Implementing Standard Diagnosis and Treatment for Locally Advanced Breast Cancer Through Global Research in Latin America: Results From a Multicountry Pragmatic Trial.

PURPOSE: Breast cancer mortality rates in Latin America (LA) are higher than those in the United States, possibly because of advanced disease presentation, health care disparities, or unfavorable molecular subtypes. The Latin American Cancer Research Network was established to address these challenges and to promote collaborative clinical research. The Molecular Profiling of Breast Cancer Study (MPBCS) aimed to evaluate the clinical characteristics and treatment outcomes of LA participants with locally advanced breast cancer (LABC). PATIENTS AND METHODS: The MPBCS enrolled 1,449 participants from Argentina, Brazil, Chile, Mexico, and Uruguay. Through harmonized procedures and quality assurance measures, this study evaluated clinicopathologic characteristics, neoadjuvant chemotherapy response, and survival outcomes according to residual cancer burden (RCB) and the type of surgery. RESULTS: Overall, 711 and 480 participants in the primary surgery and neoadjuvant arms, respectively, completed the 5-year follow-up period. Overall survival was independently associated with RCB (worse survival for RCBIII-adjusted hazard ratio, 8.19, P < .001, and RCBII [adjusted hazard ratio, 3.69, P < .008] compared with RCB0 [pathologic complete response or pCR]) and type of surgery (worse survival in mastectomy than in breast-conserving surgery [BCS], adjusted hazard ratio, 2.97, P = .001). The hormone receptor-negative-human epidermal growth factor receptor 2-positive group had the highest proportion of pCR (48.9%). The analysis of the ASCO Quality Oncology Practice Initiative breast module revealed high compliance with pathologic standards but lower adherence to treatment administration standards. Notably, compliance with trastuzumab administration varied widely among countries (33.3%-88.7%). CONCLUSION: In LABC, we demonstrated the survival benefit of BCS and the prognostic effect of the response to available neoadjuvant treatments despite an important variability in access to key treatments. The MPBCS represents a significant step forward in understanding the real-world implementation of oncologic procedures in LA.

Desafios e possibilidades da jurimetria na judicialização em saúde: uma investigação em Minas Gerais do período 2014 a 2020 / Challenges and possibilities of jurimetry in health judicialization: an investigation in Minas Gerais state from 2014 2020 / Desafíos y posibilidades de la jurimetría en la judicialización de la salud: una investigación en Minas Gerais de 2014 a 2020

Objetivo: analisar os processos de saúde, de medicamentos e de medicamentos antineoplásicos em Minas Gerais, em 2014 a 2020, a partir da comparação de diferentes bases de dados. Metodologia: foram utilizadas técnicas de pareamento de bases de dados entre os processos existentes no Tribunal de Justiça do Estado de Minas Gerais e os processos recebidos pela Secretaria Estadual de Saúde de Minas Gerais, descreveram-se as dificuldades encontradas na identificação e quantificação desses processos, e os resultados encontrados foram comparados com informações provenientes de outras fontes. Resultados: nas bases do Tribunal de Justiça de Minas Gerais foram identificados 564.763 processos de saúde. Houve um aumento significativo do número de processos até 2017 e uma estabilização, em patamares altos, a partir de 2017. Ao comparar com os resultados obtidos pelo Instituto Superior de Ensino e Pesquisa e pelo Laboratório de Inovação, Inteligência e Objetivos de Desenvolvimento Sustentável, houve uma importante divergência nos números de processos. Tomando como exemplo a judicialização de saúde contra o estado de Minas Gerais, não foi possível encontrar de forma direta todos os processos recebidos pela Secretaria Estadual de Saúde de Minas Gerais nas diversas bases fornecidas pelo Tribunal de Justiça de Minas Gerais, tendo sido necessária uma integração entre as diferentes bases de dados e uma busca adicional para identificar todos os processos. Conclusão: recomendam-se a padronização e organização dos dados dos processos judiciais em saúde, já na entrada de dados, para facilitar a realização de estudos quantitativos sobre a judicialização da saúde.

Objective: to analyze the health, drug, and antineoplastic drug lawsuits in Minas Gerais, in 2014 to 2020, from the comparison of different databases. Methodology: database pairing techniques were used to link lawsuits from the Minas Gerais State Court of Justice with the processes received by the Minas Gerais Health State Department, the difficulties encountered in identifying and quantifying these processes were described, and the results found were compared with information from other sources. Results: in the Minas Gerais State Court of Justice databases, 564,763 health lawsuits were identified in the studied period. There was a significant increase in the number of processes until 2017 and a stabilization, at high levels, from 2017 onwards. In comparison with the results obtained by the Institute of Higher Education and Research and the Laboratory of Innovation, Intelligence and Sustainable Development Goals there was a great divergence in the number of processes found. Conclusion: taking the health judicialization against Minas Gerais state as an example, it was not possible to directly find all the processes received by Minas Gerais Health State Department in the various databases provided by the Minas Gerais State Court of Justice, requiring integration between the different databases and an additional search to identify all processes.

