Consumption of sugar-sweetened and artificially sweetened beverages and prevalence of hypertension in adults: a population- based study

Systemic Arterial Hypertension is a multifactorial clinical condition associated with severe outcomes such as stroke and death. One of the main modifiable risk factor for hypertension is an unhealthy diet, often characterized by the consumption of ultraprocessed foods such as sweetened beverages. We aimed to investigate the relationship between the consumption of sweetened beverages, both sugar-sweetened and artificially sweetened, and the prevalence of hypertension in adults. A cross-sectional, household, population-based study with 1,162 adults from two Brazilian cities were carried out. The consumption of food groups and sweetened beverages was obtained by food frequency questionnaire and other data were self-reported. Weight, height, and waist circumference were measured. The association between sweetened beverages consumption and hypertension was analyzed using Poisson regression models, expressed as Prevalence Ratio. The prevalence of hypertension was 16.7%, with no significant difference between genders. The prevalence of consumption of sweetened beverages was 70.3% in men and 54.6% in women, being significantly higher in men. Women who consumed sugar-sweetened and artificially sweetened beverages 6 to 7 days per week had 92% higher prevalence of hypertension compared to those who did not consume or consumed at a lower frequency. Furthermore, women who consumed artificially sweetened beverages at least 1 time per week had 3.36 times higher prevalence of hypertension. The habitual consumption of sweetened beverages may be an important risk factor for hypertension, especially the consumption of diet beverages, which are often marketed as healthier than sugar-sweetened beverages.

La Hipertensión Arterial Sistémica es una condición clínica multifactorial asociada a resultados graves como el ictus y la muerte. Uno de los principales factores de riesgo modificables de la hipertensión es una dieta poco saludable, a menudo caracterizada por el consumo de alimentos ultraprocesados como las bebidas endulzadas. Nuestro objetivo fue investigar la relación entre el consumo de bebidas endulzadas, tanto azucaradas como edulcoradas artificialmente, y la prevalencia de hipertensión en adultos. Se realizó un estudio transversal, domiciliario y poblacional con 1,162 adultos de dos ciudades brasileñas. El consumo de grupos de alimentos y bebidas endulzadas se obtuvo mediante cuestionario de frecuencia de alimentos y los demás datos fueron autoinformados. Se midieron el peso, la talla y el perímetro de la cintura. La asociación entre el consumo de bebidas endulzadas y la hipertensión se analizó mediante modelos de regresión de Poisson, expresados como Ratio de Prevalencia. La prevalencia de hipertensión fue del 16,7%, sin diferencias significativas entre géneros. La prevalencia de consumo de bebidas endulzadas fue del 70,3% en los hombres y del 54,6% en las mujeres, siendo significativamente mayor en los hombres. Las mujeres que consumían bebidas azucaradas y edulcoradas artificialmente entre 6 y 7 días a la semana tenían 92% mayor prevalencia de hipertensión que las que no consumían o consumían con una frecuencia menor. Además, las mujeres que consumían bebidas edulcoradas al menos 1 vez por semana tenían una prevalencia de hipertensión 3,36 veces mayor. Así pues, el consumo habitual de bebidas endulzadas puede ser un importante factor de riesgo de hipertensión, especialmente el consumo de bebidas dietéticas, que a menudo se comercializan como más saludables que las bebidas azucaradas.

Legislation in Hospital Dentistry: Gaps, Perspectives and Desires

Abstract Objective: To analyze the existing state legislation, including not only the ordinary laws, but also their infralegal regulation and the state legislation on Hospital Dentistry. Material and Methods: A survey was carried out in the databases of the Legislative Assemblies of the Brazilian States and the Federal District, as well as the Regional and Federal Councils of Dentistry in Brazil. Subsequently, a survey was carried out in the databases of the Ministry of Health, State Dental Councils and Federal Dental Council in Brazil. Results: Only 8 Brazilian states have legislation in force regarding hospital dentistry, which represents 29.63% of the federative units. Among the Brazilian regions, the Midwest presented the highest prevalence of the laws found (37.50%), followed by the North (25%) and the other regions with the same coverage (12.50%). Also, an orientation and an ordinance from the Ministry of Health, six resolutions from the Federal Council of Dentistry, and a technical note from the National Health Surveillance Agency were found. Conclusion: Several States do not have rules on the subject, making it imperative to create a federal rule that not only imposes the presence of the dentist, but also regulates the proportion of the team, workload, and availability.

Effects of feeding diets with zinc-l-selenomethionine on growth performance of broilers subjected to cyclic heat stress.

