Cannabidiol as an Adjunctive Treatment for Acute Bipolar Depression: A Pilot Study: Le cannabidiol comme traitement d'appoint de la dépression bipolaire aiguë : une étude pilote.

OBJECTIVE: The treatment of bipolar depression remains challenging due to the limited effective and safe therapeutic options available; thus, developing newer treatments that are effective and well tolerable is an urgent unmet need. The objective of the present trial was to test 150 to 300 mg/day of cannabidiol as an adjunctive treatment for bipolar depression. METHOD: A randomized, double-blind, placebo-controlled pilot study to assess the efficacy of adjunctive cannabidiol in bipolar depression was used. Efficacy parameters were changes in the Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to week 8. Secondary outcomes included response and remission rates, changes in anxiety and psychotic symptoms, and changes in functioning. Patients continued double-blind treatment until week 12 to monitor for adverse effects, laboratory analysis, and manic symptoms. Study registry: NCT03310593. RESULTS: A total of 35 participants were included. MADRS scores significantly decreased from baseline to the endpoint (placebo, -14.56; cannabidiol, -15.38), but there was no significant difference between the groups. Similarly, there were no other significant effects on the secondary outcomes. However, an exploratory analysis showed a significant effect of cannabidiol 300 mg/day in reducing MADRS scores from week 2 to week 8 (placebo, -6.64; cannabidiol, -13.72). There were no significant differences in the development of manic symptoms or any other adverse effects. CONCLUSION: Cannabidiol did not show significantly higher adverse effects than placebo. Despite the negative finding on the primary outcome, an exploratory analysis suggested that cannabidiol should be further studied in bipolar depression in higher doses of at least 300 mg/day and under research designs that could better control for high placebo response.

Multidrug-resistant Escherichia coli strains isolated from swine manure biofertilizer in Brazil.

Escherichia coli is one of the key bacteria responsible for a variety of diseases in humans and livestock-associated infections around the globe. It is the leading cause of mortality in neonatal and weaned piglets in pig husbandry, causing diarrhea and significant harm to the industry. Furthermore, the frequent and intensive use of antimicrobials for the prevention of diseases, particularly gastrointestinal diseases, may promote the selection of multidrug-resistant (MDR) strains. These resistant genotypes can be transmitted through the excrement of animals, including swine. It is common practice to use porcine manure processed by biodigesters as fertilizer. This study aimed to examine the antimicrobial susceptibility, the presence of virulence genes frequently associated with pathotypes of intestinal pathogenic E. coli (InPEC), and antimicrobial resistance genes (ARGs) of 28 E. coli isolates collected from swine manure fertilizers. In addition, the enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) technique was used to investigate the genetic relationship among the strains. Using disk diffusion, the antimicrobial susceptibility profiles of the strains were determined. Using polymerase chain reaction (PCR), 14 distinct virulence genes associated with the most prevalent diarrhea and intestinal pathogenic E. coli (DEC/InPEC) and five ARGs were analyzed. All isolates tested positive for multidrug resistance. There was no detection of any of the 14 virulence genes associated with InPECs, indicating the presence of an avirulent commensal microbiota. Molecular classification by ERIC-PCR revealed that the majority of isolates (27 isolates) coalesced into a larger cluster with a genetic similarity of 47.7%; only one strain did not cluster in this cluster, indicating a high level of genetic diversity among the analyzed isolates. Thus, it is of the utmost importance to conduct epidemiological surveillance of animal breeding facilities in order to determine their microbiota and formulate plans to reduce the use of antimicrobials and improve animal welfare.

Levodopa-refractory hyperprolactinemia and pituitary findings in inherited disorders of biogenic amine metabolism.

