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Invasive fungal infections (IFIs) are responsible for elevated rates of morbidity and mortality, causing around of 1.5 million deaths annually worldwide. One of the main causative agents of IFIs is Candida albicans, and non-albicans Candida species have emerged as a spreading global public health concernment. Furthermore, COVID-19 has contributed to a boost in the incidence of IFIs, such as mucormycosis, in which Rhizopus oryzae is the most prevalent causative agent. The effector host immune response against IFIs depends on the activity of T cells, which are susceptible to the regulatory effects triggered by fungal virulence factors. The fungal cell wall plays a crucial role as a virulence factor, and its remodeling compromises the development of a specific T-cell response. The redirection of Jurkat T cells to target Candida spp. by recognizing targets expressed on the fungal cell wall can be facilitated using chimeric antigen receptor (CAR) technology. This study generated an M-CAR that contains an scFv with specificity to α-1,6 mannose backbone of fungal mannan, and the expression of M-CAR on the surface of modified Jurkat cells triggered a strong activation against Candida albicans (hyphae form), Candida tropicalis (hyphae form), Candida parapsilosis (pseudohyphal form), and Candida glabrata (yeast form). Moreover, M-CAR Jurkat cells recognized Rhizopus oryzae spores, which induced high expression of cell activation markers. Thus, a novel Mannan-specific CAR enabled strong signal transduction in modified Jurkat cells in the presence of Candida spp. or R. oryzae.

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A 40-year-old woman with symptomatic advanced atrioventricular (AV) block underwent cardioneuroablation (CNA) for the treatment of functional bradyarrhythmia, following the exclusion of reversible causes and intrinsic disease of the conduction system. Selective ablation of ganglia related to the AV node, performed exclusively in the left atrium, restored AV conduction, which has remained unchanged with 2 years of follow-up. CNA is a viable and effective option with low risk for the treatment of functional bradyarrhythmias, regardless of their severity.

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BACKGROUND: Painful left bundle branch block (PLBBB) syndrome remains a poorly understood cardiac anomaly. This systematic review consolidates case report evidence to elucidate effective management strategies and patient outcomes. METHODS: Databases including PubMed, Scopus, Web of Science, and Scielo were searched without restrictions on language or publication date. Following PRISMA guidelines, 128 articles were identified, with 31 meeting inclusion criteria. Data were extracted on patient demographics, clinical presentation, treatment regimens, and outcomes using Microsoft Excel and assessed for bias with the Joanna Briggs Institute's tool. RESULTS: The analysis included 45 patients with a mean age of 55.46 ± 12.23. Predominantly, LBBB episodes occurred during exercise (73.3%). Initial treatments comprised beta-blockers/calcium channel blockers (55.56%), pacemaker implantation (13.3%), antianginal medications (13.3%), and other modalities (17.7%). Refractoriness to initial treatment was observed in 66.7% of patients, with subsequent pacemaker implantation resolving symptoms in most cases. An overall satisfactory response was seen in 73.3% of patients post-treatment adjustments. CONCLUSIONS: The diverse approaches in treatment highlight the necessity for tailored therapeutic strategies. While pacemakers have demonstrated efficacy in controlling symptoms in several reported cases, it is essential to recognize the complex nature of this intervention. Pacemaker implantation, being a surgical procedure, carries long-lasting implications for patients. Hence, the continuation of pharmacological treatments might still be preferable until more definitive research is available. This review emphasizes the urgent need for further research to establish evidence-based guidelines, particularly concerning the selection of first line of treatment, to optimize outcomes for PLBBB syndrome.

