Neurotoxicity of crack cocaine exposure: evidence from a systematic review of in vitro and in vivo studies.

Several studies suggest that crack cocaine users exhibit higher prevalence of both psychiatric and psychosocial problems, with an aggressive pattern of drug use. Nevertheless, few experimental studies attempted to verify the neurotoxicity after crack cocaine exposure, especially when compared with other routes of cocaine administration. This systematic review aimed to verify whether in vitro and/or in vivo crack cocaine exposure is more neurotoxic than cocaine exposure (snorted or injected). A search was performed in the PubMed, EMBASE, Scopus, Web of Science, and LILACS databases for in vitro and in vivo toxicological studies conducted with either rats or mice, with no distinction with regard to sex or age. Other methods including BioRxiv, BDTD, Academic Google, citation searching, and specialist consultation were also adopted. Two independent investigators screened the titles and abstracts of retrieved studies and subsequently performed full-text reading and data extraction. The quality of the included studies was assessed by the Toxicological data Reliability assessment Tool (ToxRTool). The study protocol was registered with the Prospective Registry of Systematic Reviews (PROSPERO; CRD42022332250). Of the twelve studies included, three were in vitro and nine were in vivo studies. According to the ToxRTool, most studies were considered reliable either with or without restrictions, with no one being considered as not reliable. The studies found neuroteratogenic effects, decreased threshold for epileptic seizures, schizophrenic-like symptoms, and cognitive deficits to be associated with crack cocaine exposure. Moreover, both in vitro and in vivo studies reported a worsening in cocaine neurotoxic effect caused by the anhydroecgonine methyl ester (AEME), a cocaine main pyrolysis product, which is in line with the more aggressive pattern of crack cocaine use. This systematic review suggests that crack cocaine exposure is more neurotoxic than other routes of cocaine administration. However, before the scarcity of studies on this topic, further toxicological studies are necessary.

Graphene Oxide, Carbon Nanotubes, and Polyelectrolytes-Based Impedanciometric E-Tongue for Estrogen Detection in Complex Matrices.

Currently, it is necessary to maintain the quality of aquifers and water bodies, which means the need for sensors that detect molecules as emerging pollutants (EPs) at low concentrations in aqueous complex solutions. In this work, an electronic tongue (e-tongue) prototype was developed to detect 17ß-estradiol in tap water. To achieve such a prototype, an array of sensors was prepared. Each sensor consists of a solid support with interdigitated electrodes without or with thin films prepared with graphene oxide, nanotubes, and other polyelectrolytes molecules adsorbed on them. To collect data from each sensor, impedance spectroscopy was used to analyze the electrical characteristics of samples of estrogen solutions with different concentrations. To analyze the collected data from the sensors, principal components analysis (PCA) method was used to create a three-dimensional plane using the calculated principal components, namely PC1 and PC2, and the estrogen concentration values. Then, damped least squares (DLS) was used to find the optimal values for the hyperplane calibration, as the sensitivity of this e-tongue was not represented by a straight line but by a surface. For the collected data, from nanotubes and graphene oxide sensors, a calibration curve for concentration given by the 10PC1×0.492-PC2×0.14-14.5 surface was achieved. This e-tongue presented a detection limit of 10-16 M of 17ß-estradiol in tap water.

Ammonia Detection by Electronic Noses for a Safer Work Environment.

Providing employees with proper work conditions should be one of the main concerns of any employer. Even so, in many cases, work shifts chronically expose the workers to a wide range of potentially harmful compounds, such as ammonia. Ammonia has been present in the composition of products commonly used in a wide range of industries, namely production in lines, and also laboratories, schools, hospitals, and others. Chronic exposure to ammonia can yield several diseases, such as irritation and pruritus, as well as inflammation of ocular, cutaneous, and respiratory tissues. In more extreme cases, exposure to ammonia is also related to dyspnea, progressive cyanosis, and pulmonary edema. As such, the use of ammonia needs to be properly regulated and monitored to ensure safer work environments. The Occupational Safety and Health Administration and the European Agency for Safety and Health at Work have already commissioned regulations on the acceptable limits of exposure to ammonia. Nevertheless, the monitoring of ammonia gas is still not normalized because appropriate sensors can be difficult to find as commercially available products. To help promote promising methods of developing ammonia sensors, this work will compile and compare the results published so far.

