Clinical, tomographic and functional comparison of sporadic and tuberous sclerosis complex-associated forms of lymphangioleiomyomatosis: a retrospective cohort study.

Background: Lymphangioleiomyomatosis (LAM) is a rare disease that can occur sporadically (S-LAM) or associated with the tuberous sclerosis complex (TSC-LAM). The natural history of LAM is not completely understood, including whether there is a difference between the clinical courses of the two forms. This study aimed to compare the clinical, functional and tomographic features between S-LAM and TSC-LAM, and evaluate the annual rates of change in lung function. Methods: This retrospective cohort study included patients with LAM followed up between 1994 and 2019. Clinical, functional and imaging variables were evaluated, and the lung cysts were automatically quantified. Quality of life and predictors of lung function impairment were accessed, and the annual rate of lung function decline was compared between S-LAM and TSC-LAM. Results: Of the 107 patients included, 77 had S-LAM and 30 had TSC-LAM. Although patients with TSC-LAM had a higher prevalence of renal angiomyolipomas and neurological and dermatological manifestations, pulmonary function tests were similar. Patients with S-LAM had a greater rate of forced expiratory volume in 1 s decline and a higher extent of cysts. Pneumothorax, desaturation in the 6-minute walking test and a higher extent of lung cysts were predictors of functional impairment. A greater impact on vitality and emotional health was observed in the TSC-LAM. Conclusion: Greater functional decline and a higher cystic extension were found in patients with S-LAM. Our study provides a broad clinical, functional and tomographic characterisation of patients with LAM, adding valuable information to the existing evidence to better understand the two forms of the disease.

Very low-calorie ketogenic diet in the treatment of adaptive thermogenesis: A case report.

OBJECTIVES: The management of the phenomenon of adaptive thermogenesis poses a challenge to the successful treatment of overweight/obesity with a nutritional intervention that minimizes the loss of muscle mass, with little cognitive restraint use and disorganization of eating behavior. On the other hand, it creates a significant calorie deficit for the reduction of body fat. The aim of this case report was to discuss the effects of a very low-calorie ketogenic diet in a woman with obesity and low resting metabolic rate. CASE DESCRIPTION: A 36-y-old white woman with a history of obesity and bulimia nervosa who has had difficulty losing and maintaining weight despite numerous dietary and pharmacologic treatments. RESULTS: There was a loss of 12 kg in 115 d, reaching 13.4 kg, with 11.4 kg of fat mass (FM). The resting metabolic rate showed an increase of 79% in relation to the initial rate, reaching normal levels for the predictive equations and maintaining this level in the first-year follow-up. Additionally, improvement of metabolic laboratory parameters and eating behavior traits were described. CONCLUSIONS: In this specific case of bulimia nervosa resulting in hypometabolism (low resting metabolic rate/fat-free mass) and obesity, the very low-calorie ketogenic diet intervention has demonstrated a possibility of weight loss with little cognitive restraint use, thereby increasing resting metabolic rate in the short and medium terms, ultimately promoting a negative energy balance. In relation to the numeric results, it seems positive; however, more research is necessary to evaluate the effects on the overall relationship with food and its long-term repercussions.

Performance, carcass characteristics and non-carcass components of Santa Ines and crossbred (Santa Ines x Dorper) lambs finished in different confinement strategies.

Genetic group, age at entry into confinement and at slaughter, are characteristics that have an important influence on lamb performance and carcass. The aim of this study was to evaluate the performance, carcass characteristics and non-carcass components from different genetic groups (Santa Inês and ½ Dorper x ½ Santa Inês) sheep, submitted to different feedlot entry and exit strategies. Were used 72 lambs males and castrated; 36 Santa Inês (SI) and 36 crossbred (Dorper x Santa Inês-DSI), with 6 months of average initial age. The groups were established in a completely randomized experimental design, in a 2x3x4 factorial arrangement, from the combination of genetic groups (GG), body weight at the beginning of confinement (WBC) and length of stay in confinement (LSC). The body weight classes at the beginning of confinement were: light (25 kg), intermediate (28 kg) and heavy (31 kg), for Santa Inês and crossbreeds, respectively. Slaughters were carried out every 28 days of confinement, in four LSC: 0, 28, 56 and 84 days. The GG did not influence performance, carcass and non-carcass component traits of lambs (p > 0.05). There was an effect of the WBC on the weights: final (FW), metabolic (MW), body at slaughter (BWS), empty body (EBW), hot carcass (HCY) and cold (CCW), loin, shoulder, leg musculature; loin eye area (LEA) and loin fat (p < 0.05). There was also an effect on LSC, for FW, average daily weight gain (ADG), MW, weight and yield of body components, weight of cuts and tissue ratio components of cuts (p < 0.05). In non-carcass components, effect on full and empty weight of: omasum, rumen-reticulum, small intestine; empty large intestine, liver and kidneys, paws and skin, and perirenal, pelvic and inguinal fat (p < 0.05). Interaction double effect on the tissue muscle/fat:bone ratio (MF:B) and for the full omasal component (p < 0.05). And triple interaction effect for ADG, full omasum and perirenal fat (p < 0.05). Weight at the beginning of confinement and confinement time are the characteristics that most influence performance, quantitative characteristics of carcass and non-carcass components. Regardless of the genetic group and age class, the animals reach the same weight after 84 days of confinement. Thus, the confinement of heavier lambs (31 kg) can be a profitable alternative, as they presented the highest weights for the most commercially valued cuts (shank and loin). The confinement strategy must adapt to market situations.

