Challenges to the operation of Brazilian LTCIs and changes in oversight.

BACKGROUND: Despite 18 years since health surveillance regulations were promulgated in Brazil to govern Long-Term Care Institutions for Older Adults (LTCIs), many institutions fail to comply with the Differentiated Regime for Public Procurement (Resolution No. 502/2021) due to structural and operational conditions. This study aimed to investigate Brazilian LTCI managers' understanding of challenges that significantly impact institutional operation and gather suggestions for enhancing RDC No. 502/21. METHODS: A cross-sectional, exploratory, and qualitative study was conducted, involving 90 managers or technical supervisors from Brazilian LTCIs. Data were collected using a self-administered Google Forms instrument and analyzed through Thematic Analysis based on the Organizing for Quality (OQ) framework. RESULTS: The most impactful challenges for LTCIs were healthcare, financing, human resources, relationship with oversight bodies, and family members. DISCUSSION: Proposed improvements for RDC No. 502/21 included enhanced professional training, infrastructure revision, increased financial support from the state, realistic oversight/regulations, and tailored monitoring approaches. CONCLUSION: LTCIs in Brazil face numerous challenges, and the suggested improvements aim to adapt regulations to institutional realities. However, considering the regulations' variability and purposes, further investigation is warranted.

Vacuum-assisted excision: a safe minimally invasive option for benign phyllodes tumor diagnosis and treatment-a systematic review and meta-analysis.

Synopsis: This is a systematic review and meta-analysis comparing surgical excision with percutaneous ultrasound-guided vacuum-assisted excision (US-VAE) for the treatment of benign phyllodes tumor (PT) using local recurrence (LR) as the endpoint. Objective: To determine the frequency of local recurrence (LR) of benign phyllodes tumor (PT) after ultrasound-guided vacuum-assisted excision (US-VAE) compared to the frequency of LR after surgical excision. Method: A systematic review and meta-analysis [following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard] was conducted by comparing LR in women older than 18 years treated for benign PT by US-VAE compared with local surgical excision with at least 12 months of follow-up. Studies were retrieved from PubMed, Scopus, Web of Science, and Embase. The pooled effect measure used was the odds ratio (OR) of recurrence. Results: Five comparative prospective or retrospective observational studies published between January 1, 1992, and January 10, 2022, comparing surgical excision with percutaneous US-VAE for LR of benign PT met the selection criteria. Four were retrospective observational cohorts, and one was a prospective observational cohort. A total of 778 women were followed up. Of them, 439 (56.4%) underwent local surgical excision, and 339 (43.6%) patients had US-VAE. The median age of patients in the five studies ranged from 33.7 to 39 years; the median size ranged from 1.5 cm to 3.0 cm, and the median follow-up ranged from 12 months to 46.6 months. The needle gauge ranged from 7G to 11G. LR rates were not statically significant between US-VAE and surgical excision (41 of 339 versus 34 of 439; OR 1.3; p = 0.29). Conclusion: This meta-analysis suggests that using US-VAE for the removal of benign PT does not increase local regional recurrence and is a safe minimally invasive therapeutic option. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022309782.

Imaging associations enhance the understanding of ECG abnormalities in male Brazilian football players: findings from the B-Pro Foot ECG study.

OBJECTIVES: To evaluate the prevalence of abnormal ECG findings and their association with imaging results in male Brazilian football players. METHODS: The 'B-Pro Foot ECG' is a multicentre observational study conducted in 82 Brazilian professional clubs. It analysed 6125 players aged 15-35 years (2496 white, 2004 mixed-race and 1625 black individuals) who underwent cardiovascular screening from 2002 to 2023. All ECGs were reviewed by two experienced cardiologists in the athlete's care. Those with abnormal findings underwent further investigations, including a transthoracic echocardiogram (TTE). Cardiac magnetic resonance (CMR) was subsequently performed based on TTE findings or clinical suspicion. RESULTS: In total, 180 (3%) players had abnormal ECGs and 176 (98%) showed normal TTE results. Athletes aged 26-35 years had a higher prevalence of abnormal ECGs than younger athletes (15-25 years). Black players had a higher prevalence of T-wave inversion (TWI) in the inferior leads than white players (2.6% vs 1.4%; p=0.005), as well as in V5 (2.9%) and V6 (2.1%) compared with white (1.2% and 1.0%; p<0.001) and mixed-race (1.5% and 1.2%; p<0.05) players, respectively. TTE parameters were similar across ethnicities. However, four out of 75 players with inferolateral TWI showed abnormal TTEs and CMR findings consistent with cardiomyopathies. CMR also showed cardiomyopathies or myocarditis in four players with inferolateral TWI and normal TTEs. In total, nine (0.1%) athletes were diagnosed with cardiac diseases and were followed for 40±30 months, with no cardiac events documented. CONCLUSION: This study found a 3% prevalence of abnormal ECGs in male Brazilian football players. Inferolateral TWI was associated with cardiac pathologies confirmed by CMR, even in athletes with a normal TTE.