Limited information exists on the use of zinc-l-selenomethionine (Zn-L-SeMet) in broiler diets and its effects on the growth performance, body temperature, mortality rates, blood profile, and gene expression, especially when animals are reared under cyclic heat stress conditions. This study aimed to investigate the impact of Zn-L-SeMet in broiler diets from 1 to 42 days of age reared under cyclic heat stress and its effects on growth performance, cloacal temperatures, mortality rate, blood parameters, and insulin-like growth factor 1 (IGF-1) and growth hormone receptor (GHR) gene expression in the breast muscle. A total of 1000 male Cobb 500® broiler chicks were randomly assigned to five treatments: 0, 0.15, 0.23, 0.47, and 1.30 mg/kg of Zn-L-SeMet. Each treatment consisted of 10 replicates with 20 birds each. No statistically significant differences in growth performance were observed from 1 to 21 days of age (P > 0.05). However, from 1 to 42 days, feed intake (FI) and feed conversion ratio (FCR) decreased linearly (P < 0.05). Cloacal temperatures showed no significant effects (P > 0.05), while overall mortality rate exhibited a quadratic response (P < 0.05), with the optimal inclusion level predicted to reduce broiler mortality at 0.71 mg/kg. Triglyceride (TRG) levels increased with 0.97 mg/kg (P < 0.05), and gama-glutamil transferase (GGT) levels decreased with the inclusion of 1.19 mg/kg (P < 0.05). No significant effects on IGF-1 and GHR gene expression were found (P > 0.05). In conclusion, the inclusion of 1.30 mg/kg of Zn-L-SeMet in diets of heat-stressed broilers improved growth performance from 1 to 42 days of age. An inclusion of 0.71 mg/kg reduced mortality rate, while 0.97 mg and 1.19 mg increased and reduced TRG and GGT levels, respectively.

Unintended Consequence: Diversity as a Casualty of Eliminating United States Medical Licensing Examination Step 1 Scores.

PURPOSE: The purpose of this study was to use a discrete-choice experiment to model the trade-offs evaluators make between academic attributes and demographics when the United States Medical Licensing Examination (USMLE) Step 1 switches to pass/fail. METHODS: A discrete-choice experiment was administered to faculty members from a geographically diverse mix of 14 academic and community radiology departments in the United States from August through November 2020. Reviewers reviewed 10 applicant pairs with numeric Step 1 scores (part 1) and 10 applicant pairs with a pass Step 1 result (part 2). Applicant attributes included medical school rank, gender, race/ethnicity, USMLE Step 1 score, USMLE Step 2 score, class rank, clerkship honors, and publications. Conditional logistic regression modeled the influence of attribute levels. RESULTS: Two hundred twelve evaluators completed the study (response rate 59%). The most influential attribute was Step 1 score in part 1 and medical school rank in part 2. The relative importance of race/ethnicity and gender decreased by 25% and 29%, respectively, when Step 1 switches to pass/fail. Evaluators weigh race/ethnicity the strongest when applicants have the same Step 1 score (preference weights of 0.85 for African American, 1.42 for Hispanic, and 0 for White and Asian applicants). Race/ethnicity is relatively more important when Step 1 scores are higher (preference weights of 1.58 for African American, 0.90 for Hispanic, and 0 for White and Asian applicants). CONCLUSIONS: The loss of numeric Step 1 scores reduced the residency evaluator preference for diversity. Reviewers prioritize underrepresented-in-medicine applicants when Step 1 scores are higher and comparable with White and Asian applicants.

Hydrogen peroxide signal photosynthetic acclimation of Solanum lycopersicum L. cv Micro-Tom under water deficit.

The current climate change setting necessitates the development of methods to mitigate the effects of water scarcity to ensure the sustainability of agricultural activities.f Hydrogen peroxide (H2O2) is a plant signaling molecule that can trigger metabolic defense mechanisms in response to adverse environmental circumstances like as drought. The purpose of this study was to investigate if foliar application of H2O2 stimulates modifications in photosynthetic metabolism for adaptation of tomato plants to a period of water deficit and recovery. The study, which was carried out in a factorial scheme, tested plants subjected to two water conditions (well-watered plants and plants subjected to water deficit), as well as foliar application of 1 mM H2O2 (zero, one, or two applications, 24 h after the first), and was evaluated in two moments, during the deficit period and after recovery. Foliar application of 1 mM H2O2 resulted in a 69% increase in the maximum rate of RuBisCO carboxylation in well-watered plants, contributing to tomato photosynthetic adjustment. H2O2 treatment resulted in a 37% increase in dry mass in these plants. In plants subjected to water deficiency, 2× H2O2 increased stress tolerance by reducing the maximal rate of RuBisCO carboxylation by only 18%, but in plants that did not receive H2O2 treatment, the reduction was 86% in comparison to the wet plants. Plants exposed to a water shortage and given 2× H2O2 stored sucrose in the leaves and had a 17% higher relative water content than plants not given H2O2. Thus, H2O2 foliar treatment can be used in tomato management to induce drought tolerance or to boost photosynthetic activity and dry mass formation in well-watered plants.