Explaining the stickiness of supply chain relations in the Brazilian soybean trade.

The global trade of agricultural commodities has profound social-ecological impacts, from potentially increasing food availability and agricultural efficiency, to displacing local communities, and to incentivizing environmental destruction. Supply chain stickiness, understood as the stability in trading relationships between supply chain actors, moderates the impacts of agricultural commodity production and the possibilities for supply-chain interventions. However, what factors determine stickiness, that is, how and why farmers, traders, food processors, and consumer countries, develop and maintain trading relationships with specific producing regions, remains unclear. Here, we use data on the Brazilian soy supply chain, a mixed methods approach based on extensive actor-based fieldwork, and an explanatory regression model, to identify and explore the factors that influence stickiness between places of production and supply chain actors. We find four groups of factors to be important: economic incentives, institutional enablers and constraints, social and power dimensions, and biophysical and technological conditions. Among the factors we explore, surplus capacity in soy processing infrastructure, (i.e., crushing and storage facilities) is important in increasing stickiness, as is export-oriented production. Conversely, volatility in market demand expressed by farm-gate soy prices and lower land-tenure security are key factors reducing stickiness. Importantly, we uncover heterogeneity and context-specificity in the factors determining stickiness, suggesting tailored supply-chain interventions are beneficial. Understanding supply chain stickiness does not, in itself, provide silver-bullet solutions to stopping deforestation, but it is a crucial prerequisite to understanding the relationships between supply chain actors and producing regions, identifying entry points for supply chain sustainability interventions, assessing the effectiveness of such interventions, forecasting the restructuring of trade flows, and considering sourcing patterns of supply chain actors in territorial planning.

Oral pregabalin is effective as preemptive analgesia in abdominal hysterectomy-A randomized controlled trial.

Postoperative pain is one of the main negative symptoms resulting from surgery and the use of new methods to control this symptom is of ever-increasing relevance. Opioid-sparing strategies, such as multimodal analgesia, are trends in this scenario. Pregabalin is a well-established treatment for neuropathic pain; however, it is still controversial in the surgical context for postoperative analgesia. This study investigated the effect of pregabalin on postoperative analgesia in patients undergoing abdominal hysterectomy. It is a prospective, randomised, double-blind, placebo-controlled clinical trial. Female patients undergoing abdominal hysterectomy were randomised to use pregabalin (group P1), 300 mg orally 2 h before surgery, or identical placebo pills (group P0). The main outcome includes the postoperative pain index by visual analogue scale (VAS) and McGill's pain questionnaire. Secondary outcomes include opioid consumption and the presence of adverse effects. A value of p < 0.05 was used to reject type I error. Fifty-five patients were randomised amongst the groups. Patients in group P1 had lower pain rates by VAS scale, both at rest and in active motion, than group P0. In McGill's questionnaire, patients from group P1 also had lower pain rates (12 × 28.5). There was approximately twice as much opioid consumption amongst patients in group P0. Regarding side effects, there was a difference between the two groups only for dizziness, being more incident in group P1. This study suggests that pregabalin is an important adjuvant drug in treating postoperative pain in patients with abdominal hysterectomy.

Are oral overuse behaviours associated with painful temporomandibular disorders? A cross-sectional study in Portuguese university students.

