Cardiovascular health of Brazilian adolescents within the framework of Life's Essential 8: Findings from the ERICA study.

BACKGROUND: The Life's Essential 8 (LE8) is an official cardiovascular health (CVH) assessment tool, however, its use remains limited within the adolescent population. We aim to describe the prevalence of CVH in Brazilian adolescents using the LE8 framework and to analyze its distribution considering sociodemographic factors. METHODS: The sample comprised 36,956 adolescents aged 12 to 17 years, who participated in the Study of Cardiovascular Risks in Adolescents, a nationwide, cross-sectional, school-based study. CVH was assessed by the LE8 score (0-100 points), comprising eight metrics categorized into two domains: health behaviors (diet, physical activity, nicotine exposure, and sleep) and health factors (body mass index, non-HDL cholesterol, blood glucose, and blood pressure). Sociodemographic factors were sex, age, type of school, skin color, and region of residence. The results were expressed as means with 95 % confidence intervals (95 % CI). RESULTS: The overall average score was 75.8 points (95 % CI: 75.3-76.3), classified as moderate CVH. The general score was higher among males (76.8; 95 % CI: 76.6-77.7) and younger adolescents (12-14 years old) (78.5; 95 % CI: 77.7-79.4). The health factors had a higher mean than behavioral factors (87.6, 95 % CI: 87.3-87.9 vs. 64.0, 95 % CI: 63.3-64.7). The best score was blood glucose (94.7; 95 % CI: 94.2-95.2), while the diet score was the lowest (48.5; 95 % CI: 46.3-50.6). CONCLUSION: The CVH of Brazilian adolescents is classified as moderate and varied according to sociodemographic characteristics. Intervention actions should prioritize behavioral factors to improve the LE8 score and consequently prevent cardiovascular events in adulthood.

Cost-Utility of Venoarterial Extracorporeal Membrane Oxygenation in Refractory Cardiogenic Shock: A Brazilian Perspective Study. / Custo-Efetividade da Oxigenação por Membrana Extracorpórea Venoarterial no Choque Cardiogênico Refratário: Um Estudo na Perspectiva Brasileira.

BACKGROUND: Refractory cardiogenic shock (CS) is associated with high mortality rates, and the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a therapeutic option has generated discussions. Therefore, its cost-effectiveness, especially in low- and middle-income countries like Brazil, remains uncertain.Objectives: To conduct a cost-utility analysis from the Brazilian Unified Health System perspective to assess the cost-effectiveness of VA-ECMO combined with standard care compared to standard care alone in adult refractory CS patients. METHODS: We followed a cohort of refractory CS patients treated with VA-ECMO in tertiary care centers located in Southern Brazilian. We collected data on hospital outcomes and costs. We conducted a systematic review to supplement our data and utilized a Markov model to estimate incremental cost-effectiveness ratios (ICERs) per quality-adjusted life year (QALY) and per life-year gained. RESULTS: In the base-case analysis, VA-ECMO yielded an ICER of Int$ 37,491 per QALY. Sensitivity analyses identified hospitalization cost, relative risk of survival, and VA-ECMO group survival as key drivers of results. Probabilistic sensitivity analysis favored VA-ECMO, with a 78% probability of cost-effectiveness at the recommended willingness-to-pay threshold. CONCLUSIONS: Our study suggests that, within the Brazilian Health System framework, VA-ECMO may be a cost-effective therapy for refractory CS. However, limited efficacy data and recent trials questioning its benefit in specific patient subsets highlight the need for further research. Rigorous clinical trials, encompassing diverse patient profiles, are essential to confirm cost-effectiveness and ensure equitable access to advanced medical interventions within healthcare systems, particularly in socio-economically diverse countries like Brazil.

