CONSTIPATION SCORING SYSTEM VALIDATED FOR THE PORTUGUESE LANGUAGE (ÍNDICE DE GRAVIDADE DA CONSTIPAÇÃO INTESTINAL): IS IT RELIABLE IN ASSESSING THE SEVERITY OF INTESTINAL CHRONIC CONSTIPATION IN OUR POPULATION?

BACKGROUND: There is a lack of valid and specific tools to measure chronic constipation severity in Brazil. AIMS: To validate the Constipation Scoring System for Brazilian spoken Portuguese. METHODS: Translation, cultural adaptation, and validation itself (reliability and convergent and divergent validation). Translation: definitive version from the original version's translation and evaluation by specialists. Cultural adaptation: score content analysis of the definitive version, as an interview to patients. Interobserver reliability: application by two researchers on the same day. Intraobserver reliability: same researcher at different times, in a 7-day interval. Divergent validation: non-constipated volunteers. Convergent validation: two groups, good response to clinical treatment and refractory to treatment. RESULTS: Cultural adaptation: 81 patients, 89% female, with mean age of 55 and seven years of schooling, and overall content validity index was 96.5%. Inter and intraobserver reliability analysis: 60 patients, 86.7% female, mean age of 56 and six years of schooling, and the respective intraclass correlation coefficients were 0.991 and 0.987, p<0.001. Divergent validation: 40 volunteers, 25 male, mean age of 49 years, and the mean global score was 2. Convergent validation of patients with good response to clinical treatment: 47 patients, 39 female, mean age of 60 and six years of schooling, and the pre- and post-treatment scores were 19 and 8, respectively (p<0.001). Convergent validation of refractory to clinical treatment patients: 75 patients, 70 female, mean age of 53 and seven years of schooling, and the global average score was 22. CONCLUSIONS: The Constipation Scoring System (Índice de Gravidade da Constipação Intestinal) validated for the Brazilian population is a reliable instrument for measuring the severity of intestinal chronic constipation.

Optimized two-stage time-truncated control chart for Weibull distribution.

In this article, an attribute control chart is proposed when the lifetime of a product follows a Weibull distribution in two-stage sampling, which is based on the number of failures from a truncated life test. The coefficients of the proposed double sampling attribute control chart and the test duration are determined so that the average run length when the process is in control is close to the target value. An overview is reported on how double sampling np control charts work. Tables reporting the out-of-control average run lengths are given for various shift parameters. A case study is given to illustrate the proposed control chart for industrial use. A comparison of two-stage and single-stage sampling of failure of products is discussed.

PIF4 enhances the expression of SAUR genes to promote growth in response to nitrate.

Nitrate supply is fundamental to support shoot growth and crop performance, but the associated increase in stem height exacerbates the risks of lodging and yield losses. Despite their significance for agriculture, the mechanisms involved in the promotion of stem growth by nitrate remain poorly understood. Here, we show that the elongation of the hypocotyl of Arabidopsis thaliana, used as a model, responds rapidly and persistently to upshifts in nitrate concentration, rather than to the nitrate level itself. The response occurred even in shoots dissected from their roots and required NITRATE TRANSPORTER 1.1 (NRT1.1) in the phosphorylated state (but not NRT1.1 nitrate transport capacity) and NIN-LIKE PROTEIN 7 (NLP7). Nitrate increased PHYTOCHROME INTERACTING FACTOR 4 (PIF4) nuclear abundance by posttranscriptional mechanisms that depended on NRT1.1 and phytochrome B. In response to nitrate, PIF4 enhanced the expression of numerous SMALL AUXIN-UP RNA (SAUR) genes in the hypocotyl. The growth response to nitrate required PIF4, positive and negative regulators of its activity, including AUXIN RESPONSE FACTORs, and SAURs. PIF4 integrates cues from the soil (nitrate) and aerial (shade) environments adjusting plant stature to facilitate access to light.

Liver immunopathogenesis in fatal cases of dengue in children: detection of viral antigen, cytokine profile and inflammatory mediators.

