Identifying Genetic Etiology in Patients with Intellectual Disability: An Experience in Public Health Services in Northeastern Brazil.

Intellectual disability (ID) is considered a common neuropsychiatric disorder that affects up to 3% of the population. The etiologic origin of ID may be genetic, environmental, and multifactorial. Chromosomopathies are relatively common among the genetic causes of ID, especially in the most severe cases and those associated with dysmorphic features. Currently, the application of new molecular cytogenetics technologies has increasingly allowed the identification of microdeletions, microduplications, and unbalanced translocations as causes of ID. The objective of this study was to investigate the etiology of ID in patients admitted to a public hospital in Northeastern Brazil. In total, 119 patients with ID who had normal karyotypes and fragile X exams participated in this study. The patients were initially physically examined for microdeletion syndromes and then tested using fluorescence in situ hybridization (FISH), multiplex ligation-dependent probe amplification (MLPA), methylation-sensitive polymerase chain reaction (MS-PCR), and chromosome microarray analysis (CMA), according to clinical suspicion. Patients with no diagnoses after FISH, MLPA, and/or MS-PCR evaluations were subsequently tested by CMA. The rate of etiologic diagnoses of ID in the current study was 28%. FISH diagnosed 25 out of 79 tested (31%), MLPA diagnosed 26 out of 79 tested (32%), MS-PCR diagnosed 7 out of 20 tested (35%), and the single nucleotide polymorphism array diagnosed 6 out of 27 tested (22%). Although the CMA is the most complete and recommended tool for the diagnosis of microdeletions, microduplications, and unbalance translocations in patients with ID, FISH, MLPA, and MS-PCR testing can be used as the first tests for specific syndromes, as long as the patients are first physically screened clinically, especially in the public health networks system in Brazil, where resources are scarce.

Influence of diimine bidentate ligand in the nitrosyl and nitro terpyridine ruthenium complex on the HSA/DNA interaction and antiviral activity.

Nitric oxide (NO) acts in different physiological processes, such as blood pressure control, antiparasitic activities, neurotransmission, and antitumor action. Among the exogenous NO donors, ruthenium nitrosyl/nitro complexes are potential candidates for prodrugs, due to their physicochemical properties, such as thermal and physiological pH stability. In this work, we proposed the synthesis and physical characterization of the new nitro terpyridine ruthenium (II) complexes of the type [RuII(L)(NO2)(tpy)]PF6 where tpy = 2,2':6',2″-terpyridine; L = 3,4-diaminobenzoic acid (bdq) or o-phenylenediamine (bd) and evaluation of influence of diimine bidentate ligand NH.NHq-R (R = H or COOH) in the HSA/DNA interaction as well as antiviral activity. The interactions between HSA and new nitro complexes [RuII(L)(NO2)(tpy)]+ were evaluated. The Ka values for the HSA-[RuII(bdq)(NO2)(tpy)]+ is 10 times bigger than HSA-[RuII(bd)(NO2)(tpy)]+. The sites of interaction between HSA and the complexes via synchronous fluorescence suppression indicate that the [RuII(bdq)(NO2)(tpy)]+ is found close to the Trp-241 residue, while the [RuII(bd)(NO2)(tpy)]+ complex is close to Tyr residues. The interaction with fish sperm fs-DNA using direct spectrophotometric titration (Kb) and ethidium bromide replacement (KSV and Kapp) showed weak interaction in the system fs-DNA-[RuII(bdq)(NO)(tpy)]+. Furthermore, fs-DNA-[RuII(bd)(NO2)(tpy)]+ and fs-DNA-[RuII(bd)(NO)(tpy)]3+ system showed higher intercalation constant. Circular dichroism spectra for fs-DNA-[RuII(bd)(NO2)(tpy)]+ and fs-DNA-[RuII(bd)(NO)(tpy)]3+, suggest semi-intercalative accompanied by major groove binding interaction modes. The [RuII(bd)(NO2)(tpy)]+ and [RuII(bd)(NO)(tpy)]3+ inhibit replication of Zika and Chikungunya viruses based in the nitric oxide release under S-nitrosylation reaction with cysteine viral.

Percepção de enfermeiros acerca dos processos de cuidado durante a pandemia da covid-19 / Nurses' perception about care processes during the covid-19 pandemic / Percepción de las enfermeras sobre los procesos de atención durante la pandemia de covid-19

Objetivo: analisar a percepção do enfermeiro acerca dos processos de cuidado durante a pandemia da COVID-19. Métodos: estudo de campo, descritivo e abordagem qualitativa, realizado entre dezembro de 2020 a abril de 2021. Participaram 45 enfermeiros atuantes há três anos ou mais na Atenção Primária de municípios paraibanos classificados em urbano, intermediário adjacente e remoto, rural adjacente e remoto. Realizou-se a coleta através de entrevistas semiestruturadas pela plataforma Google Meet, essas eram gravadas pela própria plataforma e transcritas na íntegra para análise. A análise de dados deu-se por meio da Análise de Conteúdo considerando as etapas de pré-análise, codificação do texto e a inferência e interpretação dos resultados. O estudo atendeu ao que preconiza os padrões éticos. Resultados: no contexto pandêmico, os enfermeiros identificaram déficits existentes em suas práticas, elencando desafios e limitações nas condutas, como as de biossegurança e prevenção de doenças, fazendo-os repensar sobre futuras mudanças a serem realizadas após o período de pandemia. Conclusão: infere-se que os enfermeiros atuantes da Atenção Primária obtiveram novas percepções relacionadas ao cuidado, a preocupação com a saúde física e mental no planejamento desse cuidado, não apenas do usuário, mas de si mesmo e às pessoas do convívio. (AU)