Trends in the epidemiological and microbiological profiles of infectious keratitis in southeastern Brazil / Perfil epidemiológico e microbiológico das ceratites infecciosas no sudeste do Brasil

ABSTRACT Purpose: To investigate the antibiotic susceptibility as well as the clinical, epidemiological, and microbiological profiles of microbial keratitis. Methods: This was a longitudinal retrospective study, and we retrospectively reviewed medical and laboratory records from 2015 to 2019. Results: In total, 380 pathogens (321 bacteria and 59 fungi) were isolated from the corneas of 352 patients. Staphylococcus species (45%) were most abundant within the organisms that were isolated, followed by Pseudomonas (18.4%), fungi (15.5%), Streptococcus (7.9%), and Serratia species (3.2%). The isolated gram-positive bacteria were not resistant to amikacin or vancomycin, although 14.8% of the gram-positive isolates were resistant to ciprofloxacin (p<0.05). All the gram-negative isolates were susceptible to amikacin. Male patients represented 62.8% of the 129 cases with accessible clinical data. The mean age of the patients was 53.17 ± 21 years. The time to presentation (from onset of symptoms) was 14.9 ± 19.4 days (median: 7 days). Large ulcers (>5 mm in any dimension) were present in 49.6% (64 eyes) of the cases. The duration of treatment was 49 ± 45.9 days (median: 38 days). Direct ocular trauma was reported by 48 (37.2%) patients, and 15 patients (11.6%) reported using contact lenses. For 72 (55.8%) patients, topical treatment had been previously prescribed, and 16 (12.4%) patients reported using other classes of drugs. Hospitalizations were required for 79 (61.2%) patients, and in terms of major complications, 53 (41.1%) patients had corneal perforations. A total of 40 patients (31%) underwent tectonic penetrating keratoplasty, and 28 (21.7%) developed secondary glaucoma. A progression to endophthalmitis occurred in 8 (6.2%) patients, with 50% of those patients' (3.1% of the total) endophthalmitis evolving to evisceration. The patients' microbial keratitis was largely treated empirically, with 94 (72.9%) patients prescribed moxifloxacin and 56 (43.4%) prescribed ciprofloxacin before receiving their culture results. Conclusions: For the most part, our hospital treated patients with severe microbial keratitis. Despite identifying gram-positive bacteria in most of the isolates, we also frequently identified gram-negative rods and fungi. Our susceptibility results support prescribing a combination of vancomycin and amikacin as an effective empirical therapeutic regimen to treat microbial keratitis.

RESUMO Objetivo: Investigar a susceptibilidade a antibió­ticos, o perfil clínico, epidemiológico e microbiológico das ce­ratites infecciosas. Métodos: Estudo retrospectivo longitu­dinal. Registros médicos e laboratoriais de 2015 a 2019 fo­ram revisados retrospectivamente. Resultados: Trezentos e oitenta patógenos (321 bactérias e 59 fungos) foram isolados das córneas de 352 pacientes. As espécies de Staphylococcus foram os microorganismos mais isolados (45%), seguidos de Pseudomonas (18,4%), fungos (15,5%), Streptococcus (7,9%) e Serratia (3,2%). Não houve resistência das bactérias Gram-positivas à amicacina ou vancomicina, enquanto 14,8% isolados Gram-positivos foram resistentes à ciprofloxacina (p<0,05). Todos os organismos Gram-negativos eram suscetíveis à amicacina. Pacientes do sexo masculino representaram 62,8% de 129 casos com dados clínicos acessíveis. A média de idade foi 53,17 ± 21 anos. O tempo até a apresentação (desde o início dos sintomas) foi de 14,9 ± 19,4 dias (mediana: 7 dias). Úlceras grandes (>5mm em qualquer extensão) representaram 49,6% (64 olhos) dos casos. A duração do tratamento foi de 49 ± 45,9 dias (mediana: 38 dias). Trauma ocular direto foi relatado por 48 (37,2%) pacientes e uso de lentes de contato por 15 (11,6%) pacientes. Foi prescrito tratamento prévio para 72 (55.8%) pacientes. Outras classes de medicamentos foram prescritas para 16 (12.4%). Setenta e nove (61,2%) pacientes tiveram que ser hospitalizados. Como complicações maiores, 53 (41,1%) pacientes apresentaram perfuração corneana, 40 pacientes (31%) foram submetidos à ceratoplastia penetrante tectônica e 28 (21,7%) desenvolveram glaucoma secundário. Oito pacientes (6,2%) evoluíram para endoftalmite. O tratamento empírico da ceratite microbiana foi amplamente empregado, com 94 (72,9%) pacientes em uso de moxifloxacina e 56 (43,4%) em uso de ciprofloxacina antes do resultado da cultura. Conclusões: Nosso hospital tratou predominantemente de pacientes com úlceras microbianas graves. Embora bactérias Gram-po­sitivas constituíssem a maioria dos isolados, bacilos e fungos Gram-negativos também foram frequentemente identificados nas ceratites microbianas. Os resultados de suscetibilidade sugerem a combinação de vancomicina e amicacina como um regime terapêutico empírico eficaz para essa condição grave com risco de perda visual permanente.

Trends in the epidemiological and microbiological profiles of infectious keratitis in southeastern Brazil.

