Evaluation of type 1 diabetes' partial clinical remission after three years of heterologous adipose tissue derived stromal/stem cells transplantation associated with vitamin D supplementation.

BACKGROUND: Mesenchymal stem cell infusion and vitamin D supplementation may have immunomodulatory actions that could prolong the preservation of residual insulin secretion in patients with type 1 diabetes (T1D). Intervention with these agents after onset of T1D could favor the development of a remission phase, with potential clinical impact. We aimed to compare the presence of clinical remission (CR), glycemic control and daily insulin requirement at 6, 12, 18, 24 and 36 months after the diagnosis of T1D using IDAA1c in patients who received therapy with adipose tissue-derived mesenchymal stem cell (ASC) infusion and vitamin D supplementation and a control group. METHODS: This retrospective cohort study analyzed data from the medical records of patients with T1D diagnosed between 15 and 40 years. Partial CR was defined as an IDAA1c index < 9. Patients in the intervention group received an infusion of adipose tissued-derived mesenchymal stem cells (ASCs) within 3 months after diagnosis and supplementation with 2000 IU of cholecalciferol for 1 year, started on the day following the infusion. Partial CR was also determined using the ISPAD criteria, to assess its agreement with IDAA1c. RESULTS: A total of 28 patients were evaluated: 7 in the intervention group (group 1) and 21 in the control group (group 2). All patients in group 1 evolved with partial CR while only 46.7% of patients in group 2 had this outcome. Group 1 had a higher frequency of CR when evaluated with IDAA1c and ISPAD criteria. The mean duration of CR varied between the two criteria. Although HbA1c was similar between groups during follow-up, group 1 had a lower total daily insulin requirement (p < 0.005) at all time points. At 36 months, group 1 used 49% of the total daily insulin dose used by group 2 with similar glycemic control. CONCLUSION: The intervention with infusion of ASC + vitamin D supplementation was associated with partial CR at 6 months. Although there were no differences in CR established by the IDAA1c and ISPAD criteria after three years of follow-up, patients who underwent intervention had nearly the half insulin requirement of controls with conventional treatment, with similar glycemic control. TRIAL REGISTRATION: 37001514.0.0000.5257.

Cognitive debriefing e fidedignidade do NOPPAIN-Br / Cognitive debriefing y fiabilidad del NOPPAIN-Br / NOPPAIN-Br cognitive debriefing and reliability

Resumo Objetivos Realizar o cognitive debriefing e testar a fidedignidade do Non-Communicative Patient's Pain Instrument (NOPPAIN). Métodos Estudo metodológico de verificação do NOPPAIN (versão brasileira) adaptado à cultura brasileira. Cognitive debriefing: participaram 56 profissionais de saúde e cuidadores; sua tarefa foi avaliar e fazer sugestões sobre a equivalência e adequação do NOPPAIN-Br. A versão final, intitulada "NOPPAIN-Versão brasileira" foi submetida a um Comitê de Especialistas (n=8). Foi calculado o Índice de Validade de Conteúdo. Para testar a fidedignidade três observadores aplicaram a nova versão do NOPPAIN em uma amostra (n=171) de pessoas idosas com demência e comunicação prejudicada onde foi calculada a concordância interobservadores - KAPPA. Resultados O NOPPAIN-Br foi alterado em palavras tais como: "não comunicativo", "enfermeiro", "deve fazer" e "paciente". A equivalência da nova versão com o instrumento original foi reforçada (IVC>0,80). A concordância entre observadores foi quase perfeita para a "Lista de Verificação de Atividades I" (Kappa>0,80), "Comportamentos de dor II: Presença" (Kappa>0,80) e "Comportamentos de dor III: Intensidade" (Kappa>0,80; ICCsingle>0,75). Foi observada evidência de alta confiabilidade (ICC single>0,75) para todas subescalas do instrumento e pontuação total. A melhor concordância foi para intensidade geral da dor (ICCsingle 0,97). Conclusão O NOPPAIN-Br é equivalente ao instrumento original e fidedigno, podendo ser disponibilizado para novas pesquisas e avaliação da dor em brasileiros com demência e comunicação prejudicada.

Resumen Objetivos Realizar el cognitive debriefing y verificar la fiabilidad del Non-Communicative Patient's Pain Instrument (NOPPAIN). Métodos Estudio metodológico de verificación del NOPPAIN (versión brasileña) adaptado a la cultura brasileña. Cognitive debriefing: participaron 56 profesionales de la salud y cuidadores, cuya función fue evaluar y realizar sugerencias sobre la equivalencia y la adaptación del NOPPAIN-Br. La versión final, titulada "NOPPAIN-Versión brasileña", fue sometida a un Comité de Especialistas (n=8). Se calculó el Índice de Validez de Contenido. Para verificar la fiabilidad, tres observadores aplicaron la nueva versión del NOPPAIN en una muestra (n=171) de personas mayores con demencia y deterioro de la comunicación, donde se calculó la concordancia entre observadores - KAPPA. Resultados Se modificaron algunas palabras en el NOPPAIN-Br, tales como "no comunicativo", "enfermero", "debe hacer" y "paciente". La equivalencia entre la nueva versión y el instrumento original fue reforzada (IVC>0,80). La concordancia entre observadores fue casi perfecta en la "Lista de verificación de actividades I" (Kappa>0,80), "Comportamientos de dolor II: presencia" (Kappa>0,80) y "Comportamientos de dolor III: intensidad" (Kappa>0,80; ICCsingle>0,75). Se observó evidencia de alta fiabilidad (ICC single>0,75) en todas las subescalas del instrumento y en el puntaje total. La mejor concordancia fue en la intensidad general del dolor (ICCsingle 0,97). Conclusión El NOPPAIN-Br es equivalente al instrumento original y fidedigno y puede ponerse a disposición para nuevos estudios y para la evaluación del dolor en brasileños con demencia y deterioro de la comunicación.