FUNDAMENTO: O choque cardiogênico (CC) refratário está associado com altas taxas de mortalidade, e o uso de oxigenação por membrana extracorpórea venoarterial (VA-ECMO, do inglês venoarterial extracorporeal membrane oxygenation) como uma opção terapêutica tem gerado discussões. Nesse sentido, sua custo-efetividade, principalmente em países de baixa e média renda como o Brasil, continua incerto.Objetivos: Conduzir uma análise de custo-efetividade na perspectiva do Sistema Único de Saúde (SUS) para avaliar a custo-efetividade de VA-ECMO combinado com o tratamento padrão em comparação ao tratamento padrão isolado em pacientes adultos com CC refratário. MÉTODOS: Acompanhamos uma coorte de pacientes com CC refratário tratados com VA-ECMO em centros de assistência terciária do sul brasileiro. Coletamos dados de desfechos e custos hospitalares. Realizamos uma revisão sistemática para complementar nossos dados e usamos o modelo de Markov para estimar a razão de custo-efetividade incremental (RCEI) por ano de vida ajustado pela qualidade (QALY) e por ano de vida ganho. RESULTADOS: Na análise do caso-base, a VA-ECMO gerou uma RCEI de Int$ 37 491 por QALY. Análises de sensibilidade identificaram o custo de internação, o risco relativo de sobrevida, e a sobrevida do grupo submetido à VA-ECMO como principais variáveis influenciando os resultados. A análise de sensibilidade probabilística mostrou um benefício do uso de VA-ECMO, com uma probabilidade de 78% de custo-efetividade no limiar recomendado de disposição a pagar. CONCLUSÕES: Nosso estudo sugere que, dentro do SUS, VA-ECMO pode ser uma terapia custo-efetiva para o CC refratário. Contudo, a escassez de dados sobre a eficácia e de ensaios clínicos recentes que abordem seus benefícios em subgrupos específicos de pacientes destaca a necessidade de mais pesquisas. Ensaios clínicos rigorosos, incluindo perfis diversos de pacientes, são essenciais para confirmar a custo-efetividade com uso de VA-ECMO e assegurar acesso igualitário a intervenções médicas avançadas dentro dos sistemas de saúde, especialmente em países com desigualdades socioeconômicas como o Brasil.

Custo-Efetividade da Oxigenação por Membrana Extracorpórea Venoarterial no Choque Cardiogênico Refratário: Um Estudo na Perspectiva Brasileira / Cost-Utility of Venoarterial Extracorporeal Membrane Oxygenation in Refractory Cardiogenic Shock: A Brazilian Perspective Study

Resumo Fundamento O choque cardiogênico (CC) refratário está associado com altas taxas de mortalidade, e o uso de oxigenação por membrana extracorpórea venoarterial (VA-ECMO, do inglês venoarterial extracorporeal membrane oxygenation) como uma opção terapêutica tem gerado discussões. Nesse sentido, sua custo-efetividade, principalmente em países de baixa e média renda como o Brasil, continua incerto.Objetivos: Conduzir uma análise de custo-efetividade na perspectiva do Sistema Único de Saúde (SUS) para avaliar a custo-efetividade de VA-ECMO combinado com o tratamento padrão em comparação ao tratamento padrão isolado em pacientes adultos com CC refratário. Métodos Acompanhamos uma coorte de pacientes com CC refratário tratados com VA-ECMO em centros de assistência terciária do sul brasileiro. Coletamos dados de desfechos e custos hospitalares. Realizamos uma revisão sistemática para complementar nossos dados e usamos o modelo de Markov para estimar a razão de custo-efetividade incremental (RCEI) por ano de vida ajustado pela qualidade (QALY) e por ano de vida ganho. Resultados Na análise do caso-base, a VA-ECMO gerou uma RCEI de Int$ 37 491 por QALY. Análises de sensibilidade identificaram o custo de internação, o risco relativo de sobrevida, e a sobrevida do grupo submetido à VA-ECMO como principais variáveis influenciando os resultados. A análise de sensibilidade probabilística mostrou um benefício do uso de VA-ECMO, com uma probabilidade de 78% de custo-efetividade no limiar recomendado de disposição a pagar. Conclusões Nosso estudo sugere que, dentro do SUS, VA-ECMO pode ser uma terapia custo-efetiva para o CC refratário. Contudo, a escassez de dados sobre a eficácia e de ensaios clínicos recentes que abordem seus benefícios em subgrupos específicos de pacientes destaca a necessidade de mais pesquisas. Ensaios clínicos rigorosos, incluindo perfis diversos de pacientes, são essenciais para confirmar a custo-efetividade com uso de VA-ECMO e assegurar acesso igualitário a intervenções médicas avançadas dentro dos sistemas de saúde, especialmente em países com desigualdades socioeconômicas como o Brasil.