PURPOSE: To investigate the antibiotic susceptibility as well as the clinical, epidemiological, and microbiological profiles of microbial keratitis. METHODS: This was a longitudinal retrospective study, and we retrospectively reviewed medical and laboratory records from 2015 to 2019. RESULTS: In total, 380 pathogens (321 bacteria and 59 fungi) were isolated from the corneas of 352 patients. Staphylococcus species (45%) were most abundant within the organisms that were isolated, followed by Pseudomonas (18.4%), fungi (15.5%), Streptococcus (7.9%), and Serratia species (3.2%). The isolated gram-positive bacteria were not resistant to amikacin or vancomycin, although 14.8% of the gram-positive isolates were resistant to ciprofloxacin (p<0.05). All the gram-negative isolates were susceptible to amikacin. Male patients represented 62.8% of the 129 cases with accessible clinical data. The mean age of the patients was 53.17 ± 21 years. The time to presentation (from onset of symptoms) was 14.9 ± 19.4 days (median: 7 days). Large ulcers (>5 mm in any dimension) were present in 49.6% (64 eyes) of the cases. The duration of treatment was 49 ± 45.9 days (median: 38 days). Direct ocular trauma was reported by 48 (37.2%) patients, and 15 patients (11.6%) reported using contact lenses. For 72 (55.8%) patients, topical treatment had been previously prescribed, and 16 (12.4%) patients reported using other classes of drugs. Hospitalizations were required for 79 (61.2%) patients, and in terms of major complications, 53 (41.1%) patients had corneal perforations. A total of 40 patients (31%) underwent tectonic penetrating keratoplasty, and 28 (21.7%) developed secondary glaucoma. A progression to endophthalmitis occurred in 8 (6.2%) patients, with 50% of those patients' (3.1% of the total) endophthalmitis evolving to evisceration. The patients' microbial keratitis was largely treated empirically, with 94 (72.9%) patients prescribed moxifloxacin and 56 (43.4%) prescribed ciprofloxacin before receiving their culture results. CONCLUSIONS: For the most part, our hospital treated patients with severe microbial keratitis. Despite identifying gram-positive bacteria in most of the isolates, we also frequently identified gram-negative rods and fungi. Our susceptibility results support prescribing a combination of vancomycin and amikacin as an effective empirical therapeutic regimen to treat microbial keratitis.

Amazonian Guarana- and Açai-Conjugated Extracts Improve Scratched Fibroblast Healing and Eisenia fetida Surgical Tail Amputation by Modulating Oxidative Metabolism.

Background: Previous studies have suggested that guarana (Paullinia cupana) and açai (Euterpe oleracea) have antioxidant, anti-inflammatory, and proliferative properties, indicating their potential therapeutic action in wound healing. We produced a conjugated guarana-açai (GA) extract and tested its healing action on earthworms (Eisenia fetida) subjected to tail amputation by surgical incision. Methods: Extract from roasted guarana seeds and fresh açai seed berries was produced. The antioxidant and genoprotective capacity of GA extract was tested. The concentration with the most remarkable healing potential was used in subsequent tests. The last three posterior segments of the clitellate earthworm tail reared under standardized conditions were surgically amputated. Next, topical PBS or GA extract was applied to the surgical wound. The rate of cell migration and tissue regeneration at the local wound site was histologically evaluated after the procedure. Expression of the SOX4 gene that acts in epithelial-to-mesenchymal transition was determined by RT-qPCR. Results: Sixteen bioactive molecules, including some previously described substances, were identified. All tested concentrations exhibited antioxidant and genoprotective effects. The GA extract accelerated the healing processes as observed through macroscopic and histological analyses and increased expression of SOX4. Conclusion: The GA extract has a potential role in the healing of surgically induced wounds.

Moral judgment and hormones: A systematic literature review.

This systematic review of the literature aims to evaluate possible associations between moral judgment and hormones. The electronic databases PsycINFO, PubMed, Scielo, Web of Science, Scopus, and LILACS were used. Twenty studies with different methodological designs were reviewed, covering the hormones cortisol, oxytocin, and testosterone, assessing aspects related to polymorphisms in receptor genes, endogenous levels, and exogenous administration. Taken together, the reviewed studies showed a trend towards an association between hormones and moral judgment, with important specificities involving biological, environmental, and individual aspects. Endogenous levels of cortisol, released under stress, showed negative associations with altruistic and utilitarian decisions only in highly emotionally charged dilemmas. Oxytocin receptor gene polymorphisms (rs2268498, rs237889, and rs2254298) and acute administration of this hormone were associated with variability in moral judgment, with sex as an important moderating variable. Testosterone studies have tended to show a positive association with utilitarian moral judgments, particularly in female and in individuals with low prenatal exposure to this hormone. Knowing how hormones influence moral judgment may help expand our understanding of the plurality of human behavior. However, this area of research is new and still little explored, which does not allow for conclusions with a high level of evidence. Subsequent research will benefit from methodological improvements to extend current findings.

Seroprevalence of bovine vaccinia in cows and its correlation with the productive profile of affected farms in Distrito Federal, Brazil.