Abstract Objectives To perform cognitive debriefing and test the Non-Communicative Patient's Pain Instrument (NOPPAIN) reliability. Methods This is a methodological study to verify NOPPAIN adapted to the Brazilian culture. Cognitive debriefing: 56 healthcare professionals and caregivers participated; its task was to assess and make suggestions about NOPPAIN-Br equivalence and adequacy. The final version entitled "NOPPAIN-Versão brasileira" was submitted to a committee of experts (n=8). The Content Validity Index was calculated. To test reliability, three observers applied the new version of NOPPAIN to a sample (n=171) of older adults with dementia and impaired communication where interobserver agreement was calculated - KAPPA. Results NOPPAIN-Br was changed in words such as "não comunicativo", "enfermeiro", "deve fazer" and "paciente". The equivalence of the new version with the original instrument was reinforced (CVI>0.80). Interobserver agreement was almost perfect for "Activity Checklist I" (Kappa>0.80), "Pain Behaviors II: Presence" (Kappa>0.80) and "Pain Behaviors III: Intensity" (Kappa>0.80; ICCsingle>0.75). Evidence of high reliability (ICCsingle>0.75) was observed for all subscales of the instrument and total score. The best agreement was for general pain intensity (ICCsingle 0.97). Conclusion NOPPAIN-Br is equivalent to the original and reliable instrument and can be made available for further research and assessment of pain in Brazilians with dementia and impaired communication.

Comparison of Incidence and Prognosis of Myocardial Injury in Patients with COVID-19-Related Respiratory Failure and Other Pulmonary Infections: A Contemporary Cohort Study.

Myocardial injury (MI) is frequent in critically ill patients with COVID-19, but its pathogenesis remains unclear. We hypothesized that MI is not solely due to viral infection by SARS-CoV-2 but rather due to the common pathophysiological mechanisms associated with severe pulmonary infections and respiratory failure. This contemporary cohort study was designed to compare the incidence of MI in patients with acute respiratory failure caused by COVID-19 to patients with other pulmonary infections. In addition, we aimed to investigate whether MI was a distinct risk factor for in-hospital mortality in patients with COVID-19 compared to those with non-COVID-19 infections. This study included 1444 patients with COVID-19 (55.5% men; age 58 (46;68) years) and 182 patients with other pulmonary infections (46.9% men; age 62 (44;73) years). The incidence of MI at ICU admission was lower in COVID-19 patients (36.4%) compared to non-COVID-19 patients (56%), and this difference persisted after adjusting for age, sex, coronary artery disease, heart failure, SOFA score, lactate, and C-reactive protein (RR 0.84 (95% CI, 0.71-0.99)). MI at ICU admission was associated with a 59% increase in mortality (RR 1.59 (1.36-1.86); p < 0.001), and there was no significant difference in the mortality between patients with COVID-19 and those with other pulmonary infections (p = 0.271). We concluded that MI is less frequent in patients with critical COVID-19 pneumonia and respiratory failure compared to those with other types of pneumonia. The occurrence of MI is a significant risk factor for in-hospital mortality, regardless of the etiology of the pulmonary infection.

Classifying micropollutants by environmental risk in groundwater using screening analysis associated to a hybrid multicriteria method combining (Q)SAR tools, fuzzy AHP and ELECTRE.

This study aimed to evaluate and monitor pesticides in groundwater of the Serra Geral aquifer, located in the Paraná Basin 3 (southern Brazil), using Liquid Chromatography coupled with a Quadrupole-Time-of-Flight Mass Spectrometer (LC-QTOF MS). A total of 117 samples, collected in three different moments, were analyzed over 36 months. Groundwater samples from 35 wells and four surface water points were monitored in each sampling campaign. A pesticide screening methodology was proposed with the tentative identification of 1607 pesticides and pesticide metabolites. The application of the proposed methodology resulted in the verification of 29 pesticides and pesticide metabolites, 7 as confirmed analytes and 22 as suspect compounds. (Q)SAR in silico predictions and GUS index calculation provided data on the potential environmental risk of the identified compounds, with eight endpoints considered. After in silico predictions, an alternative hybrid multicriteria method was applied, combining the weighting of endpoints of fuzzy AHP and micropollutants classification by environmental risk using ELECTRE. The fuzzy AHP results indicated the greatest importance of mutagenicity among the eight evaluated indicators, while the scarce influence of the physicochemical properties on the environmental risk suggested their exclusion from the model. Accordingly, the ELECTRE results highlighted the prevalence of thiamethoxam and carbendazim as the most dangerous for the environment. The application of the proposed method enabled the selection of the compounds that must be monitored, considering mutagenicity and toxicity predictions for environmental risk analysis.

Adipose Tissue-Derived Stromal/Stem Cells Transplantation with Cholecalciferol Supplementation in Recent-Onset Type 1 Diabetes Patients: Twelve Months Follow-Up.

To evaluate safety and therapeutic effect along 12 months of allogenic adipose tissue-derived stromal/stem cells (ASCs) transplantation with cholecalciferol (VITD) in patients with recent-onset type 1 diabetes (T1D). Prospective, phase II, open trial, pilot study in which patients with recent onset T1D received ASCs (1xKgx106 cells) and VITD 2000UI/day for 12 months (group 1) and were compared to controls with standard insulin therapy (group 2). Adverse events, C-peptide area under the curve (CPAUC), insulin dose, HbA1c and frequency of FoxP3+ in CD4+ or CD8+ T-cells(flow cytometry) were evaluated at baseline(T0), after 3(T3), 6(T6) and 12 months(T12). Eleven patients completed follow up (7:group 1;4:group 2). Group 1 had lower insulin requirement at T3(0.24±0.18vs0.53±0.23UI/kg,p=0.04), T6(0.24±0.15vs0.66±0.33 UI/kg,p=0.04) and T12(0.39±0.15vs0.74±0.29 UI/Kg,p=0.04).HbA1c was lower at T6 (50.57±8.56vs72.25±10.34 mmol/mol,p=0.01), without differences at T12 (57.14±11.98 in group 1 vs. 73.5±14.57 mmol/min in group 2, p=0.16). CPAUC was not significantly different between groups at T0(p=0.07), higher in group 1 at T3(p=0.04) and T6(p=0.006), but similar at T12(p=0.23). IDAA1c was significantly lower in group 1 than group 2 at T3,T6 and T12 (p=0.006, 0.006 and 0.042, respectively). IDDA1c was inversely correlated to FoxP3 expression in CD4 and CD8+ T cells at T6 (p<0.001 and p=0.01, respectively). In group 1, one patient had recurrence of a benign teratoma that was surgically removed, not associated to the intervention. ASCs with VITD without immunosuppression were safe and associated lower insulin requirements, better glycemic control, and transient better pancreatic function in recent onset T1D, but the potential benefits were not sustained.

