Coupling of α-bromoamides and unactivated alkenes to form γ-lactams through EDA and photocatalysis.

γ-Lactams are prevalent in small-molecule pharmaceuticals and provide useful precursors to highly substituted pyrrolidines. Despite numerous methods for the synthesis of this valuable motif, previous redox approaches to γ-lactam synthesis from α-haloamides and olefins require additional electron withdrawing functionality as well as N-aryl substitution to promote electrophilicity of the intermediate radical and prevent competitive O-nucleophilicity about the amide. Using α-bromo imides and α-olefins, our strategy enables the synthesis of monosubstituted protected γ-lactams in a formal [3 + 2] fashion. These species are poised for further derivatization into more complex heterocyclic scaffolds, complementing existing methods. C-Br bond scission occurs through two complementary approaches, the formation of an electron donor-acceptor complex between the bromoimide and a nitrogenous base which undergoes photoinduced electron transfer, or triplet sensitization with photocatalyst, to furnish an electrophilic carbon-centered radical. The addition of Lewis acids allows for further increased electrophilicity of the intermediate carbon-centered radical, enabling tertiary substituted α-Br-imides to be used as coupling partners as well as internal olefins.

Alterations in deglutition in children with congenital Zika virus syndrome.

PURPOSE: To characterize swallowing in children with congenital Zika virus syndrome in comparison to typical children. METHODS: This cross-sectional study enrolled 45 children diagnosed with congenital Zika virus syndrome and 45 others with typical development. Swallowing was evaluated through clinical feeding evaluations Protocolo de Avaliação Clínica da Disfagia Pediátrica and using acoustic swallowing parameters (Doppler sonar). RESULTS: The mean age of children with congenital Zika virus syndrome was 26.69 ± 4.46 months and the mean head circumference was 29.20 ± 1.98 cm. Moderate/severe oropharyngeal dysphagia was found in 32(71.1%) of the children with congenital Zika virus syndrome. Significant differences were found between the groups on clinical evaluation: Children with congenital Zika virus syndrome presented insufficient lip closure 42(93.3%) and altered tonus of the tongue 35(77.8%) and cheeks 34(75.6%). In the children in the comparison group, only 6(13.3%) presented insufficient lip closure and 1(2.2%) had inadequate tongue posture. Changes during swallowing with liquid and spoonable food were not observed in the comparison group. When liquid/food was offered, affected children presented difficulties in sipping movements 14(77.8%) and lip/spoon contact 35(75%). The presence of residual food in the oral cavity after swallowing 38(86.4%) and clinical signs indicative of laryngotracheal penetration/aspiration, such as coughing, gagging and/or labored breathing, were also notable. No differences were found between the groups with regard to the acoustic parameters evaluated instrumentally. CONCLUSION: Children with congenital Zika virus syndrome present alterations in the oral phase of swallowing, as well as clinical signs indicative of pharyngeal phase impairment.

Alterations in deglutition in children with congenital Zika virus syndrome / Alterações na deglutição em crianças com síndrome congênita do vírus Zika

ABSTRACT Purpose To characterize swallowing in children with congenital Zika virus syndrome in comparison to typical children. Methods This cross-sectional study enrolled 45 children diagnosed with congenital Zika virus syndrome and 45 others with typical development. Swallowing was evaluated through clinical feeding evaluations Protocolo de Avaliação Clínica da Disfagia Pediátrica and using acoustic swallowing parameters (Doppler sonar). Results The mean age of children with congenital Zika virus syndrome was 26.69 ± 4.46 months and the mean head circumference was 29.20 ± 1.98 cm. Moderate/severe oropharyngeal dysphagia was found in 32(71.1%) of the children with congenital Zika virus syndrome. Significant differences were found between the groups on clinical evaluation: Children with congenital Zika virus syndrome presented insufficient lip closure 42(93.3%) and altered tonus of the tongue 35(77.8%) and cheeks 34(75.6%). In the children in the comparison group, only 6(13.3%) presented insufficient lip closure and 1(2.2%) had inadequate tongue posture. Changes during swallowing with liquid and spoonable food were not observed in the comparison group. When liquid/food was offered, affected children presented difficulties in sipping movements 14(77.8%) and lip/spoon contact 35(75%). The presence of residual food in the oral cavity after swallowing 38(86.4%) and clinical signs indicative of laryngotracheal penetration/aspiration, such as coughing, gagging and/or labored breathing, were also notable. No differences were found between the groups with regard to the acoustic parameters evaluated instrumentally. Conclusion Children with congenital Zika virus syndrome present alterations in the oral phase of swallowing, as well as clinical signs indicative of pharyngeal phase impairment.

