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The study objective was to evaluate the temporal trend of nutritional status assessment coverage among Quilombola children in the Food and Nutrition Surveillance System (SISVAN). An ecological time-series study was conducted on the coverage of SISVAN data among Quilombola children under five years of age in Brazilian municipalities between 2008 and 2019. Prais-Winsten regression was performed to analyze the trend and the average annual percentage change (APC) of coverage, in accordance with demographic, socioeconomic and healthcare variables. The results revealed that national coverage varied from 0.1% in 2008 to 2.8% in 2013, decreasing to 0.3% in 2019. The national APC coverage was 11% from 2008 to 2019, corresponding to a stationary trend (p=0.68). All states showed an increase in coverage from 2008 to 2013, followed by a decrease through to 2019. The States of Mato Grosso do Sul and Sergipe showed an increasing trend, while Acre had a decreasing trend. The other states revealed a stationary trend. No temporal variation was observed in coverage according to the variables of interest. The conclusion drawn was that low SISVAN coverage was found among Quilombola children, with a steady temporal trend in most Brazilian states.

O objetivo é avaliar a tendência temporal da cobertura de avaliação do estado nutricional entre crianças quilombolas no Sistema de Vigilância Alimentar e Nutricional (SISVAN). Estudo ecológico de série temporal sobre a cobertura do SISVAN entre crianças quilombolas menores de cinco anos de idade nos municípios brasileiros entre 2008 e 2019. Realizou-se regressão de Prais-Winsten para analisar a tendência e a variação percentual anual (VPA) média da cobertura, segundo variáveis demográficas, socioeconômicas e assistência à saúde. A cobertura nacional variou de 0,1% em 2008 para 2,8% em 2013, decrescendo para 0,3% em 2019. A VPA da cobertura nacional foi de 11% entre 2008 e 2019, correspondente a tendência estacionária (p=0,68). Todas os estados apresentaram aumento na cobertura de 2008 para 2013, seguida de uma redução até 2019. Os estados do Mato Grosso do Sul e Sergipe apresentaram tendência crescente, enquanto o Acre demonstrou tendência decrescente. Os demais estados demonstraram tendência estacionária. Nenhuma variação temporal foi observada na cobertura segundo as variáveis de interesse. Baixas coberturas do SISVAN foram encontradas entre crianças quilombolas, com tendência temporal estacionária na maioria dos estados brasileiros.

El objetivo es evaluar la tendencia temporal en la cobertura de la evaluación del estado nutricional de los niños quilombolas en el Sistema de Vigilancia Alimentaria y Nutricional (SISVAN). Estudio ecológico de series temporales sobre la cobertura del SISVAN en niños quilombolas menores de cinco años en municipios brasileños entre 2008 y 2019. Se realizó una regresión de Prais-Winsten para analizar la tendencia y la variación porcentual anual promedio (VPA) de la cobertura, según variables demográficas, socioeconómicas y atención de salud. La cobertura nacional varió de 0,1% en 2008 a 2,8% en 2013, disminuyendo a 0,3% en 2019. El VPA de la cobertura nacional fue de 11% entre 2008 y 2019, correspondiente a una tendencia estacionaria (p=0,68). Todos los estados mostraron un aumento en la cobertura entre 2008 y 2013, seguido de una reducción hasta 2019. Los estados de Mato Grosso do Sul y Sergipe mostraron una tendencia creciente, mientras que Acre mostró una tendencia decreciente. Los estados restantes mostraron una tendencia estacionaria. No se observó variación temporal en la cobertura según las variables de interés. Se encontró baja cobertura del SISVAN entre los niños quilombolas, con una tendencia temporal estacionaria en la mayoría de los estados brasileños.

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This article deals with the relationship between time, in health care, and the society where it takes place. Care as a clinic committed to the integrality of the health-disease process and to the autonomy of the subjects, which takes place in the intercessory encounters. It deals with two dimensions of care time: the chronos or duration between two events, which guides health interventions with deadlines and goals to control the results; and the aiôn temporality of events. Such dimensions are examined in the society of performance or weariness, and the possibility of privileging interruptions, the contemplative "not doing" and the temporal in-between. Based on the propositions of a social movement and a verbal neologism, "slow care" is proposed as the construction of strategies for managing either the various chronological times that cross the health care, and the opening of oneself to events and the interferences they produce, as resonances, subtleties, small changes (aiôn). Finally, harm reduction is pointed out as a strategy of slow care.

O artigo trata da relação entre o tempo, no cuidado em saúde, e a sociedade onde o mesmo se dá. Cuidado como uma clínica comprometida com a integralidade do processo saúde-doença e com a autonomia dos sujeitos, e que ocorre no encontro intercessor. Trata de duas dimensões do tempo do cuidado: o cronos ou duração entre dois eventos, que guia as intervenções em saúde com prazos e metas para o controle dos resultados; e a temporalidade aiôn, dos acontecimentos. Examina-se tais dimensões na sociedade do desempenho ou do cansaço, e a possibilidade de se privilegiar nela as interrupções, o "não fazer" contemplativo e o entre temporal. A partir das proposições de um movimento social e de um neologismo verbal, propõe-se o acontecimento "ralentar o cuidado" (slow care), ou seja, construir estratégias para a gestão tanto dos vários tempos cronos que atravessam o cuidado, como abrir-se aos acontecimentos e às interferências que estes produzem, enquanto ressonâncias, sutilezas, pequenas mudanças (aiôn). Por fim, aponta-se a redução de danos como uma estratégia para se ralentar o cuidado.