Elevated serum prolactin concentrations occur in inherited disorders of biogenic amine metabolism because dopamine deficiency leads to insufficient inhibition of prolactin secretion. This work from the International Working Group on Neurotransmitter Related Disorders (iNTD) presents the results of the first standardized study on levodopa-refractory hyperprolactinemia (LRHP; >1000 mU/L) and pituitary magnetic resonance imaging (MRI) abnormalities in patients with inherited disorders of biogenic amine metabolism. Twenty-six individuals had LRHP or abnormal pituitary findings on MRI. Tetrahydrobiopterin deficiencies were the most common diagnoses (n = 22). The median age at diagnosis of LRHP was 16 years (range: 2.5-30, 1st-3rd quartiles: 12.25-17 years). Twelve individuals (nine females) had symptoms attributed to hyperprolactinemia: menstruation-related abnormalities (n = 7), pubertal delay or arrest (n = 5), galactorrhea (n = 3), and decreased sexual functions (n = 2). MRI of the pituitary gland was obtained in 21 individuals; six had heterogeneity/hyperplasia of the gland, five had adenoma, and 10 had normal findings. Eleven individuals were treated with the dopamine agonist cabergoline, ameliorating the hyperprolactinemia-related symptoms in all those assessed. Routine monitoring of these symptoms together with prolactin concentrations, especially after the first decade of life, should be taken into consideration during follow-up evaluations. The potential of slow-release levodopa formulations and low-dose dopamine agonists as part of first-line therapy in the prevention and treatment of hyperprolactinemia should be investigated further in animal studies and human trials. This work adds hyperprolactinemia-related findings to the current knowledge of the phenotypic spectrum of inherited disorders of biogenic amine metabolism.

Comparison of Periodization Models of Concurrent Training in Recreationally Active Postmenopausal Women.

ABSTRACT: Medeiros, LHL, Sandbakk, SB, Bertazone, TMA, and Bueno Júnior, CR. Comparison of periodization models of concurrent training in recreationally active postmenopausal women. J Strength Cond Res 36(4): 977-983, 2022-Although concurrent training is the most effective way to improve both neuromuscular and cardiorespiratory functions in older populations, there are no studies in the literature comparing different periodization models on cardiorespiratory and muscle strength adaptations. Thus, the main objective of this study was to investigate the effects of different periodization models of concurrent aerobic and strength training using equalized training volume programs on muscle strength and cardiorespiratory fitness in recreationally active postmenopausal women. After 3 weeks of adaptation, 58 women aged 50-75 years were randomly assigned to (a) nonperiodization (NP), (b) daily nonlinear periodization (NLP), or (c) flexible daily NLP (FNLP). At baseline and after 12 weeks, aerobic fitness (peak oxygen uptake [V̇o2peak] and the 6-minute walk test) and maximal muscle strength (1 repetition maximum of bench press and leg press) were measured. It was shown that maximal strength increased in the bench press (effect size [ES] 1.18 in NLP and 1.22 in FNLP) and leg press (ES 0.92 in NLP and 0.89 in FNLP) in the periodized groups-in the NP group, these values were 0.49 and 0.46, respectively. In the 6-minute walk test, aerobic fitness statistically improved in all groups-with an ES of 1.02 in the NP, 1.33 in the NLP, and 0.54 in the FNLP. This study showed that only periodization models (NLP and FNLP) induced a moderate ES in maximal strength, and all groups (NP, NLP, and FNLP) demonstrated improved aerobic fitness evaluated by V̇o2peak and the 6-minute walk test in recreationally active postmenopausal women.

Effects of Different Periodization Strategies of Combined Aerobic and Strength Training on Heart Rate Variability in Older Women.