BACKGROUND: Many different types of oral overuse behaviours occur frequently in adult populations with painful temporomandibular disorders (TMDs). Less is known regarding these behaviours and their associations with TMDs in university students. OBJECTIVES: Test the association between frequency of different oral overuse behaviours evaluated by the Oral Behaviour Checklist (OBC) and the severity of painful TMDs. METHODS: In this cross-sectional study, 1381 students from 19 universities in the Oporto District, Portugal, completed the Research Diagnostic Criteria for TMD (RDC/TMD) Personal History Questionnaire and the OBC, and they received an RDC/TMD clinical examination. The OBC sum score (ranging from 0 to 84 points) was classified as normal (0 ≤ 16 points), low overuse (17 ≤ 24) or high overuse (≥25). Painful TMD subtypes (myalgia, arthralgia or combined) were identified. Associations were tested using multivariable binary logistic regression models (α = .05), adjusted for age and sex, and referencing the normal parafunction group. RESULTS: University students with high overuse were more likely to have a painful TMD: myalgia (OR = 1.9, 95% CL: 1.3-3.0); arthralgia (OR = 2.2; 95% CL: 1.4-3.4), combined (OR = 5.0; 95% CL: 3.1-8.1). Students with low overuse were more likely to have only the combined painful TMD (OR = 2.4; 95% CL: 1.4-4.0) but not the individual painful disorders. Of the 21 different behaviours, 13 were reported at least 50% of the time. CONCLUSIONS: In this university student sample, oral overuse behaviours are widespread, and their overall extent exhibited a dose-response relationship with respect to severity of painful TMDs based on pain and chronicity. Only some behaviours were independently associated with painful TMDs, suggesting the value of further OBC instrument development.

Limits of Brazil's Forest Code as a means to end illegal deforestation.

The 2012 Brazilian Forest Code governs the fate of forests and savannas on Brazil's 394 Mha of privately owned lands. The government claims that a new national land registry (SICAR), introduced under the revised law, could end illegal deforestation by greatly reducing the cost of monitoring, enforcement, and compliance. This study evaluates that potential, using data from state-level land registries (CAR) in Pará and Mato Grosso that were precursors of SICAR. Using geospatial analyses and stakeholder interviews, we quantify the impact of CAR on deforestation and forest restoration, investigating how landowners adjust their behaviors over time. Our results indicate rapid adoption of CAR, with registered properties covering a total of 57 Mha by 2013. This suggests that the financial incentives to join CAR currently exceed the costs. Registered properties initially showed lower deforestation rates than unregistered ones, but these differences varied by property size and diminished over time. Moreover, only 6% of registered producers reported taking steps to restore illegally cleared areas on their properties. Our results suggest that, from the landowner's perspective, full compliance with the Forest Code offers few economic benefits. Achieving zero illegal deforestation in this context would require the private sector to include full compliance as a market criterion, while state and federal governments develop SICAR as a de facto enforcement mechanism. These results are relevant to other tropical countries and underscore the importance of developing a policy mix that creates lasting incentives for sustainable land-use practices.

Cultural equivalence, reliability and utility of the Portuguese version of the Oral Behaviours Checklist.

BACKGROUND: Oral behaviors (OBs) must be assessed as part of a biobehavioural evaluation for patients with temporomandibular disorders (TMD). OBJECTIVES: The aims of this study were: to translate and culturally adapt the Oral Behaviors Checklist (OBC) into Portuguese; to evaluate its basic psychometric properties; and to assess the utility of the Portuguese OBC. METHODS: The Portuguese translation, cross-cultural equivalence, and two studies (Pre-field test, N = 8, and field test, N = 45) of the OBC adhered to official guidelines of the International RDC/TMD Research Consortium (now, INfORM). In the formal test (N = 120) the Portuguese RDC/TMD was used for TMD diagnosis. RESULTS: Translation and cultural equivalence of the OBC into Portuguese was reviewed and approved by an expert panel. In the field test, item agreement between English and Portuguese OBC versions was very good (weighted Kappa ≥ 0.934). Test-retest reliability of the OBCS umScore was excellent intra-class correlation coefficient ((ICC) = 0.998, P < 0.001). As an initial probe into validity using parallel forms, comparison of the sleep bruxism and awake clenching questions included in the RDC/TMD with the corresponding OBC questions yielded excellent (Kappa = 0.932) and very good (k = 0.850), respectively, convergent validity as well as excellent (that is, poor agreement, kappa = 0.013) discriminant validity for these specific OBs. The mean OBCS umScore was significantly lower for the healthy group, compared to the painful TMD group (ANOVA, P = 0.037). CONCLUSIONS: The Portuguese translation of the OBC exhibits cross-cultural equivalence for use in Portugal, and the instrument performs with acceptable psychometric properties. The validity of the parafunction construct requires additional research in both Portuguese and other languages.

