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Immunosuppressive therapy in decompensated cirrhotic patients with an indication for liver transplantation (LT) is controversial. This study aims to evaluate transplant-free survival rates in patients diagnosed with decompensated autoimmune hepatitis (AIH) with and without immunosuppressants (IS) treatment, and to identify predictors of mortality or LT. We retrospectively analyzed LT-evaluated consecutive patients with decompensated AIH at a single center, between 2013 and 2021. Patients were categorized into IS (IS Group) and non-IS (No IS Group). Survival curves for the 2 groups were evaluated using the Kaplan-Meier method, and differences were compared using the Log-rank test. Multiple regression analysis was conducted using Cox test. A total of 125 consecutive patients (mean age: 36.4 years; 81.6% female) were evaluated. The median transplant-free survival in the IS Group (72/125) were 22.6 months vs 6.57 months in the No IS Group (53/125) (P = .002). Cox-regression analysis revealed associations between moderate/severe ascites (hazard ratio [HR] = 2.37, 95% CI = 1.48-3.80, P = <.001) and MELD-Na (HR = 1.12, 95% CI = 1.08-1.16, P = <.001) with transplantation or death, while immunosuppression treatment acted protectively (HR = 0.55, 95% CI = 0.86-0.85, P = .008). Analyzing patients with MELD >22 (27/125) showed a loss of IS protective effect (OR = 0.45, 95% CI = 0.17-1.20, P = .11), and the presence of moderate/severe ascites increased the risk of death/LT (HR = 5.86, 95% CI = 1.26-27.2, P = .02). Autoimmune decompensated cirrhosis is associated with high overall mortality, and IS improves the transplant-free survival rate. In patients with MELD-Na >22, treatment ceases to be beneficial, especially if they have moderate/severe ascites. These patients, if receiving immunosuppression, may be disadvantaged in the possibility of accessing LT.

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BACKGROUND: Liver transplantation is the treatment of choice in patients with chronic liver disease and acute liver failure of any etiology. Scales such as the Survival Outcome Following Transplantation (SOFT) score and the Balance of Risk (BAR) score can be used to predict survival. In this study, we compared these scales in the Mexican population. METHODS: A cross-sectional analytical study was carried out in a Mexican third-level transplant center. The MELD, SOFT, and BAR scales were adopted. The ROC curves of the three predictive scores were constructed, and the areas under the curve were obtained and compared. A bivariate analysis and Cox regression were performed. Finally, a survival analysis was performed using Kaplan-Meier curves. RESULTS: We analyzed 123 liver transplant (LT) recipients. The bivariate analysis and Cox regression indicated that portal thrombosis, with an HR of 3.36 (IC 1.069-10.59, p = 0.038), and the number of red blood cells transfused, with an HR of 1.084 (CI 1.039-1.130, p < 0.000), were significantly associated with mortality. The receiver height was a protective factor, with an HR of 0.001 (CI 0.000-0.761, p = 0.041). Regarding the Pearson correlation analysis, the BAR scale had a coefficient of 0.199 (p = 0.032) for transfusion, while the SOFT scale's correlation coefficients for cold ischemia and transfusion were 0.236 (p = 0.011) and 0.274 (p = 0.003), respectively, all indicating weak correlations. The areas under the curve (AUCs) of MELD, SOFT, and BAR in predicting 3-month mortality were 0.495 (P = 0.94), 0.608 (p = 0.129), and 0.502 (p = 0.97), respectively. Finally, in the survival analysis using Kaplan-Meier curves, an estimated mean survival period of 71.52 months was obtained, with a survival rate of 89.3 % at 30 days and 81.1 % at five years. CONCLUSION: In this study, it was found that all three scales were deficient in discriminating among the outcomes obtained in the Mexican population.

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PURPOSE: To compare the self-perception of vocal fatigue and insomnia severity between teachers at risk and not at risk for dysphonia and between men and women. METHOD: The study included 120 female and 80 male teachers from various teaching levels. All participants completed self-assessment questionnaires on their working conditions, the Screening Index for Voice Disorder (SIVD), the Vocal Fatigue Index (VFI), and the Insomnia Severity Index (ISI). Teachers were grouped into those at risk (DG) and not at risk for dysphonia (NDG). RESULTS: Both DG and NDG reported noise, stress, and dust in the work environment. These factors were more frequent in DG, which also scored above the cutoff for all VFI factors, while NDG scored high in Factor I and the total score but scored below the cutoff in Factor IV. Analysis per gender revealed no difference between DG and NDG among males, except for Factor IV. Among females, Factor IV scores were above the cutoff in DG. ISI indicated all participants had subthreshold insomnia. CONCLUSION: Teachers often had symptoms of vocal fatigue and subthreshold insomnia regardless of the risk for dysphonia. However, DG teachers had higher scores on both protocols. Also, DG females recovered from vocal fatigue symptoms after vocal rest, unlike their counterparts who were not at risk. Both DG and NDG males and females experienced vocal fatigue and limitations, but only those at risk recovered after vocal rest.

