Sustainable Composites: Analysis of Filler-Rubber Interaction in Natural Rubber-Styrene-Butadiene Rubber/Polyurethane Composites Using the Lorenz-Park Method and Scanning Electron Microscopy.

This study examined micronized polyurethane residues as a reinforcing filler in elastomeric composites made from natural rubber (NR) and styrene-butadiene rubber (SBR). Due to growing environmental concerns, this research aimed to find sustainable alternatives to synthetic materials. The results indicated that adding micronized polyurethane improved the mechanical properties of the composites, reinforcing the polymer matrix and increasing the cross-link density as a barrier against solvents. The composites met the requirements for industrial applications, though; at 40 phr of polyurethane filler, material deformation was reduced, indicating saturation. FTIR analysis confirmed the homogeneity of the materials without chemical reactions, while electron microscopy revealed an increase in the number of particles and irregularities with the filler. The composite with 10 phr showed a lower volume loss in abrasion resistance, meeting the standards for soles. The composite with 30 phr of polyurethane achieved the best results without the filler's saturation and met the footwear industry's requirements. The results show the potential for sustainable practices in industry using this elastomeric blend.

Temporal trend and spatial distribution of gestational and congenital syphilis in the State of Espírito Santo from 2010 to 2019. / Tendencia temporal y distribución espacial de la sífilis gestacional y congénita en el Estado de Espírito Santo de 2010 a 2019. / Tendência temporal e distribuição espacial das sífilis gestacional e congênita no Estado do Espírito Santo entre 2010 a 2019

Objective: To evaluate the temporal trend and spatial distribution of gestational and congenital syphilis in the State of Espírito Santo from 2010 to 2019. Materials and methods: This is an ecological time series study with data on gestational and congenital syphilis obtained from the National System of Diseases and Notifications (SINAN) and live births in the Information System on Live Births (SINASC). Incidence rates of gestational and congenital syphilis were calculated, which were grouped according to the IBGE health macro-regions and analyzed in biennia. Results: 9,763 cases of gestational syphilis and 3,912 cases of congenital syphilis were reported. Gestational syphilis rates ranged from 1.46 in 2013 to 31.49 cases per 1,000 live births in 2018, congenital syphilis rates ranged from 0.12 in 2010 to 11.51 cases per 1,000 live births in 2017. The South region had the lowest incidence rates (2.32 cases/1,000 live births for gestational syphilis and 0.54/1,000 live births for congenital syphilis) and the Metropolitan region the highest (37.08 cases/1,000 live births for gestational syphilis and 13.74/1,000 live births for congenital syphilis). Conclusion: The increase in cases of the disease suggests a deficiency in the quality of prenatal care.

Objetivo: Avaliar a tendência temporal e a distribuição espacial da sífilis gestacional e congênita no Estado do Espírito Santo de 2010 a 2019. Materiais e métodos: Trata-se de um estudo ecológico de série temporal com dados sobre sífilis gestacional e congênita obtidos do Sistema Nacional de Agravos e Notificações (SINAN) e de nascidos vivos no Sistema de Informação sobre os Nascidos Vivos (SINASC). Foram calculadas taxas de incidência de sífilis gestacional e congênita, que foram agrupadas conforme as macrorregiões de saúde do IBGE e analisadas em biênios. Resultados: Foram notificados 9.763 casos de sífilis gestacional e 3.912 casos de sífilis congênita. As taxas de sífilis gestacional variaram de 1,46 em 2013 a 31,49 casos por 1.000 nascidos vivos em 2018, as taxas de sífilis congênita, por sua vez, variaram de 0,12 em 2010 a 11,51 casos por 1.000 nascidos vivos em 2017. Quanto às macrorregiões, a região Sul apresentou as menores taxas de incidência (2,32 casos/1.000 nascidos vivos para sífilis gestacional e 0,54/1.000 nascidos vivos para sífilis congênita) e a região Metropolitana as maiores (37,08 casos/1.000 nascidos vivos para sífilis gestacional e 13,74/1.000 nascidos vivos para sífilis congênita). Conclusão: O aumento dos casos da doença sugere deficiência na qualidade do pré-natal.