Abstract Background Refractory cardiogenic shock (CS) is associated with high mortality rates, and the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a therapeutic option has generated discussions. Therefore, its cost-effectiveness, especially in low- and middle-income countries like Brazil, remains uncertain.Objectives: To conduct a cost-utility analysis from the Brazilian Unified Health System perspective to assess the cost-effectiveness of VA-ECMO combined with standard care compared to standard care alone in adult refractory CS patients. Methods We followed a cohort of refractory CS patients treated with VA-ECMO in tertiary care centers located in Southern Brazilian. We collected data on hospital outcomes and costs. We conducted a systematic review to supplement our data and utilized a Markov model to estimate incremental cost-effectiveness ratios (ICERs) per quality-adjusted life year (QALY) and per life-year gained. Results In the base-case analysis, VA-ECMO yielded an ICER of Int$ 37,491 per QALY. Sensitivity analyses identified hospitalization cost, relative risk of survival, and VA-ECMO group survival as key drivers of results. Probabilistic sensitivity analysis favored VA-ECMO, with a 78% probability of cost-effectiveness at the recommended willingness-to-pay threshold. Conclusions Our study suggests that, within the Brazilian Health System framework, VA-ECMO may be a cost-effective therapy for refractory CS. However, limited efficacy data and recent trials questioning its benefit in specific patient subsets highlight the need for further research. Rigorous clinical trials, encompassing diverse patient profiles, are essential to confirm cost-effectiveness and ensure equitable access to advanced medical interventions within healthcare systems, particularly in socio-economically diverse countries like Brazil.

Social transmission of inflammation in mice.

The ability to detect and respond to sickness in others promotes survival. Here we show that mouse dams respond to immune challenged pups by mirroring their inflammatory response. Dams with pups subjected to immune challenge displayed a marked induction of inflammatory mediators in both the brain and the periphery, accompanied by an increase in maternal behaviors and corticosterone levels. This social transmission of inflammation did not require physical contact, and it contributed to the stress hormone response in the dams. In adult dyads, interaction with an immune challenged cagemate did not elicit robust inflammatory signaling but induced an increased responsiveness to a subsequent immune challenge. The identification of social transmission of inflammation, or inflammatory responsiveness, may open new avenues for research on social behavior, just like the description of similar phenomena such as observational fear and transmitted pain has done.

Normal Fermi Surface in the Nodal Superconductor CeCoIn_{5} Revealed via Thermal Conductivity.

The thermal conductivity of heavy-fermion superconductor CeCoIn_{5} was measured with a magnetic field rotating in the tetragonal a-b plane, with the heat current in the antinodal direction, J|| [100]. We observe a sharp resonance in thermal conductivity for the magnetic field at an angle Θ≈12°, measured from the heat current direction [100]. This resonance corresponds to the reported resonance at an angle Θ^{'}≈33° from the direction of the heat current applied along the nodal direction, J||[110]. Both resonances, therefore, occur when the magnetic field is applied in the same crystallographic orientation in the two experiments, regardless of the direction of the heat current, proving conclusively that these resonances are due to the structure of the Fermi surface of CeCoIn_{5}. We argue that the uncondensed Landau quasiparticles, emerging with field, are responsible for the observed resonance. We support our experimental results with density-functional-theory model calculations of the density of states in a rotating magnetic field. Our calculations, using a model Fermi surface of CeCoIn_{5}, reveal several sharp peaks as a function of the field direction. Our study demonstrates that the thermal-conductivity measurement in rotating magnetic field can probe the normal parts of the Fermi surface deep inside the superconducting state.

Towards a species-level phylogeny for Neotropical Myrtaceae: Notes on topology and resources for future studies.

PREMISE: Increasingly complete phylogenies underpin studies in systematics, ecology, and evolution. Myrteae (Myrtaceae), with ~2700 species, is a key component of the exceptionally diverse Neotropical flora, but given its complicated taxonomy, automated assembling of molecular supermatrices from public databases often lead to unreliable topologies due to poor species identification. METHODS: Here, we build a taxonomically verified molecular supermatrix of Neotropical Myrteae by assembling 3909 published and 1004 unpublished sequences from two nuclear and seven plastid molecular markers. We infer a time-calibrated phylogenetic tree that covers 712 species of Myrteae (~28% of the total diversity in the clade) and evaluate geographic and taxonomic gaps in sampling. RESULTS: The tree inferred from the fully concatenated matrix mostly reflects the topology of the plastid data set and there is a moderate to strong incongruence between trees inferred from nuclear and plastid partitions. Large, species-rich genera are still the poorest sampled within the group. Eastern South America is the best-represented area in proportion to its species diversity, while Western Amazon, Mesoamerica, and the Caribbean are the least represented. CONCLUSIONS: We provide a time-calibrated tree that can be more reliably used to address finer-scale eco-evolutionary questions that involve this group in the Neotropics. Gaps to be filled by future studies include improving representation of taxa and areas that remain poorly sampled, investigating causes of conflict between nuclear and plastid partitions, and the role of hybridization and incomplete lineage sorting in relationships that are poorly supported.

