An Intramyocardial Mass Mimicking ST-Segment Elevation Myocardial Infarct at Presentation.

ST-segment elevation on the electrocardiogram typically indicates acute myocardial infarction but can mimic ST-segment elevation myocardial infarction in various conditions. We present a case of a patient with an intramyocardial mass and anterior ST-segment elevation without significant myocardial biomarker elevation. Multimodality imaging was crucial in revealing cardiac metastasis as the attributable cause.

Severe COVID-19 in pregnant women: Analysis of placental features and perinatal outcomes.

OBJECTIVES: Changes in placental features, such as maternal and fetal vascular malperfusion, are associated with SARS-CoV-2 infection. The anatomopathologic study of the placenta is crucial for understanding pregnancy and fetal complications. To that end, this study aimed to describe placental features and analyze the association between placental findings and perinatal outcomes in a cohort of pregnant women with severe COVID-19. METHODS: This nested study within a prospective cohort study consisted of 121 singleton pregnant women with a diagnosis of severe COVID-19. Placental pathologic findings were described, and the associations between severe COVID-19 and clinical parameters and perinatal outcomes were assessed. RESULTS: The prevalence of maternal vascular malperfusion was 52.1%, followed by fetal vascular malperfusion at 21.5%, ascending intrauterine infections at 11.6%, and inflammatory lesions at 11.6%. Other lesions were observed in 39.7% of the placentas examined. Inflammatory lesions were an independent factor (P = .042) in 5-minute Apgar scores below 7. Ascending infection was associated with fetal death (P = .027). CONCLUSIONS: Maternal vascular malperfusion was the most prevalent placental feature in patients with severe COVID-19. Chorangiosis is associated with poor perinatal outcomes.

Congenital diaphragmatic hernia treated via fetal endoscopic tracheal occlusion improves outcome in a middle-income country.

OBJECTIVES: A recent European randomized trial - Tracheal Occlusion To Accelerate Lung Growth - demonstrated that fetoscopic endoluminal tracheal occlusion (FETO) is associated with increased postnatal survival among infants with severe congenital diaphragmatic hernia (CDH). However, this differs in middle-income countries such as Brazil, where abortion is illegal and neonatal intensive care is inadequate. This study evaluated the effects of FETO on improving the survival of infants with moderate-to-severe CDH in isolated and non-isolated cases. METHODS: This retrospective cohort study selected 49 fetuses with CDH, a normal karyotype, and a lung-to-head ratio (LHR) of <1 from a single national referral center for fetal surgery in São Paulo, Brazil, between January 2016 and November 2019. FETO was performed between 26 and 29 weeks of gestation. The primary outcomes were infant survival until discharge from the neonatal intensive care unit and survival until six months of age. RESULTS: Forty-six women with singleton fetuses having severe CDH underwent prenatal intervention with FETO. Infant survival rates until discharge and at six months of age were both 38 %. The observed-to-expected LHR increased by 25 % after FETO in neonates who survived until discharge. Spontaneous intrauterine death occurred in four growth-restricted fetuses after FETO. Preterm birth in <37 weeks and preterm rupture of membranes in <34 weeks occurred in 56.5 % (26) and 26 % (12) cases, respectively. CONCLUSIONS: FETO may increase neonatal survival in fetuses with severe CDH, particularly in countries with limited neonatal intensive care.

A randomized clinical trial of transdermal (gel) versus oral estrogen for endometrial preparation in frozen embryo transfer cycle.

OBJECTIVE: The aim of this study was to compare endometrial thickness with the use of transdermal estrogen (gel) versus oral estrogen (pills) for endometrial preparation in the frozen embryo transfer cycle and serum estrogen concentrations during the preparation cycle, side effects, and chemical and clinical pregnancy rates. METHODS: This was a prospective, randomized controlled trial of women undergoing endometrial preparation for cryopreserved blastocyst transfer. A total of 88 women were randomized, of which 82 completed the study protocol. Of this group, 44 received 6 mg/day of estradiol valerate orally (pills group) and 38 received 4.5 mg/day of estradiol hemihydrate transdermally (gel group). Endometrial thickness was measured using transvaginal ultrasound between the 7 and 10th day of the cycle. Serum estradiol concentrations were measured on the day of initiating the cycle, on control transvaginal ultrasounds, and on the day of embryo transfer. Side effects were documented at each study visit. p<0.05 were adopted as statistically significant. The groups were compared using Student's t-test for continuous variables and chi-square or Fisher's exact test for categorical variables. RESULTS: There were no significant group differences (p>0.05) in endometrial thickness, biochemical and clinical pregnancy rates, miscarriage rate, blood estradiol concentrations, duration of estradiol administration, or cycle cancellation rates. CONCLUSION: Endometrial preparation with transdermal estrogen yielded similar reproductive outcomes to oral estrogen with fewer side effects.

