Vessel element morphology of Allagoptera campestris (Mart.) Kuntze (Arecaceae) belowground organs affected by growing conditions.

Allagoptera campestris is an acaulescent, rhizomatous palm tree that occurs in grassland and savanna areas (Cerrado). In the Santa Bárbara Ecological Station (Águas de Santa Bárbara, São Paulo, Brazil) the species is found growing in three distinct conditions: 1) in the understory of Pinus species plantations introduced in the 1970s in formerly open savanna, 2) in an area where Pinus species cultivated in the 1970s were later removed and the remaining material burned, and 3) in an open, undisturbed savanna area without the interference of pines. Anatomical studies carried out with A. campestris leaves collected in the same three areas indicated leaf plasticity in response to growth conditions. To verify whether there are differences in vessel element morphology in belowground organs, light, and scanning electron microscopy analyses were conducted on portions just below the crown, in the middle of the rhizome, and the median portions of three longer adventitious roots sampled from three plants in each area. The study reveals significant variations in vessel element characteristics of A. campestris, with roots consistently displaying longer and larger elements than rhizomes, and environmental conditions, especially in pine understory, influence vessel dimensions, and hydraulic conductivity in a negative manner.

Evaluation of Conflicts of Financial Interest in Publications on the Consumption of High-Intensity Sweeteners and Body-Weight Changes: A Systematic Review.

CONTEXT: Diseases related to excessive sugar consumption have become a public health concern. However, there may be a direct association between the consumption of artificial sweeteners and changes in body weight. OBJECTIVE: The aim was to evaluate potential industry financial conflicts of interest in publications on the relationship between high-intensity sweetener consumption and changes in body weight in observational and intervention studies. DATA SOURCES: The systematic review used the Medline, Embase, Cochrane, Scopus, and the VHL (Virtual Health Library) Regional Portal, including the LILACS databases. The PICOS strategy were used in the search strategy for intervention studies and for observational studies used the exposure factor as the criterion. DATA EXTRACTION: Inclusion criteria were observational and intervention studies in adults, without population or health status restrictions, without restriction on the year of publication, but restricted to full articles in Portuguese, English, and Spanish. Exclusion criteria were humans younger than 18 years, cross-sectional studies, and animal and in vitro studies. DATA ANALYSIS: There were extracted effect estimates, odds ratios, and linear associations, quantifying the effects per unit of intake of high-intensity sweeteners. The risk of bias in the intervention studies was assessed using the Cochrane Collaboration Risk of Bias tool (RoB). The Newcastle Ottawa Scale was used for observational studies (case-control and cohort). CONCLUSION: Most clinical trials favor using artificial sweeteners and receive contributions from the food industry. Observational studies, for the most part, show that the use of artificial sweeteners is unfavorable. In these studies, there was no sponsorship from the food industry, only from regulatory bodies. This result suggests that studies that had the support of the food industry had their influence on their outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no: CRD42016036204.

Influence of the Onset of Menopause on the Risk of Developing Alzheimer's Disease.

Menopause is a natural phase marked by the permanent cessation of menstrual cycles, occurring when the production of reproductive hormones from the ovaries stops for at least 12 consecutive months. Studies have suggested a potential connection between menopause and a heightened risk of developing Alzheimer's disease (AD), underscoring the significant role of reduced estrogen levels in the development of AD. Estrogen plays a crucial role in brain metabolism, influencing energy metabolism, synaptic plasticity, and cognitive functions. The cognitive benefits associated with hormone replacement therapy (HRT) are believed to be linked to estrogen's neuroprotective effects, either through direct action on the brain or indirectly by improving cardiovascular health. Extensive literature supports the positive impact of estrogen on brain cells. While the physiological effects of estrogen on the brain have not been consistently replicated in clinical trials, further research is crucial to provide more definitive recommendations to menopausal patients regarding the influence of HRT on AD. This review aims to comprehensively explore the interplay between menopause and AD, as well as the potential of HRT to mitigate cognitive decline in post-menopausal individuals.

