Training to Analyze Functional Parameters with Fiberoptic Endoscopic Evaluation of Swallowing: A Scoping Review.

Analyzing fiberoptic endoscopic evaluation of swallowing (FEES) is challenging and requires training to ensure the proficiency of health professionals and improve reliability. This scoping review aims to identify and map the available evidence on training health professionals to analyze FEES functional parameters. The method proposed by the Joanna Briggs Institute and the PRISMA-ScR guidelines were followed. The search was performed in MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, CINAHL databases, and in the gray literature. Two blinded independent reviewers screened articles by title and abstract. Then, they read the full text of the included reports, considering the eligibility criteria. Data were extracted using a standardized form. Six studies met the established eligibility criteria, published between 2009 and 2022, with few participants. All these studies addressed training as part of the process to validate a rating scale. No standardized criteria were observed regarding the selection of experts and participants, training structure, and outcome measures to assess participants' competence. The reviewed literature indicates that training must be developed to equip students and health professionals who treat dysphagia, enabling them to analyze the functional parameters of the FEES, considering variables that may influence the participants' performance.

Radiographic dental age estimation applying and comparing Demirjian's seven (1973) and four (1976) teeth methods.

To apply Demirjian's seven (1973, D7) and four (1976, D4) teeth methods in a sample of Brazilian children and compare their performances for age estimation. Panoramic radiographs of 1200 children (600 females and 600 males) were collected from Southeast Brazil. The children were equally distributed (n = 60 females and 60 males) between age intervals of 1 year between 6 and 15.9 (mean age = 10.9; standard deviation [SD]: 2.9) years. D7 and D4 dental age estimation methods were applied by two observers and were compared based on their error rates (error = estimated age-chronological age). Both methods overestimated the chronological age (p < 0.0001). D7 led to overestimations of 0.71 (p < 0.0001) in females and 0.83 (p < 0.0001) in males, while the overestimations with D4 were 0.14 (p = 0.0067) and 0.73 (p < 0.0001) for females and males, respectively. The mean age estimated by D7 was 11.7 (SD: 3.1) years, while for D4, it was 11.3 (SD: 3.3) years. Intra- and interobserver agreement was ≥ 0.98. D4 optimized the performance of radiographic dental age estimation compared to D7. Improvements were reflected in the total sample and separately for female and male children from Southeast Brazil.

Regulation and Use of Health Information Systems in Brazil and Abroad: Integrative Review.

There is increasing debate about the importance of using information and communication technologies to strengthen health systems. Information systems are one of the most widespread technologies for this end in different healthcare contexts. The primary objective of this study was to highlight and discuss the main characteristics of the regulation and use of health information systems in Brazil and abroad. As a secondary objective, the main characteristics identified in Brazil were compared with the findings for other countries. A robust search strategy incorporated five electronic databases. The research question was defined using the SPIDER strategy, and thematic content analysis was applied. Fourteen articles composed the final sample, and three analytic categories were identified: "Use in the Context of Health Systems"; "Implications for Health Management"; and "Communication and Interoperability." The regulation and use of health information systems in different countries was directly related to their socioeconomic context. In Latin America and Africa, policy strengthening and implementation possibilities for health management were discussed. In the United States, Europe, and Asia, the discussions on interoperability between different services was emphasized. The complexity of the Brazilian health system leads to similarities in the data analysis with several countries from different regions and with distinct political configurations.

Anteromedial meniscofemoral ligament-A rare finding.

We report a case of a 49-year-old patient presenting an anteromedial meniscofemoral ligament (AMMFL) on both knees with a tear of this ligament in the left knee associated to a normal anterior cruciate ligament (ACL). The AMMFL is a relatively rare anatomic structure that may correspond to a variant of the ACL type anterior root insertion of the medial meniscus. The findings reported in the literature were in most part results of incidental situations. AMMFL can be visualized through magnetic resonance imaging (MRI) and arthroscopy.

