The impact of a biocellulose-based repair of fetal open spina bifida on the need to untether the cord: is it time to unify techniques for prenatal repair?

OBJECTIVE: To report the need for cord untethering after prenatal repair of open spina bifida using a unique biocellulose-based technique performed at a later gestational age. METHODS: An observational cohort study was conducted to determine the incidence of tethered cord syndrome. Between May 2013 and May 2022, we performed 172 procedures using the percutaneous fetoscopic approach in fetuses at 26-28 weeks of gestation. After placode dissection, a biocellulose patch was placed to cover the placode, a myofascial flap (when possible) was dissected, and the skin was closed. Owing to death or loss to follow-up, 23 cases were excluded. Cord tethering syndrome was defined as symptoms of medullary stretching, and the infants were evaluated and operated on by local neurosurgeons after an magnetic resonance imaging examination. Infants over 30-month had ambulation and neurodevelopment evaluations (PEDI scale). RESULTS: Among 172 cases operated at a median gestational age of 26.7 weeks and delivered at 33.2 weeks, 149 cases were available for postnatal follow-up, and cord untethering was needed in 4.4% of cases (6/136; excluding 13 cases younger than 12 months). Cerebrospinal fluid diversion and bladder catheterization were needed in 38% and 36% of cases, respectively. Of the 78 cases evaluated at 30 months, 49% were ambulating independently, and 94% had normal social function. CONCLUSION: The biocellulose-based technique was associated with a low rate of cord tethering, wich may be attributed to the lack of the duramater suture during prenatal repair, the formation of a neoduramater and/or later gestational age of surgery.

'Meat' the Influencers: Crafting Authentic Endorsements that Drive Willingness to Buy Cultured Meat.

Cultured meat is a promising substitute for regular meat, but its introduction faces challenges and expected consumer resistance. While some studies investigate how communication strategies and advertising appeals can address these concerns, the role of social media influencers in promoting cultured adoption remains yet to be explored. Across two online experimental studies involving 752 participants recruited from Prolific, this research investigates how influencer type (micro- vs. mega-influencer) affects consumers' willingness to buy cultured meat. Study 1 reveals that consumers are more willing to buy cultured meat when it is endorsed by micro- rather than mega-influencers. Further, perceived endorsement authenticity mediates this effect such that micro-influencers endorsements are perceived as more authentic than those of mega-influencers. Study 2 demonstrates that these effects are moderated by influencer expertise and type of meat, where micro-influencers with health (but not fashion) expertise have a more pronounced impact on increasing willingness to purchase cultured meat (but not regular meat). This research provides theoretical insights into how consumers perceive influencer endorsements for cultured meat. These findings aim to enhance consumer acceptance of cultured meat while offering actionable guidance for practitioners on promoting cultured meat brands on social media.

Toxicological impact of strobilurin fungicides on human and environmental health: a literature review.

Fungicides are specifically used for controlling fungal infections. Strobilurins, a class of fungicides originating from the mushroom Strobilurus tenacellus, act on the fungal mitochondrial respiratory chain, interrupting the ATP cycle and causing oxidative stress. Although strobilurins are little soluble in water, they have been detected in water samples (such as rainwater and drinking water), indoor dust, and sediments, and they can bioaccumulate in aquatic organisms. Strobilurins are usually absorbed orally and are mainly eliminated via the bile/fecal route and urine, but information about their metabolites is lacking. Strobilurins have low mammalian toxicity; however, they exert severe toxic effects on aquatic organisms. Mitochondrial dysfunction and oxidative stress are the main mechanisms related to the genotoxic damage elicited by toxic compounds, such as strobilurins. These mechanisms alter genes and cause other dysfunctions, including hormonal, cardiac, neurological, and immunological impairment. Despite limitations, we have been able to compile literature information about strobilurins. Many studies have dealt with their toxic effects, but further investigations are needed to clarify their cellular and underlying mechanisms, which will help to find ways to minimize the harmful effects of these compounds.

Assessment of ultra processed foods consumption in Senegal: validation of the Nova-UPF screener.

BACKGROUND: Ultra-processed foods (UPF), as proposed by the Nova food classification system, are linked to the development of obesity and several non-communicable chronic diseases and deaths from all causes. The Nova-UPF screener developed in Brazil is a simple and quick tool to assess and monitor the consumption of these food products. The aim of this study was to adapt and validate, against the 24-hour dietary recall, this short food-based screener to assess UPF consumption in the Senegalese context. METHODS: The tool adaptation was undertaken using DELPHI methodology with national experts and data from a food market survey. Following the adaptation, sub-categories were renamed, restructured and new ones introduced. The validation study was conducted in the urban area of Dakar in a convenience sample of 301 adults, using as a reference the dietary share of UPF on the day prior to the survey, expressed as a percentage of total energy intake obtained via 24-hour recall. Association between the Nova-UPF score and the dietary share of UPF was evaluated using linear regression models. The Pabak index was used to assess the agreement in participants' classification according to quintiles of Nova-UPF score and quintiles of the dietary share of UPF. RESULTS: The results show a linear and positive association (p-value < 0.001) between intervals of the Nova-UPF score and the average dietary share of UPF. There was a near perfect agreement in the distribution of individuals according to score's quintiles and UPF dietary share quintiles (Pabak index = 0.84). CONCLUSION: The study concluded that the score provided by the Nova-UPF screener adapted to the Senegalese context is a valid estimate of UPF consumption.