Objetivo: analizar los juicios de salud, drogas y medicamentos antineoplásicos en Minas Gerais, en 2014 a 2020, a partir de la comparación de diferentes bases de datos. Metodología: técnicas de emparejamiento de bases de datos fueron utilizadas para vincular los juicios existentes en el Tribunal de Justicia del Estado de Minas Gerais con los procesos recibidos por la Secretaría de Estado de Salud de Minas Gerais, las dificultades encontradas en la identificación y cuantificación de esos procesos fueron descritas, y los resultados encontrados fueron comparados con informaciones de otras fuentes. Resultados: en las bases del Tribunal de Justicia del Estado de Minas Gerais se identificaron 564.763 procesos de salud. Hubo un aumento significativo en el número de procesos hasta 2017 y una estabilización, en niveles altos, a partir de 2017. Sin embargo, al comparar con los resultados obtenidos por el Instituto Superior de Educación e Investigación y por el Laboratorio de Innovación, Inteligencia y Objetivos de Desarrollo Sostenible hubo una divergencia importante en el número de procesos. Conclusión: tomando como ejemplo la judicialización de la salud contra el estado de Minas Gerais, no era posible encontrar directamente todos los procesos recibidos por la Secretaría de Estado de Salud de Minas Gerais en las diversas bases de datos proporcionadas por el Tribunal de Justicia del Estado de Minas Gerais, lo que requería una integración entre las diferentes bases de datos y una búsqueda adicional a identificar todos los procesos.

Utilidad de la consulta electrónica entre los centros de atención primaria y el Servicio de Reumatología de un hospital terciario / Usefulness of an electronic consultation system between primary care health centres and the rheumatology department of a tertiary hospital

Introducción y objetivo: Las enfermedades reumáticas representan casi el 30% de las consultas atendidas en los centros de atención primaria españoles. El objetivo principal fue analizar la demanda de consultas reumatológicas desde atención primaria y su resolución mediante el sistema de consulta electrónica. Pacientes y métodos: Estudio descriptivo retrospectivo de las consultas electrónicas procedentes de los centros de atención primaria del área sanitaria al Servicio de Reumatología de un hospital terciario, entre los meses de julio de 2020 y mayo de 2021. Resultados: Se recogieron las últimas 500 consultas consecutivas. La media de edad de los pacientes fue 59 años; el 74% eran mujeres. Los principales motivos de consulta fueron la osteoporosis y el tratamiento de pacientes en seguimiento por el servicio por artritis reumatoide y espondiloartritis. El tiempo medio de respuesta fue de dos días; el 57% necesitaron ser citados en consulta externa. Discusión: La consulta electrónica permitió resolver, en una media de dos días, las consultas del 42,6% de los pacientes.(AU)

Background and objective: Rheumatic diseases account for almost 30% of consultations attended in Spanish primary care centres. The main objective was to analyse the demand for rheumatology consultations from Primary Care and their resolution using the electronic consultation system. Patients and methods: Retrospective descriptive study of electronic consultations from primary care centres in the health area to the Rheumatology service of a tertiary hospital, between July 2020 and May 2021. Results: The last 500 consecutive consultations were collected. Mean age of patients was 59.5 years; 74.2% were women. Main reasons for consultation were osteoporosis and treatment of patients with rheumatoid arthritis and spondyloarthritis under follow-up by the department. Mean response time was 2 days. Fifty-seven per cent of patients required outpatient appointments. Discussion: Over 40% of queries were resolved thanks to the electronic consultation system in an average of 2 days, otherwise patients would have been referred to specialized care.(AU)

Positive Effect of Green Photo-Selective Filter on Graft Union Formation in Tomatoes.

This study investigated the effects of green and red photo-selective filters (shade nets) on the process of graft union formation (healing and acclimation) in grafted tomato plants. The research evaluated oxidative stress, physiological characteristics, and anatomical development of graft unions. Plants were subjected to green-netting, red-netting, and no-netting treatments for 28 days, starting 4 days after grafting. Markers of oxidative stress, including reactive oxygen species (ROS), superoxide dismutase (SOD), peroxidase (POD), and malondialdehyde (MDA), as well as protein concentration of SOD/POD enzyme-enriched extracts, were quantified. The anatomical development of the graft unions was examined using microscopy. The results demonstrated that the red and green photo-selective filters increased ROS production by 5% and 4% after 3 days of exposure, by 58% and 14% after 7 days, and by 30% and 13% after 14 days in comparison to the control treatment. The increase in ROS activates the defense mechanism, enhancing the activity of SOD and POD enzymes. In terms of anatomy, the green netting resulted in enhanced cell proliferation and early differentiation of vascular tissue cells. Notably, at the 28-day mark, when the plants were ready for transplanting, the green-net treatment showed a reduction in lipid peroxidation damage and increases of 20% and 54% in dry weight compared with the control and red-net treatments, respectively. Finally, our results suggest that the use of a green photo-selective filter has a positive effect on oxidative stress, anatomical development, and overall growth of grafted tomato plants during the process of graft union formation.