Este artículo aborda la relación entre el tiempo, en el cuidado de la salud y la sociedad donde se desarrolla. El cuidado como clínica comprometida con la integralidad del proceso salud-enfermedad y la autonomía de los sujetos, y que se desarrolla en el encuentro intercesor. Se trata de dos dimensiones del tiempo de atención: el cronos o duración entre dos eventos, que orienta las intervenciones en salud con plazos y metas para controlar los resultados; y la temporalidad aiôn, de los acontecimientos. Estas dimensiones se examinan en la sociedad del desempeño o del cansancio, y la posibilidad de privilegiar las interrupciones, el "no hacer" contemplativo y los intermedios temporales. A partir de propuestas de un movimiento social y de un neologismo verbal, se propone el evento "cuidado lento", es decir, construir estrategias para gestionar tanto los diversos cronos que abarcan el cuidado, como abrirse a los eventos y las interferencias que estos producen, como resonancias, sutilezas, pequeños cambios (aiôn). Finalmente, se destaca la reducción de daños como una estrategia para ralentizar la atención.

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The objective was to evaluate the opening hours of establishments selling in natura and mixed foods, located in areas with and without Food and Nutrition Public Establishments (FNPE). A cross-sectional study, carried out in Belo Horizonte, Brazil. Average hours of operation were recorded, and compared between in natura and mixed food establishments (Student's t-test). The functioning of establishments was divided into status and compared between types of establishments (Chi-square). The average operation hours of the establishments were compared according to their location in areas with or without FNPE (Student's t-test). Mixed establishments were open, on average, longer hours than in natura food establishments (p<0.001). The number of mixed establishments open at extended hours (after 18 hours) was significantly higher than the number of in natura establishments (p<0.001), on weekdays (90.9% vs. 67.8%), Saturdays (84. 1% vs. 55.9%) and Sundays (40.9% vs. 3.4%). On weekdays operation of in natura food establishments was lower in areas with FNPE (p<0.05). Mixed establishments open longer hours and are more available during extended hours and on Sundays. Areas with FNPE had lower average opening hours for in natura food establishments.

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Breastfeeding experiences differ between primiparous and multiparous women. This study aims to investigate how parity influences breastfeeding duration among Brazilian women and to examine the relationship between the number of siblings and the duration of breastfeeding for each child. Data from the Pró-Saúde Study (1999-2012) were used to analyze breastfeeding duration. Differences between parity groups were tested using the chi-square test, while Kruskal-Wallis test and analysis of variance assessed variations in breastfeeding duration, with comparisons visualized using Kaplan-Meier plots. Characteristics such as maternal age and mode of delivery are relevant, especially among primiparous mothers, while maternal education and household income have a positive impact on breastfeeding duration. The use of the Cox model to analyze breastfeeding duration highlights the need for further investigation into the factors influencing this practice, especially considering the decrease in breastfeeding duration among children born in the 1990s and 2000s. These results point to the complex interaction of social, economic, and behavioral factors that should be considered in public policies aimed at maternal and child health.

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In this study, the biochemical parameters and physico-chemical reactions of the body in experimental hypoxia, using a Sprague Dawley Rat Model. Hypoxia changed the dynamics and biochemical parameters of blood and lymph, as well as urine. During hypoxia, there was a change in the osmotic resistance of erythrocytes. Hypoxic training was conducted in a hypoxic animal chamber for 15 days and 30 days for 40 minutes every day. Physical and chemical parameters of blood, lymph and its morphological composition were studied on a hematological analyser, oxygen tension and pH of blood and lymph on an OPTI CCA-TS2 Blood Gas and Electrolyte Analyser. The value of osmotic pressure in the lymph changed slightly from 280.22 ± 2.07 to 293.3±3.1 and 285.6 ± 2.8 mOsm/l, respectively, 15 and 30 days of hypoxia. Urine osmotic pressure decreased by 15.1-10.4%, respectively, compared to the control group. After 15 and 30 days of hypoxia, ion exchange in the blood plasma showed a decrease in the concentration of K+, Cl- ions and an increase in the concentration of Na+ ions in the blood plasma and lymph. Ca2+ concentrations decreased in blood plasma and increased in lymph and urine. The analysis of the osmotic resistance of erythrocytes showed its decrease. Lipid peroxidation of erythrocyte membranes showed a significant increase in the level of malondialdehyde and diene conjugates by 52.2% and 69.6%, as well as a decrease in the activity of superoxide dismutase and catalase by 32% and 29.7%. Hypoxia leads to a decrease in erythrocyte resistance and lipid peroxidation in experimental animals. Shifts in pH on the side of acidosis and disturbances in physico-chemical properties in the blood and lymph were detected. As a result of developing hypoxia in the body, structural and functional rearrangements occur in the whole blood of experimental animals.