An integrated view of cisplatin-induced nephrotoxicity, hepatotoxicity, and cardiotoxicity: characteristics, common molecular mechanisms, and current clinical management.

Cisplatin (CP) is a chemotherapy drug widely prescribed to treat various neoplasms. Although fundamental for the therapeutic action of the drug, its cytotoxic mechanisms trigger adverse effects in several tissues, such as the kidney, liver, and heart, which limit its clinical use. In this sense, studies point to an essential role of damage to nuclear and mitochondrial DNA associated with oxidative stress, inflammation, and apoptosis in the pathophysiology of tissue injuries. Due to the limitation of effective preventive and therapeutic measures against CP-induced toxicity, new strategies with potential cytoprotective effects have been studied. Therefore, this article is timely in reviewing the characteristics and main molecular mechanisms common to renal, hepatic, and cardiac toxicity previously described, in addition to addressing the main validated strategies for the current management of these adverse events in clinical practice. We also handle the main promising antioxidant substances recently presented in the literature to encourage the development of new research that consolidates their potential preventive and therapeutic effects against CP-induced cytotoxicity.

Posterior circulation collaterals as predictors of outcome in basilar artery occlusion: a sub-analysis of the BASICS randomized trial.

Introduction and purpose: Basilar artery occlusion (BAO) is still one of the most devastating neurological conditions associated with high morbidity and mortality. In the present study, we aimed to assess the role of posterior circulation collaterals as predictors of outcome in the BASICS trial and to compare two grading systems (BATMAN score and PC-CS) in terms of prognostic value. Methods: We performed a sub-analysis of the BASICS trial. Baseline clinical and imaging variables were analyzed. For the imaging analysis, baseline CT and CTA were analyzed by a central core lab. Only those patients with good or moderate quality of baseline CTA and with confirmed BAO were included. Multivariable binary logistic regression analysis was used to test the independent association of clinical and imaging characteristics with a favorable outcome at 3 months (defined as a modified Rankin Score of ≤3). ROC curve analysis was used to assess and compare accuracy between the two collateral grading systems. Results: The mean age was 67.0 (±12.5) years, 196 (65.3%) patients were males and the median NIHSS was 21.5 (IQR 11-35). Median NCCT pc-ASPECTS was 10 (IQR10-10) and median collateral scores for BATMAN and PC-CS were 8 (IQR 7-9) and 7 (IQR 6-8) respectively. Collateral scores were associated with favorable outcome at 3 months for both BATMAN and PC-CS but only with a modest accuracy on ROC curve analysis (AUC 0.62, 95% CI [0.55-0.69] and 0.67, 95% CI [0.60-0.74] respectively). Age (OR 0.97, 95% CI [0.95-1.00]), NIHSS (OR 0.91, 95% CI [0.89-0.94]) and collateral score (PC-CS - OR 1.2495% CI [1.02-1.51]) were independently associated with clinical outcome. Conclusion: The two collateral grading systems presented modest prognostic accuracy. Only the PC-CS was independently associated with a favorable outcome at 3 months.

Path analysis of urinary incontinence in older adults living in nursing homes / Fatores associados à incontinência urinária em idosos institucionalizados

Objective: To investigate the factors associated with urinary incontinence in older adults living in nursing homes. Methods: This was an exploratory, cross-sectional, observational, and quantitative study using exploratory and path analysis (PA). Eighty-six older adults living in nursing homes in the city of Salvador, Brazil, and the city of Brasília, Brazil, were included. Data were collected from January to March 2020, before the Covid-19 pandemic. The following variables were evaluated: sex, age group, functional performance, global cognitive function, comorbidities, and health conditions. Results: Urinary incontinence was associated with educational level, marital status, hypertension, one or more difficulties in basic activities of daily living, mood, insomnia, loss of appetite, fecal incontinence, and difficulty swallowing. In the PA, depression and difficulty swallowing were directly associated with urinary incontinence, and urinary incontinence was directly and significantly associated with insomnia and fecal incontinence. Conclusion: Given the variety of social and health components associated with urinary incontinence, it is necessary to assess, prevent, treat, and rehabilitate this condition in Brazilian nursing homes. Interventions in urinary incontinence demand integrated actions in functional, clinical, and mental health aspects to promote the well-being of older adults living in nursing homes. (AU)