ABSTRACT: Rodrigues, JAL, Santos, BC, Medeiros, LH, Gonçalves, TCP, and Júnior, CRB. Effects of different periodization strategies of combined aerobic and strength training on heart rate variability in older women. J Strength Cond Res 35(7): 2033-2039, 2021-The preservation of autonomic function has been proposed to be a key determinant of health and longevity. Periodization in combined training (CT) (strength plus aerobic exercise in the same session) might improve autonomic modulation. However, the specific influences of nonperiodized (NP), flexible nonlinear periodized (FNLP), and nonlinear periodized (NLP) strategies of CT on heart rate variability (HRV) are currently unknown. Therefore, we investigated the effects of NP, FNLP, and NLP strategies of CT on HRV in physically active women. In total, 54 physically active older women (61.6 ± 6.3 years) previously engaged in a regular exercise training were randomly allocated into 3 groups: NP, FNLP, and NLP. All the subjects performed 12 weeks of training, 3 times per week, with the sessions divided into aerobic (bicycle or treadmill) and strength exercises. Before and after the exercise training, we examined anthropometric, body composition, and HRV measures (low-frequency [LF], high-frequency [HF], LF/HF, and root mean square successive difference of RR intervals [RMSSD]) during rest, a maximum exercise test, and recovery post-test. Mixed-model measures were used, and statistical significance was set at α = 0.05. The waist circumference reduced only in the NP group (∆ = -2.01%). The RMSSD increased in the NLP (∆ = 76.5%) and LF/HF ratio increased in the FNLP (∆ = 34.51%) during the rest period. There were no differences during the exercise test and recovery after test for LF, HF, LF/HF, or RMSSD. In active women, nonlinear periodization strategies of CT improved one of the cardiovascular health outcomes because HRV is a direct predictor of cardiovascular risk.

Virulence Genes and Antimicrobial Resistance in Escherichia coli from Cheese Made from Unpasteurized Milk in Brazil.

Cow raw milk cheese is widely eaten in Brazil. These products may be contaminated with pathogenic bacteria. In this work, we investigated the presence of Escherichia coli in raw milk cheese from different States in Brazil. From 147 "Minas" cheese samples, 28 cheeses were positive for E. coli. Among 39 E. coli isolates of the cheeses, one was positive for eae and negative for bpfA and efa1/lifA using PCR, and so was classified as atypical Enteropathogenic E. coli (aEPEC). Two other isolates were positive for extraintestinal pathogenic E. coli (ExPEC) genes. The aEPEC isolate belongs to serogroup O127 and was classified in A phylogenetic group, and ExPEC isolates were found in O73:H12 (EC-2 strain) and O64474:H8 (EC-9 strain) serotype. This ExPEC belongs to A and C phylogenetic group, respectively. Most of E. coli strains belonged to Clermont phylogenetic groups A (28.2%), C, and E (23.1%). Six strains (15.4%) of E. coli were positive for group B1 and two (5.1%) for B2. E. coli isolates presented an aggregative (46.0%) and diffuse (12.6%) adherence pattern to HeLa cells, and the other isolates did not show adhesion (41.4%). Four E. coli isolates (10.3%) were shown to produce moderate biofilm. The antimicrobial resistance rate was tetracycline (25.6%), followed by ampicillin (17.9%), cefoxitin (7.7%), nalidixic acid (5.1%), and amoxicillin-clavulanic acid (2.6%). One strain was resistant to three antimicrobials (tetracycline, ampicillin, and nalidixic acid). The presence of these microorganisms, the O127 strain, and a new serogroup in Brazil is a potential risk for public health.

Presence of pathogenicity islands and virulence genes of extraintestinal pathogenic Escherichia coli (ExPEC) in isolates from avian organic fertilizer.

Poultry litter is commonly used as fertilizer in agriculture. However, this poultry litter must be processed prior to use, since poultry have a large number of pathogenic microorganisms. The aims of this study were to isolate and genotypically and phenotypically characterize Escherichia coli from avian organic fertilizer. Sixty-four E. coli isolates were identified from avian organic fertilizer and characterized for ExPEC virulence factors, pathogenicity islands, phylogenetic groups, antimicrobial resistance, biofilm formation, and adhesion to HEp-2 cells. Sixty-three isolates (98.4%) showed at least one virulence gene (fimH, ecpA, sitA, traT, iutA, iroN, hlyF, ompT and iss). The predominant phylogenetic groups were groups A (59.3%) and B1 (34.3%). The pathogenicity island CFT073II (51.5%) was the most prevalent among the isolates tested. Thirty-two isolates (50%) were resistant to at least one antimicrobial agent. Approximately 90% of isolates adhered to HEp-2 cells, and the predominant pattern was aggregative adherence (74.1%). In the biofilm assay, it was observed that 75% of isolates did not produce biofilm. These results lead us to conclude that some E. coli isolates from avian organic fertilizer could be pathogenic for humans.