The reverse quantum limit and its implications for unconventional quantum oscillations in YbB12.

The quantum limit in a Fermi liquid, realized when a single Landau level is occupied in strong magnetic fields, gives rise to unconventional states, including the fractional quantum Hall effect and excitonic insulators. Stronger interactions in metals with nearly localized f-electron degrees of freedom increase the likelihood of these unconventional states. However, access to the quantum limit is typically impeded by the tendency of f-electrons to polarize in a strong magnetic field, consequently weakening the interactions. In this study, we propose that the quantum limit in such systems must be approached in reverse, starting from an insulating state at zero magnetic field. In this scenario, Landau levels fill in the reverse order compared to regular metals and are closely linked to a field-induced insulator-to-metal transition. We identify YbB12 as a prime candidate for observing this effect and propose the presence of an excitonic insulator state near this transition.

Neuro-immune interactions in health and disease: Insights from FENS-Hertie 2022 Winter School.

In a great partnership, the Federation of European Neuroscience Societies (FENS) and the Hertie Foundation organized the FENS-Hertie 2022 Winter School on 'Neuro-immune interactions in health and disease'. The school selected 27 PhD students and 13 postdoctoral fellows from 20 countries and involved 14 faculty members experts in the field. The Winter School focused on a rising field of research, the interactions between the nervous and both innate and adaptive immune systems under pathological and physiological conditions. A fine-tuned neuro-immune crosstalk is fundamental for healthy development, while disrupted neuro-immune communication might play a role in neurodegeneration, neuroinflammation and aging. However, much is yet to be understood about the underlying mechanisms of these neuro-immune interactions in the healthy brain and under pathological scenarios. In addition to new findings in this emerging field, novel methodologies and animal models were presented to foment research on neuro-immunology. The FENS-Hertie 2022 Winter School provided an insightful knowledge exchange between students and faculty focusing on the latest discoveries in the biology of neuro-immune interactions while fostering great academic and professional opportunities for early-career neuroscientists from around the world.

Sudden adiabaticity signals reentrant bulk superconductivity in UTe2.

There has been a recent surge of interest in UTe2 due to its unconventional magnetic field (H)-reinforced spin-triplet superconducting phases persisting at fields far above the simple Pauli limit for H∥[010]. Magnetic fields in excess of 35 T then induce a field-polarized magnetic state via a first-order-like phase transition. More controversially, for field orientations close to H∥[011] and above 40 T, electrical resistivity measurements suggest that a further superconducting state may exist. However, no Meissner effect or thermodynamic evidence exists to date for this phase making it difficult to exclude alternative scenarios. In this paper, we describe a study using thermal, electrical, and magnetic probes in magnetic fields of up to 55 T applied between the [010] (b) and [001] (c) directions. Our MHz conductivity data reveal the field-induced state of low or vanishing electrical resistance; our simultaneous magnetocaloric effect measurements (i.e. changes in sample temperature due to changing magnetic field) show the first definitive evidence for adiabaticity and thermal behavior characteristic of bulk field-induced superconductivity.

Association between dairy products consumption and the prevalences of combined prediabetes and type 2 diabetes mellitus in Brazilian adolescents: a cross-sectional study.