Objetivo: Investigar os fatores associados à incontinência urinária em pessoas idosas institucionalizadas segundo a Análise de Caminhos. Metodologia: Trata-se de um estudo transversal. Foram avaliados 86 idosos em Instituições de Longa Permanência para Idosos brasileiras de Salvador (BA) e Brasília (DF), no período entre janeiro e março de 2020, período pré-pandemia de COVID-19. Os fatores analisados incluíram: sexo, faixa etária, desempenho funcional, desempenho cognitivo global, comorbidades e condições de saúde. Resultados: Observou-se que a incontinência urinária esteve associada ao nível de escolaridade, estado civil, hipertensão, uma ou mais dificuldades nas atividades básicas da vida diária, humor, insônia, perda de apetite, incontinência fecal e dificuldade de deglutição. Na Análise de Caminhos, os sintomas depressivos e as dificuldades de deglutição tiveram associação direta com a incontinência urinária, e a incontinência urinária teve associação direta e significativa com a insônia e a incontinência fecal. Conclusão: Dada a variedade de componentes sociais e de saúde associados à incontinência urinária, é necessário avaliar, prevenir, recuperar e reabilitar essa condição nas Instituições de Longa Permanência para Idosos brasileiras. Intervir na incontinência urinária requer ações integradas nos aspectos funcionais, clínicos e de saúde mental, que podem favorecer o bem-estar das pessoas idosas institucionalizadas. (AU)

Manejo em odontopediatria: técnicas para facilitar o tratamento odontológico infantil / Management techniques in pediatric dentistry: techniques to facilitate children's dental treatment

A ansiedade é uma reação do organismo, considerada como uma emoção de alarme que se encontra associada a sensações de angústia medo. O atendimento em odontopediatria é rodeado de desafios, sendo necessária a preparação psicológica da criança pelo cirurgião dentista, seus assistentes e os responsáveis pelo paciente. A presente revisão de literatura teve como objetivo relatar as principais técnicas de manejo comportamental para facilitar a colaboração da criança com o tratamento odontológico. Esta é uma revisão narrativa da literatura realizada através do levantamento bibliográfico utilizando os descritores Odontopediatria; Comportamento infantil; Manejo comportamental nas bases de dados PubMed, LILACS e SciELO. Foram encontrados artigos nas línguas portuguesa e inglesa, entre o período de 2010 e 2020. As técnicas de manejo de comportamento são mecanismos disponíveis para o cirurgião-dentista. A escolha do método deve levar em consideração o estágio de desenvolvimento da criança, e efetividade do método e aceitação dos pais. Normalmente a técnica mais utilizada é o controle pela voz, falar-mostrar-fazer e distração, sendo esses dois últimos mais aceitos pelos pais, e o método com maior rejeição é o mão-sobre-a-boca. Para obter a colaboração das crianças durante os procedimentos odontológicos, é necessário o profissional conhecer e respeitar cada fase do desenvolvimento da criança e aplicar cada técnica de acordo com a necessidade individual do paciente e adequada a cada situação.

Anxiety is a reaction of the body, considered as an alarm emotion that is associated with feelings of fear anguish. The care in pediatric dentistry is surrounded by challenges, being necessary the psychological preparation of the child by the dentist, his assistants and those responsible for the patient. This literature review aimed to report the main behavioral management techniques to facilitate the collaboration of the child with dental treatment. This is a narrative review of the literature performed through the bibliographic survey using the descriptors Pediatric Dentistry; Childish behaviour; Behavioral management in PubMed, LILACS and SciELO databases. Articles were found in Portuguese and English between 2010 and 2020. Behavior management techniques are mechanisms available to the dentist. The choice of method should consider the stage of development of the child, and effectiveness of the method and acceptance of parents. Usually, the most used technique is voice control, talk-show-do and distraction, the latter two being more accepted by parents, and the method with greater rejection is hand-over-the-mouth. In order to obtain the collaboration of children during dental procedures, it is necessary for the professional to know and respect each phase of the child's development and apply each technique according to the individual needs of the patient and appropriate to each situation.

3-min All-out Test to Evaluate Aerobic and Anaerobic Indexes in Court Team Sports.