Enhancement of the Mechanical and Drug-Releasing Properties of Poloxamer 407 Hydrogels with Casein.

PURPOSE: Topical therapy of local disease (e.g. skin) is advantageous over oral therapy since there is less systemic drug distribution (so fewer side-effects), no first-pass effect, etc. However, patient compliance with topical therapy can be poor as it may require many applications a day and can last months. Here we propose a topical controlled release formulation with thermoresponsive gelation at body temperature and improved adhesiveness, making it easier to remain in contact with the body. METHODS: The formulation contains two excipients, poloxamer 407 (P407) and casein. Casein can modify the properties of the hydrogel through molecular entanglement. In addition, tissue reaction and drug release profile were evaluated. RESULTS: Changes in casein concentration affected adhesive strength, viscosity, mechanical properties and drug release, presumably by hydrophobic interactions between casein and P407. Two different concentrations of P407 were tested with two different concentrations of casein. Formulations containing 5% and 10% casein released 80% of model drug in 48 h, while formulations without casein released the same fraction in around 24 h hours. Formulations with 10% casein had almost twice the adhesive strength of those without casein. CONCLUSIONS: Addition of casein modified the mechanical properties and drug release rate of the hydrogel. There was no inflammation or injury after brief exposure in vivo.

An ultrasonic-based experimental model to evaluate the setting time of endodontic sealers.

AIM: To evaluate an ultrasonic-based experimental model (US), to assess the setting time of AH Plus® , Bio-C Sealer® and MTA Fillapex® , and compare the results obtained with ANSI/ADA specifications (2012). METHODS: To determine the setting time according to the ANSI/ADA specification, moulds measuring 10 mm (diameter) × 2 mm (thickness) were used, and for the US tests a transducer (1 MHz) and an oscilloscope were used. Fourier-transform infrared spectroscopy (FTIR) was used to evaluate the changes on chemical structure at the different setting times found by the US and ANSI/ADA methods. After checking the normal distribution, setting time data were analysed using unilateral analysis of variance with Tukey-HSD post-test to compare the methods. RESULTS: AH Plus® and Bio-C Sealer® had longer mean setting time values for the US method than for the ANSI/ADA (p < .05), whilst for MTA Fillapex® no significant difference was found between the methods (p < .05). FTIR spectra demonstrated that at the setting time determined by the US method, AH Plus® and Bio-C Sealer® were in a more advanced stage of polymerization than at the ANSI/ADA, whilst there was no significant difference for MTA Fillapex® . CONCLUSIONS: The use of US was effective for setting time determination and measured longer values than ANSI/ADA specification for AH Plus® and Bio-C Sealer® , identifying the entire (and not only superficial) setting of the endodontic sealers.

Cachexia: Pathophysiology and Ghrelin Liposomes for Nose-to-Brain Delivery.

Cachexia, a severe multifactorial condition that is underestimated and unrecognized in patients, is characterized by continuous muscle mass loss that leads to progressive functional impairment, while nutritional support cannot completely reverse this clinical condition. There is a strong need for more effective and targeted therapies for cachexia patients. There is a need for drugs that act on cachexia as a distinct and treatable condition to prevent or reverse excess catabolism and inflammation. Due to ghrelin properties, it has been studied in the cachexia and other treatments in a growing number of works. However, in the body, exogenous ghrelin is subject to very rapid degradation. In this context, the intranasal release of ghrelin-loaded liposomes to cross the blood-brain barrier and the release of the drug into the central nervous system may be a promising alternative to improve its bioavailability. The administration of nose-to-brain liposomes for the management of cachexia was addressed only in a limited number of published works. This review focuses on the discussion of the pathophysiology of cachexia, synthesis and physiological effects of ghrelin and the potential treatment of the diseased using ghrelin-loaded liposomes through the nose-to-brain route.

Properties, Extraction Methods, and Delivery Systems for Curcumin as a Natural Source of Beneficial Health Effects.