Objective: to analyze nurses' perceptions of care processes during the COVID-19 pandemic. Methods: field study, descriptive and qualitative approach, carried out between December 2020 and April 2021. Participated 45 nurses working for three years or more in Primary Care in municipalities in Paraíba classified as urban, intermediate adjacent and remote, rural adjacent and remote. The collection was carried out through semi-structured interviews through the Google Meet platform, these were recorded by the platform itself and transcribed in full for analysis. Data analysis was carried out through Content Analysis considering the pre-analysis steps, text coding and the inference and interpretation of results. The study complied with ethical standards. Results: in the pandemic context, nurses identified existing deficits in their practices, listing challenges and limitations in conduct, such as biosecurity and disease prevention, making them rethink about future changes to be made after the period of pandemic. Conclusion: it is inferred that nurses working in Primary Care obtained new perceptions related to care, the concern with physical and mental health in the planning of this care, not only of the user, but of himself and the people around him. (AU)

Objetivo: analizar las percepciones de los enfermeros sobre los procesos de atención durante la pandemia de COVID-19. Métodos: estudio de campo, de abordaje descriptivo y cualitativo, realizado entre diciembre de 2020 y abril de 2021. Participaron 45 enfermeros que actúan desde hace tres años o más en Atención Básica en municipios de Paraíba clasificados como urbano, intermedio adyacente y remoto, rural adyacente y remoto. La recolección se realizó a través de entrevistas semiestructuradas a través de la plataforma Google Meet, estas fueron grabadas por la propia plataforma y transcritas en su totalidad para su análisis. El análisis de los datos se realizó a través del Análisis de Contenido considerando las etapas del preanálisis, la codificación del texto y la inferencia e interpretación de los resultados. El estudio cumplió con las normas éticas. Resultados: en el contexto de la pandemia, los enfermeros identificaron déficits existentes en sus prácticas, enumerando desafíos y limitaciones en la conducta, como la bioseguridad y la prevención de enfermedades, lo que les hizo repensar sobre los cambios futuros que se deben realizar después del período de pandemia. Conclusión: se infiere que los enfermeros que actúan en la Atención Primaria obtuvieron nuevas percepciones relacionadas con el cuidado, la preocupación por la salud física y mental en la planificación de este cuidado, no sólo del usuario, sino de sí mismo y de las personas que lo rodean. (AU)

Mycobacterium tuberculosis latent infection in healthcare students: systematic review of prevalence.

OBJECTIVE: The aim of this study was to synthesize the evidence on the prevalence of latent Mycobacterium tuberculosis infection (LTBI) among undergraduate health care students. METHODS: A systematic review of prevalence with meta-analysis was conducted. Prospective and retrospective cohorts and cross-sectional studies involving probable exposure to M. tuberculosis during undergraduate education, along with the tuberculin skin test (TST) or interferon-γ release assay (IGRA) for investigation of latent tuberculosis were searched. Searches were conducted in MEDLINE, CINAHL, EMBASE, LILACS, Scopus, and Web of Science databases. Independent reviewers were responsible for the selection and inclusion of studies. Data were extracted, critically appraised, and synthesized using the JBI approach. PRISMA was used to report the study. RESULTS: Twenty-two studies were analyzed. The overall prevalence in healthcare undergraduate students was 12.53%. CONCLUSION: The prevalence of LTBI in undergraduate health students was high for such a highly educated population. Screening with TST and/or IGRA and chemoprophylaxis, when necessary, should be provided to undergraduate health students when in contact with respiratory symptomatic patients.

Beauveria bassiana biogenic nanoparticles for the control of Noctuidae pests.

BACKGROUND: Biogenic metallic and oxide metal nanoparticles have potential as alternatives for several current problems in agriculture, such as the control of caterpillars which cause huge losses in the production of important crops. In the present study, capped and uncapped silver, iron oxide and titanium dioxide nanoparticles were synthesized from the filtrate of Beauveria bassiana and evaluated in regard to physico-chemical characteristics, capping composition, cytotoxicity, genotoxicity and biological activity on Helicoverpa armigera and Spodoptera frugiperda caterpillars. RESULTS: A difference in the physico-chemical parameters of the capped and uncapped nanoparticles was observed, with larger aggregation and lower stability of the uncapped. In regard to the study of the capping, the presence of functional groups of biomolecules as well as the activity of B. bassiana hydrolytic enzymes were observed. Cytotoxic effects on the tested cell lines were not observed and DNA damage levels increased with more intense effects of the uncapped nanoparticles. In regard to the biological activity against Noctuidae pests, the uncapped and capped iron oxide, and uncapped titanium dioxide nanoparticles occasioned higher mortality (76%, 60% and 51%, respectively) but no differences in LC50 were recorded. Moreover, sublethal effects were reported on Helicoverpa armigera whereas Spodoptera frugiperda showed low susceptibility to the nanoparticles. CONCLUSION: The results demonstrate that biogenic metallic and oxide metal nanoparticles might show promising effects for the control of caterpillars which cause damage on important agricultural crops. Further investigations are necessary to understand the mechanisms of action and optimize the biological activity of these new nanomaterials. © 2023 Society of Chemical Industry.