Genistein Suppresses IL-6 and MMP-13 to Attenuate Osteoarthritis in Obese Diabetic Mice.

Type 2 diabetes mellitus and osteoarthritis (OA) often present as comorbidities. We examined the role of plasma IL-6, chondrocyte MMP-13, and col10a expression in the development of OA in obese diabetic mice. We further investigated dietary genistein and exercise training as potential mitigators of OA. One hundred adult mice (50 females, 50 males) aged 6 weeks were randomized into 5 groups, including lean controls, obese diabetic controls, and obese diabetic mice treated with genistein, exercise training, and genistein plus exercise training. The obese diabetic state was induced by feeding the mice a high-fat, high-sugar diet. Genistein was incorporated into the diet at a concentration of 600 mg genistein/kg. Exercise training was performed on a treadmill and consisted of daily 30 min sessions at 12 m/min, 5 days/week for a 12-week period. After treatment, plasma was collected, and proximal tibias were removed for analysis. Plasma IL-6 and MMP-13 were elevated while col10a was reduced in obese diabetic mice in comparison to lean controls. Dietary genistein treatment reduced IL-6 and MMP-13 expression and increased col10a expression. Histological examination of articular cartilage showed reduced thickness of the uncalcified zones and proteoglycan content in the cartilage of diabetic mice in comparison to mice fed genistein. Exercise training had no significant effect. In conclusion, genistein (and not exercise training) attenuates OA by reducing IL-6 and MMP-13 expression in diabetic mice.

Evaluating the potential of (epi)genotype-by-low pass nanopore sequencing in dairy cattle: a study on direct genomic value and methylation analysis.

BACKGROUND: Genotype-by-sequencing has been proposed as an alternative to SNP genotyping arrays in genomic selection to obtain a high density of markers along the genome. It requires a low sequencing depth to be cost effective, which may increase the error at the genotype assigment. Third generation nanopore sequencing technology offers low cost sequencing and the possibility to detect genome methylation, which provides added value to genotype-by-sequencing. The aim of this study was to evaluate the performance of genotype-by-low pass nanopore sequencing for estimating the direct genomic value in dairy cattle, and the possibility to obtain methylation marks simultaneously. RESULTS: Latest nanopore chemistry (LSK14 and Q20) achieved a modal base calling accuracy of 99.55%, whereas previous kit (LSK109) achieved slightly lower accuracy (99.1%). The direct genomic value accuracy from genotype-by-low pass sequencing ranged between 0.79 and 0.99, depending on the trait (milk, fat or protein yield), with a sequencing depth as low as 2 × and using the latest chemistry (LSK114). Lower sequencing depth led to biased estimates, yet with high rank correlations. The LSK109 and Q20 achieved lower accuracies (0.57-0.93). More than one million high reliable methylated sites were obtained, even at low sequencing depth, located mainly in distal intergenic (87%) and promoter (5%) regions. CONCLUSIONS: This study showed that the latest nanopore technology in useful in a LowPass sequencing framework to estimate direct genomic values with high reliability. It may provide advantages in populations with no available SNP chip, or when a large density of markers with a wide range of allele frequencies is needed. In addition, low pass sequencing provided nucleotide methylation status of > 1 million nucleotides at ≥ 10 × , which is an added value for epigenetic studies.

Usefulness of an electronic consultation system between primary care health centres and the rheumatology department of a tertiary hospital.

BACKGROUND AND OBJECTIVE: Rheumatic diseases account for almost 30% of consultations attended in Spanish primary care centres. The main objective was to analyse the demand for rheumatology consultations from Primary Care and their resolution using the electronic consultation system. PATIENTS AND METHODS: Retrospective descriptive study of electronic consultations from primary care centres in the health area to the Rheumatology service of a tertiary hospital, between July 2020 and May 2021. RESULTS: The last 500 consecutive consultations were collected. Mean age of patients was 59.5 years; 74.2% were women. Main reasons for consultation were osteoporosis and treatment of patients with rheumatoid arthritis and spondyloarthritis under follow-up by the department. Mean response time was 2 days. Fifty-seven per cent of patients required outpatient appointments. DISCUSSION: Over 40% of queries were resolved thanks to the electronic consultation system in an average of 2 days, otherwise patients would have been referred to specialized care.

Palliative Care Needs of Families of Adults With Advanced Cancer.