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INTRODUCTION: Mechanical ventilation (MV) is one of the factors that may be associated with postoperative complications of cardiac surgeries. This study aimed to verify the clinical and biological factors related to prolonged MV and extubation failure in children and adolescents submitted to cardiac surgeries. METHOD: This retrospective cohort included all patients aged between 0 and 15 years at the Unidade de Recuperação Cardio-Torácica Pediátrica who were submitted to the first extubation after cardiac surgery. Those tracheostomized and under MV before the surgery or who suffered accidental extubation were excluded. The following data was collected - age, weight, and sex; body mass index (BMI); heart disease; surgical severity (Risk Adjustment for Congenital Heart Surgery-1); hospitalization period and length of stay at intensive care unit; MV, cardiopulmonary bypass, and anoxia duration; use of continuous sedation (midazolam and/or fentanyl); pulmonary hypertension; nitric oxide use; Down syndrome, extubation site, and failure. The outcomes were prolonged MV and extubation failure. RESULTS: A total of 233 patients were included - 79 (33.9%) aged below 12 months, 47 (20.2%) had Down syndrome, and 215 (92.3%) presented low BMI. Down syndrome patients and those under continuous sedation in the immediate postoperative period presented a higher risk of prolonged MV (P<0.001). Moreover, patients aged below 12 months (P=0.048) and those under prolonged MV (P=0.006) presented the highest risk of extubation failure. CONCLUSION: Patients with continuous sedation or Down syndrome required longer MV. In addition, children younger than 12 months or under prolonged MV presented a high extubation failure rate.

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INTRODUCTION: The quality of coronary anastomoses is one of the important parameters that may affect graft patency in coronary artery bypass grafting patients. Therefore, we compared two different anastomotic techniques to improve graft flow and patency rates. METHODS: This study was conducted by performing two different fashions of anastomosis with a human saphenous vein graft on 24 various coronary segments of five postmortem porcine hearts. Each arteriotomy was used for both anastomotic techniques. In the first method, epicardial fat tissue around the coronary artery was involved to the saphenous vein anastomosis line (coronary wall and epicardial fat tissue [CWE] technique). In the second method, the saphenous vein graft was sutured to the coronary wall only, without involving epicardial fat tissue (only coronary wall [OCW] technique).The time it tookfor 30 cc of 0.9% isotonic saline solution to pass through the anastomosis in a free-flow fashion by gravity was measured following each technique. Additionally, the anastomotic areas in mm2 were measured and compared between the two techniques. RESULTS: The mean flow time for the CWE technique was 77.5 ± 21.4 seconds, whereas for the OCW technique, it was 87.2 ± 19.5 seconds (P<0.001). The flow rates were 23.2 ml/min and 20.6 ml/min, respectively. The anastomotic area was 3.947 mm2 for the CWE technique and 1.430 mm2 for the OCW technique. CONCLUSION: When the sutures penetrate both the epicardial fat tissue and the coronary artery wall simultaneously, a larger anastomosis area can be created. Consequently, potentially better graft flow and hemodynamic performance could be achieved.

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Cassava dregs are a byproduct of processing cassava into tapioca. These ingredients possess a simplified carbohydrate structure after fermentation, which also serves as an essential carbon source to support bacterial growth. This research aims to examine the utilization of cassava dregs ferment (CDF) in accelerating biofloc formation for intensive whiteleg shrimp (Penaeus vannamei) culture. The research was carried out over 60 days in two HDPE-lined ponds. Treatment A (with CDF) was stocked with 200 shrimp/m2. Treatment B (without CDF) was stocked with 300 shrimp/m2. Treatment A accelerated the formation of biofloc at DOC 26, whereas the biofloc formation in Treatment B started at DOC 38. Weight growth of shrimp was similar to Treatment A, averaging 6.21 ±1.27 g as compared to 6.21 ±1.73 g in Treatment B. Survival rates were significantly different, with 99.1% in Treatment A and 75.3% in Treatment B. Feed conversion ratio and total biomass were 1.4/1,153 kg (Treatment A) and 1.49/1,263 kg (Treatment B). Based on these findings, it appears that CDF can be used as an alternative source of exogenous carbon in biofloc technology and improve the productivity of intensive whiteleg shrimp culture.

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This study evaluated the effects of days-fasting followed by days-refeeding on growth, biochemical, and hepatic parameters in pacu (Piaractus mesopotamicus). One hundred and twenty juveniles P. mesopotamicus with initial average weight and length of 47.7 ± 9.2 g and 13.4 ± 0.9 cm were randomly distributed into six experimental units (20 fish per unit) and subjected to treatments: 30 days-fasting followed by 50 days-refeeding, and control group, fed continuously throughout the period. During the fasting period, samples were collected at 10, 20, and 30 days, while during the refeeding period at 15 and 50 days. Animals in the control group were sampled at the same periods. Weight (g), relative condition factor (Kn), and hepatosomatic index (biometric parameters) were measured. Liver assessments were performed. Additionally, glucose, plasma biochemical parameters levels were measured. After 30 days of fasting, hepatocyte density (73.8 ± 1.09%), liver glycogen (14.9 ± 0.87%) and hepatocyte nuclear volume (27.3 ± 0.30 µm3) were lower compared to the control group (82.0 ± 0.67%, 19.4 ± 0.74% and 43.40 ± 0.48 µm3 respectively). The relative condition factor remained unchanged. Cholesterol values, blood vessels, and sinusoidal density increased significantly during fasting. After refeeding, parameters were restored to the control level. On the 50th day of refeeding, the hepatosomatic index was significantly higher than the control group. The results showed that fasting associated with refeeding did not affect fish growth. The period over 50 days of refeeding may influence the pacu's compensation compared to daily-fed animals. The effects of fasting and its relationship with the pacu's physiological response through nutritional status become useful in contributing to feeding practices in P. mesopotamicus fish farming.