Enhancing Methylene Blue Dye Removal using pyrolyzed Mytella falcata Shells: Characterization, Kinetics, Isotherm, and Regeneration through Photolysis and Peroxidation.

The potential of pyrolyzed Mytella falcata shells as an adsorbent for removing methylene blue dye molecules from aqueous solutions was investigated. The study found that the adsorbent produced at 600 °C of pyrolysis temperature, with an adsorbent mass of 0.5 g, particle diameter of 0.297-0.149 mm, and pH 12.0, demonstrated the highest dye molecule removal efficiency of 82.41%. The material's porosity was observed through scanning electron microscopy, which is favorable for adsorption, while Fourier-transform infrared spectroscopy and X-Ray diffraction analysis analyses confirmed the presence of calcium carbonate in the crystalline phases. The pseudo-second order model was found to be the best fit for the data, suggesting that the adsorption mechanism involves two steps: external diffusion and diffusion via the solid pores. The Redlich-Peterson isotherm model better represented the equilibrium data, and the methylene blue adsorption was found to be spontaneous, favorable, and endothermic. The hydrogen peroxide with UV oxidation was found to be the most efficient method of regeneration, with a regeneration percentage of 63% achieved using 600 mmol.L-1 of oxidizing agents. The results suggest that pyrolyzed Mytella falcata shells could serve as an ecologically viable adsorbent alternative, reducing the amount of waste produced in the local environment and at the same time removing pollutants from the water. The material's adsorption capacity remained almost constant in the first adsorption-oxidation cycles, indicating its potential for repeated use.

Mycobacterium tuberculosis latent infection in healthcare students: systematic review of prevalence / Infecção latente por Mycobacterium tuberculosis em estudantes da área da saúde: revisão sistemática de prevalência / Infección latente por Mycobacterium tuberculosis en estudiantes de la salud: revisión sistemática de la prevalencia

ABSTRACT Objective: The aim of this study was to synthesize the evidence on the prevalence of latent Mycobacterium tuberculosis infection (LTBI) among undergraduate health care students. Methods: A systematic review of prevalence with meta-analysis was conducted. Prospective and retrospective cohorts and cross-sectional studies involving probable exposure to M. tuberculosis during undergraduate education, along with the tuberculin skin test (TST) or interferon-γ release assay (IGRA) for investigation of latent tuberculosis were searched. Searches were conducted in MEDLINE, CINAHL, EMBASE, LILACS, Scopus, and Web of Science databases. Independent reviewers were responsible for the selection and inclusion of studies. Data were extracted, critically appraised, and synthesized using the JBI approach. PRISMA was used to report the study. Results: Twenty-two studies were analyzed. The overall prevalence in healthcare undergraduate students was 12.53%. Conclusion: The prevalence of LTBI in undergraduate health students was high for such a highly educated population. Screening with TST and/or IGRA and chemoprophylaxis, when necessary, should be provided to undergraduate health students when in contact with respiratory symptomatic patients.

RESUMO Objetivo: O objetivo deste estudo foi sintetizar as evidências sobre a prevalência de infecção de Mycobacterium tuberculosis (ILTB) entre estudantes de graduação da área da saúde. Método: Foi realizada uma revisão sistemática de prevalência com metanálise. Coortes prospectivas e retrospectivas e estudos transversais envolvendo provável exposição a M. tuberculosis durante a graduação, juntamente com o teste tuberculínico (TT) ou ensaio de liberação de interferon-γ (IGRA) para investigação de tuberculose latente foram pesquisados. As buscas foram realizadas nas bases de dados MEDLINE, CINAHL, EMBASE, LILACS, Scopus e Web of Science. Revisores independentes foram responsáveis pela seleção e inclusão dos estudos. Os dados foram extraídos, avaliados criticamente e sintetizados utilizando a abordagem JBI. PRISMA foi usado para relatar o estudo. Resultados: Vinte e dois estudos foram analisados. A prevalência geral em estudantes de graduação da área da saúde foi de 12,53%. Conclusão: A prevalência de ILTB em estudantes de graduação em saúde foi alta para uma população com alto nível de escolaridade. Triagem com TT e/ou IGRA e quimioprofilaxia, quando necessária, deve ser fornecida aos estudantes de graduação da área da saúde quando em contato com pacientes sintomáticos respiratórios.