The association between dairy products consumption in adults and the likelihood of type 2 diabetes mellitus (T2DM) has been described, but more information on the adolescent population is needed. This nationally representative, cross-sectional school-based study aimed to describe the consumption of dairy products and their subtypes and to evaluate their association with prediabetes and T2DM in adolescents. The Study of Cardiovascular Risks in Adolescents (ERICA) includes adolescents aged 12-17 years. Dairy products consumption was evaluated by 24-h food recall. Associations with fasting glucose, glycated hemoglobin (HbA1c) and insulin resistance, as measured by homeostatic model assessment-insulin resistance (HOMA-IR), were evaluated by multivariate linear regression. Poisson regression was also used to assess the association between dairy products consumption and the combined prevalence of prediabetes and T2DM. Models were adjusted for sociodemographic, nutritional, behavioural and anthropometrics. The final sample analysed consisted of 35 614 adolescents. Total intake of dairy products was inversely associated with fasting blood glucose levels after adjusting for all covariates (ß = -0·452, 95 % CI -0·899, -0·005). The associations were stronger for overweight and obese adolescents. Findings were similar for full-fat dairy products and yogurt. Higher consumption of low-fat dairy products and cheese were associated with a 46 % (prevalence ratio, PR 1·46, 95 % CI 1·18, 1·80) and 33 % (PR 1·33, 95 % CI 1·14, 1·57) higher combined prevalence of prediabetes and T2DM, respectively. The total consumption of dairy products and full-fat dairy products was associated with a lower combined prevalence of prediabetes and T2DM, while the consumption of cheese and low-fat dairy products was associated with higher combined prevalence of prediabetes and T2DM in Brazilian adolescents.

Microscopic Imaging Homogeneous and Single Phase Superfluid Density in UTe_{2}.

Odd-parity superconductor UTe_{2} shows spontaneous time-reversal symmetry breaking and multiple superconducting phases, which imply chiral superconductivity, but only in a subset of samples. Here we microscopically observe a homogeneous superfluid density n_{s} on the surface of UTe_{2} and an enhanced superconducting transition temperature near the edges. We also detect vortex-antivortex pairs even at zero magnetic field, indicating the existence of a hidden internal field. The temperature dependence of n_{s}, determined independent of sample geometry, does not support point nodes along the b axis for a quasi-2D Fermi surface and provides no evidence for multiple phase transitions in UTe_{2}.

Topical gentamicin for the prevention of tunneled hemodialysis catheter-related infections: a randomized double-blind study.

INTRODUCTION: Infection is the second leading cause of death in dialysis patients, with catheter-related bloodstream infection being the most serious. Exit Site Infection and Tunnel Infection are also related to the catheter. OBJECTIVE: To compare the infection rates achieved with the application of either topical gentamicin or placebo to the exit-site of tunneled catheters filled with locking solution in chronic hemodialysis patients. METHODS: This randomized double-blind clinical trial compared the application of 0.1% gentamicin versus placebo to the exit site of tunneled hemodialysis catheters filled with a prophylactic locking solution. A total of 91 patients were randomly allocated to 2 groups: placebo or 0.1% gentamicin. RESULTS: Mean patient age was 60.4 (+ 15.3) years, with predominance of males (60.4%). The main cause of chronic kidney disease was diabetes (40.7%). The rates of exit site infection (placebo = 30% vs. gentamicin = 34.1%, p = 0.821), and bloodstream infection (placebo = 22% vs. gentamicin = 17.1%, p = 0.60), as well as both exit site infection and bloodstream infection incidence density per 1000 catheter-days (p = 1) did not differ between groups. The infection-free curve was also similar in both groups. CONCLUSION: The application of topical 0.1% gentamicin to the exit site of tunneled catheters filled with lock solution did not reduce infectious complications when compared to topical placebo in patients on chronic hemodialysis.

Probing FeSi, a d-electron topological Kondo insulator candidate, with magnetic field, pressure, and microwaves.

Recently, evidence for a conducting surface state (CSS) below 19 K was reported for the correlated d-electron small gap semiconductor FeSi. In the work reported herein, the CSS and the bulk phase of FeSi were probed via electrical resistivity ρ measurements as a function of temperature T, magnetic field B to 60 T, and pressure P to 7.6 GPa, and by means of a magnetic field-modulated microwave spectroscopy (MFMMS) technique. The properties of FeSi were also compared with those of the Kondo insulator SmB6 to address the question of whether FeSi is a d-electron analogue of an f-electron Kondo insulator and, in addition, a "topological Kondo insulator" (TKI). The overall behavior of the magnetoresistance of FeSi at temperatures above and below the onset temperature TS = 19 K of the CSS is similar to that of SmB6. The two energy gaps, inferred from the ρ(T) data in the semiconducting regime, increase with pressure up to about 7 GPa, followed by a drop which coincides with a sharp suppression of TS. Several studies of ρ(T) under pressure on SmB6 reveal behavior similar to that of FeSi in which the two energy gaps vanish at a critical pressure near the pressure at which TS vanishes, although the energy gaps in SmB6 initially decrease with pressure, whereas in FeSi they increase with pressure. The MFMMS measurements showed a sharp feature at TS ≈ 19 K for FeSi, which could be due to ferromagnetic ordering of the CSS. However, no such feature was observed at TS ≈ 4.5 K for SmB6.