Patient safety with covid-19 in hospital units: a scoping review.

OBJECTIVE: Map, in the scientific literature, the actions taken to promote the safety of patients with covid-19 in the hospital context. METHODS: This is a scoping review according to the Joanna Briggs Institute, using the Checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. In April 2022, searches were performed on nine data sources. The results were summarized in a table and analyzed descriptively. RESULTS: Fifteen studies were selected to compose the final sample. Most articles refer to cohort studies, followed by clinical trials. As for the areas of activity, there was a predominance of surgical centers, followed by adult and pediatric Intensive Care Units. CONCLUSIONS: With this review, it was possible to map measures such as contingency plans and reorganization of beds, rooms, and operating rooms, in addition to the isolation and distancing practiced by patients and professionals.

Protective effect of Agaricus bisporus mushroom against maternal and fetal damage induced by lead administration during pregnancy in rats.

INTRODUCTION: Lead (Pb) is a toxic pollutant, which can affect different tissues of the human body. The use of natural elements, as medicinal mushroom can reduce the toxic effects of Pb. OBJECTIVE: We evaluated, through preclinical tests, the oral co exposures to mushroom Agaricus bisporus (Ab) by gavage and Pb in drinking water, and the capability of Ab be a protective agent for both pregnant rats and their fetuses. METHODS: Female Wistar rats were divided into four groups (n = 5/group): Group I-Control; Group II-Ab 100 mg/kg; Group III-Pb 100 mg/L; Group IV-Ab +Pb -100 mg/kg +100 mg/L. Exposure was performed until the 19th day of gestation. On the 20th day, pregnant rats were euthanized, and the outcomes evaluated were weight gain; hematological profile; biochemical markers; oxidative stress markers; reproductive capacity; and embryo fetal development. RESULTS: The characterization of mushrooms reveals them to be a valuable source of nutrients. However, Pb ingestion resulted in reduced weight gain and negative impacts on hematological and biochemical parameters. Fortunately, co administration of mushrooms helped to mitigate these negative effects and promote recovery. The mushroom also showed antioxidant activity, improving parameters of oxidative stress. In addition, Ab partially recovered the damage in fetal morphology and bone parameters. CONCLUSION: Our findings indicated that the co administration of Ab improved the toxicity caused by Pb, and the mushroom could be used as a natural alternative as a protective/chelator agent.

The use of noninvasive measurements of intracranial pressure in patients with traumatic brain injury: a narrative review.

BACKGROUND: The most frequent cause of death in neurosurgical patients is due to the increase in intracranial pressure (ICP); consequently, adequate monitoring of this parameter is extremely important. OBJECTIVES: In this study, we aimed to analyze the accuracy of noninvasive measurement methods for intracranial hypertension (IH) in patients with traumatic brain injury (TBI). METHODS: The data were obtained from the PubMed database, using the following terms: intracranial pressure, noninvasive, monitoring, assessment, and measurement. The selected articles date from 1980 to 2021, all of which were observational studies or clinical trials, in English and specifying ICP measurement in TBI. At the end of the selection, 21 articles were included in this review. RESULTS: The optic nerve sheath diameter (ONSD), pupillometry, transcranial doppler (TCD), multimodal combination, brain compliance using ICP waveform (ICPW), HeadSense, and Visual flash evoked pressure (FVEP) were analyzed. Pupillometry was not found to correlate with ICP, while HeadSense monitor and the FVEP method appear to have good correlation, but sensitivity and specificity data are not available. The ONSD and TCD methods showed good-to-moderate accuracy on invasive ICP values and potential to detect IH in most studies. Furthermore, multimodal combination may reduce the error possibility related to each technique. Finally, ICPW showed good accuracy to ICP values, but this analysis included TBI and non-TBI patients in the same sample. CONCLUSIONS: Noninvasive ICP monitoring methods may be used in the near future to guide TBI patients' management.