Effect of a lifestyle intervention among pregnant women with overweight on neonatal adiposity: A randomized controlled clinical trial.

BACKGROUND: The excess neonatal adiposity is considered a risk factor for the development of childhood obesity and the birth weight is a marker of health throughout life. AIMS: To evaluate the effect of a lifestyle intervention conducted among pregnant women with overweight on neonatal adiposity and birth weight. METHODS: A total of 350 pregnant women were recruited and randomly allocated into the control (CG) and intervention (IG) groups. Pregnant women in the IG were invited to participate in three nutritional counselling sessions based on encouraging the consumption of unprocessed and minimally processed foods, rather than ultra-processed foods, following the NOVA food classification system, which categorizes foods according to the extent and purpose of industrial processing, and the regular practice of physical activity. Neonatal adiposity was estimated using a previously validated anthropometric model. Adjusted linear regression models were used to measure the effect. RESULTS: Adopting the modified intention-to-treat principle, data from 256 neonates were analyzed for birth weight, and data from 163 for body composition estimation. The treatment had no effect on the proportion of fat mass [ß 0.52 (95 % CI -1.03, 2.06); p = .51], fat-free mass [ß -0.50 (95 % CI -2.45, 1.45); p = .61] or birth weight [ß 53.23 (95 % CI -87.19, 193.64); p = .46]. CONCLUSIONS: In the present study, the lifestyle counselling used had no effect on neonatal adiposity or birth weight. Future studies should investigate the effect of more intensive interventions.

Effectiveness of nutritional counseling with overweight pregnant women on child growth at 6 months: A randomized controlled trial.

OBJECTIVE: Studies that have investigated the effect of nutritional counseling during the prenatal period on the follow-up outcomes of children at 6 mo have produced inconclusive results. The present study aimed to investigate the effect of nutritional counseling, based on the NOVA food classification, encouraging the consumption of fresh and minimally processed foods, with overweight adult pregnant women on infant growth at 6 mo of age. METHODS: A randomized controlled trial with 195 pairs of pregnant overweight women and their infants at 6 mo of age was conducted in a Brazilian municipality. The pregnant women were allocated to the control group (CG) or intervention group (IG) at the beginning of the pregnancy. The IG received three sessions of nutrition counseling throughout the pregnancy. Linear regression models were used to investigate the effect of the nutritional counseling on infant growth. RESULTS: One hundred ninety-five mother-infant pairs with complete data were included (96 CG, and 99 IG). The mean ± SD infant weight (g) at 6 mo was 7856.1 ± 1.1, and length (cm) was 67.0 ± 2.9. There were no differences in maternal and newborn characteristics between the groups. In the linear regression models, the counseling had no effect on anthropometric parameters of the infants at 6 mo of age: weight-for-length Z-score (ß 0.089 [95% CI -0.250; 0.427], P = 0.61); length-for-age Z-score (ß 0.032 [95% CI -0.299; 0.363], P = 0.85); weight-for-age Z-score (ß 0.070 [95% CI -0.260; 0.400], P = 0.68); BMI-age Z-score (ß 0.072 [95% CI -0.270; 0.414], P = 0.68). CONCLUSIONS: There was no effect on infant growth at 6 mo of age after the nutritional counseling during pregnancy. Future studies are needed to confirm this hypothesis.

Assessment of Human Fetuses Undergoing Acute Pain: Validation of the Fetal-7 Scale.