Development of recycled and miniaturized electroanalytical sensor: Probing isoniazid determination in environmental water matrices.

Surface water pollution has become relevant because growing population and intense industrial activities. Thus, to protect the environment from contamination, recently the electroanalytical sensors that require small sample volume and easy preparation have shown a prominent performance for pharmaceuticals monitoring. For this purpose, a miniaturized electrochemical platform was developed based on recycling obsolete computer integrated circuits (microchips), fitting with the ideals of green chemistry and circular economy. The gold microelectrodes array (Au-µEA) was easily exposed by polishing the device surface and then characterized by optical microscopy, scanning electron microscopy and cyclic voltammetry. To enhance the analytical performance for isoniazid detection, the Au-µEA was modified with electrochemically reduced graphene oxide (ERGO). The developed sensor presented a linear range between 5 and 100 µmol L-1 and a limit of detection of 1.38 µmol L-1 demonstrating a reliable performance. Looking to its environmental application, the ERGO/Au-µEA sensor was used for isoniazid quantification in lagoon, river, tap water and synthetic effluent spiked samples with recovery values between 92.5 and 108.4%. Thus, this research field opens up new possibilities in global water-related issues contributing with innovative sustainable solutions.

Oral Dantrolene Reduces Myalgia and Hyperckemia in a Child with RYR1-Related Exertional Myalgia/Rhabdomyolysis.

RYR1-related exertional myalgia/rhabdomyolysis (ERM) is an underrecognized condition, which can cause limiting muscle symptoms, and may account for more than one-third of undiagnosed rhabdomyolysis cases. Dantrolene has shown promising results in controlling muscle symptoms in individuals with ERM, however, its use in children remains poorly documented. This case report presents the successful treatment of a 5-year-old patient with ERM using oral dantrolene. The patient experienced notable improvements, including a reduction in the frequency and intensity of myalgia episodes, no hospitalizations due to rhabdomyolysis, a substantial decrease in creatine phosphokinase (CPK) levels, and enhanced performance on the 6-minute walk test. The use of dantrolene was well-tolerated, and no significant adverse effects were observed. This report adds to the existing evidence supporting the effectiveness of oral dantrolene in managing ERM, and, to the best of our knowledge, this is the first report of the use of dantrolene in a pediatric patient for controlling anesthesia-independent muscle symptoms.

Synthesis of films based on chitosan and protic ionic liquids to be used as wound dressing on the oral mucosa.

Oral mucosal ulcerations expose connective tissue to different pathogens and this can progress to systemic infection. This study aimed to synthesize environmentally-friendly films with chitosan and protic ionic liquids, possessing mucoadhesive properties, activity against opportunistic microorganisms, enhanced malleability and mechanical resistance to be used as a wound dressing on the oral mucosa. Therefore, films with chitosan and 10, 35, and 50 % (wt/wt) of 2-hydroxy diethylammonium lactate, salicylate, and maleate protic ionic liquids were synthesized. Thickness measurements and mechanical properties analysis were performed. In addition, oral mucoadhesion, antimicrobial activity, and cytotoxicity properties were investigated. Results showed that the addition of 35wt% and 50wt% of all kinds of protic ionic liquids tested presented significant improvements in film thickness and mechanical properties. Films based on chitosan and the protic ionic liquid 2-hydroxy diethylammonium salicylate at percentages of 35 and 50wt% exhibited superior mucoadhesive properties, antimicrobial activity on opportunistic microorganisms and an improvement in their flexibility after immersion in synthetic saliva. Cytotoxicity results suggest that all kinds of chitosan/protic ionic liquids films tested are safe for intra-oral use. Therefore, the results of this study indicate that these materials could be good candidates for efficient and environmentally-friendly wound dressing films on the oral mucosa.