Hybrid scaffolds for bone tissue engineering: Integration of composites and bioactive hydrogels loaded with hDPSCs.

Bone tissue regeneration remains a significant challenge in clinical settings due to the complexity of replicating the mechanical and biological properties of bone environment. This study addresses this challenge by proposing a hybrid scaffold designed to enhance both bioactivity and physical stability for bone tissue regeneration. This research is the fisrt to develop a rigid 3D structure composed of polycaprolactone (PCL) and hydroxyapatite nanoparticles (nHA) integrated with a bioink containing human dental pulp stem/stromal cells (hDPSCs), alginate, nHA and collagen (Col). The biofabricated constructs were extensively characterized through cytocompatibility tests, osteogenic differentiation assessment, and biocompatibility evaluation in a rat model. In vitro results demontrated that the hybrid scaffolds presented significantly higher cell viability after 168 h compared to the control group. Furthermore, the hybrid scaffolds showed increased osteogenic differentiation relative to other groups. In vivo evaluation indicated good biocompatibility, characterized by minimal inflammatory response and successful tissue integration. These findings highlight the scaffold's potential to support bone tissue regeneration by combining the mechanical strength of PCL and nHA with the biological activity of the alginate-nHA-Col and hDPSCs bioink. The current study provides a promising foundation for the development of biomaterials aimed at improving clinical outcomes in bone repair and regeneration, particulary for the treatment of critical-size bone defects, targeted drug administration, and three-dimensional models for bone tissue engineering.

Ectopic thyroid adenoma diagnosed in a Senegal seabream (Diplodus bellottii, Steindachner 1882): Towards an accurate diagnosis.

Thyroid tissue in teleosts is located mainly in the pharyngeal region, usually reaching other adjacent anatomical locations. Herein, a nodular lesion located in the left operculum of a Senegal seabream (Diplodus bellottii) was surgically excised and sent for microscopical evaluation. Microscopically, the lesion presented irregular borders and consisted in columnar epithelial cells arranged in a tubulopapillary pattern, surrounding a central lumen filled with acellular, acidophilic and homogeneous, material ('colloid'). To determine the lesion's histogenesis, immunohistochemistry was performed employing antibodies for AE1/AE3, CK7, thyroglobulin and vimentin. The neoplastic cells presented low mitotic index and positive immunolabelling for CK7 and thyroglobulin. Therefore, a diagnosis of ectopic thyroid adenoma was made. Herein, the successful employment of antibodies classically used in mammals for accurate diagnosis of thyroid disorders is described. Proliferation of thyroid tissue in fish may reflect environmental and physiological imbalances, making the study and correct diagnosis of these tumours in this species important.

Effects of Dolomitic Limestone on the Properties of Magnesium Oxysulfate Cement.

This study investigated the effects of substituting magnesium oxide (MgO) with dolomitic limestone (DL) on the mechanical and physical properties of magnesium oxysulfate (MOS) cement. Additionally, the hydration formation phases and the influence of the molar ratio on the MOS cement's performance were examined. The corresponding action mechanisms were identified and explored by compressive strength tests, scanning electron microscopy (SEM), X-ray diffraction (XRD), isothermal calorimetry, and a thermogravimetric analysis (TGA). The results showed that replacing MgO with DL decreased the reaction speed and heat release rate generated in the hydration process of the MOS cement. This substitution also reduced the quantity of non-hydrated MgO particles and delayed the formation of Mg(OH)2. The diminished formation of Mg(OH)2 contributed to an increase in the apparent porosity of pastes containing DL, thus alleviating internal stresses induced by Mg(OH)2 formation and enhancing their mechanical strength after 28 days of curing. Conversely, the increased porosity improved the CO2 diffusion within the structure, promoting the formation of magnesium carbonates (MgCO3). Through the characterization of the cement matrix (XRD and TGA), it was possible to identify phases, such as the brucite, periclase, and 318 phases. The obtained results revealed the potential of incorporating mineral fillers like limestone as a promising approach to producing MOS cement with a reduced environmental impact and better properties at higher curing ages.