Introduction: Dengue virus (DENV), the etiologic agent of dengue fever illness, represents a global public health concern, mainly in tropical and subtropical areas across the globe. It is well known that this acute viral disease can progress to severe hemorrhagic stages in some individuals, however, the immunopathogenic basis of the development of more severe forms by these patients is yet to be fully understood. Objective: In this context, we investigated and characterized the histopathological features as well as the cytokine profile and cell subpopulations present in liver tissues from three fatal cases of DENV in children. Methods: Hematoxylin and Eosin, Periodic Acid Schiff and Picro Sirius Red staining were utilized for the histopathological analysis. Immunohistochemistry assay was performed to characterize the inflammatory response and cell expression patterns. Results: Vascular dysfunctions such as hemorrhage, vascular congestion and edema associated with a mononuclear infiltrate were observedin all three cases. Liver tissues exhibited increased presence of CD68+ and TCD8+ cells as well as high expression of MMP-9, TNF-a, RANTES, VEGFR-2 mediators. Viral replication was confirmed by the detection of NS3 protein. Conclusion: Taken together, these results evidenced key factors that may be involved in the development of severe alterations in liver tissues of children in response to DENV infection.

Feasibility and Performance of Free-Hand Single-Photon Computed Tomography/Ultrasonography for Preoperative Parathyroid Adenoma Localization: A Pilot Study.

The aim of this prospective pilot study was to evaluate the feasibility of a new hybrid imaging modality, free-hand single-photon computed tomography/ultrasonography (fhSPECT/US), for preoperative localization of parathyroid adenomas and to compare its performance with conventional ultrasonography and SPECT/CT. Twelve patients diagnosed with primary hyperparathyroidism underwent sequentially US and parathyroid scintigraphy, including SPECT/CT, followed by fhSPECT/US, allowing for real-time fusion between US and freehand-generated gamma-camera images. The fhSPECT/US detection rates were correlated with histopathology, when available, or with the imaging modality showing the most lesions. Based on a per patient analysis, the detection rate was significantly different when comparing SPECT/CT to fhSPECT/US (p = 0.03), and not significantly different when comparing SPECT/CT to US (p = 0.16) and US to fhSPECT/US (p = 0.08). Based on a per-lesion analysis, the detection rate of SPECT/CT was significantly higher than that of US (p = 0.01) and fhSEPCT/US (p = 0.003), and there was no significant difference in detection rate when comparing US to fhSPECT/US (p = 0.08). The main perceived limitations of fhSPECT/US in lesion detection were: (i) lesions localized at a depth ≥4.5 cm; (ii) imperfect image fusion due to tissue compression; (iii) limited spatial manipulation ability of the SPECT mobile camera handheld probe; and (iv) a wide spread of detected activity. In conclusion, clinical use of fhSPECT/US for localization of parathyroid adenomas is feasible, but shows lower sensitivity than conventional modalities and requires technical improvements.

The First Brazilian Cardiovascular Registry of Atrial Fibrillation: Primary Results of the RECALL Study.

BACKGROUND: It is estimated that atrial fibrillation (AF) affects approximately 1.5 million people in Brazil; however, epidemiological data are limited. We sought to evaluate the characteristics, treatment patterns, and clinical outcomes in patients with AF in Brazil by creating the first nationwide prospective registry. METHODS: RECALL was a multicenter, prospective registry that included and followed for 1 year 4,585 patients with AF at 89 sites across Brazil from April 2012 to August 2019. Patient characteristics, concomitant medication use, and clinical outcomes were analyzed using descriptive statistics and multivariable models. RESULTS: Of 4,585 patients enrolled, the median age was 70 (61, 78) years, 46% were women, and 53.8% had permanent AF. Only 4.4% of patients had a history of previous AF ablation and 25.2% had a previous cardioversion. The mean (SD) CHA2DS2-VASc score was 3.2 (1.6); median HAS-BLED score was 2 (2, 3). At baseline, 22% were not on anticoagulants. Of those taking anticoagulants, 62.6% were taking vitamin K antagonists and 37.4% were taking direct oral anticoagulants. The primary reasons for not using an oral anticoagulant were physician judgment (24.6%) and difficulty in controlling (14.7%) or performing (9.9%) INR. Mean (SD) TTR for the study period was 49.5% (27.5). During follow-up, the use of anticoagulants and INR in the therapeutic range increased to 87.1% and 59.1%, respectively. The rates/100 patient-years of death, hospitalization due to AF, AF ablation, cardioversion, stroke, systemic embolism, and major bleeding were 5.76 (5.12-6.47), 15.8 (14.6-17.0), 5.0 (4.4-5.7), 1.8 (1.4-2.2), 2.77 (2.32-3.32), 1.01 (0.75-1.36), and 2.21 (1.81-2.70). Older age, permanent AF, New York Heart Association class III/IV, chronic kidney disease, peripheral arterial disease, stroke, chronic obstructive pulmonary disease, and dementia were independently associated with increased mortality while the use of anticoagulant was associated with lower risk of death. CONCLUSIONS: RECALL represents the largest prospective registry of patients with AF in Latin America. Our findings highlight important gaps in treatment, which can inform clinical practice and guide future interventions to improve the care of these patients.