Association between Consumption of Ultra-Processed Food and Body Composition of Adults in a Capital City of a Brazilian Region.

The present study investigates the relationship between the consumption of ultra-processed foods (UPF) and anthropometric indices of body composition in adults and seniors living in Teresina, the state capital of an area in northeastern Brazil. The article seeks to address two questions: Is UPF consumption linked to worsening body composition in different age groups? Do anthropometric indicators of body composition change with the increasing consumption of UPF? The study is a cross-sectional, household, population study, carried out with 490 adults and seniors. The food consumption was obtained with a 24 h food recall, and the foods were classified using NOVA. Anthropometric indicators evaluated were waist-to-height ratio, triceps skinfold thickness, arm circumference, corrected arm muscle area, subscapular skinfold thickness, and calf circumference. The association between energy contribution of UPF with anthropometric indicators was verified with a simple and multiple linear regression analysis. Individuals aged 20 to 35 years showed a significant association between UPF consumption and skinfold thickness (ß: 0.04; CI: 0.03/0.09), demonstrating an increase in this subcutaneous body fat marker with higher UPF consumption. Moreover, in participants aged 36 to 59 years, an inverse correlation between UPF intake and muscle mass markers, arm circumference (ß: -0.02; confidence interval: -0.03/-0.01), and corrected arm muscle area (ß: -0.07; confidence interval: -0.12/-0.02) were observed. Such results suggest there is decreased muscle mass with increasing UPF consumption. This is the first study that verified an association between UPF consumption and low-cost body composition indicators in different age groups.

Prevalence of overweight and association with lifestyle habits in adults: A population-based study

The objective of this study was to verify the association between lifestyle habits and obesity in a sample of adults from the "Inquérito de Saúde Domiciliar no Piauí - ISAD-PI" (Home Health Survey in Piauí - ISAD-PI). A cross-sectional population-based household study was performed with a representative sample of 1,163 adults from the cities of Teresina and Picos, Piauí, Brazil who were participants of ISAD-PI. Sociodemographic and lifestyle data were collected utilizing a structured questionnaire adapted from other Brazilian population studies and analyzed using Stata. Most of the population had healthy lifestyle habits, with adequate consumption of fruits/vegetables and beans, as well as a low consumption of soft drinks, sweets, and red meats. Alcohol consumption was more prevalent among overweight individuals. Individuals who had the habit of consuming alcohol and those who consumed beans less than five days a week had a significantly higher prevalence of overweight. A higher prevalence of overweight was significantly associated with weekly frequency of beans consumption and alcohol intake.

El objetivo de este estudio fue verificar la asociación entre los hábitos de vida y la obesidad en adultos en una muestra del Inquérito de Saúde Domiciliar - ISAD (Encuesta de Salud en el Hogar). Estudio transversal de base poblacional y domiciliar, muestra representativa de 1.163 adultos, de los municipios de Teresina y Picos, Piauí, Brasil, de la ISAD-PI. La recopilación de datos sociodemográficos y de estilo de vida se realizó utilizando un cuestionario estructurado adaptado de otros estudios de población brasileños y analizado con Stata. La mayor parte de la población tenía hábitos de vida más saludables, con un consumo adecuado de frutas/verduras y frijoles, así como un bajo consumo de refrescos, dulces y carnes rojas. El consumo de alcohol fue más frecuente entre las personas con sobrepeso. Los individuos que tenían el hábito de consumir alcohol y los que consumían frijoles menos de cinco días a la semana presentaron prevalencias significativamente mayores de sobrepeso. Se observó dada la alta prevalencia de sobrepeso, que mostró asociaciones significativas entre frecuencia semanal de consumo de frijol y consumo de alcohol.

Risk governance in the response to global health emergencies: understanding the governance of chaos in Brazil's handling of the Covid-19 pandemic.