The chemistry of Vernonanthura nudiflora (Less.) H. Rob. flowers and its antimicrobial activities.

Twenty-one known specialised metabolites were isolated from the flowers of Vernonanthura nudiflora (Less.) H. Rob., the structures of the compounds were established based on 1 D and 2 D NMR spectroscopic experiments. Others 28 compounds were putatively identified using the dereplication technique by UHPLC-HRMS/MS. Twenty-three of the compounds are being reported for the first time in this species. The mixture of sesquiterpene lactones piptocarphins A and B (17 + 18), and the flavone velutin (14) were tested against several microorganisms and showed promising activity against Mycobacterium tuberculosis with MIC of 15.6 µg/mL and 31.2 µg/mL, respectively. Furthermore, 17 + 18 showed greater cytotoxicity against VERO cells (IC50 = 7.0 ± 1.73) compared to compound 14 (IC50 85.0 ± 10.6 µg/mL). These findings reveal the feasibility of using the UHPLC-ESI-HRMS/MS-based dereplication strategy in complex fractions to identify specialised metabolites, moreover to V. nudiflora flowers being a source of compounds with antimycobacterial potential.

Perception of health, quality of life and functional capacity in adults and elderly after hospitalization due to complications of COVID-19 - a longitudinal study with 6-month follow-up / Percepción de salud, calidad de vida y capacidad funcional en adultos y ancianos poshospitalización por complicaciones del COVID-19 - estudio longitudinal con seguimiento de seis meses / Percepção de saúde, qualidade de vida e capacidade funcional em adultos e idosos pós-internação hospitalar em função de complicações da COVID-19 - estudo longitudinal com follow-up de seis meses

ABSTRACT The study aims to evaluate the perception of health, quality of life and functional capacity during six months after COVID-19-related hospitalization. This is a prospective longitudinal study carried out at Universidade São Judas Tadeu (USJT) in partnership with the Instituto Ânima Brasil. Thirteen adult participants, including young and older adults, were evaluated, had a confirmed diagnosis of COVID-19 and were hospitalized. A characterization and interdisciplinary questionnaire built by the researchers was used to assess health perception, quality of life, and functional capacity of participants. In this study, participants were followed for a 6-month period and the main results obtained were: the identification of a significant increase in walking time after three months (p=0.002) as well as an improvement in the perception of quality of life (p=0.002). In addition, the levels of tiredness and physical activity were evaluated; the mean responses were "little tired" and "irregularly active," respectively, and remained unchanged over six months. Considering that patients who were hospitalized due to COVID-19 showed a reduction in the perception of quality of life and walking time soon after the hospital period, it was identified that over time they tend to improve these perceptions.

RESUMEN El objetivo de este estudio fue evaluar la percepción de salud, calidad de vida y capacidad funcional durante seis meses posteriores a la hospitalización por COVID-19. Se trata de un estudio prospectivo longitudinal, realizado en la Universidade São Judas Tadeu (USJT) y el Instituto Ânima Brasil. Se evaluaron a trece participantes, entre adultos jóvenes y adultos mayores, que tenían diagnóstico confirmado del COVID-19 y se encontraban hospitalizados por complicaciones de esa enfermedad. Se utilizó un cuestionario de caracterización e interdisciplinario elaborado por los investigadores para evaluar la percepción de salud, la calidad de vida y la capacidad funcional de los participantes. En este estudio se realizó seguimiento de los participantes durante un período de seis meses, y los principales resultados fueron: un significativo aumento en el tiempo de caminata después de tres meses (p=0,002), así como una mejora en la percepción de la calidad de vida (p=0,002). Además, se evaluaron los niveles de cansancio y de actividad física, y las respuestas medias fueron "poco cansado" e "irregularmente activo", las cuales se mantuvieron sin cambios durante seis meses. Considerando que los pacientes que fueron hospitalizados por COVID-19 presentaron una reducción en la percepción de calidad de vida y en el tiempo de marcha tras el período en el hospital, se identificó que con el tiempo tienden a mejorar estas percepciones.

RESUMO O objetivo do estudo foi avaliar a percepção de saúde, a qualidade de vida e a capacidade funcional dos pacientes durante seis meses após a internação por COVID-19. Trata-se de um estudo de delineamento prospectivo longitudinal realizado na Universidade São Judas Tadeu (USJT) em parceria com o Instituto Ânima Brasil. Foram avaliados 13 participantes adultos, entre jovens e idosos, que apresentaram diagnóstico confirmado de COVID-19 e foram internados. Foi utilizado um questionário de caracterização e interdisciplinar construído especificamente para inquirir a percepção de saúde, a qualidade de vida e a capacidade funcional dos participantes. Neste estudo, eles foram acompanhados no período de seis meses, e os principais resultados obtidos foram: a identificação do aumento significativo no tempo de caminhada após três meses (p=0,002), bem como a melhora na percepção de qualidade de vida (p=0,002). Além disso, foram avaliados os níveis de cansaço e de prática de atividade física, e as respostas médias foram, respectivamente, "pouco cansaço" e "irregularmente ativo", as quais se mantiveram inalteradas ao longo de seis meses. Tendo em vista que os pacientes que foram submetidos à internação hospitalar devido à COVID-19 apresentaram redução da percepção de qualidade de vida e do tempo de caminhada logo após o período hospitalar, foi identificado que, com o decorrer do tempo, eles demonstraram tendência de melhora dessas percepções.