This study aimed to test the reproducibility of the 3-min all-out effort applied using shuttle running and compare its values to aerobic parameters. On the first day, 14 futsal players underwent an exhaustive test to determine the maximal incremental speed (MIS) and anaerobic threshold (AnT). On the second day, the participants performed the 3-min all-out effort (n=14), which was repeated after 48 h (third day) to test its reproducibility (n=11). Peak oxygen consumption (V̇ O2PEAK) and peak blood lactate concentrations ([La-]) were determined from 3-min all-out efforts performed through a 20-m shuttle run on the official court. The distance covered, mean speed, and critical speed (CS) during the 3-min all-out presented direct relationships with aerobic parameters determined through the incremental test (r>0.62). The distance covered above CS (D') presented a direct relationship with peak lactate concentrations induced by a 3-min all-out effort (r=0.81). Despite the acceptable levels of reproducibility observed for most of the 3-min all-out variables, the minimal detectable change for D' was high (72%). Our results demonstrated the potential use of mean speed to evaluate aerobic fitness. However, the applicability of the 3-min all-out shuttle run test to monitor training adaptations should be avoided, at least in nonexperienced athletes.

A simplified BRADEN scale for the risk of developing pressure injuries.

BACKGROUND: Pressure injuries (PIs) are a major problem for healthcare providers, impacting both care costs and patients' quality of life, although they are predominately preventable. These injuries are especially present in Intensive Care Units (ICUs) as a result of the severity of the clinical conditions of patients in this unit. AIM: To develop a simplified version of the Braden scale by removing two of the most subjective subscores-Nutrition and Sensory Perception-in an attempt to reduce the chance of errors by the nursing team during the application of the scale. STUDY DESIGN: A cross-sectional study was conducted on data collected from patients admitted to the ICU of a private Brazilian tertiary hospital. The resulting data consisted of 5194 patients, 6353 hospital admissions, and 6974 ICU stays. The overall prevalence of PI was 1.09%. RESULTS: The T-test showed that both the Braden and the simplified Braden scores were significantly different between patients with and without PI (p < .001). Patients who developed PIs scored lower than those who did not. The area under the Receiver Operating Characteristic curve of the Braden Scale was 74.21% (95% CI: 68.61%-79.8%) and of the simplified scale was 72.54% (95% CI: 66.87%-78.22%). The Positive Predictive Value of the Braden Scale was 3.17% when interpolated at the same sensitivity as the simplified scale (47.37%), which achieved 3.26%. CONCLUSIONS: By removing two of the six subscores of the Braden scale we propose a new tool for identifying patients at risk of developing PI in a more objective and fast way. Our results show that classification performance had little negative impact. RELEVANCE TO CLINICAL PRACTICE: A simplified, less subjective scale allows for more precise and less time-consuming risk classification.

Mercury cyanide complexes and their relevance as environmental contaminants.

This review addresses the formation and relevance of mercury cyanide complexes as environmental contaminants. Gold extraction is traditionally carried out through the process of mercury amalgamation (Hg) due to its simplicity and low cost. However, this process is inefficient, capturing only about 30% of the gold present in the processed material. Additionally, mercury is toxic, mobile, and capable of accumulating in aquatic ecosystems, leading to its prohibition in several countries. As an alternative, cyanidation has been widely used in gold extraction. However, the frequent combination of Hg amalgamation with cyanidation can result in the formation of mercury cyanide complexes, which can be released into local water bodies, potentially impacting human health and the environment. This article reviews the existing knowledge of these complexes and highlights the remaining gaps in understanding their environmental behavior. It also emphasizes the need to address concerns related to the formation of these complexes and seek solutions to minimize their negative impacts. Furthermore, the article highlights the lack of updates in the literature regarding the impacts of cyanidation and the limited availability of comprehensive information on the topic. It is essential to conduct updated research in this area to advance knowledge and promote safer and more responsible practices in the mining industry.

Factors associated with above-average cognitive performance in long-lived older adults / Fatores associados ao desempenho cognitivo acima da média em idosos longevos

Objective To investigate the factors associated with performance equal to or higher than the 95th percentile in the Mini Mental State Examination of elderly people aged 80 years and over. Method This is a cross-sectional, descriptive, and quantitative research conducted with a convenience sample composed of 101 cognitively healthy older adults residing in Brazil's Federal District, assessed by scales that measure mood, social support, functional performance, and health. Results Bivariate statistical analyses indicated that older individuals with better cognitive performance in the Mini Mental State Examination, when compared to participants with performance below the 95th percentile, showed better self-perceived health, greater satisfaction with the ability to perform daily tasks, and a more positive evaluation of general social support and in the domain of having someone to talk to when feeling lonely. Conclusion High global cognitive performance in old age is associated with perceived health, satisfaction with functional performance, and social support.