Improvements in fetal ultrasound have allowed for the diagnosis and treatment of fetal diseases in the uterus, often through surgery. However, little attention has been drawn to the assessment of fetal pain. To address this gap, a fetal pain scoring system, known as the Fetal-7 scale, was developed. The present study is a full validation of the Fetal-7 scale. The validation involved 2 steps: 1) 4 fetuses with the indication of surgery were evaluated in 3 conditions perioperatively: acute pain, rest, and under loud sound stimulation. Facial expressions were assessed by 30 raters using screenshots from 4D high-definition ultrasound films; 2) assessment of sensitivity and specificity of the Fetal-7 scale in 54 healthy fetuses and 2 fetuses undergoing acute pain after preoperative anesthetic intramuscular injection. There was high internal consistency with Cronbach's alpha (α) of .99. Intrarater reliability of the Fetal-7 scale (test-retest) calculated by intraclass correlation coefficient was .95, and inter-rater reliability was .99. The scale accurately differentiated between healthy fetuses at rest and those experiencing acute pain (sensitivity of 100% and specificity of 94.4%). The Fetal-7 scale is a valid tool for assessing acute pain-related behavior in third-trimester fetuses and may be of value in guiding analgesic procedures efficacy in these patients. Further research is warranted to explore the presence of postoperative pain in fetuses and its effects after birth. PERSPECTIVE: Recordings with 3-dimensional ultrasound of human fetuses undergoing preoperative anesthetic injections revealed complex facial expressions during acute pain, similar to those collected in newborns. This study presented the validation process and cut-off value of the Fetal-7 scale, paving the way for the study of pain before birth in humans.

Splenic Embolism in Infective Endocarditis: A Systematic Review of the Literature with an Emphasis on Radiological and Histopathological Diagnoses.

Infective endocarditis (IE) is characterised by fever, heart murmurs, and emboli. Splenic emboli are frequent in left-sided IE. A systematic review of the literature published on splenic embolism (SE) between 2000 and 2023 was conducted. Search strategies in electronic databases identified 2751 studies published between 1 January 2000 and 4 October 2023, of which 29 were finally included. The results showed that the imaging tests predominantly used to detect embolisms were computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)/CT, single-photon emission computed tomography/CT, ultrasound, and contrast-enhanced ultrasound. More recent studies typically used 18F-FDG PET-CT. The proportion of SE ranged from 1.4% to 71.7%. Only seven studies performed systematic conventional CT screening for intra-abdominal emboli, and the weighted mean frequency of SE was 22% (range: 8-34.8%). 18F-FDG PET-CT was performed systematically in seven studies, and splenic uptake was found in a weighted mean of 4.5%. There was a lack of uniformity in the published literature regarding the frequency and management of splenic embolisation. CT scans were the most frequently used method, until recently, when 18F-FDG PET-CT scans began to predominate. More data are necessary regarding the frequency of SE, especially focusing on their impact on IE management and prognosis.

Myocardial tissue expression of mRNA and preoperative neutrophil-lymphocyte ratio in children undergoing congenital heart surgery.

Background: The neutrophil-lymphocyte ratio (NLR) is an easily accessible and inexpensive biomarker that has been shown to predict morbidity and mortality in congenital cardiac surgery. However, its regulatory mechanism remains unclear. This study aims to compare and correlate the tumor necrosis factor alpha (TNF-α), interleukin (IL)-1ß, IL-6, and IL-10 messenger RNAs (mRNAs) with the NLR in patients with tetralogy of Fallot (ToF) and ventricular septal defect (VSD). Methods: A prospective translational study was conducted on 10 children with ToF and 10 with VSD, aged between 1 and 24 months. The NLR was calculated from the blood count taken 24 hours before surgery. The expression of these mRNAs was analyzed in the myocardial tissue of the right atrium prior to cardiopulmonary bypass. Results: Patients with ToF exhibited a higher NLR [ToF 0.46 (interquartile range; IQR) 0.90; VSD 0.28 (IQR 0.17); P=0.02], longer mechanical ventilation time [ToF 24 h (IQR 93); VSD 5.5 h (IQR 8); P<0.001], increased use of vasoactive drugs [ToF 2 days (IQR 1.75); VSD 0 (IQR 1); P=0.01], and longer ICU [ToF 5.5 (IQR 1); VSD 2 (IQR 0.75); P=0.02] and hospital length of stays [ToF 18 days (IQR 17.5); VSD 8.5 days (IQR 2.5); P<0.001]. A negative correlation was found between NLR and oxygen saturation (SaO2) (r=-0.44; P=0.002). In terms of mRNA expression, the ToF group showed a lower expression of IL-10 mRNA (P=0.03). A positive correlation was observed between IL-10-mRNA and SaO2 (r=0.40; P=0.07), and a negative correlation with NLR (r=-0.27; P=0.14). Conclusions: Patients with ToF demonstrated a higher preoperative NLR and lower IL-10 mRNA expression by what appears to be a pro-inflammatory phenotype of cyanotic patients.