ANTECEDENTES: A causa mais frequente de morte em pacientes neurocirúrgicos é devido ao aumento da pressão intracraniana (PIC); consequentemente, o monitoramento adequado desse parâmetro é de extrema importância. OBJETIVOS: Avaliar na literatura científica os principais métodos não invasivos de medida da PIC em pacientes com traumatismo cranioencefálico (TCE). MéTODOS: Os dados foram obtidos na base de dados PubMed, utilizando os seguintes termos: pressão intracraniana, não invasivo, monitoramento, avaliação e medida, resultando em 147 artigos. Os artigos selecionados datam de 1980 a 2021, sendo todos estudos observacionais ou ensaios clínicos, em inglês e especificando a medida da pressão intracraniana em traumatismo cranioencefálico. Ao final da seleção, 21 artigos foram incluídos nesta revisão. RESULTADOS: Foram analisados os seguintes métodos: diâmetro da bainha do nervo óptico (ONSD), pupilometria, doppler transcraniano (TCD), combinação multimodal, complacência cerebral por meio da análise de ondas intracerebrais (ICPW), HeadSense e visual evocado por flashes de luz (FVEP). A pupilometria não se correlacionou com os valores de PIC, enquanto que o monitor HeadSense e o método FVEP parecem ter uma boa correlação, mas os dados de sensibilidade e especificidade desses métodos não estão disponíveis. Os métodos ONSD e TCD mostraram acurácia de boa a moderada quanto aos valores de IPCi, além de bom potencial para detectar hipertensão intracraniana. Ademais, a combinação multimodal pode reduzir a possibilidade de erro relacionado a cada técnica. Por fim, o ICPW apresentou boa acurácia quanto aos valores de ICPi, mas, no estudo analisado, foram incluídos pacientes com e sem TCE em uma mesma amostra. CONCLUSõES: Métodos não invasivos de medição da PIC podem atuar no futuro no manejo de pacientes com TCE como uma potencial ferramenta de triagem para TCE grave e para a detecção de hipertensão intracraniana.

The use of noninvasive measurements of intracranial pressure in patients with traumatic brain injury: a narrative review / Avaliação não invasiva da pressão intracraniana em pacientes com traumatismo cranioencefálico: uma revisão narrativa

Abstract Background The most frequent cause of death in neurosurgical patients is due to the increase in intracranial pressure (ICP); consequently, adequate monitoring of this parameter is extremely important. Objectives In this study, we aimed to analyze the accuracy of noninvasive measurement methods for intracranial hypertension (IH) in patients with traumatic brain injury (TBI). Methods The data were obtained from the PubMed database, using the following terms: intracranial pressure, noninvasive, monitoring, assessment, and measurement. The selected articles date from 1980 to 2021, all of which were observational studies or clinical trials, in English and specifying ICP measurement in TBI. At the end of the selection, 21 articles were included in this review. Results The optic nerve sheath diameter (ONSD), pupillometry, transcranial doppler (TCD), multimodal combination, brain compliance using ICP waveform (ICPW), HeadSense, and Visual flash evoked pressure (FVEP) were analyzed. Pupillometry was not found to correlate with ICP, while HeadSense monitor and the FVEP method appear to have good correlation, but sensitivity and specificity data are not available. The ONSD and TCD methods showed good-to-moderate accuracy on invasive ICP values and potential to detect IH in most studies. Furthermore, multimodal combination may reduce the error possibility related to each technique. Finally, ICPW showed good accuracy to ICP values, but this analysis included TBI and non-TBI patients in the same sample. Conclusions Noninvasive ICP monitoring methods may be used in the near future to guide TBI patients' management.

Resumo Antecedentes A causa mais frequente de morte em pacientes neurocirúrgicos é devido ao aumento da pressão intracraniana (PIC); consequentemente, o monitoramento adequado desse parâmetro é de extrema importância. Objetivos Avaliar na literatura científica os principais métodos não invasivos de medida da PIC em pacientes com traumatismo cranioencefálico (TCE). Métodos Os dados foram obtidos na base de dados PubMed, utilizando os seguintes termos: pressão intracraniana, não invasivo, monitoramento, avaliação e medida, resultando em 147 artigos. Os artigos selecionados datam de 1980 a 2021, sendo todos estudos observacionais ou ensaios clínicos, em inglês e especificando a medida da pressão intracraniana em traumatismo cranioencefálico. Ao final da seleção, 21 artigos foram incluídos nesta revisão. Resultados Foram analisados os seguintes métodos: diâmetro da bainha do nervo óptico (ONSD), pupilometria, doppler transcraniano (TCD), combinação multimodal, complacência cerebral por meio da análise de ondas intracerebrais (ICPW), HeadSense e visual evocado por flashes de luz (FVEP). A pupilometria não se correlacionou com os valores de PIC, enquanto que o monitor HeadSense e o método FVEP parecem ter uma boa correlação, mas os dados de sensibilidade e especificidade desses métodos não estão disponíveis. Os métodos ONSD e TCD mostraram acurácia de boa a moderada quanto aos valores de IPCi, além de bom potencial para detectar hipertensão intracraniana. Ademais, a combinação multimodal pode reduzir a possibilidade de erro relacionado a cada técnica. Por fim, o ICPW apresentou boa acurácia quanto aos valores de ICPi, mas, no estudo analisado, foram incluídos pacientes com e sem TCE em uma mesma amostra. Conclusões Métodos não invasivos de medição da PIC podem atuar no futuro no manejo de pacientes com TCE como uma potencial ferramenta de triagem para TCE grave e para a detecção de hipertensão intracraniana.

Magnetized vermiculite as a tool for the treatment of produced water generated by oil companies: Effects on aquatic organisms before and after treatment.