RESUMEN Objetivo: El objetivo de este estudio fue sintetizar la evidencia sobre la prevalencia de infección latente por Mycobacterium tuberculosis (ILTB) entre estudiantes universitarios de la salud. Métodos: Se realizó una revisión sistemática de la prevalencia con metanálisis. Cohortes prospectivas y retrospectivas y estudios transversales que involucran exposición probable a M tuberculosis durante la educación universitaria, junto con la prueba cutánea de tuberculina (TST) o el ensayo de liberación de interferón-γ (IGRA) para la investigación de tuberculosis latente. Las búsquedas se realizaron en las bases de datos MEDLINE, CINAHL, EMBASE, LILACS, Scopus y Web of Science. Revisores independientes fueron responsables de la selección e inclusión de los estudios. Los datos se extrajeron, se evaluaron críticamente y se sintetizaron utilizando el enfoque JBI. Se utilizó PRISMA para informar el estudio. Resultados: Se analizaron veintidós estudios. La prevalencia global en estudiantes universitarios en salud fue del 12,53%. Conclusión: La prevalencia de LTBI en estudiantes universitarios de salud fue alta para una población con un nivel educativo tan alto. Se debe proporcionar tamizaje con TST y/o IGRA y quimioprofilaxis, cuando sea necesario, a los estudiantes universitarios en salud cuando estén en contacto con pacientes sintomáticos respiratorios.

A percepção dos trabalhadores de enfermagem sobre o atendimento psiquiátrico em um hospital geral / Nursing workers' perception of psychiatric care in a general hospita / Percepciones de los trabajadores de enfermería sobre la atención psiquiátrica en un hospital genera

Objetivo: Analisar a produção do cuidado de enfermagem às pessoas em sofrimento psíquico atendidas em um hospital geral na perspectiva da corresponsabilidade e integralidade. Método:Foi realizado estudo qualitativo, exploratório, por meio da análise documental, observação participante e entrevista semiestruturada com 12 técnicos de enfermagem e 15 enfermeiros do Hospital Municipal de Serrinha-Bahia/Brasil. Os dados foram analisados apartir análise de conteúdo. Resultados:O atendimento psiquiátrico no hospital geral é visto pela maioria da equipe como porta de entrada para o primeiro atendimento, porém demonstram sentir receio, insegurança e despreparo para lidar com estes pacientes,sinalizando a necessidade de educação permanente para elaboração e integração de novos saberes. Considerações finais: Para efetivação do novo modelo de assistência à saúde mental, faz-se necessário a promoção de reflexão direcionada a desconstrução de preconceitos e estigmas previamente estabelecidos. Nesse sentido, torna-se imprescindível a compreensão das novas práticas para o enfrentamento do processo de transição de paradigma, que demanda dos profissionais, a disponibilidade para rever suas próprias percepções e práticas diante dos desafios advindos do processo de aproximação da pessoa em sofrimento psíquico no serviço de saúde.

Objective: To analyze the production of nursing care for people in psychological distress treated in a general hospital from the perspective of co-responsibility and comprehensiveness. Method:A qualitative, exploratory study was carried out using document analysis, participant observation and semi-structured interviews with 12 nursing technicians and 15 nurses from the Municipal Hospital of Serrinha-Bahia/Brazil. The data was analyzed using content analysis. Results:Psychiatric care in the general hospital is seen by most of the team as the gateway to first aid, but they feel afraid, insecure and unprepared to deal with these patients, signaling the need for ongoing education to develop and integrate new knowledge.Final considerations: In order to implement the new mental health care model, it is necessary to promote reflection aimed at deconstructing previously established prejudices and stigmas. In this sense, it is essential to understand the new practices in order to cope with the process of paradigm transition, which requires professionals to be willing to review their own perceptions and practices in the face of the challenges arising from the process of approaching people in psychological distress in the health service.

Objetivo: analizar la producción de cuidados de enfermería a personas en situación de malestar psíquico atendidas en un hospital general desde la perspectiva de la corresponsabilidad y la integralidad. Método:Se realizó un estudio cualitativo y exploratorio mediante análisis de documentos, observación participante y entrevistas semiestructuradas con 12 técnicos de enfermería y 15 enfermeros del Hospital Municipal de Serrinha-Bahia/Brasil. Los datos se analizaron mediante análisis de contenido. Resultados:La atención psiquiátrica en el hospital general es vista por la mayoría del equipo como la puerta de entrada a los primeros auxilios, pero se sienten temerosos, inseguros y poco preparados para tratar con estos pacientes, lo que señala la necesidad de una formación continua para desarrollar e integrar nuevos conocimientos. Consideraciones finales: Para implementar el nuevo modelo de atención en salud mental es necesario promover una reflexión orientada a deconstruir prejuicios y estigmas previamente establecidos. En este sentido, es esencial comprender las nuevas prácticas para hacer frente al cambio de paradigma, lo que requiere que los profesionales estén dispuestos a revisar sus propias percepciones y prácticas frente a los desafíos derivados del proceso de acercamiento a las personas que sufren enfermedades mentales en el servicio de salud.

Gelatin Carbon Dots Interaction with Nitrosyl Ruthenium Complex: Fluorescence Quenching and Chemiluminescence Mechanisms.