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PURPOSE: To establish a profile of the inflammatory response in the preoperative and postoperative period of pulmonary resection of patients without postoperative complications, in order to trace the inflammatory profile of lung resection surgery. METHODS: Six collections of arterial and venous blood were performed for data analysis, one sample in the preoperative, immediate postoperative, 4, 8, 24, and 48 hours after surgery. Twenty-seven patients with a median age of 63 years old, ranging from 29 to 80 years old, were included. RESULTS: The leukocyte count showed a significant increase in the times: immediate postoperative and 4 hours after surgery, in relation to the preoperative period. Concomitantly, there was an increase in lactate, heart rate, interleukin (IL)-6 and IL-8 after 4 hours of surgery. The platelet count showed a significant decrease in 48 h, associated with an increase in IL-1ß and tumor necrosis factor-α. A significant increase in IL-10 was observed in the immediate postoperative. CONCLUSION: The study may contribute to the search for more specific and adequate alternatives for controlling the inflammatory response. In this way, the intervention would be specific to that cytokine that causes the greatest harm to the patient, as well as to the moment of the intervention.

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BACKGROUND: In patients with persistent atrial fibrillation (AF), addition of posterior wall isolation (PWI) to pulmonary vein isolation (PVI) is controversial. OBJECTIVE: Compare PVI plus PWI versus PVI alone in patients with persistent AF. METHODS: We searched PubMed (by MEDLINE), Embase, LILACS, CENTRAL (by Cochrane Library), and Clinicaltrials.gov databases for randomized trials comparing PVI + PWI and PVI alone in persistent AF. The outcomes were: (i) AF recurrence; (ii) composite of recurrent atrial arrhythmias (i.e., AF, atrial tachycardia, or atrial flutter); (iii) major clinical complications (i.e., pericardial effusion or tamponade, sinus node dysfunction, or atrioesophageal fistula); (iv) mean ablation time. Risk of bias and quality of evidence were evaluated using the Cochrane Risk of Bias 2.0 tool and GRADE, respectively. Statistical significance was set at 5%, and subgroup and sensitivity analyses were performed. RESULTS: We included eight studies and 1119 patients, of which 561 underwent PVI + PWI. During follow-up (12 - 24 months), recurrence of AF was significantly reduced with adjunctive PWI (RR 0.66, 95% CI 0.44-0.98). Composite of recurrent atrial arrhythmias did not differ significantly (RR 0.83, 95% CI 0.65-1.06). Major clinical complications (RR 0.81, 95% CI 0.42-1.58) were similar, with PVI alone having a shorter mean procedure time (mean difference -23.37 minutes, 95% CI -30.23, -16.50). CONCLUSION: Adjunctive PWI appears to be effective in improving recurrent AF, but not recurrence of all atrial arrhythmias. Procedure time was longer with PVI + PWI without significant change in overall safety. Further studies should focus on long-term benefit.

FUNDAMENTO: Em pacientes com fibrilação atrial (FA) persistente, a realização do isolamento da parede posterior (IPP) além do isolamento das veias pulmonares (IVP) é controversa. OBJETIVO: Comparar IVP mais IPP versus IVP exclusivo em pacientes com FA persistente. MÉTODOS: Trata-se de uma revisão sistemática conduzida nas bases de dados PubMed (MEDLINE), Embase, LILACS, CENTRAL (Cochrane Library), e Clinicaltrials.gov por ensaios clínicos randomizados comparando IVP + IPP e IVP exclusivo e FA persistente. Os desfechos foram (i) recorrência de FA; (ii) recorrência de arritmias atriais, isto é, FA, taquicardia atrial, ou flutter atrial); (iii) complicações clínicas importantes (isto é, derrame ou tamponamento pericárdico; disfunção do nó sinusal ou fístula atrioesofágica); (iv) tempo médio de ablação. O risco de viés e a qualidade da evidência foram avaliados usando a ferramenta Cochrane de avaliação de risco de viés (RoB 2.0) e o GRADE, respectivamente. A significância estatística foi estabelecida em 5%, e análises por subgrupos e de sensibilidade foram realizadas. RESULTADOS: Foram incluídos oito estudos e 1119 pacientes, dos quais 561 se submeteram a IVP+IPP. Durante o seguimento (12-24 meses), a recorrência de FA foi significativamente diminuída com IPP adjuvante (RR 0,66; IC 95%; 0,44-0,98). O composto de arritmias atriais recorrentes não difere significativamente (RR 0,83, IC 95% 0,65- 1,06). As complicações clínicas maiores (RR 0,81, IC95% 0,42-1,58) foram similares, e o IVP exclusivo foi associado a um tempo médio mais curto de procedimento (diferença média -23,37 minutos, IC 95% -30,23, -16,50). CONCLUSÃO: O IPP adjuvante parece efetivo em melhorar FA recorrente, mas não a recorrência de todas as arritmias atriais. O tempo de procedimento foi mais longo com IVP + IPP sem mudança significativa na segurança global. Mais estudos são necessários para investigar os benefícios em longo prazo.