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BACKGROUND: The ethanolamine oleate (EO) in different concentrations has been used in sclerotherapy of oral benign vascular lesions (OBVLs). The aim of the present study was to define demographic and clinical characteristics of patients with OBVLs treated with 5% EO. MATERIAL AND METHODS: A retrospective study was conducted of cases treated by sclerotherapy from 1992 to 2022, and medical records of 52 patients with OBVLs were analysed. Thus, 44 cases with complete data were selected and described. Categorical data were analyzed using the chi-square test, with the significance level set at 5% (p < 0.05). RESULTS: Mean age was 52.89 years (range seven to 82 years). The female sex was predominant (77%) and brown was the most common skin color (54%). Most lesions occurred on the lower lip (65.9%), tongue (11.4%), buccal mucosa (9.1%), upper lip (6.8%) and palate (25%.3%). Approximately 73% of the lesions were ≤ 1 cm, > 1 ≤ 2 cm (18.2%,) and > 2 cm (9.1%). Complete regression of the lesions occurred in 97.7% of the cases, with no case of recurrence and no need for complementary surgery. All patients were satisfied with the treatment. CONCLUSIONS: Sclerotherapy with 5% EO is a safe and effective method for the treatment of OBVLs.

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OBJECTIVE: This study aims to map the literature on screening, diagnosis, treatment and outcomes of developmental dysplasia of the hip (DDH) in the Brazilian population aged 0-18 years, to describe regional variations in its presentation and management. DESIGN: Scoping review. DATA SOURCES: PubMed/MEDLINE, Web of Science, Scopus, "Biblioteca Virtual em Saúde" and "Biblioteca Digital Brasileira de Teses e Dissertações". The journals, Revista Brasileira Ortopedia and Acta Ortopédica Brasileira, were manually searched for non-indexed issues. Databases were searched from their inception to February 2024. ELIGIBILITY CRITERIA: This scoping review included studies on Brazilian patients aged 0-18 years diagnosed with or being assessed for DDH. No language or date restrictions were applied. DATA EXTRACTION AND SYNTHESIS: Studies were assessed based on title, authors, publication year, study design, sample size, level of evidence, region of Brazil and healthcare setting (public or private). The articles were then analysed across four categories: screening, diagnosis, treatment and outcomes. RESULTS: 52 studies, published between 1951 and 2023, were included. Reported prevalence rates ranged from 0.75 to 56.4 cases per 1000 children. No study examined the effectiveness of specific screening programmes or compared their outcomes. The most common diagnostic methods were the Ortolani manoeuvre and ultrasonography using the Graf method. Of the 27 articles on treatment, 17 focused exclusively on surgical interventions, with the Salter osteotomy being the most frequent procedure. CONCLUSIONS: There should be a greater focus on understanding the prevalence of DDH in Brazil, the availability of ultrasound devices and trained operators, and the follow-up of conservative treatments. More information on DDH in Brazil is essential for designing and implementing effective screening and treatment programmes. Future research should be done to understand the prevalence of the disease, optimal forms of screening and early treatment.

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INTRODUCTION: Headache is common among patients diagnosed with pituitary adenoma (PA). There are still controversies regarding the headache presentation, pathophysiology and outcome after treatment in these patients. OBJECTIVES: To determine the prevalence of headache among patients with PA, describe their phenotypes and identify precipitating factors. Also, to evaluate prospectively if PA treatment leads to headache improvement. METHODS: Treatment-naïve adult patients with PA were included. A questionnaire based on the beta version of the International Classification of Headache Disorders 3rd edition was created to classify the headaches. Patients submitted to surgery or medical treatment were reevaluated at least three to six months after treatment. RESULTS: Headache during the previous 3 months was present in 62% of the 104 patients. The most prevalent phenotypes were migraine and tension-type headache. Trigeminal autonomic cephalalgias (TACs) were observed only in prolactinoma patients. Both genders presented headache at similar rates (64% in females and 58% in males) but patients with headache were younger (41.5 ± 13.8 vs. 56.8 ± 13.6 years). Tumor characteristics were not determinant of headache. Patients with acromegaly that presented headache had higher GH levels. Headache was more frequent in prolactinomas (83%) than in NFPA (52%). After disease remission or control, resolution of headache was observed in 83%, 50% and 33% of the NFPA, somatotropinomas and prolactinomas, respectively. CONCLUSIONS: Migraine and tension-type are the most common headache phenotypes in PA patients, and TACs were only observed in prolactinomas. Also, headache was more common in prolactinomas than in NFPA. GH levels were higher in patients with acromegaly that presented headache. Surgical and medical treatments completely resolve the headaches in 50% of the patients.

