Bismuth(III) triflate: an economical and environmentally friendly catalyst for the Nazarov reaction.

We describe the use of bismuth(III) triflate as an efficient and environmentally friendly catalyst for the Nazarov reaction of aryl vinyl ketones, leading to the synthesis of 3-aryl-2-ethoxycarbonyl-1-indanones and 3-aryl-1-indanones. By changing the temperature and reaction time, it was possible to modulate the reactivity, allowing the synthesis of two distinct product classes (3-aryl-2-ethoxycarbonyl-1-indanones and 3-aryl-1-indanones) in good to excellent yield. The reaction did not require additives and was insensitive to both air and moisture. Preliminary biological evaluation of some indanones showed a promising profile against some human cancer line cells.

Analysis of signs and symptoms in confirmed cases of severe dengue among children aged 0 to 10 years old.

OBJECTIVE: The prevalent symptoms of severe dengue in pediatric patients are divided into three subgroups: severe plasma leakage, severe bleeding, and severe organ damage. In addition, the seasonal patterns of the disease and the outcomes of cure or death from dengue were evaluated. METHODS: An epidemiological, observational, analytical, cross-sectional study was conducted with data from the Notifiable Disease Information System (SINAN - Sistema de Informação de Agravos de Notificação and DATASUS - Departamento de Informática do Sistema Único de Saúde) of the Ministry of Health from 2019 to 2020. RESULTS: During the study period, 1,857 cases of severe dengue were observed in the pediatric age group, with the most common symptoms being respiratory failure, melena, hematemesis, and altered level of consciousness. The total proportion of patients hospitalized for severe dengue was 89.6%, and 51.2% of these patients died, corroborating the importance of early detection of the disease. CONCLUSION: Severe dengue is more prevalent during the seasonal period, with hot and humid characteristics owing to the mechanism involved in the viral cycle. The most prevalent symptoms of severe dengue in pediatric patients were respiratory failure alone, gastrointestinal bleeding, and altered level of consciousness. It is important to identify signs of severity for early intervention and a better prognosis, considering that death is closely related to a delayed diagnosis.

Assessing the water quality in a World Heritage Site using biomarkers in top fish predators.

The use of biomarkers in fish for biomonitoring is a valuable approach to reveal effects of human impacts on biota health. Top predator fish are effective models for monitoring human activities' impacts on aquatic ecosystems. The Guaraguaçu River is the largest river-system on coastal region of South Brazil and a World Heritage site. The river receives contaminants from disorderly urban growth, including discharges of domestic sewage and small fishery boats, particularly during the tourist season. Our study aimed to assess impact of anthropogenic activities on water quality in the Guaraguaçu River by analyzing environmental contamination biomarkers in the top fish predator Hoplias malabaricus. Fish were collected using a fyke net trap across sectors representing a gradient of anthropic impact: sector 1 - pristine; sector 2 - impacted; and sector 3 - less impacted. Water samples were collected to analyze the presence of trace elements and pesticide. Biomarkers of the antioxidant system, histopathology, genotoxicity, neurotoxicity, and concentration of trace elements were analyzed in fish tissues. In water samples Al, Fe and Mn were detected, but no pesticides were found. In fish muscle, zinc and iron were detected. Brain acetylcholinesterase activity decreased in impacted sectors, indicating neurotoxic effects. The antioxidant system increased activity in gills and liver, and damage from lipoperoxidation was observed, particularly in sector 2 when compared to sector 1, suggesting oxidative stress. Histopathological biomarkers revealed lesions in the liver and gills of fish in impacted sectors. Micronuclei, a genotoxicity biomarker, were observed in organisms from all sectors. Our results demonstrate detrimental effects of poor water quality on biota health, even when contaminants are not detected in water.

The bladder microbiota is not significantly altered by intravesical BCG therapy.