Produced water (PW) generated by oil companies is a highly impacting waste that contains chemicals such as metals and organic and inorganic compounds. Given its polluting potential, PW requires effective treatment before being discharged into the environment. Conventional treatments have limited efficiency in removing PW toxicity, so alternative approaches must be developed and standardized. In this context, treatment with adsorbent materials like magnetized vermiculite (VMT-mag) is highlighted. This work aimed to evaluate the efficiency of treatment with VMT-mag in reducing PW toxicity to aquatic biota. For this purpose, three aquatic species (the midge Chironomus riparius, the planarian Girardia tigrina, and the crustacean Daphnia magna) were exposed to untreated PW and to PW treated with VMT-mag at laboratory conditions. The assessed endpoints included mortality, growth, emergence, and developmental time of C. riparius; mortality, locomotion, feeding, and head regeneration of G. tigrina; and intrinsic population growth rate (r) and reproductive output of D. magna. The results showed that all the species exposed to raw PW were impaired: C. riparius had delayed development, G. tigrina had reduced locomotor activity and delayed head regeneration, and D. magna had reduced reproduction and delayed intrinsic population growth rate (r). Most of the analyzed parameters showed that treatment with VMT-mag diminished PW toxicity. Therefore, using VMT-mag to treat PW may be the key to reducing the PW effects on aquatic organisms.

Longitudinal evolution of central nervous system anomalies in fetuses with open spina bifida fetoscopic repair and correlation with neurologic outcome.

BACKGROUND: Open spina bifida is associated with central nervous system anomalies such as abnormal corpus callosum and heterotopias. However, the impact of prenatal surgery over these structures remains unclear. OBJECTIVE: This study aimed to describe longitudinal changes of central nervous system anomalies before and after prenatal open spina bifida repair and to evaluate their relationship with postnatal neurologic outcomes. STUDY DESIGN: Retrospective cohort study of fetuses with open spina bifida who underwent percutaneous fetoscopic repair from January 2009 to August 2020. All women had presurgical and postsurgical fetal magnetic resonance imaging, at an average of 1 week before and 4 weeks after surgery, respectively. We evaluated defect characteristics in the presurgical magnetic resonance images; and fetal head biometry, clivus supraocciput angle, and the presence of structural central nervous system anomalies, such as abnormalities in corpus callosum, heterotopias, ventriculomegaly, and hindbrain herniation, in both presurgical and postsurgical magnetic resonance images. Neurologic assessment was performed using the Pediatric Evaluation of Disability Inventory scale in children who were 12 months or older, covering 3 different sections, namely self-care, mobility, and social and cognitive function. RESULTS: A total of 46 fetuses were evaluated. Presurgery and postsurgery magnetic resonance imaging were performed at a median gestational age of 25.3 and 30.6 weeks, with a median interval of 0.8 weeks before surgery, and 4.0 weeks after surgery. There was a 70% reduction in hindbrain herniation (100% vs 32.6%; P<.001), and a normalization of the clivus supraocciput angle after surgery (55.3 [48.8-61.0] vs 79.9 [75.2-85.4]; P<.001). No significant increase in abnormal corpus callosum (50.0% vs 58.7%; P=.157) or heterotopia (10.8% vs 13.0%; P=.706) was observed. Ventricular dilation was higher after surgery (15.6 [12.7-18.1] vs 18.8 [13.7-22.9] mm; P<.001), with a higher proportion of severe ventricular dilation after surgery (≥15mm) (52.2% vs 67.4%; P=.020). Thirty-four children underwent neurologic assessment, with 50% presenting a global optimal Pediatric Evaluation of Disability Inventory result and 100% presenting a normal social and cognitive function. Children with optimal global Pediatric Evaluation of Disability Inventory presented a lower rate of presurgical anomalies in corpus callosum and severe ventriculomegaly. When analyzed as independent variables to global Pediatric Evaluation of Disability Inventory scale, the presence of abnormal corpus callosum and severe ventriculomegaly showed an odds ratio of 27.7 (P=.025; 95% confidence interval, 1.53-500.71) for a suboptimal result. CONCLUSION: Prenatal open spina bifida repair did not change the proportion of abnormal corpus callosum nor heterotopias after surgery. The combination of presurgical abnormal corpus callosum and severe ventricular dilation (≥15 mm) is associated with an increased risk of suboptimal neurodevelopment.

Evaluation of Bacillus subtilis as a Tool for Biodegrading Diesel Oil and Gasoline in Experimentally Contaminated Water and Soil.

Benzene, toluene, ethylbenzene and xylene (BTEX) are toxic petroleum hydrocarbons pollutants that can affect the central nervous system and even cause cancer. For that reason, studies regarding BTEX degradation are extremely important. Our study aimed evaluate the microorganism Bacillus subtilis as a tool for degrading petroleum hydrocarbons pollutants. Assays were run utilizing water or soil distinctly contaminated with gasoline and diesel oil, with and without B. subtilis. The ability of B. subtilis to degrade hydrophobic compounds was analyzed by Fourier-Transform Infrared Spectroscopy (FTIR) and gas chromatography. The FTIR results indicated, for water assays, that B. subtilis utilized the gasoline and diesel oil to produce the biosurfactant, and, as a consequence, performed a biodegradation process. In the same way, for soil assay, B. subtilis biodegraded the diesel oil. The gas chromatography results indicated, for gasoline in soil assay, the B. subtilis removed BTEX. So, B. subtilis was capable of degrading BTEX, producing biosurfactant and it can also be used for other industrial applications. Bioremediation can be an efficient, economical, and versatile alternative for BTEX contamination.