This review discusses the impact of curcumin-an aromatic phytoextract from the turmeric (Curcuma longa) rhizome-as an effective therapeutic agent. Despite all of the beneficial health properties ensured by curcumin application, its pharmacological efficacy is compromised in vivo due to poor aqueous solubility, high metabolism, and rapid excretion that may result in poor systemic bioavailability. To overcome these problems, novel nanosystems have been proposed to enhance its bioavailability and bioactivity by reducing the particle size, the modification of surfaces, and the encapsulation efficiency of curcumin with different nanocarriers. The solutions based on nanotechnology can improve the perspective for medical patients with serious illnesses. In this review, we discuss commonly used curcumin-loaded bio-based nanoparticles that should be implemented for overcoming the innate constraints of this natural ingredient. Furthermore, the associated challenges regarding the potential applications in combination therapies are discussed as well.

Praziquantel-Solid Lipid Nanoparticles Produced by Supercritical Carbon Dioxide Extraction: Physicochemical Characterization, Release Profile, and Cytotoxicity.

Solid lipid nanoparticles (SLNs) can be produced by various methods, but most of them are difficult to scale up. Supercritical fluid (SCF) is an important tool to produce micro/nanoparticles with a narrow size distribution and high encapsulation efficiency. The aim of this work was to produce cetyl palmitate SLNs using SCF to be loaded with praziquantel (PZQ) as an insoluble model drug. The mean particle size (nm), polydispersity index (PdI), zeta potential, and encapsulation efficiency (EE) were determined on the freshly prepared samples, which were also subject of Differential Scanning Calorimetry (DSC), Fourier-Transform Infrared Spectroscopy (FTIR), drug release profile, and in vitro cytotoxicity analyses. PZQ-SLN exhibited a mean size of ~25 nm, PdI ~ 0.5, zeta potential ~-28 mV, and EE 88.37%. The DSC analysis demonstrated that SCF reduced the crystallinity of cetyl palmitate and favored the loading of PZQ into the lipid matrices. No chemical interaction between the PZQ and cetyl palmitate was revealed by FTIR analysis, while the release or PZQ from SLN followed the Weibull model. PZQ-SLN showed low cytotoxicity against fibroblasts cell lines. This study demonstrates that SCF may be a suitable scale-up procedure for the production of SLN, which have shown to be an appropriate carrier for PZQ.

Friedelin in Maytenus ilicifolia Is Produced by Friedelin Synthase Isoforms.

Triterpenes are interesting compounds because they play an important role in cell homeostasis and a wide variety exhibiting defense functions is produced by plant secondary metabolism. Those same plant secondary metabolites also exhibit biological properties with promising therapeutic potential as anti-inflammatory and antitumor agents. Friedelin is a triterpene ketone with anti-inflammatory and gastroprotective activities and it is a precursor of relevant antitumor quinonemethides. Although many triterpene synthases have been described, only two friedelin synthases were characterized and there is no information about their genomic features and alleles. In the present work, we aimed to identify the gene and new isoforms of friedelin synthase in Maytenus ilicifolia leaves to be functionally characterized in Saccharomyces cerevisiae. The gene sequence analysis elucidated the exon/intron structure and confirmed the presence of single nucleotide polymorphisms with four non-synonymous mutations outside the active site of the enzyme. Therefore, two new isoforms were observed and the heterologous production of the enzymes in yeast showed similar production of friedelin. This first description of different alleles of the gene of friedelin synthase in M. ilicifolia can guide their validation as markers for friedelin-producer specimens.

Association of Silver Nanoparticles and Curcumin Solid Dispersion: Antimicrobial and Antioxidant Properties.