The Brazilian Center for Health Studies and the Brazilian Association of Collective Health: the issue of the nationalization of health in the Brazilian public health reform, 1976-1988.

An analysis is presented of the approaches taken by the Brazilian Center for Health Studies (Cebes) and the Brazilian Association of Collective Health (Abrasco) towards the nationalization of health during the Brazilian public health reform between 1976 (when Cebes was founded) and the enshrinement of public health in the Federal Constitution (1988). Discussions are presented of the theoretical and strategic principles defended by their intellectuals and the institutions' positions towards the nationalization of health. By positioning themselves against complete nationalization, they did not break away from the privatizing rationale embedded in the prevailing model of healthcare, and endeavored to conciliate private interests within the new framework for public health.

Sotrovimab in the treatment of coronavirus disease-2019 (COVID-19): a systematic review and meta-analysis of randomized clinical trials.

This study was carried out to verify the evidence regarding the effectiveness and safety of sotrovimab in patients with COVID-19. This is a systematic review of randomized clinical trials retrieved from the PubMed, Embase, Scopus, Lilacs, and Cochrane Library databases. The risk of bias was measured using the Cochrane Risk and Bias Checklist (RoB 2). For the meta-analysis, RStudio Version 2024.04.2 software was used. The certainty of evidence was assessed using GRADE. The study protocol was registered in PROSPERO (CRD42022355786). A total of 1893 studies were identified and four were included in the study. The total population consisted of 5470 patients with COVID-19, 1921 (35%) in the sotrovimab group and 3549 (65%) in the control group (placebo or BRII-196 + BRII-198 or casirivimab + imdevimab or bamlanivimab + etesevimab, administered in a similar way to sotrovimab, in a single dose with a 60-min intravenous infusion). For the effectiveness outcome, three studies presented low risk and one high risk of bias, while for safety all presented high risk of bias. The meta-analysis showed no significant difference between the sotrovimab and control groups in terms of hospitalization rates (95% confidence interval (CI) - 2.10-0.51; p = 0 > 0.05), use of invasive mechanical ventilation (95% CI - 2.78-0.65; p = 0.35) and mortality (95% CI - 0.92-0.59; p = 0.39). However, sensitivity analysis showed that sotrovimab may be effective in reducing hospitalization rates compared to the control (IV = - 1.57; 95% CI - 2.41-0.73; p = 0.99). The use of sotrovimab in the treatment of patients with COVID-19 had no significant impact on mortality and need for mechanical ventilation and did not appear to be safer compared to controls. However, there was evidence of effectiveness in reducing the rate of hospitalization, although the certainty of the evidence is moderate and the risk of bias is high.

Prenatal caffeine consumption and neurobehavioral disorders - A systematic review.

Studies have suggested associations between gestational exposure to caffeine and adverse outcomes, however the evidence is still limited. Therefore, a systematic review was conducted to investigate the association between prenatal caffeine exposure and neurobehavioral disorders. The MEDLINE (PubMed), EMBASE, Scopus, Web of Science, and LILACS databases were searched. Observational studies involving women with documented caffeine consumption during pregnancy were eligible for inclusion. The outcomes evaluated were behavioral and intellectual development, Attention Deficit Hyperactivity Disorder, and related behaviors. The data were analyzed by qualitative synthesis. The ROBINS-I tool was employed to assess the risk of bias, and the certainty of evidence was evaluated using GRADE (PROSPERO: CRD42023421164). The search yielded fourteen studies that met the inclusion/exclusion criteria. The sample size among pregnant women ranged from 173 to 64,189, and among children ranged from 88 to 49,190. Maternal caffeine consumption during pregnancy ranged from 0 to 1000 mg/day, with the highest levels observed during mid-pregnancy. Seven studies indicated a potential association between prenatal caffeine exposure and neurobehavioral/neurodevelopment deficits, one study showed that prenatal caffeine exposure improved peer problems, and six studies did not show a significant effect of prenatal caffeine consumption on neurobehavioral disorders. The included studies were classified as moderate for the risk of bias and with very low certainty of evidence. Thus, the evidence is insufficient to confirm with certainty that the prenatal caffeine exposure leads to neurobehavioral disorders. Studies heterogenicity, as well as their variable quality and the presence of several confounding factors, generate uncertainty.