Intervenção educativa dos pacientes com doença renal crônica terminal: fatores de risco e complicaçõe associadas / intervención educativa de pacientes con enfermedad renal crónica terminal: factores de riesgo y complicaciones asociadas / Educational intervention in patients with end-stage chronic kidney disease:risk factors and associated complications

Objetivo:avaliar o conhecimento dos pacientes com doença renal crônica terminal quantoaos fatores de risco e complicações associadas antes e após uma intervenção educativa. Método: estudo de intervenção, randomizado com 101 participantes subdivididos em dois gruposde um setor de hemodiálise entre 2019 a julho de 2020. Para as análises fizeram-se testes McNemar, t-Student pareado, Qui-Quadrado de Pearson e Exato de Fisher, com nível de significância de 5%. Resultados: após intervenção, houve diminuição significativa (p<0,05) das complicações como hipotensão, hipoglicemia, câimbra, náuseas ,tremores, calafrio e febre. As equipes de enfermagem e médica verificaram posicionamento ativo dos participantes quanto aos cuidados com a fístula arteriovenosa e com o cateter venoso central. O aumento do conhecimento sobre o processo de hemodiálise propiciou entender a causa das complicações associadas ao tratamento. Conclusão: a ação educativa foi efetiva e gerou indicadores de avaliação positivos, permitindo que os participantes se tornassem protagonistas do autocuidado (AU)

Objective:to assess the knowledge of patients with end-stage chronic kidney disease regarding the risk factors and associated complications before and after an educational intervention. Method:an intervention and randomized study conducted with 101 participants divided into two groups of a hemodialysis sector from 2019 to July 2020. The analyses were performed using the McNemar, paired Student'st, Pearson's Chi-Square and Fisher's Exact tests, with a 5% significance level. Results:after the intervention, there was a significant reduction (p<0.05) in the number of complications such as hypotension, hypoglycemia, cramps, nausea, tremors, chills and fever. The nursing and medical team verified the participants' active stance regarding the care measures for the arteriovenous fistula and the central venous catheter. The increase in knowledge about the hemodialysis process made it possible to understand the cause of the complications associated with the treatment. Conclusion:the educational action was effective and generated positive evaluation indicators, allowing the participants to become protagonists of self-care(AU)

Objetivo:evaluar el conocimiento de los pacientes con enfermedad renal crónica terminal sobre los factores de riesgo y las complicaciones asociadas antes y después de una intervención educativa. Método:estudio de intervención, aleatorizado con 101 participantes divididos en dos grupos de un sector de hemodiálisis entre 2019 a julio de 2020. Los análisis se realizaron mediante las pruebas de McNemar, t-Student pareada, Chi-Cuadrado de Pearson y Exacta de Fisher, con nivel de significancia del 5%. Resultados:tras la intervención hubo una disminución significativa (p<0,05) de complicaciones como hipotensión, hipoglucemia, calambres, náuseas, temblores, escalofríos y fiebre. El personal médico y de enfermería verificó la posición activa de los participantes con respecto al cuidado de la fístula arteriovenosa y del catéter venoso central. El aumento del conocimiento sobre el proceso de hemodiálisis permitió comprender la causa de las complicaciones asociadas al tratamiento. Conclusión:la acción educativa fue efectiva y generó indicadores de evaluación positivos, permitiendo a los participantes convertirse en protagonistas del autocuidado (AU)

TOCSY, hydrogen decoupling and computational calculations to an unequivocal structural elucidation of a new sesquiterpene derivative and identification of other constituents from Praxelis sanctopaulensis.

INTRODUCTION: Praxelis genus comprises 24 species, however, only two species of this genus have been chemically investigated. Here we investigated Praxelis sanctopaulensis, a native plant from Brazil, that occurs mainly in Cerrado regions. OBJECTIVE: The goal was to identify the specialised metabolites from P. sanctopaulensis, and compare with those described from Praxelis and Chromolaena species. METHODS: The phytochemical study of P. sanctopaulensis was performed through different chromatography techniques, including high-performance liquid chromatography (HPLC), gas chromatography flame ionisation detector (GC-FID), and ultra-high-performance liquid chromatography high-resolution tandem mass spectrometry (UHPLC-HRMS/MS). The structures of the compounds were established based on spectroscopic analysis, total correlated spectroscopy (TOCSY), hydrogen decoupling and computational calculations was used to an unequivocal structural elucidation of a new sesquiterpene. The antioxidant activity was evaluated using 1,1-diphenyl-2-picrylhydrazyl (DPPH) and ferric reducing antioxidant power (FRAP), and antimicrobial assay was performed by the microdilution method. Comparison of the flavonoids described P. sanctopaulensis was carried out using principal component analysis. RESULTS: The phytochemical investigation of P. sanctopaulensis led to the isolation of a pair of diastereomers, praxilone A and praxilone B. Seven known compounds were isolated from this species, another 14 fatty acids were detected in hexane fraction, and 26 compounds were identified from ethyl acetate fraction. All these compounds are being described for the first time in this species, with the exception of viridifloric acid. The ethyl acetate fraction showed potent antioxidant activity. CONCLUSIONS: Forty-seven compounds are described from P. sanctopaulensis. The combination of different techniques of nuclear magnetic resonance (NMR) spectroscopy and computational calculations allowed the unequivocal structure elucidation of a new cadinene. The clustering analysis showed similarities between the flavonoids identified in P. sanctopaulensis and in Chromolaena species.