The last century, more precisely after 1945, was marked by major advances in the treatment of infectious diseases which promoted a decrease in mortality and morbidity. Despite these advances, currently the development of antimicrobial resistance has been growing drastically and therefore there is a pressing need to search for new compounds. Silver nanoparticles (AgNps) have been demonstrating good antimicrobial activity against different bacteria, viruses, and fungi. Curcumin (CUR) extracted from rhizomes of Curcuma longa has a variety of applications including antiinflammatory, antioxidant, and antibacterial agent. The association between silver nanoparticles and curcumin in a formulation can be a good alternative to control infectious diseases due the antimicrobial properties of both compounds. The objective of this work was to develop a formulation composed of a thermoresponsive gel-with antimicrobial and antioxidant properties due to the association of AgNps with PVP and PVA polymers. After AgNp synthesis, these were incorporated together with the previously prepared CUR/P407 (1:2) solid dispersion (SD) into a polymer dispersion of 20% P407 (thermosensitive gel). Our results showed that the association between the AgNps with CUR SD demonstrated good antioxidant activity as compared to the standard compound. Measures of MIC showed more efficacy against Gram-negative bacteria (Escherichia coli and Pseudomonas aeruginosa) than for Gram-positive bacteria (Staphylococcus aureus). This association enhances antimicrobial activity against E. coli and P aeruginosa and added antioxidant value in formulations.

Spotlight on Biomimetic Systems Based on Lyotropic Liquid Crystal.

The behavior of lyotropic biomimetic systems in drug delivery was reviewed. These behaviors are influenced by drug properties, the initial water content, type of lyotropic liquid crystals (LLC), swell ability, drug loading rate, the presence of ions with higher or less kosmotropic or chaotropic force, and the electrostatic interaction between the drug and the lipid bilayers. The in vivo interaction between LCC-drugs, and the impact on the bioavailability of drugs, was reviewed. The LLC with a different architecture can be formed by the self-assembly of lipids in aqueous medium, and can be tuned by the structures and physical properties of the emulsion. These LLC lamellar phase, cubic phase, and hexagonal phase, possess fascinating viscoelastic properties, which make them useful as a dispersion technology, and a highly ordered, thermodynamically stable internal nanostructure, thereby offering the potential as a sustained drug release matrix for drug delivery. In addition, the biodegradable and biocompatible nature of lipids demonstrates a minimum toxicity and thus, they are used for various routes of administration. This review is not intended to provide a comprehensive overview, but focuses on the advantages over non modified conventional materials and LLC biomimetic properties.

[Promoting health in vulnerable communities: social technologies for poverty reduction and sustainable development]. / Promovendo saúde em comunidades vulneráveis: tecnologias sociais na redução da pobreza e desenvolvimento sustentável.

OBJECTIVE: To report the experience of implementing social technologies in vulnerable communities to foster individual and community potential for health promotion, poverty reduction and sustainable development. METHOD: The experience reports were collected from July 2010 to June 2015 with 200 individuals residing in vulnerable communities, in Bahia, Brazil. The experiences were reported in stages: 1) Awareness and diagnostics; 2) Workshops on different subjects; 3) Deployment of social technologies. RESULTS: The participants were notified of the importance of sustainable development and the environmental and health conditions were diagnosed. Actions for sustainable development were planned, with the implementation of acoustic artefacts (natural fibres) and experimental kitchens (homemade sweets). CONCLUSIONS: Considering that health comprises actions that promote the quality of life, the use of social technologies favoured health promotion because they stimulated the potential of the participants. It also allowed the diversification of the community's income source and sustainable development, which reduces poverty and fosters sustainability, quality of life and health promotion.

Interaction Between Macrophages and Cryptococcus neoformans: Distinguishing Phagocytosed Versus External Fungi.

The interaction between macrophages and Cryptococcus neoformans is crucial in the pathogenesis of cryptococcosis. These phagocytes are important immune effectors, but also a niche in which facultative intracellular parasites, such as C. neoformans, thrive. Consequently, phagocytosis of cryptococcal cells and its outcomes are very frequently studied. One major issue with several of the tests used for this, however, is that macrophage-C. neoformans interaction does not always result in phagocytosis, as fungi may be attached to the external surface of the phagocyte. The most used methodologies to study phagocytosis of cryptococcal cells have varying degrees of precision in separating fungi that are truly internalized from those that are outside macrophages. Here we describe two assays to measure phagocytosis that can differentiate internal from external C. neoformans cells.