INTRODUCTION: Bladder microbiota dysbiosis has been associated with several urological disorders. However, dysbiosis markers in bladder cancer have not been identified and little is known about the effect of Bacillus Calmette-Guérin (BCG) intravesical therapy on the bladder microbiota. In this study, we compared the bladder microbiota of patients with non-muscle-invasive bladder cancer (NMIBC) undergoing BCG therapy to nononcological controls. We also longitudinally analyzed the impact of BCG therapy on the bladder microbiota of NMIBC patients and addressed whether bladder microbiota is associated with BCG efficacy. METHODS: We collected catheterized urine samples from males with intermediate/high-risk NMIBC (cancer group, n = 32) or benign prostatic hyperplasia (control group, n = 41). The cancer group also provided urine samples during and after BCG induction. We used 16S rRNA gene sequencing to characterize the bladder microbiota. Bladder microbiota parameters, such as diversity and taxonomic composition, were compared between groups and associated with clinicopathological data and BCG efficacy. RESULTS: We observed no significant differences between the bladder microbiota of NMIBC patients and controls. BCG intravesical instillations did not significantly alter the bladder microbiota of NMIBC patients, and BCG was rarely detected in the bladder during and after BCG therapy. Microbiota diversity and overall composition before BCG induction did not influence disease persistence at 3 months. However, higher abundance of Lactobacillus, Streptococcus, and Cutibacterium in the pre-BCG bladder microbiota was associated with BCG effectiveness. CONCLUSION: We were unable to identify markers of bladder microbiota dysbiosis among male NMIBC patients. Moreover, we demonstrated for the first time using longitudinally collected samples that BCG cannot persist in the bladder microbiota nor significantly alter its diversity and composition. The associations found between bladder microbes and BCG efficacy highlight the potential of microbial-based therapeutic and risk-stratification strategies in the intermediate/high-risk NMIBC setting.

Urinary microbiota is associated to clinicopathological features in benign prostatic hyperplasia.

BACKGROUND: The urinary microbiota of patients with benign prostatic hyperplasia (BPH) has been associated with lower urinary tract symptoms (LUTS), however, little is known about urinary microbiota correlations with clinicopathological parameters associated with BPH. Here, we investigate associations between the urinary microbiota and clinical parameters of patients with BPH undergoing surgery. METHODS: Forty-one patients with BPH undergoing surgery were recruited from two medical centers. Catheterized urine specimens were collected and the microbiota was characterized by 16S rRNA gene sequencing. Patients were segregated into two groups according to each clinical parameter and differences in urinary microbiota diversity and composition were evaluated. RESULTS: Higher prostate weight and prostate-specific antigen (PSA) levels were associated with higher alpha diversity in the urinary microbiota of BPH patients. At the specific microbe level, we found that the greater the prostatic weight, the lower the relative abundance of Streptococcus, while the greater the PSA levels, the higher the abundance of Lactobacillus. Treatment with 5-α-reductase inhibitor was associated with overall urinary microbiota composition, in part due to a higher abundance of Corynebacterium and Anaerococcus in this group. CONCLUSIONS: We demonstrated that the urinary microbiota of BPH patients is associated with clinicopathological features, paving the way for larger studies in which causality between urinary microbiota and BPH can be appropriately explored.

Does vaginal surgery for correction of pelvic organ prolapse improve urinary function? A prospective cohort study.

INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) is caused by an imbalance in the stability of the pelvic organs, resulting in loss of support. The most common types of POP, anterior and apical, are associated with lower urinary tract symptoms (LUTS) such as bladder outlet obstruction and detrusor overactivity (DO). Vaginal surgery may improve LUTS and overall urinary symptoms. We assessed urodynamic (UD) parameters and urinary symptoms before and after vaginal surgery for POP correction. METHODS: A prospective cohort of 59 women with symptomatic anterior and/or apical POP associated with urinary symptoms and with indications for vaginal surgery were included. POP surgeries included anterior colporrhaphy and vaginal hysterectomy with culdoplasty (VH) and with/without concomitant posterior colporrhaphy and mid-urethral sling (MUS). All participants underwent UD evaluation and answered urinary symptom questionnaires pre- and 3 months post-surgery. RESULTS: Anterior colporrhaphy was performed in all patients: 45.7% with associated VH and 54.2% with concomitant MUS. Preoperative ICIQ-OAB score >8 points was significantly associated with DO (p<0.02) and decreased after surgery (9±4.3 to 3.2±3.0, p<0.001). All other questionnaires demonstrated improvements in urinary symptoms. Stress urinary incontinence rate decreased from 59.6% to 21% (p<0.001). Post-void residual (PVR) volume and Valsalva maneuver also decreased (p<0.001). CONCLUSIONS: Pelvic organ prolapse surgery reduced the prevalence of urgency symptoms, and all questionnaires on urinary symptoms showed clinically significant improvement. Vaginal surgery for POP, even combined with MUS, significantly reduced PVR volume and improved urgency symptoms.

Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: Systematic review and meta-analysis.

INTRODUCTION: Men with detrusor underactivity (DUA) and concomitant bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) may present poorer functional outcomes after surgical desobstruction. This study aimed to evaluate the safety and efficacy of BPE surgery in men with DUA compared with those with normal detrusor contractility (NC). MATERIALS AND METHODS: This review was performed according to the 2020 PRISMA framework. A comprehensive literature search was performed until May 7, 2023, using MEDLINE, EMBASE, and Cochrane Database. No date limits were imposed. Only comparative studies were accepted. The primary endpoint was to assess if there was any difference in short- and long-term functional outcomes after BPE surgery in men with DUA and NC. The secondary endpoint was to evaluate the differences in perioperative outcomes and postoperative complications between the two groups. Meta-analysis was performed using Review Manager (RevMan) software. RESULTS: There were 5 prospective nonrandomized studies and 12 retrospective studies, including 1701 DUA and 1993 NC patients. Regarding surgical procedures, there were eight TURP (transurethral resection of the prostate) studies, four GreenLight PVP (photoselective vaporization of the prostate) studies, two HoLEP (Holmium laser enucleation of the prostate) studies, one GreenLight PVP/HoLEP study, one Holmium laser incision of the prostate study, and one study did not report the type of surgery. We did not find a statistically significant difference between the two groups in terms of perioperative outcomes, including postoperative catheterization time, hospitalization time, urinary retention, need to recatheterization, transfusion rate, or urinary tract infections. Also, we found no significant differences in long-term complications, such as bladder neck stenosis or urethral stenosis. Posttreatment bladder recatheterization and retreatment rate for BPE regrowth could not be evaluated properly, because only one study reported these findings. When we analyzed functional outcomes at 3 months, those with NC had lower International Prostatic Symptom Score (IPSS), lower quality-of-life (QoL) score, better maximum flow rate (Qmax), and lower post-voiding residual (PVR) of urine. These results were maintained at 6 months postoperatively, with exception of PVR that showed no difference. However, at 12 and more than 12 months the functional outcomes became similar regarding IPSS and QoL. There were few data about Qmax and PVR at longer follow-up. CONCLUSION: In this meta-analysis, data suggest that BOO surgical treatment in patients with concomitant BPE and DUA appears to be safe. Despite patients with DUA may present worse functional outcomes in the short postoperative term compared with the NC population, IPSS and QoL scores become comparable again after a longer follow-up period after surgery.

Analysis of signs and symptoms in confirmed cases of severe dengue among children aged 0 to 10 years old

ABSTRACT Objective: The prevalent symptoms of severe dengue in pediatric patients are divided into three subgroups: severe plasma leakage, severe bleeding, and severe organ damage. In addition, the seasonal patterns of the disease and the outcomes of cure or death from dengue were evaluated. Methods: An epidemiological, observational, analytical, cross-sectional study was conducted with data from the Notifiable Disease Information System (SINAN - Sistema de Informação de Agravos de Notificação and DATASUS - Departamento de Informática do Sistema Único de Saúde) of the Ministry of Health from 2019 to 2020. Results: During the study period, 1,857 cases of severe dengue were observed in the pediatric age group, with the most common symptoms being respiratory failure, melena, hematemesis, and altered level of consciousness. The total proportion of patients hospitalized for severe dengue was 89.6%, and 51.2% of these patients died, corroborating the importance of early detection of the disease. Conclusion: Severe dengue is more prevalent during the seasonal period, with hot and humid characteristics owing to the mechanism involved in the viral cycle. The most prevalent symptoms of severe dengue in pediatric patients were respiratory failure alone, gastrointestinal bleeding, and altered level of consciousness. It is important to identify signs of severity for early intervention and a better prognosis, considering that death is closely related to a delayed diagnosis.

Determination of server location in emergency care systems: an index proposal using data envelopment analysis and the hypercube queuing model.

