Development and evaluation of an anti-candida cream based on silver nanoparticles.

The ineffectiveness of azole drugs in treating Vulvovaginal Candidiasis (VVC) and Recurrent Vulvovaginal Candidiasis (RVVC) due to antifungal resistance of non-albicans Candida has led to the investigation of inorganic nanoparticles with biological activity. Silver nanoparticles (AgNPs) are important in nanomedicine and have been used in various products and technologies. This study aimed to develop a vaginal cream and assess its in vitro antimicrobial activity against Candida parapsilosis strains, specifically focusing on the synergy between AgNPs and miconazole. AgNPs were synthesized using glucose as a reducing agent and sodium dodecyl sulfate (SDS) as a stabilizer in varying amounts (0.50, 0.25, and 0.10 g). The AgNPs were characterized using UV-Visible (UV-Vis) and Fourier-Transform Infrared (FT-IR) spectroscopies, X-Ray Diffraction (XRD), Dynamic Light Scattering (DLS), Scanning Electron Microscopy (SEM), and Energy Dispersive X-Ray Analysis (EDX). Fifty strains of Candida parapsilosis were used to evaluate the synergistic activity. AgNPs synthesized with 0.5 g SDS had an average size of 77.58 nm and a zeta potential of -49.2 mV, while AgNPs with 0.25 g showed 91.22 nm and -47.2 mV, respectively. AgNPs stabilized with 0.1 g of SDS were not effective. When combined with miconazole, AgNPs exhibited significant antifungal activity, resulting in an average increase of 80% in inhibition zones. The cream developed in this study, containing half the miconazole concentration of commercially available medication, demonstrated larger inhibition zones compared to the commercial samples.

Antifungal Activity of Nanobiocomposite Films Based on Silver Nanoparticles Obtained Through Green Synthesis.

The high incidence of Candida albicans infections has raised concerns regarding side effects and drug resistance, compounded by a limited number of alternative drugs. Silver nanoparticles (AgNPs) have prominent antimicrobial activity, but effective administration remains a challenge. In this study, AgNPs were synthesized via a green chemistry approach, using glucose as a reducing agent, and incorporated into an agar matrix to form a film (AgFilm). The AgNPs and AgFilm were characterized by Ultraviolet-visible (UV-vis) spectroscopy, Fourier transform infrared (FTIR) spectroscopy, dynamic light scattering (DLS), powder X-ray diffraction (PXRD), scanning electron microscopy (SEM), and atomic force microscopic (AFM). The UV-Vis spectra of the AgNPs and AgFilm showed bands at 415 and 413 nm, respectively. The PXRD and UV-Vis data suggest that the growth of AgNPs was effectively inhibited in the AgFilm. The diameter of AgNPs dispersed in AgFilm was 76 ± 42 nm, and the thickness of the film and 35 ± 3 µm. The antifungal activity of AgFilm was evaluated against 20 strains of C. albicans, demonstrating high antifungal activity with an inhibition zone of 19 ± 2 mm. Therefore, AgFilm could be a promising option for the treatment of superficial C. albicans infections.

External Oblique Intercostal Block for Living Kidney Donor Open Nephrectomy: A Case Series.

The external oblique intercostal (EOI) block is a novel regional technique that provides analgesia for upper abdominal incisions. We performed single-injection and continuous EOI blocks in living kidney donors who underwent open nephrectomy. In this case series, we report our experience with pain management using this technique in five patients at our centre. EOI block resulted in good pain relief in our patients. The median (IQR) numerical rating scale score was 3 (1-6) at rest immediately after the end of the surgery, predominantly visceral. We want to highlight the benefits regarding pain management of the association of EOI block with conventional therapy.

Isolated and combined association of excessive screen time and physical inactivity with negative self-rated health in adolescents.