Can I Have My Coffee and Drink It? A Systematic Review and Meta-analysis to Determine Whether Habitual Caffeine Consumption Affects the Ergogenic Effect of Caffeine.

OBJECTIVE: The aim was to quantify the proportion of the literature on caffeine supplementation that reports habitual caffeine consumption, and determine the influence of habitual consumption on the acute exercise response to caffeine supplementation, using a systematic review and meta-analytic approach. METHODS: Three databases were searched, and articles screened according to inclusion/exclusion criteria. Three-level meta-analyses and meta-regression models were used to investigate the influence of habitual caffeine consumption on caffeine's overall ergogenic effect and within different exercise types (endurance, power, strength), in men and women, and in trained and untrained individuals. Sub-analyses were performed according to the following: acute relative dose (< 3, 3-6, > 6 mg/kg body mass [BM]); whether the acute caffeine dose provided was lower or higher than the mean daily caffeine dose; and the caffeine withdrawal period prior to the intervention (< 24, 24-48, > 48 h). RESULTS: Sixty caffeine studies included sufficient information on habitual consumption to be included in the meta-analysis. A positive overall effect of caffeine was shown in comparison to placebo (standard mean difference [SMD] = 0.25, 95% confidence interval [CI] 0.20-0.30; p < 0.001) with no influence of relative habitual caffeine consumption (p = 0.59). Subgroup analyses showed a significant ergogenic effect when the caffeine dose was < 3 mg/kg BM (SMD = 0.26, 95% CI 0.12-0.40; p = 0.003) and 3-6 mg/kg BM (SMD = 0.26, 95% CI 0.21-0.32; p < 0.0001), but not > 6 mg/kg BM (SMD = 0.11, 95% CI - 0.07 to 0.30; p = 0.23); when the dose was both higher (SMD = 0.26, 95% CI 0.20-0.31; p < 0.001) and lower (SMD = 0.21, 95% CI 0.06-0.36; p = 0.006) than the habitual caffeine dose; and when withdrawal was < 24 h, 24-48 h, and > 48 h. Caffeine was effective for endurance, power, and strength exercise, with no influence (all p ≥ 0.23) of relative habitual caffeine consumption within exercise types. Habitual caffeine consumption did not modify the ergogenic effect of caffeine in male, female, trained or untrained individuals. CONCLUSION: Habitual caffeine consumption does not appear to influence the acute ergogenic effect of caffeine.

Nonplacebo Controls to Determine the Magnitude of Ergogenic Interventions: A Systematic Review and Meta-analysis.

INTRODUCTION: Placebos are used as a control treatment that is meant to be indistinguishable from the active intervention. However, where substantive placebo effects may occur, studies that do not include a nonplacebo control arm may underestimate the overall effect of the intervention (active plus placebo components). This study aimed to determine the relative magnitude of the placebo effect associated with nutritional supplements (caffeine and extracellular buffers) by meta-analyzing data from studies containing both placebo and nonplacebo control sessions. METHODS: Bayesian multilevel meta-analysis models were used to estimate pooled effects and express the placebo effect as a percentage of the overall intervention effect. RESULTS: Thirty-four studies were included, with the median pooled effect size (ES0.5) indicating a very small (ES0.5 = 0.09 (95% credible interval (CrI), 0.01-0.17)) improvement in the performance of placebo compared with control. There was no moderating effect of exercise type (capacity or performance), exercise duration, or training status. The comparison between active intervention and control indicated a small to medium effect (ES0.5 = 0.37 (95% CrI, 0.20-0.56)). Expressed in relative terms, the placebo effect was equivalent to 25% (75% CrI, 16%-35%) and 59% (75% CrI, 34%-94%) of the total intervention effect for buffers and caffeine. CONCLUSIONS: These results demonstrate a very small but potentially important placebo effect with nutritional supplementation studies. A substantive proportion of supplement effects may be due to placebo effects, with the relative proportion influenced by the magnitude of the overall ergogenic effect. Where feasible, intervention studies should use nonplacebo control-arm comparators to identify the proportion of the effect estimated to come from placebo effects and avoid underestimating the overall benefits that the physiological plus psychobiological aspects associated with an intervention provide in the real world.

Seat Assignments With Physical Distancing in Single-Destination Public Transit Settings.