The objective of this article is to propose a new composite index (CI) that helps to determine the most effective location of servers in an Emergency Care System (ECS), using Benefit of the Doubt (BoD)/Data Envelopment Analysis (DEA) and the Hypercube queuing model. The CI proposed was developed in four stages: (1) definition of a number of possible ECS configurations through the application of mathematical partitions and permutations; (2) application of the hypercube queuing model to determine performance parameters for each ECS configuration; (3) application of DEA/BoD to build the CI and generate performance rankings, and (4) evaluation of the rankings obtained to define the best configuration for the ECS analyzed. Data from two real cases from Brazil were used to assess the CI proposal. The results obtained confirm that: (a) the hypercube model could, relatively quickly, determine the configuration parameters generated; (b) the application of an appropriate DEA/BoD model enabled the different configurations to be ranked with good discrimination; (c) a pattern in the relationship between ambulance concentration and configuration effectiveness could be identified; and (d) the CI proposed would benefit ECS managers who are making resource location decisions.

Orientação sexual e sintomas depressivos: papel mediador da autoestima e satisfação com a vida / Sexual orientation and depressive symptoms: mediating role of self-esteem and life satisfaction / Orientación sexual y síntomas depresivos: papel mediador de la autoestima y la satisfacción con la vida

Objetivo: verificar se autoestima e satisfação com a vida exercem efeitos mediadores na relação entre orientações sexuais minoritárias e sintomatologia depressiva em amostra de pós-graduandos stricto sensu. Método: estudo analítico, transversal, conduzido com 321 pós-graduandos stricto sensu entre março/abril de 2021. Utilizou-se o Patient Health Questionnaire-9 para avaliação de sintomas depressivos, Escala de Autoestima de Rosemberg e Escala de Satisfação com a Vida. Análises de mediação simples foram conduzidas por meio da macro PROCESS. Resultados: pós-graduandos de orientações sexuais minoritárias apresentaram maior severidade de sintomas depressivos e menores indicadores de autoestima e satisfação com a vida do que seus pares heterossexuais. Autoestima e satisfação com a vida mediaram parcialmente a relação entre orientação sexual e severidade de sintomas depressivos em uma proporção de, respectivamente, 48,26% e 37,54%. Conclusão: autoestima e satisfação com a vida apresentaram-se como importantes mediadores da relação entre orientações sexuais minoritárias e sintomas depressivos entre pós-graduandos(AU)

Objective: to verify whether self-esteem and satisfaction with life exert mediating effects on the relationship between minority sexual orientations and depressive symptoms in a sample of graduate students. Method: analytical, cross-sectional study conducted with 321 Brazilian graduate students between March/April 2021. The Patient Health Questionnaire-9 was used to assess depressive symptoms, was used too, Rosemberg´s Self-Esteem Scale and the Life Satisfaction Scale. Simple mediation analyzes were conducted using the PROCESS macro. Results: graduate students with minority sexual orientations had more severe depressive symptoms and lower indicators of self-esteem and life satisfaction than their heterosexual peers. Self-esteem and satisfaction with life partially mediated the relationship between sexual orientation and severity of depressive symptoms in a proportion of, respectively, 48.26% and 37.54%. Conclusion: self-esteem and life satisfaction were important mediators of the relationship between minority sexual orientations and depressive symptoms among graduate students(AU)

Objetivo: verificar si la autoestima y la satisfacción con la vida ejercen efectos mediadores en la relación entre las orientaciones sexuales minoritarias y la sintomatología depresiva en una muestra de estudiantes de posgrado stricto sensu. Método: estudio transversal analítico realizado junto a 321 estudiantes de posgrado stricto sensu entre marzo y abril de 2021. Para evaluar los síntomas depresivos, se utilizó el Patient Health Questionnaire-9, la Escala de Autoestima de Rosemberg y la Escala de Satisfacción con la Vida. Los análisis de mediación simple se realizaron utilizando la macro PROCESS. Resultados: los estudiantes de posgrado con orientaciones sexuales minoritarias presentaron síntomas depresivos más severos y menores indicadores de autoestima y satisfacción con la vida que sus pares heterosexuales. La autoestima y la satisfacción con la vida mediaron parcialmente la relación entre la orientación sexual y la severidad de los síntomas depresivos en una proporción de, respectivamente, 48,26% y 37,54%. Conclusión: la autoestima y la satisfacción con la vida fueron importantes mediadores de la relación entre la orientación sexual minoritaria y los síntomas depresivos entre estudiantes de posgrado(AU)

Systemic and local inflammatory response after implantation of biomaterial in critical bone injuries.