Diagnosis and treatment of a terminal illness can significantly impact patients and their families, as well as their functionality and daily routines. This study aimed to understand the palliative care needs of a group of families with an adult relative with advanced cancer receiving palliative care. A qualitative approach was used to conduct a content analysis. Fourteen semistructured interviews were carried out with family members in Cundinamarca (Colombia) between March and April 2022. The information was analyzed by coding and categorizing the emerging themes using NVivo. Three main categories emerged: the diagnosis' harsh surprise, the family's coping with the disease, and the palliative care needs of families. Identifying the resources available to families to care for relatives with advanced cancer can facilitate the work of palliative care teams. It is necessary to prevent the family from giving up on caring, which can result from exhaustion due to various causes. Families who have an adult relative with advanced cancer in palliative care face significant challenges. Their situation involves accepting the diagnosis, changing family routines, dealing with the disease and the health care system, and coping with circumstances that create needs of different kinds.

Tunable hybrid zeolites prepared by partial interconversion.

Zeolite interconversion is a widely used strategy due to its unique advantages in the synthesis of some zeolites. By using a long-chain quaternary amine as both a structure-directing agent and porogen, we have produced superior catalysts, which we named Hybrid Zeolites, as their structures are made of building units of different zeolite types. The properties of these materials can be conveniently tuned, and their catalytic performance can be optimized simply by stopping the interconversion at different times. For cracking the 1,3,5-triisopropylbenzene, Hybrid Zeolites made of FAU and MFI units show a 5-fold increase in selectivity towards the desired product, that is, 1,3-diisopropylbenzene, compared to the commercial FAU, and a 7-fold increase in conversion at constant selectivity compared to MFI zeolite.

Health litigation and cancer survival in patients treated in the public health system in a large Brazilian city, 2014-2019.

BACKGROUND: Litigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access health services. The study aimed to evaluate whether cancer patients in Belo Horizonte, Minas Gerais, Brazil, increased their overall survival by increasing access to certain drugs or treatments through litigation, controlling for the effect of demographic and disease-related variables. METHODS: A retrospective cohort study was conducted. Patients with breast, prostate, brain, lung, or colon cancers from 2014 to 2019 were included. Survival analysis was performed using the Cox proportional hazards model. RESULTS: In the multivariate analysis, litigation was significantly associated with increased survival in cancers of breast (HR = 0.51, 95%CI 0.33-0.80), prostate (HR = 0.50, 95%CI 0.30-0.85), colon (HR = 0.59, 95%CI 0.38-0.93), and lung (HR = 0.36, 95%CI 0.22-0.60). Five-year survival rates of patients who sued for treatment were 97.8%, 88.7%, 59.3%, and 26.0%, compared to median survival of 95.7%, 78.7%, 41.2%, and 2.4%, respectively, among patient that did not resort to court action. The study suggests that litigation for access to cancer treatment may represent a step forward in obtaining more effective treatment. This study´s main limitations are the lack of patients´ clinical information for use as control variables and the lack of variables to assess patients´ quality of life. The study also found that many cases involved claims that could have been solved by administrative rather than legal action. Some claims thus reflect the lack of adequate administrative procedures. CONCLUSION: When based on scientific evidence, access to new therapies, combined with other technologies already available, can favor patient survival. Access to new therapies through litigation may increase health inequalities since low-income patients have limited access to legal recourse against the State to meet their needs. The timely approval of new effective therapies can mitigate the judicialization of cancer treatment.

Argentine consensus recommendations for lung cancer screening programmes: a RAND/UCLA-modified Delphi study.

BACKGROUND: Lung cancer (LC) screening improves LC survival; the best screening method in terms of improving survival is low-dose CT (LDCT), outpacing chest X-ray and sputum cytology. METHODS: A consensus of experts in Argentina was carried out to review the literature and generate recommendations for LC screening programmes. A mixed-method study was used with three phases: (1) review of the literature; (2) modified Delphi consensus panel; and (3) development of the recommendations. The Evidence to Decision (EtD) framework was used to generate 13 evaluation criteria. Nineteen experts participated in four voting rounds. Consensus among participants was defined using the RAND/UCLA method. RESULTS: A total of 16 recommendations scored ≥7 points with no disagreement on any criteria. Screening for LC should be performed with LDCT annually in the population at high-risk, aged between 55 and 74 years, regardless of sex, without comorbidities with a risk of death higher than the risk of death from LC, smoking ≥30 pack-years or former smokers who quit smoking within 15 years. Screening will be considered positive when finding a solid nodule ≥6 mm in diameter (or ≥113 mm3) on baseline LDCT and 4 mm in diameter if a new nodule is identified on annual screening. A smoking cessation programme should be offered, and cardiovascular risk assessment should be performed. Institutions should have a multidisciplinary committee, have protocols for the management of symptomatic patients not included in the programme and distribute educational material. CONCLUSION: The recommendations provide a basis for minimum requirements from which local institutions can develop their own protocols adapted to their needs and resources.

Influence of socioeconomic inequality on the distribution of COVID-19 hospitalizations and deaths in Brazilian municipalities, 2020: an ecological study. / Influência da desigualdade socioeconômica na distribuição das internações e dos óbitos por covid-19 em municípios brasileiros, 2020: um estudo ecológico.