While the importance of physical (social) distancing in reducing the spread of COVID-19 has been well-documented, implementing similar controls in public transit remains an open question. For instance, in the United States, guidance for maximum seating capacity in single-destination public transit settings, such as school buses, is only dependent on the physical distance between passengers. In our estimation, the available models/guidance are suboptimal/inefficient since they do not account for the possibility of passengers being from the same household. This paper discusses and addresses the aforementioned limitation through two types of physical distancing models. First, a mixed-integer programming model is used to assign passengers to seats based on the reported configuration of the vehicle and desired physical distancing requirement. In the second model, we present a heuristic that allows for household grouping. Through several illustrative scenarios, we show that seating assignments can be generated in near real-time, and the household grouping heuristic increases the capacity of the transit vehicles (e.g., airplanes, school buses, and trains) without increasing the risk of infection. A running application and its source code are available to the public to facilitate adoption and to encourage enhancements.

Use of remdesivir for patients with Covid-19: a review article.

The etiological agent of COVID-19, which causes severe respiratory diseases such as pneumonia and pulmonary insufficiency, has been confirmed as a new coronavirus, now known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). There is currently no authorized medication for the treatment of COVID-19. No vaccines have been authorized. Thus, this study aimed at conducting a review of the use of Remdesivir in patients with COVID-19. The following electronic databases were used MEDLINE, SCIELO, LILACS, and PUBMED. On May 1, Remdesivir received emergency use authorization from the Food and Drug Administration. Remdesivir is currently the most promising molecule in the treatment of COVID-19, taking into account its broad antiviral spectrum (considering the genetic sequences of the virus, it is expected to maintain activity against SARS-CoV-2). There is in vitro and in vivo information available for coronaviruses, as well as an extensive clinical safety database (from a clinical trial of the Ebola virus and in the context of the Monitored Emergency Use of Unregistered and Investigational Interventions - MEURI). Further studies are relevant as available data on the efficacy and safety of Remdesivir against SARS-nCoV-2 are limited.

Epidemiology, diagnosis, treatment, and future perspectives concerning SARS-COV-2: a review article.

The present study aimed to review the epidemiology, clinical manifestation, laboratory diagnosis, treatment, and future perspectives related to COVID-19 infections. The following electronic databases were used searched: MEDLINE, SCIELO, and LILACS. It became clear that COVID-19 infections occur through exposure to the virus, and both the immunosuppressed and healthy population appear susceptible. The clinical course of COVID-19 is still not clear, although the SARS-CoV-2 infection seems to develop with mild, influenza-like symptoms in the vast majority of subjects, i.e., 10%-15% of COVID-19 patients. Since rRT-PCR tests serve as the gold standard method to confirm a SARS-CoV-2 infection, false-negative results could hinder the prevention and control of the epidemic, particularly considering the test plays a key role in the decision for continued isolated medical observation or discharge. Our findings also indicate that a radical increase in the identification and isolation of currently undocumented infections would be needed to fully control SARS-CoV2.

Use of remdesivir for patients with Covid-19: a review article

SUMMARY The etiological agent of COVID-19, which causes severe respiratory diseases such as pneumonia and pulmonary insufficiency, has been confirmed as a new coronavirus, now known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). There is currently no authorized medication for the treatment of COVID-19. No vaccines have been authorized. Thus, this study aimed at conducting a review of the use of Remdesivir in patients with COVID-19. The following electronic databases were used MEDLINE, SCIELO, LILACS, and PUBMED. On May 1, Remdesivir received emergency use authorization from the Food and Drug Administration. Remdesivir is currently the most promising molecule in the treatment of COVID-19, taking into account its broad antiviral spectrum (considering the genetic sequences of the virus, it is expected to maintain activity against SARS-CoV-2). There is in vitro and in vivo information available for coronaviruses, as well as an extensive clinical safety database (from a clinical trial of the Ebola virus and in the context of the Monitored Emergency Use of Unregistered and Investigational Interventions - MEURI). Further studies are relevant as available data on the efficacy and safety of Remdesivir against SARS-nCoV-2 are limited.