PURPOSE: To evaluate inflammatory response in critical bone injuries after implantation of the biomaterial composed of hydroxyapatite (HA)/poly (lactic-coglycolic acid) (PLGA)/BLEED. METHODS: Forty-eight male Wistar rats (280 ± 20 grams) were divided into two groups: control group (CG), in which the animals do not receive any type of treatment; and biomaterial group (BG), in which the animals received the HA/PLGA/BLEED scaffold. Critical bone injury was induced in the medial region of the skull calotte with the aid of a trephine drill 8 mm in diameter. The biomaterial was implanted in the form of 1.5-mm thick scaffolds. Serum and calotte were collected at one, three and seven days. RESULTS: Biomaterial had a significant effect on the morphological structure of the bone, accelerating osteoblast activation within three days, without causing exacerbated systemic inflammation. In addition, quantitative real-time polymerase chain reaction (qRT-PCR) analysis showed that BG induced upregulation of osteogenic genes such as runt-related transcription factor 2, and stimulated genes of inflammatory pathways such as tumor necrosis factor-α, on the first day without overexpressing genes related to bone matrix degradation, such as tissue inhibitor of metalloproteinases-1 and matrix metalloproteinase-9. CONCLUSIONS: The HA/PLGA/BLEED® association can be used as a bone graft to aid bone repair, as it is capable of modulating expression of important genes at this stage of the repair process.

Perioperative outcomes and risk factors for major complications associated with nephrectomy for Xanthogranulomatous pyelonephritis: a multicenter study.

PURPOSE: To determine the risk factors associated with major complications in patients with histologically confirmed Xanthogranulomatous pyelonephritis (XGP) who underwent nephrectomy. METHODS: A multicenter retrospective study was performed including patients who underwent nephrectomy between 2018 and 2022 with histopathological diagnosis of XGP. Clinical and laboratory parameters at the initial presentation were evaluated. Data on extension of XGP was recorded as per the Malek clinical-radiological classification. Characteristics of nephrectomy and perioperative outcomes were obtained. The primary outcome was major complications, defined as a CD ≥ grade 3 and the need for intensive care unit (ICU) admission. Secondary outcomes included the comparison of complications evaluating the nephrectomy approach (transperitoneal, retroperitoneal, and laparoscopic). A sub-analysis stratifying patients who needed ICU admission and Malek classification was performed. RESULTS: A total of 403 patients from 10 centers were included. Major complications were reported in 98 cases (24.3%), and organ injuries were reported in 58 patients (14.4%), being vascular injuries the most frequent (6.2%). Mortality was reported in 5 cases (1.2%). A quick Sepsis-related Organ Failure Assessment (qSOFA) score ≥ 2, increased creatinine, paranephric extension of disease (Malek stage 3), a positive urine culture, and retroperitoneal approach were independent factors associated with major complications. CONCLUSION: Counseling patients on factors associated with higher surgical complications is quintessential when managing this disease. Clinical-radiological staging, such as the Malek classification may predict the risk of major complications in patients with XGP who will undergo nephrectomy. A transperitoneal open approach may be the next best option when laparoscopic approach is not feasible.

One-pot organocatalyzed synthesis of tricyclic indolizines.

Indolizines and their saturated derivatives are important structural motifs present in several biologically active compounds of both natural and synthetic origin. We describe herein a one-pot approach for the synthesis of tricyclic indolizines catalyzed by a bicyclic imidazole-alcohol. The protocol is based on an aqueous Morita-Baylis-Hillman reaction between pyridine-2-carboxaldehydes and six- or seven-membered cyclic enones, followed by sequential intramolecular cyclization and dehydration. So, in a single operational step two new bonds (C-C and C-N) are formed in an organocatalyzed process that takes place in simple conditions (stirring in water at 60 °C for 12 h) and with great atom economy (water as the sole byproduct), affording the purified compounds in yields ranging from 19 to 70%. The facility of the cyclization strongly depends on the size of the cycloalkenone ring: while MBH adducts derived from six-, seven- or eight-membered cycloenones are readily transformed into the corresponding indolizines, cyclopentenone-derived MBH adducts do not cyclize. A competition experiment revealed that cycloheptenone-derived MBH adducts cyclize faster than cyclohexenone-derived adducts. Model DFT calculations have been performed to rationalize these reactivity trends.

Urodynamic profile of voiding in patients with pelvic organ prolapse after surgery: a systematic review with meta-analysis.

INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) is a defect of the female pelvic floor. Stress urinary incontinence (SUI), urge urinary incontinence (UUI), and obstructive symptoms may occur in these patients. The objective of surgical treatment is to restore the anatomy and function of the pelvic floor; however, it may prompt urinary symptoms not present previously. We performed a systematic review and meta-analysis to determine urodynamic changes in patients undergoing surgical correction for POP. METHODS: PubMed and Cochrane databases were searched for studies that contained data from urodynamic evaluation before and after vaginal surgery for POP. The main urodynamic data collected were free uroflowmetry (maximum flow [Qmax], voided volume, and post-void residual volume [PVR]), cystometry (bladder capacity, presence of detrusor overactivity [DO], SUI or UUI, and Valsalva leak point pressure), and pressure × flow study (detrusor pressure at maximum flow [PdetQmax], Qmax, and PVR). RESULTS: A total of 22 studies were included (1,549 women). Patients had a significantly higher prevalence of DO before surgery (OR = 1.56; 95% CI = 1.06-2.29), and surgeries without sling placement demonstrated a tendency to ameliorate DO. Patients who did not receive a sling were more incontinent after surgery. Bladder-emptying parameters improved after surgery, with higher PdetQmax before surgery (IV = 3.23; 95% CI = 0.45-1.18). Patients who did not receive MUS presented a lower Qmax (IV = -3.19; 95%CI = -4.09 to -2.30) and a higher PVR (IV = 27.89; 95%CI = 15.68-40.1) before surgery. CONCLUSION: Correction surgery for POP yields better urodynamic emptying parameters, with a reduction in the prevalence of DO. In contrast, sling placement enhances obstructive parameters.

Ingestive behavior of Holstein × Zebu cows managed on deferred supplemented pasture

This study aimed to evaluate the ingestive behavior of F1 Holstein × Zebu cows grazing on deferred pasture receiving different supplementation strategies. The experimental design was completely randomized, in a 3×4 factorial, with three supplementation strategies and four evaluation periods. The ingestive behavior of 24 cows divided into three groups of supplementation provided at milking was observed, and two of these groups received protein in the pasture. Ingestive behavior was monitored every 10 minutes for 24 hours and analyzed in the form of periods (morning, afternoon, night, and dawn) and total time. The animals remained longer grazing during the afternoon when the BGHI presented values of 83.8. Protein consumption did not influence grazing time but interfered with forage consumption. For the total grazing time, the animals in group 2 spent less time grazing. The groups of animals presented no difference concerning the time spent on rumination and idleness. During night and dawn, when the climate was characterized as thermal comfort, the animals spent more time ruminating. The climatic conditions did not influence the ingestive behavior, as the grazing peak was observed at times of higher BGHI. However, supplementation of the animals in group 2 modified the ingestive behavior of F1 H × Z cows.

Hematological and coagulation parameters as predictors of death by Coronavirus disease in hospitalized patients: a Brazilian follow-up study

Abstract This study aimed to evaluate the hematological and coagulation parameters according to the clinical outcomes of coronavirus disease (COVID-19). We analyzed the hematological and coagulation parameters of hospitalized patients with COVID-19 at admission, and two and three weeks during hospitalization. To assess the performance of these parameters in predicting poor outcomes, receiver operating characteristic (ROC) curves were created. We studied 128 patients with COVID-19 (59.2±17.7 years, 56% male). Non-survivors (n=54, 42%) presented significant alterations in hematological and coagulation parameters at admission, such as increased in white blood cells (WBC), neutrophil, and band cell counts, as well as elevated prothrombin time (PT), activated partial thromboplastin time, and D-dimer levels. During follow-up, the same group presented a gradual increase in D-dimer and PT levels, accompanied by a reduction in PT activity, hemoglobin, and red blood cell count (RBC). ROC curves showed that WBC, neutrophil, and band cell counts presented the best area under the curve (AUC) values with sensitivity and specificity of >70%; however, a logistic regression model combining all the parameters, except for RBC, presented an AUC of 0.89, sensitivity of 84.84%, and specificity of 77.41%. Our study shows that significant alterations in hematological and coagulation tests at admission could be useful predictors of disease severity and mortality in COVID-19.