The Covid-19 caused by the SARS-CoV-2 virus has shown how inadequate institutional strategies interact with, and exacerbate, social inequalities, thus impacting upon the intensity of the harm produced and amplifying negative consequences. One of the lessons from this pandemic, which happens against the background of other, interconnected systemic crises, is the urgency of adopting a 'whole-of-society' approach to determining what does and what does not work in the context of a health emergency response. However, how can institutional performance in health emergency response be assessed? How to make sense of success or failure? We argue that the adoption of a risk governance approach sheds light on institutional performance in the response to health emergencies. Risk governance is particularly pertinent in situations where the potential for extreme consequences is considered high, where there are enormous uncertainties regarding the consequences and where different values are present and in dispute. Based on a documentary evidence review, we analyse the Brazilian response to Covid-19 by considering: (1) how the Brazilian federal government performed on its central role of managing the national response, (2) the reactions from other actors prompted by this performance and (3) the main observed effects emerging from this scenario. We argue that the Brazilian federal government response was weak in five risk governance parameters that are essential in a health crisis response: risk communication, transparency and accessibility of data, negotiation between actors, social cohesion and public participation and decisions based on technical and scientific evidence, resources and contexts. The neglect of risk governance parameters, combined with an attempt to spread doubt, confusion and disinformation-which could be termed a 'governance by chaos'-is an important element for making sense of the effects and controversies surrounding Covid-19 in Brazil.

Comparison Theorems for Stochastic Chemical Reaction Networks.

Continuous-time Markov chains are frequently used as stochastic models for chemical reaction networks, especially in the growing field of systems biology. A fundamental problem for these Stochastic Chemical Reaction Networks (SCRNs) is to understand the dependence of the stochastic behavior of these systems on the chemical reaction rate parameters. Towards solving this problem, in this paper we develop theoretical tools called comparison theorems that provide stochastic ordering results for SCRNs. These theorems give sufficient conditions for monotonic dependence on parameters in these network models, which allow us to obtain, under suitable conditions, information about transient and steady-state behavior. These theorems exploit structural properties of SCRNs, beyond those of general continuous-time Markov chains. Furthermore, we derive two theorems to compare stationary distributions and mean first passage times for SCRNs with different parameter values, or with the same parameters and different initial conditions. These tools are developed for SCRNs taking values in a generic (finite or countably infinite) state space and can also be applied for non-mass-action kinetics models. When propensity functions are bounded, our method of proof gives an explicit method for coupling two comparable SCRNs, which can be used to simultaneously simulate their sample paths in a comparable manner. We illustrate our results with applications to models of enzymatic kinetics and epigenetic regulation by chromatin modifications.

Prevalence of childhood obesity in Brazil: a systematic review.

The present study aimed to analyze the prevalence of childhood obesity in Brazil and compare it between boys and girls. This systematic review was conducted and reported according to the guidelines outlined in the PRISMA statement. A systematic search of electronic databases, including PubMed, LILACS, and SciELO, was performed in November 2021. Studies that met the following criteria were included: (i) original quantitative studies regardless of their design; (ii) childhood obesity was clearly defined; (iii) prevalence of childhood obesity was reported or it was possible to extract from tables or figures in the text; and (iv) eligible population included children under 12 years of age. A total of 112 articles were included in the systematic review. The prevalence of childhood obesity in Brazil was of 12.2%, being 10.8% in girls and 12.3% in boys. In addition, wide heterogeneity in the childhood obesity prevalence was observed between the states, since it was 2.6% in Pará, while it was 15.8% in Rondônia. Thus, the importance of urgently implementing measures to prevent and treat childhood obesity should be emphasized aiming to reduce obese children and adolescents and future health problems in adult life resulting from this cardiovascular risk factor.

Modification of Sugar Profile and Ripening in Atemoya (Annona × atemoya Mabb.) Fruits through Copper Hydroxide Application.

Atemoya (Annona × atemoya Mabb.), a climacteric fruit of the Annonaceae family, is becoming increasingly popular due to its organoleptic and nutritional properties. Anthracnose, a fungus of the Colletotrichum genus, is one of the most serious diseases in orchards, causing significant damage if not controlled, so producers use phytosanitary products. The current study sought to investigate the quality of atemoya fruits after harvest in an orchard with anthracnose controlled by Cu(OH)2 application: T1-no Cu(OH)2, T2-7.8 mL Cu(OH)2 L1 divided into two applications, T3-15.6 mL Cu(OH)2 L1 divided into four, T4-8.0 mL Cu(OH)2 L1 divided into eight, and T5-13.0 mL Cu(OH)2 L1 divided into thirteen applications. The sugar profile of fruits was examined, as well as MDA, H2O2, and quality parameters such as pH, mass, soluble solids, titratable acidity, and maturation index. MDA, such as H2O2, can function as a signal molecule. Eight applications of 1.0 mL L-1 Cu(OH)2 resulted in increased concentrations of H2O2 and MDA, signal molecules involved in sugar modification profiles such as glucose, fructose, and trehalose. It also had a high titratable acidity, a lower maturation index, better fruit quality, and a longer shelf life.