OBJECTIVE: The aim of this study was to analyze isolated and combined associations of physical inactivity excessive screen time with negative self-rated health, according to sex, among school adolescents. METHODS: In this cross-sectional study conducted with 2,517 adolescents in Amazonas State, participants were asked about their self-rated health with the following question: How do you rate your health? Responses were dichotomized into positive (excellent and good) and negative (regular, bad, and terrible). Information on sex, age group, family income, physical activity, and screen time (watching TV, using a computer, or playing video games) was collected through a self-administered questionnaire. Adolescents simultaneously classified as physically inactive (<60 min/day) and having excessive screen time (>2 h/day) were considered to have two risk factors. Data was analyzed using binary logistic regression. RESULTS: Out of every 10 adolescents, 2 had a negative self-rated health. After adjusting for age and family income, there were no isolated or combined associations between physical inactivity or excessive screen time and negative self-rated health in girls. In boys, negative self-rated health was associated with insufficient levels of physical activity (odds ratio [OR]: 2.39; 95% confidence interval [CI]: 1.03-5.59) and with the accumulation of two risk factors (OR: 1.61; 95%CI 1.10-2.34). CONCLUSIONS: Being insufficiently active and the combination of physical inactivity and excessive screen time become exposure factors to the negative self-rated health of adolescent boys.

Isolated and combined association of excessive screen time and physical inactivity with negative self-rated health in adolescents / Associação isolada e combinada do tempo de tela excessivo e da inatividade física com autopercepção de saúde negativa em adolescentes

Abstract Objective: The aim of this study was to analyze isolated and combined associations of physical inactivity excessive screen time with negative self-rated health, according to sex, among school adolescents. Methods: In this cross-sectional study conducted with 2,517 adolescents in Amazonas State, participants were asked about their self-rated health with the following question: How do you rate your health? Responses were dichotomized into positive (excellent and good) and negative (regular, bad, and terrible). Information on sex, age group, family income, physical activity, and screen time (watching TV, using a computer, or playing video games) was collected through a self-administered questionnaire. Adolescents simultaneously classified as physically inactive (<60 min/day) and having excessive screen time (>2 h/day) were considered to have two risk factors. Data was analyzed using binary logistic regression. Results: Out of every 10 adolescents, 2 had a negative self-rated health. After adjusting for age and family income, there were no isolated or combined associations between physical inactivity or excessive screen time and negative self-rated health in girls. In boys, negative self-rated health was associated with insufficient levels of physical activity (odds ratio [OR]: 2.39; 95% confidence interval [CI]: 1.03-5.59) and with the accumulation of two risk factors (OR: 1.61; 95%CI 1.10-2.34). Conclusions: Being insufficiently active and the combination of physical inactivity and excessive screen time become exposure factors to the negative self-rated health of adolescent boys.

RESUMO Objetivo: Analisar a associação isolada e combinada do tempo excessivo de tela e inatividade física com a autopercepção negativa de saúde, de acordo com o sexo, em adolescentes estudantes. Métodos: Estudo transversal conduzido em 2.517 adolescentes amazonenses, os quais foram questionados sobre a autopercepção de saúde: "Como você considera a sua saúde?", dicotomizada em positiva (excelente, boa) e negativa (regular, ruim, péssima). Informações sobre sexo, faixa etária, renda familiar, atividade física e tempo excessivo de tela (assistindo TV, usando o computador ou jogando videogame) foram coletadas mediante questionário autoadministrado. Aqueles classificados, simultaneamente, como fisicamente inativos (<60 min/dia) e com tempo excessivo de tela (>2 horas/dia) foram considerados com dois fatores de risco. Os dados foram analisados utilizando-se a regressão logística binária. Resultados: Dois em cada dez adolescentes apresentaram autopercepção negativa de saúde. Após o ajuste pelas variáveis idade e renda familiar, não foram observadas, no sexo feminino, associações da inatividade física e do tempo excessivo de tela, de maneira isolada ou agrupada, com a autopercepção negativa de saúde. No sexo masculino, a percepção negativa de saúde foi associada com os níveis insuficientes de atividade física (odds ratio — OR: 2,39; intervalo de confiança — IC95% 1,03-5,59) e com o acúmulo de dois fatores de risco (OR: 1,61; IC95% 1,10-2,34). Conclusões: Ser insuficientemente ativo e associar a inatividade física com tempo excessivo de tela tornam-se fatores de exposição à percepção negativa em saúde de meninos adolescentes.

A Comprehensive Review on Photoacoustic-Based Devices for Biomedical Applications.