OBJETIVO: Comparar autopercepção de fadiga vocal e gravidade da insônia de professores com e sem risco para disfonia, bem como entre homens e mulheres. MÉTODO: Participaram 120 professoras e 80 professores, de vários níveis de ensino. Todos responderam aos questionários de autoavaliação: condições de trabalho docente, Índice de Triagem de Distúrbios da Voz-ITDV, Índice de Fadiga Vocal-IFV e Índice de Gravidade da Insônia-IGI. Os professores foram distribuídos em grupo com risco (GD) e sem risco para disfonia (GND). RESULTADOS: GD e GND relataram ruído, estresse e poeira no ambiente de trabalho, sendo mais frequentes no GD. No IFV, GD apresentou escores acima dos valores de corte para todos os fatores, enquanto GND apresentou valores elevados para o fator-I e total, e valores abaixo da nota de corte para o fator-IV. Na análise por gênero, não houve diferença no grupo masculino entre GD e GND apenas para o fator-IV. Para as professoras, o fator-IV apresentou escore acima do valor de corte para GD. Quanto ao IGI, todos apresentaram insônia subliminar. CONCLUSÃO: Independente do risco para disfonia, professores apresentaram frequente sintomatologia de fadiga vocal e insônia subliminar, porém, professores com risco para disfonia apresentaram escores mais elevados para ambos os protocolos. Além disso, professoras com risco para disfonia recuperam sintomas de fadiga vocal após repouso vocal, o que não ocorreu com as professoras sem risco. Os professores com e sem risco para disfonia apresentaram fadiga e limitação vocal, sendo que apenas os professores com risco se recuperam após repouso vocal.

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TNF and IFN-γ are key proinflammatory cytokines implicated in the pathophysiology of COVID-19. Toll-like receptor (TLR)7 and TLR8 are known to recognize SARS-CoV-2 and induce TNF and IFN-γ production. However, it is unclear whether TNF and IFN-γ levels are altered through TLR-dependent pathways and whether these pathways mediate disease severity during COVID-19. This study aimed to investigate the association between TNF/IFN-γ levels and immune cell activation to understand their role in disease severity better. We enrolled 150 COVID-19 patients, who were classified by their systemic TNF and IFN-γ levels (high (H) or normal-low (N-L)) as TNFHIFNγH, TNFHIFNγN-L, TNFN-LIFNγH, and TNFN-LIFNγN-L. Compared to patients with TNFN-LIFNγN-L, patients with TNFHIFNγH had high systemic levels of pro- and anti-inflammatory cytokines and cytotoxic molecules, and their T cells and monocytes expressed TNF receptor 1 (TNFR1). Patients with TNFHIFNγH presented the SNP rs3853839 to TLR7 and increased levels of MYD88, NFκB, and IRF7 (TLR signaling), FADD, and TRADD (TNFR1 signaling). Moreover, critical patients were observed in the four COVID-19 groups, but patients with TNFHIFNγH or TNFHIFNγN-L most required invasive mechanical ventilation. We concluded that increased TNF/IFN-γ levels are associated with hyperactive immune cells, whereas normal/low levels are associated with hypoactivity, suggesting a model to explain that the pathophysiology of critical COVID-19 may be mediated through different pathways depending on TNF and IFN-γ levels. These findings highlight the potential for exploring the modulation of TNF and IFN-γ as a therapeutic strategy in severe COVID-19.

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BACKGROUND: Vitamin D is beneficial for musculoskeletal health. Although low levels of vitamin D are linked to increased pain in knee osteoarthritis (OA), their association with functionality remains understudied. OBJECTIVE: This study aimed to investigate the association between vitamin D deficiency and functional status in elderly individuals with OA and explore the potential correlation between vitamin D deficiency and plasma levels of tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6). METHODS: The study included older adults (≥60 years) from an ageing study, encompassing 105 OA patients and 152 controls. OA diagnosis was confirmed radiographically, and the WOMAC questionnaire assessed functional impairment in these patients. Blood samples were collected to measure 25(OH) vitamin D levels by chemiluminescence and TNF-α and IL-6 levels by ELISA. RESULTS: Patients with vitamin D insufficiency/deficiency exhibited more severe cases of OA compared to those with normal vitamin D levels (p = 0.04). Vitamin D levels were inversely correlated with functional impairment in OA, according to the WOMAC Index (global: rS = -0.25, p = 0.01; pain: rS = -0.21, p = 0.03). Moreover, OA patients with vitamin D deficiency showed significantly higher levels of TNF-α and IL-6 (p < 0.05, Mann-Whitney test). CONCLUSIONS: Reduced levels of vitamin D are associated with more severe cases of hip and knee osteoarthritis, increased pain, greater functional impairment, and elevated serum levels of TNF-α and IL-6. Further research is required to elucidate the mechanisms underlying the influence of vitamin D on osteoarthritis and to evaluate the potential benefits of vitamin D supplementation for mitigating disease symptoms and progression.

