transformations, yielding densely functionalized tetra-substituted olefins. This underscores the versatility and efficiency of our method in assembling intricate molecular frameworks.

Pediatric Organ Donation: 16-Year Experience of PICU/ICU of a Third Level Hospital in Portugal, 2006-2021.

Although pediatric organ donation represents a small proportion of overall organ donation, children and adolescents make a significant contribution to the pool of donated organs. In this study 252 solid organs were collected from children and adolescent. Two hundred and two recipients benefited from 62 pediatric organ donors, with a recipient/donor ratio of 3.3.

BACKGROUND: Pediatric organ donors represent a small but important portion of the deceased donor pool, helping both children and adults in the transplant waitlist. Despite this, pediatric donation remains an overlooked subject of research. METHODS: Retrospective, single­center, descriptive study. All brain death patients under 18 years old who were admitted to the Intensive Care Unit (ICU) between January 1st, 2006, and December 31st, 2021, and who were eligible for organ donation were included. RESULTS: Between January 2006 and December 2021, 200 children/adolescent died in the ICU. From those, 62 patients (31%) were considered eligible for organ donation. The mean age of the donors at the time of death was 8.8 years. Sixty­three per cent were male. The most frequent cause of death was traumatic brain injury (n = 36). Two hundred and fifty organs were collected benefitting 202 persons with a recipient/donor ratio of 3.3. Kidneys were the most frequent organ donated (n = 116), followed by liver (n = 56) and heart (n = 34). The median number of organs donated per child was four, with a minimum of 1 organ and maximum of 8. CONCLUSIONS: Pediatric organ donation represents a small proportion of overall organ donation, but children and adolescents have important impact on the lives they save. The field of pediatric organ donation needs more research to better understand the contribution of the pediatric population to both adults and children who wait for an organ.

Use of neem vegetable cake (Azadirachta indica A. Juss) increases corn productivity.

The need to transition to more sustainable agriculture that is adaptable to environmental challenges, reducing dependence on chemical fertilizers and minimizing environmental impact, represents the new paradigm of the moment. In this scenario, studies with the adoption of bioinputs in corn cultivation emerge as a viable option for the sustainability of agricultural activity. Therefore, the objective was to evaluate the effect of doses of neem vegetable cake on the yield components of corn crops. An experimental design was used of randomized blocks was used, consisting of four doses of neem vegetable rendering (3 kg ha-1, 6 kg ha-1, 9 kg ha-1 and 12 kg ha-1) and a treatment control without the presence of organic fertilizer. The result indicates the presence of a significant effect of treatments with the application of neem cake on the main components of corn yield, including grain productivity, suggesting that the high carbon content present in the organic product can induce phytochemical effects and biological changes. in the soil, making it more productive. It was found that, when administering the maximum experimental dose, compared to the control group, there was a significant effect (p≤0.01) of 21.3% on grain productivity, jumping from 2,140 kg ha -1, when did not apply organic fertilizer, to 2,596 kg ha-1 with the application of 12 kg of neem cake per hectare. It is noted that the increase in grain productivity was in the proportion of 38 kg ha-1 of corn for each kilo of neem cake applied. To facilitate interpretation and decision-making, an analysis of the economic viability of neem cake for rainfed corn was also determined, also identifying the maximum experimental dose of 12 kg ha-1, as the most economically viable, providing an increase in profit of around R$ 119.92 per hectare, in relation to the control.

Lessons from the COVID-19 pandemic: the unequal burden of COVID-19 on vulnerable populations in the Brazilian Central-West.