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The objective of this study is to investigate the influence of physical activity on heart rate (HR) recovery, after treadmill exercise testing, in asymptomatic adults, with and without familial risk factors (FR) for cardiovascular disease. Two hundred and fifty (250) adults of both sexes aged 18 to 59 years were included in the study. None of the participants had a history of cardiovascular disease or used medications for chronic diseases. All individuals underwent exercise testing using the Ellestad protocol. Delta values were calculated by subtracting peak HR from HR in the first, second, fourth, and sixth minutes of recovery. The family history of cardiovascular disease and physical activity were documented. For statistical analysis, ANOVA was performed, followed by Bonferroni or Kruskall-Wallis multiple comparisons, followed by Dunn's multiple comparisons. The delta values at the first, second, fourth, and sixth minutes of recovery were lower in individuals who did not engage in physical activity and had no family cardiovascular risk factor, compared to those who were physically active and had no family risk factor. No differences in delta values were observed between physically active individuals with cardiovascular risk factors and physically inactive individuals with a family history at the time points studied. In individuals without a family risk factor, physical activity appears to enhance autonomic control, increasing the capacity to reduce HR after exercise. However, this effect was not evident in those with a family risk factor, as physical activity did not impact recovery HR.

O objetivo do presente estudo é investigar a influência da prática de atividade física, na frequência cardíaca (FC) de recuperação após o teste ergométrico, em esteira, em adultos assintomáticos, com e sem fator de risco familiar para doença cardiovascular. Duzentos e cinquenta adultos de ambos os sexos com idades entre 18 e 59 anos foram estudados. Nenhum dos participantes tinham histórico de doença cardiovascular e não utilizavam remédios para doenças crônicas. Todos foram submetidos ao teste de esforço com o protocolo Ellestad. Os valores de delta foram calculados pela subtração da FC de pico pela FC do primeiro, segundo, quarto e sexto minuto de recuperação. O histórico familiar cardiovascular e de atividade física foram documentados. Para a análise estatística foi feito o teste de ANOVA seguido pelas comparações múltiplas de Bonferroni ou Kruskall-Wallis seguido das comparações múltiplas de Dunn. O delta do primeiro, segundo, quarto e sexto minuto da recuperação, foi menor nos indivíduos que não praticavam atividade física e que não tinham fator de risco cardiovascular familiar, em comparação aos fisicamente ativos e sem fator de risco familiar. Os valores de delta não foram diferentes entre os fisicamente ativos com fatores de risco cardiovascular em comparação aos fisicamente inativos com histórico familiar nos momentos estudados. A prática de atividade física, em indivíduos sem fator de risco familiar, pode promover melhor controle autonômico, proporcionando maior capacidade de reduzir a FC após o esforço. Isso não foi observado naqueles com fator de risco familiar, pois a prática de atividade física não influenciou a FC de recuperação.

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Status epilepticus (SE) is the most severe presentation of epilepsy. Currently, SE is defined according to 2 sequential time frames: time 1, after which it is unlikely that the seizure will resolve spontaneously, therefore requiring the initiation of therapy; and time 2, when long-term consequences become more likely. For convulsive SE, these time frames are well defined: 5 minutes for time 1 and 30 minutes for time 2. "Time is brain" in the treatment of SE, as delays in diagnosis and treatment are associated with worse outcomes. After clinical stabilization, the first step is the administration of intravenous (IV) benzodiazepines. Rapid initiation of treatment and use of appropriate dosing are more important than the selection of a specific benzodiazepine. Following this, treatment continues with the use of an IV antiseizure medication (ASM). In Brazil, the recommended options available are phenytoin and levetiracetam. Status epilepticus is considered refractory to treatment if seizures persist after the administration of benzodiazepines and IV ASM. The cornerstone of this stage is the induction of therapeutic coma using IV anesthetic drugs (IVADs), although evidence is limited regarding the choice among midazolam, propofol, or barbiturates. Super-refractory SE is defined when seizures persist despite continuous infusion of IVADs or recur after these drugs are tapered. There is very limited data regarding the treatment of super-refractory SE. In the absence of randomized controlled trials, treatment should be guided by the physician's experience, clinical judgment, and established therapeutic options from previous reports.

