Chronic Pancreatitis in a Large Developing Country: Temporal Trends of Over 64,000 Hospitalizations from 2009 to 2019.

BACKGROUND/OBJECTIVES: Chronic pancreatitis (CP) is a progressive inflammatory disorder associated with marked morbidity and mortality and frequently requires hospitalization. This study aimed to investigate the time trends and geographical distribution of hospital admissions, the lethality rate of CP across Brazil, and the potential relationship with social indicators and associated risk factors. METHODS: Data were retrospectively obtained from the Brazilian Public Health System Registry between January 2009 and December 2019. The prevalence and lethality rates of CP per 100,000 inhabitants in each municipality were estimated from hospitalizations to in-hospital deaths and classified by age, sex, and demographic features. RESULTS: During the study period, 64,609 admissions were retrieved, and most of the patients were males (63.54%). Hospitalization decreased by nearly half (-54.68%) in both sexes. CP rates in males were higher in all age groups. The greatest reduction in admissions (- 64%) was also noted in patients ≥ 70y. CP In-hospital lethality remained stable (5-6%) and similar for males and females. Patients ≥ 70y showed the highest lethality. The greatest increase in CP lethality rates (+ 10%) was observed in municipalities integrated into metropolises, which was mainly driven by small-sized municipalities (+ 124%). CONCLUSIONS: CP hospitalizations decrease in both urban and rural areas, particularly in the North, Northeast, and Central-West regions, and in those above 70 years of age, but are not correlated with lethality rates in the South. This suggests ongoing changes in the environmental and socioeconomic factors in Brazil.

New plant-based fermented beverage made of baru nut enriched with probiotics and green banana: composition, physicochemical and sensory properties.

This study aimed to evaluate the influence of potential functional ingredients-green banana starch, green banana pulp flour or whole green banana flour-on the composition, physicochemical and sensory properties of plant-based fermented beverages made of baru nuts. The incorporation of green banana-derived ingredients, especially the whole flour, increased protein (2.44-2.81 g/100 g), fibre (1.53-2.32 g/100 g), resistant starch (0.15-0.33 g/100 g) and ash (0.36-0.61 g/100 g) content in fermented beverages. The total phenolic content and antioxidant capacity were higher in beverages added with pulp or whole flour. The main polyphenols identified were catechin (0.75-4.97 mg/100 g), gallic acid (0.29-0.52 mg/100 g) and ferulic acid (0.17-0.64 mg/100 g). All beverages showed to be rich in unsaturated fatty acids (68%) as omega-3, omega-6, and conjugated linoleic acid. The incorporation of green banana in beverages enhanced the probiotic bacteria growth indicating the potential prebiotic effect of the unripe fruit. The sensory acceptance of fermented beverages was also improved after adding green banana. Overall, whole green banana flour stood out as the main factor that increased the nutritional value of baru nut fermented beverage. Green banana was used for the first time as a potential prebiotic ingredient in a plant-based beverage. This novel product represents a potential symbiotic non-dairy alternative that could offer health benefits to consumers. Supplementary Information: The online version contains supplementary material available at 10.1007/s13197-023-05781-5.

Esthetics outcomes in patients submitted to pterional craniotomy and its variants: A scoping review.

BACKGROUND: Highly performed nowadays, the pterional craniotomy (PC) has several widespread variants. However, these procedures are associated with complications such as temporalis muscle atrophy, facial nerve frontal branch damage, and masticatory difficulties. The postoperative cranial aesthetic is, nonetheless, the main setback according to patients. This review aims to map different pterional approaches focusing on final aesthetics. METHODS: This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Studies were classified through the Oxford method. We searched PubMed/MEDLINE, EMBASE, and Cochrane Library from January 1969 to February 2021 for cohorts and randomized clinical trials that met our inclusion criteria. RESULTS: 1484 articles were initially retrieved from the databases. 1328 articles did not fit the inclusion criteria. 118 duplicates were found. 38 studies were found eligible for the established criteria. 27 (71.05%) were retrospective cohorts, with low evidence level. Only 5 (13.15%) clinical trials were found eligible to the criteria. The majority of the studies (36/38) had the 2B OXFORD evidence level. A limited number of studies addressed cosmetic outcomes and patient satisfaction. The temporal muscle atrophy or temporal hollowing seems to be the patient's main complaint. Only 17 (44.73%) studies addressed patient satisfaction regarding the aesthetics, and only 10 (26.31%) of the studies reported the cosmetic outcome as a primary outcome. Nevertheless, minimally invasive approaches appear to overcome most cosmetic complaints and should be performed whenever possible. CONCLUSION: There are several variants of the classic PC. The esthetic outcomes are poorly evaluated. The majority of the studies were low evidence articles.