The photoacoustic effect is an emerging technology that has sparked significant interest in the research field since an acoustic wave can be produced simply by the incidence of light on a material or tissue. This phenomenon has been extensively investigated, not only to perform photoacoustic imaging but also to develop highly miniaturized ultrasound probes that can provide biologically meaningful information. Therefore, this review aims to outline the materials and their fabrication process that can be employed as photoacoustic targets, both biological and non-biological, and report the main components' features to achieve a certain performance. When designing a device, it is of utmost importance to model it at an early stage for a deeper understanding and to ease the optimization process. As such, throughout this article, the different methods already implemented to model the photoacoustic effect are introduced, as well as the advantages and drawbacks inherent in each approach. However, some remaining challenges are still faced when developing such a system regarding its fabrication, modeling, and characterization, which are also discussed.

Association between loneliness, physical activity, and participation in physical education among adolescents in Amazonas, Brazil.

Loneliness is an individual and social problem associated with an unhealthy lifestyle among adolescents. We examined the association between loneliness, physical activity, and participation in physical education lessons among school-going adolescents. Participants included 2517 adolescents aged 14-19 years selected from state public high schools in Amazonas, Brazil. Participants answered a questionnaire containing demographic information, physical activity, and participation in physical education lessons and loneliness. Our results showed that physically inactive adolescents and those who did not participate in physical education lessons were more likely to feel lonely. These findings underscore the need to target physically inactive adolescents and those non-engaged in physical education lessons when developing interventions to address loneliness.

Functional disability and factors of elderly people with regular physical activity: a cross-sectional study / Incapacidade funcional e fatores associados de idosas praticantes de atividade física regular: um estudo transversal

ABSTRACT Conducting studies in different regions of the country can help to understand which factors are associated with the functional disability of the elderly, considering that this is an important health indicator and may contribute to interventions in this population, aiming to reduce the risk of future dependence, complication or establishment of chronic diseases and morbidities. This study aimed to verify the factors associated with the functional disability of elderly women participating in a physical activity program in Manaus/AM. A cross-sectional study was conducted with 416 elderly women who answered a questionnaire with information on functional disability (dependent variable) and independent variables: age, marital status, monthly income, schooling, retirement, medication use, body mass index, depression symptoms, self-reported illness, and health perception. The overall prevalence of functional disability was 25.7%, which was associated with age ≥80 (OR=2.34, IC95%=1.11-4,94), incomplete primary school (OR=3.22, IC95%=1.24-8.35) and complete primary (OR=3.24, IC95%=1.40-7.50), overweight (OR=2.77, IC95%=1.69-4.54), presence of depression symptoms (OR=4.40, IC95%=1.48-13.07), arthrosis (OR=3.31, IC95%=1.80-5.73), rheumatoid arthritis (OR=2.84, IC95%=1.57-5.15) and negative health perception (OR=3.04, IC95%=1.19-7.78). It was concluded that functional disability was associated with modifiable health factors (scholling, overweight, depression syntoms) ans non modifiable (age, arthritis and arthrosis).

RESUMO A realização de estudos em diferentes regiões do país pode auxiliar no entendimento dos fatores associados à incapacidade funcional do idoso, considerando que este é um importante indicador de saúde e pode contribuir para intervenções nessa população, com o objetivo de reduzir o risco de dependência futura, complicação ou estabelecimento de doenças e morbidades crônicas. Esse estudo objetivou verificar os fatores associados à incapacidade funcional de idosas participantes de programa de atividade física de Manaus-AM. Estudo transversal foi conduzido em 416 mulheres idosas que responderam um questionário contendo informações sobre a incapacidade funcional (IF) (variável dependente) e variáveis independentes: idade, estado civil, renda mensal, escolaridade, aposentadoria, uso de medicação, índice de massa corporal, sintomas depressivos, doenças autorreferidas e percepção de saúde. A prevalência geral de IF foi de 25,7%, a qual esteve associada à idade ≥80 (OR=2.34, IC95%=1.11-4,94), ensino fundamental incompleto (OR=3,22, IC95%=1,24-8,35) e fundamental completo (OR=3,24, IC95%=1,40-7,50), sobrepeso (OR=2,77, IC95%=1,69-4,54), presença de sintomas depressivos (OR=4.40, IC95%=1.48-13.07), artrose (OR=3.31, IC95%=1.80-5.73), artrite reumatoide (OR=2.84, IC95%=1.57-5.15) e percepção de saúde negativa (OR=3.04, IC95%=1.19-7.78). Conclui-se que a IF esteve associada a fatores modificáveis de saúde (escolaridade, sobrepeso e sintomas depressivos) e não modificáveis (idade, artrite e artrose).