Global conservation prioritization areas in three dimensions of crocodilian diversity.

Crocodilians are a taxonomic group of large predators with important ecological and evolutionary benefits for ecosystem functioning in the face of global change. Anthropogenic actions affect negatively crocodilians' survival and more than half of the species are threatened with extinction worldwide. Here, we map and explore three dimensions of crocodilian diversity on a global scale. To highlight the ecological importance of crocodilians, we correlate the spatial distribution of species with the ecosystem services of nutrient retention in the world. We calculate the effectiveness of global protected networks in safeguarding crocodilian species and provide three prioritization models for conservation planning. Our results show the main hotspots of ecological and evolutionary values are in southern North, Central and South America, west-central Africa, northeastern India, and southeastern Asia. African species have the highest correlation to nutrient retention patterns. Twenty-five percent of the world's crocodilian species are not significantly represented in the existing protected area networks. The most alarming cases are reported in northeastern India, eastern China, and west-central Africa, which include threatened species with low or non-significant representation in the protected area networks. Our highest conservation prioritization model targets southern North America, east-central Central America, northern South America, west-central Africa, northeastern India, eastern China, southern Laos, Cambodia, and some points in southeastern Asia. Our research provides a global prioritization scheme to protect multiple dimensions of crocodilian diversity for achieving effective conservation outcomes.

Cheilitis glandularis: case report and systematic literature review.

Cheilitis glandularis (CG) is a rare inflammatory disease of unknown etiology that affects the minor salivary glands predominantly in the lower lip. In this article, we report the case of an 18-year-old black woman who presented with a deep suppurative type of CG in both lips. In addition, we performed a systematic literature review in five databases (PubMed, Scopus, Web of Science, Ovid, and Embase) to identify CG case reports or case series. A total of 360 references were retrieved in the electronic databases. Thirty-four articles met the inclusion criteria, and six were retrieved through manual search, totaling 40 articles included in the systematic review. Thirty-nine (68.4%) cases occurred in male individuals and 18 (31.6%) in female individuals. The mean age of affected individuals was 40.9 years. Different clinical manifestations ranging from no symptoms to discomfort, pain, swelling, erythema, eversion of the lip, dilated ductal openings, ulcers, and crust have been reported. Among the included CG cases, 41 affected exclusively the lower lip (71.9%). In four cases, the CG only affected the upper lip (7.0%). In 12 cases, the lesion affected both the lower and upper lips (21.1%). Different treatment modalities were adopted in the management of CG. Although the surgical treatment was indicated (42.1%), the conservative treatment with topical medications, as in the present case, resulted in resolution in 21.0% of cases.

Modeling the impact of child vaccination (5-11 y) on overall COVID-19 related hospitalizations and mortality in a context of omicron variant predominance and different vaccination coverage paces in Brazil.

Background: Developing countries have experienced significant COVID-19 disease burden. With the emergence of new variants, particularly omicron, the disease burden in children has increased. When the first COVID-19 vaccine was approved for use in children aged 5-11 years of age, very few countries recommended vaccination due to limited risk-benefit evidence for vaccination of this population. In Brazil, ranking second in the global COVID-19 death toll, the childhood COVID-19 disease burden increased significantly in early 2022. This prompted a risk-benefit assessment of the introduction and scaling-up of COVID-19 vaccination of children. Methods: To estimate the potential impact of vaccinating children aged 5-11 years with mRNA-based COVID-19 vaccine in the context of omicron dominance, we developed a discrete-time SEIR-like model stratified in age groups, considering a three-month time horizon. We considered three scenarios: No vaccination, slow, and maximum vaccination paces. In each scenario, we estimated the potential reduction in total COVID-19 cases, hospitalizations, deaths, hospitalization costs, and potential years of life lost, considering the absence of vaccination as the base-case scenario. Findings: We estimated that vaccinating at a maximum pace could prevent, between mid-January and April 2022, about 26,000 COVID-19 hospitalizations, and 4200 deaths in all age groups; of which 5400 hospitalizations and 410 deaths in children aged 5-11 years. Continuing vaccination at a slow/current pace would prevent 1450 deaths and 9700 COVID-19 hospitalizations in all age groups in this same time period; of which 180 deaths and 2390 hospitalizations in children only. Interpretation: Maximum vaccination of children results in a significant reduction of COVID-19 hospitalizations and deaths and should be enforced in developing countries with significant disease incidence in children. Funding: This manuscript was funded by the Brazilian Council for Scientific and Technology Development (CNPq - Process # 402834/2020-8).