RESUMO O agente etiológico da COVID-19, que causa doenças respiratórias graves, como pneumonia e insuficiência pulmonar, foi confirmado como um novo coronavírus, agora conhecido como coronavirus de síndrome respiratória aguda grave 2 (SARS-CoV-2). Não existem atualmente medicamentos autorizados para o tratamento de COVID-19, nem estão também autorizadas quaisquer vacinas. Assim, o estudo teve como objetivo realizar uma revisão sobre a utilização de Remdesivir em pacientes com COVID-19. As seguintes bases de dados eletrônicas foram utilizadas MEDLINE, SCIELO, LILACS e PUBMED. Em primeiro de maio, o Redemsivir recebeu autorização de uso de emergência da Food and Drug Administration. Remdesivir é presentemente a molécula promissora no tratamento da COVID-19 tendo em conta o seu largo espetro antiviral (considerando as sequências genéticas do vírus, é expectável que mantenha atividade contra o SARS-CoV-2). A informação in vitro e in vivo está disponível para os coronavírus, assim como a extensiva base de dados de segurança clínica (proveniente de ensaio clínico do vírus Ebola e no contexto do Monitored Emergency Use of Unregistered and Investigational Interventions - MEURI). A realização de novos estudos torna-se relevantes uma vez que os dados disponíveis são limitados sobre eficácia e segurança do Remdesivir contra SARS-nCoV-2.

Epidemiology, diagnosis, treatment, and future perspectives concerning SARS-COV-2: a review article

SUMMARY The present study aimed to review the epidemiology, clinical manifestation, laboratory diagnosis, treatment, and future perspectives related to COVID-19 infections. The following electronic databases were used searched: MEDLINE, SCIELO, and LILACS. It became clear that COVID-19 infections occur through exposure to the virus, and both the immunosuppressed and healthy population appear susceptible. The clinical course of COVID-19 is still not clear, although the SARS-CoV-2 infection seems to develop with mild, influenza-like symptoms in the vast majority of subjects, i.e., 10%-15% of COVID-19 patients. Since rRT-PCR tests serve as the gold standard method to confirm a SARS-CoV-2 infection, false-negative results could hinder the prevention and control of the epidemic, particularly considering the test plays a key role in the decision for continued isolated medical observation or discharge. Our findings also indicate that a radical increase in the identification and isolation of currently undocumented infections would be needed to fully control SARS-CoV2.

RESUMO O presente estudo teve como objetivo realizar uma revisão sobre epidemiologia, manifestações clínicas, diagnóstico laboratorial, tratamento e perspectivas futuras relacionados à infecção pelo COVID-19. As seguintes bases de dados eletrônicas foram utilizadas MEDLINE, SCIELO e LILACS. Ficou claro que a infecção pelo COVID-19 ocorre por exposição ao vírus, e tanto a população imunossupressora quanto a normal parecem suscetíveis. O curso clínico do COVID-19 ainda não está claro, embora a infecção por SARS-CoV-2 pareça ocorrer com sintomas leves e semelhantes à gripe na grande maioria dos indivíduos, em 10%-15% dos pacientes com COVID-19. Uma vez que os testes rRT-PCR servem como o método padrão-ouro para confirmar a infecção do SARS-CoV-2, os resultados falso-negativos podem dificultar a prevenção e o controle da epidemia, particularmente quando este teste desempenha um papel de referência fundamental na decisão da necessidade de observação médica isolada ou alta. Nossos achados também indicam que seria necessário um aumento radical na identificação e isolamento de infecções não documentadas atualmente para controlar totalmente o SARS-CoV2.

Panorama atual do ensino da Patologia Clínica/Medicina Laboratorial nas escolas médicas do Brasil / Current overview of the teaching of Clinical Pathology/Laboratory Medicine in medical schools in Brazil