This study aimed to estimate the prevalence and identify social factors and preventive strategies associated with the coronavirus disease 2019 (COVID-19) in socio and economically vulnerable people (recyclable waste pikers, immigrants/refugees, and homeless people) in Goiânia, Goiás State, Central-Western Brazil. A cross-sectional study was conducted from July 2020 to October 2020. COVID-19 positivity was defined as a positive total anti-SARS-COV-2 antibody test and/or RNA test for SARS-COV-2. Univariable and multiple regression analyses were performed to identify the variables associated with COVID-19. Of the 594 participants, 47.3% were recyclable waste pickers, 29.6% were immigrants/refugees, and 23.1% were homeless people. The positivity for SARS-CoV-2 RNA was 14.1%, whereas for anti-SARS-CoV-2 a total of 30.8% were positive, and 39.4% were positive for at least one COVID-19 marker. Among the 541 individuals, being immigrants/refugees, not wearing a surgical mask, and having three or more people sleeping in the same room were associated with SARS-CoV-2 infection, while using TV news as the main source of information about the pandemic was a protective predictor of COVID-19. This study revealed ethnic and socioeconomic inequalities in the prevalence of COVID-19 among impoverished people in Brazil. Additionally, a high prevalence of COVID-19 was detected in all three groups. Developing new strategies to combat and prevent communicable diseases affecting this population is essential for mitigating future and ongoing pandemics.

Enhancing early identification of high-fertile cattle females using infrared blood serum spectra and machine learning.

Artificial insemination (AI) success in bovine reproduction is vital for the cattle industry's economic sustainability and for advancing the understanding of reproductive physiology. Identify high-fertile animals' fertility is a complex task due to multifactorial traits, including hormonal, age-related, and body condition factors. Early high-fertility identification is crucial for timely interventions and enhancing AI success. In this study, we present the potential use of Fourier-transform infrared (FTIR) spectroscopy on blood serum for early identification of high-fertile Nellore female cows for AI protocols. Blood serum FTIR spectra were obtained from Nellore female cows before AI. FTIR spectra underwent data analysis and the results demonstrated successful discrimination between animals that exhibit pregnant and non-pregnant diagnoses 30 days after AI. FTIR spectra revealed consistent vibrational modes, emphasizing Amide I and II bands. Principal Component Analysis (PCA) effectively segregated groups based on molecular information. Linear SVM with C = 10 and 4 PCs achieved 100% accuracy in the group classification. This innovative approach using FTIR spectroscopy and ML algorithms offers a promising means of high-fertile cow identification, potentially improving AI outcomes in Nellore cattle. The study presents valuable insights into advancements in reproductive management practices for this economically significant breed.

Instruments to Assess the Comfort of Hospitalized Elderly People: A Scoping Review.

Background and Purpose: The purpose of this study was to map the instruments for assessing the comfort of hospitalized older adults in the scientific literature, identifying those instruments validated and transculturally adapted to the realities of Brazil. Methods: This was a scoping review of 14 articles and a website retrieved from the following databases: MEDLINE/PubMed, CINAHL, EMBASE, Web of Science, Scopus, Science Direct/Elsevier, and gray literature (Oasisbr, Catalog of Theses and Dissertations [CAPES], OATD, BDBTD, and The Comfort Line). Results: Seventeen instruments for assessing the comfort of hospitalized older adults were mapped; however, none were specifically designed for this population, as they were originally intended for adults or individuals with neuropsychiatric conditions. Among these, three have been validated and transculturally adapted to the Brazilian context. Conclusions: This study reveals the need for a specific instrument tailored for hospitalized older adults without neuropsychiatric conditions.

Enhancing the Horse Grimace Scale (HGS): Proposed updates and anatomical descriptors for pain assessment.

The use of grimace scales enables the clinical identification of changes in the facial expressions of animals caused by pain. The Horse Grimace Scale (HGS) is one such tool, comprising a pain coding system based on facial expressions and assessing six Facial Action Units (FAUs). Each FAU is accompanied by descriptions and anatomical details to assist the evaluator. However, the morphological descriptions for certain FAUs in the HGS are not sufficiently detailed, potentially hindering accurate interpretation. This study is an analytical investigation aimed at enhancing the morphoanatomical details in the HGS and providing raters with more comprehensive materials for pain evaluation in horses using this scale. To achieve this, detailed anatomical analyses were conducted using established references in veterinary anatomy. Initially, we propose substituting the term 'ear' with 'auricle' or 'pinna' and replacing 'area above the eye' with 'supraorbital region' for anatomical accuracy. Additionally, we introduce detailed morphoanatomical descriptions that identify specific landmarks, with the goal of ensuring more consistent application of the HGS and reducing interpretation variability. Furthermore, this study provides an explanation of the muscles involved in the investigated FAUs. These adjustments on the descriptions and evaluations remain unverified, however it is anticipated that the descriptive enhancements lead us to understand that higher interobserver reliability can be achieved for each of the FAUs.