Checklist of the ichthyofauna of Mamirauá Sustainable Development Reserve, Middle Solimões, Amazonas, Brazil: high richness in a large protected area of Western-Central Amazonia / Lista de verificação da ictiofauna da Reserva de Desenvolvimento Sustentável Mamirauá, Médio Solimões, Amazonas, Brasil: alto endemismo e riqueza em uma grande área protegida da Amazônia Centro-Ocidental

Abstract: The present study reviews the records of occurrences of fish species found in the Mamirauá Sustainable Development Reserve (MSDR). The reserve is located in a large section of the middle Solimões River basin, in its interflow with Japurá River. For the elaboration of the list of fish species occurring in Mamirauá Reserve, we used a database of different studies on fish communities carried out in the area over the last three decades, in addition to the material deposited in the ichthyological collections of three scientific institutions, the National Institute for Amazon Research - INPA, the Mamirauá Sustainable Development Institute - IDSM and the Science and Technology Museum of the Catholic University of Rio Grande do Sul - PUCRS. The ichthyofauna of the MSDR is composed of 541 species, encompassing 45 families and 15 orders. These correspond to 20% of all valid species known for the entire Amazonia so far. As observed in other studies in the Neotropical Region, the more represented orders were Siluriformes (209 species) and Characiformes (185 species), followed by the Gymnotiformes (78 species). The results presented here demonstrate a considerable increase (86%) in the knowledge about the fish diversity found in Mamirauá Reserve, in relation to its first list of fish species, published in the 90's. This increase reflects not only the growth in number of studies on fish diversity in the area, with new surveys, but also the continuous taxonomic work on the collections, and descriptions of twenty-eight new species, with one hundred and ten type series. Further surveys are expected to take place in the Northwestern, more isolated areas of the Reserve, and will allow the identification of new occurrences, and may even unveil new fish species yet to be described to Science..

Resumo: Este estudo apresenta uma revisão dos registros de ocorrências das espécies de peixes encontradas na Reserva de Desenvolvimento Sustentável Mamirauá (RDSM), ampla área localizada na bacia do Médio Solimões, em seu interflúvio com o Rio Japurá. Para a elaboração da lista de peixes que ocorrem na Reserva Mamirauá foram utilizados os bancos de dados de diferentes estudos sobre comunidades de peixes realizados na área ao longo das últimas décadas, além de informações referentes ao material tombado nas coleções ictiológicas de três instituições científicas, o Instituto Nacional de Pesquisas da Amazônia- INPA,o Instituto de Desenvolvimento Sustentável Mamirauá - IDSM e o Museu de Ciências e Tecnologia da Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS. A ictiofauna da RDSM é composta por 541 espécies, incluindo 45 famílias e 15 ordens. Estes valores correspondem a cerca de 20% de todas espécies válidas conhecidas para toda a Amazônia até o momento. Assim como em outros estudos na região Neotropical as ordens que apresentaram as maiores riquezas foram siluriformes (209 espécies) e Characiformes (185 espécies), seguidas de Gymnotiformes (78 espécies). Os resultados apresentados neste trabalho demonstram um aumento considerável (86%) no conhecimento sobre a diversidade de peixes encontrados na Reserva Mamirauá, em relação à primeira lista de peixes da RDSM, publicada na década de 1990. Este aumento reflete não apenas o crescimento no número de estudos sobre a diversidade de peixes na área, com a ocorrência de novos levantamentos, como também a intensificação dos trabalhos taxonômicos de classificação e descrição de vinte oito novas espécies com cento e dez séries tipos. Novos levantamentos deverão ocorrer nas áreas mais isoladas da Reserva, na sua porção noroeste. Estas atividades permitirão a identificação de novas ocorrências, e podem até revelar espécies novas a serem descritas..

Genetic timestamping of plasma cells in vivo reveals tissue-specific homeostatic population turnover.