Introdução: Os testes laboratoriais exercem papel fundamental no atendimento médico de uma maneira geral há muitos anos. Além disso, o gasto com exames laboratoriais representa menos de 3% do custo total em saúde, tornando a relação custo-benefício altamente favorável ao uso dessa ferramenta. A despeito dessa enorme importância, a educação médica em relação a testes laboratoriais no Brasil ainda é incerta não existindo dados concretos sobre o ensino da Patologia Clínca/Medicina Laboratorial até a data do estudo (2019). Objetivo: Pretende-se traçar um panorama atual do ensino da Patologia Clínica/Medicina Laboratorial na graduação das escolas médicas do Brasil, comparando com o ensino da Patologia Geral. Materiais e métodos: Foi realizada uma pesquisa de levantamento ou um inquérito de dados das matrizes curriculares das escolas médicas do Brasil, por meio do acesso ao seu portal eletrônico. A relação de todas as instituições de ensino médico foi obtida junto ao site do Ministério da Educação no ano de 2019. Resultados: No Brasil há um predomínio de escolas privadas sobre públicas, sendo método de ensino tradicional (59%) mais comum em relação ao Problem-Based Learning (39%). Somente 23% das escolas médicas do Brasil possuem a disciplina de Patologia Clínica/Medicina Laboratorial em suas matrizes curriculares. Em contrapartida, a Patologia Geral está presente em 57% das escolas. A região Centro-Oeste possui a menor prevalência (14,24%) quanto ao ensino de Patologia Clínica/Medicina Laboratorial, enquanto que a região Sudeste mostrou a maior prevalência (28,57%). Conclusão: Apenas 23% das escolas médicas no Brasil possuem o ensino da Patologia Clínica/Medicina Laboratorial em suas grades curriculares. (AU)

Introduction: Laboratory tests play, in general, a fundamental role in medical care for many years. In addition, the cost of laboratory tests represents less than 3% of the total spent on the health system, making the cost-benefit ratio highly favorable to its use. Despite this enormous importance, medical education regarding those tests in Brazil is still uncertain, with no concrete data about the teaching of Clinical Pathology/Laboratory Medicine found until the date of the study (2019). Objective: To draw a current overview of the teaching of Clinical Pathology/Laboratory Medicine in undergraduate medical schools in the country, comparing with the teaching of General Pathology. Materials and methods: A survey was conducted by a data collection from curricular matrices of medical schools in Brazil, by the access to their websites. The list of the medical education institutions was obtained by the website of the Ministério da Educação in 2019. Results: In Brazil there is a predominance of private over public schools, the traditional teaching method (59%) is more common in relation to Problem-Based Learning (39%). Only 23% of medical schools in Brazil have the subject of Clinical Pathology/Laboratory Medicine in their curriculum matrix. In contrast, General Pathology subject is present in 57% of the schools. The Midwest region has the lowest prevalence (14,24%) regarding the teaching of Clinical Pathology/Laboratory Medicine, while the Southeast region showed the highest prevalence (28,57%) .Conclusion: Only 23% of medical schools in Brazil have the teaching of Clinical Pathology/Laboratory Medicine in their curriculum.

Silagens de milho inoculadas microbiologicamente em diferentes estádios de maturidade: perdas fermentativas, composição bromatológica e digestibilidade in vitro / Corn silage inoculated with lactic acid bacteria in different maturity stages: fermentative losses, chemical composition and in vitro digestibility

Objetivou-se com este estudo avaliar as perdas fermentativas, composição bromatológica e digestibilidade in vitro da matéria orgânica de silagens de milho produzidas em diferentes estádios de maturidade, inoculadas microbiologicamente. Aplicaram-se dois inoculantes comerciais nas silagens produzidas nos estádios SLL, 1/3 LL, 1/2 LL, 2/3 LL e CN, permanecendo ainda um tratamento sem inoculação (silagem controle), configurando um esquema fatorial 3x5. A inoculação com BAL resultou em menores perdas fermentativas (P=0,0348), ao passo que silagens produzidas com plantas mais secas também apresentam menores perdas de MS (P<0,01). A inoculação das silagens resultou em maiores concentrações de PB nas silagens produzidas nos estádios SLL, 2/3 LL e CN (P=0,0033). O uso do inoculante Maize All® resultou em menor concentração de FDN (P=0,0140) no estádio CN e acréscimo dos coeficientes de DIVMO quando as plantas foram colhidas com 2/3 LL e CN (P=0,0006). As perdas fermentativas diminuem devido à utilização dos inoculantes bacterianos e também em silagens produzidas com plantas mais secas. A aplicação de bactérias ácido-láticas (inoculante Maize All®) em silagens de milho produzidas com plantas em estádio de maturidade mais avançado melhora a composição química e digestibilidade in vitro.