Inflammatory Bowel Disease and Cardiovascular Disease: An Integrative Review With a Focus on the Gut Microbiome.

Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is a chronic inflammatory condition of the gastrointestinal tract. Recent research indicates a significant link between IBD and cardiovascular disease (CVD), the leading cause of global morbidity and mortality. This review examines the association between IBD and CVD, emphasizing the role of the gut microbiome in this relationship. IBD patients have a higher risk of cardiovascular events, such as coronary artery disease, heart failure, and cerebrovascular incidents, primarily due to chronic systemic inflammation, genetic factors, and gut microbiota imbalance (dysbiosis). Dysbiosis in IBD increases intestinal permeability, allowing bacterial products to enter the bloodstream, which promotes inflammation and endothelial dysfunction, contributing to CVD. Understanding the gut microbiome's role in IBD and CVD suggests new therapeutic interventions. Modulating the microbiome through diet, probiotics, and fecal microbiota transplantation (FMT) are promising research avenues. These interventions aim to restore a healthy gut microbiota balance, potentially reducing inflammation and improving cardiovascular outcomes. Additionally, the review emphasizes the importance of regular cardiovascular risk assessments and personalized preventive measures in managing IBD patients. Such measures include routine monitoring of cardiovascular health, tailored lifestyle modifications, and early intervention strategies to mitigate cardiovascular risk. By integrating current knowledge, this review aims to improve understanding and management of the interconnected pathophysiology of IBD and CVD. This approach will ultimately enhance patient outcomes and provide a foundation for future research and clinical practice guidelines in this area.

Multidrug-Resistant Escherichia coli Accumulated by Freshwater Bivalves: An Underestimated Risk for Public Health?

As bioindicators, freshwater bivalves are crucial for the assessment of the contamination impact on different levels of biological integration. Escherichia coli is used as a bioindicator of water fecal contamination, representing a critical global concern, especially with the rise of multidrug-resistant (MDR) strains. Phylogenetic diversity, pathotypic characterization, and antibiotic resistance profiles of E. coli isolated from freshwater bivalves (Anodonta anatina) were assessed. Samples were collected from the Tua River in Northern Portugal, from two different sites, Chelas and Barcel, representing different degrees of contamination. Antimicrobial susceptibility testing was performed by the disk diffusion method, and characterizations of the phylogenetic groups and pathotypes were assessed by PCR-multiplex and real-time PCR-multiplex, respectively. Results showed that 60% of isolates were characterized as MDR, including resistance to carbapenems, considered the last resort against multidrug-resistant bacteria. Within this study, it was also possible to verify the antimicrobial resistance (AMR) profile differences between the two sampling sites, with bivalve isolates from the Chelas site showing a higher percentage of antibiotic resistance. Among the E. coli isolates, the highest prevalence (55%) was observed in group B1, followed by group D or E (15%), group A (10%), and group E or Clade I (10%). None of the isolates were classified as diarrheagenic E. coli (DEC). This work highlights the potential transmission of antimicrobial-resistant bacteria through bivalves in the food chain. The 'One Health' approach is crucial for combating antimicrobial resistance, namely in edible freshwater species, emphasizing active surveillance to protect human, animal, and environmental health against the spread of antibiotic-resistant bacteria in aquatic environments.

Maintenance of postharvest quality of 'Palmer' mango coated with biodegradable coatings based on cassava starch and emulsion of lemongrass essential oil.