Plasma cells (PCs) are essential for protection from infection, and at the origin of incurable cancers. Current studies do not circumvent the limitations of removing PCs from their microenvironment and confound formation and maintenance. Also, the investigation of PC population dynamics has mostly relied on nucleotide analog incorporation that does not label quiescent cells, a property of most PCs. The main impediment is the lack of tools to perform specific genetic manipulation in vivo. Here we characterize a genetic tool (JchaincreERT2) in the mouse that permits first-ever specific genetic manipulation in PCs in vivo, across immunoglobulin isotypes. Using this tool, we found that splenic and bone marrow PC numbers remained constant over-time with the decay in genetically labeled PCs being compensated by unlabeled PCs, supporting homeostatic population turnover in these tissues. The JchaincreERT2 tool paves the way for an in-depth mechanistic understanding of PC biology and pathology in vivo, in their microenvironment.

Where does patient autonomy live, in times of crisis in Portugal? / Onde mora a autonomia do paciente em tempos de crise em Portugal?

Coronavirus disease 2019 made us question daily practices, such as the simple handshake. It also raised some ethical and legal issues. Are the ethical principles, that should guide the provision of individualized care, being fulfilled? Will we, as health professionals, be able to provide patients with instruments so that they can fully exercise their autonomy? The guarantee of necessary security solutions, to reduce the risk of contagion in the provision of care, safeguards the principle of non-maleficence. However, the risk of contagion is impossible to completely eliminate, and there is a residual risk associated with the use of physical facilities in healthcare services. But, shouldn't the decision to take that risk be the subject of the patient's free and informed will? The incorporation of telemedicine platforms is ideal for managing several challenges posed by COVID-19, such as the decrease in face-to-face health care assistance. Can the patient really decide how he prefers to be consulted, or are we imposing the consultation model? There have been profound changes in healthcare systems. However, one must remember that there are ethical principles of biomedicine, that should always prevail?

A pandemia de COVID-19 fez-nos questionar práticas diárias até então instituídas, como o simples aperto de mão. Levantou também outras questões, algumas de índole ético-legal. Estarão a ser cumpridos os princípios éticos que devem orientar a prestação de cuidados individualizados? Conseguiremos nós, profissionais de saúde, fornecer instrumentos aos doentes para que possam usufruir plenamente do seu direito de autonomia? A garantia de soluções de segurança necessárias, para diminuir o risco de contágio na prestação de cuidados, salvaguarda o princípio da não maleficiência. Todavia, o risco de contágio é impossível de eliminar na totalidade, existindo um residual associado à utilização das instalações físicas dos serviços de saúde. Mas, não deverá a decisão de assumir esse risco ser alvo do arbítrio livre, informado e esclarecido do doente? A diminuição da atividade assistencial presencial motivou a incorporação de outras ferramentas de comunicação como telefone, correio eletrónico e videochamada. Poderá o paciente realmente decidir sobre a forma como prefere ser consultado, ou estaremos nós a impor o modelo de consulta? Nos últimos meses ocorreram mudanças profundas na forma de trabalho em Saúde, que permanecerão. Não existirão, contudo, princípios éticos da biomedicina, que deverão sempre prevalecer?

Significações de criança/infância no universo das canções de Chico Buarque – momentos da vida / Significations of child/childhood in the universe of songs by Chico Buarque - moments of life / Niño e infancia y sus significados en el universo de las canciones de Chico Buarque - momentos de la vida

As expressões artísticas constituem e são constituídas pelos contextos sociais e históricos, contribuindo para uma compreensão ampliada das realidades. Refletindo sobre as significações de infância e criança nas canções de Chico Buarque, este estudo efetivou: pesquisa bibliográfica sobre arte e realidade social, infância e ser criança, escuta e reescuta do conjunto de suas canções desde a década de 1960 a 2000. Submetemos os dados construídos à análise de conteúdo temática, emergindo, desse modo, as seguintes categorias: brincadeira, características da infância, cuidados e descuidos, infâncias, momentos da vida. Neste artigo, apresentaremos e discutiremos a categoria "momentos da vida". Encontramos que ser criança faz-se esperança; ser adulto e velho não. Ao adulto cabe trabalho e cuidado; ao velho, desesperança, tristeza e cansaço.