Bovine vaccinia (BV) is an infectious disease caused by Vaccinia virus (VACV) characterized by vesicular and exanthematic lesions, mainly in cattle. Although BV has been described in some Brazilian regions in the last decades, official information regarding the current prevalence in bovine herds of Midwestern Brazil is lacking. Thus, the current study aimed to estimate the seroprevalence and risk factors associated with BV in cattle in the Distrito Federal (DF), Brazil. Sera of 312 cows of 64 herds were tested by virus-neutralizing test for VACV antibodies. Herd and animal seroprevalence were estimated to be 33.3% (CI 95%: 18.2-48.3%) and 10.6% (CI 95%: 1.0-20.2%), respectively. Seropositive cows were detected in dairy, beef, and mixed-purpose farms. The results of an epidemiological questionnaire showed that no risk factor analyzed was positively associated with seropositivity to VACV. There was no significant association between type of milking (manual/mechanic) and seropositivity to VACV; however, most seropositive cows were present in farms with high daily milk production and high number of lactating and adult cows. Our results indicate that VACV circulates in many regions of DF with considerable prevalence in dairy cows. Control measures to restrict VACV circulation and consequences of the infection may be advisable.

Programas de estimulação cognitiva para idosos com ou sem síndromes demenciais supervisionados ou aplicados por enfermeiros: revisão integrativa / Cognitive stimulation programs for elderly people with and without dementia syndromes supervised or applied by nurses: integrative review / Programas de estimulación cognitiva para personas mayores con o sin síndromes de demencia supervisados o aplicados por enfermeras: revisión integradora

RESUMO Objetivo: identificar, descrever e avaliar a eficácia de Programas de Estimulação Cognitiva, aplicados e/ou supervisionados por enfermeiros, para idosos com e sem síndromes demenciais em qualquer cenário de cuidado. Método: revisão integrativa com coleta nas bases PubMed, Scopus, Bdenf, Scielo, Web of Science, Cinahl e BVS, em maio de 2020 a novembro de 2021, cujos principais descritores foram: "cognitive stimulation program", "nursing" e "older". Resultados: nos seis estudos selecionados, identificou-se falta de padronização na utilização de instrumentos pré e pós implementação. As técnicas foram: orientação para a realidade, terapia por reminiscência e de validação. Comprovou-se, por meio de escalas validadas, a eficácia do programa. Dois estudos demonstraram aplicações dos programas e quatro foram sobre supervisão/orientação para cuidadores. Não foram encontrados estudos brasileiros. Conclusões: programas de Estimulação Cognitiva são eficazes, pois reduzem sintomas comportamentais e psicológicos da demência. Destaca-se a necessidade de mais estudos clínicos conduzidos por enfermeiros.

ABSTRACT Objective: to identify, describe and evaluate the effectiveness of Cognitive Stimulation Programs, applied and/or supervised by nurses, for older adults with and without dementia syndromes in any care setting. Method: integrative review with collection in PubMed, Scopus, Bdenf, Scielo, Web of Science, Cinahl and BVS, from May 2020 to November 2021, whose main descriptors were: "cognitive stimulation program", "nursing" and "older". Results: in the six selected studies, a lack of standardization was identified in the use of pre- and post-implementation instruments. The techniques were: reality orientation, reminiscence therapy and validation. The effectiveness of the program was proven by validated scales. Two studies demonstrated program applications and four were about supervision/guidance for caregivers. No Brazilian studies were found. Conclusions: Cognitive Stimulation programs are effective in reducing behavioral and psychological symptoms of dementia. The need for more clinical studies conducted by nurses is highlighted.

RESUMEN Objetivo: identificar, describir y evaluar la eficacia de los programas de estimulación cognitiva, aplicados y/o supervisados por personal de enfermería, para personas mayores con y sin síndromes de demencia en cualquier ámbito asistencial. Método: revisión integradora con recogida en PubMed, Scopus, Bdenf, Scielo, Web of Science, Cinahl y BVS, desde mayo de 2020 hasta noviembre de 2021, cuyos descriptores principales fueron: "cognitive stimulation program", "nursing" y "older". Resultados: en los seis estudios seleccionados, se identificó una falta de estandarización en el uso de los instrumentos previos y posteriores a la aplicación. Las técnicas fueron: orientación a la realidad, terapia de reminiscencia y validación. La eficacia del programa se comprobó mediante escalas validadas. Dos estudios mostraban la aplicación de los programas y cuatro trataban sobre la supervisión/orientación de los cuidadores. No se encontraron estudios brasileños. Conclusiones: los programas de estimulación cognitiva son eficaces para reducir los síntomas conductuales y psicológicos de la demencia. Se destaca la necesidad de más estudios clínicos realizados por enfermeras.

Domínios de competências essenciais nas práticas colaborativas em equipe interprofissional: revisão integrativa da literatura / Core competency domains in the collaborative practices of interprofessional health teams: an integrative literature review / Dominios de competencias esenciales en las prácticas colaborativas en equipo interprofesional: revisión integradora de la literatura

O objetivo desta pesquisa foi sintetizar evidências das práticas colaborativas interprofissionais segundo os domínios de competências essenciais do Canadian Interprofessional Health Collaborative (CIHC). Foi conduzida revisão integrativa da literatura, dos últimos dez anos, nas bases Pubmed, Web of Science e Biblioteca Virtual em Saúde e síntese das práticas segundo a estrutura proposta pela CIHC. Dos 364 artigos selecionados, 21 foram incluídos com amostras entre 12 e 972 participantes; 11 estudos utilizaram instrumentos para avaliação das práticas; 43% evidenciaram os seis domínios essenciais; e 38%, de três a quatro. A resolução de conflitos interprofissionais não foi abordada em 48% dos artigos. Foi observada a adesão aos domínios de competências essenciais, o que tende a qualificar o processo de trabalho. Entretanto, a lacuna observada na abordagem do enfrentamento dos conflitos interprofissionais representa um obstáculo para vencer a formação uniprofissional. (AU)