RESUMO Objetivo Caracterizar a deglutição das crianças com síndrome congênita do Zika vírus e comparar com crianças típicas. Método Estudo de delineamento transversal, com 45 crianças diagnosticadas com síndrome congênita do Zika vírus e 45 típicas. A deglutição foi avaliada por meio de avaliações clínicas da alimentação através do Protocolo de Avaliação Clínica da Disfagia Pediátrica e dos parâmetros acústicos da deglutição (sonar Doppler). Resultados A idade média das crianças com síndrome congênita do vírus Zika foi de 26,69 ± 4,46 meses e o perímetro cefálico médio foi de 29,20 ± 1,98 cm. Disfagia orofaríngea de moderada a grave foi observada em 32(71,1%) das crianças com síndrome congênita do Zika vírus, ao contrário do grupo comparação que não revelou alterações na deglutição. Nas crianças com síndrome congênita do Zika vírus foram verificados lábios entreabertos 42(93,3%) e tônus alterado em língua 35(77,8%) e bochechas 34(75,6%). Nas crianças do grupo comparação apenas 6(13,3%) apresentaram fechamento labial insuficiente e 1(2,2%) postura de língua inadequada. Alterações durante a deglutição com líquido e alimento pastoso não foram observadas no grupo comparação. Durante a oferta do alimento ocorreram dificuldades no movimento de sorver 14(77,8%), na captação da colher 35(75%), resíduo em cavidade oral 38(86,4%) e sinais clínicos indicativos de penetração/aspiração laringotraqueal como tosse, engasgo e respiração com esforço. Não foram encontradas diferenças nos parâmetros acústicos da avaliação instrumental. Conclusão as crianças com síndrome congênita do Zika vírus têm alterações nas fases oral e faríngea da deglutição, com sinais clínicos indicativos de penetração/aspiração laringotraqueal quando comparadas a crianças típicas.

The impact of botulinum toxin type A in the treatment of drooling in children with cerebral palsy secondary to Congenital Zika Syndrome: an observational study.

OBJECTIVE: The main aim of this study was to determine the impact of botulinum toxin A (BTX-A) on severity and frequency of drooling in children with Cerebral Palsy (CP) secondary to Congenital Zika Syndrome (CZS). METHODS: This is a prospective longitudinal observational study including 23 children who received bilateral injections of BTX in the parotid and submandibular glands. The Thomas-Stonell & Greenberg Drooling Severity and Frequency Scale was applied by a multidisciplinary team including Speech, Language and Hearing professionals. The Global Impression of Improvement (GII) Scale was also applied to assess parents' subjective perceptions of therapeutic response. Swallowing was assessed using Doppler ultrasonography. Univariate logistic regression was used to analyse differences between responders and non-responders. RESULTS: Participant age varied from 27 to 38 months (mean 31.78, SD = 2.61) all presented with Gross Motor Function Classification System (GMFCS) V. Drooling Severity and Frequency Scale scores ranged from 7 to 9 points (median = 9) prior to BTX administration and from 4 to 6 (median = 6) after. Pre- and post-treatment reduction in drooling severity occurred (Z = -3.746; p < 0.001). No cases of drooling worsening were reported. Only two subjects presented adverse effects attributed to BTX administration. Correlation was only confirmed with GII. DISCUSSION: This article presents the safe and positive impact of BTX-A administration guided by anatomical references described in the literature, even on children with microcephaly. Further studies are needed to facilitate the use of Doppler ultrasonography as a tool to characterize changes in sensory processing and motor response following intraoral input in children with CP.

Fragilidades e potencialidades do trabalho fonoaudiológico em ambiente virtual em tempo de pandemia de Covid-19 (SARS-CoV-2) / Weaknesses and potentialities of Speech Therapy' work in virtual environment in times Covid-19 pandemic (SARS-CoV-2)