Hernia de Morgagni en la edad adulta / Morgagni's hernia in adulthood

Introducción: La hernia de Morgagni es una anomalía congénita rara, responsable del 3 por ciento de las hernias diafragmáticas, que provoca opacidades radiológicas paracardíaca y retroesternal que suelen confundirse con otras afecciones. Objetivo: Notificar el caso de un paciente adulto diagnosticado con hernia de Morgagni en el Hospital General Docente Dr. Antonio Luaces Iraolade Ciego de Ávila. Caso clínico: Se presenta el caso de un varón de 28 años de edad con antecedentes de contusión torácica severa, que presentó dolor abdominal, dispepsias, dolor recurrente en región baja posterior del hemitórax derecho, falta de aire ligera y tos seca. Con la aplicación de un correcto método clínico se excluyeron otros posibles diagnósticos planteados previamente y se concluyó con estudios imagenológicos como una hernia de Morgagni. Se realizó tratamiento quirúrgico mediante laparotomía convencional. La evolución fue favorable, sin complicaciones posoperatorias y con egreso hospitalario precoz. Conclusiones: Se notificó el caso de un paciente diagnosticado con hernia de Morgagni que constituyó un tipo raro de hernia en adultos, cuyo diagnóstico se debe tener en cuenta en pacientes con manifestaciones clínicas digestivas o respiratorias, que presentan radiopacidad paracardíaca en la radiografía de tórax. Es necesario realizar tratamiento quirúrgico oportuno para prevenir posibles complicaciones(AU)

Introduction: Morgagni's hernia is a rare congenital anomaly, responsible for 3percent of diaphragmatic hernias, which causes paracardiac and retrosternal radiological opacities that are often confused with other conditions. Objective: To report the case of an adult patient diagnosed with Morgagni's hernia at Dr. Antonio Luaces Iraola General Teaching Hospital from Ciego de Avila. Clinical casereport: We report the case of a 28-year-old man with history of severe chest contusion, who showed abdominal pain, dyspepsia, recurrent pain in the lower posterior region of the right hemithorax, slight shortness of breath, and dry cough. With the use of the correct clinical method, other possible diagnoses were excluded from what was previously raised. Imaging studies concluded to be a Morgagni hernia. Surgical treatment was performed by conventional laparotomy. The evolution was favorable, without postoperative complications and with early hospital discharge. Conclusions: The case of a patient diagnosed with Morgagni's hernia was reported. It constituted a rare type of hernia in adults. Its diagnosis should be taken into account in patients with digestive or respiratory clinical manifestations, showing paracardiac radiopacity on chest X-ray. Timely surgical treatment is necessary to prevent possible complications(AU)

Digital Planning for Immediate Implants in Anterior Esthetic Area: Immediate Result and Follow-Up after 3 Years of Clinical Outcome-Case Report.

In this case report, we demonstrate how the correct positioning of implants, associated with optimal gingival conditioning, and the correct choice of biomaterial can yield very predictable and fantastic aesthetic results. OBJECTIVE: We aimed to use dental implants to rehabilitate the area of elements #11 and #21 in a satisfactory surgical and prosthetic manner, using guided surgery, connective tissue, nano-biomaterials, and a porcelain prosthesis. CASE REPORT: A 32-year-old male patient presented with bone loss of elements #11 and #21, which was proven radiographically and clinically. Thus, oral rehabilitation with the use of dental implants was required. It was decided to proceed via digital planning with the DSD program (Digital smile design) and with the software Exoplan, (Smart Dent-Germany) whenever it was possible to plan immediate provisional and accurate dental implant positioning through reverse diagnostics (Software Exoplan, Smart Dent-German). The dental elements were extracted atraumatically; then, a guide was established, the implants were positioned, the prosthetic components were placed, the conjunctive tissue was removed from the palate and redirected to the vestibular wall of the implants, the nano-graft (Blue Bone®) was conditioned in the gaps between the vestibular wall and the implants, and, finally, the cemented provision was installed. RESULTS: After a 5-month accompaniment, an excellent remodeling of the tissues had been achieved by the implants; consequently, the final prosthetic stage could begin, which also achieved a remarkable aesthetic result. CONCLUSIONS: This report demonstrates that the correct planning of dental implants, which is associated with appropriate soft tissue and bone manipulation, allows for the achievement of admirable clinical results.