This study aimed to evaluate the effect of applying oxidized cassava starch-based edible coatings with addition of lemongrass essential oil emulsion on 'Palmer' mangoes stored under refrigeration. A completely randomized design was used, arranged in a 5 × 3 factorial scheme, with five types of coatings and three evaluation times. The evaluated postharvest quality parameters consisted of weight loss, pulp and peel firmness, biochemical transformations related to pigments, and pulp and peel coloration of mango. The application of edible coatings with a 0.9 % EO concentration resulted in delayed fruit ripening, evidenced mainly by a 7.25 % reduction in weight loss, a 29.23 % increase in soluble solids content, and a 24.15 % decrease in total chlorophyll, when compared to uncoated fruits, which showed 19.8 %, 48.66 %, and 82.00 %, respectively, over the storage period. This effect was also evident in the angle Hue (°h) measurement, with uncoated fruits showing a decrease of 32.2 %. The antimicrobial effect and absence of anthracnose symptoms were observed in the fruits in which the coating with 0.9 % EO was applied. Therefore, biodegradable coating with the addition of 0.9 % emulsion EO, can be used as postharvest treatments for maintenance quality of 'Palmer' mangoes during refrigerated storage.

Surgical Residents' Perception of Feedback on Their Education: Protocol for a Scoping Review.

BACKGROUND: Feedback is an essential tool for learning and improving performance in any sphere of education, including training of resident physicians. The learner's perception of the feedback they receive is extremely relevant to their learning progress, which must aim at providing qualified care for patients. Studies pertinent to the matter differ substantially with respect to methodology, population, context, and objective, which makes it even more difficult to achieve a clear understanding of the topic. A scoping review on this theme will unequivocally enhance and organize what is already known. OBJECTIVE: The aim of this study is to identify and map out data from studies that report surgical residents' perception of the feedback received during their education. METHODS: The review will consider studies on the feedback perception of resident physicians of any surgical specialty and age group, attending any year of residency, regardless of the type of feedback given and the way the perceptions were measured. Primary studies published in English, Spanish, and Portuguese since 2017 will be considered. The search will be carried out in 6 databases and reference lists will also be searched for additional studies. Duplicates will be removed, and 2 independent reviewers will screen the selected studies' titles, abstracts, and full texts. Data extraction will be performed through a tool developed by the researchers. Descriptive statistics and qualitative analysis (content analysis) will be used to analyze the data. A summary of the results will be presented in the form of diagrams, narratives, and tables. RESULTS: The findings of this scoping review were submitted to an indexed journal in July 2024, currently awaiting reviewer approval. The search was executed on March 15, 2024, and resulted in 588 articles. After the exclusion of the duplicate articles and those that did not meet the eligibility criteria as well as the inclusion of articles through a manual search, 13 articles were included in the review. CONCLUSIONS: Conducting a scoping review is the best way to map what is known about a subject. By focusing on the feedback perception more than the feedback itself, the results of this study will surely contribute to gaining a deeper understanding of how to proceed to enhance internal feedback and surgical residents' learning progress. TRIAL REGISTRATION: Open Science Framework yexb; https://osf.io/yexkb. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/56727.

A cost-effective method for the sensitive detection of levofloxacin using a 3D composite electrode composed of nail polish, graphite and aluminium oxide.

The potential impact on human health and the environment has spurred significant interest in detecting and quantifying pharmaceutical compounds across various matrices, from environmental to biological samples. Here, we present an electrochemical approach for determining levofloxacin in drug, synthetic urine, water, and breast milk samples. An affordable sensor was constructed using 3D printing and composite material based on nail polish, graphite, and aluminum oxide. The conductive composite material was characterized spectroscopically, electrochemically, and by imaging techniques. Subsequently, an electrochemical method based on square wave voltammetry was optimized and applied. The method exhibited good sensitivity (5.11 ± 0.0912 µA L µmol-1 cm-2) and enhanced stability (RSD = 7.2%), with electrochemical responses correlating with the concentration of levofloxacin in the samples tested, yielding recovery values in the range of 98 to 111%. The developed method demonstrated a robust linear working range from 2 to 100 µmol L-1 and a nanomolar detection limit of 128 nmol L-1, rendering it suitable for quantitative analysis. The sensor also shows promise as a platform for the sensitive detection of pharmaceutical compounds, contributing to greater safety and sustainability in these domains.

Efficient and Selective, In Vitro and In Vivo, Antimicrobial Photodynamic Therapy with a Dicationic Chlorin in Combination with KI.