Introdução: os desafios decorrentes da propagação da Covid-19 têm promovido uma aceleração do uso das ferramentas tecnológicas. A conectividade digital se estabelece ainda mais nos hábitos diários, especialmente no trabalho em saúde. Objetivo: Descrever as fragilidades e potencialidades do trabalho fonoaudiológico em ambiente virtual, em tempos de pandemia da Covid-19. Metodologia: estudo transversal, de abordagem quali-quantitativa. Participaram desta pesquisa 32 fonoaudiólogos inscritos no Conselho Regional de Fonoaudiologia 4ª Região, com atuação no Estado da Bahia. Utilizou-se um questionário online no Google Forms como instrumento de coleta de dados. Os resultados foram tabulados em planilha eletrônica Excel. Os dados categóricos foram resumidos por meio de frequência absoluta (n) e relativa (%). Resultados: acerca das fragilidades, 65,6% referiram-nas como referentes ao manuseio de ferramentas tecnológicas e plataformas digitais; 87,5% referiram resistência do paciente em aderir ao tratamento fonoaudiológico diante da mudança do modo presencial para o teleatendimento, ocorrendo o abandono da assistência fonoaudiológica. Quanto às potencialidades, têm-se a manutenção da assistência fonoaudiológica mesmo durante o isolamento social, comodidade do profissional devido a não locomoção e principalmente dos pacientes, cuja moradia é distante dos serviços de saúde; maior flexibilidade nos horários de reuniões virtuais, aumento da frequência de contato com o usuário e maior participação da família no atendimento fonoaudiológico. Conclusão: apesar das fragilidades observadas, as potencialidades encontradas no trabalho virtual permitiram a manutenção da assistência fonoaudiológica a pacientes, mesmo em tempos de pandemia. Portanto, a tecnologia mostra-se como uma forte aliada no atendimento à saúde.

Introduction: the challenges arising from the spread of Covid-19 accelerated the use of technological tools. Digital connectivity is has established itself even more in our daily habits, especially in health care work. Objective: to describe the weaknesses and potentialities of phonoaudiological work in a virtual environment in times of Covid-19 pandemic (SARS-CoV-2). Methodology: transversal study, of qualitative-quantitative approach. 32 speech therapist registered in the Regional Council of Speech Therapy (4th Region) in the State of Bahia participated in this research. An online questionnaire on Google Forms was used as a data collection tool. The results were tabulated in Excel. Categorical data were summarized using absolute (n) and relative (%) frequency. Results: about the weaknesses, 65.6% reported difficulties in dealing with technological tools and digital platforms; 87.5% reported patient resistance regarding doing speech therapy, due to the change from face-to-face to online interaction and abandonment of speech therapy. As for potentialities, speech therapist assistance has been continued, even during social isolation, convenient for the professional for not having to commute, and especially for patients whose home are far from health services; more flexibility for virtual meeting hours, increased frequency of contact with the user and more family participation in phonotherapy. Conclusion: Despite the observed weaknesses, the potential found in virtual work allowed the maintenance of speech assistance to patients even in times of pandemic of Covid-19. Therefore, technology shows itself as a strong ally in health care.

Impact of Transcranial Direct Current Stimulation on Reading Skills of Children and Adolescents With Dyslexia.

Introduction: Rehabilitation techniques have been used to facilitate reading acquisition in dyslexia. However, many individuals continue to present academic impairment throughout life. New intervention strategies are necessary to further help this population. Objectives: Assess the impact of transcranial direct current stimulation on reading skills in children and adolescents with dyslexia. Methods: The study was conducted with one-group pretest-posttest. Participants received 2 mA transcranial direct current stimulation during 30 minutes for 5 consecutive days. Reading performance was measured by a group of tasks (identification and reading of letters, syllables, words, nonwords, and text). Results: A significant increase in the number of correct answers for nonwords and text tasks was observed after transcranial direct current stimulation (P = .035 and P = .012, respectively). Conclusion: The transcranial direct current stimulation seems to be a promising tool for the treatment of reading problems in dyslexia. Future studies are necessary to confirm the effects of transcranial direct current stimulation and to establish optimal intervention protocol in this population.

Bronchial Laceration as a Complication of Transbronchial Lung Cryobiopsy / Laceración bronquial como complicación de una criobiopsia transbronquial

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Role of epidermal growth factor mutational status for distinction between recurrent lung cancer and second primary lung cancer: case report.

INTRODUCTION: In a patient with previous radically treated lung adenocarcinoma, the detection of a new lung cancer raises the question whether recurrence or a second primary lung cancer is involved. Current criteria for differentiating multiple lung tumors lack a biologic and molecular basis and may lead to misclassification with impact on survival. OBJECTIVES: We report the case of a female patient with a recent diagnosis of lung adenocarcinoma and a previous lung adenocarcinoma submitted to curative surgical therapy 4 years before. As both lesions were resected, were of the same histologic subtype and presented the same immunohistochemistry profile; we decided to perform mutational analysis of the epidermal growth factor (EGFR) gene to differentiate between recurrence and second primary lung cancer. METHODS: The EGFR gene was screened for mutations in exons 18, 19, 20 and 21 using direct sequencing of polymerase chain reaction products in DNA obtained from paraffin preserved cells from both tumors. RESULTS: Mutational analysis of the EGFR gene, revealed different mutations in each tumor (both on exon 19) allowing the confirmation of the diagnosis of two metachronous primary lung cancers. CONCLUSIONS: In this patient, mutational analysis of the EGFR gene was superior to histologic and immunohistochemistry characterization in differentiating between recurrent lung cancer and second primary lung cancer; allowing confirmation of the diagnosis of two metachronous primary lung cancers.