The somatic mutation profile of estrogen receptor-positive HER2-negative metastatic breast cancer in Brazilian patients.

Background: Breast cancer is the leading cause of cancer death among women worldwide. Studies about the genomic landscape of metastatic breast cancer (MBC) have predominantly originated from developed nations. There are still limited data on the molecular epidemiology of MBC in low- and middle-income countries. This study aims to evaluate the prevalence of mutations in the PI3K-AKT pathway and other actionable drivers in estrogen receptor (ER)+/HER2- MBC among Brazilian patients treated at a large institution representative of the nation's demographic diversity. Methods: We conducted a retrospective observational study using laboratory data (OC Precision Medicine). Our study included tumor samples from patients with ER+/HER2- MBC who underwent routine tumor testing from 2020 to 2023 and originated from several Brazilian centers within the Oncoclinicas network. Two distinct next-generation sequencing (NGS) assays were used: GS Focus (23 genes, covering PIK3CA, AKT1, ESR1, ERBB2, BRCA1, BRCA2, PALB2, TP53, but not PTEN) or GS 180 (180 genes, including PTEN, tumor mutation burden [TMB] and microsatellite instability [MSI]). Results: Evaluation of tumor samples from 328 patients was undertaken, mostly (75.6%) with GS Focus. Of these, 69% were primary tumors, while 31% were metastatic lesions. The prevalence of mutations in the PI3K-AKT pathway was 39.3% (95% confidence interval, 33% to 43%), distributed as 37.5% in PIK3CA and 1.8% in AKT1. Stratification by age revealed a higher incidence of mutations in this pathway among patients over 50 (44.5% vs 29.1%, p=0.01). Among the PIK3CA mutations, 78% were canonical (included in the alpelisib companion diagnostic non-NGS test), while the remaining 22% were characterized as non-canonical mutations (identifiable only by NGS test). ESR1 mutations were detected in 6.1%, exhibiting a higher frequency in metastatic samples (15.1% vs 1.3%, p=0.003). Additionally, mutations in BRCA1, BRCA2, or PALB2 were identified in 3.9% of cases, while mutations in ERBB2 were found in 2.1%. No PTEN mutations were detected, nor were TMB high or MSI cases. Conclusion: We describe the genomic landscape of Brazilian patients with ER+/HER2- MBC, in which the somatic mutation profile is comparable to what is described in the literature globally. These data are important for developing precision medicine strategies in this scenario, as well as for health systems management and research initiatives.

Extragastrointestinal Stromal Tumor in the Peritoneum: A Case Report.

Gastrointestinal stromal tumors (GIST) are tumors of mesenchymal origin, accounting for less than 1% of the primary neoplasms of the digestive tract, which can affect any segment of the gastrointestinal tract. However, they can also occur in other locations outside the gastrointestinal tract. In such situations, these are known as extragastrointestinal stromal tumors (eGIST). We present a 58-year-old male, who attended the emergency department due to asthenia, anorexia, heartburn, abdominal pain, and distension, who was ultimately diagnosed with an eGIST in the peritoneum. The immunohistochemistry pattern of the tumor sample obtained favored this diagnosis, especially demonstrated by the positivity for discovered on GIST protein 1 (DOG1) and negativity of smooth muscle markers. Due to the rarity of extragastrointestinal tumors and the even greater rarity of those originating in the peritoneum, the authors consider this a pertinent clinical case to be published due to its originality.

Applicability of the Neuman Systems Model to the Gerontology Nursing practice: a scoping review.

OBJECTIVE: to map scientific productions on the application of the Neuman Systems Model to the Nursing practice focused on health care for aged people. METHOD: a scoping review based on the methodology proposed by the Joanna Briggs Institute. Seven electronic databases were consulted. Regarding the eligibility criteria, the following were considered: Population - Aged people; Concept - Application of the Neuman Systems Model in the Nursing practice; and Research Context - Health services. RESULTS: a total of 14 studies made up the sample. The data were analyzed and summarized into two categories: implementation of the Neuman Systems Model in hospital, institutional and outpatient settings; and use of the Neuman Systems Model in community and home environments. CONCLUSION: the application of Neuman Systems approach to the Gerontology Nursing practice, in different care scenarios, proved to be promising, considering aged people as comprehensive individuals with multiple dimensions. This perspective has shown adaptability and effectiveness in meeting the diverse needs of older adults, resulting in an improvement in their quality of life in old age.