Various cationic photosensitizers employed in antimicrobial photodynamic therapy (aPDT) have the ability to photoinactivate planktonic bacteria under conditions of low phototoxicity to mammalian cells and without generating antimicrobial resistance (AMR). However, the photoinactivation of biofilms requires orders-of-magnitude higher photosensitizer concentrations, which become toxic to host cells. Remarkably, the bactericidal effect of a dicationic di-imidazolyl chlorin toward planktonic S. aureus and E. coli was observed in this work for concentrations below 400 nM under illumination at 660 nm and below 50 µM for the corresponding biofilms. At the latter concentrations, the chlorin is phototoxic toward human keratinocyte cells. However, in the presence of 50 mM KI, bactericidal concentrations are reduced to less than 50 nM for planktonic bacteria and to less than 1 µM for biofilms. It is shown that the potentiation with KI involves the triiodide anion. This potentiation elicits a bactericidal effect without appreciable cytotoxicity to keratinocytes. It becomes possible to selectively inactivate biofilms with aPDT. An exploratory study treating mice with wounds infected with E. coli expressing GFP with 20 µM chlorin and 120 J cm-2 at 652 nm confirmed the potential of this chlorin to control localized infections.

Evaluation of the use of telemedicine in pediatric intensive care units: a cluster-randomized trial.

INTRODUCTION: Telemedicine has shown promising results, allowing specialists to provide rapid and effective care in remote locations. However, to our knowledge, current evidence is not robust enough to prove the effectiveness of this tool. This cluster-randomized trial (CRT) aimed to evaluate the impact of telemedicine on clinical care indicators in pediatric intensive care units (PICUs). METHODS: An open-label CRT was conducted in 16 PICUs within the Brazilian public health system. The trial took place from August 2022 to December 2023 and compared an intervention group, which received telemedicine support, with a control group, which received usual PICU care. The primary outcome was the PICU length of stay. The main secondary outcomes were mortality rate and ventilator-free days. RESULTS: A total of 1393 participants were included, 657 in the control group and 736 in the intervention group. The mean PICU length of stay was 10.42 (SD, 10.71) days for the control group and 11.52 (SD, 10.80) days for the intervention group. The overall mean of ventilator-free days was 6.82 (SD, 7.71) days. Regarding mortality, 7.54% of participants died in total. No significant difference was found in the outcomes between the groups. CONCLUSION: Despite the potential benefits of telemedicine, its effective implementation in the Brazilian public health system faces considerable challenges, highlighting the continued importance of investigating and improving the role of telemedicine in pediatric critical care. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT05260710 and ReBEC - RBR-7×j4wyp.

Assessment of peripheral venous catheters microbiota and its association with phlebitis.

BACKGROUND: Peripheral venous catheters (PVCs) remain the primary mode of short-term venous access for managing intravenous fluid, obtaining blood samples, and peripheral parenteral nutrition. They may get contaminated and require regular monitoring to prevent complications. This study evaluated the occurrence of phlebitis and its associated-clinical and microbiological indicators. METHODS: The frequency of phlebitis was evaluated in hospitalized patients of both medical and surgical fields. Subsequently, the dichotomous association between the presence of phlebitis and the clinical aspects was investigated. In parallel, the bacterial contamination of PVCs was assessed through culture-based methods, microscopy observation, and 16S rRNA gene sequencing. RESULTS: Approximately one in four patients presented phlebitis (28.4%). The most frequent symptom was erythema at access site, with or without pain, corresponding to Score 1 on the phlebitis scale (17.9%). Colonization of both lumen and external surface of PVC was observed in 31.3% of the samples. Staphylococcus and Pseudomonas were the most isolated bacterial genera on the PVC surface. No significant association was observed between the presence of phlebitis and the clinical aspects, as well as the presence of microorganisms. CONCLUSION: Microorganism were present on both internal and external PVC surface, without being associated to phlebitis.

Success rate of Hall Technique for restoring carious primary molars - systematic review and meta-analysis.