Objetivo Investigar os fatores associados ao desempenho igual ou superior ao percentil 95 no Miniexame de Estado Mental de pessoas idosas com 80 anos e mais. Método Trata-se de uma pesquisa transversal, descritiva e quantitativa, conduzida com uma amostra de conveniência composta por 101 idosos cognitivamente saudáveis, residentes no Distrito Federal e avaliados por escalas de humor, suporte social, desempenho funcional e saúde. Resultados Análises estatísticas bivariadas indicaram que os longevos com melhor desempenho cognitivo no Miniexame de Estado Mental, quando comparados aos participantes com desempenho abaixo ao percentil 95, apresentaram melhor autopercepção de saúde, maior satisfação com a capacidade de resolução de tarefas cotidianas, avaliação mais positiva do suporte social geral e relacionado ao domínio de ter com quem conversar quando se sente sozinho. Conclusão O elevado desempenho cognitivo global na velhice se associa à saúde percebida, à satisfação em relação ao desempenho funcional e ao suporte social.

Relação entre saúde mental de idosos do Distrito Federal e exposição a informações sobre COVID-19 / Relation Between Mental Health of Elderly People in Distrito Federal and Exposure to Informations about COVID-19

A fim de conhecer o tempo e a frequência com que idosos se expõem a notícias e informações sobre a COVID-19 por diferentes mídias e relacioná-los com sintomas depressivos e de ansiedade, 154 idosos (M = 69,06) do Distrito Federal responderam a um questionário online. A amostra foi composta majoritariamente por mulheres, brancas, escolarizadas e com renda proveniente de aposentadoria e/ou pensão. Constatou-se que a televisão foi o meio de comunicação mais utilizado pelos participantes, seguido pelas redes sociais. Ao considerar características demográficas, idosos mais jovens (60 a 74 anos) e com ensino superior completo apresentaram maior exposição a notícias por meio das redes sociais do que os mais velhos e com menor escolaridade. Idosos com rastreio para depressão e transtorno de ansiedade generalizada permaneceram mais horas expostos a informações sobre a COVID-19 veiculadas pela televisão que idosos não rastreados. Além disso, aqueles com rastreio para depressão relataram maior frequência de exposição a esse conteúdo pela televisão e pelas redes sociais. Os resultados deste estudo revelam a necessidade de planejamento de medidas de promoção e prevenção em saúde específicas para a população idosa a fim de lidar com as consequências da pandemia e, especialmente, infodemia de COVID-19(AU)

Para conocer el tiempo y la frecuencia con que los ancianos están expuestos a noticias e informaciones sobre el COVID-19 por diferentes medios de comunicación y relacionarlos con los síntomas depresivos y de ansiedad, 154 ancianos (m = 69,06) del Distrito Federal respondieron a un cuestionario online. La muestra estaba compuesta mayoritariamente por mujeres, de raza blanca, con estudios y con ingresos por jubilación y/o pensión. Se comprobó que la televisión era el medio de comunicación más utilizado por los participantes, seguido de las redes sociales. Teniendo en cuenta las características demográficas, los más jóvenes (60 a 74 años) y con estudios superiores completos presentan una mayor exposición a las noticias a través de las redes sociales que los más mayores y con menor escolaridad. Los ancianos con cribado de depresión y trastorno de ansiedad generalizada permanecieron más horas expuestos a la información sobre COVID-19 emitida por televisión que los ancianos no cribados. Además, los que se sometieron a pruebas de detección de la depresión informaron de una mayor frecuencia de exposición a este contenido por parte de la televisión y los medios sociales. Los resultados de este estudio revelan la necesidad de planificar medidas de promoción de la salud y de prevención específicas para la población de edad avanzada con el fin de hacer frente a las consecuencias de la pandemia y, especialmente, de la infodemia de COVID-19(AU)

In order to know the time and frequency with which elderly are exposed to news and information about COVID-19 through different media and relate them with depressive and anxiety symptoms, 154 elderly (M = 69.06) from Distrito Federal answered an online questionnaire. The sample was composed mostly of women, white, educated, and with income from retirement and/or pension. It was found that television was the media most used by participants, followed by social networks. Considering demographic characteristics, younger elders (60 to 74 years old) and with complete college education had more exposure to news through social networks than the older ones and with less education. Elderly with screening for depression and generalized anxiety disorder remained exposed more hours to information about COVID-19 broadcast on television than unscreened elderly. In addition, those with screening for depression reported greater frequency of exposure to this content on television and social media. The results of this study reveal the need for health promotion and prevention measures planning specific to the elderly population to deal with the consequences of the pandemic and especially infodemic of COVID-19(AU)

The presence of depressive symptoms and cognitive performance among older individuals with and without self-reported chronic diseases.