The aim of this study was to synthesize evidence of collaborative practices based on the core competency domains proposed by the Canadian Interprofessional Health Collaborative (CIHC). We conducted an integrative literature review of articles published over the last 10 years. Searches were performed of the PubMed, Web of Science and Virtual Health Library databases and a synthesis of the practices based on the framework proposed by the CIHC. The search yielded 364 articles, 21 of which were included in the sample. The included studies used samples of between 12 and 972 participants. Eleven of the studies used practice assessment instruments; 43% included all six core competency domains and 38% included three to four. Forty-eight per cent of the studies did not address interprofessional conflict resolution. The findings demonstrate that adherence to the core competency domains tends to improve the quality of work process. However, the gap represented by the failure to address interprofessional conflict resolution is an obstacle to overcoming uniprofessional training. (AU)

El objetivo de este estudio fue sintetizar evidencias de las prácticas colaborativas interprofesionales según los dominios de competencias esenciales del Canadian Interprofessional Health Collaborative (CIHC). Se realizó una revisión integradora de la literatura de los últimos diez años en las bases Pubmed, Web of Science y Biblioteca Virtual em Saúde y síntesis de las prácticas según la estructura propuesta por la CIHC. De los 364 artículos seleccionados se incluyeron 21, con muestras entre 12 y 972 participantes. Once estudios utilizaron instrumentos para evaluación de las prácticas, el 43% puso en evidencia los seis dominios esenciales, y el 38% de 3 a 4. La resolución de conflictos interprofesionales no se abordó en el 48% de los artículos. Se observó la adhesión a los dominios de competencias esenciales, lo que tiende a calificar el proceso de trabajo. Sin embargo, la brecha observada en el abordaje del enfrentamiento de los conflictos interprofesionales representa un obstáculo para vencer la formación uniprofesional. (AU)

Use of machine learning to predict the risk of early morning intraocular pressure peaks in glaucoma patients and suspects / Uso de aprendizado de máquina para predizer o risco de picos de pressão intraocular no início da manhã em pacientes com glaucoma e suspeitos

ABSTRACT Purpose: To use machine learning to predict the risk of intraocular pressure peaks at 6 a.m. in primary open-angle glaucoma patients and suspects. Methods: This cross-sectional observational study included 98 eyes of 98 patients who underwent a 24-hour intraocular pressure curve (including the intraocular pressure measurements at 6 a.m.). The diurnal intraocular pressure curve was defined as a series of three measurements at 8 a.m., 9 a.m., and 11 a.m. from the 24-hour intraocular pressure curve. Two new variables were introduced: slope and concavity. The slope of the curve was calculated as the difference between intraocular pressure measurements at 9 a.m. and 8 a.m. and reflected the intraocular pressure change in the first hour. The concavity of the curve was calculated as the difference between the slopes at 9 a.m. and 8 a.m. and indicated if the curve was bent upward or downward. A classification tree was used to determine a multivariate algorithm from the measurements of the diurnal intraocular pressure curve to predict the risk of elevated intraocular pressure at 6 a.m. Results: Forty-nine (50%) eyes had intraocular pressure measurements at 6 a.m. >21 mmHg, and the median intraocular pressure peak in these eyes at 6 a.m. was 26 mmHg. The best predictors of intraocular pressure measurements >21 mmHg at 6 a.m. were the intraocular pressure measurements at 8 a.m. and concavity. The proposed model achieved a sensitivity of 100% and a specificity of 86%, resulting in an accuracy of 93%. Conclusions: The machine learning approach was able to predict the risk of intraocular pressure peaks at 6 a.m. with good accuracy. This new approach to the diurnal intraocular pressure curve may become a widely used tool in daily practice and the indication of a 24-hour intraocular pressure curve could be rationalized according to risk stratification.

RESUMO Objetivo: Utilizar aprendizado de máquina para predizer o risco de picos de pressão intraocular às 6 AM em pacientes com glaucoma primário de ângulo aberto e suspeitos. Métodos: Esse estudo observacional transversal incluiu 98 olhos de 98 pacientes submetidos à curva de 24 horas de pressão intraocular (incluindo as medidas às 6 AM). A curva diurna de pressão intraocular foi definida como uma série de três medidas da curva de 24 horas de pressão intraocular às 8 AM, às 9 AM e às 11 AM. Duas novas variáveis foram apresentadas: inclinação e concavidade. A inclinação da curva às 8 AM foi calculada como a diferença entre pressão intraocular às 9 AM e 8 AM e reflete a variação da pressão intraocular na primeira hora. A concavidade da curva foi calculada como a diferença entre as inclinações às 9 AM e às 8 AM e pode ser para cima ou para baixo. Uma árvore de classificação foi usada para determinar um algoritmo multivariado a partir das medidas da curva diurna para prever o risco de pressão intraocular elevada às 6 AM. Resultados: Quarenta e nove (50%) olhos apresentaram pressão intraocular às 6 AM >21 mmHg e a mediana do pico de pressão intraocularPIO foi 26 mmHg. Os melhores preditores de pressão intraocular às 6 AM >21 mmHg foram a pressão intraocular às 8 AM e a concavidade. O modelo proposto apresentou uma sensibilidade de 100% e uma especificidade de 86%, com uma acurácia de 93%. Conclusões: A abordagem de aprendizado de máquina foi capaz de prever o risco de picos de pressão intraocular às 6 AM com uma boa acurácia. Essa nova abordagem para a curva diurna de pressão intraocular pode se tornar uma ferramenta amplamente utilizada na prática clínica e a indicação da curva de 24 horas de pressão intraocular pode ser racionalizada de acordo com a estratificação de risco.