Ten years follow up of first degree relatives of type 1 diabetes patients: presence of autoimmune biomarkers and the progression to diabetes in a retrospective cohort

ABSTRACT Objective: The aim of the study was to assess the autoimmunity in first degrees relatives (FDR) of patients with type 1 diabetes (T1DM) and the progression to T1DM after 10 years of follow up in the Brazilian population. Subjects and methods: Non-diabetic FDR of T1DM patients were interviewed and blood was drawn for autoantibodies measurement (GADA, IA-2A, IAA, ZnT8A). Serum samples were analyzed by standard radioligand binding assays performed at the Federal University of Rio de Janeiro (GADA, IAA and IA2A), and at the Skäne University Hospital, Sweden (ZnT8A). The FDR were interviewed by phone after 10 years to determine if they had developed T1DM. Descriptive statistical analysis was performed and results were described as means and standard deviation (SD). Results: 81 individuals were analyzed. Thirteen subjects had positive autoantibodies associated with T1DM.10 were positive for 1 autoantibody and 3 subjects were positive for multiple autoantibodies (1 of them showed positivity for 2 autoantibodies - GADA, ZnT8A - and the other two were positive for 3 autoantibodies - GADA, IA2A, ZnT8A). The 3 subjects with multiple positive autoantibodies developed T1DM within 10 years. Conclusions: In Brazilian FDR of T1DM patients, the positivity for multiple autoantibodies indicate a greater chance of progression to T1DM, similar to observed in Caucasians. ZnT8A was helpful in the risk assessment for T1DM development.

Ten years follow up of first degree relatives of type 1 diabetes patients: presence of autoimmune biomarkers and the progression to diabetes in a retrospective cohort.

OBJECTIVE: The aim of the study was to assess the autoimmunity in first degrees relatives (FDR) of patients with type 1 diabetes (T1DM) and the progression to T1DM after 10 years of follow up in the Brazilian population. METHODS: Non-diabetic FDR of T1DM patients were interviewed and blood was drawn for autoantibodies measurement (GADA, IA-2A, IAA, ZnT8A). Serum samples were analyzed by standard radioligand binding assays performed at the Federal University of Rio de Janeiro (GADA, IAA and IA2A), and at the Skäne University Hospital, Sweden (ZnT8A). The FDR were interviewed by phone after 10 years to determine if they had developed T1DM. Descriptive statistical analysis was performed and results were described as means and standard deviation (SD). RESULTS: 81 individuals were analyzed. Thirteen subjects had positive autoantibodies associated with T1DM.10 were positive for 1 autoantibody and 3 subjects were positive for multiple autoantibodies (1 of them showed positivity for 2 autoantibodies - GADA, ZnT8A - and the other two were positive for 3 autoantibodies - GADA, IA2A, ZnT8A). The 3 subjects with multiple positive autoantibodies developed T1DM within 10 years. CONCLUSION: In Brazilian FDR of T1DM patients, the positivity for multiple autoantibodies indicate a greater chance of progression to T1DM, similar to observed in Caucasians. ZnT8A was helpful in the risk assessment for T1DM development.

CINESUS: a discussão de saúde pública na universidade pela ótica do cinema / CINESUS: the discussion of public health at the University through the lens of Cinema

O uso de filmes enquanto estratégia pedagógica para educação em saúde no ensino superior é uma forma efetiva de promover debate e reflexão através de recursos que despertem o interesse entre discentes. Objetivo: Relatar a experiência de uma liga acadêmica de saúde da família e comunidade, vinculada a uma faculdade de medicina de Minas Gerais, ao fazer uso de filmes para propor debates em saúde pública na Universidade, através de um projeto intitulado CineSUS. Métodos: A definição dos filmes e temática de cada evento foi acordada em reuniões semanais da própria liga acadêmica. O evento foi delineado para ocorrer em um anfiteatro. Após a exibição dos filmes, foi reservado um tempo para mediação de um diálogo entre os presentes sobre a temática trabalhada no curta ou longa metragem. O tema de cada evento foi definido com base no Calendário de Saúde, disponibilizado pelo Ministério da Saúde do Brasil. Resultados: O projeto resultou na realização de cinco eventos que contaram com a presença de discentes de cursos da área da saúde e comunidade geral, permitindo abordar, através do diálogo, temáticas relativas à homofobia, criação do Sistema Único de Saúde, cuidado em saúde mental, racismo e violência contra a mulher. Conclusão: Eventos que fazem uso de recursos audiovisuais com subsequente debate sobre a temática abordada no filme permitem o desenvolvimento de um olhar crítico-reflexivo entre os presentes, no que concerne às populações vulneráveis e políticas de saúde pública, bem como para o fomento da luta social para manutenção do Sistema Único de Saúde no Brasil.

The use of movies as a pedagogical strategy for health education in higher education is an effective way to promote debate and reflection through resources that increased the interest in the students. Objective: to report the experience of an Academic League of Family and Community Health, linked to a medical school in Minas Gerais, when making use of movies to propose debates on public health at the University, through a project entitled CineSUS. Methods: The definition of the movies and theme of each event was agreed at weekly meetings of the academic league itself. The event was designed to take place in an amphitheater. After the screening of the movies, a time was reserved for the mediation of a discussion between those present regarding the theme worked on in the short-film or movie. The theme of each event was defined based on the Health Calendar, made available by the Brazilian Ministry of Health. Results: The project resulted in the realization of five events that were attended by students from health courses and the general community, allowing them to address, through dialogue, themes related to homophobia, the creation of the Unified Health System, mental health care, racism and violence against women. Conclusion: Events that make use of audiovisual resources with subsequent debate on the theme addressed in the movie may develop a critical-reflexive view among participants, regarding vulnerable populations and public health policies, as well as to foment the social struggle for the maintenance of the Unified Health System in Brazil.