Dementias secondary to cardiovascular diseases are the second cause of neurogenerative diseases. These conditions can be prevented by controlling risk factors, and it is necessary to observe the relationship between chronic diseases. Objective: to know the influence of chronic non-communicable diseases on cognition and depressive symptoms in the elderly, amid the COVID-19 pandemic. Methods: 578 older adults were evaluated using a sociodemographic questionnaire, the Brazilian Telephone version of the Mini Mental State Examination (Braztel-MMSE), the Geriatric Depression Scale (GDS-15) and an open questionnaire related to NCDs. Results: the association of Non-Communicable Diseases (NCD) with age, depressive symptoms and schooling was confirmed. Conclusion: no association with cognitive decline was evident due to the relationship of high schooling of participants and control of NCDs.

As demências secundárias às doenças cardiovasculares são a segunda causa de doenças neurodegenerativas. Essas condições podem ser prevenidas pelo controle de fatores de risco, sendo necessário observar a relação entre doenças crônicas. Objetivo: Conhecer a influência das doenças crônicas não transmissíveis (DCNT) na cognição e nos sintomas depressivos em pessoas idosas, em meio à pandemia da COVID-19. Métodos: Foram avaliados 578 idosos utilizando um questionário sociodemográfico, o Brazilian telephone version of the Mini Mental State Examination (Braztel-MMSE), a Escala de Depressão Geriátrica (GDS-15) e um questionário aberto relacionado às DCNT. Resultados: Foi confirmada a associação das DCNT crônicas com idade, sintomas depressivos e escolaridade. Conclusão: Nenhuma associação com declínio cognitivo foi evidente em razão da relação da alta escolaridade dos participantes com o controle das DCNT.

Factors Affecting Enteric Emission Methane and Predictive Models for Dairy Cows.

Enteric methane emission is the main source of greenhouse gas contribution from dairy cattle. Therefore, it is essential to evaluate drivers and develop more accurate predictive models for such emissions. In this study, we built a large and intercontinental experimental dataset to: (1) explain the effect of enteric methane emission yield (g methane/kg diet intake) and feed conversion (kg diet intake/kg milk yield) on enteric methane emission intensity (g methane/kg milk yield); (2) develop six models for predicting enteric methane emissions (g/cow/day) using animal, diet, and dry matter intake as inputs; and to (3) compare these 6 models with 43 models from the literature. Feed conversion contributed more to enteric methane emission (EME) intensity than EME yield. Increasing the milk yield reduced EME intensity, due more to feed conversion enhancement rather than EME yield. Our models predicted methane emissions better than most external models, with the exception of only two other models which had similar adequacy. Improved productivity of dairy cows reduces emission intensity by enhancing feed conversion. Improvement in feed conversion should be prioritized for reducing methane emissions in dairy cattle systems.

Implementação da 3ª Edição da Caderneta de Saúde da Pessoa Idosa em duas regiões brasileiras / Implementation of the 3rd Edition of the Elderly Health Handbook in two Brazilian regions

O objetivo do presente estudo foi avaliar as condições estruturais, recursos humanos e estratégias de distribuição na implementação dessa Caderneta em 43 municípios da região Norte e 48 da região Sul do Brasil. Os dados foram coletados por meio de inquérito conduzido pela Fundação Oswaldo Cruz, a pedido do Ministério da Saúde, entre 2017 e 2018, no qual foram entrevistados os responsáveis técnicos pela saúde da pessoa idosa nesses municípios. Observou-se que em ambas as regiões a capacitação presencial foi predominante. A estratégia de implementação mais utilizada foi a orientação individual por meio da Estratégia de Saúde da Família e a distribuição foi realizada pela Estratégia de Agentes Comunitários de Saúde, sendo essa a mais prevalente na região Norte. Um dos maiores desafios na distribuição foi o desinteresse em receber as cadernetas por parte das Unidades Básicas de Saúde (27,3% dos municípios da Região Norte e 19,1% da Região Sul). Concluiu-se que os responsáveis técnicos pela saúde da pessoa idosa utilizam-se dos recursos humanos disponíveis para implementação e distribuição da caderneta. A Região Norte, mesmo apresentando mais dificuldades, sinalizou o comprometimento da gestão em saúde da pessoa idosa em buscar concretizar ações que fortaleçam e promovam a Política Nacional de Saúde da Pessoa Idosa.