Artistic expressions build and are built by social and historical contexts, contributing to a broad understanding of realities. This study, reflecting on the meanings of childhood and child in Chico Buarque’s songs, performed: bibliographic research on art and social reality, childhood and being a child, listening, and re-listening to a set of this artist’s songs from the 1960s to 2000s. We submitted the obtained data to thematic content analysis, where the following categories emerged: plays, childhood characteristics, care and carelessness, childhoods, and moments of life. In this study, we display and discuss the category "moments of life". Thus, we realize that being a child turns into hope, being adults and elders do not. The adult faces work and care; the elderly, hopelessness, sadness and fatigue.

Las expresiones artísticas constituyen y son constituidas por los contextos sociales e históricos. En la búsqueda de comprender los significados de infancia y de niño en las canciones de Chico Buarque, este estudio realizó: investigación bibliográfica sobre el arte y la realidad social, niñez y ser niño, escuchar y volver a escuchar al conjunto de sus canciones, desde la década de 1960 hasta la década de 2000. Presentamos datos incorporados al análisis de contenido temático, que emerge de las siguientes categorías: juguete, características de la infancia, cuidado y descuidos, infancia, momentos de la vida. En este artículo, vamos a presentar y analizar la categoría "momentos de la vida". Por lo tanto, descubrimos que el ser niño se hace la esperanza. Ser adulto y viejo, no. Al adulto cabe destacar el trabajo y el cuidado del otro; al viejo, la desesperanza, la tristeza y la fatiga.

Onde mora a autonomia do paciente em tempos de crise em Portugal? / Where does patient autonomy live, in times of crisis in Portugal?

Resumo A pandemia de COVID-19 fez-nos questionar práticas diárias até então instituídas, como o simples aperto de mão. Levantou também outras questões, algumas de índole ético-legal. Estarão a ser cumpridos os princípios éticos que devem orientar a prestação de cuidados individualizados? Conseguiremos nós, profissionais de saúde, fornecer instrumentos aos doentes para que possam usufruir plenamente do seu direito de autonomia? A garantia de soluções de segurança necessárias, para diminuir o risco de contágio na prestação de cuidados, salvaguarda o princípio da não maleficiência. Todavia, o risco de contágio é impossível de eliminar na totalidade, existindo um residual associado à utilização das instalações físicas dos serviços de saúde. Mas, não deverá a decisão de assumir esse risco ser alvo do arbítrio livre, informado e esclarecido do doente? A diminuição da atividade assistencial presencial motivou a incorporação de outras ferramentas de comunicação como telefone, correio eletrónico e videochamada. Poderá o paciente realmente decidir sobre a forma como prefere ser consultado, ou estaremos nós a impor o modelo de consulta? Nos últimos meses ocorreram mudanças profundas na forma de trabalho em Saúde, que permanecerão. Não existirão, contudo, princípios éticos da biomedicina, que deverão sempre prevalecer?

Abstract Coronavirus disease 2019 made us question daily practices, such as the simple handshake. It also raised some ethical and legal issues. Are the ethical principles, that should guide the provision of individualized care, being fulfilled? Will we, as health professionals, be able to provide patients with instruments so that they can fully exercise their autonomy? The guarantee of necessary security solutions, to reduce the risk of contagion in the provision of care, safeguards the principle of non-maleficence. However, the risk of contagion is impossible to completely eliminate, and there is a residual risk associated with the use of physical facilities in healthcare services. But, shouldn't the decision to take that risk be the subject of the patient's free and informed will? The incorporation of telemedicine platforms is ideal for managing several challenges posed by COVID-19, such as the decrease in face-to-face health care assistance. Can the patient really decide how he prefers to be consulted, or are we imposing the consultation model? There have been profound changes in healthcare systems. However, one must remember that there are ethical principles of biomedicine, that should always prevail?

Monozygotic Twins Concordant for Common Variable Immunodeficiency: Strikingly Similar Clinical and Immune Profile Associated With a Polygenic Burden.