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OBJECTIVE: This study evaluated the effect of Stemregen® nutritional supplement on inflammation and resorption in apical periodontitis using a rat model. METHODOLOGY: Rats were divided in three groups: negative control (n=7), positive control (n=10), and Stemregen® (Stem) (n=10). Apical periodontitis was induced in the positive control and Stem groups, and all rats were sacrificed on the 30th day. Serum phosphorus (P), calcium (Ca), and alkaline phosphatase (ALP) were analyzed. Histopathological assessments measured osteoblastic and osteoclastic activity, inflammation, fibrosis, and abscess density. Immunohistochemical analyses evaluated RANKL, TRAP, and OPG levels. RESULTS: Results showed significantly lower osteoblastic activity in the negative control compared to Stem and positive control groups (p=0.005). Osteoclastic activity was higher in the positive control (p=0.032). Inflammation and abscess formation were reduced in the Stem group compared to the positive control (p<0.001). OPG levels were lower in the negative control compared to the other groups (p=0.005). CONCLUSION: Stemregen® effectively reduced inflammation and bone destruction, suggesting potential benefits for apical periodontitis management, though further research is needed.

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The aim of this study was to assess the impact of orthodontic treatment with orthodontic aligners (OAs) and fixed appliances (FAs) on oral health-related quality of life (OHRQoL). This parallel randomized clinical trial included 40 male and female patients aged 13 to 35 years diagnosed with Angle's Class I malocclusion. Participants were assigned to two groups: OA (n = 20) and FA (n = 20). OHRQoL was assessed using the Brazilian OHIP-14, which was administered before treatment (T0), at 1 month (T1), 6 months (T2), and 12 months (T3) after treatment initiation. Data were analyzed using the independent t test, the chi-square test, the Mann-Whitney test, and Friedman test (p < 0.05). FAs had a significantly (p < 0.05) higher impact on OHRQoL at T1 in terms of functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, and overall score. Within-group comparison showed higher scores for the FA group in comparison to the OA group. Functional limitation scores were higher at T1 than at T0 (p = 0.034), while physical pain scores were higher at T1 compared to T0 (p = 0.034) and T2 (p = 0.010). Psychological discomfort scores were higher at T1 than at T2 (p = 0.015). Physical disability scores were higher at T1 compared to T0 (p = 0.008). Overall scores were higher at T1 than at T2 (p = 0.003). No significant changes were observed in the OA within-group comparison. Patients treated with OAs had less impact on OHRQoL compared to those treated with FAs in the first month. There was no difference between the groups at the 6-month follow-up.

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The study objective was to analyze dimensional change, flexural strength, surface hardness, wear profile, and conversion degree of different additive splint materials under various post-polymerization conditions of time and artificial aging. Two additive manufacturing systems (Cara Print 4.0, Dima Print Ortho, Kulzer; SprintRay Pro, SprintRay Splint, SprintRay), and a thermally activated resin control (Clássico) were evaluated in artificial aging (deionized water or saliva; 28 or 84 days at 37°C), with recommended or doubled post-polymerization cycles. Dimensional change (surface metrology), flexural strength (ISO 20795-1:2013), fractography (SEM), Knoop hardness, two-body wear profilometry (150,000 cycles; 3mmØ; 20N; 2.1Hz), and conversion degree (FTIR spectroscopy) were assessed. Two-way ANOVA and post-hoc Tukey tests were used for parametric data, and Kruskal-Wallis and post-hoc Dunn tests, for non-parametric data (α = 0.05). Results indicated no statistically significant differences in dimensional change or flexural strength among the materials. Recommended post-polymerization cycles resulted in lower hardness for additive resins than the thermally activated control. Doubling post-polymerization time significantly increased flexural strength and hardness of Dima Print Ortho, but decreased flexural strength of SprintRay Splint, and did not affect wear resistance. Dima Print Ortho demonstrated the highest wear resistance. Artificial aging did not affect flexural strength, surface wear, or dimensional change, but negatively impacted the hardness of all materials except Dima Print Ortho. The conversion degree was unaffected by post-polymerization time, and no significant differences were found among the materials. Overall, additive materials exhibited mechanical and dimensional properties comparable to thermally activated resin, with doubling post-polymerization time positively influencing the properties.

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This study evaluated the microtensile bond strength (µTBS) and fracture pattern of direct composite resin reinforced with polyethylene fiber (Ribbond®) on dentin substrate after thermomechanical cycling (TMC). Dentin blocks (dentin thickness=2 mm) were obtained from forty human third molars and randomly divided into four groups (n=10) according to type of restoration (composite resin with or without Ribbond®) and to whether they were or were not subjected to TMC (100,000 cycles of 50 N / 2 Hz / 1-minute baths of 5 and 55ºC). The 1-mm-thick square-shaped specimens were submitted to µTBS testing in a universal testing machine at 0.5 mm/min. The fracture patterns were assessed by stereoscopic magnifying glass (30X magnification). The µTBS (in MPa) and failure pattern data were subjected to the generalized linear model and G tests (a=0.05). Neither the polyethylene fiber nor TMC had any statistically significant effect (p=0.196 and p=0.136, respectively) on the µTBS of the composite resin to dentin. Adhesive failures were more prevalent in the composite resin group compared with the Ribbond-containing group when subjected to TMC. Additionally, the composite resin containing Ribbond® showed a higher proportion of cohesive failures in composite resin than the resin groups not containing this fiber, irrespective of TMC. It was concluded that reinforcing the direct layer of composite resin with Ribbond® polyethylene fiber did not influence the adhesive resistance to dentin, even when subjected to TMC. However, its incorporation did result in a higher frequency of cohesive failures in resin after TMC.