Impact of umbilical cord mesenchymal stromal/stem cell secretome and cord blood serum in prostate cancer progression.

Prostate cancer (PCa) is the second most common malignancy in men, and the fifth leading cause of death worldwide. Mesenchymal stromal/stem cells (MSC) have been identified in PCa, although contradictory effects in malignant transformation and tumor progression have been described. Since umbilical cord (UC) MSC and cord blood serum (CBS) are rich in numerous growth and anti-inflammatory factors, UC-MSC secretome and CBS are able to modulate tumor cell proliferation and survival as well as immunity and angiogenesis. In the present study, we address this relationship and investigate the influence of UC-MSC secretome and CBS on two human PCa cell lines (PC3 and LNCaP) and a normal epithelial prostate cell line (HPEpiC). Our results disclosed that upon exposure to UC-MSC-conditioned medium or CBS, both PC3 and LNCaP cells exhibited reduced viability, proliferation, and motility while non-malignant epithelial prostate cells were unaffected. These findings were corroborated by expression analysis of AKT/PI3K signaling pathway, p53 and interleukin genes. UC-MSC and CBS factors decreased the expression of growth-stimulating AKT and PI3K effectors and simultaneously up-regulated the expression of tumor-suppressor p53. Moreover, a more anti-inflammatory expression profile was found in both malignant PCa cell lines. Altogether, these results shed light into possible mechanisms by which UC-MSC and CBS reduce PCa progression, further reinforcing their potential use as novel therapeutic agents in PCa.

Impacto da aquisição de alimentos ultraprocessados e da carne bovina sobre a agrobiodiversidade no Brasil (2017-18) / Impact of ultra-processed food and beef acquisition on agrobiodiversity in Brazil (2017-18)

Introdução: A agrobiodiversidade é recurso essencial para a promoção de dietas e sistemas alimentares saudáveis e sustentáveis. Apesar disso, a agrobiodiversidade global está em declínio, especialmente a diversidade de espécies vegetais utilizadas para consumo humano. Objetivo: Esta tese buscou estudar a agrobiodiversidade mobilizada pela aquisição domiciliar de alimentos no Brasil e a influência que padrões de aquisição de alimentos ultraprocessados e de carne bovina exercem sobre a agrobiodiversidade. Métodos: Estudo transversal em que foram analisados dados da Pesquisa Nacional de Orçamentos Familiares 2017-18 a fim de estimar a quantidade total de alimentos adquiridos. Agregados de domicílios (n=575) foram utilizados como unidade de análise do estudo. Os itens alimentares adquiridos foram classificados segundo a classificação Nova. Metodologia inédita de quatro passos foi aplicada para estimar a diversidade de espécies subjacentes às aquisições domiciliares de alimentos. O índice de Shannon foi utilizado para avaliar a diversidade de espécies vegetais mobilizadas. Modelos de regressão linear foram utilizados para testar associações entre a participação da carne bovina e de alimentos ultraprocessados no total adquirido e o índice de Shannon. O primeiro manuscrito apresenta as hipóteses desta tese e ressalta a ausência do debate a respeito dos efeitos dos alimentos ultraprocessados sobre a agrobiodiversidade nas agendas internacionais de sistemas alimentares, biodiversidade e mudanças climáticas. O segundo manuscrito descreve a abordagem metodológica utilizada para estimar a agrobiodiversidade demandada pela dieta, bem como aplicar esta abordagem em dados de aquisição de alimentos no Brasil. O terceiro manuscrito descreve a diversidade de espécies vegetais mobilizadas pela população brasileira, além de investigar o impacto de diferentes padrões de aquisição (de ultraprocessados e de carne bovina) sobre a diversidade de espécies vegetais mobilizadas. Resultados: Mais de 95% da quantidade total de espécies vegetais mobilizadas pela aquisição domiciliar de alimentos no Brasil foram provenientes de apenas seis espécies: braquiária, milho, soja, arroz, cana-de-açúcar e trigo. O valor médio do índice de Shannon relativo à diversidade de espécies vegetais mobilizadas foi de 0,86 indicando baixa diversidade. Os efeitos simultâneos da participação de alimentos ultraprocessados e da carne bovina no total adquirido sobre a diversidade de espécies vegetais mobilizadas mostraram que os valores médios ajustados do índice de diversidade diminuíram significativamente em todos os cenários de aquisição de alimentos ultraprocessados com o aumento da participação de carne no total adquirido. De forma semelhante, o índice de Shannon tendeu a diminuir significativamente em todos os cenários de aquisição de carne bovina com aumento da participação de ultraprocessados no total adquirido, com exceção do último quinto de participação da carne bovina (p>0,05). O índice de Shannon caiu pela metade (51%) passando de um cenário com menor participação de ultraprocessados e de carne bovina (1,22) para um cenário com a maior participação de ambos os grupos (0,60). Conclusões: Os resultados deste estudo demonstram uma baixa diversidade de espécies vegetais mobilizadas por agregados de domicílios brasileiros, com alta concentração em um número muito reduzido de espécies. Observou-se piora da diversidade de espécies mobilizadas com o aumento da participação de alimentos ultraprocessados e da carne bovina.