Concepção materna sobre a amamentação em lactentes de um programa do método mãe canguru / Concepción materna acerca del amamantamiento en lactantes de un programa del método "mãe canguru" / Mother concept of infant feeding in a program of kangaroo mother care

Este estudo teve como objetivo descrever a concepção das mães inseridas na segunda etapa do Método Mãe Canguru, sobre a amamentação, nos primeiros dias de vida do recém-nascido prematuro. Pesquisa qualitativa, descritiva, composta por nove mães que participavam do Método Mãe Canguru. Os dados foram coletados por meio de entrevista semiestruturada. A partir da análise de conteúdo emergiram quatro categorias: os sentimentos maternos diante da prematuridade; tristeza e preocupação em não poder amamentar versus felicidade materna em amamentar seu filho no peito; importância do apoio familiar e orientação profissional. Conclui-se que a concepção materna sobre a amamentação perpassa por diversos sentimentos, não somente a frustração: a percepção de que amamentação é fator importante e integrante para essas mães, a necessidade do apoio familiar para a confiança materna e a contribuição da orientação profissional para as mães.

This study aimed to describe the conception of mothers who entered the second stage of Kangaroo Mother Care about breastfeeding in the newborn premature first days of life. Qualitative, descriptive investigation, compound of nine mothers who participated in the Kangaroo Mother Care. Data were collected through semi-structured interview. From the content analysis, four categories emerged: the maternal feelings in front of prematurity; sadness and concern about not being able to breastfeed versus maternal happiness to breastfeed her child in the chest; importance of family support and vocational guidance. We conclude that maternal conception about breastfeeding permeates many feelings, not only frustration: the perception that breastfeeding is an integral and important factor for these mothers, the need for family support for the contribution of maternal confidence and professional guidance to mothers.

Este estudio tuvo como objetivo describir la concepción de las madres en la segunda etapa del Método "Mãe Canguru" acerca del amamantamiento en los primeros días de vida de los recién nacidos prematuros. Investigación cualitativa, descriptiva, compuesta por nueve madres que participaron en el Método "Mãe Canguru". Los datos fueron recolectados por medio de entrevista semi-estructurada. A partir del análisis de contenido, emergieron cuatro categorías: Los sentimientos maternales frente al prematuro; Tristeza y la preocupación por no poder amamantar frente a la felicidad de la madre a amamantar a su hijo en el pecho; Importancia del apoyo familiar y la Orientación profesional. Llegamos a la conclusión de que la concepción de la madre acerca del amamantamiento impregna muchos sentimientos, no sólo la frustración; la percepción de que el amamantamiento es un factor importante e integrante para esas madres, la necesidad de apoyo familiar para la confianza de la madre y la contribuición de la orientación profesional a las madres.

Implante endodóntico intraóseo, un recurso a tener en cuenta: biomateriales - biocompatibilidad / Intraosseous endodontic implantation, a resource to be taken into account: biomaterials - biocompatibility

Se ha tratado de utilizar una técnica preconizada hace 50 años atrás que ha sido dejada en desuso por diversas razones. Con el advenimiento de nuevos materiales, estudios más profundos de la biocompatibilidad de los mismos justifican ser tenidos en cuenta en el arsenal terapéutico bucal. Destacamos su uso en aquellos casos de pérdida de tejido dentario ya sea por: alteraciones paradenciales, procesos apicales o la pérdida de la longitud de la raíz por traumatismos, o en casos de estabilización por traumatismos sin fracturas. También justificamos su empleo en forma transitoria o definitiva como complemento durante el período de oseointegración de otros implantes

Implante endodóntico intraóseo, un recurso a tener en cuenta: biomateriales - biocompatibilidad / Intraosseous endodontic implantation, a resource to be taken into account: biomaterials - biocompatibility

Se ha tratado de utilizar una técnica preconizada hace 50 años atrás que ha sido dejada en desuso por diversas razones. Con el advenimiento de nuevos materiales, estudios más profundos de la biocompatibilidad de los mismos justifican ser tenidos en cuenta en el arsenal terapéutico bucal. Destacamos su uso en aquellos casos de pérdida de tejido dentario ya sea por: alteraciones paradenciales, procesos apicales o la pérdida de la longitud de la raíz por traumatismos, o en casos de estabilización por traumatismos sin fracturas. También justificamos su empleo en forma transitoria o definitiva como complemento durante el período de oseointegración de otros implantes (AU)