Clinical guidelines for herpes labialis: recommendations and quality evaluation according to AGREE II.

Cold sores require Healthcare professionals to employ specific approaches for prevention and management, with the need for effective therapeutic guidelines and ongoing improvement in patient care. AIM: To evalúate the methodological quality of Clinical Guidelines (CG), clinical guides and manuals for care of the population affected by herpes labialis, to verify their compliance with evidence-based health standards. MATERIALS AND METHOD: A search was conducted for CG on labial herpes in the MedicalLiteratureAnalysis andRetrieval System Online (Medline) database, Google Scholar, Brazilian Virtual Health Library (BVS), and sites of institutions/professional categories, using the descriptors "herpes labialis" or "oral herpes". Document quality was assessed using the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II). The Kappa test was used to avoid randomness or poor agreement between results. RESULTS: Analysis of the 12 selected publications on the management of labial herpes revealed flaws in quality, as the publications did not follow a quality standard. The main quality flaws identified were in "rigor in development" and "applicability. ". CONCLUSIONS: Priorities need to be redefined in the development of CG for clinical practice related to fever blisters to reduce the variability of the quality standard, and generate reliable, applicable recommendations.

A Herpes labial requer dos profissionais abordagens específicas para prevenido e manejo, com a ne-cessidade de diretrizes terapéuticas eficazes e continuo aprimoramento do cuidado ao paciente. OBJETIVO: avaliar a qualidade metodológica de documentos que abordaram Diretrizes Clínicas (DC), guias clínicos e manuais para o cuidado da populando afetada pelo herpes labial, verificando sua conformidade com padroes de saúde baseados em evidencias. MATERIAIS E MÉTODO: As DC sobre herpes labial foram pesquisadas na base de dados Medical Literature Analysis and Retrieval System Online (Medline), Google Académico, Biblioteca Virtual em Saúde (BVS) e em sites de instituigoes/categorias profissionais, utilizando os descritores "herpes labial" ou "herpes oral". Utilizamos aferramenta The Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II) para a avaliagdo da qualidade. O teste Kappa também foi utilizado para evitar aleatoriedade ou baixa concordáncia entre os resultados. RESULTADOS: Na análise das 12 publicagoes selecionadas sobre o manejo do herpes labial, foram identificadas falhas na qualidade dos documentos, que ndo seguiram um padrdo de qualidade. As principais falhas de qualidade identificadas foram em "rigor no desenvolvimento" e "aplicabilida-de". CONCLUSÃO: é necessário um reenfoque para definir prioridades no desenvolvimento de DC para a prática clínica do herpes labial, a fim de reduzir a variabilidade do padrdo de qualidade e gerar recomendagoes que possam ser confiáveis e aplicáveis.

Three-Dimensional Printed Teeth in Endodontics: A New Protocol for Microcomputed Tomography Studies.

This study aimed to describe a support material removal protocol (SMRP) from inside the root canals of three-dimensional printed teeth (3DPT) obtained by the microcomputed tomography (microCT) of a natural tooth (NT), evaluate its effectiveness by comparing the 3DPT to NT in terms of internal anatomy and behaviour toward endodontic preparation, and evaluate if 3DPT are adequate to assess the differences between two preparation systems. After the SMRP, twenty 3DPT printed by PolyJet™ were microCT scanned before preparation and thereafter randomly assigned into two groups (n = 10). One group and NT were prepared using ProTaper Gold® (PTG), and the other group with Endogal® (ENDG). MicroCT scans were carried out after preparation, and the volume increase, volume of dentin removed, centroids, transportation, and unprepared areas were compared. For the parameters evaluated, no significant differences were found between the 3DPT and NT before and after preparation (p > 0.05), and no significant differences were found between the 3DPT PTG group and the 3DPT ENDG group (p > 0.05). It can be concluded that the SMRP described is effective in removing the support material SUP706B™. PolyJet™ is adequate for printing 3DPT. Furthermore, 3DPT printed with high-temperature RGD525™ have similar behaviour during endodontic preparation with PTG as the NT, and 3DPT can be used to compare two preparation systems.