Monozygotic twins provide a unique opportunity to better understand complex genetic diseases and the relative contribution of heritable factors in shaping the immune system throughout life. Common Variable Immunodeficiency Disorders (CVID) are primary antibody defects displaying wide phenotypic and genetic heterogeneity, with monogenic transmission accounting for only a minority of the cases. Here, we report a pair of monozygotic twins concordant for CVID without a family history of primary immunodeficiency. They featured a remarkably similar profile of clinical manifestations and immunological alterations at diagnosis (established at age 37) and along the subsequent 15 years of follow-up. Interestingly, whole-exome sequencing failed to identify a monogenic cause for CVID, but unraveled a combination of heterozygous variants, with a predicted deleterious impact. These variants were found in genes involved in relevant immunological pathways, such as JUN, PTPRC, TLR1, ICAM1, and JAK3. The potential for combinatorial effects translating into the observed disease phenotype is inferred from their roles in immune pathways, namely in T and B cell activation. The combination of these genetic variants is also likely to impose a significant constraint on environmental influences, resulting in a similar immunological phenotype in both twins, despite exposure to different living conditions. Overall, these cases stress the importance of integrating NGS data with clinical and immunological phenotypes at the single-cell level, as provided by multi-dimensional flow-cytometry, in order to understand the complex genetic landscape underlying the vast majority of patients with CVID, as well as those with other immunodeficiencies.

Brazilian consensus on Duchenne muscular dystrophy. Part 2: rehabilitation and systemic care.

Significant advances in the understanding and management of Duchenne muscular dystrophy (DMD) have occurred since the publication of international guidelines for DMD care in 2010. Our objective was to provide an evidence-based national consensus statement for multidisciplinary care of DMD in Brazil. A combination of the Delphi technique with a systematic review of studies from 2010 to 2016 was employed to classify evidence levels and grade of recommendations for the guideline. Our recommendations were divided in two parts. Guideline methodology and overall disease concept descriptions are found in Part 1. Here we present Part 2, where we provide the results and recommendations on rehabilitation and systemic care for DMD.

Brazilian consensus on Duchenne muscular dystrophy. Part 2: rehabilitation and systemic care / Consenso brasileiro para distrofia muscular de Duchenne. Parte 2: reabilitação e cuidados sistêmicos

ABSTRACT Significant advances in the understanding and management of Duchenne muscular dystrophy (DMD) have occurred since the publication of international guidelines for DMD care in 2010. Our objective was to provide an evidence-based national consensus statement for multidisciplinary care of DMD in Brazil. A combination of the Delphi technique with a systematic review of studies from 2010 to 2016 was employed to classify evidence levels and grade of recommendations for the guideline. Our recommendations were divided in two parts. Guideline methodology and overall disease concept descriptions are found in Part 1. Here we present Part 2, where we provide the results and recommendations on rehabilitation and systemic care for DMD.

RESUMO Avanços significativos na compreensão e no manejo da Distrofia Muscular de Duchenne (DMD) ocorreram desde a publicação de diretrizes internacionais para o cuidado destes pacientes em 2010. Nosso objetivo foi elaborar um consenso nacional baseado em evidências para o cuidado multidisciplinar dos pacientes com DMD no Brasil. Utilizamos uma combinação da técnica de Delphi com uma revisão sistemática da literatura de 2010 a 2016 para classificarmos os níveis de evidência e graus de recomendação para o consenso. Nossas recomendações foram divididas em duas partes. A metodologia utilizada na elaboração do consenso e conceitos gerais da doença encontram-se na parte 1. Neste artigo fornecemos os resultados e recomendações sobre reabilitação e cuidados sistêmicos para DMD.

Atypical Squamous Cells: Cytopathological Findings and Correlation with HPV Genotype and Histopathology.