ABSTRACT

BACKGROUND: Stress arises in response to threats or challenges, affecting both physical and mental health. While its harmful effects on the heart are widely recognized, cellular-level investigations remain limited. Antidepressants, including vortioxetine (VOR), are known to impact the cardiovascular system. VOR, used to treat major depressive disorder, is considered a promising option for patients with heart disease due to its anti-inflammatory and antioxidant properties, which may reduce cardiac damage. OBJECTIVES: This study aimed to assess the effects of chronic unpredictable mild stress (CUMS) on rat hearts and evaluate VOR's potential protective effects against stress-induced cardiac damage. METHODS: Twenty-eight male Wistar Albino rats were divided into four groups. The CUMS group experienced random daily stress for 6 weeks, while the CUMS+VOR group received VOR treatment alongside stress. VOR and control groups were not exposed to stress. Heart samples were examined histopathologically and immunohistochemically. RESULTS: The CUMS group showed increased hyperemia, hemorrhage, edema, vacuolar degeneration, and mononuclear cell infiltrations, with reduced troponin and IL-10 and increased caspase-3 and NF-κB expressions compared to the control group (p≤0.001). VOR treatment improved these findings, normalizing histopathological and immunohistochemical results. CONCLUSIONS: CUMS caused significant cardiac damage in rats, while VOR treatment showed protective effects by alleviating these pathological changes.

FUNDAMENTO: O estresse surge em resposta a ameaças ou desafios, afetando a saúde física e mental. Embora seus efeitos nocivos ao coração sejam amplamente reconhecidos, as investigações em nível celular permanecem limitadas. Antidepressivos, incluindo vortioxetina (VOR), são conhecidos por impactar o sistema cardiovascular. VOR, usado para tratar transtorno depressivo maior, é considerado uma opção promissora para pacientes com doença cardíaca devido às suas propriedades anti-inflamatórias e antioxidantes, que podem reduzir danos cardíacos. OBJETIVOS: Este estudo teve como objetivo avaliar os efeitos do estresse crônico moderado imprevisível (ECMI) em corações de ratos e avaliar os potenciais efeitos protetores do VOR contra danos cardíacos induzidos por estresse. MÉTODOS: Vinte e oito ratos Wistar Albino machos foram divididos em quatro grupos. O grupo ECMI experimentou estresse diário aleatório por 6 semanas, enquanto o grupo ECMI+VOR recebeu tratamento VOR junto com estresse. Os grupos VOR e controle não foram expostos ao estresse. Amostras de coração foram examinadas histopatologicamente e imuno-histoquimicamente. RESULTADOS: O grupo ECMI apresentou aumento de hemorragia, edema, degeneração vacuolar e infiltrações de células mononucleares, com redução de troponina e IL-10 e aumento de expressões de caspase-3 e NF-κB em comparação ao grupo controle (p≤0,001). O tratamento com VOR melhorou esses achados, normalizando os resultados histopatológicos e imuno-histoquímicos. CONCLUSÕES: O ECMI causou danos cardíacos significativos em ratos, enquanto o tratamento com VOR mostrou efeitos protetores ao aliviar essas alterações patológicas.

ABSTRACT

BACKGROUND: Vitamin K antagonists (VKA) represent an important therapeutic strategy offered by the Brazilian Unified Public Health System to patients with atrial fibrillation (AF). However, predictors of relevant clinical outcomes are understudied in the real world. OBJECTIVE: To determine the incidence and independent predictors of clinical outcomes in patients with valvular and nonvalvular AF treated with VKA. METHODS: This prospective cohort included patients with valvular and nonvalvular AF receiving VKA for ≥ 1 year. The primary outcomes were cardiovascular death, thromboembolic events, and major and clinically relevant non-major bleeding, separately and as a composite outcome. The outcomes were independently adjudicated. P values < 0.05 were considered statistically significant. RESULTS: The study included 1,350 patients, with a mean age of 69.2 (± 11.8) years, 53.6% female, followed up for 17 (15 - 19) months. The annual incidence of thromboembolic events and cardiovascular death was 4.4%, and predictors were prior thromboembolism (hazard ratio [HR] 2.12; 95% confidence interval [CI] 1.22 - 3.67), time in therapeutic range (TTR) < 50% (HR 1.98; 95% CI 1.16 - 3.37), and glomerular filtration rate (GFR) < 45 mL/min/1.73 m2 (HR 2.76; 95% CI 4.82 - 1.58). The rate of major and clinically relevant non-major bleeding was 3.24% per year (95% CI 2.47 - 4.14), and predictors were prior bleeding (HR 2.60; 95% CI 1.47 - 4.61) and mechanical prosthesis (HR 1.91; 95% CI 1.15 - 3.15). The composite outcome was 8.7% per year, and predictors were prior bleeding (HR 1.70; 95% CI 1.07 - 2.70), TTR < 41% (HR 1.79; 95% CI 1.11 - 2.86), and left atrial diameter > 44 mm (HR 1.97; 95% CI 3.26 - 1.19). CONCLUSIONS: Prior thromboembolism or bleeding, reduced GFR and TTR levels, and enlarged left atrium were predictors of clinical outcomes in patients with AF treated with VKA.