OBJECTIVES: The overall pooled success rate of the Hall Technique (HT) in various types of studies has not been investigated. The present study aims to evaluate the success rate of HT to restore carious primary molars. METHODS: A systematic search was carried out in the MEDLINE/PubMed, Excerpta Medica Database (EMBASE), Scopus, Web of Science, and LIVIVO electronic databases, as well as the ProQuest database for grey literature review. A search was carried out up to September 2023 for studies meeting the eligibility criteria: Randomised Clinical Trials (RCTs) and Non-Randomised Studies of Interventions (NRSIs); children with primary molars treated using HT; and reporting success for at least 1-month post-treatment. Single-arm meta-analysis assessed the pooled proportion (95% CI) of HT success rates. Risk of bias and certainty of evidence using the GRADE approach were assessed. RESULTS: Searching identified 665 studies, with 25 (15 RCTs and 10 NRSIs) meeting the eligibility criteria. In meta-analyses of RCTs, the pooled proportion success rate was 98% (95% CI: 97-99%) at 12-month follow-up. For NRSIs, the pooled proportion success rate was 95% (95% CI: 91-100%) up to 89 months. CONCLUSIONS: HT presents a high success rate, even though the primary studies had "low" to "high" risk of bias and demonstrated "moderate" to "low" certainty of evidence. One of the main reasons for downgrading was related to blinding, which was generally unfeasible due to visibly different restorative materials. The systematic review protocol was registered in PROSPERO (ID: CRD42021204415).

Strategies for Pain Management after Extraction of Primary Teeth: A Systematic Review of Randomized Clinical Trials.

BACKGROUND: In dental extractions, particularly when local anesthesia is used, it usually offers analgesic relief for a few hours. However, pain can become a notable concern in the immediate postoperative period due to the trauma experienced by both soft and hard oral tissues. OBJECTIVES: This systematic review aimed to evaluate the most effective strategies for managing postoperative pain in primary tooth extractions. METHODS: Two examiners conducted a search across five electronic databases: MEDLINE (via PubMed), Embase, Scopus, Web of Science, CENTRAL, and OpenGray. Studies were included if they met the following criteria after reviewing their titles and abstracts: they involved children and evaluated pain management following primary tooth extraction. Subsequently, articles that described extractions performed under any form of sedation, were not conducted under local anesthesia, in an outpatient setting, and in children aged 0 to 12 years, or were not randomized controlled trials, were excluded. RESULTS: The search yielded 374 relevant articles, of which 9 were included. Among these, 5 utilized preoperative medications as a pain management strategy, one evaluated low-level laser therapy (LLLT) postoperatively, one assessed calendula drops postoperatively, and another explored virtual reality during the procedure and arnica in solution both pre and postoperatively. CONCLUSION: Among all the strategies evaluated, the strategy involving analgesics administered 30 minutes before tooth extractions was supported by better-designed studies. However, there is a high risk of bias.

Atenção primária e informação em saúde: desempenho e financiamento no município de Natal/rn / Primary Care and Health Information: Performace and finance in the municipality Natal/RN / Atención Primaria e Información en Salud: Desempenõ y financiamiento en elmunicipio de Natal/RN

Introdução: O país adotou, com a criação do Programa Previne Brasil, uma nova forma de financiamento da Atenção Primária à Saúde, com a portaria ministerial 2.979/2019, a qual estabeleceu critérios para alocação de recursos, com foco para o desempenho e produtividade da Atenção Primária. Talmodelo vem sendo alvo de críticas pelo campo acadêmico da Saúde Coletiva e por gestões municipais, que em diferentes situações demonstram perdas financeiras, sobretudo, devido ao componente de capitação ponderada. Objetivo: Sistematizar o desempenho da Atenção Primária à Saúde do município de Natal, Rio Grande do Norte, com base em indicadores de desempenho do Sistema de Informação em Saúde para a Atenção Básica, e o financiamento da Atenção Primária, com base no Sistema de Informações sobre Orçamentos Públicos em Saúde, entre os anos 2019 a 2022. Metodologia: Trata-se de uma pesquisa descritiva-exploratória, com utilização de dados secundários e sistematização dos sete indicadores de desempenho da Atenção Primária e análise das despesas com saúdedo município de Natal. Resultados:Dos sete indicadores analisados, o município de Natal alcançou a meta em dois indicadores, referente à proporção de gestantes com pelo menos seis consultas pré-natal realizadas (46% em 2022) e com realização de exames para sífilis e HIV (67% em 2022). O município destinou à Atenção Primária, em 2022, apenas 6,33% de todas suas despesas com saúde. Destaca-se, também, que a cobertura da Atenção Primária no município é de 60%, havendo ainda um vazio assistencial para grande parte da população natalense. Conclusões:A análise de indicadores de saúde, torna-se importante ferramenta para a ação avaliativa do Sistema Único de Saúde, bem como dá suporte para a tomada de decisão por parte de gestores e equipes de saúde, além de produzir conhecimento crítico para a qualificação da Atenção Primária à Saúde (AU).