Carbon dots (CDs) exhibit luminescence, biocompatibility, and higher water solubility. This material has been developed for biological applications, specifically in bioimaging. In this work, the gelatin carbon dots (CDg) was obtained from commercial gelatin using a hydrothermal method in domestic microwave, and the suppression fluorescent mechanism were enhanced by the addition of the [RuII(bdq)(NO)(tpy)]3+ (Rubdq-NO+) complex ion. After purification through a dialysis bag, the resulting CDs (CDg) exhibit fluorescent emission at 400 nm and maintained fluorescence stability in an aqueous solution (pH = 7) for 30 days under 5 ◦C. Fluorescence quenching studies revealed an electrostatic interaction between the negative charge from CDg (δ = - 20 mV) and the positively charged nitrosyl (NO+) ligand of the ruthenium complex (Rubdq-NO+), resulting in quenching of the CDg fluorescence due to the inner filter effects (IFE). The chemiluminescence reaction of CDg and Rubdq-NO-CDg in presence of norepinephrine (NOR) were evaluated. NOR in PBS are liable to undergo spontaneous oxidation to quinone form (NOR-quinone). CDg are believed interact with NOR-quinone and an electron transfer occur obtained CDg+ accompanied to green emission fluorescence (520 nm). While for Rubdq-NO-CDg in presence of NOR, the green emission occurs accompanied by NO0 release using DAF-2 probe.

Desfechos assistenciais na implantação do protocolo minimalista de implante transcateter de válvula aórtica / Care outcomes in the implementation of the minimalist protocol for transcatheter aortic valve implantation

INTRODUÇÃO: A abordagem minimalista no implante transcateter da válvula aórtica tornou-se ideal tecnicamente pela redução das comorbidades pré-operatórias e consequentemente, recuperação mais rápida e com menos riscos associados comparados com a cirurgia de troca de válvula aórtica convencional. O conceito de Implante Transcateter de Válvula Aórtica minimalista é definido pela simplificação dos aspectos técnicos como anestesias local/sedação consciente, acesso percutâneo, ecotranstorácico, monitorização em unidade de pós-procedimento anestésico, associados à assistência multidisciplinar, visando simplificar os aspectos da atenção ao paciente, sem perder o foco na segurança da assistência e na obtenção dos melhores desfechos clínicos, assim como na diminuição da internação e custos hospitalares. OBJETIVO: Descrever desfechos assistenciais obtidos na implantação do protocolo minimalista. MÉTODOS Estudo retrospectivo, unicêntrico, realizado em uma Instituição de grande porte especializada em Cardiologia do município de São Paulo. Os dados agregados foram extraídos do laboratório de hemodinâmica da sessão de intervenção Percutânea em Valvopatias, no período de janeiro de 2022 a maio 2023. RESULTADOS Dos 106 procedimentos de Implante Transcateter de Válvula Aórtica realizados no laboratório de hemodinâmica, 94,3% foram minimamente invasivos associados a ações multiprofissional de acordo com o protocolo estabelecidos pelo Heart Team da sessão de Intervenção em Valvopatias. CONCLUSÃO: O Enfermeiro é o profissional essencial na gestão de recursos de materiais específicos, recursos humanos especializados e na mobilização da equipe em assistir e garantir a assistência segura no procedimento minimamente.

O tempo porta-balão como indicador de qualidade de uma instituição pública de grande porte / Door-to-balloon time as an indicator of quality in a large public institution

INTRODUÇÃO: O tempo porta-balão é definido como o intervalo entre a entrada do paciente no serviço de saúde até a recanalização mecânica da artéria culpada, conforme as recomendações atuais nacionais e internacionais o tempo porta balão ideal tem que ser ≤60 minutos. Um elemento essencial para o sucesso das metas cronológicas é o profissional enfermeiro, ele está envolvido em todos os tempos para a realização de uma Intervenção Coronária Percutânea primária bem-sucedida. OBJETIVO: Identificar o tempo porta-balão nos pacientes diagnosticados com IAMCSST. METODOLOGIA Estudo observacional, descritivo, coorte retrospectivo e de abordagem quantitativa, realizado no laboratório de Hemodinâmica de um hospital de grande porte especializado em Cardiologia entre os meses de fevereiro de 2022 a fevereiro de 2023. RESULTADO Dos 53 exames realizados com diagnóstico IAMCSST na hemodinâmica, 37.5% atingiram o tempo de 90 minutos e 62.5% dos pacientes ≤60 minutos. CONCLUSÃO: Com Educação Permanente e uma equipe preparada e qualificada atuante no laboratório de Hemodinâmica se mantém a meta preconizada a nível nacional para segurança do paciente como proposta de um indicador assistencial importante para enfermagem. Observou-se que acima dos 50% dos casos assistidos na Instituição mantiveram-se na meta estabelecida em 2018 pela Sociedade Europeia de Cardiologia, o tempo porta balão de ≤60 minutos.

Safety and Efficacy of Lebrikizumab in Adolescent Patients with Moderate-to-Severe Atopic Dermatitis: A 52-Week, Open-Label, Phase 3 Study.