Perfil clínico e hemodinâmico de pacientes consecutivos com estenose aórtica valvar estudados na era pré-implante transcateter valvar aórtico em instituição acadêmica. Análise comparativa da avaliação invasiva com a ecocardiográfica / Clinical and hemodynamic profile of consecutive patients with aortic valve stenosis studied in the pre-transcatheter aortic valve implantation era at an academic institution. Comparative analysis of invasive evaluation with echocardiography

Introdução: Face à melhor compreensão da fisiopatologia da estenose valvar aórtica, cresceu paralelamente a complexidade da avaliação de sua gravidade, persistindo relevante incerteza quanto à aplicabilidade dos métodos invasivos pelo cateterismo cardíaco e os não invasivos, com base em ecocardiografia. O objetivo deste estudo foi analisar os padrões hemodinâmicos da avaliação com ecocardiografia comparativamente à estimativa da gravidade da estenose aórtica com o cateterismo em pacientes consecutivos referidos para avaliação diagnóstica por laboratório de hospital acadêmico terciário no triênio 2016-2018. Métodos: Estudo observacional, descritivo e retrospectivo das características clínicas e dos resultados das avaliações da gravidade da estenose valvar aórtica obtidas em 96 pacientes consecutivos, por meio de cateterismo e ecocardiografia. Resultados: Amostra populacional de 49 homens e 47 mulheres, com mediana de idade de 66,5 (56,5 a 72,8) anos, estenose valvar aórtica degenerativa em 49% e reumática em 40%, além de diversas comorbidades, inclusive doença coronária (37%). Pelo cateterismo, com base no gradiente pico de 48 (20 a 68), a estenose valvar aórtica foi avaliada como grave em 56%, sendo a pressão telediastólica ventricular de 20mmHg (16 a 30mmHg). Pela ecocardiografia, a área valvar foi 0,9cm2 (0,7 a 1,2cm2), sendo indexado 0,5cm2/m2 (0,43 a 0,5cm2/m2), com gradiente pico de 62±26 mmHg. A estenose valvar aórtica foi considerada severa em 69,2%. Houve discordância entre os métodos sobre a severidade da estenose valvar aórtica em 30% dos exames, com coeficiente de Spearman entre área valvar pelo ecocardiograma e gradiente pico pelo cateterismo de -0,7 (p<0,001). Conclusão: Em amostra representativa dos vários padrões hemodinâmicos, a avaliação da gravidade da estenose valvar aórtica, como praticada rotineiramente em laboratório acadêmico, limitou-se à medida de pico de gradiente transvalvar. A estimativa da área valvar pelo método ecocardiográfico, sendo indireta e também passível de crítica, contribui para as discrepâncias encontradas, tornando-se justificável buscar o aperfeiçoamento de ambos os métodos, em vista da complexidade clínica e hemodinâmica detectada.

Background: In view of the better understanding of the pathophysiology of aortic valve stenosis, the complexity of assessing its severity has simultaneously grown, with relevant uncertainty persisting as to the applicability of invasive methods by cardiac catheterization and non-invasive methods based on echocardiography. The objective of this study was to analyze the hemodynamic patterns of evaluation with echocardiography compared to the estimation of severity of aortic stenosis with catheterization in consecutive patients referred for diagnostic evaluation by the laboratory of a tertiary academic hospital in the 2016 to 2018 triennium. Methods: An observational, descriptive and retrospective study of clinical characteristics and results of assessments of severity of aortic valve stenosis obtained in 96 consecutive patients, through catheterization and echocardiography. Results: A population sample of 49 men and 47 women, with a median age of 66.5 (56.5 to 72.8) years, degenerative aortic valve stenosis in 49%, and rheumatic aortic stenosis in 40%, in addition to several comorbidities, including coronary disease (37%). Using catheterization, based on the peak gradient of 48 (20 to 68), aortic valve stenosis was assessed as severe in 56%, with ventricular end-diastolic pressure of 20mmHg (16 to 30mmHg). Using echocardiography, the valve area was 0.9cm2 (0.7 to 1.2cm2), indexed valve area was 0.5cm2/m2 (0.43 to 0.5cm2/m2), with peak gradient of 62±26mmHg. Aortic valve stenosis was considered severe in 69.2%. There was disagreement between the methods regarding severity of aortic valve stenosis in 30% of exams, with a Spearman coefficient between the valve area on the echocardiogram and the peak gradient on catheterization of -0.7 (p<0.001). Conclusion: In a representative sample of various hemodynamic patterns, the assessment of severity of aortic valve stenosis, as routinely practiced in an academic laboratory, was limited to measuring the peak transvalvular gradient. The estimation of the valve area using the echocardiographic method was indirect and also subject to criticism, and contributed to the discrepancies found, rendering it justifiable to seek the improvement of both methods, in view of the clinical and hemodynamic complexity detected.