Natural and Synthetic Capsaicin Analogues: A Comprehensive Review of Biological Effects and Synthetic Pathways.

Capsaicin analogs, whether sourced from natural origins or synthesized de novo, have garnered significant attention across diverse scientific disciplines. This comprehensive investigation explores the expansive domain of medicinal chemistry and pharmacology, focusing on capsaicin and its analogs. Notably, these analogs exhibit a wideranging pharmacological spectrum, with a particular emphasis on their potent antitumor properties. Researchers frequently explore structural modifications, particularly in region C, consistently enhancing their pharmacological activities. A highlighted finding is that analogs with alterations in both regions A and C manifest a diverse array of effects, spanning from anti-obesity to protection against ischemia. They also demonstrate anti- Alzheimer's, anti-fibrotic, anti-inflammatory, anti-diabetic, antimalarial, and anti-epileptic properties. This underscores the potential of structural adaptations in these regions, expanding the therapeutic applications of capsaicin-like compounds. Additionally, manipulations in regions B and C result in compounds that possess antioxidant and anti-obesity properties, providing valuable insights for the development of novel compounds. The therapeutic potential of capsaicin analogs opens innovative avenues for drug design and development, promising to address a broad spectrum of diseases and enhance global quality of life. Moreover, this article meticulously examines various synthetic methodologies for synthesizing capsaicin analogs, complementing the main review. These methodologies distinguish themselves through their simplicity, mild reaction conditions, and reliance on readily available commercial reagents. The accessible synthesis pathways enable researchers from diverse backgrounds to explore these compounds, fostering investigations and potential therapeutic applications.

Health technologies for tackling client absenteeism in primary and secondary care services.

BACKGROUND: Tackling client absenteeism in primary and secondary care settings is crucial to ensure the continuity of care for individuals, families and communities, as well as preventing waste of resources within healthcare systems. METHODOLOGY: This article is an integrative review to identify advancements in health technologies that address client absenteeism in primary and secondary care. The databases Medical Literature and Retrieval System Online (MEDLINE/PubMed®), Scientific Electronic Library Online and Virtual Health Library were consulted. The inclusion criteria were as follows: full papers, published between 2013 and 2023, in English, Portuguese or Spanish. The descriptors used were the following: patients, mobile applications, health services management, absenteeism and primary care, and secondary care. Eleven articles published from 2014 to 2021 were included. RESULTS: Most articles were identified in the MEDLINE/PUBMED database, employed a randomized controlled trial methodology (36.36%), and were published between 2019 and 2021 (90.0%) in English (63.7%). The applications had managerial, assistive and/or educational purposes. In addition to absenteeism control, these applications strived to promote client engagement with health services, increase health literacy and tackle structural barriers to care, such as language barriers. CONCLUSION: Efforts are needed to ensure that providers receive training to educate clients on the applications. Moreover, community-based participatory studies to ensure the feasibility of applications are warranted.

Psidium guajava L. phenolic compound-reinforced lamellar scaffold for tracheal tissue engineering.

The aim of this work was to develop a dense lamellar scaffold, as a biomimetic material with potential applications in the regeneration of tracheal tissue after surgical tumor resection. The scaffolds were produced by plastic compression technique, exploiting the use of total phenolic compounds (TPC) from Psidium guajava Linn as a potential cross-linking agent in a polymeric mixture based on collagen (COL), silk fibroin (SF), and polyethylene glycol 400 (PEG 400). Fourier transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC) confirmed the chemical interactions between the polymers and the cross-linking of TPC between COL and SF. Morphological analyses showed scaffolds with porosity, interconnectivity, and a porous surface structure with a gyroid-like geometry. The analysis of the anisotropic degree resulted in anisotropic structures (0.1% TFC and 0.3% TFC) and an isotropic structure (0.5% TFC). In the mechanical properties, it was evidenced greater resistance for the 0.3% TFC formulation. The addition of TPC percentages did not result in a significant difference (p > 0.05) in swelling capacity and disintegration rate. The results confirmed that TPC were able to modulate the morphological, morphometric, and mechanical properties of scaffolds. Thus, this study describes a potential new material to improve the regeneration of major tracheal structures after surgical tumor removal.