OBJECTIVE: to analyze the influence of socioeconomic inequality on COVID-19 distribution in larger Brazilian municipalities, controlling for effect of hospital infrastructure, comorbidities and other variables. METHODS: this was an ecological study of COVID-19 hospitalizations and deaths in 2020; outcome data were obtained from the Ministry of Health; incidence ratios were estimated using a generalized linear model. RESULTS: we identified 291,073 hospitalizations and 139,953 deaths; we found higher mortality rates in municipalities with a higher proportion of non-White people (95%CI 1.01;1.16) and with more households with more than two people per room (95%CI 1.01;1.13); presence of sewerage systems was protective for both outcomes (hospitalizations: 95%CI 0.87;0.99 - deaths: 95%CI 0.90;0.99), while a higher proportion of the population in subnormal housing clusters was a risk factor (hospitalizations: 95%CI 1.01;1.16 - deaths: 95%CI 1.09;1.21), with this variable interacting with the proportion of people receiving Emergency Aid (hospitalizations: 95%CI 0.88;1.00 - deaths: 95%CI 0.89;0.98). CONCLUSION: socioeconomic conditions affected illness and death due to COVID-19 in Brazil.

Influence of socioeconomic inequality on the distribution of hospitalizations and deaths from COVID-19 in Brazilian municipalities, 2020: an ecological study / Influencia de la desigualdad socioeconómica en la distribución de hospitalizaciones y muertes por COVID-19 en municipios brasileños, 2020: un estudio ecológico / Influência da desigualdade socioeconômica na distribuição das internações e dos óbitos por covid-19 em municípios brasileiros, 2020: um estudo ecológico

Objective: to analyze the influence of socioeconomic inequality on COVID-19 distribution in Brazilian municipalities, controlling for effect of hospital infrastructure, comorbidities, and other variables. Methods: ecological study on hospitalizations and deaths from Covid-19 in 2020; outcome data obtained from Ministry of Health. Incidence ratio estimated via a generalized linear model with negative binomial distribution. Results: 291,073 hospitalizations and 139,953 deaths were identified; higher mortality rate in municipalities with highest proportion of non-white population (95%CI 1.01;1.16) and with more households with more than two people per room (95%CI 1.01;1.13); presence of sanitary sewage was protective (hospitalizations: 95%CI 0.87;0.99 ­ deaths: 95%CI 0.90;0.99) and higher proportion of population in subnormal agglomerations was a risk factor (hospitalizations: 95%CI 1.01;1.16 ­ deaths: 95%CI 1.09;1.21), with this variable interacting with the proportion of people with emergency assistance (hospitalizations: 95%CI 0.88;1.00 ­ deaths: 95%CI 0.89;0.98). Conclusion: Socioeconomic conditions affected illness and death from COVID-19 in Brazil

Objetivo: analizar influencia de desigualdad socioeconómica en distribución de COVID-19 en municipios brasileños, controlando por infraestructura hospitalaria, comorbilidades y otras variables. Métodos: estudio ecológico sobre hospitalizaciones y muertes por COVID-19 en 2020; datos de resultado del Ministerio de Salud; razón de incidencia estimada a través de modelo lineal generalizado con distribución binomial negativa. Resultados: 291.073 hospitalizaciones y 139.953 defunciones; mayor tasa de mortalidad en municipios con mayor proporción de población no blanca (IC95% 1,01;1,16) y con más hogares con más de dos personas por habitación (IC95% 1,01;1,13); alcantarillado sanitario resultó protector (hospitalizaciones: IC95% 0,87;0,99 ­ muertes: IC95% 0,90;0,99) y mayor proporción de población en aglomeraciones subnormales fue factor de riesgo (hospitalizaciones: IC95% 1,01;1,16 ­ muertes: IC95% 1,09;1,21), interactuando con proporción de personas con asistencia de emergencia (hospitalizaciones IC95% 0,88;1,00, defunciones IC95% 0,89;0,98). Conclusión: Condiciones socioeconómicas afectaron enfermedad y muerte por COVID-19.

Objetivo: analisar a influência da desigualdade socioeconômica na distribuição da covid-19 nos maiores municípios brasileiros (> 100 mil habitantes), controlando, pelo efeito da infraestrutura hospitalar, comorbidades e outras variáveis. Métodos: estudo ecológico sobre internações e óbitos por covid-19 em 2020; dados de desfecho obtidos do Ministério da Saúde; a razão de incidência foi estimada via modelo linear generalizado. Resultados: identificados 291.073 internações e 139.953 óbitos; encontrou-se maior taxa de mortalidade nos municípios com maior população não branca (IC95% 1,01;1,16) e nos domicílios com mais de duas pessoas por cômodo (IC95% 1,01;1,13); para ambos desfechos, esgotamento sanitário foi protetivo(internações: IC95% 0,87;0,99 ­ óbitos: IC95% 0,90;0,99), e população em aglomerados subnormais revelou-se fator de risco (internações: IC95% 1,01;1,16 ­ óbitos: IC95% 1,09;1,21) com interação, com a proporção de pessoas a receber auxílio emergencial (internações: IC95%0,88;1,00 ­ óbitos: IC95% 0,89;0,98). Conclusão: condições socioeconômicas afetaram o adoecimento e morte por covid-19 no Brasil.