FUNDAMENTO: Antagonistas da vitamina K (AVK) representam uma importante estratégia terapêutica oferecida pelo Sistema Único de Saúde no Brasil aos pacientes com fibrilação atrial (FA). Entretanto, os preditores de desfechos clínicos relevantes são pouco estudados no mundo real. OBJETIVO: Determinar a incidência e os preditores independentes de desfechos clínicos em pacientes com FA valvar e não valvar tratados com AVK. MÉTODOS: Coorte prospectivo de pacientes com FA valvar e não valvar em uso ≥ 1 ano de AVK. Desfechos primários foram morte cardiovascular, eventos tromboembólicos, sangramento maior e não maior clinicamente relevante, separadamente e como desfecho composto, e adjudicados de modo independente. Valores de p < 0,05 foram considerados estatisticamente significantes. RESULTADOS: Incluídos 1.350 pacientes, idade média de 69,2 (± 11.8) anos e 53,6% do sexo feminino, seguidos por 17 (15 - 19) meses. Incidência anual de eventos tromboembólicos e morte cardiovascular foi 4,4% e preditores foram tromboembolismo prévio (hazard ratio [HR] 2,12; intervalo de confiança [IC] de 95% 1,22 - 3,67), tempo na faixa terapêutica (TFT) < 50% (HR 1,98; IC95% 1,16 - 3,37), e taxa de filtração glomerular (TFG) < 45 mL/min/1.73 m2 (HR 2,76; IC95% 4,82 - 1,58). Taxa de sangramento maior e não maior clinicamente relevante foram 3,24% por ano (IC95% 2,47 - 4,14) e preditores foram sangramento prévio (HR 2,60; IC95% 1,47 - 4,61) e prótese mecânica (HR 1,91; IC95% 1,15 - 3,15). O desfecho composto foi 8,7% por ano e preditores foram sangramento prévio (HR 1,70; IC95% 1,07 - 2,70), TFT < 41% (HR 1,79; IC95% 1,11 - 2,86) e diâmetro do átrio esquerdo > 44 mm (HR 1,97; IC95% 3,26 - 1,19). CONCLUSÕES: Tromboembolismo ou sangramento prévios, TFG e TFT reduzidos e átrio esquerdo aumentado foram preditores de desfechos clínicos em pacientes com FA tratados com AVK.

ABSTRACT

Motivation for the study. There is a need for information on population adherence to colon cancer screening. Main findings. Adherence to screening in health insurance increased to a maximum of 47.1% in December 2022, which is below desirable targets. The most commonly used method was colonoscopy. Public health implications. This information could contribute to the design of a multicomponent intervention to improve adherence to colon cancer screening. In order to evaluate adherence to colorectal cancer (CRC) screening among members of the Health Plan of the Hospital Italiano de Buenos Aires in Argentina, we conducted a retrospective cohort study using secondary data from the electronic medical record. We included all members over 50 years of age during the period 2008-2022. We assessed the number and type of screening tests performed and the proportion of members covered for screening. We analyzed 112,112 participants, with a median age of 58.6 years and a follow-up time of 8.6 years. Colonoscopy was the most commonly used test. The maximum coverage reached was 47.1% in December 2022. In conclusion, adherence to CRC screening was suboptimal, as was the method used. This information can be used for the design of a multicomponent intervention.

Con el objetivo de evaluar la adherencia al tamizaje de cáncer colorrectal (CCR) de los afiliados al Plan de Salud del Hospital Italiano de Buenos Aires en Argentina, realizamos un estudio de cohorte retrospectivo con datos secundarios de la historia clínica electrónica. Se incluyó a todos los afiliados mayores de 50 años durante el período 2008-2022. Se evaluó el número y tipo de pruebas de tamizaje realizadas y la proporción de afiliados que se encontraba cubierta para el tamizaje. Se analizaron 112,112 participantes, con una mediana de edad de 58,6 años y un tiempo de seguimiento de 8,6 años. La prueba más utilizada fue la videocolonoscopía. El máximo de cobertura alcanzado fue 47,1% en diciembre de 2022. En conclusión, la adherencia al tamizaje de CCR fue subóptima, al igual que el método utilizado. Esta información puede ser utilizada para el diseño de una intervención multicomponente de mejora. Motivación para realizar el estudio. Es necesario contar con información sobre la adherencia de la población al tamizaje de cáncer de colon. Principales hallazgos. La adherencia al tamizaje en el seguro de salud aumentó hasta alcanzar un máximo de 47,1% en diciembre de 2022, lo cual se encuentra por debajo de los objetivos deseables. El método más utilizado fue la colonoscopía. Implicancias en salud pública. Esta información podría contribuir al diseño de una intervención multicomponente de mejora para la adherencia al tamizaje de cáncer de colon.