Safety of metamizole (dipyrone) for the treatment of mild to moderate pain-an overview of systematic reviews.

Metamizole, as known as dipyrone or novaminsulfone is widely used, especially in Latin America, for its analgesic and antipyretic function. However, several countries have banned it due to the risk of agranulocytosis, skin necrosis, and other serious adverse effects. To assess the safety of metamizole compared to other commonly used non-opioid analgesics (paracetamol, ibuprofen, and acetylsalicylic acid). An overview of systematic reviews. The searches were performed in the PubMed, Cochrane Library, Embase, Scopus and LILACS databases. Systematic reviews of randomized and nonrandomized clinical trials with adult patients with mild to moderate pain that assessed the adverse effects of metamizole were included. A methodological quality assessment was performed through ROBIS. The protocol of this systematic review was submitted to the International Prospective Register of Systematic Reviews (Prospero, CRD42021295272). Of 387 identified studies, four were included, with a total of 20,643 participants, all submitted to a single dose by oral, intramuscular, or intravenous route. No study reported a serious adverse effect. However, 60 of 778 patients (7.7%) who used metamizole; 120/828 (14.5%) who used acetylsalicylic acid; 56/443 (12.6%) who used paracetamol; and 27/213 (12.7%) who used ibuprofen had mild adverse effects. A complementary statistical analysis showed that metamizole, at any dose, has a 38.8% lower chance of adverse effects compared to paracetamol and 46.8% compared to acetylsalicylic acid. The results shows that metamizole is a safe drug with evidence of a lower incidence of adverse effects compared to paracetamol and acetylsalicylic acid.

Effectiveness of epidural morphine for the treatment of cancer pain in patients with gastrointestinal neoplasm-a systematic review.

One-third of cancer pain patients do not experience adequate pain relief using analgesic ladder by the World Health Organization. Interventional procedures, such as epidural morphine, have been considered. This study aimed to review the literature comparing the effects of epidural administration of morphine with the oral route. This systematic review included randomized controlled trials (RCTs) conducted with patients with gastrointestinal neoplasm. A search was conducted on PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, and CINAHL databases to identify studies published up to May 2023. The retrieved study was evaluated using the Risk of Bias 2 (RoB 2) tool and qualitatively synthesized. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach (Prospero: CRD42021264728). Only one RCT, a crossover trial, was included in this systematic review. The study was conducted with ten participants (one withdrawal) and reported a statistically significant difference between both subcutaneous and epidural morphine solutions and oral morphine. The adverse events were not described. The included study presents some concerns of bias and low certainty of evidence on the effectiveness and security of epidural morphine administration. The available literature does not suffice to elucidate whether morphine administration via the epidural route is more effective than other routes. Further RCTs are necessary to improve the level of evidence on the effectiveness and risk-benefit of epidural morphine in the management of cancer pain in gastrointestinal neoplasm patients.

Engineering optical tools for remotely controlled brain stimulation and regeneration.

Neurological disorders are one of the world's leading medical and societal challenges due to the lack of efficacy of the first line treatment. Although pharmacological and non-pharmacological interventions have been employed with the aim of regulating neuronal activity and survival, they have failed to avoid symptom relapse and disease progression in the vast majority of patients. In the last 5 years, advanced drug delivery systems delivering bioactive molecules and neuromodulation strategies have been developed to promote tissue regeneration and remodel neuronal circuitry. However, both approaches still have limited spatial and temporal precision over the desired target regions. While external stimuli such as electromagnetic fields and ultrasound have been employed in the clinic for non-invasive neuromodulation, they do not have the capability of offering single-cell spatial resolution as light stimulation. Herein, we review the latest progress in this area of study and discuss the prospects of using light-responsive nanomaterials to achieve on-demand delivery of drugs and neuromodulation, with the aim of achieving brain stimulation and regeneration.