Influência da desigualdade socioeconômica na distribuição das internações e dos óbitos por covid-19 em municípios brasileiros, 2020: um estudo ecológico / Influencia de la desigualdad socioeconómica en la distribución de hospitalizaciones y muertes por COVID-19 en municipios brasileños, 2020: un estudio ecológico / Influence of socioeconomic inequality on the distribution of COVID-19 hospitalizations and deaths in Brazilian municipalities, 2020: an ecological study

Objetivo analisar a influência da desigualdade socioeconômica na distribuição da covid-19 nos maiores municípios brasileiros (> 100 mil habitantes), controlando, pelo efeito da infraestrutura hospitalar, comorbidades e outras variáveis. Métodos estudo ecológico sobre internações e óbitos por covid-19 em 2020; dados de desfecho obtidos do Ministério da Saúde; a razão de incidência foi estimada via modelo linear generalizado. Resultados identificados 291.073 internações e 139.953 óbitos; encontrou-se maior taxa de mortalidade nos municípios com maior população não branca (IC95% 1,01;1,16) e nos domicílios com mais de duas pessoas por cômodo (IC95% 1,01;1,13); para ambos os desfechos, esgotamento sanitário foi protetivo (internações: IC95% 0,87;0,99 - óbitos: IC95% 0,90;0,99), e população em aglomerados subnormais revelou-se fator de risco (internações: IC95% 1,01;1,16 - óbitos: IC95% 1,09;1,21) com interação, com a proporção de pessoas a receber auxílio emergencial (internações: IC95% 0,88;1,00 - óbitos: IC95% 0,89;0,98). Conclusão condições socioeconômicas afetaram o adoecimento e morte por covid-19 no Brasil.

Objetivo: analizar la influencia de la desigualdad socioeconómica en la distribución de COVID-19 en los mayores municipios brasileños (> 100 mil habitantes), controlando, por la infraestructura hospitalaria, comorbilidades y otras variables. Métodos: estudio ecológico sobre hospitalizaciones y muertes por COVID-19 en 2020; datos del resultado fueran obtenidos del Ministerio de Salud; razón de incidencia estimada a través del modelo lineal generalizado. Resultados: 291.073 hospitalizaciones y 139.953 muertes; mayor tasa de mortalidad en municipios con mayor proporción de población no blanca (IC95% 1,01;1,16) y con más hogares con más de dos personas por habitación (IC95% 1,01;1,13); el alcantarillado sanitario resultó protector (hospitalizaciones: IC95% 0,87;0,99 - muertes: IC95% 0,90;0,99) y la mayor proporción de población en aglomeraciones subnormales fue un factor de riesgo (hospitalizaciones: IC95% 1,01;1,16 - muertes: IC95% 1,09;1,21), interactuando con proporción de personas con asistencia de emergencia (hospitalizaciones IC95% 0,88;1,00, defunciones IC95% 0,89;0,98). Conclusión: las condiciones socioeconómicas afectaron la enfermedad y la muerte por COVID-19.

Objective: to analyze the influence of socioeconomic inequality on COVID-19 istribution in larger Brazilian municipalities, controlling for effect of hospital infrastructure, comorbidities and other variables. Methods: this was an ecological study of COVID-19 hospitalizations and deaths in 2020; outcome data were obtained from the Ministry of Health; incidence ratios were estimated using a generalized linear model. Results: we identified 291,073 hospitalizations and 139,953 deaths; we found higher mortality rates in municipalities with a higher proportion of non-White people (95%CI 1.01;1.16) and with more households with more than two people per room (95%CI 1.01;1.13); presence of sewerage systems was protective for both outcomes (hospitalizations: 95%CI 0.87;0.99 - deaths: 95%CI 0.90;0.99), while a higher proportion of the population in subnormal housing clusters was a risk factor (hospitalizations: 95%CI 1.01;1.16 - deaths: 95%CI 1.09;1.21), with this variable interacting with the proportion of people receiving Emergency Aid (hospitalizations: 95%CI 0.88;1.00 - deaths: 95%CI 0.89;0.98). Conclusion: socioeconomic conditions affected illness and death due to COVID-19 in Brazil.

Effects of LED Light Spectra on the Development, Phytochemical Profile, and Antioxidant Activity of Curcuma longa from Easter Island.