Resistance and Virulence Surveillance in Escherichia coli Isolated from Commercial Meat Samples: A One Health Approach.

Escherichia coli is a key indicator of food hygiene, and its monitoring in meat samples points to the potential presence of antimicrobial-resistant strains capable of causing infections in humans, encompassing resistance profiles categorized as serious threats by the Centers for Disease Control and Prevention (CDC), such as Extended-Spectrum Beta-Lactamase (ESBL)-a problem with consequences for animal, human, and environmental health. The objective of the present work was to isolate and characterize ESBL-producing E. coli strains from poultry, pork, and beef meat samples, with a characterization of their virulence and antimicrobial resistance profiles. A total of 450 meat samples (150 chicken, 150 beef, and 150 pork) were obtained from supermarkets and subsequently cultured in medium supplemented with cefotaxime. The isolated colonies were characterized biochemically, followed by antibiogram testing using the disk diffusion technique. Further classification involved biofilm formation and the presence of antimicrobial resistance genes (blaCTX-M, AmpC-type, mcr-1, and fosA3), and virulence genes (eaeA, st, bfpA, lt, stx1, stx2, aggR, iss, ompT, hlyF, iutA, iroN, fyuA, cvaC, and hylA). Statistical analysis was performed via the likelihood-ratio test. In total, 168 strains were obtained, with 73% originating from chicken, 22% from pork, and 17% from beef samples. Notably, strains exhibited greater resistance to tetracycline (51%), ciprofloxacin (46%), and fosfomycin (38%), apart from ß-lactams. The detection of antimicrobial resistance in food-isolated strains is noteworthy, underscoring the significance of antimicrobial resistance as a global concern. More than 90% of the strains were biofilm producers, and strains carrying many ExPEC genes were more likely to be biofilm formers (OR 2.42), which increases the problem since the microorganisms have a greater chance of environment persistence and genetic exchange. Regarding molecular characterization, bovine samples showed a higher prevalence of blaCTX-M-1 (OR 6.52), while chicken strains were more likely to carry the fosA3 gene (OR 2.43, CI 1.17-5.05) and presented between 6 to 8 ExPEC genes (OR 2.5, CI 1.33-5.01) compared to other meat samples. Concerning diarrheagenic E. coli genes, two strains harbored eae. It is important to highlight these strains, as they exhibited both biofilm-forming capacities and multidrug resistance (MDR), potentially enabling colonization in diverse environments and causing infections. In conclusion, this study underscores the presence of ß-lactamase-producing E. coli strains, mainly in poultry samples, compared to beef and pork samples. Furthermore, all meat sample strains exhibited many virulence-associated extraintestinal genes, with some strains harboring diarrheagenic E. coli (DEC) genes.

Temporal trend of tracheostomy in patients hospitalized in the Brazilian National Unified Health System from 2011 to 2020.

OBJECTIVE: to analyze the temporal trend in the tracheostomy use in patients hospitalized by the Sistema Único de Saúde in Brazil from 2011 to 2020. METHODS: ecological observational study with a quantitative approach and including the Brazilian population aged 20 or over that were admitted by Sistema único de Saúde and had a record of performing the tracheostomy procedure at any time during hospitalization. RESULTS: 113.569.570 Hospitalizations studied were identified 172.456 tracheostomies realized in Brazil (0,15%). The average tax of this procedure showed a downward trend during the study procedure. The highest tracheostomy rate was found in the southern region, and the most affected age group was 80 years old or more. The average rate of tracheostomy in males was 1.8 times higher than in females. The average mortality and lethality rates of admissions with tracheostomy were 3.36 and 28.57% in the period but showed a tendency to decrease in the period studied. The main causes associated with the performance of tracheostomy were respiratory, oncological, and external causes. Respiratory causes contributed to 73% of the total procedures performed in the analyzed period. CONCLUSION: the average mortality and lethality rates of hospitalizations with tracheostomy in Brazil were 3.36 and 28.57%, but showed a downward trend in the period.