Constipation scoring system validated for the portuguese language (índice de gravidade da constipação intestinal): is it reliable in assessing the severity of intestinal chronic constipation in our population? / O instrumento constipation scoring system validado para a língua portuguesa (índice de gravidade da constipação intestinal): é confiável na avaliação da gravidade da constipação intestinal crônica em nossa população?

ABSTRACT BACKGROUND: There is a lack of valid and specific tools to measure chronic constipation severity in Brazil. AIMS: To validate the Constipation Scoring System for Brazilian spoken Portuguese. METHODS: Translation, cultural adaptation, and validation itself (reliability and convergent and divergent validation). Translation: definitive version from the original version's translation and evaluation by specialists. Cultural adaptation: score content analysis of the definitive version, as an interview to patients. Interobserver reliability: application by two researchers on the same day. Intraobserver reliability: same researcher at different times, in a 7-day interval. Divergent validation: non-constipated volunteers. Convergent validation: two groups, good response to clinical treatment and refractory to treatment. RESULTS: Cultural adaptation: 81 patients, 89% female, with mean age of 55 and seven years of schooling, and overall content validity index was 96.5%. Inter and intraobserver reliability analysis: 60 patients, 86.7% female, mean age of 56 and six years of schooling, and the respective intraclass correlation coefficients were 0.991 and 0.987, p<0.001. Divergent validation: 40 volunteers, 25 male, mean age of 49 years, and the mean global score was 2. Convergent validation of patients with good response to clinical treatment: 47 patients, 39 female, mean age of 60 and six years of schooling, and the pre- and post-treatment scores were 19 and 8, respectively (p<0.001). Convergent validation of refractory to clinical treatment patients: 75 patients, 70 female, mean age of 53 and seven years of schooling, and the global average score was 22. CONCLUSIONS: The Constipation Scoring System (Índice de Gravidade da Constipação Intestinal) validated for the Brazilian population is a reliable instrument for measuring the severity of intestinal chronic constipation.

RESUMO RACIONAL: No Brasil há escassez de instrumentos específicos e validados para a avaliação da gravidade da constipação intestinal crônica. OBJETIVOS: Validar o instrumento Constipation Scoring System para pacientes com constipação crônica. MÉTODOS: Tradução, adaptação cultural e validação propriamente dita. Tradução: versão definitiva a partir de traduções do original avaliadas por especialistas. Adaptação cultural: avaliação do conteúdo por entrevista a pacientes. Confiabilidade interobservadores: entrevista por dois pesquisadores no mesmo dia. Confiabilidade intraobservador: duas entrevistas pelo mesmo pesquisador (intervalo de 7 dias). Validação divergente: voluntários não constipados. Validação convergente: dois grupos, boa resposta e refratários ao tratamento clínico. RESULTADOS: Adaptação cultural: 81 pacientes, sendo 89% do sexo feminino, com média de idade de 55 anos e 7 anos de escolaridade. O índice de validade de conteúdo global foi de 96,5%. Confiabilidade interobservadores e intraobservador: 60 pacientes, sendo 86,7% do sexo feminino, com média de idade de 56 anos e 6 anos de escolaridade. O coeficiente de correlação intraclasse foi de 0,991 e 0,987 (p<0,001), respectivamente. Validação divergente: 40 voluntários, sendo 62,5% do sexo masculino, com média de idade de 49 anos e pontuação média: 0. Validação convergente dos pacientes com boa resposta do tratamento clínico: 47 pacientes, sendo 83% do sexo feminino, com média de idade de 60 anos e 6 anos de escolaridade. Os índices pré e pós-tratamento foram 19 e 8 (p<0,001), respectivamente. Validação convergente dos pacientes refratários ao tratamento clínico: 75 pacientes sendo 93% do sexo feminino, com média de idade de 53 anos e 7 anos escolaridade. A pontuação média foi 22. CONCLUSÕES: O Constipation Scoring System validado para população brasileira (Índice de Gravidade da Constipação Intestinal), é instrumento confiável para a aferição da gravidade da constipação intestinal crônica.

Immunopathology of Renal Tissue in Fatal Cases of Dengue in Children.