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BACKGROUND: In the last decade, several studies have proven the effectiveness of low-intensity shock waves (LI-ESWT), but with several factors that make it difficult to carry out systematic reviews. AIM: To demonstrate the effectiveness of LI-ESWT and define the best tool for routine clinical assessment of erectile dysfunction. MATERIALS AND METHODS: Twenty-one participants with purely vasculogenic erectile dysfunction were selected and randomized to LI-ESWT or placebo. All patients underwent evaluation with The International Index of Erectile Function (IIEF-5), V-EHS (new visual scale), and standardized penile doppler ultrasound before and after shock wave therapy. OUTCOMES: LI-ESWT has proven effective in the treatment of moderate erectile dysfunction, and the new V-EHS has demonstrated greater accuracy than Doppler in the diagnosis and follow-up of erectile dysfunction. RESULTS: Using the IIEF-5 as a control tool, we observed a clinical response after 1 month, with a greater increase in the shock wave therapy arm of +3.21 points compared to + 0.57 in the sham group. At six months, the treated group showed a mean increase of 4.71 points compared to baseline (p = 0.006), while those who received sham therapy had a decrease (case = +4.71 points vs. sham control = -1.0, p = 0.006). Based on this observed difference, we performed a comparative analysis between the V-EHS and penile doppler ultrasound to observe whether the test results corroborated the IIEF-5 findings. The correlation between V-EHS and IIEF-5 in the therapy group in the pre-therapy period was strong (r = 0.816, p < 0.001), and at 6 months it increased to very strong (r = 0.928, p < 0.001). Penile Doppler ultrasound did not show the same correlation strength with IIEF-5, presenting a moderate correlation at 6 months (Pearson correlation score = 0.540), as also demonstrated in the ROC curve through the V-EHS AUC = 0.963 (p = 0.001) vs. Doppler AUC = 0.713 (p = 0,290). Strengths and Limitations: The main strengths of the present study are the blinded, randomized, placebo-controlled clinical trial and the comparison between penile Doppler and a new visual classification for erection hardness score. The limitations are the number of patients and the short follow-up. CONCLUSIONS: LI-ESWT has proven effective in the treatment of moderate vasculogenic erectile dysfunction, with optimal results at 6 months. The new V-EHS offers a simple, reliable and reproducible assessment of erectile function.

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PURPOSE: to describe sociodemographic characteristics of individuals with multiple sclerosis and correlate and compare vocal fatigue, voice handicap, and voice-related quality of life of individuals with and without the disease. METHODS: Cross-sectional, quantitative study with 52 volunteers with multiple sclerosis and 52 control volunteers, matched by sex, age, and education level. Sociodemographic and clinical data were collected through a questionnaire and medical record analysis. Participants responded to the reduced Voice Handicap Index (VHI-10), Vocal Fatigue Index (VFI), and Voice-Related Quality of Life (V-RQOL). Correlational and comparative analyses were performed, with a 5% significance level (p < 0.05). RESULTS: There was a greater predominance of females diagnosed with multiple sclerosis, with a mean age of 40 years, who graduated from high school, and with a relapsing-remitting disease course. Voice handicap was positively correlated with vocal fatigue, and voice handicap and vocal fatigue were negatively correlated with voice-related quality of life in both groups. Participants with multiple sclerosis exceeded the VHI-10 and VFI cutoff scores and were below the V-RQOL cutoff score. CONCLUSION: There was a prevalence of the disease in young, educated females with relapsing-remitting disease. The greater the voice handicap and/or vocal fatigue, the lower the voice-related quality of life in both groups. However, people with multiple sclerosis self-reported greater voice handicap and vocal fatigue and poorer voice-related quality of life.