The aim of this study was to evaluate the fermentative losses, chemical composition and in vitro organic matter digestibility of corn silages produced in different maturity stages microbiologically inoculated. Two commercial inoculants were applied in the silages produced in stages SLL, 1/3 LL, 1/2 LL, 2/3 LL and CN, remaining an uninoculated treatment (control silage), illustrating a factorial scheme 3 x 5. The lactic acid bacteria (LAB) inoculation resulted in lower fermentative losses (P=0.0348), whereas silages produced with dried plants present lower DM losses (P<0.01). Because of inoculant application, there was higher concentrations of CP in the silages produced in stages SLL, 2/3 LL and CN (P=0.0033) and concentration lower of NDF (P=0.0140) in CN stage because of the Maize All® inoculant. This inoculant provided increase in the IVOMD coefficients when the plants were harvested with 2/3 LL and CN (P= 0.0006). Fermentative losses decreased because of the use of microbial inoculants, and this fact it is also observed in silages produced with dried plants. Application of lactic acid bacteria (Maize All® inoculant) in corn silages produced with plants harvested in more advanced stages of maturity improve the chemical composition and in vitro digestibility.

Tratamento do blefaroespasmo e distonias faciais correlatas com toxina botulínica: estudo de 16 casos / Treatment of blepharospasm and related facial dystonia with botulinum toxin: study of 16 cases

Objetivo: Analisar a eficácia do tratamento com Botox e estudar o comportamento destes pacientes após aplicações sucessivas, dando ênfase ao possível efeito de tolerância após o uso prolongado deste medicamento. Métodos: Foi realizado estudo prospectivo em 16 pacientes com distonias faciais no ambulatório de Oftalmologia, no Setor de Plástica Ocular do Hospital das Clínicas da Faculdade de Medicina da Iniversidade de São Paulo, entre abril de 1998 a março de 1999. Todos os pacientes foram submetidos ao exame oftalmológico completo, neurológico e tomografia computadorizada de crânio. Os pacientes com sintomas importantes de espasmo foram tratados com aplicação da toxina botulínica tipo A (Botox). Dez pacientes eram do sexo feminino. A idade média fo 64,75 anos. Resultados: Dentre as distonias faciais, o espasmo hemifacial foi o mais encontrado, num total de 8 pacientes. O índice de sucesso do Botox foi de 87, 5 por cento, com duração média do efeito de 30 a 90 dias, variando de acordo com o número de aplicações. Conclusões: O tratamento dos espasmos faciais com a toxina botulínica mostrou-se eficaz em 87,5 por cento de nossos pacientes.

Xantogranuloma Orbitário isolado: relato de caso e abordagem terapêutica / Isolated Orbital Xantogranuloma: report of case and therapeutic approach

Objetivo: Apresentar, no melhor do nosso conhecimento, o primeiro caso no Brasil de xantogranuloma orbitário isolado, bilateral, sem envolvimento sistêmico, confirmado clinica e histopatologicamente. Local: CEROF - Centro de Referência em Oftalmologia do Hospital das Clínicas da Universidade Federal de Góiás, Goiânia - GO - Brasil. Método: Relato de caso. Conclusão: A ressecção cirúrgica das lesões propiciou melhora da estética facial e correção funcional da ptose.

Ceratoplastia penetrante: positividade das culturas dos anéis corneo-esclerais em nosso meio / Penetrating Keratoplasty: positivity of corneoscleral ring cultures in our service

Objetivo: Avaliar os principais microorganismos responsáveis pela contaminação da córnea doadora no nosso meio e a susceptibilidade destes germes aos antibióticos. Métodos: Realizamos um estudo retrospectivo das culturas dos anéis de córnea doadas para transplante de córnea no HC-FMUSP na última década. Resultados: Entre as 35 culturas analisadas, 4 apresentaram crescimento bacteriano. Conclusões: Apesar de não haver ocorrido nenhum caso de endoftalmite bacteriana em nosso estudo e da baixa incidência descrita na literatura, é prudente colher cultura do líquido de preservação e do anel de córnea de todos os pacientes submetidos ao transplante de córnea.