In vivo recordings in freely behaving mice using independent silicon probes targeting multiple brain regions.

In vivo recordings in freely behaving animals are crucial to understand the neuronal circuit basis of behavior. Although current multi-channel silicon probes provide unparalleled sampling density, the study of interacting neuronal populations requires the implantation of multiple probes across different regions of the brain. Ideally, these probes should be independently adjustable, to maximize the yield, and recoverable, to mitigate costs. In this work, we describe the implementation of a miniaturized 3D-printed headgear system for chronic in vivo recordings in mice using independently movable silicon probes targeting multiple brain regions. We successfully demonstrated the performance of the headgear by simultaneously recording the neuronal activity in the prelimbic cortex and dorsal hippocampus. The system proved to be sturdy, ensuring high-quality stable recordings and permitted reuse of the silicon probes, with no observable interference in mouse innate behaviors.

Gestational lead exposure and its effects on fetal/infant development - A systematic review.

Studies suggest that gestational exposure to lead (Pb) is related to spontaneous abortions, preterm birth, lower infant birth weight and length, and neurological dysfunctions. However, the evidence about its effects during pregnancy exposure on fetal and child development is still poor. Thus, the aim of this systematic review was to verify the association between prenatal exposure to Pb and the occurrence of neurobehavioral deficits, miscarriages, and child mortality. Observational studies with pregnant women exposed to Pb during pregnancy were included, without gender or ethnicity restrictions. The MEDLINE, Cochrane Library, EMBASE, Scopus, Web of Science, and LILACS databases were searched. The reading of titles and abstracts was conducted, followed by reading in full format and data extraction, that were performed independently by two reviewers. The included studies were evaluated by Downs and Black tool and qualitatively synthesized. Certainty of evidence was assessed by Grading of Recommendations Assessment, Development, and Evaluations (GRADE). The study protocol was registered with the Prospective Registry of Systematic Reviews (PROSPERO; CRD42022296750). Among twenty-one studies included, sixteen were classified as prospective cohort, two case-control, one nested case-control, one cohort, and one longitudinal study. No study that evaluated child mortality associated with gestational Pb exposure was found. There is a very low certainty of evidence in the association of gestational Pb exposure and neurobehavioral deficits or miscarriages. This systematic review reflects the poor evidence and the challenges of human toxicology studies, since it was not possible to associate gestational Pb exposure to neurobehavioral deficits, miscarriages, and child mortality.

Small extracellular vesicles administered directly in the brain promote neuroprotection and decreased microglia reactivity in a stroke mouse model.

Herein, we investigate the bioactivity of small extracellular vesicles (sEVs), focusing on their local effect in the brain. sEVs from mononuclear cells (MNCs) showed superior effects in vitro to sEVs from mesenchymal stem cells (MSCs) and were able to promote neuroprotection and decrease microglia reactivity in a stroke mouse model.

Availability of emergency contraception in large Brazilian municipalities: a guaranteed right?

Introduction: Emergency Contraception (EC) is available in Brazil since 1996, when it was adopted as one if the family planning strategies and, in 1998, for use in services assisting victims of sexual violence. In the country, its use is regulated by guidelines. Its access through SUS (Unified Health System), however, does not seem to occur in a standardized manner. Methods: The aim of the study was to analyze the availability and barriers to accessing emergency contraception (levonorgestrel) in Brazilian municipalities with more than 500 thousand inhabitants. The survey was carried out by a form sent to the Municipal Health Departments (SMS) managers and a search on the list of standardized medicines by the hospitals in the same municipalities. Results: The Basic Health Units were identified as the standard access places to EC. However, one of the obstacles mentioned is the need for a prescription for dispensing in almost 80% of the analyzed cities. Access in emergency situations at night and on weekends is also uncertain, since although 67% of the places stated that they dispense at the hospital level, the item was only standardized in 21% of the hospital lists. Discussion: The difficult access this drug in the public system essentially tends to harm the poorest women, who are the ones who suffer most from the consequences of an unwanted pregnancy.