Can local anesthesia with ropivacaine provide postoperative analgesia in extraction of impacted mandibular third molars? A randomized clinical trial.

OBJECTIVE: The aim of this study was to compare the local anesthesia efficacy of ropivacaine 0.75% compared to lidocaine 2% with 1:100,000 epinephrine for postoperative analgesia following extraction of impacted mandibular third molars. STUDY DESIGN: In this randomized, double-blind crossover clinical trial, 30 participants underwent surgical removal of bilateral impacted mandibular third molars under local anesthesia using ropivacaine 0.75% or lidocaine 2% with 1:100,000 epinephrine. The pain was recorded on a visual analog scale at 4, 8, 12, 24, and 48 h postoperatively. The use of analgesics and the presence of adverse effects were recorded. RESULTS: The duration of soft tissue anesthesia in the ropivacaine group was significantly longer than that in the lidocaine group. The lidocaine group recorded significantly higher visual analog scale scores at all postoperative time intervals, except in the final 48-h period. Analgesic use was higher in the lidocaine group. Rescue medication was used by 2 patients in each group (6.7%). Significantly more postoperative bleeding was seen in the ropivacaine group. CONCLUSION: Ropivacaine 0.75% injection before the surgical procedure may be associated with preventive analgesia for extraction of impacted mandibular third molars.

Antimicrobial susceptibility and detection of virulence-associated genes of Escherichia coli and Salmonella spp. isolated from domestic pigeons (Columba livia) in Brazil.

Overpopulation of domestic pigeons is considered to be one of the major problems of urban centers, as these birds are responsible for the dissemination of relevant pathogens to animal and human health. The aim of this study was to detect potentially pathogenic Escherichia coli and Salmonella spp. in domestic pigeons captured in areas near silos used for grain and feed storage, analyzing the antimicrobial sensitivity and the presence of virulence-associated genes. We evaluated 41 pigeons. From each bird, cecal contents and a pool of viscera (heart, spleen, and liver) were collected. Fifty strains of E. coli and three strains of S. Typhimurium were isolated. The antimicrobial susceptibility assay showed that 2% of the isolates of E. coli were resistant to chloramphenicol and the combination of sulfamethoxazole + trimethoprim and 4% to tetracycline, doxycycline, and sulfonamide. The three S. Typhimurium strains were sensitive to all antimicrobials tested. The pathogenicity profile demonstrated that no E. coli isolates showed a STEC compatible profile. Regarding the APEC pathotype, all genes were observed in 8% of E. coli, 6% had only the iss gene and 4% presented ompT, hlyF, and iutA genes. invA, hilA, avrA, and lpfA genes were detected in 100% of Salmonella isolates. The sitC and pefA genes were only present in one strain and the remaining genes were detected in two. In conclusion, it was found that pigeons living in the vicinity of silos are carriers of important pathogens, and control measures should be taken to minimize animal and human health risks.

Detection of ESBL/AmpC-Producing and Fosfomycin-Resistant Escherichia coli From Different Sources in Poultry Production in Southern Brazil.