Curcuma longa (C. longa), an herbaceous plant used for medicinal purposes by the indigenous people of Easter Island, has been overexploited in its natural habitat, leading to its conservation status being designated as a vulnerable species. We have recently reported on the use of light-emitting diodes (LEDs) to improve the productivity of C. longa in vitro cultures under a temporary immersion system (TIS), but the effects of light quality on plant growth, phytochemical composition, and antioxidant capacity remained unexplored. Here, we set out to study these three aspects as observed at the end of TIS culture (day 0) and after 30 days of greenhouse acclimation (day 30). Thus, we evaluated plant morphological characteristics, phytochemical profile (polyphenols, tannins, flavonoids, reducing sugars, and curcumin), and radical scavenging activity by DPPH, ORAC, and FRAP assays. The results showed that, during in vitro cultivation under TIS, the red:blue (RB) LED light spectrum promoted C. longa shoot proliferation, with the resulting seedlings exhibiting greater fresh weight and no signs of etiolation. In the acclimation phase, the RB spectrum increased phytochemicals, such as polyphenols, flavonoids, and reducing sugars, and boosted curcumin synthesis. Nevertheless, the antioxidant activity of the plants under the RB light spectrum did not intensify. We surmise that this may be due to the premature intraplant allocation of metabolites to alternative pathways (e.g., curcumin synthesis) under RB light.

Risk factors for hospitalization and death due to COVID-19 among frail community-dwelling elderly people: a retrospective cohort study

ABSTRACT BACKGROUND: Advanced age, multiple chronic diseases and frailty have been correlated with worse prognosis among coronavirus disease 2019 (COVID-19) inpatients. OBJECTIVE: To investigate potential risk factors for hospitalization and death due to COVID-19 among frail community-dwelling elderly people. DESIGN AND SETTING: Retrospective cohort study of patients followed up at a geriatric outpatient clinic in Belo Horizonte, Minas Gerais, Brazil. METHODS: The associations of demographic characteristics (age and sex) and clinical characteristics (frailty, multimorbidity, number of medications with long-term use, obesity, smoking, diabetes mellitus, pulmonary diseases, cardiovascular diseases, cerebrovascular disease, and chronic kidney disease) with the risk of hospitalization and death due to COVID-19 were explored using a multivariable logistic regression model. RESULTS: 5,295 patients (mean age 78.6 ± 9.4 years; 72.6% females) were included. After adjustments, the number of medications with long-term use was found to increase the odds of hospitalization due to COVID-19 (odds ratio, OR: 1.13; 95% confidence interval, CI: 1.06-1.22). Frailty, multimorbidity and diabetes mellitus also increased the odds of hospitalization (OR: 1.06, 95% CI: 1.02-1.09; OR: 1.17, 95% CI: 1.09-1.26; and OR: 2.27, 95% CI: 1.45-3.54, respectively) and the odds of death due to COVID-19 (OR: 1.07, 95% CI: 1.00-1.14; OR: 1.16, 95% CI: 1.03-1.32; and OR: 2.69, 95% CI: 1.79-6.14, respectively). CONCLUSIONS: Multimorbidity, frailty and diabetes mellitus increased the odds of hospitalization and death due to COVID-19 and the number of medications with long-term use increased the odds of hospitalization due to COVID-19 among frail community-dwelling elderly people.

Chemistry and Bioactivity of Microsorum scolopendria (Polypodiaceae): Antioxidant Effects on an Epithelial Damage Model.

Microsorum scolopendia (MS), which grows on the Chilean island of Rapa Nui, is a medicinal fern used to treat several diseases. Despite being widely used, this fern has not been deeply investigated. The aim of this study was to perform a characterization of the polyphenolic and flavonoid identity, radical scavenging, antimicrobial, and anti-inflammatory properties of MS rhizome and leaf extracts (RAE and HAE). The compound identity was analyzed through the reversed-phase high-performance liquid chromatography (RP-HPLC) method coupled with mass spectrometry. The radical scavenging and anti-inflammatory activities were evaluated for DPPH, ORAC, ROS formation, and COX inhibition activity assay. The antimicrobial properties were evaluated using an infection model on Human Dermal Fibroblast adult (HDFa) cell lines incubated with Staphylococcus aureus and Staphylococcus epidermidis. The most abundant compounds were phenolic acids between 46% to 57% in rhizome and leaf extracts, respectively; followed by flavonoids such as protocatechic acid 4-O-glucoside, cirsimaritin, and isoxanthohumol, among others. MS extract inhibited and disaggregated the biofilm bacterial formed and showed an anti-inflammatory selective property against COX-2 enzyme. RAE generated a 64% reduction of ROS formation in the presence of S. aureus and 87.35% less ROS in the presence of S. epidermidis on HDFa cells. MS has great therapeutic potential and possesses several biological properties that should be evaluated.

Micropropagation of Citronella mucronata D. Don, a Vulnerable Chilean Endemic Tree Species.