Smartphone-based evaluation of static balance and mobility in type 2 Diabetes.

It was compared smartphone-based measurements of static balance control and mobility of elderly population with and without type 2 diabetes mellitus (DM2). The present cross-sectional study investigated 73 participants grouped in a control group (n = 36) and a DM2 group (n = 37). Smartphone's built in inertial sensors were used to record inertial changes of the participants during static balance and mobility (Timed Up and Go test - TUG) tasks. The inertial variations as a function of the time were analyzed and compared between groups. Both groups were matched in age, body mass index, male-female proportion, but DM2 group had significant larger fasting glucose than control group. Additionally, DM2 group had worst static balance control with open and closed eyes than the controls (p < 0.05) as well as they also had longer duration to execute the different events of the mobility test than the controls (p < 0.05). DM2 patients had decline of motor functions compared to controls and the use of bult-in sensors of smartphones was feasible to identify these functional impairments. The easy access of smartphones could be improving the screening of functional impairments in DM2 patients.

Clinical and molecular characterization of limb-girdle muscular dystrophy 2G/R7 in a large cohort of Brazilian patients.

Limb-girdle muscular dystrophy type 2G/R7 (LGMD2G/R7) is an ultra-rare condition initially identified within the Brazilian population. We aimed to expand clinical and genetic information about this disease, including its worldwide distribution. A multicenter historical cohort study was performed at 13 centers in Brazil in which data from index cases and their affected relatives from consecutive families with LGMD2G/R7 were reviewed from July 2017 to August 2023. Additionally, a systematic literature review was conducted to identify case reports and series of the disease worldwide. Forty-one LGMD2G/R7 cases were described in the Brazilian cohort, being all subjects homozygous for the c.157C>T/(p.Gln53*) variant in TCAP. Survival curves showed that the median disease duration before individuals required walking aids was 21 years. Notably, women exhibited a slower disease progression, requiring walking aids 13 years later than men. LGMD2G/R7 was frequently reported not only in Brazil but also in China and Bulgaria, with 119 cases identified globally, with possible founder effects in the Brazilian, Eastern European, and Asian populations. These findings are pivotal in raising awareness of LGMD2G/R7, understanding its progression, and identifying potential modifiers. This can significantly contribute to the development of future natural history studies and clinical trials for this disease.

Nursing care for hospitalized older adults - fall accidents versus safe mobility: a scoping review.

OBJECTIVES: to map the constituent elements of the safe mobility concept present in hospital care for older adults. METHODS: a scoping review of 35 articles searched in databases and gray literature - BDENF/VHL, Scopus, CINAHL/EBSCO, Embase, Web of Science, PEDro, MEDLINE/PubMed and CAPES Theses and Dissertations Catalog. No time or language cut-off was established. RESULTS: none of the studies presented a clear safe mobility concept, however its constituent elements involve factors related to patient (behavioral factors, conditions, diseases, signs and symptoms, nutritional status, age, balance, strength, gait quality, sleep), the institution (environment, treatment devices, guidelines, medications and polypharmacy, material and human resources and clothing/shoes) and the nature of the interventions (related to the patient, institution and family). FINAL CONSIDERATIONS: the constituent elements of safe mobility express hospital units' capacity to guarantee care and protection from fall accidents for hospitalized older adults.