Electronic Structure and Triplet-Triplet Energy Transfer in Artificial Photosynthetic Antennas.

Three Pd(II) phthalocyanine-carotenoid dyads featuring chromophores linked by amide bonds were prepared in order to investigate the rate of triplet-triplet (T-T) energy transfer from the tetrapyrrole to the covalently attached carotenoid as a function of the number of conjugated double bonds in the carotenoid. Carotenoids having 9, 10 and 11 conjugated double bonds were studied. Transient absorption measurements show that intersystem crossing in the Pd(II) phthalocyanine takes place in 10 ps in each case and that T-T energy transfer occurs in 126, 81 and 132 ps in the dyads bearing 9, 10 and 11 double bond carotenoids, respectively. To identify the origin of this variation in T-T energy transfer rates, density functional theory (DFT) was used to calculate the T-T electronic coupling in the three dyads. According to the calculations, the primary reason for the observed T-T energy transfer trend is larger T-T electronic coupling between the tetrapyrrole and the 10-double bond carotenoid. A methyl group adjacent to the amide linker that connects the Pd(II) phthalocyanine and the carotenoid in the 9 and 11-double bond carotenoids is absent in the 10-double bond carotenoid, and this difference alters its electronic structure to increase the coupling.

Chronic and acute effects of kefir: the role of angiotensin converting enzyme inhibition instead of nitric oxide balance

Probiotic consumption promotes numerous health benefits. The aim of this study is 1) to evaluate the antihypertensive effect of kefir in a hypertension rat model caused by the administration of the nitric oxide synthesis inhibitor, L-NAME, and 2) to evaluate the acute angiotensin converting enzyme (ACE) inhibitory activity of the soluble nonbacterial fraction (SNBF) of kefir. To develop the first aim, male rats were separated into three groups: control group (C) treated with 0.3 mL/100 g of milk; L-NAME group (LN) received 10 mg/kg of said inhibitor; and Kefir group (K) treated with 0.3 mL/100 g of kefir plus L-NAME (10 mg/kg of said inhibitor). The treatments were given by oral gavage twice a day for four weeks. For the second aim"instead additionally, male rats received angiotensin I (in bolus) in three doses (Ang I: 0.03, 3 and 300 µg/kg) and were separated into two groups: a) received captopril (30 mg/kg i.v.) and b)received SNBF of kefir (5 mL/kg i.v.). Blood pressure were evaluated before and after Ang I. After treatment, hemodynamic parameters were evaluated, heart weight was recorded, and body weight gain was calculated. SNBF of kefir did not decrease the blood pressure for L-NAMEtreated animals, and no changes were observed in the cardiac parameters. However, the SNBF of kefir demonstrated acute inhibition of ACE in vivo similar to that of captopril. Thus, our results suggest that kefir may improve human cardiovascular systems by using mechanisms independent of nitric oxide syntheses. Additionally, the renin angiotensin system is probably the most important system involved in kefir effect regarding hypertension.

Functional significance of a deep intronic mutation in the ATM gene and evidence for an alternative exon 28a.

Screening for ATM mutations is usually performed using genomic DNA as a template for PCR amplification across exonic regions, with the consequence that deep intronic sequences are not analyzed. Here we report a novel pseudoexon-retaining deep intronic mutation (IVS28-159A>G; g.75117A>G based on GenBank U82828.1) in a patient with ataxia-telangiectasia (A-T), as well as the identification of a previously unrecognized alternative exon in the ATM gene (exon 28a) expressed in lymphoblastoid cell lines (LCL) derived from normal individuals. cDNA analysis using the A-T patient's LCL showed the retention of two aberrant intronic segments of 112 and 190 nt between exons 28 and 29. Minigenes were constructed to determine the functional significance of two genomic changes in the region of aberrant splicing: IVS28-193C>T (g.75083C>T) and IVS28-159A>G, revealing that: 1) the first is a polymorphism; 2) IVS28-159A>G weakens the 5' splice site of the alternative exon 28a and activates a cryptic 5' splice site (ss) 83 nt downstream; and 3) wild-type constructs also retain a 29-nt segment (exon 28a) as part of both the 112- and 190-nt segments. Maximum entropy estimates of ss strengths corroborate the cDNA and minigene findings. Such mutations may prove relevant in planning therapy that targets specific splicing aberrations.

ATM mutations on distinct SNP and STR haplotypes in ataxia-telangiectasia patients of differing ethnicities reveal ancestral founder effects.