INTRODUCTION: Atopic dermatitis (AD) is a chronic inflammatory skin disorder with limited treatment options for adolescents with moderate-to-severe disease. Lebrikizumab, a monoclonal antibody targeting interleukin (IL)-13, demonstrated clinical benefit in previous Phase 3 trials: ADvocate1 (NCT04146363), ADvocate2 (NCT04178967), and ADhere (NCT04250337). We report 52-week safety and efficacy outcomes from ADore (NCT04250350), a Phase 3, open-label study of lebrikizumab in adolescent patients with moderate-to-severe AD. The primary endpoint was to describe the proportion of patients who discontinued from study treatment because of adverse events (AEs) through the last treatment visit. METHODS: Adolescent patients (N = 206) (≥ 12 to < 18 years old, weighing ≥ 40 kg) with moderate-to-severe AD received subcutaneous lebrikizumab 500 mg loading doses at baseline and Week 2, followed by 250 mg every 2 weeks (Q2W) thereafter. Safety was monitored using reported AEs, AEs leading to treatment discontinuation, vital signs, growth assessments, and laboratory testing. Efficacy analyses included Eczema Area and Severity Index (EASI), Investigator's Global Assessment (IGA), Body Surface Area (BSA), (Children's) Dermatology Life Quality Index ((C)DLQI), and Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, and PROMIS Depression. RESULTS: 172 patients completed the treatment period. Low frequencies of SAEs (n = 5, 2.4%) and AEs leading to treatment discontinuation (n = 5, 2.4%) were reported. Overall, 134 patients (65%) reported at least one treatment-emergent AE (TEAE), most being mild or moderate in severity. In total, 62.6% achieved IGA (0,1) with ≥ 2-point improvement from baseline and 81.9% achieved EASI-75 by Week 52. The EASI mean percentage improvement from baseline to Week 52 was 86.0%. Mean BSA at baseline was 45.4%, decreasing to 8.4% by Week 52. Improvements in mean change from baseline (CFB) to Week 52 were observed in DLQI (baseline 12.3; CFB - 8.9), CDLQI (baseline 10.1; CFB - 6.5), PROMIS Anxiety (baseline 51.5; CFB - 6.3), and PROMIS Depression (baseline 49.3; CFB - 3.4) scores. CONCLUSIONS: Lebrikizumab 250 mg Q2W had a safety profile consistent with previous trials and significantly improved AD symptoms and quality of life, with meaningful responses at Week 16 increasing by Week 52. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT04250350.

Atopic dermatitis is a chronic relapsing inflammatory skin disease that affects up to 15% of adolescents worldwide, with up to 50% suffering from moderate-to-severe disease. Signs and symptoms include dry, cracked skin; redness; itching; and painful lesions, which can negatively affect quality of life and lead to complications, including skin infections. Adolescents also report increased rates of anxiety and stress. Lebrikizumab is a novel monoclonal antibody that binds with high affinity and slow off-rate to interleukin (IL)-13, the key cytokine in atopic dermatitis, blocking the downstream effects of IL-13 with high potency. Lebrikizumab has been shown previously to improve symptoms of atopic dermatitis, including itch, skin clearance, and quality of life in ADvocate1, ADvocate2 and ADhere. The ADore study aimed to evaluate the safety and efficacy of lebrikizumab in adolescents with moderate-to-severe atopic dermatitis. Investigators recruited patients ≥ 12 to < 18 years old, weighing ≥ 40 kg, from Australia, Canada, Poland, and the US who were diagnosed with moderate-to-severe atopic dermatitis. These patients received a loading dose of 500 mg of lebrikizumab at Weeks 0 and 2, followed by 250 mg every 2 weeks for 52 weeks. The safety profile of lebrikizumab was consistent with previously published reports, with mostly mild or moderate adverse events, which did not lead to treatment discontinuation. Lebrikizumab improved skin clearance; 62.6% of patients had clear or almost clear skin by the end of the trial. Lebrikizumab also improved the patients' quality of life. These safety and efficacy results support lebrikizumab's role in treating adolescents with moderate-to-severe atopic dermatitis. Safety and Efficacy of Lebrikizumab in Adolescent Patients with Moderate-to-Severe Atopic Dermatitis: A 52-Week, Open-Label, Phase 3 Study (MP4 44681 KB).

The Role of Digital Technology and New Strategies in Engagement and Adherence Among Patients With Cardiometabolic Disease

Abstract This article explores challenges and barriers to managing cardiometabolic conditions, highlighting strategies and technologies for improving patient adherence. Approaches such as simplifying prescriptions, patient empowerment, health education, setting short-term goals, understanding social context, self-monitoring, and gamification have been effective in promoting adherence. The use of health apps for chronic diseases has also been increasing, facilitating medication adherence and self-monitoring. Integrating these approaches into clinical practice can lead to consistent outcomes and reduce care-associated costs.

Titanium biogenic nanoparticles to help the growth of Trichoderma harzianum to be used in biological control.