Magnetic and electronic properties unveil polaron formation in Eu[Formula: see text]In[Formula: see text]Sb[Formula: see text].

The intermetallic compound Eu[Formula: see text]In[Formula: see text]Sb[Formula: see text], an antiferromagnetic material with nonsymmorphic crystalline structure, is investigated by magnetic, electronic transport and specific heat measurements. Being a Zintl phase, insulating behavior is expected. Our thermodynamic and magnetotransport measurements along different crystallographic directions strongly indicate polaron formation well above the magnetic ordering temperatures. Pronounced anisotropies of the magnetic and transport properties even above the magnetic ordering temperature are observed despite the Eu[Formula: see text] configuration which testify to complex and competing magnetic interactions between these ions and give rise to intricate phase diagrams discussed in detail. Our results provide a comprehensive framework for further detailed study of this multifaceted compound with possible nontrivial topology.

The antidepressant-like effect of guanosine involves the modulation of adenosine A1 and A2A receptors.

Guanosine has been considered a promising candidate for antidepressant responses, but if this nucleoside could modulate adenosine A1 (A1R) and A2A (A2AR) receptors to exert antidepressant-like actions remains to be elucidated. This study investigated the role of A1R and A2AR in the antidepressant-like response of guanosine in the mouse tail suspension test and molecular interactions between guanosine and A1R and A2AR by docking analysis. The acute (60 min) administration of guanosine (0.05 mg/kg, p.o.) significantly decreased the immobility time in the tail suspension test, without affecting the locomotor performance in the open-field test, suggesting an antidepressant-like effect. This behavioral response was paralleled with increased A1R and reduced A2AR immunocontent in the hippocampus, but not in the prefrontal cortex, of mice. Guanosine-mediated antidepressant-like effect was not altered by the pretreatment with caffeine (3 mg/kg, i.p., a non-selective adenosine A1R/A2AR antagonist), 8-cyclopentyl-1,3-dipropylxanthine (DPCPX - 2 mg/kg, i.p., a selective adenosine A1R antagonist), or 4-(2-[7-amino-2-{2-furyl}{1,2,4}triazolo-{2,3-a}{1,3,5}triazin-5-yl-amino]ethyl)-phenol (ZM241385 - 1 mg/kg, i.p., a selective adenosine A2AR antagonist). However, the antidepressant-like response of guanosine was completely abolished by adenosine (0.5 mg/kg, i.p., a non-selective adenosine A1R/A2AR agonist), N-6-cyclohexyladenosine (CHA - 0.05 mg/kg, i.p., a selective adenosine A1 receptor agonist), and N-6-[2-(3,5-dimethoxyphenyl)-2-(methylphenyl)ethyl]adenosine (DPMA - 0.1 mg/kg, i.p., a selective adenosine A2A receptor agonist). Finally, docking analysis also indicated that guanosine might interact with A1R and A2AR at the adenosine binding site. Overall, this study reinforces the antidepressant-like of guanosine and unveils a previously unexplored modulation of the modulation of A1R and A2AR in its antidepressant-like effect.

Spatial distribution and incidence of HIV/AIDS cases in Santa Cruz do Sul, state of Rio Grande do Sul, 2001 to 2020. / Distribuição espacial e incidência de casos de HIV/aids em Santa Cruz do Sul, Rio Grande do Sul, 2001 a 2020.

OBJECTIVE: to describe the spatial distribution, treatment status and characteristics of cases of people infected with the human immunodeficiency virus HIV in Santa Cruz do Sul, RS, 2001 to 2020. METHODS: descriptive study with data from individuals undergoing treatment for HIV/AIDS, in Santa Cruz do Sul, diagnosed from January 2001 to October 2020. RESULTS: 708 (94.4%) cases were analyzed, of these (58.2%) were male, with a mean age of 39 years, the maximum incidence rate was in 2019 (59.4/100,000 inhabitants), there was a high frequency of cases in the south and central region of the city, 92.9% of these individuals were still in active treatment and the dropout rate was 7.1% in the period. CONCLUSION: a higher incidence of HIV was observed in adult male, from the central and southern regions of the city, with a treatment rate close to the goals of the World Health Organization and a low dropout rate.