Roles of Calcium Signaling in Gene Expression and Photosynthetic Acclimatization of Solanum lycopersicum Micro-Tom (MT) after Mechanical Damage.

A momentary increase in cytoplasmic Ca2+ generates an oscillation responsible for the activation of proteins, such as calmodulin and kinases, which interact with reactive oxygen species (ROS) for the transmission of a stress signal. This study investigated the influence of variations in calcium concentrations on plant defense signaling and photosynthetic acclimatization after mechanical damage. Solanum lycopersicum Micro-Tom was grown with 0, 2 and 4 mM Ca2+, with and without mechanical damage. The expression of stress genes was evaluated, along with levels of antioxidant enzymes, hydrogen peroxide, lipid peroxidation, histochemistry, photosynthesis and dry mass of organs. The ROS production generated by mechanical damage was further enhanced by calcium-free conditions due to the inactivation of the oxygen evolution complex, contributing to an increase in reactive species. The results indicated that ROS affected mechanical damage signaling because calcium-free plants exhibited high levels of H2O2 and enhanced expression of kinase and RBOH1 genes, necessary conditions for an efficient response to stress. We conclude that the plants without calcium supply recognized mechanical damage but did not survive. The highest expression of the RBOH1 gene and the accumulation of H2O2 in these plants signaled cell death. Plants grown in the presence of calcium showed higher expression of SlCaM2 and control of H2O2 concentration, thus overcoming the stress caused by mechanical damage, with photosynthetic acclimatization and without damage to dry mass production.

[Analysis of a clinical ethics committee activities at a general hospital]. / Experiencia del Comité de Ética Asistencial del Hospital Carlos van Buren entre los años 2007-2020.

BACKGROUND: Clinical Ethics Committees are deliberative groups whose main functions are to assess cases with ethical-clinical conflicts, to generate institutional protocols for preventive purposes, and to train health teams. AIM: To analyze the activity of a clinical ethics committee of a general hospital in the period 2007-2020. MATERIAL AND METHODS: A retrospective analysis of all session records, annual reports, case resolution and documents generated by the Clinical Ethics Committee of Carlos van Buren Hospital in Valparaíso, Chile, between 2007 and 2020, was carried out. RESULTS: On average, 12 cases are analyzed per year. Sixty percent correspond to requests from pediatric units and in 78% of these cases there was at least one neurological disease. In 62% of cases, the main ethical dilemma was adequacy of therapeutic effort, followed by dilemmas related to the exercise of autonomy in 18.2%. In education, two courses are identified aimed to doctors, residents, and other members of the health team. Regarding normative functions, several documents were generated at the request of the Hospital management or in different clinical situations. During COVID-19 pandemia, the active role of the committee was linked to the three main functions, namely evaluating cases, participating in morbidity and mortality meetings for preventive purposes, and issuing guidelines and recommendations for action. The active participation of Pediatric Neurology residents in the Committee, for educational and administrative purposes, stands out. CONCLUSIONS: The three main functions described for the ethics committees were exerted by this Committee during the evaluated period. The impact of our recommendations remain to be objectively evaluated.

Analysis of Mortality from Asbestos-Related Diseases in Brazil Using Multiple Health Information Systems, 1996-2017.