The impact of craniofacial and dental osteogenesis imperfecta manifestations on oral health-related quality of life of children and adolescents.

OBJECTIVE: Craniofacial and oral manifestations of Osteogenesis Imperfecta (OI) can affect the functioning of the stomatognathic system and impact the patient's quality of life. The objective of the study was to evaluate the relationship between craniofacial and oral manifestations and the Oral Health-related Quality of Life (OHRQoL) of OI children and adolescents. MATERIAL AND METHODS: A total of 30 OI patients aged eight to fourteen years old followed up at the Oral Care Center for Inherited Diseases were enrolled in the research. OHRQoL was assessed using the short form of the Child Perceptions Questionnaire (CPQ) for eight to ten-year-olds (CPQ8-10) and 11 to 14-year-olds (CPQ11-14). The relationship between the OHRQoL index and its assessment domains, OI types, and the presence of dentinogenesis imperfecta (DI), class III malocclusion, and dental agenesis were evaluated. RESULTS: The median CPQ score of patients was 5, and there was no significant difference in OHRQoL between children and adolescents, nor associated with the disease severity or the presence of DI. The oral manifestations evaluated did not directly impact the patients' OHRQoL. CONCLUSIONS: The study demonstrated that the perception of OHRQoL is similar for both adolescents and children. The oral symptom was the most relevant domain for the index among patients aged eight to fourteen years while the emotional well-being was the most impacted. CLINICAL RELEVANCE: this study makes contributions by indicating that addressing dental care for children and adolescents with OI is important in clinical management and better OHRQoL for this population.

Deep Learning in High-Resolution Anoscopy: Assessing the Impact of Staining and Therapeutic Manipulation on Automated Detection of Anal Cancer Precursors.

INTRODUCTION: High-resolution anoscopy (HRA) is the gold standard for detecting anal squamous cell carcinoma (ASCC) precursors. Preliminary studies on the application of artificial intelligence (AI) models to this modality have revealed promising results. However, the impact of staining techniques and anal manipulation on the effectiveness of these algorithms has not been evaluated. We aimed to develop a deep learning system for automatic differentiation of high-grade squamous intraepithelial lesion vs low-grade squamous intraepithelial lesion in HRA images in different subsets of patients (nonstained, acetic acid, lugol, and after manipulation). METHODS: A convolutional neural network was developed to detect and differentiate high-grade and low-grade anal squamous intraepithelial lesions based on 27,770 images from 103 HRA examinations performed in 88 patients. Subanalyses were performed to evaluate the algorithm's performance in subsets of images without staining, acetic acid, lugol, and after manipulation of the anal canal. The sensitivity, specificity, accuracy, positive and negative predictive values, and area under the curve were calculated. RESULTS: The convolutional neural network achieved an overall accuracy of 98.3%. The algorithm had a sensitivity and specificity of 97.4% and 99.2%, respectively. The accuracy of the algorithm for differentiating high-grade squamous intraepithelial lesion vs low-grade squamous intraepithelial lesion varied between 91.5% (postmanipulation) and 100% (lugol) for the categories at subanalysis. The area under the curve ranged between 0.95 and 1.00. DISCUSSION: The introduction of AI to HRA may provide an accurate detection and differentiation of ASCC precursors. Our algorithm showed excellent performance at different staining settings. This is extremely important because real-time AI models during HRA examinations can help guide local treatment or detect relapsing disease.

Evaluation of novel dendrimer-gold complex nanoparticles for theranostic application in oncology.