OBJETIVO: descrever características sociodemográficas de indivíduos com esclerose múltipla, correlacionar e comparar a fadiga, desvantagem vocal e a qualidade de vida em voz de indivíduos com e sem a doença. MÉTODO: Estudo transversal, quantitativo e com 52 voluntários com esclerose múltipla e 52 voluntários-controle, pareados por sexo, idade e escolaridade. Dados sociodemográficos e clínicos foram coletados com questionário e análise de prontuários. Os participantes responderam ao Índice de Desvantagem Vocal reduzido (IDV-10), Índice de Fadiga Vocal (IFV) e Qualidade de Vida em Voz (QVV). Análises correlacionais e comparativas foram realizadas, com um nível de significância de 5% (p<0,05). RESULTADO: Maior predomínio de participantes diagnosticados com esclerose múltipla do sexo feminino, média de 40 anos, ensino médio completo e curso da doença do tipo remitente-recorrente. Houve correlação positiva entre a desvantagem e a fadiga vocal, e correlação negativa entre a desvantagem e fadiga vocal com a qualidade de vida em voz em ambos os grupos. Além disso, os participantes com esclerose múltipla ultrapassaram as notas de corte do IDV-10 e do IFV e ficaram abaixo da nota de corte do QVV. CONCLUSÃO: Houve prevalência da doença em indivíduos jovens do sexo feminino, escolarizados e do tipo remitente-recorrente. Quanto maior a desvantagem e/ou a fadiga vocal, menor é a qualidade de vida em voz em ambos os grupos. No entanto, pessoas com esclerose múltipla autorreferem maior desvantagem e fadiga vocal, além de menor qualidade de vida relacionada à voz.

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An association between bruxism and musculoskeletal disorders, such as neck pain, has been established. This study investigated the association of possible sleep bruxism (PSB) activities, including grinding, bracing, and thrusting, with smartphone use, smartphone-induced neck pain, and sleep features. This cross-sectional study involved 403 Brazilian adolescents aged 11 to 19 years. A self-administered questionnaire was used to assess the severity of PSB, smartphone use, smartphone-induced neck pain, and sleep features (sleep duration and quality and history of nightmares). Sociodemographic factors, as well as snoring and drooling on the pillow, were considered potential confounders and were assessed based on reports from parents/caregivers. Participants were selected using multiple-stage sampling. Descriptive analysis and multinomial regression were performed (p ≤ 0.05). Adolescents reporting nightmares at least once a month (OR = 3.402; 95%CI: 1.315-8.802) and sometimes experiencing smartphone-induced neck pain (OR: 3.697, 95%CI: 1.103-12.388) were more likely to report moderate/severe grinding. Drooling on the pillow (OR = 3.105, 95%CI: 1.316-7.329), poor/fairly good sleep quality (OR = 2.717, 95%CI: 1.279-5.770), and smartphone-induced neck pain (OR = 3.227, 95%CI: 1.121-9.285) were associated with mild bracing. Adolescents experiencing nightmares once a week (OR = 3.209, 95% CI: 1.202- 8.565) had a higher prevalence of mild thrusting. Self-reported smartphone-induced neck pain, nightmares, poor/fairly good sleep quality, and drooling on the pillow were associated with a higher prevalence of PSB activities among Brazilian adolescents. Clinicians and researchers are encouraged to include assessments of smartphone use and sleep features in anamnesis, promoting a comprehensive approach to PSB, from diagnosis to treatment.

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Background: The angiotensin-converting enzyme 2 (ACE2) and the transmembrane serine protease 2 (TMPRSS2) are central human molecules in the SARS-CoV-2 virus-host interaction. Evidence indicates that ACE1 may influence ACE2 expression. This study aims to determine whether ACE1, ACE2, and TMPRSS2 mRNA expression levels, along with the ACE1 Alu 287 bp polymorphism (rs4646994), contribute to the severity and mortality of COVID-19. Methods: Swabs were collected in two Brazilian cities in 2020: Belo Horizonte (n = 134) and Rio de Janeiro (n = 41). A swab of mild patients in Rio de Janeiro who were not hospitalized (n = 172) was also collected. All analyzed biological material was obtained from residual diagnostic samples in 2020, prior to the emergence of SARS-CoV-2 variants of concern. ACE1, ACE2, TMPRSS2, and B2M (reference gene) expression levels were evaluated in 40 cycles of quantitative PCR. ACE1 Alu 287 bp polymorphism was genotyped using the FastStart Universal SYBR Green Master kit. Results: The median age differed between clinical sites (p = 0.016), but no difference in median days of hospitalization was observed (p = 0.329). Age was associated with severity (p = 0.014) and mortality (p = 0.014) in the Belo Horizonte cohort. No alteration in ACE1, ACE2 and TMPRSS2 expression was associated with severity or mortality. ACE1 polymorphism rs4646994 did not influence the likelihood of either outcome. A meta-analysis including available data from the literature showed significant effects: the D-allele conferred risk (OR = 1.39; 95% CI [1.12-1.72]).