Adipose tissue-derived stromal/stem cells + cholecalciferol: a pilot study in recent-onset type 1 diabetes patients

ABSTRACT Objective: Adipose tissue-derived stromal/stem cells (ASCs) and vitamin D have immunomodulatory actions that could be useful for type 1 diabetes (T1D). We aimed in this study to investigate the safety and efficacy of ASCs + daily cholecalciferol (VIT D) for 6 months in patients with recent-onset T1D. Materials and methods: In this prospective, dual-center, open trial, patients with recent onset T1D received one dose of allogenic ASC (1 x 106 cells/kg) and cholecalciferol 2,000 UI/day for 6 months (group 1). They were compared to patients who received chol-ecalciferol (group 2) and standard treatment (group 3). Adverse events were recorded; C-peptide (CP), insulin dose and HbA1c were measured at baseline (T0), after 3 (T3) and 6 months (T6). Results: In group 1 (n = 7), adverse events included transient headache (all), mild local reactions (all), tachycardia (n = 4), abdominal cramps (n = 1), thrombophlebitis (n = 4), scotomas (n = 2), and central retinal vein occlusion at T3 (n = 1, resolution at T6). Group 1 had an increase in basal CP (p = 0.018; mean: 40.41+/-40.79 %), without changes in stimulated CP after mixed meal (p = 0.62), from T0 to T6. Basal CP remained stable in groups 2 and 3 (p = 0.58 and p = 0.116, respectively). Group 1 had small insulin requirements (0.31+/- 0.26 UI/kg) without changes at T6 (p = 0.44) and HbA1c decline (p = 0.01). At T6, all patients (100%; n = 7) in group 1 were in honeymoon vs 75% (n = 3/4) and 50% (n = 3/6) in groups 2 and 3, p = 0.01. Conclusions: Allogenic ASC + VIT D without immunosuppression was safe and might have a role in the preservation of β-cells in patients with recent-onset T1D. ClinicalTrials.gov: NCT03920397.

Adipose tissue-derived stromal/stem cells + cholecalciferol: a pilot study in recent-onset type 1 diabetes patients.

OBJECTIVE: Adipose tissue-derived stromal/stem cells (ASCs) and vitamin D have immunomodulatory actions that could be useful for type 1 diabetes (T1D). We aimed in this study to investigate the safety and efficacy of ASCs + daily cholecalciferol (VIT D) for 6 months in patients with recent-onset T1D. METHODS: In this prospective, dual-center, open trial, patients with recent onset T1D received one dose of allogenic ASC (1 × 106 cells/kg) and cholecalciferol 2,000 UI/day for 6 months (group 1). They were compared to patients who received chol-ecalciferol (group 2) and standard treatment (group 3). Adverse events were recorded; C-peptide (CP), insulin dose and HbA1c were measured at baseline (T0), after 3 (T3) and 6 months (T6). RESULTS: In group 1 (n = 7), adverse events included transient headache (all), mild local reactions (all), tachycardia (n = 4), abdominal cramps (n = 1), thrombophlebitis (n = 4), scotomas (n = 2), and central retinal vein occlusion at T3 (n = 1, resolution at T6). Group 1 had an increase in basal CP (p = 0.018; mean: 40.41+/-40.79 %), without changes in stimulated CP after mixed meal (p = 0.62), from T0 to T6. Basal CP remained stable in groups 2 and 3 (p = 0.58 and p = 0.116, respectively). Group 1 had small insulin requirements (0.31+/- 0.26 UI/kg) without changes at T6 (p = 0.44) and HbA1c decline (p = 0.01). At T6, all patients (100%; n = 7) in group 1 were in honeymoon vs 75% (n = 3/4) and 50% (n = 3/6) in groups 2 and 3, p = 0.01. CONCLUSION: Allogenic ASC + VIT D without immunosuppression was safe and might have a role in the preservation of ß-cells in patients with recent-onset T1D. ClinicalTrials.gov: NCT03920397.

Efeitos de oito semanas de canoagem no equilíbrio corporal dinâmico de crianças e adolescentes com Síndrome de Down / Effects of eight weeks of canoeing on the dynamic body balance of children and adolescents with Down Syndrome

O objetivo dessa pesquisa foi analisar os efeitos de oito semanas de treinamento de canoagem no equilíbrio corporal dinâmico de crianças e adolescentes com síndrome de Down. Sete sujeitos, sendo 4 meninos e 3 meninas (10,8±2 anos) participaram da pesquisa durante oito semanas de canoagem, com duas sessões semanais. Para mensurar o equilíbrio corporal dinâmico adotou-se o Four Square Step Test (FSST) que compreende em completar um percurso com obstáculos o mais rápido possível. O teste de Wilcoxon foi utilizado para comparar os valores de equilíbrio corporal dinâmico obtidos no pré e pós. Para comparar os valores entre meninos e meninas, foi utilizado o teste de Mann-Whitney, sendo o tamanho do efeito da intervenção calculada pela escala de Cohen. Pode se afirmar que oito semanas de aulas de canoagem são suficientes para produzir efeitos positivos no equilíbrio corporal dinâmico de crianças e adolescentes com síndrome de Down.

The objective herein was to analyse the effects of eight weeks of canoe training on the dynamic body balance of children and adolescents with Down syndrome. Seven subjects, four boys and three girls (10.8 ± 2 years), participated in this study, attending eight weeks of canoe training (two weekly sessions). The Four Square Step Test was used to measure dynamic body balance; this test involves completing a course with obstacles as quickly as possible. The Wilcoxon test was used to compare the values of dynamic body balance obtained in the pre- and post-tests. To compare the values between the boys and girls, the Mann­Whitney test was used, and the size of the effect of the intervention was calculated using the Cohen scale. It was concluded that eight weeks of canoeing was sufficient to produce positive effects on the dynamic body balance of children and adolescents with Down syndrome.

Anatomy of the paranasal sinuses of the common marmoset (Callithrix jacchus Linnaeus, 1758) and radiographic positioning for diagnosis of these structures.