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BACKGROUND: Rapid progression of symptoms and development of Acute Respiratory Distress Syndrome (ARDS) frequently occurred during COVID-19 pandemic, while CT-Scan was useful to assess severity of lung damage, with classic patterns like early Ground Glass Opacity and/or late consolidation. Likewise, lung injury has been related to activation of the coagulation-fibrinolysis systems and pro-inflammatory mediators; where D-Dimer acquires prognostic relevance. The present study aimed to evaluate whether the extent of lung involvement and pattern of lung injury, as determined by chest CT-scan, are related with D-Dimer; and further impact clinical prognosis in patients with ARDS due to COVID-19. METHODS: Longitudinal, prospective, observational, multi-center study. Patients diagnosed with ARDS due to COVID-19, without previous lung damage, clotting disorder and/or anticoagulants use, who were attended at the Intensive Care Unit and Internal Medicine Department from March to June 2020. Tomographic extent of lung involvement was analyzed by image software, as well as damage patterns, assessed by experienced radiologists. Endpoints included relation of lung injury with coagulopathy markers like D-Dimer, and prognostic outcome including mortality, mechanical ventilation and hospitalization time. RESULTS: One-hundred and four patients mean aged 55 years old, 66% males, main comorbidities obesity, hypertension and diabetes mellitus. Larger lung damage was associated with older age, male gender and higher pro-inflammatory mediators like leukocytes and ferritin; whilst consolidation pattern was related to higher Body Mass Index. Higher values of D-Dimer were related either to a larger extent of lung involvement or late consolidation pattern. In addition, the extent of lung involvement was related with longer hospital stay, higher requirement of mechanical ventilation (HR 0.12, p < 0.01) and mortality rate (HR 0.13, p < 0.01); whereas late consolidation was mainly associated with requirement of mechanical ventilation (HR 0.23, p < 0.01). CONCLUSION: Tomographic extent of lung involvement and the pattern of lung injury are related with coagulopathy severity markers like D-Dimer, and own prognostic clinical ability in ARDS.

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Atypical hemolytic uremic syndrome (aHUS) is a rare cause of thrombotic microangiopathy (TMA) caused by the dysregulation of the alternative complement pathway. The diagnosis of TMA is made clinically by the triad: microangiopathic hemolytic anemia, thrombocytopenia, and organ damage (mainly acute kidney injury). The heterogeneity of clinical manifestation and the lack of a gold standard diagnostic test makes the precise diagnosis of aHUS a challenging process that may impact patient management. Until one decade ago, there was no specific treatment for aHUS and patients were submitted to plasma therapy (plasma exchange and/or plasma infusion) and/or liver transplantation, procedures that are not free of serious complications and that do not address the underlying pathophysiology of the disease. Since 2011, an anti-C5 complement monoclonal antibody has been approved by the Food and Drug Administration (FDA) for aHUS patients beginning a new era in treatment. Clinical trials on new complement inhibitors may also add to the treatment portfolio in the future. The Brazilian population is a mixed race with a unique genetic and clinical profile. This consensus aims to offer recommendations for the diagnosis and treatment of patients with aHUS in this population based on expert experience, data from the aHUS Brazilian Registry and literature review. The GRADE system was used to classify the quality of the evidence.