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OBJECTIVES: To compare the impact of COVID-19 on the clinical status and psychological distress of patients with immune-mediated rheumatic disease (IMRD) caused by SARS-CoV-2 infection with that of noninfected IMRD controls during a 6-month follow-up period. METHODS: The ReumaCoV Brazil is a longitudinal study designed to follow IMRD patients for 6 months after COVID-19 (patients) compared with IMRD patients without COVID-19 (controls). Clinical data, disease activity measurements and current treatments regarding IMRD and COVID-19 outcomes were evaluated in all patients. Disease activity was assessed through validated tools at inclusion and at 3 and 6 months post-COVID-19. Fatigue, using FACIT-F (Functional Assessment of Chronic Illness Therapy) and psychological distress, using DASS 21 (Depression, Anxiety and Stress Scale - 21 Items), used to evaluated psychological distress, were evaluated at 6 months after COVID-19 in both groups. The significance level was set as p < 0.05, with a 95% confidence interval. RESULTS: A total of 601 patients were evaluated-321 patients (IMRD COVID-19 + patients) and 280 controls (IMRD COVID-19- patients)-who were predominantly female with similar median ages. Disease activity assessment over a 6-month follow-up showed no significant difference between cases and controls. Although the mean activity scores did not differ significantly, some patients reported worsened disease activity post-COVID-19, particularly in rheumatoid arthritis (RA) (32.2%) and systemic lupus erythematosus (SLE) patients (23.3%). Post-COVID-19 worsening in RA patients correlated with medical global assessment (MGA) and CDAI scores, with a moderate to large effect size. Diabetes mellitus showed a positive association (OR = 7.15), while TNF inhibitors had a protective effect (OR = 0.51). Fatigue, depression, anxiety, and stress were significantly greater in patients than in controls. Worse disease activity post-COVID-19 correlated with worse FACIT-F and DASS-21 scores in RA patients. No significant associations were found between COVID-19 outcomes and post-COVID-19 disease activity, FACIT-F or DASS-21. CONCLUSIONS: Post-COVID-19 IMRD patients exhibited significant fatigue, depression, anxiety, and stress, which can be mistaken for disease activity, despite having similar disease activity scores. The variability in reports on IMRD flares and the potential triggering of SARS-CoV-2 for autoimmune manifestations underscore the need for detailed clinical assessment and a comprehensive approach to managing them.

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BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is a common and severe form of acute myocardial infarction (AMI). OBJECTIVES: The study aimed to investigate the relationship between serum nitric oxide (NO) and endothelin-1 (ET-1) levels with the severity of STEMI and their predictive value for major adverse cardiovascular events (MACE) within one year after percutaneous coronary intervention (PCI) in STEMI patients. METHODS: The retrospective study was conducted on 269 STEMI patients who underwent PCI. The patients were categorized into two groups: those who developed MACE (112 cases) and those who did not (157 cases) within one year. NO and ET1 levels were measured in collected serum using enzyme-linked immunosorbent assay. Receive-operating characteristics (ROC) curve was used to analyze the prognostic potential of NO and ET1 individually and in combination, p<0.05 was considered statistically significant. RESULTS: Significant differences were noted between the two groups concerning age, Killip classification, left ventricular ejection fraction, cardiac troponin I (cTnI), creatine kinase-MB (CK-MB), as well as serum NO and ET-1 levels. The study observed that patients who developed MACE had lower serum NO and higher ET-1 levels upon admission. Further analysis revealed a significant inverse relationship between serum NO and ET-1 levels and the severity of myocardial infarction. A combined detection model, -0.082 * NO + 0.059 * ET-1, demonstrated promising prognostic value for the occurrence of MACE within one year post-PCI. CONCLUSIONS: Serum NO and ET-1 levels serve as valuable prognostic markers for MACE in STEMI patients undergoing PCI, exhibiting a strong correlation with AMI severity.