"Nenhuma Pessoa Idosa Merece Passar por Isso": Compreensão da Violência para Mulheres Gerontes / "Ninguna Persona Adulta Mayor Merece Pasar Por Esto": Comprensión de la Violencia para las Mujeres Adultas Mayores / "No Elderly Person Deserves to Go Through This": Understanding Violence Towards Elderly Women

Resumo Introdução: A violência contra idosos é um fenômeno crescente, ocasionando prejuízos à saúde, com diferentes desfechos e consequências às vítimas. A chance de idosas sofrerem-na no âmbito familiar supera a dos homens, sendo o gênero um fator de risco considerável. Objetivo: Analisar a compreensão da violência contra pessoas idosas segundo mulheres gerontes. Metodologia: Pesquisa descritiva com abordagem qualitativa desenvolvida com 22 idosas de uma comunidade no estado da Paraíba, Brasil, escolhidas por conveniência. Utilizou-se para coleta de dados entrevistas semiestruturadas, processadas pelo software Iramuteq, com posterior Análise de Conteúdo. Resultados: Foram evidenciadas cinco classes: ciclo de violência; rede de apoio ao idoso vítima de violência; Vivência de situações violentas; violência financeira; e simbologia da violência na sociedade, as quais denotam compreensão da violência envolvendo os diferentes tipos. Apoiam-se nos fatores da vivência familiar, cultura e outros, consubstanciando o profissional de saúde como fundamental para o desfecho. O gênero influenciou no que concerne ao olhar lançado sobre a violência física e psicológica, bem como na relevância dada às equipes de saúde para identificação de ocorrências e prevenção de possíveis danos. Conclusão: Os diversos tipos de violência contra a pessoa idosa foram reconhecidos, incluindo fatores individuais, comunitários e sociais no ciclo violento. Além disso, associaram o envelhecimento a maior suscetibilidade para sofrer violência, independente da tipologia. Destaca-se a potencialidade do serviço de saúde na assistência à pessoa idosa vítima de violência, elucidando casos e atuando precocemente para interrupção dos ciclos perpetrados, exigindo a necessidade constante de atualização profissional para lidar com situações detectadas.

Resumen Introducción: La violencia contra las personas adultas mayores es un fenómeno creciente, que causa daños a la salud, con diferentes desenlaces y consecuencias para las víctimas. La posibilidad de que las mujeres adultas mayores la sufran en el ámbito familiar supera la de los hombres, siendo el género un factor de riesgo considerable. Objetivo: Analizar la comprensión de la violencia contra las personas mayores según las mujeres adultas mayores. Metodología: Investigación descriptiva con enfoque cualitativo desarrollada con 22 mujeres adultas mayores de una comunidad en el estado de Paraíba, Brasil, elegidas por conveniencia. Para la recolección de datos, se utilizaron entrevistas semiestructuradas, procesadas por el software Iramuteq, con posterior análisis de contenido. Resultados: Se evidenciaron cinco tipos de violencia: ciclo de la violencia, red de apoyo población adulta mayor víctima de violencia, experimentar situaciones violentas, violencia financiera y simbología de la violencia en la sociedad, que denotan la comprensión de la violencia de diferentes tipos. Estas ideas están respaldadas en los factores de la experiencia familiar, la cultura y otros, donde la persona profesional de la salud se identifica como fundamental para el cuidado y apoyo. El género influyó en la mirada lanzada sobre la violencia física y psicológica, así como en la relevancia dada a los equipos de salud para la identificación de sucesos y la prevención de posibles daños. Conclusión: Se han reconocido los diversos tipos de violencia contra las personas mayores, incluidos los factores individuales, comunitarios y sociales en el ciclo de violencia. Además, asociaron el envejecimiento con una mayor susceptibilidad a sufrir violencia, independientemente de la tipología. Destaca la potencialidad del servicio de salud en la asistencia a la persona mayor víctima de violencia, mediante la identificación de casos y la actuación temprana para la interrupción de los ciclos perpetrados. De manera que, se evidencia la necesidad constante de actualización profesional para hacer frente a situaciones detectadas.