Spatial distribution and incidence of HIV/AIDS cases in Santa Cruz do Sul, state of Rio Grande do Sul, 2001 to 2020 / Distribución espacial e incidencia de casos de VIH/SIDA en Santa Cruz do Sul, Rio Grande dol Sul, 2001 a 2020 / Distribuição espacial e incidência de casos de HIV/aids em Santa Cruz do Sul, Rio Grande do Sul, 2001 a 2020

Objective: to describe the spatial distribution, treatment status and characteristics of cases of people infected with the human immunodeficiency virus HIV in Santa Cruz do Sul, RS, 2001 to 2020. Methods: descriptive study with data from individuals undergoing treatment for HIV/AIDS, in Santa Cruz do Sul, diagnosed from January 2001 to October 2020. Results: 708 (94.4%) cases were analyzed, of these (58.2%) were male, with a mean age of 39 years, the maximum incidence rate was in 2019 (59.4/100,000 in habitants), there was a high frequency of cases in the south and central region of the city, 92.9% of these individuals were still in active treatment and the dropout rate was 7.1% in the period. Conclusion: a higher incidence of HIV was observed in adult male, from the central and southern regions of the city, with a treatment rate close to the goals of the World Health Organization and a low dropout rate.

Objetivo: describir la distribución espacial, estado de tratamiento y características de los casos de personas infectadas por el virus de la inmunodeficiencia humana en Santa Cruz do Sul, RS, 2001 hasta 2020. Métodos: estudio descriptivo con datos de individuos en tratamiento por VIH/SIDA, en Santa Cruz do Sul, diagnosticados de enero de 2001 a octubre de 2020. Resultados: se analizaron 708 (94,4%) casos, de estos (58,2%) eran del sexo masculino, con una edad media de 39 años, la tasa de incidencia máxima fue en 2019 (59,4/100.000 habitantes), hubo una alta frecuencia de casos en la región sur y centro del municipio, el 92,9% de estos individuos seguían en tratamiento activo y la deserción fue del 7,1% en el período. Conclusión: se observó una mayor incidencia de VIH en hombres adultos, de las regiones centro y sur de la ciudad, con una tasa de tratamiento cercana a las metas de la Organización Mundial de la Salud y una baja tasa de deserción.

Objetivo: descrever a distribuição espacial, a situação do tratamento e as características dos casos de pessoas infectadas pelo vírus da imunodeficiência humana (HIV), em Santa Cruz do Sul/RS, de 2001 a 2020. Métodos: estudo descritivo com dados de indivíduos em tratamento para HIV/aids, em Santa Cruz do Sul, diagnosticados no período de janeiro de 2001 a outubro de 2020. Resultados: foram analisados 708 (94,4%) casos, dos quais 58,2% eram do sexo masculino, com idade média de 39 anos. A taxa de incidência máxima foi registrada em 2019 (59,4/100 mil habitantes), e observou-se frequência elevada de casos nas regiões sul e central do município; 92,9% dos indivíduos continuavam em tratamento ativo, e a taxa de abandono alcançou 7,1% no período. Conclusão: observou-se uma maior incidência de HIV entre adultos do sexo masculino, das regiões central e sul da cidade, com uma taxa de tratamento próxima às metas da Organização Mundial da Saúde (OMS) e baixa taxa de abandono.

Development of a nanotechnological hydrogel containing desonide nanocapsules in association with acai oil: design and in vivo evaluation.

Nanotechnological products have been used as strategies to optimize the therapy and minimize the side effects of topical corticoids. The objective of this study was to develop hydrogels by the addition of sclerotium gum to the suspensions of desonide-loaded açai oil-based nanocapsules and to study their biological effect using an animal model of acute skin inflammation. The hydrogels presented a pH compatible with topical application (4.4 to 5.0), nanometric mean diameter (131 to 165 nm), pseudoplastic behavior, and stability under room conditions during 30 days. The in vitro skin permeation/penetration study demonstrated that a higher amount of desonide (p < 0.05) was retained in the epidermis from the nanotechnological-hydrogels (0.33 to 0.36 µg.cm2) in comparison to the commercial gel cream (0.16 µg.cm2). In the dermis, the nanostructured hydrogels promoted a lower DES retention compared to the non-nanostructured formulations (p < 0.05). This result may indicate a smaller amount of drug reaching the bloodstream and, thus, fewer side effects can be expected. Concerning the anti-inflammatory effect, the developed hydrogels reduced both ear edema and inflammatory cell infiltration, showing an effect comparable to the commercially available formulation, which presents twice the drug concentration. The hydrogels developed may be considered a promising approach to treat dermatological disorders.