Introduction: Agrobiodiversity is key for promoting healthy diets and moving towards more sustainable food systems. Despite this, global agrobiodiversity is declining, especially the diversity of plant species used for human consumption. Objective: This thesis aims to study the agrobiodiversity mobilized by household food acquisition in Brazil and the influence that ultra-processed food and beef acquisitions might exert on agrobiodiversity. Methods: Cross-sectional study in which data from the 2017-18 National Household Budget Survey were used to quantify the total amount of foods purchased. Household aggregates (n=575) were used as the unit of analysis. All food items were classified according to the Nova classification system. A sequential, four-step approach was applied to estimate the plant species underlying household food acquisitions. The Shannon index was used to evaluate the diversity of plant species mobilized. Linear regression models were used to test associations between the share of beef and of ultra-processed foods in total food acquisition and the Shannon index. The first manuscript presents the hypotheses of this thesis and highlights the lack of debate around the effects of ultra-processed foods on agrobiodiversity in global food systems fora, biodiversity conventions and climate change conferences. The second manuscript describes the methodological approach used to estimate the agrobiodiversity linked to human diet, and applies this approach to Brazilian food purchase data. The third manuscript describes the diversity of plant species mobilized by the Brazilian population, and investigates the impact of different food acquisition patterns (with a focus on ultra-processed foods and beef) on the diversity of plant species mobilized. Results: More than 95% of the total amount of plant species required by Brazilian household food acquisitions came from only six species - brachiaria, maize, soybean, rice, sugarcane and wheat. The average Shannon index relative to the diversity of plant species that underlie household food acquisitions in Brazil was 0.86, indicating low diversity. Adjusted mean values of the diversity index decreased significantly as the share of beef to total food acquisition increased, in all scenarios of ultra-processed food acquisition. Similarly, the Shannon index tended to significantly decrease with an increase in the share of ultra-processed foods to total food acquisition in all scenarios of beef acquisition, except in the fifth quintile of beef (p>0.05). The Shannon index decreased by half (51%) moving from a scenario with the lowest share of both ultra-processed foods and beef to total food acquisition (1.22) to a scenario with the highest share of both food groups (0.60). Conclusion: Our findings demonstrate a low diversity of species mobilized by Brazilian household aggregates and a high concentration in a small number of species. The diversity of species mobilized decreased with an increase in both the share of ultra-processed foods and of beef in total food acquisitions.

Patient safety with covid-19 in hospital units: a scoping review / Seguridad del paciente con covid-19 en unidades hospitalarias: revisión de ámbito / Segurança do paciente com covid-19 em unidades hospitalares: revisão de escopo

ABSTRACT Objective: Map, in the scientific literature, the actions taken to promote the safety of patients with covid-19 in the hospital context. Methods: This is a scoping review according to the Joanna Briggs Institute, using the Checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. In April 2022, searches were performed on nine data sources. The results were summarized in a table and analyzed descriptively. Results: Fifteen studies were selected to compose the final sample. Most articles refer to cohort studies, followed by clinical trials. As for the areas of activity, there was a predominance of surgical centers, followed by adult and pediatric Intensive Care Units. Conclusions: With this review, it was possible to map measures such as contingency plans and reorganization of beds, rooms, and operating rooms, in addition to the isolation and distancing practiced by patients and professionals.

RESUMEN Objetivo: Mapear, en la literatura científica, las acciones adoptadas para promover la seguridad del paciente con covid-19 en el contexto hospitalario. Métodos: Se trata de una revisión de ámbito de acuerdo con el Instituto Joanna Briggs, utilizando el Checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. En abril de 2022, fueron realizadas búsquedas en nueve fuentes de datos. Los resultados fueron sintetizados en un cuadro y analizados de manera descriptiva. Resultados: Fueron seleccionados 15 estudios para componer la muestra final. La mayoría de los artículos se refieren a estudios de cohorte, seguidos de ensayos clínicos. Cuanto las áreas de actuación, notado predominancia de los centros quirúrgicos, seguidos por Unidades de Cuidados Intensivos adulto y pediátrica. Conclusiones: Con esta revisión, fue posible mapear medidas como planes de contingencia y reorganización de lechos, cuartos y salas quirúrgicas, además del aislamiento y distanciamiento practicados por pacientes y profesionales.

RESUMO Objetivo: Mapear, na literatura científica, as ações adotadas para promover a segurança do paciente com covid-19 no contexto hospitalar. Métodos: Trata-se de uma revisão de escopo de acordo com o Instituto Joanna Briggs, utilizando o Checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Em abril de 2022, foram realizadas buscas em nove fontes de dados. Os resultados foram sintetizados em um quadro e analisados de forma descritiva. Resultados: Foram selecionados 15 estudos para compor a amostra final. A maioria dos artigos se refere a estudos de coorte, seguidos de ensaios clínicos. Quanto às áreas de atuação, notou-se predominância dos centros cirúrgicos, seguidos por Unidades de Terapia Intensiva adulto e pediátrica. Conclusões: Com esta revisão, foi possível mapear medidas como planos de contingência e reorganização de leitos, quartos e salas de cirurgias, além do isolamento e distanciamento praticados pelos pacientes e profissionais.