This study discussed the use of antimicrobials in the commercial chicken production system and the possible factors influencing the presence of Extended-spectrum ß-lactamase (ESBL)/AmpC producers strains in the broiler production chain. The aim of this study was to perform longitudinal monitoring of ESBL-producing and fosfomycin-resistant Escherichia coli from poultry farms in southern Brazil (Paraná and Rio Grande do Sul states) and determine the possible critical points that may be reservoirs for these strains. Samples of poultry litter, cloacal swabs, poultry feed, water, and beetles (Alphitobius sp.) were collected during three distinct samplings. Phenotypic and genotypic tests were performed for characterization of antimicrobial resistant strains. A total of 117 strains were isolated and 78 (66%) were positive for ESBL production. The poultry litter presented ESBL positive strains in all three sampled periods, whereas the cloacal swab presented positive strains only from the second period. The poultry litter represents a significant risk factor mainly at the beginning poultry production (odds ratio 6.43, 95% confidence interval 1-41.21, p < 0.05). All beetles presented ESBL positive strains. The predominant gene was bla CTX-M group 2, which occurred in approximately 55% of the ESBL-producing E. coli. The cit gene was found in approximately 13% of the ESBL-producing E. coli as AmpC type determinants. A total of 19 out of 26 fosfomycin-resistant strains showed the fosA3 gene, all of which produced ESBL. The correlation between fosA3 and bla CTX-M group 1 (bla CTX-M55 ) genes was significant among ESBL-producing E. coli isolated from Paraná (OR 3.66, 95% CI 1.9-9.68) and these genetic determinants can be transmitted by conjugation to broiler chicken microbiota strains. Our data revealed that poultry litter and beetles were critical points during poultry production and the presence of fosfomycin-resistant strains indicate the possibility of risks associated with the use of this antimicrobial during production. Furthermore, the genetic determinants encoding CTX-M and fosA3 enzymes can be transferred to E. coli strains from broiler chicken microbiota, thereby creating a risk to public health.

Charophytes collapse beyond a critical warming and brownification threshold in shallow lake systems.

Charophytes play a critical role for the functioning of shallow lake ecosystems. Although growth of charophytes can be limited by many factors, such as temperature, nutrients and light availability, our understanding about concomitant effects of climate warming and other large-scale environmental perturbations, e.g. increases in humic matter content ('brownification') is still limited. Here we conducted an outdoor mesocosm experiment during 71days with a common charophyte species, Chara vulgaris, along an increasing gradient of temperature and brownification. We hypothesized the growth of C. vulgaris to increase with temperature, but to level off along the combined temperature and brownification gradient when reaching a critical threshold for light limitation via brownification. We show that C. vulgaris increases the relative growth rate (RGR), main and total shoot elongation, as well as number of lateral shoots when temperature and brownification increased by +2°C and+100%, respectively above today's levels. However, the RGR, shoot elongation and number of lateral shoots declined at further increment of temperature and brownification. Macrophyte weight-length ratio decreased with increased temperature and brownification, indicating that C. vulgaris allocate more resources or energy for shoot elongation instead of biomass increase at warmer temperatures and higher brownification. Our study shows that C. vulgaris will initially benefit from warming and brownification but will then decline as a future scenario of increased warming and brownification reaches a certain threshold level, in case of our experiment at +4°C and a 2-fold increase in brownification above today's levels.

Physical Therapy Service delivered in the Polyclinic During the Rio 2016 Paralympic Games.

OBJECTIVE: To characterize the Physical Therapy Services delivered at the Polyclinic during the Rio 2016 Paralympic Games. DESIGN: Retrospective Cohort Study. SETTING: Physical Therapy Services (PTS) of the Polyclinic. PARTICIPANTS: Athletes attended for Physical Therapy treatment at the Polyclinic during Rio 2016 Paralympic Games. MAIN OUTCOME MEASURES: The number of athletes treated, their nationalities, their sports modality, the most frequently treated regions and the interventions applied. RESULTS: A total of 4504 interventions were delivered and 399 athletes were treated in the PTS. Athletes representing athletics and sitting volleyball were the most frequently attended for treatment. The main diagnoses were muscle tension and tendinopathy. Analgesia was the main purpose of treatment and myofascial release and electrotherapy was the most frequent interventions. Recovery service had a total of 1579 encounters and male athletes used cryo-immersion 3 times more when compared to female. CONCLUSION: Athletes representing athletics and sitting volleyball were the most frequently attended for treatment and the thoracic/lumbar spine and pelvis/hip were the most commonly affected regions. Muscle strain and tendinopathy were the most frequent diagnoses and myofascial release and electrotherapy were the most frequent therapies used to achieve analgesia.