BACKGROUND: The biogenic synthesis of metallic nanoparticles is a green alternative that reduces the toxicity of this nanomaterials and may enable a synergy between the metallic core and the biomolecules employed in the process enhancing biological activity. The aim of this study was to synthesize biogenic titanium nanoparticles using the filtrate of the fungus Trichoderma harzianum as a stabilizing agent, to obtain a potential biological activity against phytopathogens and mainly stimulate the growth of T. harzianum, enhancing its efficacy for biological control. RESULTS: The synthesis was successful and reproductive structures remained in the suspension, showing faster and larger mycelial growth compared to commercial T. harzianum and filtrate. The nanoparticles with residual T. harzianum growth showed inhibitory potential against Sclerotinia sclerotiorum mycelial growth and the formation of new resistant structures. A great chitinolytic activity of the nanoparticles was observed in comparison with T. harzianum. In regard to toxicity evaluation, an absence of cytotoxicity and a protective effect of the nanoparticles was observed through MTT and Trypan blue assay. No genotoxicity was observed on V79-4 and 3T3 cell lines while HaCat showed higher sensitivity. Microorganisms of agricultural importance were not affected by the exposure to the nanoparticles, however a decrease in the number of nitrogen cycling bacteria was observed. In regard to phytotoxicity, the nanoparticles did not cause morphological and biochemical changes on soybean plants. CONCLUSION: The production of biogenic nanoparticles was an essential factor in stimulating or maintaining structures that are important for biological control, showing that this may be an essential strategy to stimulate the growth of biocontrol organisms to promote more sustainable agriculture.

Conhecimento sobre as verdadeiras e falsas contraindicações às imunizações em uma Unidade Básica de Saúde

Material desenvolvido por Renata Holanda dos Anjos Lima para Dissertação: Conhecimento sobre as verdadeiras e falsas contraindicações às imunizações em uma Unidade Básica de Saúde, apresentada ao Programa de Pós-Graduação - Mestrado Profissional em Enfermagem na Atenção Primária em Saúde no Sistema Único de Saúde da Escola de Enfermagem da Universidade de São Paulo.

Two Phase 3 Trials of Lebrikizumab for Moderate-to-Severe Atopic Dermatitis.

BACKGROUND: Lebrikizumab, a high-affinity IgG4 monoclonal antibody targeting interleukin-13, prevents the formation of the interleukin-4Rα-interleukin-13Rα1 heterodimer receptor signaling complex. METHODS: We conducted two identically designed, 52-week, randomized, double-blind, placebo-controlled, phase 3 trials; both trials included a 16-week induction period and a 36-week maintenance period. Eligible patients with moderate-to-severe atopic dermatitis (adults [≥18 years of age] and adolescents [12 to <18 years of age, weighing ≥40 kg]) were randomly assigned in a 2:1 ratio to receive either lebrikizumab at a dose of 250 mg (loading dose of 500 mg at baseline and week 2) or placebo, administered subcutaneously every 2 weeks. Outcomes for the induction period were assessed up to 16 weeks and are included in this report. The primary outcome was an Investigator's Global Assessment (IGA) score of 0 or 1 (indicating clear or almost clear skin; range, 0 to 4 [severe disease]) with a reduction (indicating improvement) of at least 2 points from baseline at week 16. Secondary outcomes included a 75% improvement in the Eczema Area and Severity Index score (EASI-75 response) and assessments of itch and of itch interference with sleep. Safety was also assessed. RESULTS: In trial 1, the primary outcome was met in 43.1% of 283 patients in the lebrikizumab group and in 12.7% of 141 patients in the placebo group (P<0.001); an EASI-75 response occurred in 58.8% and 16.2%, respectively (P<0.001). In trial 2, the primary outcome was met in 33.2% of 281 patients in the lebrikizumab group and in 10.8% of 146 patients in the placebo group (P<0.001); an EASI-75 response occurred in 52.1% and 18.1%, respectively (P<0.001). Measures of itch and itch interference with sleep indicated improvement with lebrikizumab therapy. The incidence of conjunctivitis was higher among patients who received lebrikizumab than among those who received placebo. Most adverse events during the induction period were mild or moderate in severity and did not lead to trial discontinuation. CONCLUSIONS: In the induction period of two phase 3 trials, 16 weeks of treatment with lebrikizumab was effective in adolescents and adults with moderate-to-severe atopic dermatitis. (Funded by Dermira; ADvocate1 and ADvocate2 ClinicalTrials.gov numbers, NCT04146363 and NCT04178967, respectively.).

Acoustic Monitoring of Black-Tufted Marmosets in a Tropical Forest Disturbed by Mining Noise.

All habitats have noise, but anthropogenic sounds often differ from natural sounds in terms of frequency, duration and intensity, and therefore may disrupt animal vocal communication. This study aimed to investigate whether vocalizations emitted by black-tufted marmosets (Callithrix penicillata) were affected by the noise produced by mining activity. Through passive acoustic monitoring, we compared the noise levels and acoustic parameters of the contact calls of marmosets living in two study areas (with two sampling points within each area)-one near and one far from an opencast mine in Brazil. The near area had higher anthropogenic background noise levels and the marmosets showed greater calling activity compared to the far area. Calls in the near area had significantly lower minimum, maximum and peak frequencies and higher average power density and bandwidth than those in the far area. Our results indicate that the mining noise affected marmoset vocal communication and may be causing the animals to adjust their acoustic communication patterns to increase the efficiency of signal propagation. Given that vocalizations are an important part of social interactions in this species, concerns arise about the potential negative impact of mining noise on marmosets exposed to this human activity.