The objective of the present study was to evaluate the structural conditions, human resources and distribution strategies in the implementation of The3rd edition of the Elderly Health Booklet in 43 municipalities in the North region and 48 in the South region of Brazil. Data were collected through a survey conducted by the Oswaldo Cruz Foundation, at the request of the Ministry of Health, between 2017 and 2018, in which the technicians responsible for the health of the elderly in these municipalities were interviewed. It was observed that in both regions face-to-face training was predominant. The most used implementation strategy was individual guidance through the Family Health Strategy and distribution was carried out by the Community Health Agents Strategy, which is more prevalent in the North region. One of the biggest challenges in distribution was the lack of interest in receiving the booklets by the Basic Health Units (27.3% of the municipalities in the North Region and 19.1% in the South Region). It was concluded that the technicians responsible for the health of the elderly use the human resources available for the implementation and distribution of the booklet. The North Region, despite having more difficulties, signaled the commitment of health management for the elderly to seek to implement the actions that strengthen and promote the National Health Policy for the Elderly.

In Vitro Antioxidant and Antitrypanosomal Activities of Extract and Fractions of Terminalia catappa.

Chagas disease is a severe infectious and parasitic disease caused by the protozoan Trypanosoma cruzi and considered a public health problem. Chemotherapeutics are still the main means of control and treatment of the disease, however with some limitations. As an alternative treatment, plants have been pointed out due to their proven pharmacological properties. Many studies carried out with Terminalia catappa have shown several biological activities, but its effect against T. cruzi is still unknown. The objective of this work is to evaluate the therapeutic potential of extracts and fractions obtained from T. catappa on the parasite T. cruzi, in addition to analyzing its antioxidant activity. T. catappa ethyl acetate fraction were produced and submitted the chemical characterization by Liquid Chromatography Coupled to Mass Spectrometry (LC-MS). From all T. catappa extracts and fractions evaluated, the ethyl acetate and the aqueous fraction displayed the best antioxidant activity by the 2,2-diphenyl-1-picryl-hydrazyl (DPPH) radical scavenging method (IC50 of 7.77 ± 1.61 and 5.26 ± 1.26 µg/mL respectively), and by ferric ion reducing (FRAP) method (687.61 ± 0.26 and 1009.32 ± 0.13 µM of Trolox equivalent/mg extract, respectively). The ethyl acetate fraction showed remarkable T. cruzi inhibitory activity with IC50 of 8.86 ± 1.13, 24.91 ± 1.15 and 85.01 ± 1.21 µg/mL against epimastigotes, trypomastigotes and intracellular amastigotes, respectively, and showed no cytotoxicity for Vero cells (CC50 > 1000 µg/mL). The treatment of epimastigotes with the ethyl acetate fraction led to drastic ultrastructural changes such as the loss of cytoplasm organelles, cell disorganization, nucleus damage and the loss of integrity of the parasite. This effect could be due to secondary compounds present in this extract, such as luteolin, kaempferol, quercetin, ellagic acid and derivatives. The ethyl acetate fraction obtained from T. catappa leaves can be an effective alternative in the treatment and control of Chagas disease, and material for further investigations.

Extra-articular manifestations of rheumatoid arthritis remain a major challenge: data from a large, multi-centric cohort.

INTRODUCTION: Although Rheumatoid Arthritis (RA) extra-articular manifestations (ExtRA) occurrence has been decreasing over time, they are still a major mortality risk factor for patients. OBJECTIVE: To determine the prevalence of ExtRA in a large cohort, and its association with demographic and clinical variables. METHOD: Cross-sectional and observational study, based on a multi-centric database from a prospective cohort, in which 11 public rheumatology centres enrolled RA patients (1987 ARA or 2010 ACR-EULAR). Data collection began in 08-2015, using a single online electronic medical record. Continuous variables were compared using Mann-Whitney U-test, and Fisher's exact test or chi-square test, as appropriate, were used for categorical variables. The level of significance was set at 5% (p < 0.05). RESULTS: 1115 patients were included: 89% women, age [mean ± SD] 58.2 ± 11.5 years, disease duration 14.5 ± 12.2 years, positive Rheumatoid Factor (RF, n = 1108) in 77%, positive anti-cyclic citrullinated peptide (ACPA, n = 477) in 78%. Regarding ExtRA, 334 occurrences were registered in 261 patients, resulting in an overall prevalence of 23.4% in the cohort. The comparison among ExtRA and Non-ExtRA groups shows significant higher age (p < 0.001), disease duration (p < 0.001), RF high titers (p = 0.018), Clinical Disease Activity index (CDAI) (p < 0.001), Disease Activity Index 28 (DAS 28) (p < 0.001), and Health Assessment Questionnaire (HAQ) (p < 0.001) in ExtRA group. Treatment with Azathioprine (p = 0.002), Etanercept (p = 0.049) Glucocorticoids (GC) ('p = 0.002), and non-steroidal anti-inflammatory drugs (NSAIDs) (p < 0.001) were more frequent in ExtRA group. CONCLUSIONS: ExtRA manifestations still show an expressive occurrence that should not be underestimated. Our findings reinforce that long-term seropositive disease, associated with significant disability and persistent inflammatory activity are the key factors related to ExtRA development.