Food consumption in Brazil: influence of beef on environmental impact and nutritional quality of the diet.

OBJECTIVE: To estimate beef consumption and its influence on carbon and water footprints, as well as to improve the nutritional quality of the Brazilian diet. METHODS: The amount of beef and other foods consumed was evaluated by two 24-hour food records in a representative sample of the Brazilian population ≥ 10 years of age (n = 32,853) from 2008 to 2009. The environmental impact of the diet considered the coefficients of the carbon footprint (gCO2 and/kg) and the water footprint (liters/kg) of the foods, as well as their nutritional quality considering the nutrient composition of each food associated with the prevention of nutritional deficiencies or the increase/decrease in chronic disease risk. Linear and logistic regression models, crude and adjusted for sex, age, education, income, region, and area, were used to respectively study the association of fifths of the caloric contribution of beef with the environmental impacts of the diet and inadequate nutrient intake. RESULTS: Carbon and water footprints and protein, iron, zinc, vitamin B12, saturated fat, and sodium contents were higher in the fraction of the diet composed of beef, whereas fiber and added sugar contents were higher in the fraction composed by the other foods. Dietary beef contribution was directly associated with the carbon and water footprints of the diet and the risk of saturated fat and sodium excess, besides fiber insufficiency, inversely associated with the risk of protein, iron, zinc, and vitamin B12 insufficiency. CONCLUSION: Reducing beef consumption in Brazil would also reduce the carbon and water footprints of the diet, as well as the risk of chronic diseases related to food. Therefore, in order not to increase the risk of nutritional deficiencies, monitoring the increased intake of other foods rich in protein, iron, zinc, and vitamin B12 is suggested.

Effects of Green Tea and Green Tea Incorporated in Nanoparticle Lyotropic Liquid Crystal on Exercise Adaptations: A High-Intensity Interval Training Pre-Clinical Study.

Green tea (GT) is a natural antioxidant, sensitive to oxidation after preparation. Lyotropic liquid crystals (LLCs) are nanostructured systems used to incorporate bioactive compounds. High-intensity interval training (HIIT) is a workout modality that increases the production of reactive oxygen species (ROS). Thus, this research aimed to compare the effects of GT and GT loaded in LLC in animals subjected to HIIT, considering hematological, biochemical and histological parameters, redox status, and body mass. Monoolein, GT in infusion and Poloxamer 407 were mixed to obtain nanoparticles of LLC (NP-LLC). Healthy male rats were randomized into six groups (n = 6/group): Control (C), GT, GT-NP-LLC, Exercise (Ex), GT+Ex, GT-NP-LLC+Ex. Body weight was significantly lower in all groups subjected to HIIT compared to C. The percentages of body mass reduction were 11.3, 13.0, 10.0 and 11.0% for Ex, GT+Ex, GT-NP-LLC and GT-NP-LLC+Ex, respectively, compared to control. GT-NP-LLC and Ex reduced triglycerides compared to C. GT and GT-NP-LLC supplementation combined with HIIT presented higher muscle hypertrophy (25 and 21%, respectively), better physical conditioning, and reduced body weight gain rate compared to HIIT by itself. Moreover, the effects of GT-NP-LLC itself on body mass and biochemical parameters are promising, suggesting NP-LLC could improve the bioavailability of GT.

"I Like the One With Minions": The Influence of Marketing on Packages of Ultra-Processed Snacks on Children's Food Choices.

Objective: This study aimed to assess the most consumed school snacks using the free listing and understand how marketing strategies on food labels influenced children's perceptions of snacks via focus groups. Design: The study design involved free lists and semi-structured focus group interviews. Setting: São Paulo, Brazil. Participants: A total of 69 children were involved in this study. Phenomenon of Interest: Children's perceptions of food labels. Analysis: Food groups mentioned on the free lists were analyzed for their frequency and priority of occurrence. The focus groups were analyzed through content analysis. Results: Juices and chips were the most salient snacks, with availability and flavor as reasons for their consumption. Children found images on labels appealing, which created a desire for the food, although could be deceptive. Snacks perceived as healthy were encouraged by parents, and children could more easily convince them to buy snacks with health claims. Colors and brands were important to catch children's attention and make the snack recognizable. Television commercials and mascots reinforced marketing strategies on labels. Conclusions and Implications: Our results point to the need for public health strategies to deal with the obesity epidemic through creating and implementing specific legislation to regulate food labels to discourage the consumption of unhealthy snacks and prohibit food marketing targeted at children.

Trough-guided Versus AUC/MIC-Guided Vancomycin Monitoring: A Cost Analysis.