Dengue virus (DENV) infection represents a worldwide public health concern and can cause damage to multiple organs, including the kidney. In this work, we investigated the histopathological changes caused by dengue virus infection along with the detection of inflammatory mediators, cytokines, and cell expression patterns in the renal tissue of three fatal cases in children. Hematoxylin and Eosin staining was performed to analyze these histopathological changes. Immunohistochemistry allowed for the detection of immunological inflammatory markers in renal tissues that were quantified and further analyzed. Vascular congestion, edema and glomerular infiltrate were observed in the three cases, in addition to the thickening of the matrix area around the glomerular capillaries and mononuclear infiltrate associated with vascular congestion in the medullary region. The renal tissues exhibited collagen deposition and high expression of CD68+ Mø, CD8+ T, CD56+ cells and MMP-9, and the cytokine profile was mainly characterized by the expression of IFN-γ and TNF-α. Additionally, the expression of RANTES, VEGFR-2 and VCAM-1 were observed. The replication of DENV was evidenced by the detection of the NS3 protein. These results contributed to clarifying the main factors that may be involved in changes in the renal tissue of fatal cases of dengue in children.

Síndrome de Budd-Chiari secundario asociado a hepatitis alcohólica grave: reporte de caso / Secondary Budd-Chiari syndrome associated with severe alcoholic hepatitis: A case report

Resumen La hepatitis alcohólica es la inflamación aguda del hígado secundaria al consumo de alcohol en cantidades hepatotóxicas, su fisiopatología está influida por diversos factores asociados. El diagnóstico tiene tres escenarios: la hepatitis alcohólica probable, posible y definitiva. La hepatitis alcohólica probable se basa en el cumplimiento de criterios diagnósticos clínicos y laboratoriales; la hepatitis alcohólica posible corresponde a casos de cumplimiento de estos criterios, pero con presencia de factores potencialmente confusores del diagnóstico, y la definitiva se sustenta sobre una base histopatológica. El síndrome de Budd-Chiari es una entidad poco frecuente, heterogénea y potencialmente letal, caracterizada por la presencia de trombos a nivel de las venas suprahepáticas, así como de la vena cava inferior. El diagnóstico definitivo está basado en pruebas de imagen. Por su parte, el síndrome de Budd-Chiari secundario es una entidad aún más infrecuente, poco estudiada, cuyo diagnóstico es difícil debido a su gran similitud al síndrome de Budd-Chiari primario, tanto clínica como en imágenes diagnósticas, por lo que se tiene que acudir a métodos diagnósticos de mayor complejidad e incluso invasivos. A continuación, se presenta un caso inusual de un paciente con consumo crónico de alcohol que presenta síndrome de Budd-Chiari secundario asociado a hepatitis alcohólica grave confirmada mediante biopsia hepática y sometido a múltiples estudios de imagen que descartaron la presencia de trombosis a nivel de las venas suprahepáticas.

Abstract Alcoholic hepatitis is an acute inflammation of the liver secondary to the consumption of alcohol in hepatotoxic amounts; various associated factors influence its pathophysiology. The diagnosis has three scenarios: probable, possible, and definite alcoholic hepatitis. Probable alcoholic hepatitis is based on compliance with clinical and laboratory diagnostic criteria; possible alcoholic hepatitis corresponds to cases that meet these criteria but with potentially confounding factors in the diagnosis, and the definite one is based on histopathology. Budd-Chiari syndrome is a rare, heterogeneous, potentially lethal entity characterized by thrombi in the suprahepatic veins and the inferior vena cava. The final diagnosis relies on imaging tests. Moreover, secondary Budd-Chiari syndrome is an even rarer entity, little studied, whose diagnosis is difficult due to its remarkable similarity to primary Budd-Chiari syndrome, both clinically and in diagnostic images, for which more complex and even invasive diagnostic methods must be used. Then, we describe an unusual case of a male patient with chronic alcohol consumption presenting with secondary Budd-Chiari syndrome associated with severe alcoholic hepatitis confirmed by liver biopsy and subjected to multiple imaging studies that ruled out thrombosis in the suprahepatic veins.

SARS-CoV-2 Is Persistent in Placenta and Causes Macroscopic, Histopathological, and Ultrastructural Changes.

SARS-CoV-2 is a virus that belongs to the Betacoronavirus genus of the Coronaviridae family. Other coronaviruses, such as SARS-CoV and MERS-CoV, were associated with complications in pregnant women. Therefore, this study aimed to report the clinical history of five pregnant women infected with SARS-CoV-2 (four symptomatic and one asymptomatic who gave birth to a stillborn child) during the COVID-19 pandemic. They gave birth between August 2020 to January 2021, a period in which there was still no vaccination for COVID-19 in Brazil. In addition, their placental alterations were later investigated, focusing on macroscopic, histopathological, and ultrastructural aspects compared to a prepandemic sample. Three of five placentas presented SARS-CoV-2 RNA detected by RT-PCRq at least two to twenty weeks after primary pregnancy infection symptoms, and SARS-CoV-2 spike protein was detected in all placentas by immunoperoxidase assay. The macroscopic evaluation of the placentas presented congested vascular trunks, massive deposition of fibrin, areas of infarctions, and calcifications. Histopathological analysis showed fibrin deposition, inflammatory infiltrate, necrosis, and blood vessel thrombosis. Ultrastructural aspects of the infected placentas showed a similar pattern of alterations between the samples, with predominant characteristics of apoptosis and detection of virus-like particles. These findings contribute to a better understanding of the consequences of SARS-CoV-2 infection in placental tissue, vertical transmission.