Aim: Despite some successful examples of therapeutic nanoparticles reaching clinical stages, there is still a significant need for novel formulations in order to improve the selectivity and efficacy of cancer treatment. Methods: The authors developed two novel dendrimer-gold (Au) complex-based nanoparticles using two different synthesis routes: complexation method (formulation A) and precipitation method (formulation B). Using a biomimetic cancer-on-a-chip model, the authors evaluated the possible cytotoxicity and internalization by colorectal cancer cells of dendrimer-Au complex-based nanoparticles. Results: The results showed promising capabilities of these nanoparticles for selectively targeting cancer cells and delivering drugs, particularly for the formulation A nanoparticles. Conclusion: This work highlights the potential of dendrimer-Au complex-based nanoparticles as a new strategy to improve the targeting of anticancer drugs.

Enhancing Arrhythmogenic Right Ventricular Cardiomyopathy Detection and Risk Stratification: Insights from Advanced Echocardiographic Techniques.

INTRODUCTION: The echocardiographic diagnosis criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) are highly specific but sensitivity is low, especially in the early stages of the disease. The role of echocardiographic strain in ARVC has not been fully elucidated, although prior studies suggest that it can improve the detection of subtle functional abnormalities. The purposes of the study were to determine whether these advanced measures of right ventricular (RV) dysfunction on echocardiogram, including RV strain, increase diagnostic value for ARVC disease detection and to evaluate the association of echocardiographic parameters with arrhythmic outcomes. METHODS: The study included 28 patients from the Heart Institute of São Paulo ARVC cohort with a definite diagnosis of ARVC established according to the 2010 Task Force Criteria. All patients were submitted to ECHO's advanced techniques including RV strain, and the parameters were compared to prior conventional visual ECHO and CMR. RESULTS: In total, 28 patients were enrolled in order to perform ECHO's advanced techniques. A total of 2/28 (7%) patients died due to a cardiovascular cause, 2/28 (7%) underwent heart transplantation, and 14/28 (50%) patients developed sustained ventricular arrhythmic events. Among ECHO's parameters, RV dilatation, measured by RVDd (p = 0.018) and RVOT PSAX (p = 0.044), was significantly associated with arrhythmic outcomes. RV free wall longitudinal strain < 14.35% in absolute value was associated with arrhythmic outcomes (p = 0.033). CONCLUSION: Our data suggest that ECHO's advanced techniques improve ARVC detection and that abnormal RV strain can be associated with arrhythmic risk stratification. Further studies are necessary to better demonstrate these findings and contribute to risk stratification in ARVC, in addition to other well-known risk markers.

Community-developed checklists for publishing images and image analyses.

Images document scientific discoveries and are prevalent in modern biomedical research. Microscopy imaging in particular is currently undergoing rapid technological advancements. However, for scientists wishing to publish obtained images and image-analysis results, there are currently no unified guidelines for best practices. Consequently, microscopy images and image data in publications may be unclear or difficult to interpret. Here, we present community-developed checklists for preparing light microscopy images and describing image analyses for publications. These checklists offer authors, readers and publishers key recommendations for image formatting and annotation, color selection, data availability and reporting image-analysis workflows. The goal of our guidelines is to increase the clarity and reproducibility of image figures and thereby to heighten the quality and explanatory power of microscopy data.

Segurança medicamentosa de pessoas idosas no contexto hospitalar: revisão de escopo / Medication safety of older patients in the hospital setting: a scoping review

Resumo Objetivo Identificar as evidências científicas disponíveis na literatura sobre segurança medicamentosa de pessoas idosas no contexto hospitalar. Método Trata-se de uma Revisão de escopo. Foram feitas buscas nas seguintes bases de dados: LILACS, SCIELO, MEDLINE, e PUBMED, sobre a temática segurança medicamentosa de pacientes idosos no contexto hospitalar. Utilizaram-se os descritores em saúde de acordo com o DECS: Segurança do paciente, idoso, medicamentos, hospital. Foram incluídos na pesquisa: artigos completos disponíveis na íntegra, com os idiomas português, inglês e espanhol. Excluídos artigos duplicados, teses e dissertações. Resultados A busca resultou 172 publicações. Após leitura dos títulos e resumos, oito artigos foram selecionados por se adequarem aos critérios de inclusão. A amostra final desta revisão de escopo totalizou oito estudos selecionados e excluídos o restante por não contemplarem o tema da pesquisa. A revisão possibilitou mapear um quantitativo expressivo de publicações sobre segurança medicamentosa de pessoas idosas hospitalizadas. Conclusão Esta revisão encontrou propostas de estratégias de prevenção de erros de medicação no ambiente hospitalar.