Background: In Brazil, asbestos was intensively used from the 1960s until its ban in 2017. Mesothelioma, asbestosis, and pleural plaques are typical asbestos-related diseases (ARD-T). To create an ARD-T national database, death records from 1996-2017 were retrieved from several health information systems (HIS). Methods: All national HIS containing coded diagnoses (ICD-10) and death information were obtained. Linkage was performed to create a single database of ARD-T death records, either as underlying or contributory causes, in adults aged 30 years and older. Results: A total of 3,057 ARD-T death records were found, 2,405 (76.4%) of which being malignant mesotheliomas (MM). Pleural MM (n = 1,006; 41.8%) and unspecified MM (n = 792; 32.9%) prevailed. Male to female MM ratio (M:F) was 1.4:1, and higher ratios were found for non-malignant ARD-T: 3.5:1 for asbestosis and 2.4:1 for pleural plaques. Male crude annual mesothelioma mortality (CMmm x1,000,000) was 0.98 in 1996 and 2.26 in 2017, a 131.1% increment, while for females it was 1.04 and 1.25, a 20.2% increase, correspondingly. The small number of deaths with asbestosis and pleural plaques records precluded conclusive interpretations. Conclusions: Even with the linkage of several HIS, ARD-T in death records remained in low numbers. MM mortality in men was higher and showed a rapid increase and, along with non-malignant ARD-T, higher M:F ratios suggested a predominant pattern of work-related exposure. The monitoring of workplace and environmental asbestos exposure needs to be improved, as well as the workers surveillance, following the recent Brazilian ban.

The Effectiveness of Pap and Visual Inspection With Acetic Acid (VIAA) Tests in Cervical Dysplasia Screenings During the COVID-19 Pandemic.

Objective This study was aimed at analyzing the validity and reliability of the Papanicolaou (Pap) test and visual inspection with acetic acid (VIAA) tests for cervical dysplasia screenings during the COVID-19 pandemic. Material and methods This was a retrospective study of patients 21 years or older seen at the Luis Negreiros Primary Care Center in Lima, Peru between 2020 and 2021, who underwent cervical dysplasia screening (Pap or VIAA). Relevant information regarding patient age, date of service, and Pap and VIAA results were collected. Parallel form reliability was analyzed with chi-square tests, and phi, contingency and Cramer's V coefficients. The validity of these tests was analyzed through the calculation of the sensitivity, specificity, and positive and negative predictive values with confidence intervals. A p-value less than 0.05 indicated statistical significance. Results From 4,503 records, the sensitivity, specificity, and positive and negative predictive values for Pap were 0.87 (0.81-0.92), 1.0 (1.0-1.0), 1.0 (1.0-1.0) and 0.99 (0.98-0.99), respectively, and those for VIAA were 0.22 (0.14-0.31), 0.10 (0.10-0.10), 0.53 (0.38-0.69) and 0.10 (0.10-0.10), respectively. Test validity varied slightly according to patient age and the year of testing. The correlation, although significant, was inverse; chi-square = 39.18, p <0.001, phi = -0.60, contingency = 0.51 and Cramer's V = -0.59. Conclusion The validity and reliability of Pap testing and VIAA for cervical dysplasia screening significantly decreased during the COVID-19 pandemic. The correlation between these tests, although significant, was inverse. More larger-scale studies are needed to confirm these findings and understand the reasons underlying the decreased effectiveness of these tests.

Spatial relationships between fishes and amphibians: implications for conservation planning in a Neotropical Hotspot.

Species distribution patterns are widely used to guide conservation planning and are a central issue in ecology. The usefulness of spatial correlation analysis has been highlighted in several ecological applications so far. However, spatial assumptions in ecology are highly scale-dependent, in which geographical relationships between species diversity and distributions can have different conservation concerns. Here, an integrative landscape planning was designed to show the spatial distribution patterns of taxonomic and functional diversity of amphibians and fishes, from multiple species traits regarding morphology, life history, and behavior. We used spatial, morphological, and ecological data of amphibians and fishes to calculate the functional diversity and the spatial correlation of species. Mapping results show that the higher taxonomic and functional diversity of fishes is concentrated in the West Atlantic Forest. Considering amphibians, are located in the East portion of the biome. The spatial correlation of species indicates the regions of the Serra do Mar and the extreme southern part of the Central Corridor as the main overlapped species distribution areas between both groups. New key conservation sites were reported within the Brazilian Atlantic Forest hotspot, revealing cross-taxon mismatches between terrestrial and freshwater ecosystems. This study offers useful spatial information integrating suitable habitats of fishes and amphibians to complement existing and future research based on terrestrial and freshwater conservation. New priorities for biodiversity conservation in rich-species regions highlight the importance of spatial pattern analysis to support land-use planning in a macroecological context.