EARLY FLOWERING 3 represses the nighttime growth response to sucrose in Arabidopsis.

Plant growth depends on the supply of carbohydrates produced by photosynthesis. Exogenously applied sucrose promotes the growth of the hypocotyl in Arabidopsis thaliana seedlings grown under short days. Whether this effect of sucrose is stronger under the environmental conditions where the light input for photosynthesis is limiting remains unknown. We characterised the effects of exogenous sucrose on hypocotyl growth rates under light compared to simulated shade, during different portions of the daily cycle. The strongest effects of exogenous sucrose occurred under shade and during the night; i.e., the conditions where there is reduced or no photosynthesis. Conversely, a faster hypocotyl growth rate, predicted to enhance the demand of carbohydrates, did not associate to a stronger sucrose effect. The early flowering 3 (elf3) mutation strongly enhanced the impact of sucrose on hypocotyl growth during the night of a white-light day. This effect occurred under short, but not under long days. The addition of sucrose enhanced the fluorescence intensity of ELF3 nuclear speckles. The elf3 mutant showed increased abundance of PHYTOCHROME INTERACTING FACTOR4 (PIF4), which is a transcription factor required for a full response to sucrose. Sucrose increased PIF4 protein abundance by post-transcriptional mechanisms. Under shade, elf3 showed enhanced daytime and reduced nighttime effects of sucrose. We conclude that ELF3 modifies the responsivity to sucrose according to the time of the daily cycle and the prevailing light or shade conditions.

The Factors for Success and Lack of Success in the Breast Cancer Patient Care Pathway: A Qualitative Study From the Health Care Staff Perspective.

Objective: To produce information about factors related to successful and unsuccessful breast cancer care pathways from the health care staff perspective. Materials and Methods: An electronic qualitative survey was used to collect data simultaneously from hospitals located in four different countries, focusing on four professional groups: diagnostic radiographers; radiation therapists; breast cancer nurses; and biomedical laboratory scientists (n = 23). The hospitals participating in the study treat breast cancer patients and research permits were applied from all of them. Data was analysed by deductive thematic analysis. Results: At the core of a successful breast cancer care pathway is the right content and timely information provided to the patient at the pace the patient is able to adopt. This is especially highlighted at the beginning of the treatment process. In regards to diagnostic services, rigorous execution of mammography, sampling techniques and analyses were seen as important. Staff also valued the importance of aftercare and follow-up, and highlighted the fact that the patient should be given a chance to keep in close contact with care and treatment staff, even after their active treatment process has finished. Conclusion: Health care staff recognized the same success factors for optimal breast cancer care and treatment pathways as patients reported in previous studies, yet more emphasis was put on patient characteristics and the technical performance features of the process. Both patient and staff viewpoints should be taken into account in planning breast cancer care pathways.

Cytokines and inflammatory mediators: Markers involved in interstitial damage to the pancreas in two dengue fever cases associated with acute pancreatitis.

Dengue viral (DENV) infections can lead to acute pancreatitis and associated tissue damage. This study examined the pancreas from two fatal cases of DENV for histopathological changes as well as for the detection of cytokines, and other inflammatory mediators. Tissue sections were prepared for examination by ultrastructural and histopathological techniques. Sections from the pancreas of non-infected individuals were prepared in parallel as a control. The presence of viral replication in macrophages was detected by co-staining for the proteins NS3 and CD68 by immunofluorescence. Immunohistochemistry was used to detect cells that expressed cytokines and inflammatory mediators to characterize the inflammatory response. Edema, acinar necrosis and fibrosis areas associated with a mononuclear infiltrate were found in infected tissues. The major site of virus replication appeared to be macrophages based on their exclusive presentation of the viral protein NS3. Pancreatic tissues from the infected individuals also displayed increased levels of high mobility group box-1, caspase-3, gelatinase B and tumor necrosis factor alpha compared to controls. The presence of virus replicating macrophages in the pancreas was associated with multiple changes in tissue structure that included elevated levels of cytokines and inflammatory markers that may differentiate acute pancreatitis due to DENV infections from other causes.