Abstract Introduction: Violence against the elderly is a growing phenomenon, causing damage to health, with different outcomes and consequences to the victims. The possibility of elderly women suffering it in the family context surpasses that of men, with gender being a considerable risk factor. Objective: To analyze the understanding of violence against the elderly according to elderly women. Method: Descriptive research with a qualitative approach developed with 22 elderly women from a community in the state of Paraíba, Brazil, chosen for convenience. The data collection was based on semi-structured interviews, processed by the Iramuteq software, with subsequent Content Analysis. Results: Five classes of violence against the elderly were evidenced: cycle of violence; support network for the elderly victims of violence; experience of violent situations; financial violence; and symbolism of violence in society, which denote an understanding of violence involving the different types. They are based on the factors of family experience, culture, and others, placing the health professional as a fundamental element for care and support. Gender influenced the perspective on physical and psychological violence, as well as the relevance given to health teams for the identification of occurrences and the prevention of possible damage. Conclusion: The various types of violence against the elderly have been recognized, including individual, community, and social factors in the violent cycle. In addition, they associated aging with greater susceptibility to suffering violence, regardless of the typology. It highlights the potential of the health service in assisting the elderly victim of violence, elucidating cases, and acting early to interrupt the cycles perpetrated, requiring the constant need for professional updating to deal with detected situations.

Hemophagocytic Lymphohistiocytosis: A Case Report.

The hemophagocytic syndrome (HS) or hemophagocytic lymphohistiocytosis (HLH) is a syndrome with apoptosis deficiency that results in the impairment of a regulatory pathway with consequent immune and inflammatory responses. Fever, cytopenias, splenomegaly, and hemophagocytosis are cardinal signs. It may be familial or secondary to infection, autoimmunity, or neoplasia. Impaired natural killer (NK)-cell cytotoxicity is the hallmark of HLH. All genetic defects in familial HLH are related to granule-dependent cytotoxicity. The authors present a 50-year-old black female patient with a history of drepanocytosis who attended the emergency department due to fever, asthenia, lethargy, and hypogastric pain. Her laboratory workup on admission revealed severe pancytopenia. She was ultimately diagnosed with HLH due to sepsis of urinary origin, with a fatal outcome. HLH is a rare and life-threatening syndrome. The delay in its diagnosis due to the variability of the clinical and laboratory findings constitutes the main obstacle to a successful prognosis, as illustrated in this case report.

Assessment of GFR in Patients with Cancer: A Statement from the American Society of Onco-Nephrology.

Accurate assessment of GFR is crucial to guiding drug eligibility, dosing of systemic therapy, and minimizing the risks of both undertreatment and toxicity in patients with cancer. Up to 32% of patients with cancer have baseline CKD, and both malignancy and treatment may cause kidney injury and subsequent CKD. To date, there has been lack of guidance to standardize approaches to GFR estimation in the cancer population. In this two-part statement from the American Society of Onco-Nephrology, we present key messages for estimation of GFR in patients with cancer, including the choice of GFR estimating equation, use of race and body surface area adjustment, and anticancer drug dose-adjustment in the setting of CKD. These key messages are based on a systematic review of studies assessing GFR estimating equations using serum creatinine and cystatin C in patients with cancer, against a measured GFR comparator. The preponderance of current data involving validated GFR estimating equations involves the CKD Epidemiology Collaboration (CKD-EPI) equations, with 2508 patients in whom CKD-EPI using serum creatinine and cystatin C was assessed (eight studies) and 15,349 in whom CKD-EPI with serum creatinine was assessed (22 studies). The former may have improved performance metrics and be less susceptible to shortfalls of eGFR using serum creatinine alone. Since included studies were moderate quality or lower, the American Society of Onco-Nephrology Position Committee rated the certainty of evidence as low. Additional studies are needed to assess the accuracy of other validated eGFR equations in patients with cancer. Given the importance of accurate and timely eGFR assessment, we advocate for the use of validated GFR estimating equations incorporating both serum creatinine and cystatin C in patients with cancer. Measurement of GFR via exogenous filtration markers should be considered in patients with cancer for whom eGFR results in borderline eligibility for therapies or clinical trials.

Prevalence of urinary incontinence in Brazilian para athletes.