The prevalence and clinical correlates of cannabis use and cannabis use disorder among patients with bipolar disorder: A systematic review with meta-analysis and meta-regression.

Bipolar disorder (BD) is commonly associated with comorbidities, especially substance use disorders. In light of this, the present review aimed to investigate the prevalence and clinical correlates of cannabis use in BD. Studies evaluating the prevalence of cannabis use among patients with BD and studies reporting a dichotomous sample of patients with cannabis use compared to those without the use were included. Meta-analyses using random-effects models were performed, and sources of heterogeneity were explored using meta-regression. The search resulted in 2918 publications, of which 53 were included. The prevalence of cannabis use was 24% (95%CI:18-29; k = 35; n = 51,756). Cannabis use was significantly associated with being younger, male, and single; having fewer years of education and an earlier onset of affective symptoms; and lifetime psychotic symptoms, suicide attempts, and use of tobacco, alcohol, and other substances. In conclusion, cannabis use present in almost one-quarter of patients with BD and is associated with factors that are highly relevant for both clinical practice and public health.

Impacto da disseminação de informação sobre endometriose no autocuidado de adolescentes de escola pública / Impact of dissemination of information about endometriosis on self-care of public school adolescents

Objetivo: Averiguar o conhecimento das adolescentes sobre endometriose, que é uma doença estrogênio-dependente, podendo ser progressiva, e que se caracteriza pela presença do tecido endometrial fora do útero. Estima-se que a endometriose acometa cerca de 10% das mulheres em idade reprodutiva, sendo 4% a 17% das adolescentes. Métodos: A pesquisa foi desenvolvida com adolescentes estudantes do terceiro ano do ensino médio de escolas estaduais do município de Avaré (São Paulo) de forma descritiva, exploratória e quali-quantitativa, em três etapas: aplicação de questionário, realização de palestra e nova aplicação de questionário. Participaram quatro escolas, totalizando 80 adolescentes participantes na primeira fase e 48 adolescentes na terceira fase. Resultados: Houve aumento de 21,35 vezes no número de adolescentes que se beneficiaram dos conhecimentos gerados pelas palestras, além da replicação da informação para terceiros, possivelmente aumento no número de mulheres que tomaram conhecimento sobre o que é endometriose. Conclusão: Verificou-se que a aplicação de palestras informativas sobre sinais e sintomas de endometriose aumentou o grau de conhecimento de adolescentes entre 16 e 17 anos de escola pública.

Objective: To investigate the knowledge of adolescents about Endometriosis, which is a progressive, estrogen/dependent disease, which can be progressive and which is characterized by the presence of endometrial tissue outside the uterus. It is estimated that it affects about 10% of women of reproductive age, of which 2%-4% are postmenopausal, with or without hormonal treatment, and 4% to 17% of adolescents. Methods: The research was carried out with adolescent students in the 3rd year of high school from state schools in the city of Avaré (São Paulo) in a descriptive, exploratory and qualitative-quantitative manner in three stages: application of a questionnaire, holding a lecture and a new application of quiz. Four schools participated, totaling 80 adolescents participating in the first phase and 48 adolescents in the third phase. Results: There was a 21.35-fold increase in the number of adolescents who benefited from the knowledge generated by the lectures, in addition to the replication of information to third parties, possibly an increase in the number of women who learned about what endometriosis is. Conclusion: It was found that the application of informative lectures on signs and symptoms of endometriosis increased the level of knowledge of adolescents between 16 and 17 years of age in public school.