Introduction:The country adopted, with the creation of the Previne Brasil Program, a new form of financing Primary Health Care, with ministerial decree 2.979/2019, which established criteria for resource allocation, focusing on the performance and productivity of Primary Care. This model has been criticized by the academic field of Public Health and by municipal administrations, which in different situations demonstrate financial losses, mainly due to the weighted capitation component. Objective:Systematize the performance of Primary Health Care in the city of Natal, Rio Grande do Norte, based on performance indicators from the Health Information System for Primary Care, and the financing of Primary Care, based on the Information System of Public Health Budgets, between the years 2019 and 2022. Methodology:This is descriptive-exploratory research, using secondary data and systematization of the seven Primary Care performance indicators and analysis of health expenses in the city of Natal. Results: Of the seven indicators analyzed, the municipality of Natal reached the target in two indicators, referring to the proportion of pregnant women with at least six prenatal consultations carried out (46% in 2022) and with tests for syphilis and HIV (67% in 2022). In 2022, the municipality allocated only 6.33% of all its health expenses to PrimaryCare. It is also noteworthy that Primary Care coverage in the municipality is 60%, with there still being a care gap for a large part of the population of Natal. Conclusions:The analysis of health indicators becomes an important tool for the evaluative action of the Unified Health System, as well as providing support for decision-making by managers and health teams, in addition to producing critical knowledge for the qualification of Primary Health Care (AU).

Introducción: El país adoptó, con la creación del Previne Brasil, una nueva forma de financiamiento de la Atención Primaria de Salud, con el decreto ministerial 2.979/2019, que estableció criterios para la asignación de recursos, con foco en el desempeño y productividad de la Atención Primaria. Este modelo ha sido criticado por el ámbito académico de la Salud Pública y por las administraciones municipales, que en diferentes situaciones demuestran pérdidas financieras, principalmente por el componente de capitación ponderada. Objetivo: Sistematizar el desempeño de la Atención Primaria de Salud en la ciudad de Natal, Rio Grande do Norte, con base en indicadores de desempeño del Sistema de Información en Salud para la Atención Primaria, y el su financiamiento, con base en el Sistema de Información Presupuestaria Pública en Salud, entre los años 2019 y 2022. Metodología: Se trata de una investigación descriptiva-exploratoria, utilizando datos secundarios y sistematización de siete indicadores de desempeño de la Atención Básica y análisis del gasto en salud. Resultados: De los siete indicadores analizados, el municipio de Natal alcanzó la meta en dos indicadores, referidos a la proporción de gestantes con al menos seis consultas prenatales realizadas (46% en 2022) y con pruebas de sífilis y HIV (67% en 2022). En 2022, el municipio destinó sólo el 6,33% de todos sus gastos sanitarios a la Atención Primaria. También se destaca que la cobertura de Atención Primaria en el municipio es del 60%, existiendo aún brecha de atención para gran parte de la población. Conclusiones: El análisis de indicadores de salud se convierte en herramienta importante para la acción de evaluación del Sistema Único de Salud, además de brindar apoyo para la toma de decisiones de gestores y equipos de salud, además de producir conocimiento crítico para la calificación de la Atención Primaria de Salud (AU).