PURPOSE: Recent vancomycin dosing and monitoring guidelines recommend monitoring vancomycin area under the 24-hour time-concentration curve instead of traditional trough-only monitoring. This study aimed to compare the total costs of vancomycin dosing and monitoring between trough-guided and AUC-guided approaches in a quaternary hospital from Brazil. METHODS: In this retrospective cohort study, patients were divided into 2 groups according to the monitoring method. Patients with previous renal impairment were excluded. Vancomycin AUC was estimated by using 2 steady-state serum concentrations and first-order kinetics equations. The primary outcome was total cost of vancomycin therapy and monitoring from the hospital perspective, which included costs of cumulative doses, laboratory fees, materials used in blood collection, nursing time for collection, and pharmacist time for result interpretation. FINDINGS: A total of 68 patients were included in the AUC/MIC-guided monitoring group, and 76 patients were included in the trough-guided monitoring group. There were no significant differences between groups regarding baseline serum creatinine level, duration of vancomycin therapy, and cumulative vancomycin dose. The median (interquartile range) total vancomycin drug and monitoring cost was $298.32 ($153.81-$429.85) for the AUC/MIC-guided group compared with $285.59 ($198.81-$435.57) for the trough-guided group (P = 0.9658). IMPLICATIONS: Vancomycin AUC estimation using 2 steady-state serum concentrations and first-order kinetics equations is a feasible alternative for limited-resource institutions that intend to transition from a trough approach to AUC/MIC-guided monitoring.

Association between advertising patterns and ultra-processed food in small markets. / Associação entre padrão de publicidade e alimento ultraprocessado em pequenos mercados.

This article aims to characterize the advertising appeals present in the food environment to market ultra-processed foods and to analyze the nutritional profile of these foods according to PAHO criteria and the presence of food additives. Cross-sectional study, with data audited in 20 small supermarkets in São Paulo. The INFORMAS protocol was used to classify the advertising messages. The foods were classified according to NOVA. The PAHO profile model was used to classify foods high in critical nutrients. Advertising patterns were identified by factor analysis. The association between patterns and food groups was investigated by linear regression. More than 95% of the ultraprocessed foods had at least 1 critical nutrient in excess. There was a positive association between the new brand, fun and advantageous pattern with snacks, ready-made products, dairy products and cookies; between the new brand and suggested use pattern with dairy products. The standardization of food advertising in small retail stores is associated with offering snacks, dairy products, ready-to-eat foods and cookies, products that exceed critical nutrients.

O objetivo deste artigo é caracterizar os apelos publicitários presentes no ambiente alimentar para comercializar alimentos ultraprocessados e analisar o perfil nutricional desses alimentos segundo critérios da OPAS e presença de aditivos alimentares. Estudo transversal, com dados auditados em 20 pequenos supermercados de São Paulo. O protocolo INFORMAS foi utilizado para classificar as mensagens publicitárias. Os alimentos foram classificados segundo a NOVA. O perfil nutricional da OPAS foi utilizado para classificar os alimentos elevados em nutrientes críticos. Os padrões de publicidade foram identificados por análise fatorial. A associação entre os padrões e os grupos de alimentos foi investigada por regressão linear. Mais de 95% dos alimentos ultraprocessados tinham pelo menos um nutriente crítico em excesso. Verificou-se associação positiva entre o padrão nova marca, divertido e vantajoso com salgadinhos, produtos pré-prontos, lácteos e biscoitos, e entre o padrão nova marca e uso sugerido com lácteos. A padronização da publicidade de alimentos nos pequenos comércios varejistas está associada à oferta de salgadinhos, produtos lácteos, alimentos pré-prontos e biscoitos, produtos que excedem em nutrientes críticos.

Urethral leiomyoma: combined vaginal and abdominal approach - a case report / Mioma uretral: abordagem combinada vaginal e abdominal - um relato de caso

Abstract Introduction: leiomyomas are benign mesenchymal tumors of smooth muscle origin that can develop in various locations. Urethral leiomyomas are rare, with approximately only 120 cases reported in the literature. These tumors often occur in the third and fourth decades of life but are rare in menopausal patients. In general, treatment involves surgery, only three recurrence reports in the literature. Description: a case report on a 56-year-old woman; the patient had type II diabetes mellitus and chronic high blood pressure, was overweight (body mass index, 27.1 kg/m2), and a smoker. Besides this, the patient presented symptoms of urinary obstruction and had a large urethral leiomyoma. The tumor was completely removed with no associated urethral lesions using a complex, combined abdominalvaginal surgical approach. Discussion: the management and treatment on urethral leiomyomas is challenging and have not been established yet due to the rarity of these tumors.

Resumo Introdução: os leiomiomas são tumores mesenquimais benignos de origem muscular lisa, podendo manifestar-se em diversas localizações. Os leiomiomas uretrais são raros, tendo apenas aproximadamente 120 casos relatados na literatura. São mais comuns na terceira e quarta décadas de vida, sendo raros em pacientes menopausadas. Em geral, são tratados cirurgicamente, com apenas três relatos de recidivas na literatura. Descrição: relato de caso de uma paciente do sexo feminino, 56 anos, portadora de diabetes mellitus do tipo II, hipertensão arterial crônica, sobrepeso (IMC 27,1Kg/m2) e tabagismo. Além disso, com quadro de sintomas obstrutivos urinários e portadora de um grande leiomioma uretral, este que foi completamente removido, através de uma desafiadora abordagem cirúrgica combinada (abdominal e vaginal), sem lesões uretrais associadas. Discussão: os leiomiomas uretrais são tumores raros e seu manejo é desafiador e ainda não foi estabelecido.