Due to the large size (150 kb) of the ataxia-telangiectasia mutated (ATM) gene and the existence of over 400 mutations, identifying mutations in patients with ataxia-telangiectasia (A-T) is labor intensive. We compared the SNP and STR haplotypes of A-T patients from varying ethnicities who were carrying common ATM mutations. We used SSCP to determine SNP haplotypes. To our surprise, all of the most common ATM mutations in our large multiethnic cohort were associated with specific SNP haplotypes, whereas the STR haplotypes varied, suggesting that ATM mutations predated STR haplotypes but not SNP haplotypes. We conclude that these frequently observed ATM mutations are not hot spots, but have occurred only once and spread with time to different ethnic populations. More generally, a combination of SNP and STR haplotyping could be used as a screening strategy for identifying mutations in other large genes by first determining the ancestral SNP and STR haplotypes in order to identify specific founder mutations. We estimate this approach will identify approximately 30% of mutations in A-T patients across all ethnic groups.

Nonclassical splicing mutations in the coding and noncoding regions of the ATM Gene: maximum entropy estimates of splice junction strengths.

Ataxia-telangiectasia (A-T) is an autosomal recessive neurological disorder caused by mutations in the ATM gene. Classical splicing mutations (type I) delete entire exons during pre-mRNA splicing. In this report, we describe nine examples of nonclassical splicing mutations in 12 A-T patients and compare cDNA changes to estimates of splice junction strengths based on maximum entropy modeling. These mutations fall into three categories: pseudoexon insertions (type II), single nucleotide changes within the exon (type III), and intronic changes that disrupt the conserved 3' splice sequence and lead to partial exon deletion (type IV). Four patients with a previously reported type II (pseudoexon) mutation all shared a common founder haplotype. Three patients with apparent missense or silent mutations actually had type III aberrant splicing and partial deletion of an exon. Five patients had type IV mutations that could have been misinterpreted as classical splicing mutations. Instead, their mutations disrupt a splice site and use another AG splice site located nearby within the exon; they lead to partial deletions at the beginning of exons. These nonclassical splicing mutations create frameshifts that result in premature termination codons. Without screening cDNA or using accurate models of splice site strength, the consequences of these genomic mutations cannot be reliably predicted. This may lead to further misinterpretation of genotype-phenotype correlations and may subsequently impact upon gene-based therapeutic approaches.

Independent mutational events are rare in the ATM gene: haplotype prescreening enhances mutation detection rate.

Mutations in the ATM gene are responsible for the autosomal recessive disorder ataxia-telangiectasia (A-T). Many different mutations have been identified using various techniques, with detection efficiencies ranging from 57 to 85%. In this study, we employed short tandem repeat (STR) haplotypes to enhance mutation identification in 55 unrelated A-T families of Iberian origin (20 Spanish, 17 Brazilian, and 18 Hispanic-American); we were able to identify 95% of the expected mutations. Allelic sizes were standardized based on a reference sample (CEPH 1347-2). Subsequent mutation screening was performed by PTT, SSCP, and DHPLC, and abnormal regions were sequenced. Many STR haplotypes were found within each population and six haplotypes were observed across several of these populations. Single nucleotide polymorphism (SNP) haplotypes further suggested that most of these common mutations are ancestrally related, and not hot spots. However, two mutations (8977C>T and 8264_8268delATAAG) may indeed be recurring mutational events. Common haplotypes were present in 13 of 20 Spanish A-T families (65%), in 11 of 17 Brazilian A-T families (65%), and, in contrast, in only eight of 18 Hispanic-American families (44%). Three mutations were identified that would be missed by conventional screening strategies. In all, 62 different mutations (28 not previously reported) were identified and their associated haplotypes defined, thereby establishing a new database for Iberian A-T families, and extending the spectrum of worldwide ATM mutations.

Five haplotypes account for fifty-five percent of ATM mutations in Brazilian patients with ataxia telangiectasia: seven new mutations.

We have studied the molecular genetics of 27 Brazilian families with ataxia telangiectasia (AT). Five founder effect haplotypes accounted for 55.5% of the families. AT is an autosomal recessive disorder of childhood onset characterized by progressive cerebellar ataxia, ocular apraxia, telangiectasia, immunodeficiency, radiation sensitivity, chromosomal instability, and predisposition to cancer. The ATM gene spans more than 150 kb on chromosome region 11q23.1 and encodes a product of 3056 amino acids. The ATM protein is a member of the phosphatidylinositol 3-kinase (PI-3K) family of proteins and is involved in cell cycle control and DNA repair pathways. DNA was isolated from lymphoblastoid cell lines and haplotyped using four STR markers (D11S1818, NS22, D11S2179, D11S1819) within and flanking the ATM gene; all allele sizes were standardized in advance. In addition to the STR haplotypes, SNP haplotypes were determined using 10 critical polymorphisms. The entire gene was screened sequentially by protein truncation testing (PTT), single strand conformation polymorphism (SSCP), and then denaturing high performance liquid chromatography (dHPLC) to identify the disease-causing mutations. Of the expected 54 mutations, 50 were identified. All mutations but one, led to a truncated or null form of the ATM protein (nonsense, splice site, or frameshift). Five families (18.5%) carried a deletion of 3450nt (from IVS28 to Ex31), making this one of the two most common Brazilian mutations. Mutations were located throughout the entire gene, with no clustering or hotspots. Standardized STR haplotype analysis greatly enhanced the efficiency of mutation screening.