Sustainable-use protected areas catalyze enhanced livelihoods in rural Amazonia.

Finding new pathways for reconciling socioeconomic well-being and nature sustainability is critically important for contemporary societies, especially in tropical developing countries where sustaining local livelihoods often clashes with biodiversity conservation. Many projects aimed at reconciling the goals of biodiversity conservation and social aspirations within protected areas (PAs) have failed on one or both counts. Here, we investigate the social consequences of living either inside or outside sustainable-use PAs in the Brazilian Amazon, using data from more than 100 local communities along a 2,000-km section of a major Amazonian river. The PAs in this region are now widely viewed as conservation triumphs, having implemented community comanagement of fisheries and recovery of overexploited wildlife populations. We document clear differences in social welfare in communities inside and outside PAs. Specifically, communities inside PAs enjoy better access to health care, education, electricity, basic sanitation, and communication infrastructure. Moreover, living within a PA was the strongest predictor of household wealth, followed by cash-transfer programs and the number of people per household. These collective cobenefits clearly influence life satisfaction, with only 5% of all adult residents inside PAs aspiring to move to urban centers, compared with 58% of adults in unprotected areas. Our results clearly demonstrate that large-scale "win-win" conservation solutions are possible in tropical countries with limited financial and human resources and reinforce the need to genuinely empower local people in integrated conservation-development programs.

Use of machine learning to predict the risk of early morning intraocular pressure peaks in glaucoma patients and suspects.

PURPOSE: To use machine learning to predict the risk of intraocular pressure peaks at 6 a.m. in primary open-angle glaucoma patients and suspects. METHODS: This cross-sectional observational study included 98 eyes of 98 patients who underwent a 24-hour intraocular pressure curve (including the intraocular pressure measurements at 6 a.m.). The diurnal intraocular pressure curve was defined as a series of three measurements at 8 a.m., 9 a.m., and 11 a.m. from the 24-hour intraocular pressure curve. Two new variables were introduced: slope and concavity. The slope of the curve was calculated as the difference between intraocular pressure measurements at 9 a.m. and 8 a.m. and reflected the intraocular pressure change in the first hour. The concavity of the curve was calculated as the difference between the slopes at 9 a.m. and 8 a.m. and indicated if the curve was bent upward or downward. A classification tree was used to determine a multivariate algorithm from the measurements of the diurnal intraocular pressure curve to predict the risk of elevated intraocular pressure at 6 a.m. RESULTS: Forty-nine (50%) eyes had intraocular pressure measurements at 6 a.m. >21 mmHg, and the median intraocular pressure peak in these eyes at 6 a.m. was 26 mmHg. The best predictors of intraocular pressure measurements >21 mmHg at 6 a.m. were the intraocular pressure measurements at 8 a.m. and concavity. The proposed model achieved a sensitivity of 100% and a specificity of 86%, resulting in an accuracy of 93%. CONCLUSIONS: The machine learning approach was able to predict the risk of intraocular pressure peaks at 6 a.m. with good accuracy. This new approach to the diurnal intraocular pressure curve may become a widely used tool in daily practice and the indication of a 24-hour intraocular pressure curve could be rationalized according to risk stratification.

24-Epibrassinolide modulates the neurodevelopmental outcomes of high caffeine exposure in zebrafish (Danio rerio) embryos.

Previous embryonic fish data have shown caffeine to induce potential teratogenic and long-term neurodevelopmental outcomes through oxidative stress-mediated apoptosis. In this context, antioxidants may have the potential to counteract the caffeine-induced effects. Therefore, the present study aimed to investigate the potential protective role of 24-epibrassinolide (24-EPI), a natural brassinosteroid with proven antioxidant properties, against caffeine-induced teratogenic effects during early zebrafish development. Embryos (~2 h post-fertilization - hpf) were exposed to 0.5 mM caffeine, co-exposed to 24-EPI (0.01, 0.1 and 1 µM) and to 24-EPI alone (1 µM) for 96 h. During exposure, lethal and sublethal developmental parameters were evaluated. At the end of the exposure, biochemical evaluations were made, and 24 h after, different behavioural paradigms were assessed. An increased number of animals showing oedema and malformations were observed after caffeine exposure, while these were reduced after co-exposure to 24-EPI concentration, namely the tail curvature. The results showed oxidative stress and related parameters similar among treatments. Yet, caffeine exposure resulted in locomotor deficits (decreased speed and distance) and disrupted anxiety-like and avoidance responses. The co-exposure to caffeine and to the highest 24-EPI concentrations resulted in less pronounced behavioural deficits. Overall, there was an absence of effects in the embryo/larvae exposed solely to 24-EPI, while caffeine caused developmental and neurotoxic effects. Although further studies are needed, the results showed promising protective effects of the highest 24-EPI concentration tested against the toxicity induced by caffeine in zebrafish.