Efficacy and Safety of Lebrikizumab in Combination With Topical Corticosteroids in Adolescents and Adults With Moderate-to-Severe Atopic Dermatitis: A Randomized Clinical Trial (ADhere).

Importance: Lebrikizumab (LEB), a high-affinity monoclonal antibody targeting interleukin (IL)-13, demonstrated efficacy and safety in patients with moderate-to-severe atopic dermatitis (AD) during 16 weeks of monotherapy in a phase 2b trial, and two 52-week phase 3 trials. Objective: To evaluate efficacy and safety of LEB combined with low- to mid-potency topical corticosteroids (TCS) in patients with moderate-to-severe AD. Design, Setting, and Participants: The ADhere trial was a 16-week randomized, double-blinded, placebo (PBO)-controlled, multicenter, phase 3 clinical trial conducted from February 3, 2020, to September 16, 2021. The study was conducted at 54 outpatient sites across Germany, Poland, Canada, and the US and included adolescent (aged ≥12 to <18 years weighing ≥40 kg) and adult patients with moderate-to-severe AD. The treatment allocation ratio was 2:1 (LEB:PBO). Interventions: Overall, 211 patients were randomized to subcutaneous LEB (loading dose of 500 mg at baseline and week 2, followed by 250 mg every 2 weeks [Q2W] thereafter) or PBO Q2W in combination with TCS for 16 weeks. Main Outcomes and Measures: Efficacy analyses at week 16 included proportions of patients achieving Investigator's Global Assessment score of 0 or 1 (IGA [0,1]) with 2 or more points improvement from baseline, and 75% improvement in the Eczema Area and Severity Index (EASI-75). Key secondary end points included evaluation of itch, itch interference on sleep, and quality of life. Safety assessments included monitoring adverse events (AEs). Results: The mean (SD) age of patients was 37.2 (19.3) years, 103 (48.8%) patients were women, 31 (14.7%) patients were Asian, and 28 (13.3%) patients were Black/African American. At week 16, IGA (0,1) was achieved by 145 (41.2%) patients in the LEB+TCS group vs 66 (22.1%) receiving PBO+TCS (P = .01); corresponding proportions of patients achieving EASI-75 were 69.5% vs 42.2% (P < .001). The LEB+TCS group showed statistically significant improvements in all key secondary end points. Most treatment-emergent adverse events (TEAEs) were nonserious, mild or moderate in severity, and did not lead to study discontinuation. The TEAEs frequently reported in the LEB+TCS group included conjunctivitis (7 [4.8%]), headache (7 [4.8%]), hypertension (4 [2.8%]), injection site reactions (4 [2.8%]), and herpes infection (5 [3.4%]) vs 1.5% or less patient-reported frequencies in the PBO+TCS group. Similar frequencies of patient-reported serious AEs following LEB+TCS (n = 2, 1.4%) and PBO+TCS (n = 1, 1.5%). Conclusions and Relevance: In this randomized phase 3 clinical trial, LEB+TCS was associated with improved outcomes in adolescents and adults with moderate-to-severe AD compared with TCS alone, and safety was consistent with previously reported AD trials. Trial Registration: ClinicalTrials.gov Identifier: NCT04250337.

Simple and cheap preparation of fluorescence paper sensor based in carbon dot for visual detection of chloramphenicol.

Carbon dots (CDs) are nanometer-scale particles produced from carbon sources that exhibit fluorescence emission. The present work presents the synthesis and characterization of CDs, as well as the sensing studies for the determination of chloramphenicol (CAP). CAP is an antibiotic used in human medicine and agriculture, and its indiscriminate use and inappropriate disposal have caused damage to human health and the environment. The carbonaceous precursor used in the synthesis of CDs was 3,4-diaminobenzoic acid (3,4-DABA) through the hydrothermal method via domestic microwave irradiation. The first synthesis procedure was carried out in the presence of water/ethanol (a-CDs) and the second in the presence of 1 mol/L sodium hydroxide/ethanol (b-CDs). The CDs were initially characterized in terms of spectroscopic properties in the ultraviolet and visible region (UV-visible), Fourier-transform infrared (FTIR) spectra, Raman spectroscopy, and fluorescence emission spectroscopy. Sensing studies for the antibiotic C were performed by fluorescence suppression in the presence of a- and b-CDs, as well as the precursor 3,4-DABA. The a- and b-CDs presented similar values of linear range 0.00080-0.0050 mg/ml and limit of detection (LOD) = 0.00030 mg/ml (0.30 ppm) for CAP. Then, a- and b-CDs were embedded in Whatman and Mellita® filter paper, and CAP sensing was evaluated through UV light excitation.