Are the recommendation of sodium and fluid restriction in heart failure patients changing over the past years? A systematic review and meta-analysis.

BACKGROUND: Heart failure (HF) is a growing problem for healthcare systems worldwide. Sodium and fluid restriction are non-pharmacological treatments recommended for patients with HF by several guidelines over the years, even without consensus. OBJECTIVE: To evaluate the effects of sodium and fluid restriction in patients with HF. METHODS: We searched MEDLINE, Embase, and Cochrane CENTRAL databases up to June 2020 and screened the reference lists of relevant articles. We included randomized controlled trials evaluating sodium and/or fluid restriction in patients with HF. We assessed three independent comparisons: (a) sodium restriction versus control; (b) fluid restriction versus control; and (c) sodium and fluid restriction versus control. Main outcomes of interest were all-cause mortality and hospitalization. Two independent reviewers selected studies and extracted data. We pooled the results using random-effects meta-analysis. We used the RoB 2.0 and the GRADE framework to assess risk of bias and quality of evidence. RESULTS: We included 16 studies totaling 3545 patients in our meta-analysis. Daily sodium intake was 1.5-2.4 g for the intervention group and >2.7 g for the control group, and daily fluid intake was 0.8-1.5 L for the intervention group and free oral fluid intake for the control group. Sodium restriction increased mortality (relative risk 1.92, 95% confidence interval 1.51 to 2.45, moderate quality of evidence) and hospitalization (relative risk 1.63, 1.11 to 2.40, low quality of evidence). Fluid restriction reduced mortality (relative risk 0.32, 0.13 to 0.82, low quality of evidence) and hospitalization (relative risk 0.46, 0.27 to 0.77, n = 331, low quality of evidence). The combination of sodium and fluid restriction did not significantly affect the risk of mortality (relative risk 0.92, 0.49 to 1.73, low quality of evidence) or the risk of hospitalization (relative risk 0.94, 0.75 to 1.19, low quality of evidence). CONCLUSION: The combination of sodium and fluid restriction in clinical trials resulted in a null effect although results in the opposite direction were observed for each intervention independently. Combined sodium and fluid restriction are usually recommended for patients with HF. Our findings of sodium restriction harm, risk of mortality and hospitalization are consistent with publications from several clinical trial and physiologic explanations. A well-designed clinical trial nested by an implementation study is urgent for definitive sodium range recommendation, specially considering the change of currently guidelines, pushing up the cut-off of sodium restriction range.

Involvement of serotonergic neurotransmission in the antidepressant-like effect elicited by cholecalciferol in the chronic unpredictable stress model in mice.

Cholecalciferol deficiency has been associated with stress-related psychiatric disorders, particularly depression. Therefore, the present study investigated the antidepressant-like effect of cholecalciferol in female mice and the possible role of the serotonergic system in this response. The ability of cholecalciferol to elicit an antidepressant-like effect and to modulate serotonin levels in the hippocampus and prefrontal cortex of mice subjected to chronic unpredictable stress (CUS) was also investigated. The administration of cholecalciferol (2.5, 7.5, and 25 µg/kg, p.o.) for 7 days, similar to fluoxetine (10 mg/kg, p.o., serotonin reuptake inhibitor), reduced the immobility time in the tail suspension test, without altering the locomotor performance in the open-field test. Moreover, the administration of p-chlorophenylalanine methyl ester (PCPA - 100 mg/kg, i.p., for 4 days, a selective inhibitor of tryptophan hydroxylase, involved in the serotonin synthesis) abolished the antidepressant-like effect of cholecalciferol and fluoxetine in the tail suspension test, demonstrating the involvement of serotonergic system. Additionally, CUS protocol (21 days) induced depressive-like behavior in the tail suspension test and decreased serotonin levels in the prefrontal cortex and hippocampus of mice. Conversely, the administration of cholecalciferol and fluoxetine in the last 7 days of CUS protocol completely abolished the stress-induced depressive-like phenotype. Cholecalciferol was also effective to abrogate CUS-induced reduction on serotonin levels in the prefrontal cortex, but not in the hippocampus. Our results indicate that cholecalciferol has an antidepressant-like effect in mice by modulating the serotonergic system and support the assumption that cholecalciferol may have beneficial effects for the management of depression.