FUNDAMENTO: O infarto do miocárdio com elevação do segmento ST (IAMCSST) é uma forma comum e grave de infarto agudo do miocárdio (IAM). OBJETIVOS: O estudo teve como objetivo investigar a relação entre os níveis séricos de óxido nítrico (NO) e endotelina-1 (ET-1) com a gravidade do IAMCSST e seu valor preditivo para eventos cardiovasculares adversos maiores (MACE) dentro de um ano após intervenção coronária percutânea (ICP) em pacientes com IAMCSST. MÉTODOS: O estudo retrospectivo foi conduzido em 269 pacientes com IAMCSST submetidos a ICP. Os pacientes foram categorizados em dois grupos: aqueles que desenvolveram MACE (112 casos) e aqueles que não desenvolveram (157 casos) em um ano. Os níveis de NO e ET-1 foram medidos no soro coletado usando ensaio imunoenzimático. A curva ROC (Receive-Operating Characteristics) foi usada para analisar o potencial prognóstico de NO e ET-1 individualmente e em combinação, p<0,05 foi considerado estatisticamente significativo. RESULTADOS: Foram observadas diferenças significativas entre os dois grupos em relação à idade, classificação de Killip, fração de ejeção do ventrículo esquerdo, troponina I cardíaca (cTnI), creatina quinase-MB (CK-MB), bem como níveis séricos de NO e ET-1. O estudo observou que pacientes que desenvolveram MACE tinham níveis séricos mais baixos de NO e níveis mais altos de ET-1 na admissão. Análises posteriores revelaram uma relação inversa significativa entre os níveis séricos de NO e ET-1 e a gravidade do infarto do miocárdio. Um modelo de detecção combinado, -0,082 * NO + 0,059 * ET-1, demonstrou valor prognóstico promissor para a ocorrência de MACE dentro de um ano após a ICP. CONCLUSÕES: Os níveis séricos de NO e ET-1 servem como marcadores prognósticos valiosos para MACE em pacientes com STEMI submetidos a ICP, exibindo uma forte correlação com a gravidade do IAM.

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BACKGROUND: Limited knowledge exists on the association between lifestyle factors and pain severity in older adults. OBJECTIVE: To assess the associations between unhealthy lifestyle variables and pain severity in the European population of older adults with pain. DESIGN: Cross-sectional. METHODS: Data were retrieved from the ninth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), a representative survey of individuals aged >50 years living in 27 European countries and Israel. Associations between lifestyle factors (sleep, smoking, diet and physical inactivity) and pain severity (mild, moderate, severe) were assessed using multivariable multinomial regression adjusted for age, sex, geographic region, education, history of chronic disease and mutually adjusted for each lifestyle. RESULTS: 27,528 cases were included (73.1 ± 9.76 years; 63.3% female). A significant association was observed between those who hardly ever or never engaged in activities that required a moderate level of energy and severe pain (OR: 4.35; 95% CI: 3.85 to 4.92). Sleep problems (OR: 1.83; 95% CI: 1.69 to 1.99), smoking (OR: 1.21; 95% CI: 1.13 to 1.34) and an inadequate diet (OR: 1.78: 95% CI: 1.22 to 2.61) were also significantly associated with severe pain, but with lower odds. Given the cross-sectional design, the bidirectionality of these relationships should be considered. CONCLUSION: Physically inactive older adults were particularly more likely to experience severe pain, while other lifestyle factors were more weakly associated with pain. As these lifestyle factors are modifiable, the results may be useful in prioritising appropriate preventive measures to attenuate pain and ensure healthy ageing.

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OBJECTIVE: Saliva is a rich-bodily fluid with recognized clinical diagnosis roles. This research aimed to investigate the salivary proteomic signatures for MIH in children with distinct degrees of severity. MATERIALS AND METHODS: In this cross-sectional study, 50 schoolers (8-13 years) were equally assigned into the following groups: G1 (Control group-Healthy first permanent molars), G2 (Mild MIH with white/creamy opacity and free of caries), G3 (Mild MIH with yellow/brown opacity and free of caries), G4 (Severe MIH with white/creamy, yellow/brown opacities including post-eruptive fracture and free of caries), G5 (Severe MIH with white/creamy, yellow/brown opacities, post-eruptive fracture, and caries). Unstimulated saliva samples were collected and later explored using mass spectrometry analysis. RESULTS: In total, 6,471 proteins were found, 5,073 exclusively from MIH children, and 778 overlapping among the different degrees of the disturb. The biological pathways displayed distinct patterns among the groups, which differed according to the MIH degrees. Gene-Ontology differences might not be verified regarding the biological processes and cellular components. Conversely, concerning molecular function, alterations among groups were evident, with proteins that would contribute to MIH in children with the severe condition (i.e., calcium ion binding, microtubule binding, platelet-derived growth factor binding). CONCLUSION: The results of this study support important salivary proteomics changes in MIH children according to distinct degrees of severity, reinforcing the interplay between the clinical characteristics and changes in the salivary proteome. CLINICAL RELEVANCE: Changes occurring in the salivary proteomics of children with distinct degrees of severity of Molar Incisor Hypomineralization (MIH) might be promising biomarkers and valuable information in clinical care, helping professionals make better clinical decisions and helping patients to understand their disturbance.