OBJECTIVE: To describe the prevalence of urinary incontinence (UI) in para athletes in Brazil. METHODS: This is a cross-sectional study with Brazilian para athletes with physical impairments from all para sports. The data from 86 participants of both sexes (60 males and 26 females) were collected through an online survey that gathered sociodemographic data and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, from March to July 2023. RESULTS: The prevalence of UI was 45.3% (n=39), with the average impact on quality of life scored at 6.1±3.5 on a scale of 0-10. Most para athletes reported moderate (43.5%) or severe (38.4%) symptoms. The most common type was mixed UI (46.1%), with an average of 3±1.9 episodes of urinary loss per athlete in the last 4 weeks. Adjusted Poisson regression (controlling for sex, age and level of competition) revealed that para athletes with orthopaedic impairments had a 58% lower prevalence of UI (prevalence ratio=0.42; 95% CI 0.24, 0.83) compared with those with neurological impairments. Furthermore, ordinal regression indicated that para athletes with neurological impairments were 147% more likely to experience a progression from 'severe' to 'very severe' UI (OR=2.47; 95% CI 1.59, 3.93). CONCLUSIONS: UI is highly prevalent among para athletes, particularly those with neurological impairments, underscoring the need for specialised genitourinary healthcare and the need for further treatment and monitoring of the condition. There is a critical need to raise awareness among coaches, healthcare providers and the athletes themselves about UI and its impact to foster the comprehensive well-being of these athletes.

Scapular dyskinesis and overhead athletes: A systematic review of electromyography studies.

OBJECTIVE: Understanding how the main scapular muscles behave in overhead athletes with scapular dyskinesis (SD). DESIGN: Systematic Review. SETTING: Electronic searches were performed in Pubmed (MedLine), Embase, CINAHL, and SPORTDiscus databases. PARTICIPANTS: Overhead athletes with SD. MAIN OUTCOME MEASURES: Electromyographic activity of the upper (UT), middle (MT), and lower (LT) trapezius, and serratus anterior (SA). RESULTS: Eight studies were included in this review. The UT activity showed a tended to increase its activity mainly during tasks over 90° compared to 45°. SA activity had similar behavior, mainly during isometric tasks. The MT also increased its activity mainly in tasks with overhead angulations when compared to lower angulations. The LT activation tended to decrease its EMG activity at angulations below 60° in overhead athletes with SD. CONCLUSIONS: The EMG behaviour of UT and SA for non-athletes appears to differ from what has already been described in the literature. The MT seems to be the most neglected muscle for scapular stabilization in overhead athletes with SD. The decrease in LT activity suggests that this may have implications for the performance of these athletes.

Cocaine/crack and cannabis use among transgender women in Goiás, Central Brazil.

INTRODUCTION: Illicit drug use is a significant public health problem. Studies have shown a high prevalence of cocaine and cannabis use in transgender women (TGW). OBJECTIVE: To describe the consumption patterns of cannabis and cocaine/crack use and variables associated with their use in TGW in Central Brazil. METHODS: A cross-sectional study was conducted on TGW in Goiás, Brazil. Participants were recruited using a respondent-driven sampling method and were interviewed face-to-face about cannabis and crack-cocaine and the variables associated with them. The Alcohol Smoking and Substance Involvement Screening Test was used to assess substance use. Unweighted logistic regression was used to identify variables associated with cannabis and crack cocaine use. P-values < 0.05 were considered statistically significant. RESULTS: A total of 440 transgender women participated in the study. Their median age was 25 years (interquartile range: 20.5-29.5 years). Most participants were single (85.5%) and had engaged in sex work in their lifetime (58.6%). Cannabis was reported by 68.9% and 53.4% of participants in their lifetime and in the past three months, respectively, and cocaine/crack use was reported by 59.8% and 44.1% of participants in their lifetime and the past three months, respectively. Of the participants, 10.2% reported high-risk cannabis use, and 9.1% reported high-risk cocaine/crack use. Furthermore, 35% of participants reported using both drugs. Previous physical violence (Adjusted Odds Ratio (AOR): 2.37), inconsistent condom uses during anal sex (AOR: 2.17), and moderate-/high-risk cocaine/crack use (AOR: 3.14) were associated with high-risk cannabis use. Previous sexual violence (AOR: 2.84), previous STI (AOR: 2.90), moderate-/high-risk cannabis (AOR: 3.82), and binge drinking (AOR; 3.28) were associated with high-risk cocaine/crack use. CONCLUSION: Our study found a high frequency, significant overlap in the use of cannabis and cocaine/crack use and violence associated with these drugs consumption among TGW, highlighting the urgent need for health policies for drug disorders among this socially marginalized group.