OBJECTIVE: We aimed to assess potential associations between atypical squamous cell (ASC) subgroups: ASC-US (undetermined significance) and ASC-H (cannot exclude high-grade squamous intraepithelial lesion), regarding cytomorphological features, high-risk (HR) human papillomavirus (HPV) testing, and histological outcomes in a sample of Brazilian women. STUDY DESIGN: Cross-sectional study which evaluated 1,346 liquid-based cytologies between January 2010 and July 2016 with ASC results. ASC-US and ASC-H were analyzed for frequency, diagnostic criteria, and cytological findings and compared with HR-HPV tests and histological outcomes. RESULTS: Enlarged nucleus was the most frequent ASC-US criterion, but alternative criteria were present in 20% of the total cases. No ASC-US criteria were associated with histological outcomes or HR-HPV positivity. Parakeratosis, corneal pearl, giant cells, and binucleation were strongly associated with ASC-US while hyperkeratosis was associated with high-grade squamous intraepithelial lesions (HSIL) or a superior outcome. HR-HPV was positive in 64.39% of ASC-US and 65.38% of ASC-H. HSIL or superior outcomes also occurred in 13.33% of ASC-US and 64.71% of ASC-H cases. CONCLUSION: Alternative criteria for ASC-US were relatively frequent. Reactive cellular changes suggestive of atypias were more abundant in ASC-US. Although ASC-H is associated with worse histological outcomes, no differences in HPV positivity were found in comparison to ASC-US.

Qualidade do sono de adolescentes que trabalham e não praticam atividade física / Sleep quality of working and sedentary adolescents

[{"text": "Introdução: O sono é uma necessidade fisiológica que, entre suas funções, busca restaurar as condições\r\nfísica e psicológica do organismo desgastadas durante o estado de vigília. Um sono de boa qualidade está\r\ndiretamente ligado ao desenvolvimento saudável, especialmente dos adolescentes. Objetivo: O objetivo deste\r\nestudo foi analisar as associações entre a qualidade do sono com a situação ocupacional e a atividade física em\r\nadolescentes do Amazonas. Método: Trata-se de um estudo epidemiológico, transversal, de base escolar, conduzido\r\nem 2.517 adolescentes (1.411 moças e 1.106 rapazes), com média de idade de 16,6 (DP = 1,2) anos, de escolas\r\npúblicas do Amazonas. Os adolescentes responderam a um questionário autopreenchível contendo informações sobre\r\na qualidade do sono (variável dependente), variáveis sociodemográficas (sexo, faixa etária, turno escolar e renda\r\nfamiliar), situação ocupacional e atividade física. A associação entre a situação ocupacional e atividade física com\r\na qualidade do sono foi testada por meio de regressão logística binária. A análise foi ajustada por todas as variáveis,\r\nmais as sociodemográficas. Resultados: A prevalência de baixa qualidade do sono foi de 20,3%. Os adolescentes que\r\ntrabalhavam tiveram 69% mais chances de terem baixa qualidade do sono, e os que eram inativos fisicamente, 66%,\r\nquando comparados com seus respectivos pares que não trabalhavam e eram ativos fisicamente. Conclusão: Dois\r\nem cada dez adolescentes apresentaram baixa qualidade do sono. O desenvolvimento de intervenções e de políticas\r\npúblicas exequíveis voltadas à melhora da qualidade do sono em adolescentes deve considerar o exercício de\r\natividades ocupacionais e a inatividade física.", "_i": "pt"}, {"text": "Introduction: Sleep is a physiological need that restore the physical and psychological conditions worn\r\nduring the waking state. A good sleep quality is directly linked to the healthy development, especially for adolescents.\r\nObjective: This study aimed to analyze the associations between sleep quality with occupational status and physical\r\nactivity of adolescents from Amazonas. Method: This is a cross-sectional, school-based epidemiological study\r\nconducted with 2,517 adolescents (1,411 girls and 1,106 boys) with a mean age of 16.6 (SD= 1.2) years, from\r\npublic schools in Amazonas. The adolescents answered a self-administered questionnaire containing information\r\non sleep quality (dependent variable), gender, age group, scholar shift, family income, occupational status and\r\nphysical activity. The association between the exploratory variables and the sleep quality was verified by means\r\nof binary logistic regression. The analysis was adjusted by all variables, including sociodemographic variables.\r\nResults: The prevalence of low sleep quality was 20.3%. Working adolescents were 69.0% more likely to have poor\r\nsleep quality, and those who were physically inactive had a 66.0% chance when compared to their respective peers\r\nwho did not work and were physically active. Conclusion: Two out of ten adolescents presented poor sleep quality.\r\nThe development of feasible interventions and public policies aimed at improving the sleep quality in adolescents\r\nshould consider the occupational activities and physical inactivity.", "_i": "en"}]