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Background: Thyroid eye disease (TED) is the most prevalent extrathyroidal manifestation of Graves' disease (GD). Emerging evidence suggests a relationship between elevated total and low-density lipoprotein (LDL) cholesterol levels and TED. This study aimed to investigate this correlation in the Brazilian population by analyzing data from two tertiary care centers. Methods: Data were collected from GD patients treated with methimazole between 1999 and 2021, excluding those receiving other treatments. Laboratory results and information on smoking habits, statin use and medications affecting lipid profiles during the euthyroid state were analyzed. Results: Smoking and elevated LDL cholesterol levels were significantly associated with TED activity and severity. Logistic regression revealed correlations between higher LDL cholesterol, total cholesterol and increased clinical activity score (P < 0.01, OR: 1.012, 95% CI: 1.003-1.021; P < 0.01, OR: 1.010, 95% CI: 1.002-1.018). These were also associated with more severe disease forms as defined by EUGOGO (P < 0.01, OR: 1.015, 95% CI: 1.006-1.024; P < 0.005, OR: 1.011, 95% CI: 1.004-1.019). Multiple regression confirmed that TED activity was significantly correlated with LDL cholesterol (P < 0.01) and smoking status (P < 0.01). Disease severity was associated with reduced HDL cholesterol (P < 0.05, OR: 0.973, 95% CI: 0.948-0.999), elevated LDL cholesterol (P < 0.005, OR: 1.013, 95% CI: 1.004-1.023) and active smoking (P < 0.05, OR: 2.881, 95% CI: 1.190-6.971). Conclusion: Elevated LDL cholesterol may serve as a potential indicator of TED. Further research is needed to determine whether lipid-lowering interventions could reduce TED risk or improve its management.

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BACKGROUND: Suicidal ideation (SI) poses a significant global health concern, particularly among hospitalized individuals, with gaps in understanding its contributing factors in low and middle-income countries like Peru. METHODS: Using a cross-sectional design, this study examined 940 patients evaluated by the Consultation-Liaison Psychiatry Unit at a major Peruvian general hospital. Sociodemographic and clinical characteristics were assessed, employing standardized instruments such as the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire-15 (PHQ-15), and Clinical Global Impressions (CGI). The prevalence of SI and its associations were explored through bivariate and multivariate analyses. RESULTS: The prevalence of SI was 19.7%, with notable associations found in patients experiencing moderate-to-severe depression (36.8%) and those rated as moderately to severely ill on CGI (33.2%). Multivariate analysis confirmed these associations, highlighting link with retirement (aPR = 1.53, 95% CI = 1.04-2.26, p = 0.032), clinical severity (aPR = 1.41, 95% CI = 1.22-1.63, p < 0.0001), and depressive symptoms (aPR = 2.98, 95% CI = 2.13-4.17, p < 0.0001) on SI. CONCLUSION: This study provides insights into factors associated with SI among hospitalized patients. Identifying risk factors, such as retirement, clinical severity, and depressive symptoms, underscores the need for targeted interventions to address SI within the Peruvian general hospital setting.

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In this study, data from 7,440 patients from six Ibero-American countries were analyzed, focusing on men who consulted for erectile dysfunction (ED). Participants were queried about infidelity in their relationships. Results showed a negative correlation between infidelity and the severity of ED, suggesting that the likelihood of infidelity decreases as the severity of ED increases. Additionally, alcohol consumption and age were identified as significant predictors of infidelity, with notable country-specific variations. No significant associations were found between infidelity and other variables such as comorbidities affecting erectile function, sexual activity frequency, or suspected hypogonadism, measured using the AMS questionnaire.

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Background: MiR-155 plays a role in inflammatory pathways and cardiovascular diseases, though its relationship with inflammation, atherosclerosis, and outcomes in ST-elevation myocardial infarction (STEMI) is not well established. Objective: To investigate associations between miR-155 levels, inflammation, atherosclerotic burden, and major adverse cardiovascular events (MACE) in STEMI patients. Methods: Sixty-nine STEMI patients and 16 healthy controls were recruited from a specialized university-affiliated cardiovascular center. MiR-155 expression and serum interleukin (IL)-1ß, IL-6, and tumor necrosis factor levels were measured. Patients were grouped into tertiles based on miR-155 expression. Clinical data, atherosclerotic burden (through cardiac catheterization), and in-hospital MACE were recorded. Results: MiR-155 levels were significantly lower in STEMI patients compared to controls (median 54.2, vs. 152.8 arbitrary units; p = 0.003). Higher miR-155 tertiles were associated with a greater prevalence of three-vessel occlusion (34% vs. 13% vs. 4%; p = 0.007) and increased incidence of pulmonary edema (13% vs. 0% vs. 0%; p = 0.030). No significant correlation was found between miR-155 and inflammatory or myocardial markers. Conclusion: Dysregulated miR-155 expression in STEMI patients may influence disease severity and MACE risk, independent of inflammation or myocardial damage markers.