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BACKGROUND: Previous studies have shown that women with coronary artery disease (CAD) are less likely to undergo angiography and have less favorable outcomes after percutaneous coronary intervention (PCI). OBJECTIVES: Assess the outcomes of women with acute coronary syndrome (ACS) and stable CAD (lesion>50%) treated with contemporary PCI using DES. METHODS: Observational, longitudinal cohort study with prospective follow-up included all female patients ≥ 18 years admitted at a tertiary public cardiovascular center in Brazil from January 2019 to December 2020. The level of significance adopted in the statistical analysis was 5%. RESULTS: 1146 women (average age 65 years) underwent guideline-recommended PCI. Risk factors were frequent (hypertension: 88%, dyslipidemia: 85%, diabetes: 47.5%), and 69% were admitted due to ACS. Radial access was used in 59% of patients; 1516 vessels were treated with 1725 stents implanted (1.5 stents/patient). PCI was successful in 97.7%, in-hospital death occurred in 1.2%, peri-procedural MI in 3.6%, and TIA in 0.4%. Predictors of in-hospital major adverse cardiac and cerebrovascular events (MACCE): previous stroke (OR: 2.97; CI: 1.06-7.15; p= 0.023), CKD (OR: 3.11; CI: 1.49-6.20; p= 0.002), and at least one procedural failure during PCI (OR: 10.2; CI: 1.17-5.9; p<0.001). The average follow-up was 576.2 days in 1047 patients. All-cause mortality occurred in 5.3%, cardiac death in 3.5%, recurrent ACS in 8%, and additional revascularization procedures in 5.5%. The predictors for MACCE during FU were hospital admission for ACS for the index PCI (OR: 1.58; HR: 1.06-2.35; p=0.023) and the presence of MACCE during hospitalization (OR: 6.66; HR: 2.42- 18.3; p< 0.001). CONCLUSION: In this pioneering study involving 1146 patients treated by contemporary PCI and followed for almost 2 years, we obtained very encouraging in-hospital and mid-term results.

FUNDAMENTO: Estudos prévios demonstram que mulheres com doença arterial coronariana (DAC) são menos submetidas a angiografia e apresentam resultados menos favoráveis após intervenção coronariana percutânea (ICP). OBJETIVOS: Avaliar os resultados de mulheres com síndrome coronariana aguda (SCA) e DAC estável (lesão>50%) tratadas com ICP contemporânea usando stents liberadores de drogas. MÉTODOS: Estudo de coorte observacional, longitudinal, com acompanhamento prospectivo, que incluiu todas as pacientes do sexo feminino > 18 anos admitidas em centro cardiológico público terciário no Brasil, no período de janeiro de 2019 a dezembro de 2020. RESULTADOS: 1146 mulheres (idade média de 65 anos) foram submetidas à ICP recomendada pela diretriz. Os fatores de risco foram frequentes (hipertensão: 88%, dislipidemia: 85%, diabetes: 47,5%) e 69% foram internadas devido à SCA. O acesso radial foi usado em 59% das pacientes; 1516 vasos foram tratados com 1725 stents implantados (1,5 stents/paciente). A ICP foi bem-sucedida em 97,7%, a morte intra-hospitalar ocorreu em 1,2%, IM periprocedimento em 3,6% e ataque isquêmico transitório em 0,4%. Preditores de eventos adversos cardíacos e cerebrovasculares maiores (ECCAM) intra-hospitalares: acidente vascular cerebral prévio (OR: 2,97; IC: 1,06-7,15; p = 0,023), DRC (OR: 3,11; IC: 1,49-6,20; p = 0,002) e pelo menos uma falha de procedimento durante ICP (OR: 10,2; IC: 1,17-5,9; p < 0,001). O acompanhamento médio foi de 576,2 dias em 1.047 pacientes. Mortalidade por todas as causas ocorreu em 5,3%, morte cardíaca em 3,5%, nova SCA em 8% e necessidade de nova revascularização em 5,5%. Os preditores de ECCM durante o seguimento foram admissão por SCA (retirar índice ICP) e a presença de ECCM durante a hospitalização (OR: 6,66; HR: 2,42-18,3; p< 0,001). CONCLUSÃO: Neste estudo pioneiro envolvendo 1146 pacientes tratados por ICP contemporânea e acompanhados por quase 2 anos, obtivemos resultados hospitalares e de médio prazo muito encorajadores.