Página web para el estudio del modelo celular de la coagulación en la carrera de medicina y residencia de especialidades clínicas / Website For The Study Of The Cellular Model Of Coagulation In Medicine Major And The Residency Of Clinical Specialties

Introducción: El modelo de la coagulación ha experimentado cambios para alcanzar un consenso con relación a los trastornos hemorrágicos que se aprecian en la práctica médica. El modelo celular de la coagulación es el más aceptado con el que se cuenta dentro de esta área del conocimiento, sin embargo, es poco conocido e integrado en los planes de estudio en Cuba. Objetivo: Confeccionar una página web que integre los elementos actuales acerca del modelo celular de la coagulación. Materiales y métodos: Se realizó un estudio de tipo innovación tecnológica entre los meses de enero de 2017 y enero de 2018 en Ciego de Ávila. Se desarrolló en tres etapas: confección, validación por expertos y comprobación de efectividad por usuarios. Para el diseño se empleó el software Drupal, y el lenguaje HTML. Para la comprobación se contó con dos grupos de expertos que valorara desde el punto de vista de pertinencia educativa e informática. Se comprobó la efectividad mediante un posprueba aplicada a 106 estudiantes de medicina y 16 residentes. Resultados: Se obtuvieron valoraciones de adecuado y muy adecuado por consenso de expertos, siendo la originalidad (7,13 ± 1,24) y la pertinencia (7,20 ± 1,74) los aspectos mejor valorados. Más del 90 % de los usuarios valoraron igualmente la página web como muy satisfactorias según los contenidos tratados y la originalidad. Durante la posprueba el 84,91 por ciento de los estudiantes y 66,67 por ciento de los residentes se suscriben a la calificación de excelente. Conclusiones: Se confeccionó una página con la capacidad de integrar los elementos actuales acerca del modelo celular de la coagulación(AU)

Introduction: The coagulation model has undergone changes to reach a consensus regarding the bleeding disorders that are seen in medical practice. The cellular model of coagulation is the most accepted that is available within this area of knowledge; however, it is little known and integrated into the curricula in Cuba. Objective: Create a web page that integrates the current elements about the cellular model of coagulation. Materials and methods: A technological innovation study was carried out between January 2017 and January 2018 in Ciego de Ávila province. It was developed in three stages: preparation, validation by experts and verification of effectiveness by users. For the design was used Drupal software, and HTML language. For the verification, there were two groups of experts to assess from the point of view of educational and computer relevance. Effectiveness was tested by a post-test applied to 106 medical students and 16 residents. Results: Adequate and very adequate assessments were obtained by consensus of experts, with originality (7.13 ± 1.24) and relevance (7.20 ± 1.74) being the best valued aspects. More than 90 percent of users also rated the website as very satisfactory according to the contents treated and originality. During the post-test, 84.91 percent of students and 66.67 percent of residents confirmed the excellent rating. Conclusions: A web page was made with the ability to integrate the current elements about the cellular model of coagulation(AU)

Página web para el estudio del modelo celular de la coagulación en la carrera de medicina y residencia de especialidades clínicas / Website For The Study Of The Cellular Model Of Coagulation In Medicine Major And The Residency Of Clinical Specialties

Introducción: El modelo de la coagulación ha experimentado cambios para alcanzar un consenso con relación a los trastornos hemorrágicos que se aprecian en la práctica médica. El modelo celular de la coagulación es el más aceptado con el que se cuenta dentro de esta área del conocimiento, sin embargo, es poco conocido e integrado en los planes de estudio en Cuba. Objetivo: Confeccionar una página web que integre los elementos actuales acerca del modelo celular de la coagulación. Materiales y métodos: Se realizó un estudio de tipo innovación tecnológica entre los meses de enero de 2017 y enero de 2018 en Ciego de Ávila. Se desarrolló en tres etapas: confección, validación por expertos y comprobación de efectividad por usuarios. Para el diseño se empleó el software Drupal, y el lenguaje HTML. Para la comprobación se contó con dos grupos de expertos que valorara desde el punto de vista de pertinencia educativa e informática. Se comprobó la efectividad mediante un posprueba aplicada a 106 estudiantes de medicina y 16 residentes. Resultados: Se obtuvieron valoraciones de adecuado y muy adecuado por consenso de expertos, siendo la originalidad (7,13 ± 1,24) y la pertinencia (7,20 ± 1,74) los aspectos mejor valorados. Más del 90 por ciento de los usuarios valoraron igualmente la página web como muy satisfactorias según los contenidos tratados y la originalidad. Durante la posprueba el 84,91 por ciento de los estudiantes y 66,67 por ciento de los residentes se suscriben a la calificación de excelente. Conclusiones: Se confeccionó una página con la capacidad de integrar los elementos actuales acerca del modelo celular de la coagulación(AU)