Association between pulmonary artery to aorta diameter ratio with pulmonary hypertension and outcomes in diffuse cystic lung diseases.

ABSTRACT: To investigate the importance of pulmonary vascular measurements on computed tomography (CT) in predicting pulmonary hypertension (PH) and worse outcomes in diffuse cystic lung diseases (DCLDs).We conducted a cross-sectional study of patients with DCLDs. Patients underwent pulmonary function tests, a six-minute walk test (6MWT), chest CT, transthoracic echocardiography, and right heart catheterization. Pulmonary artery (PA) diameter and PA-ascending aorta ratio (PA-Ao ratio) were obtained from CT. Mean pulmonary artery pressure (mPAP) from right heart catheterization was correlated with tomographic, functional, and echocardiographic variables. The association between the PA-Ao ratio with outcomes was determined by Kaplan-Meier curves.Thirty-four patients were included (18 with pulmonary Langerhans cell histiocytosis and 16 with lymphangioleiomyomatosis, mean age 46 ±â€Š9 years). Forced expiratory volume in the first second and lung diffusing capacity for carbon monoxide were 47 ±â€Š20% and 38 ±â€Š21% predicted, respectively. PA diameter and PA-Ao ratio were 29 ±â€Š6 mm and 0.95 ±â€Š0.24, respectively. PA-Ao ratio > 1 occurred in 38.2% of patients. PA-Ao ratio was a good predictor of PH. mPAP correlated best with PA-Ao ratio, PA diameter, oxygen desaturation during six-minute walk test, and echocardiographic variables. Patients with PA-Ao ratio > 1 had greater mPAP, and a higher risk of death or lung transplantation (log-rank, P < .001) than those with PA-Ao ratio ≤ 1.The PA-Ao ratio measured on CT scan has a potential role as a non-invasive tool to predict the presence of PH and as a prognostic parameter in patients with DCLDs.

Alimentação vegetariana na merenda escolar e sua relação com o estado nutricional infantil / Vegetarian nourishment in school meals and their relationship with the child nutritional status

Avaliar o reflexo da alimentação vegetariana no estado nutricional de crianças de uma escola privada que adota tal alimentação na merenda; verificar a opinião dos pais e das crianças sobre o cardápio da instituição. Obteve-se o estado nutricional através do Índice de Massa Corpórea e a opinião dos pais sobre a merenda através de questionário. O valor nutricional do cardápio foi obtido através do software DIET PRO 5®. Obteve-se a opinião dos estudantes sobre a merenda através de escala hedônica. Observou-se inadequação em todos os macro e micronutrientes, em ao menos um dia da semana. As refeições eram bem aceitas pelas crianças, das quais 75% apresentaram eutrofia. 87% das famílias achavam a merenda vegetariana uma boa ideia; 3% tinham a opinião contrária e 10% eram indiferentes. Apesar da boa aceitação da merenda vegetariana e predominância da eutrofia, o acompanhamento profissional é importante, evitando possíveis deficiências nutricionais.

Evaluate the reflex of vegetarian nourishment in the nutritional status of children from a private school that adopts such food in the lunch; check the opinion of parents and children about the institution's menu. The nutritional status was obtained through the Body Mass Index and the parents' opinion about the meal through a questionnaire. The nutritional value of the menu was obtained using the DIET PRO 5®ï¸ software. Students' opinions about school meals were obtained through a hedonic scale. It was observed inadequacy in all macro and micronutrients, on at least one day of the week. Meals were well accepted by the children, 75% of whom had normal weight. 87% of families thought vegetarian lunches were a good idea; 3% had the opposite opinion and 10% were indifferent. Despite the good acceptance of vegetarian meals and the predominance of eutrophy, the professional monitoring is important, avoiding possible nutritional deficiencies.

Examining therapeutic equivalence between branded and generic warfarin in Brazil: The WARFA crossover randomized controlled trial.

OBJECTIVES: To determine whether the generic and branded warfarins used as anticoagulants in Brazil are therapeutic equivalents based on their international normalized ratio (INR) results. METHODS: This crossover randomized controlled trial had four periods. We used the branded Marevan and two generic versions of warfarin sodium tablets, manufactured by União Química and Teuto laboratories, all purchased from retail drugstores. Eligible participants were outpatients from an anticoagulation clinic at a university hospital in São Paulo, Brazil. They had atrial fibrillation or flutter and had been using warfarin for at least 2 months with an INR therapeutic range of 2.0-3.0. Randomization was by numbered, opaque, sealed envelopes. Healthcare personnel and outcome assessors were blinded to treatments, but patients were not. The primary outcome was the variability in the INR (ΔINR) and secondary outcomes included mean INR. We accepted formulations as equivalent if the 95% confidence interval (CI) of the comparison of ΔINR between branded and generic formulations was within the limit of ±0.49. RESULTS: One hundred patients were recruited and randomized to six sequences of treatment (four sequences with n = 17 and two sequences with n = 16). União Química generic warfarin had equivalent variability in the INR to Marevan (ΔINR +0.09 [95% CI -0.29 to +0.46], n = 84). Comparison between Teuto generic warfarin and Marevan was inconclusive (ΔINR +0.29 [95% CI -0.09 to +0.68], n = 84). CONCLUSIONS: Marevan and União Química warfarin had equivalent therapeutic effectiveness and both could be confidently used for anticoagulation. The comparison between Marevan and TW was inconclusive and does not warrant a statement of equivalence. Our methods are especially important for comparing generic and branded drugs that raise concerns and may be subject of future investigations by regulatory agents. TRIAL REGISTRATION: ClinicalTrials.gov NCT02017197.