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INTRODUCTION: Pain is one of the primary symptoms affecting individuals with rotator cuff tendinopathy. Physical exercise serves as the main approach for managing this condition, aiming to restore movement patterns, optimise scapular kinematics and improve strength and local muscular endurance. Pain neuromodulation techniques, such as transcranial direct current stimulation (tDCS), may offer complementary non-pharmacological options for pain relief by promoting central modulation and altering cortical excitability. METHODS AND ANALYSIS: This protocol outlines a randomised, blinded clinical trial. Participants will be randomly allocated to two groups: G1 (active tDCS combined with progressive exercise) and G2 (sham tDCS combined with progressive exercise). The protocol will span 4 weeks, with two sessions per week. Pain intensity, measured using the numerical pain scale, will serve as the primary outcome. Secondary outcomes will include physical function, range of motion, global perception of change and treatment adherence. ETHICS AND DISSEMINATION: This protocol was approved by the Ethics Committee Health Sciences College of Trairi, Federal University of Rio Grande do Norte (number: 6.821.408). Followed the Declaration of Helsinki recommendations for research with human beings. The results will be published later in peer-reviewed journals and scientific events. TRIAL REGISTRATION NUMBER: The Brazilian Registry of Clinical Trials (RBR-59xmv6s); Results.

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OBJECTIVE: To describe the intervention of fistuloclysis in enteroatmospheric fistulas. METHOD: This is a descriptive case report constructed according to the Consensus-based Clinical Case Reporting Guideline Development, carried out with a male patient in a medium-sized philanthropic hospital in a city in Minas Gerais, Brazil. The study was previously approved by a Research Ethics Committee. RESULTS: T: Patient with a history of radical prostatectomy and elective cholecystectomy, with progression of colon ischemic necrosis, which required left colectomy and Hartmann colostomy, developed spontaneous enteroatmospheric fistulas and was on enteral nutrition for nine months. Due to complications, fistuloclysis was initiated, which resulted in significant nutritional improvement. CONCLUSION: The description of the procedure and care allows its reproduction in a safe manner for effluent control, nutritional restoration, and other clinical responses. The care provided by the stomatherapy nurse stands out, taking into account the benefits, complexity, and challenges of fistuloclysis.

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BACKGROUND: Neurotrophins are related with depressive disorders. Significant neurotrophins variations occur during renal replacement therapy, but whether peri-hemodialysis availability is associated with depression in patients with Chronic Kidney Disease (CKD) is yet unclear. AIM: To determine dynamic concentrations of neurotrophins in the peri-hemodialysis range and their association with depressive symptoms in patients with CKD. METHODS: Pre-, and post-hemodialysis plasma concentrations of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF), as well as their plasma clearance rates, were determined (multiplexing) in patients with stage 5 CKD. Depressive symptoms, as assessed by the Beck Depression Inventory-II (BDI-II), were determined. Finally, the bioavailability of BDNF and NGF was related to the score of depressive symptoms. RESULTS: Fifty-three patients were divided according to depressive symptoms. Pre-hemodialysis plasma BDNF was lower in patients with depressive disorder; whereas basal BDNF value >220 pg/mL independently reduced the risk for depressive disorder (Odds Ratio 0.23, p = 0.047) at uni- and multivariate analysis. Post-hemodialysis concentration and clearance rate of neurotrophins were not related with depressive symptoms. CONCLUSION: Higher plasma BDNF before hemodialysis reduces the risk of mild depression in patients with CKD under renal replacement therapy.