AUTONOMY FOR MEDICATION MANAGEMENT IN PATIENTS WITH MENTAL DISORDERS: SCOPE REVIEW PROTOCOL / Autonomia para gestão de medicamentos em pacientes com transtornos mentais: Protocolo de revisão de escopo

Psychiatric disorders affect millions of people globally, representing a major public health challenge. Adherence to medication treatment is essential for the effective management of these disorders, but non-adherence rates are variable and worrying. Several factors, such as concerns about side effects, lack of knowledge about the disease, treatment costs and fear of dependence, are associated with non-adherence. This study explores the importance of patient autonomy in mental health, highlighting patient-centered strategies to improve treatment adherence. The need for innovative practices that empower patients is emphasized, promoting active and informed participation in treatment decisions, aiming to improve quality of life and therapeutic results.

Os transtornos psiquiátricos afetam milhões de pessoas globalmente, representando um grande desafio para a saúde pública. A adesão ao tratamento medicamentoso é fundamental para o manejo eficaz desses transtornos, mas as taxas de não adesão são variáveis e preocupantes. Diversos fatores, como preocupações com efeitos colaterais, desconhecimento sobre a doença, custos do tratamento e medo de dependência, estão associados à não adesão. Este estudo explora a importância da autonomia do paciente na saúde mental, destacando estratégias centradas no paciente para melhorar a adesão ao tratamento. Enfatiza-se a necessidade de práticas inovadoras que empoderem os pacientes, promovendo uma participação ativa e informada nas decisões de tratamento, visando melhorar a qualidade de vida e os resultados terapêuticos.

Pharmacological mechanisms involved in the diuretic activity of the ethanol-soluble fraction of Baccharis milleflora (Less.) DC. - An ethnopharmacological investigation.

ETHNOPHARMACOLOGICAL RELEVANCE: Baccharis milleflora (Less.) DC. is a plant native to Brazil that is frequently used in traditional medicine as a diuretic and antihypertensive. However, even though it is traditionally used for these purposes, its diuretic and hypotensive effects have not been fully elucidated. AIM: Investigate the cardiorenal effects of the ethanol-soluble fraction (ESBM) of Baccharis milleflora in normotensive rats. MATERIALS AND METHODS: Cladodes of B. milleflora were analyzed using light and scanning electron microscopy to provide anatomical data to support quality control. Subsequently, the ESBM was obtained and analyzed using LC-DAD-MS, and its components were annotated. The acute toxicity of ESBM was assessed in female Wistar rats. The acute and prolonged diuretic and hypotensive effects were then studied in Wistar rats. Finally, we assessed the mechanisms responsible for the diuretic effects of ESBM, including the activity of renal Na+/K+/ATPase, angiotensin-converting enzyme, and erythrocyte carbonic anhydrase. Additionally, we also investigated the involvement of bradykinin, prostaglandins, and nitric oxide. RESULTS: From LC-DAD-MS data, thirty-three metabolites were identified from ESBM, including chlorogenic acids, glycosylated phenolic derivatives, C-glycosylated flavones, and O-glycosylated flavonols. No signs of acute toxicity were observed in female rats. The findings showed that ESBM had significant diuretic and natriuretic effects, as well as a potassium-sparing effect. The treatment with ESBM was able to significantly decrease serum levels of creatinine and malondialdehyde, and also significantly increase levels of nitrite, an indirect marker of nitric oxide bioavailability. Furthermore, pre-treatment with L-NAME abolished all diuretic effects induced by ESBM. CONCLUSION: This study presented important morpho-anatomical and phytochemical data that support the quality control of Baccharis milleflora. The ESBM exhibited a significant diuretic and natriuretic effect following acute and seven-days repeated treatment in Wistar rats, without affecting renal potassium elimination. These effects appear to be dependent on the activation of the nitric oxide-cyclic GMP pathway. This study suggests the potential use of B. milleflora preparations in clinical situations where a diuretic effect is needed.