Overview of Synthetic Cannabinoids ADB-FUBINACA and AMB-FUBINACA: Clinical, Analytical, and Forensic Implications.

ADB-FUBINACA and AMB-FUBINACA are two synthetic indazole-derived cannabinoid receptor agonists, up to 140- and 85-fold more potent, respectively, than trans-∆9-tetrahydrocannabinol (∆9-THC), the main psychoactive compound of cannabis. Synthesised in 2009 as a pharmaceutical drug candidate, the recreational use of ADB-FUBINACA was first reported in 2013 in Japan, with fatal cases being described in 2015. ADB-FUBINACA is one of the most apprehended and consumed synthetic cannabinoid (SC), following AMB-FUBINACA, which emerged in 2014 as a drug of abuse and has since been responsible for several intoxication and death outbreaks. Here, we critically review the physicochemical properties, detection methods, prevalence, biological effects, pharmacodynamics and pharmacokinetics of both drugs. When smoked, these SCs produce almost immediate effects (about 10 to 15 s after use) that last up to 60 min. They are rapidly and extensively metabolised, being the O-demethylated metabolite of AMB-FUBINACA, 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamide)-3-methylbutanoic acid, the main excreted in urine, while for ADB-FUBINACA the main biomarkers are the hydroxdimethylpropyl ADB-FUBINACA, hydroxydehydrodimethylpropyl ADB-FUBINACA and hydroxylindazole ADB-FUBINACA. ADB-FUBINACA and AMB-FUBINACA display full agonism of the CB1 receptor, this being responsible for their cardiovascular and neurological effects (e.g., altered perception, agitation, anxiety, paranoia, hallucinations, loss of consciousness and memory, chest pain, hypertension, tachycardia, seizures). This review highlights the urgent requirement for additional studies on the toxicokinetic properties of AMB-FUBINACA and ADB-FUBINACA, as this is imperative to improve the methods for detecting and quantifying these drugs and to determine the best exposure markers in the various biological matrices. Furthermore, it stresses the need for clinicians and pathologists involved in the management of these intoxications to describe their findings in the scientific literature, thus assisting in the risk assessment and treatment of the harmful effects of these drugs in future medical and forensic investigations.

Sequence analysis of the DA domain of glycoprotein E2 of pestiviruses isolated from beef cattle in Southern Brazil.

The envelope glycoprotein E2 of pestiviruses is a major target for neutralizing antibodies. In this study, we analyzed the E2 DA domain of 43 pestiviruses from Southern Brazil. The isolates were identified as Bovine viral diarrhea virus (BVDV) subtypes 1a and 1b or BVDV-2b. Compared to reference strains, the BVDV-1 and -2 isolates had four and two mutations in the DA domain, respectively. All BVDV-2 isolates had a deletion of residues 724 and 725. All mutated amino acids in the BVDV isolates had the same aa substitution, and all were in previously identified antibody binding sites. It is possible that an immunity-mediated selection is acting on the pestiviruses circulating in Southern Brazil.

Endogenous endophthalmitis due to Kingella Kingae infectious endocarditis / Endoftalmite endógena por endocardite infecciosa devido a Kingella Kingae

Abstract This report presents a rare case of endogenous endophthalmitis due to Kingella kingae infectious endocarditis. Endogenous endophthalmitis is a rare condition that has a systemic underlying cause, with hematogenic dissemination of a pathogen that will eventually reach and infect the eye. In this article, we present a case of a 54-year-old woman with fever, chills and decreased visual acuity and pain in the right eye. The slit-lamp exam showed conjunctival injection, anterior chamber reaction with a great amount of fibrinous material obscuring her visual axis. Ultrasound echography revealed profuse exudates and scarce membranous formation in the posterior segment. Blood culture was positive for Kingella kingae, and the patient was treated with intravenous ceftriaxone, along with topic dexamethasone and mydriatic. After 15 days of intravenous antibiotic therapy, the patient exhibited best visual acuity of 20/60. Endogenous endophthalmitis is an ocular emergency that demands quick diagnosis and aggressive intervention in order to preserve vision. Therefore, it is important to recognize its signs and symptoms with no retard.

Resumo O presente relato apresenta um raro caso de endoftalmite endógena por endocardite devido à Kingella kingae. Endoftalmite endógena é uma doença pouco comum com uma causa sistêmica subjacente. A disseminação hematogênica de um microrganismo infeccioso leva à infecção ocular. Nesse artigo, apresentamos o caso de uma mulher com 54 anos, febre, calafrios, baixa da acuidade visual e dor em olho direito. Ao exame na lâmpada de fenda apresentava injeção conjuntival, reação de câmara anterior e acúmulo de fibrina no eixo visual. Ultrassonografia revelou exsudatos profusos e escassa formação membranosa em segmento posterior.A hemocultura foi positiva para Kingella kingae e a paciente foi tratada com ceftriaxone venoso conjuntamente com dexametasona e midriático tópicos. Após 15 dias de terapia antibiótica endovenosa, a paciente apresentou acuidade visual corrigida de 20/60. Endoftalmite endógena é uma emergência ocular que demanda rápido diagnóstico e intervenção agressiva para preservar a visão. Portanto, é importante o reconhecimento precoce dos sinais e sintomas.