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PURPOSE: To examine the relationship between endoluminal and pathologic complete response after chemoradiotherapy for rectal cancer and identify predictors of a pathologic complete response. METHOD: The anatomic pathology reports of 102 consecutive patients with rectal cancer who underwent neoadjuvant chemoradiotherapy followed by proctectomy between 2013 and 2017 were reviewed for the presence or absence of endoluminal complete response. The presence of endoluminal complete response was compared with the anatomopathological stage. The residual lesion area was compared with the final pathologic stage to identify predictors of complete response. RESULTS: Of 102 patients, 20 (19.6 %) achieved a pathologic complete response (ypT0N0). Of these, 9 (45 %) did not achieve an endoluminal complete response. The presence of endoluminal complete response had a sensitivity of 55.00 %, specificity of 96.34 %, and accuracy of 88.24 % to identify ypT0N0. The presence of endoluminal complete response, residual lesion area ≤ 4 cm2, and tumor located in the mid-rectum were associated with pathologic complete response (ypT0N0). CONCLUSION: Almost half of the patients who had a pathologic complete response did not achieve an endoluminal complete response. Tumors located in the mid-rectum with a residual size of ≤ 4 cm2 and the presence of endoluminal complete response were significantly associated with the achievement of ypT0N0.

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Homeobox A9 promoter methylation (HOXA9) has been reported as a biomarker for early lung adenocarcinoma patients' prognosis. We aim to evaluate its prognostic value, regardless of disease stage. Using droplet digital PCR, we measured HOXA9 methylation in a cohort comprising 161 Brazilian patients. Low HOXA9 methylation was associated with higher cancer-specific survival but showed no significance after adjustment for clinical covariates. While low HOXA9 methylation was associated with earlier stages, no survival association was observed in this subset of patients. Overall, HOXA9 promoter methylation is not an independent prognostic biomarker of cancer-specific survival in Brazilian lung adenocarcinomas patients.

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OBJECTIVE: To evaluate the Cost-Efficiency of Atraumatic Restorative Treatment (ART) with a chemical-mechanical caries removal agent (CMCRA, Papacárie Duo GelⓇ) compared to conventional ART, based on pain perceived and time for selective removal of carious tissue, from the perspective of the Brazilian Unified Health System (SUS). MATERIALS AND METHODS: The Cost-Efficiency analysis was conducted using TreeAgePro software, considering a 12-month horizon and a hypothetical cohort based on Monte Carlo microsimulation. ART + CMCRA was compared to ART in deciduous teeth, based on 26,700 treatments performed on children attended by SUS in Rio de Janeiro. Direct costs were calculated in Brazilian currency using the microcosting technique. Efficiency measures related to pain and caries removal time were extracted from a high-quality randomized clinical trial. Probabilistic simulation considered a 95% confidence interval and a 5% variation in parameters, generating acceptability curves to estimate the probability of treatment choice. RESULTS: ART + CMCRA proved superior (p < 0,001) in terms of benefit. For pain perceived efficiency, ART + CMCRA resulted in a cost increase of R$ 0.23 per procedure, with an additional benefit of 47.53%. For time efficiency, there was a cost increase of R$ 0.24 per procedure, with an additional benefit of 14.19%. CONCLUSION: ART + CMCRA is a cost-efficient option for SUS. The implementation of this technique in Rio de Janeiro's public health system can be recommended due to the reduced pain, despite requiring a higher willingness to pay for the additional benefits. CLINICAL RELEVANCE: The adoption of ART + CMCRA in SUS can significantly improve the experience of pediatric patients by reducing pain, making dental treatment more efficient and humane.