Abstract Objective To identify the scientific evidence available in the literature on medication safety for older adults in the hospital setting. Method A scoping review was conducted on medication safety among older patients in the hospital setting involving searches of the LILACS, SCIELO, MEDLINE, and PUBMED databases Health descriptors were used according to DECS: patient safety, elderly, medications, hospital. The study included complete articles available in full, in Portuguese, English or Spanish. Duplicate articles, theses and dissertations were excluded. Results The search retrieved 172 publications. After reading of titles and abstracts, 8 articles that met the inclusion criteria were selected. The final sample of this scoping review comprised 8 selected studies, while the rest were excluded for being off-topic. The review allowed mapping of a significant number of publications on medication safety for hospitalized older adults. Conclusion This review found proposed strategies for preventing medication errors in the hospital environment.

A randomized clinical trial of transdermal (gel) versus oral estrogen for endometrial preparation in frozen embryo transfer cycle

SUMMARY OBJECTIVE: The aim of this study was to compare endometrial thickness with the use of transdermal estrogen (gel) versus oral estrogen (pills) for endometrial preparation in the frozen embryo transfer cycle and serum estrogen concentrations during the preparation cycle, side effects, and chemical and clinical pregnancy rates. METHODS: This was a prospective, randomized controlled trial of women undergoing endometrial preparation for cryopreserved blastocyst transfer. A total of 88 women were randomized, of which 82 completed the study protocol. Of this group, 44 received 6 mg/day of estradiol valerate orally (pills group) and 38 received 4.5 mg/day of estradiol hemihydrate transdermally (gel group). Endometrial thickness was measured using transvaginal ultrasound between the 7 and 10th day of the cycle. Serum estradiol concentrations were measured on the day of initiating the cycle, on control transvaginal ultrasounds, and on the day of embryo transfer. Side effects were documented at each study visit. p<0.05 were adopted as statistically significant. The groups were compared using Student's t-test for continuous variables and chi-square or Fisher's exact test for categorical variables. RESULTS: There were no significant group differences (p>0.05) in endometrial thickness, biochemical and clinical pregnancy rates, miscarriage rate, blood estradiol concentrations, duration of estradiol administration, or cycle cancellation rates. CONCLUSION: Endometrial preparation with transdermal estrogen yielded similar reproductive outcomes to oral estrogen with fewer side effects.

O que é a ecolalia para o autismo segundo a literatura? / What is echolalia for autism according to the literature?

Objetivo: Descrever, segundo a literatura, a relação entre o Transtorno do Espectro Autista e a ecolalia. Método: Realizou-se uma revisão integrativa da literatura científica na BVS, PubMed e Scielo, utilizando os descritores DECS/MESH "Transtorno do Espectro Autista AND ecolalia" e "Autism Spectrum Disorder AND Echolalia" combinados pelo operador booleano "AND". Resultados: Predominaram estudos qualitativos (35,7%) com baixo nível de evidência (92,8%). A maioria das pesquisas (78,6%) foi conduzida nos Estados Unidos da América em 2021, com participantes de 1 a 40 anos, sendo a ecolalia frequentemente observada em crianças de 2 anos (28,6%). A abordagem ao tratamento da ecolalia foi mencionada em apenas 21,4% dos estudos, destacando métodos comportamentais. Conclusão: A ecolalia, fenômeno persistente no TEA, é uma notável peculiaridade na comunicação verbal, apresentando variações imediatas, tardias e mitigadas. Suas implicações continuam a desafiar o desenvolvimento e as intervenções clínicas.(AU)

Objective: To describe, based on the literature, the relationship between Autism Spectrum Disorder and echolalia. Method: An integrative review of scientific literature was conducted using BVS, PubMed, and Scielo databases, employing the DECS/MESH descriptors "Autism Spectrum Disorder AND echolalia" and "Autism Spectrum Disorder AND Echolalia" combined with the Boolean operator "AND." Results: Qualitative studies predominated (35.7%) with low levels of evidence (92.8%). The majority of research (78.6%) was conducted in the United States in 2021, involving participants aged 1 to 40, with echolalia frequently observed in 2-year-old children (28.6%). The approach to echolalia treatment was mentioned in only 21.4% of the studies, emphasizing behavioral methods. Conclusion: Echolalia, a persistent phenomenon in Autism Spectrum Disorder, represents a notable peculiarity in verbal communication, exhibiting immediate, delayed, and mitigated variations. Its implications continue to challenge development and clinical interventions.(AU)