BACKGROUND: Callithrix jacchus, it is a species highly targeted by wild animal traffickers and, when apprehended, they need veterinary care. For safe therapeutic procedures, knowledge of anatomy is essential, as well as for diagnostic by imaging, good radiographic positioning is essential. METHODS: The anatomy of the paranasal sinuses and the radiographic projections was described using 10 carcasses of common marmosets. Radiographs were taken in two panoramic views of their head: profile and frontal-naso. For the anatomical study, paramedian and transverse macroscopic sections and microscopic transverse sections were performed. RESULTS: On the radiographs, it was possible to identify the frontal recess and maxillary sinuses in profile and frontal-naso incidences. In the anatomical study, the frontal recess and maxillary, sphenoid and ethmoid paranasal sinuses were identified. CONCLUSIONS: The ethmoidal sinus could be observed only microscopically and the sphenoidal sinus difficult to see on the radiography due to the overlapping adjoining structures.

Autoclassificação da saúde e autovaliação da assistência para seu cuidado segundo moradores de assentamentos rurais / Self-classification of the health of residents belonging to rural settlements and their evaluation of the healthcare received

Moradores de assentamentos rurais enfrentam dificuldades de acesso aos serviços de saúde. Isso é determinado pelas condições socioeconômicas destas populações. É possível que essas pessoas classifiquem insatisfatoriamente a própria saúde e a qualidade dos serviços públicos que têm acesso. Este estudo objetivou analisar a autoclassificação da saúde entre moradores de assentamentos rurais e sua avaliação aos serviços de saúde que utilizam. Pesquisa transversal, que entrevistou, através de um instrumento semiestruturado, moradores de dois assentamentos rurais localizados em Uberlândia, Minas Gerais, Brasil. O instrumento buscou analisar o perfil epidemiológico, a autoclassificação da saúde desses moradores, utilizando uma escala avaliativa. Foi também analisado como eles avaliam a qualidade dos serviços de saúde que acessam. Foram entrevistados 24 moradores de dois assentamentos. 54.2% deles (n=13) possuíam doenças crônicas. As mais relatadas foram Hipertensão Arterial Sistêmica e Diabetes Mellitus. Entre os moradores, 45.8% (n=11) auto classificaram a própria saúde como fraca ou razoável e 45.8% como boa. A análise dos discursos indicou insatisfação com a qualidade do serviço de saúde utilizado. Os índices de doenças crônicas encontradas entre os moradores dos assentamentos rurais podem ser decorrentes da baixa cobertura de Atenção Primária à Saúde próximos de suas residências. A melhoria da qualidade do serviço prestado pelas Unidades Básicas de Saúde da Família próximas aos assentamentos rurais pode reduzir os índices de doenças cardiovasculares futuras entre essa população.

Residents of rural settlements face difficulties in accessing health services. This is determined by the socioeconomic conditions of these populations. It is possible that these people rate their own health and the quality of public services they have access to as unsatisfactory. This study aimed to analyze the self-evaluation of health among residents of rural settlements and their assessment of the health services they use. This was a cross-sectional study, which interviewed, through a semi-structured instrument, residents of two rural settlements located in Uberlândia, Minas Gerais, Brazil. The instrument sought to analyze the epidemiological profile, the self-evaluation of the health of these residents, using an evaluative scale. Moreover, their assessment of the quality of the health services they access was evaluated. Twenty-four residents of two settlements were interviewed. 54.2% of them (n=13) had chronic diseases. The most reported were Systemic Arterial Hypertension and Diabetes Mellitus. Among residents, 45.8% (n=11) evaluated their own health as poor or fair and 45.8% as good. The analysis of the speeches indicated dissatisfaction with the quality of the health services used. The chronic disease rates found among residents of rural settlements may be due to the low coverage of Primary Health Care close to their homes. Improving the quality of the service provided by the Basic Family Health Units closest to rural settlements can reduce future cardiovascular disease rates among this population.

Anatomy and morphometry of the skull of Amazona aestiva (Linnaeus, 1758; Psittaciformes, Aves) / Anatomia e morfometria do crânio de Amazona aestiva (Linnaeus, 1758; Psittaciformes, Aves)

Obtaining craniometric data is key to establishing parameters that can help in the anatomic identification and understanding of species. The aim of the present study was to establish the craniometric data and describe the main skull bones and structures of Amazona aestiva, which has become common in veterinary clinics, originated from the legalized purchase or trafficking of animals. A total of 20 adult specimens were used, donated for studies by the Paraíba Wild Animal Screening Center (Centro de Triagem de Animais Silvestres da Paraíba (CETAS-PB)/IBAMA-PB, Brazil. The skulls were dissected and macerated with water. First were identified the frontal, maxilla, mandible, nasal, jugal and quadrate bones that served as a base to identify other bone structures that were then compared with the skull of other bird species already described in the literature, especially psitacids. Values were obtained by measuring with a digital pachymeter, and the maximum skull length was 63.0 mm, the maximum width 33.0 mm and the rhamphotheca was 33.8 mm long. No significant differences were observed between males and females and well developed cranial kinesis was a remarkable characteristic of the species. The data obtained serve as a base to identify and characterize the species. These data can also aid in the clinic, imaging and veterinary surgery.

A obtenção de dados craniométricos é fundamental para o estabelecimento de parâmetros que auxiliem na identificação anatômica e na compreensão das espécies. O objetivo do presente estudo foi estabelecer os dados craniométricos e descrever os principais ossos e estruturas do crânio do Amazona aestiva, que se tornou comum em clínicas veterinárias, oriundos de aquisição legal ou tráfico de animais. Foram utilizados 20 indivíduos adultos, doados para estudos do Centro de Triagem de Animais Silvestres da Paraíba (CETAS-PB) / IBAMA-PB, Brasil. Os crânios foram dissecados e macerados com água. Identificaram-se os ossos frontal, maxilar, mandibular, nasal, jugal e quadrado, que serviram de base para identificar outras estruturas ósseas que foram então, comparadas com o crânio de outras espécies de aves já descritas na literatura, principalmente psitacideos. Valores numéricos foram adquiridos através de mensuração com paquímetro digital, sendo o comprimento máximo do crânio de 63,0 mm, largura máxima de 33,0 mm e ranfoteca de 33,8 mm de comprimento. Não foram observadas diferenças significativas entre machos e fêmeas e, uma craniocinese bem desenvolvida foi característica marcante da espécie. Os dados obtidos servem de base para identificar e caracterizar as espécies. Estes dados também podem auxiliar na clínica, imagem e cirurgia veterinária.