Systemic and local inflammatory response after implantation of biomaterial in critical bone injuries

Purpose: To evaluate inflammatory response in critical bone injuries after implantation of the biomaterial composed of hydroxyapatite (HA)/poly (lactic-coglycolic acid) (PLGA)/BLEED. Methods: Forty-eight male Wistar rats (280 ± 20 grams) were divided into two groups: control group (CG), in which the animals do not receive any type of treatment; and biomaterial group (BG), in which the animals received the HA/PLGA/BLEED scaffold. Critical bone injury was induced in the medial region of the skull calotte with the aid of a trephine drill 8 mm in diameter. The biomaterial was implanted in the form of 1.5-mm thick scaffolds. Serum and calotte were collected at one, three and seven days. Results: Biomaterial had a significant effect on the morphological structure of the bone, accelerating osteoblast activation within three days, without causing exacerbated systemic inflammation. In addition, quantitative real-time polymerase chain reaction (qRT-PCR) analysis showed that BG induced upregulation of osteogenic genes such as runt-related transcription factor 2, and stimulated genes of inflammatory pathways such as tumor necrosis factor-α, on the first day without overexpressing genes related to bone matrix degradation, such as tissue inhibitor of metalloproteinases-1 and matrix metalloproteinase-9. Conclusions: The HA/PLGA/BLEED® association can be used as a bone graft to aid bone repair, as it is capable of modulating expression of important genes at this stage of the repair process.

Prognosis of Extended-Spectrum-Beta-Lactamase-Producing Agents in Emphysematous Pyelonephritis-Results from a Large, Multicenter Series.

BACKGROUND: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney and surrounding tissues with significant mortality. We aimed to assess the clinical factors and their influence on prognosis in patients being managed for EPN with and without ESBL-producing bacteria and to identify if those with EPN due to ESBL infections fared any different. METHODS: A retrospective analysis was performed on patients with EPN diagnosis from 22 centers across 11 countries (between 2013 and 2020). Demographics, clinical presentation, biochemical parameters, radiological features, microbiological characteristics, and therapeutic management were assessed. Univariable and multivariable analyses were performed to determine the independent variables associated with ESBL pathogens. A comparison of ESBL and non-ESBL mortality was performed evaluating treatment modality. RESULTS: A total of 570 patients were included. Median (IQR) age was 57 (47-65) years. Among urine cultures, the most common isolated pathogen was Escherichia coli (62.2%). ESBL-producing agents were present in 291/556 urine cultures (52.3%). In multivariable analysis, thrombocytopenia (OR 1.616 95% CI 1.081-2.413, p = 0.019), and Huang-Tseng type 4 (OR 1.948 95% CI 1.005-3.778, p= 0.048) were independent predictors of ESBL pathogens. Patients with Huang-Tseng Scale type 1 had 55% less chance of having ESBL-producing pathogens (OR 1.616 95% CI 1.081-2.413, p = 0.019). Early nephrectomy (OR 2.3, p = 0.029) and delayed nephrectomy (OR 2.4, p = 0.015) were associated with increased mortality in patients with ESBL infections. Conservative/minimally invasive management reported an inverse association with mortality (OR 0.314, p = 0.001). CONCLUSIONS: ESBL bacteria in EPN were not significantly associated with mortality in EPN. However, ESBL infections were associated with poor prognosis when patients underwent nephrectomy compared conservative/minimally invasive management.

Forage production, morphogenetic and structural components, and nutritional value of tropical grasses in the semiarid condition / Produção de forragem, componentes morfogênicos e estruturais e valor nutricional de gramíneas tropicais em condição semiárida

The objective of this study was to evaluate the forage mass, morphogenetic and structural characteristics, and nutritional value of tropical forage grasses in semiarid conditions. Nine grasses were evaluated, namely, three cultivars of Urochloa brizantha (Marandu, MG4, and Piatã); Urochloa decumbens cv. Basilisk; Urochloa humidicola cv. Llanero; Urochloa ruziziensis cv. Kennedy; and three cultivars of Megathyrsus maximum (Massai, Mombaça, and Tanzania). The experiment was laid out in a randomized complete block design in a split-plot arrangement in which the main factor were the grass cultivars and the secondary factor the seasons, with five replications per treatment. The statistical model included the fixed effect of treatment (grass), whereas the season was included as a random effect within treatments. Urochloa brizantha cvs. Marandu, MG4, and Piatã and Urochloa decumbens cv. Basilisk produced on average 858 kg ha-1 more forage mass than cvs. Kennedy and Basilisk. Megathyrsus maximum cv. Mombaça produced 40% more forage mass than the other cultivars of M. maximum (4205 vs. 3001 kg ha-1). Urochloa ruziziensis cv. Kennedy showed the lowest water use efficiency (36%). Urochloa ruziziensis cv. Kennedy exhibited the lowest leaf weight among the Urochloa cultivars (740 vs. 1319 kg ha-1). There was no treatment effect for leaf weight in the M. maximum cultivars. Urochloa ruziziensis cv. Kennedy showed the highest values of total digestible nutrients and dry matter digestibility (1.84 and 2.34%, respectively) among the other Urochloa cultivars. The M. maximum cultivars showed little differences in nutritional values. Cultivars Marandu, Piatã, and Massai exhibited better productive responses in the edaphoclimatic conditions of this study. However, future studies must be conducted evaluating the adaptation of the forage grass under semiarid conditions. Considering the settings of this study, the grasses Urochloa brizantha cvs. MG4, Marandu, and Piatã, as well as Megathyrsus maximum cvs. Massai and Mombaça, can be used in the semiarid condition.