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PURPOSE: To identify the prognostic variables related to the survival of patients operated on for adenocarcinoma of the rectum who underwent preoperative radiochemotherapy (RCT). METHODS: We studied 70 patients from the Discipline of Surgical Gastroenterology at Escola Paulista de Medicina from 2000 to 2019, with rectal cancer located up to 10 cm from the anal verge and with stages II or III, submitted to preoperative RCT and curative surgery (R0) and with follow-up of at least 12 months. Clinical restaging was performed four to six weeks after the end of neoadjuvant treatment to characterize the degree of clinical tumor regression. Surgery by laparotomy or videolaparoscopy was performed six to 12 weeks after RCT. Primary endpoint were: overall survival (OS), disease-free survival (DFS), metastasis-free survival (MSS), and neoplasm-specific survival (SEN). These were compared with gender, age, carcinoembryonic antigen (CEA) dosage, distance from the tumor to the anal verge, radiation dose, radiotherapy-surgery interval, clinical regression, type of surgery, pT and pN TNM stage tumor, number of nodes, circumferential resection margin, and complete pathological response. Survival was assessed by Kaplan-Meier curves. Univariate and multivariate Cox analyses were calculated to identify factors associated with survival outcomes. RESULTS: The mean follow-up time was 62 months. The pathological complete response rate was 18.6%. Univariate cox regression showed a significant relationship of CEA equal to or greater than 4 ng/mL with DFS and MFS, pT3/pT4 staging with DFS, MFS and SEN, pN1/N2 with DFS, MFS and SEN and stages II and III with DFS and MFS. Multivariate regression found that CEA, pT, and pN staging are independent prognostic factors for DFS, MFS, and SEN. CONCLUSION: Carcinoembryonic antigen level prior to radiotherapy, pT staging and pN staging were independent prognostic factors for survival in patients with rectal adenocarcinoma who are treated with preoperative radiochemotherapy.

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Motivation for the study. The frequency of malnutrition in adult patients with grade V chronic kidney disease on hemodialysis at the High Complexity Hospital of La Libertad "Virgen de la Puerta" is unknown. Main findings. We found high frequency of malnutrition in hemodialysis patients (92.4%), with moderate/severe malnutrition predominating (72.4%). Implications. This study allows us to understand the situation of malnutrition in hemodialysis patients in order to initiate early nutritional intervention, in addition to providing important data that add to the available evidence. This was a cross-sectional observational study that aimed to determine the frequency of malnutrition in adult patients with stage V chronic kidney disease on hemodialysis. The sample consisted of 105 adult patients diagnosed stage V chronic kidney disease who received hemodialysis at the "Virgen de la Puerta" High Complexity Hospital in Trujillo, Peru. We applied the Malnutrition-Inflammation Score (MIS), 97 (92.4%) patients presented malnutrition, of which 20% had mild malnutrition, 37.1% had moderate malnutrition and 35.3% had severe malnutrition; only 8 patients (7.6%) presented normal nutritional status. In conclusion, we found a high frequency of malnutrition among patients diagnosed with stage V chronic kidney disease receiving hemodialysis.

El objetivo fue determinar la frecuencia de desnutrición en pacientes adultos con enfermedad renal crónica grado V en hemodiálisis, para ello se realizó un estudio observacional transversal. La muestra estuvo constituida por 105 pacientes adultos con diagnóstico de enfermedad renal crónica grado V que recibieron hemodiálisis en el Hospital de Alta Complejidad «Virgen de la Puerta¼ de Trujillo, Perú. Se aplicó la Escala Malnutrition-Inflamation Score (MIS), 97 (92,4%) pacientes presentaron desnutrición, dividido en 20% con desnutrición leve, 37,1% con desnutrición moderada y 35,3% con desnutrición grave; solo 8 pacientes (7,6%) presentaron estado nutricional normal. En conclusión, existe una alta frecuencia de desnutrición entre los pacientes con diagnóstico de enfermedad renal crónica grado V que reciben hemodiálisis. Motivación para realizar el estudio. Se desconoce la frecuencia de la desnutrición en pacientes adultos con enfermedad renal crónica grado V en hemodiálisis en el Hospital de Alta Complejidad De La Libertad «Virgen de la Puerta¼. Principales hallazgos. Existe una alta frecuencia de desnutrición en los pacientes en hemodiálisis (92,4%), predominando la desnutrición moderada/severa (72,4%). Implicancias. Este estudio permite conocer la situación de la desnutrición en los pacientes en hemodiálisis con la finalidad de iniciar la intervención nutricional temprana, además se brindan datos importantes que se suman a la evidencia disponible.