Economically feasible strategy for confirmation of pharmaceuticals in hospital effluent using screening analysis.

The contamination of aquatic systems by pharmaceuticals has received considerable attention in recent decades, because these substances are increasingly detected in the environment. This is due to the abundant use of pharmaceuticals by the population and, consequently, their constant introduction into aquatic systems through domestic, industrial, and hospital wastewaters. Hospital effluents have highly complex compositions and present potential toxicity towards the environment. In this work, a screening methodology was developed to evaluate the occurrence of pharmaceutical products in hospital wastewater, using a viable, easy, and economical strategy employing commercial pharmaceutical compounds for screening analysis. Six samplings of hospital wastewater were carried out monthly (from winter until summer). The samples were filtered and pre-concentrated/extracted using solid phase extraction (SPE). The pharmaceuticals screening procedure required the construction of two databases, one for each ionization mode (positive and negative), which contained information that allowed the identification of the presence of these pharmaceuticals in the studied samples. Commercial pharmaceutical compounds were used as analytical standards. Based on this strategy and, using liquid chromatography coupled to high resolution mass spectrometry, it was possible to screen 110 pharmaceuticals and, from these, to confirm the presence of 38 pharmaceuticals in analyzed samples. These results indicate the analytes that should be taken into account in the further development of quantitative methods for pharmaceutical analysis.

Effects of kayaking on motor skills in children and adolescents with down syndrome / Efeitos da canoagem nas habilidades motoras de crianças e adolescentes com síndrome de down / Efectos de canoa en las habilidades motoras de niños y adolescentes com síndrome de down

ABSTRACT Introdução A síndrome de Down (SD) é uma afecção genética que se caracteriza por distribuição numérica inadequada no pareamento cromossômico, com material genético extra relacionado com o par 21 que leva a alterações que afetam o desenvolvimento de diversos componentes motores. Objetivos Analisar os efeitos do treinamento de canoagem durante oito semanas sobre as habilidades motoras grossas em crianças e adolescentes com SD. Métodos Sete indivíduos com SD (10,8 ± 2 anos), quatro do sexo masculino e três do sexo feminino participaram do estudo. Para avaliar as habilidades motoras grossas, empregou-se a bateria de Teste de Coordenação Corporal para Crianças (Körperkoordination Test für Kinder, KTK). O teste de Wilcoxon foi usado para comparar os valores de habilidades motoras grossas antes e depois do KTK e o teste de Mann-Whitney foi usado para comparar os indivíduos por sexo. O tamanho do efeito foi calculado pela escala de Cohen (1977) e nível de significância de p < 0,05 foi adotado. Resultados Os indivíduos apresentaram resultados estatisticamente significativos em todas as tarefas do teste de coordenação motora grossa e o efeito produzido pela intervenção foi moderado. Conclusão Conclui-se que oito semanas de treinamento de canoagem são suficientes para produzir desenvolvimento das habilidades motoras grossas de crianças e adolescentes com Síndrome de Down. Nível de Evidência IV; Série de casos.

RESUMO Introduction Down syndrome (DS) is a genetic condition characterized by an inadequate numerical distribution in chromosome pairing, with extra genetic material related to pair 21 leading to alterations that affect the development of several motor components. Objective To analyze the effects of kayak training for eight weeks on the gross motor skills of children and adolescents with DS. Methods Seven individuals with DS (10.8 ± 2 years), four males and three females, participated in the study. The Body Coordination Test for Children (Körperkoordination Test für Kinder, KTK) battery was used to assess gross motor skills. The Wilcoxon test was used to compare pre- and post-KTK gross motor skill values, and the Mann-Whitney test to compare subjects by sex. Effect size was calculated using Cohen's scale (1977) and a significance level of p <0.05 was adopted. Results The subjects presented statistically significant results in all tasks of the gross motor coordination test, and the effect produced by the intervention was moderate. Conclusion It can be concluded that eight weeks of kayak training are sufficient to produce a development in the gross motor skills of children and adolescents with Down syndrome. Level of Evidence IV; Case series.

RESUMEN Introducción El síndrome de Down (SD) es una afección genética que se caracteriza por una distribución numérica inadecuada en la formación de pares cromosómicos, con material genético adicional relacionado con el par 21 que lleva a cambios que afectan el desarrollo de varios componentes motores. Objetivos Analizar los efectos del entrenamiento en canoa durante ocho semanas sobre las habilidades motoras gruesas de niños y adolescentes con SD. Métodos Siete individuos con SD (10,8 ± 2 años), cuatro del sexo masculino y tres del sexo femenino participaron en el estudio. Para evaluar las habilidades motoras gruesas, se utilizó la batería de la Prueba de Coordinación Corporal para Niños (Körperkoordination Test für Kinder, KTK). La prueba de Wilcoxon se us ó para comparar los valores de las habilidades motoras gruesas antes y después de KTK y la prueba de Mann-Whitney se usó para comparar individuos por sexo. El tamaño del efecto se calculó mediante la escala de Cohen (1977) y se adoptó un nivel de significancia de p < 0,05. Resultados Los individuos presentaron resultados estadísticamente significativos en todas las tareas de la prueba de coordinación motora gruesa y el efecto producido por la intervención fue moderado. Conclusión Se concluye que ocho semanas de entrenamiento en canoa son suficientes para producir el desarrollo de las habilidades motoras gruesas de niños y adolescentes con síndrome de Down. Nivel de evidencia IV; Series de casos.