Prognostic Factors in Children and Adolescents with Lymphomas and Vertical Transmission of HIV in Rio de Janeiro, Brazil: A Multicentric Hospital-Based Survival Analysis Study.

Lymphomas related to HIV are generally aggressive and have a poor prognosis, despite the use of combined antiretroviral therapy (cART) and effective chemotherapy treatment. To determine survival and prognostic factors in children and adolescents living with HIV (CLWH) in Rio de Janeiro (RJ), Brazil, who developed lymphomas, we performed a retrospective and observational study of vertically infected CLWH aged from 0 to 20 incomplete years during1995 to 2018 at five reference centers for cancer and HIV/AIDS treatment. Of the 25 lymphomas, 19 were AIDS-defining malignancies (ADM) and 6 were non-AIDS-defining malignancies (NADM). The 5-year overall survival (OS) and 5-year event-free survival (EFS) probabilities were both 32.00% (95% CI = 13.72-50.23%), and the 5-year disease-free survival (DFS) probability was 53.30% (95% CI = 28.02-78.58%). In the multivariate Cox regression analysis, performance status 4 (PS 4) was considered a poor prognostic factor for OS (HR 4.85, 95% CI = 1.81-12.97, p = 0.002) and EFS (HR 4.95, 95% CI = 1.84-13.34, p = 0.002). For the DFS, higher CD4+ T-cell counts were considered a better prognostic factor (HR 0.86, 95% CI = 0.76-0.97, p = 0.017) in the multivariate Cox regression analysis. This study demonstrates, for the first time, survival and prognostic factors for CLWH who developed lymphomas in RJ, Brazil.

Caffeic acid recovers ischemia-induced synaptic dysfunction without direct effects on excitatory synaptic transmission and plasticity in mouse hippocampal slices.

Caffeic acid is a polyphenolic compound present in a vast array of dietary components. We previously showed that caffeic acid reduces the burden of brain ischemia joining evidence by others that it can attenuate different brain diseases. However, it is unknown if caffeic acid affects information processing in neuronal networks. Thus, we now used electrophysiological recordings in mouse hippocampal slices to test if caffeic acid directly affected synaptic transmission, plasticity and dysfunction caused by oxygen-glucose deprivation (OGD), an in vitro ischemia model. Caffeic acid (1-10 µM) was devoid of effect on synaptic transmission and paired-pulse facilitation in Schaffer collaterals-CA1 pyramidal synapses. Also, the magnitude of either hippocampal long-term potentiation (LTP) or the subsequent depotentiation were not significantly modified by 10 µM caffeic acid. However, caffeic acid (10 µM) increased the recovery of synaptic transmission upon re-oxygenation following 7 min of OGD. Furthermore, caffeic acid (10 µM) also recovered plasticity after OGD, as heralded by the increased magnitude of LTP after exposure. These findings show that caffeic acid does not directly affect synaptic transmission and plasticity but can indirectly affect other cellular targets to correct synaptic dysfunction. Unraveling the molecular mechanisms of action of caffeic acid may allow the design of hitherto unrecognized novel neuroprotective strategies.

Acute ecotoxicological effects of Hg(CN)2 in Danio rerio (zebrafish).

Artisanal and small-scale gold mining (ASGM) is the largest source of anthropogenic Hg emissions on the planet. In addition, Hg-contaminated tailings are often reprocessed with sodium cyanide (NaCN) to extract the residual gold remaining in the material. This leads to the formation of mercury cyanide (Hg(CN)2) complexes, which are often discharged in untreated form into local drainages, leading to large amounts of free cyanide being released. However, data on mercury-cyanide interactions are scarce. In this study, we investigated the impact of cyanide and Hg bioavailability in zebrafish when added as Hg(CN)2. Different concentrations of Hg(CN)2 and NaCN were used, leading to an LC50 of 0.53 mg.L-1 for NaCN and 0.16 mg.L-1 for Hg(CN)2. Analyzing free cyanide concentrations in aquarium water, >40% dissociation was observed for NaCN and about 5% for Hg(CN)2. The accumulation of total Hg (THg) in the brain, gills, muscle and kidney was quantified. All fish exposed to Hg(CN)2 had higher THg levels than their controls and kidney was the tissue with higher Hg(CN)2 accumulation. Histological effects on the kidney and gills of both cyanides in D. rerio tissues were investigated, suggesting renal alterations in fish exposed to Hg(CN)2 and showing hyperplasia in the gills of animals exposed to NaCN and Hg(CN)2. The results alert to the risks of the presence of these complexes in aquatic environments.