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BACKGROUND: Multimodal rehabilitation has shown good results in adults with temporomandibular disorder (TMD), but there is still doubt regarding the protocol's ideal format (face-to-face or online), and its effectiveness among adolescents. The purpose of this study is to describe a randomized clinical trial protocol of face-to-face and online multimodal rehabilitation, in adolescents with TMD, and to determine its effects on pain, peripheral oxygenation of the masseter muscle, and mandibular range of motion, kinesiophobia and parafunction. METHODS: A randomized, controlled clinical trial, blinded to statistical analyses, will be carried out, involving 26 adolescents, diagnosed with TMD. After randomization, the participants will be allocated into two groups: (1) telerehabilitation and (2) face-to-face treatment groups. Each group will undergo an initial assessment, followed by three treatment sessions, reassessment, and follow-up. Appointments and reassessments will be face-to-face, with instruments validated and adapted for adolescent age groups. The intervention protocol also aims at practicality, ease of execution, and strategies for the patient to easily self-manage and perform independently, adapted for face-to-face or online formats. The Diagnostic Criteria for Temporomandibular Disorders, physical and psychosocial aspects, algometry, near-infrared spectroscopy, and the Tampa scale for kinesiophobia will be used to assess the outcomes. DISCUSSION: It is expected that this study will contribute to online and face-to-face assessments and demonstrate the differences in the practice of rehabilitation of adolescents with TMD. Data will be published after the study is completed, and if the benefits are proven, care modalities may be implemented. TRIAL REGISTRATION: REBEC-RBR-5scd5tm, UTN code: U1111-1288-4495 . Registered on 19 May 2023.

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Objectives: Physical activity and costs have been consistently related each other, but mostly in cross-sectional investigations. This study aims to investigate the relationship between changes in physical activity level and changes in healthcare costs among older diabetic adults in an 8-year follow-up study. Methods: The study followed 151 diabetic adults ≥50 years of age, for a period of 8 years, who were patients of Basic Health Care Units in the city of Bauru (Brazil). Medical records were consulted to obtain information on healthcare costs. Physical activity level was assessed through an interview. Data analysis included descriptive statistics, analysis of variance, and linear regression. Results: Participants who increased leisure-time physical activity from 2010 to 2018 accumulated less healthcare costs from 2020 to 2018. The magnitude of the relationship was small (r = -0.233 [95% CI: -0.379 to -0.076]). Conclusion: In summary, among diabetic patients, to increase leisure-time physical activity from 2010 to 2018 was inversely related to the amount of healthcare costs spent over the same period of 8 years.

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The aim of this study was to assess the impact of orthodontic treatment with orthodontic aligners (OAs) and fixed appliances (FAs) on oral health-related quality of life (OHRQoL). This parallel randomized clinical trial included 40 male and female patients aged 13 to 35 years diagnosed with Angle's Class I malocclusion. Participants were assigned to two groups: OA (n = 20) and FA (n = 20). OHRQoL was assessed using the Brazilian OHIP-14, which was administered before treatment (T0), at 1 month (T1), 6 months (T2), and 12 months (T3) after treatment initiation. Data were analyzed using the independent t test, the chi-square test, the Mann-Whitney test, and Friedman test (p < 0.05). FAs had a significantly (p < 0.05) higher impact on OHRQoL at T1 in terms of functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, and overall score. Within-group comparison showed higher scores for the FA group in comparison to the OA group. Functional limitation scores were higher at T1 than at T0 (p = 0.034), while physical pain scores were higher at T1 compared to T0 (p = 0.034) and T2 (p = 0.010). Psychological discomfort scores were higher at T1 than at T2 (p = 0.015). Physical disability scores were higher at T1 compared to T0 (p = 0.008). Overall scores were higher at T1 than at T2 (p = 0.003). No significant changes were observed in the OA within-group comparison. Patients treated with OAs had less impact on OHRQoL compared to those treated with FAs in the first month. There was no difference between the groups at the 6-month follow-up.