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BACKGROUND: Parkinson's disease (PD) is characterized by motor and non-motor features. There are several proposed clinical markers to define disease severity. However, if rapid eye movement sleep behavior disorder (RBD) is associated with worse prognosis of both motor and non-motor findings in PD is unknown. OBJECTIVE: To determine whether RBD is a marker of PD clinical severity. METHODS: We cross-sectionally compared patients according to the presence of RBD and used Hoehn Yahr, Schwab and England (ADL), MDS-UPDRS, brain magnetic resonance, polysomnography and autonomic reactivity tests to evaluate PD stage and disability. Pairwise comparisons and regression techniques were used to investigate the association of PD clinical markers with RBD. RESULTS: We enrolled 120 PD patients. RBD was present in 46 % (n = 55; median age 65 years; 67 % male), who were compared to PD patients without RBD (n = 65, median age 62 years, 64 % male). There was also a healthy control group comprising 48 subjects (median age 57 years, 54 % male). Comparing PD patients with and without RBD, RBD was associated with higher MDS-UPDRS Part II scores [15(11-21) x 12(7-16), p = 0.02], higher frequency of abnormal gait (43,6 % x 21,5 %; p = 0.01), greater use of walking aids (21,8 % x 4,6 %; p = 0.005), greater dysautonomia (56,4 % x 47,7 %, p = 0.002) and osteoporosis [PR 1,64(1.37-1.96), p < 0.001) and lower ADL scores [80(80-90) x 90(80-90); p = 0.002], CONCLUSION: The presence of RBD in PD patients was associated with indirect indicators of motor impairment, lower independence in ADL, possibly a higher frequency of dysautonomia and with a higher frequency of osteoporosis.

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BACKGROUND: Chronic obstructive pulmonary disease (COPD) induces an imbalance in T helper (Th) 17/regulatory T (Treg) cells that contributes to of the dysregulation of inflammation. Exercise training can modulate the immune response in healthy subjects. OBJECTIVE: We aimed to evaluate the effects of exercise training on Th17/Treg responses and the differentiation of Treg phenotypes in individuals with COPD. METHODS: This randomized controlled trial included 50 individuals with severe or very severe COPD who were allocated to the Exercise or Control groups. The Exercise group underwent eight weeks of aerobic and muscle strength training, whereas the Control group received usual care. The primary outcome was the change in the phenotypic characteristics of Tregs and Th17 profile differentiation in systemic inflammation. RESULTS: Exercise training increased the frequency of total and activated Tregs and decreased the frequency of Th17 cells in between-group comparisons. Additionally, Th17/Treg responses were moderately correlated with improvements in the six-minute walking test, muscle strength of the upper and lower limbs, and daily life physical activity levels. CONCLUSION: Exercise training improved functional exercise capacity, muscle strength, and physical fitness, which was associated with a decrease in the Th17 inflammatory response and an increase in Treg cell phenotypes immunosuppressive activity.

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BACKGROUND: Severe COVID-19 presents a variety of clinical manifestations associated with inflammatory profiles. People living with HIV (PLWH) could face a higher risk of hospitalization and mortality from COVID-19, depending on their immunosuppression levels. This study describes inflammatory markers in COVID-19 clinical outcomes with and without HIV infection. METHODS: We analyzed 112 inpatients of the Hospital Center for COVID-19 (INI/FIOCRUZ), including 22 cases of COVID-19 in PLWH (COVID/PLWH group). Plasma samples were tested for a panel of 15 cytokines by Luminex. Sociodemographic, clinical, and laboratory data were collected from patients' clinical records. RESULTS: COVID-19 individuals were stratified according to the WHO clinical severity profiles at hospitalization. Significant differences in clinical scores, symptoms (coughs), and the occurrence of HIV infection were found among the groups. Clinical blood parameters and plasma cytokines were analyzed among COVID-19 groups with distinct severity profiles. Critical COVID-19 cases showed higher levels of inflammatory markers (Bilirubin, D-dimer, PCR, and urea, as well as IL-8, IL-10, TNF-α, INF-α, IL-1ß, IL-17A, IL-23, IL-6) than moderate and severe groups. The COVID/PLWH group had lower CD4 counts (64 cells/mm3) and cytokine levels than other COVID-19 patients. CONCLUSIONS: Overall, critically ill COVID-19 patients exhibited heightened inflammatory responses, while COVID/PLWH demonstrated unique immunological characteristics without increased mortality risk.