Bixafen, Prothioconazole, and Trifloxystrobin Alone or in Combination Have a Greater Effect on Health Related Gene Expression in Honey Bees from Nutritionally Deprived than from Protein Supplemented Colonies.

The aim of this study was to evaluate whether alterations in food availability compromise the metabolic homeostasis of honey bees exposed to three fungicides alone or together. Ten honey bee colonies were used, with half receiving carbohydrate-protein supplementation for 15 weeks while another five colonies had their protein supply reduced with pollen traps. Subsequently, forager bees were collected and exposed by contact to 1 or 7 µg of bixafen, prothioconazole, or trifloxystrobin, either individually or in combination. After 48 h, bee abdomens without the intestine were used for the analysis of expression of antioxidant genes (SOD-1, CAT, and GPX-1), detoxification genes (GST-1 and CYP306A1), the storage protein gene vitellogenin, and immune system antimicrobial peptide genes (defensin-1, abaecin, hymenoptaecin, and apidaecin), through real-time PCR. All fungicide treatments induced changes in gene expression, with bixafen showing the most prominent upregulation. Exposure to 1 µg of each of the three pesticides resulted in upregulation of genes associated with detoxification and nutrition processes, and downregulation of immune system genes. When the three pesticides were combined at a dose of 7 µg each, there was a pronounced downregulation of all genes. Food availability in the colonies affected the impact of fungicides on the expression of the studied genes in forager bees.

Iron and aluminum ore mining pollution induce oxidative and tissue damage on fruit-eating bats from the Atlantic Forest.

Mining, a vital industry for economic growth, poses significant environmental pollution challenges. Failures in tailings dam containment have caused environmental contamination and raised concerns about preserving the globally significant biodiversity in the Atlantic Forest, which is under severe threat. Fruit-eating bats are key for forest regeneration as essential seed dispersers and pollinators. This study focuses on two keystone species, Artibeus lituratus and Sturnira lilium, exploring the effects of iron ore mining area (FEOA) and aluminum ore mining area (ALOA) on these bats, respectively, and comparing to individuals from a preserved Atlantic Forest fragment (FFA). Bats from FEOA showed higher Aluminum (Al), Calcium (Ca), Iron (Fe) and Barium (Ba) liver accumulation, as well as Ca and Fe muscle accumulation. These animals also showed higher liver and kidney oxidative damage associated with liver fibrosis and kidney inflammation. Brain and muscle also showed oxidative stress. Bats from ALOA showed higher Ca and Ba liver accumulation and Ca, Zinc (Zn), and Ba muscle accumulation, along with higher brain oxidative stress, liver fibrosis, and kidney inflammation. Our findings indicate that iron and aluminum ore mining activities cause adverse effects on bat tissues, posing a potential threat to biodiversity maintenance in the Atlantic Forest.

Successful management of oral ranula: a rare case in an infant.

An oral ranula is a retention cyst that arises from the sublingual gland as a result of ductal obstruction and fluid retention. This report describes the successful management of a rare case of oral ranula in an infant. A 4-month-old male infant was referred for emergency treatment due to a 2-month history of a swelling in the right sublingual region. The examination revealed a lesion of approximately 3.5 cm in diameter, which was jeopardizing the infant's breastfeeding. The lesion's dimensions suggested a ranula. Surgical specimens were sent for histopathological analysis to confirm the diagnosis. Although there are many different ways to treat an oral ranula, the marsupialization method was followed in this case due to the serious consequences of the infant's restricted access to nourishment. The treatment proved to be successful and after 18 months of follow-up, there was no sign of recurrence.