O objetivo deste estudo foi avaliar a produtividade, características morfogênicas e estruturais e valor nutritivo de gramíneas forrageiras tropicais em condições semiáridas. Nove gramíneas foram avaliadas: Três cultivares de Urochloa brizantha (Marandu, MG4 e Piatã), Urochloa decumbens cv. Basilisk, Urochloa humidicola cv. Llanero, Urochloa ruziziensis cv. Kennedy e três cultivares de Megathyrsus maximum (Massai, capim-Mombaça e Tanzânia). O experimento foi conduzido em blocos completos casualizados em esquema de parcelas subdivididas com o fator principal (cultivar) e o fator secundário (estação) com cinco repetições por tratamento. O modelo estatístico incluiu o efeito fixo de tratamento (cultivar), e a estação do ano foi incluída como efeito aleatório dentro do tratamento. Urochloa brizantha cv. Marandu, MG4 e Piatã e Urochloa decumbens cv Basilisk produziram em média 858 kg ha-1 de massa de forragem a mais que a cv. Kennedy e Llanero. Megathyrsus cv. Mombaça produziu 40% (4205 vs. 3001 kg ha-1) a mais de massa de forragem do que as demais cultivares de Megathyrsus maximum. Urochloa ruziziensis cv. Kennedy apresentou a menor (36%) eficiência no uso da água (EUA). Urochloa ruziziensis cv. Kennedy produziu menor quantidade de folhas (740 vs. 1319 kg ha-1) para as demais cultivares de Urochloa. Não houve efeito do tratamento na produtividade de folhas para as cultivares Megathyrsus maximum. Urochloa ruziziensis cv. Kennedy apresentou os maiores valores de nutrientes digestíveis totais (NDT) e digestibilidade da matéria seca (DMS) (+1,84 e 2,34%, respectivamente) em relação à outra cultivar de Urochloa. As cultivares Megathyrsus maximum tiveram pouco efeito sobre os valores nutritivos. As cultivares Marandu, Piatã e Massai apresentaram melhores respostas produtivas nas condições edafoclimáticas deste estudo. No entanto, estudos futuros devem ser realizados avaliando a adaptação da forrageira em condições semiáridas. Nesta condição de estudo, as gramíneas Urochloa brizantha cv. MG4, Marandu e Piatã, assim como o Megathyrsus maximum cv. Massai e Mombaça podem ser usados em condições semiáridas.

Attitudes towards suicidal behavior: the effect of an educational intervention on university professors.

OBJECTIVE: To analyze the effect of an educational intervention on the attitudes of university professors towards suicidal behavior. METHODS: Experimental study, which carried out an educational intervention with 100 university professors, divided into two groups, control and intervention, developed in three moments, pre-assessment, intervention, and post-assessment, using the Eskin's Attitudes Towards Suicide Scale (E-ATSS). Comparisons before and after intervention in the same group were performed using the paired t-test for dependent samples and the Wilcoxon Signed Rank Test, and for comparisons between groups the paired t-test for independent samples and the Mann-Whitney U test were used, the significance level adopted was p < 0.05. RESULTS: There was a change in the attitude of professors in the two domains of the suicide scale such as mental illness (p<0.001) and punishment after death (p<0.001) whose attitudes were negative in the pre-assessment phase. For the control group, no changes were observed. CONCLUSION: The educational intervention promoted positive changes in attitudes, with a significant change evaluated at the end of the intervention in the domains: suicide as mental illness and punishment after death.