Objetivo: Describir, según la literatura, la relación entre el Trastorno del Espectro Autista y la ecolalia. Método: Se realizó una revisión integrativa de la literatura científica en las bases de datos BVS, PubMed y Scielo, utilizando los descriptores DECS/MESH "Trastorno del Espectro Autista AND ecolalia" y "Autism Spectrum Disorder AND Echolalia" combinados con el operador booleano "AND". Resultados: Predominaron los estudios cualitativos (35,7%) con un bajo nivel de evidencia (92,8%). La mayoría de las investigaciones (78,6%) se llevaron a cabo en Estados Unidos en 2021, con participantes de 1 a 40 años, siendo la ecolalia observada con frecuencia en niños de 2 años (28,6%). El enfoque para el tratamiento de la ecolalia se mencionó solo en el 21,4% de los estudios, destacando métodos conductuales. Conclusión: La ecolalia, un fenómeno persistente en el Trastorno del Espectro Autista, representa una notable peculiaridad en la comunicación verbal, mostrando variaciones inmediatas, tardías y mitigadas. Sus implicaciones siguen desafiando el desarrollo y las intervenciones clínicas.(AU)

Foliar Selenium Application to Reduce the Induced-Drought Stress Effects in Coffee Seedlings: Induced Priming or Alleviation Effect?

This study aimed to investigate the role of Se supply in improving osmotic stress tolerance in coffee seedlings while also evaluating the best timing for Se application. Five times of Se foliar application were assessed during induced osmotic stress with PEG-6000 using the day of imposing stress as a default, plus two control treatments: with osmotic stress and without Se, and without osmotic stress and Se. Results demonstrated that osmotic stress (OS) promoted mild stress in the coffee plants (ψw from -1.5MPa to -2.5 MPa). Control plants under stress showed seven and five times lower activity of the enzymes GR and SOD compared with the non-stressed ones, and OS was found to further induce starch degradation, which was potentialized by the Se foliar supply. The seedlings that received foliar Se application 8 days before the stress exhibited higher CAT, APX, and SOD than the absolute control (-OS-Se)-771.1%, 356.3%, and 266.5% higher, respectively. In conclusion, previous Se foliar spray is more effective than the Se supply after OS to overcome the adverse condition. On the other hand, the post-stress application seems to impose extra stress on the plants, leading them to reduce their water potential.

Gastrointestinal organs and organoids-on-a-chip: advances and translation into the clinics.

Microfluidic organs and organoids-on-a-chip models of human gastrointestinal systems have been established to recreate adequate microenvironments to study physiology and pathophysiology. In the effort to find more emulating systems and less costly models for drugs screening or fundamental studies, gastrointestinal system organoids-on-a-chip have arisen as promising pre-clinicalin vitromodel. This progress has been built on the latest developments of several technologies such as bioprinting, microfluidics, and organoid research. In this review, we will focus on healthy and disease models of: human microbiome-on-a-chip and its rising correlation with gastro pathophysiology; stomach-on-a-chip; liver-on-a-chip; pancreas-on-a-chip; inflammation models, small intestine, colon and colorectal cancer organoids-on-a-chip and multi-organoids-on-a-chip. The current developments related to the design, ability to hold one or more 'organs' and its challenges, microfluidic features, cell sources and whether they are used to test drugs are overviewed herein. Importantly, their contribution in terms of drug development and eminent clinical translation in precision medicine field, Food and Drug Administration approved models, and the impact of organoid-on-chip technology in terms of pharmaceutical research and development costs are also discussed by the authors.