Intercorrências Agudas no Domicílio 2

O Módulo 15 do Programa Multicêntrico de Qualificação em Atenção Domiciliar a Distância é intitulado "Intercorrências Agudas No Domicilio II" e foi produzido pela UNA-SUS/UFC. Aborda questões relativas ao cuidado domiciliar de pessoas que necessitam de acompanhamento constante em decorrência de limitações de locomoção, doenças crônicas ou fase terminal. As temáticas abordadas são: Avaliação e Manejo Domiciliar da Administração Errada de Medicamentos, da Broncoaspiração, da Dor Torácica, da Febre, da Incontinência Urinária, da Retenção Urinária Aguda, do Sangramento em Pacientes Anticoagulados e da Traqueostomia.

Avaliação e manejo domiciliar da administração errada de medicamentos - Caso Clínico

Caso Clínico da Unidade I Avaliação e manejo domiciliar da administração errada de medicamentos do Módulo Intercorrências Agudas no Domicílio II que aborda a análise de um caso e apresenta questões que contribuem na tomada de decisão.

O uso de antibiótico no contexto da avaliação e manejo domiciliar da broncoaspiração

Apresenta informações pertinentes ao uso de antibiótico na suspeita de aspiração em quadro de broncoaspiração

Avaliação e manejo domiciliar da incontinência urinária - Caso Clínico

Material da Unidade 4 "Avaliação e manejo domiciliar da incontinência urinária de medicamento", que compõe o Módulo 15 "Intercorrências Agudas no Domicílio II" do Programa Multicêntrico de Qualificação em Atenção Domiciliar a Distância, produzido pela UNA-SUS/UFC. Apresenta informações acerca da incontinência urinária, apontando aspectos que indicam as decisões que deverão ser tomadas em casos de pacientes que recebem atendimento domiciliar.

Avaliação e manejo domiciliar da retenção urinária aguda - Caso Clínico

Material da unidade 5 "Avaliação e Manejo Domiciliar da Retenção Urinária Aguda do Módulo Intercorrências Agudas", que compõe o módulo 15 "Intercorrências Agudas no Domicílio II" do Programa Multicêntrico de Qualificação em Atenção Domiciliar a Distância, produzido pela UNA-SUS/UFMA. Apresenta informações acerca da retenção urinária, apontando aspectos que indicam as decisões que deverão ser tomadas em casos de pacientes que recebem atendimento domiciliar.

Avaliação e manejo domiciliar de sangramentos em pacientes anticoagulados - Caso Clínico

Caso Clínico da Unidade7 "Avaliação e manejo domiciliar de sangramentos em pacientes anticoagulados" do Módulo "Intercorrências Agudas no Domicílio II" que aborda a análise de um caso e apresenta questões que contribuem na tomada de decisão.

Dor torácica cardíaca e não-cardíaca

Imagem apresentando a dor torácica cardíaca e não-cardíaca da Unidade III - Avaliação e Manejo Domiciliar da Dor Torácica do Módulo 15

Indicação e contraindicação ou risco para anticoagulação em casos de sangramento

Apresenta as indicações e contraindicações para anticoagulação em pacientes com sangramento na Unidade VII Avaliação e manejo domiciliar de sangramentos de pacientes anticoagulados do Módulo Intercorrências Agudas no Domicílio II.

Avaliação e manejo domiciliar da administração errada de medicamentos

Material da unidade 1 "Avaliação e manejo domiciliar da administração errada de medicamentos", que compõe o módulo 15 "Intercorrências Agudas no Domicílio II" do Programa Multicêntrico de Qualificação em Atenção Domiciliar a Distância, produzido pela UNA-SUS/UFMA. Apresenta informações acerca da administração de medicamentos, apontando aspectos que indicam as decisões que deverão ser tomadas em casos de erros nas prescrição de medicamentos.

Avaliação e manejo domiciliar da broncoaspiração

Material da unidade 2 "Avaliação e manejo domiciliar da broncoaspiração", que compõe o módulo 15 "Intercorrências Agudas no Domicílio II" do Programa Multicêntrico de Qualificação em Atenção Domiciliar a Distância, produzido pela UNA-SUS/UFC. Apresenta informações acerca da administração de medicamentos, apontando aspectos que indicam as decisões que deverão ser tomadas em casos de erros nas prescrição de medicamentos no tratamento da broncoaspiração.