Citronella mucronata (C. mucronata), a tree species endemic to Chile, has become threatened in its natural habitat and is currently listed as vulnerable. Tree population parameters have deteriorated due to indiscriminate logging and other anthropogenic activities, warranting research on mass propagation as a means of recovery. This study, unprecedented for this native species, has developed a successful method for its micropropagation. The objective was to establish a protocol for in vitro propagation of C. mucronata to produce large quantities of high-quality seedlings in an accelerated plant acquisition process. The best results were achieved by growing explants on Murashige and Skoog (MS) basal culture medium supplemented with 4.44 µM 6-benzylaminopurine (BAP) and 14.76 µM indole-3-butyric acid (IBA). Explant survival rate was 78 %, the average shoot length reached 3.2 cm, the number of lateral shoots was 3.9, and rooting rate was 60%. Furthermore, stimulation with red and blue light in a 1:2 ratio, supplemented with 14.76 µM IBA, improved the rooting rate to 93%. The survival rate of rooted explants reached 100% in the acclimatization stage when using peat and perlite substrate (1:1 v/v).

Risk factors for hospitalization and death due to COVID-19 among frail community-dwelling elderly people: a retrospective cohort study.

BACKGROUND: Advanced age, multiple chronic diseases and frailty have been correlated with worse prognosis among coronavirus disease 2019 (COVID-19) inpatients. OBJECTIVE: To investigate potential risk factors for hospitalization and death due to COVID-19 among frail community-dwelling elderly people. DESIGN AND SETTING: Retrospective cohort study of patients followed up at a geriatric outpatient clinic in Belo Horizonte, Minas Gerais, Brazil. METHODS: The associations of demographic characteristics (age and sex) and clinical characteristics (frailty, multimorbidity, number of medications with long-term use, obesity, smoking, diabetes mellitus, pulmonary diseases, cardiovascular diseases, cerebrovascular disease, and chronic kidney disease) with the risk of hospitalization and death due to COVID-19 were explored using a multivariable logistic regression model. RESULTS: 5,295 patients (mean age 78.6 ± 9.4 years; 72.6% females) were included. After adjustments, the number of medications with long-term use was found to increase the odds of hospitalization due to COVID-19 (odds ratio, OR: 1.13; 95% confidence interval, CI: 1.06-1.22). Frailty, multimorbidity and diabetes mellitus also increased the odds of hospitalization (OR: 1.06, 95% CI: 1.02-1.09; OR: 1.17, 95% CI: 1.09-1.26; and OR: 2.27, 95% CI: 1.45-3.54, respectively) and the odds of death due to COVID-19 (OR: 1.07, 95% CI: 1.00-1.14; OR: 1.16, 95% CI: 1.03-1.32; and OR: 2.69, 95% CI: 1.79-6.14, respectively). CONCLUSIONS: Multimorbidity, frailty and diabetes mellitus increased the odds of hospitalization and death due to COVID-19 and the number of medications with long-term use increased the odds of hospitalization due to COVID-19 among frail community-dwelling elderly people.

Usefulness of implementing the OHIP-14 questionnaire to assess the impact of xerostomia and hyposalivation on quality of life in patients with primary Sjögren's syndrome.

BACKGROUND: The aim of this study is to analyze if the results of the Oral Health Impact Profile-14 questionnaire (OHIP-14) in patients with primary Sjögren's syndrome (pSS) are correlated with salivary flow and level of xerostomia. METHODS: This observational cross-sectional study was conducted in 61 patients (60 women, one man, mean age 57.64 [13.52]) diagnosed of pSS according to the American-European Criteria (2002). After recording demographic, medical and dental data (decayed-missing-filled teeth index [DMFT]), unstimulated (UWS) and stimulated (SWS) salivary flows were collected. Subsequently, UWS flow was categorized into two groups (<0.1 ml/min and ≥0.1 ml/min) and SWS into three groups (<0.1 ml/min, 0.1-0.7 ml/min and >0.7 ml/min). Patients also filled out a visual analog scale (VAS) for xerostomia and OHIP-14 for self-reported quality of life (QoL). RESULTS: Data showed positive and significant correlation between OHIP-14 and xerostomia, based on VAS results (r = 0.52; p = 0.001). Furthermore, there was a negative correlation between UWS and OHIP-14 scores (r = -0.34; p = 0.006) and VAS for xerostomia (r = -0.22; p = 0.09). No significant correlation was found between SWS and OHIP-14 or VAS neither between DMFT and OHIP-14. When assessing the level of QoL by the UWS and SWS flow categories a significant association was found for UWS (p = 0.001) but not for SWS (p = 0.11). The OHIP-14 values were higher in the groups with lower salivary flow. The multiple linear regression to predict OHIP-14 only selected VAS for xerostomia as a statistically significant predictor. CONCLUSIONS: Increased level of xerostomia and reduced UWS flow decrease oral health-related QoL in patients with pSS.