Main Self-Care Deficits Found in Elderly People with Diabetic Foot Ulcer: An Integrative Review / Principais déficits de autocuidado encontrados em idosos com úlcera de pé diabético: uma revisão integrativa / Principales déficits de autocuidado encontrados en ancianos con úlcera de pie diabético: una revisión integradora

Introduction: The increase in the incidence of diabetes mellitus has led to public health consequences. Several individuals with diabetes lose sensitivity and may present foot deformities, resulting in diabetic foot. Knowing about self-care deficits can allow for planning healthcare in the management of diabetic foot and improve the patient's quality of life. Objective: To identify, from the scientific literature, the main self-care deficits present in elderly people with diabetic foot ulcers, based on Orem's self-care deficit theory. Materials and methods: This is an integrative review study. The search for studies was performed in January 2022, using the descriptors "diabetic foot", "self-care," and "aged." The following virtual library and databases were used: BVS, Lilacs, Medline and BDEnf via PubMed. The adaptation of the Prisma flowchart was used. A synthesis of the articles was performed with the description of the main results and self-care deficits according to Orem's self-care theory. Results: Socioeconomic conditions, skin characteristics, activities, leisure and rest, diet, neurological conditions, and lack of knowledge about the need for therapeutic support and treatment were the main factors related to self-care deficits. Conclusion: The scientific evidence generated provides a foundation for carrying out new studies on the theme, as well as assisting in decision-making by nurses to adopt measures that assist in the self-care of this population group, in addition to guiding this population regarding the necessary care.

Introdução: o aumento da incidência do diabetes mellitus vem acarretando consequências à saúde pública. Muitos indivíduos com diabetes perdem a sensibilidade e podem desenvolver deformidades nos pés, ocasionando o pé diabético. Conhecer os déficits de autocuidado pode permitir o planejamento da assistência à saúde no manejo do pé diabético e melhorar a qualidade de vida do paciente. Objetivo: identificar, a partir da literatura científica, os principais déficits de autocuidado presentes em idosos com úlceras de pé diabético, fundamentando na teoria do déficit de autocuidado de Orem. Materiais e método: trata-se de um estudo do tipo revisão integrativa. A busca dos estudos ocorreu em janeiro de 2022, a partir dos descritores "pé diabético", "autocuidado" e "idoso". Utilizaram-se as bases de dados e biblioteca virtual: BVS, Lilacs, Medline e BDEnf por meio da PubMed. A adaptação do fluxograma Prisma foi utilizada. Uma síntese dos artigos foi realizada com a descrição dos principais resultados e déficits de autocuidado conforme a teoria de autocuidado de Orem. Resultados: condições socioeconômicas, características da pele, atividades, lazer e repouso, alimentação, condições neurológicas e falta de conhecimento sobre a necessidade de suporte terapêutico e de tratamento foram as principais situações relacionadas aos déficits de autocuidado. Conclusão: a evidência científica gerada serve como base para realizar novos estudos sobre a temática, assim como auxilia na tomada de decisões por parte do enfermeiro para adotar medidas que auxiliem no autocuidado desse grupo populacional, além de orientar essa população quanto aos cuidados necessários.

Introducción: el aumento de la incidencia de la diabetes mellitus ha tenido consecuencias para la salud pública. Muchos individuos con diabetes pierden sensibilidad y pueden desarrollar deformidades en los pies, dando lugar al pie diabético. Conocer los déficits de autocuidado puede permitir la planificación de la asistencia sanitaria en el manejo del pie diabético y mejorar la calidad de vida del paciente. Objetivo: identificar, desde la literatura, los principales déficits de autocuidado presentes en adultos mayores con úlceras de pie diabético, con base en la teoría del déficit de autocuidado de Orem. Materiales y método: se trata de una revisión integradora. La búsqueda de estudios se realizó en enero de 2022, utilizando los descriptores "pie diabético", "autocuidado" y "anciano". Se utilizaron las siguientes bases de datos y bibliotecas virtuales: BVS, Lilacs, Medline y BDEnf a través de PubMed. Se utilizó la adaptación del diagrama de flujo Prisma. Se realizó una síntesis de los artículos con la descripción de los principales resultados y déficits de autocuidado según la teoría de autocuidado de Orem. Resultados: condiciones socioeconómicas, características de la piel, actividades, ocio y descanso, alimentación, condiciones neurológicas y desconocimiento de la necesidad de apoyo terapéutico y tratamiento fueron las principales situaciones relacionadas a los déficits de autocuidado. Conclusiones: se destaca la importancia de la educación sanitaria, el manejo terapéutico, los cuidados individualizados y el uso de una herramienta de consultas de enfermería para apoyar la prevención del pie diabético y mejorar la calidad de vida de los ancianos.