Introduction: The coagulation model has undergone changes to reach a consensus regarding the bleeding disorders that are seen in medical practice. The cellular model of coagulation is the most accepted that is available within this area of knowledge; however, it is little known and integrated into the curricula in Cuba. Objective: Create a web page that integrates the current elements about the cellular model of coagulation. Materials and methods: A technological innovation study was carried out between January 2017 and January 2018 in Ciego de Ávila province. It was developed in three stages: preparation, validation by experts and verification of effectiveness by users. For the design was used Drupal software, and HTML language. For the verification, there were two groups of experts to assess from the point of view of educational and computer relevance. Effectiveness was tested by a post-test applied to 106 medical students and 16 residents. Results: Adequate and very adequate assessments were obtained by consensus of experts, with originality (7.13 ± 1.24) and relevance (7.20 ± 1.74) being the best valued aspects. More than 90 percent of users also rated the website as very satisfactory according to the contents treated and originality. During the post-test, 84.91 percent of students and 66.67 percent of residents confirmed the excellent rating. Conclusions: A web page was made with the ability to integrate the current elements about the cellular model of coagulation(AU)

Ultrastructural and Physicochemical Characterization of a Non-Crosslinked Type 1 Bovine Derived Collagen Membrane.

In this work, in vitro testing was used to study the properties of non-crosslinked type 1 bovine derived collagen membranes used in bone regeneration surgery. Collagen membranes were prepared, their surface roughness was quantified by interferometry, their morphology was observed by scanning electron microscopy (SEM) and transmission electron microscopy (TEM), their wettability was measured by the contact angle technique, their mechanical properties were investigated by tensile testing, their phase transformation temperatures were measured by Differential Scanning Calorimetry (DSC), and their biocompatibility was evaluated by immunological testing. The calorimetry tests showed that the membrane is formed only by type 1 collagen. The SEM observations showed that the morphology consists of layers of highly organized collagen fibers and patterns of striated fibrils typical of type 1 collagen. The small contact angle showed that the membrane is hydrophilic, with the possibility of rapid absorption of body fluids. The tensile tests showed that the membrane has enough elasticity, ductility, and mechanical strength for use in tissue regeneration. With the immunostaining technique, it was possible to confirm the membrane biocompatibility.

Histomorphometric Evaluation of Bone-Guided Regeneration in Maxillary Sinus Floor Augmentation Using Nano-Hydroxyapatite/Beta-Tricalcium Phosphate Composite Biomaterial: A Case Report.

BACKGROUND: The development of techniques in biomaterials design and production added to advanced surgical procedures which enabled better and more predictable clinical outcomes. Maxillary sinus floor augmentation (MSFA) is among the more studied bone-guided regeneration procedure in the literature. The MSFA could be considered the gold standard procedure for bone-guided regeneration as it provides suitable functional and aesthetic solutions to alveolar ridge atrophy due to tooth loss. PURPOSE: This study aimed to conduct a detailed histomorphometric evaluation of collagen production in SFAs bone-guided regeneration, using nano-hydroxyapatite/ß-tricalcium phosphate (nano-HA/ß-TCP) composite. PATIENTS AND METHODS: A 52-year-old female had the left upper second premolar condemned due to periodontal disease, then a tooth implant replacement was planned. Due to maxillary sinus pneumatization, the MSFA had to be done before implant placement. Nano-HA/ß-TCP composite (2g) was used in the MSFA procedure. After nine months of the healing process, during the Cone Morse implant installation process, bone samples were collected for histologic analysis (sirius red, hematoxylin/eosin, polarized microscopy). Six months after implant installation, a ceramic crown was installed according to the patient's request. RESULTS: Proper masticatory function and aesthetics were re-established. The histomorphometric evaluation indicated that nano-HA/ß-TCP composite did not show any area devoid of cellular activity in sirius red or hematoxylin/eosin staining and the percentage (%) of new bone collagen fibers was achieved using polarization technique evaluation. CONCLUSION: According to these results, nano-HA/ß-TCP composite presented clinical and histomorphometric properties suit to be used as bone-guided regeneration biomaterial in MSFA. Furthermore, nano-HA/ß-TCP composite provided a favorable nano-environment to bone cells, enhancing bone matrix production.