Maize ranks as the second most widely produced crop globally, yielding approximately 1.2 billion tons, with corn cob being its primary byproduct, constituting 18 kg per 100 kg of corn. Agricultural corn production generates bioactive polysaccharide-rich byproducts, including xylan (Xyl). In this study, we used the redox method to modify corn cob xylan with gallic acid, aiming to enhance its antioxidant and protective capacity against oxidative stress. The conjugation process resulted in a new molecule termed conjugated xylan–gallic acid (Xyl-GA), exhibiting notable improvements in various antioxidant parameters, including total antioxidant capacity (1.4-fold increase), reducing power (1.2-fold increase), hydroxyl radical scavenging (1.6-fold increase), and cupric chelation (27.5-fold increase) when compared with unmodified Xyl. At a concentration of 1 mg/mL, Xyl-GA demonstrated no cytotoxicity, significantly increased fibroblast cell viability (approximately 80%), and effectively mitigated intracellular ROS levels (reduced by 100%) following oxidative damage induced by H₂O₂. Furthermore, Xyl-GA exhibited non-toxicity toward zebrafish embryos, offered protection against H₂O₂-induced stress, and reduced the rate of cells undergoing apoptosis resulting from H₂O₂ exposure. In conclusion, our findings suggest that Xyl-GA possesses potential therapeutic value in addressing oxidative stress-related disturbances. Further investigations are warranted to elucidate the molecular structure of this novel compound and establish correlations with its pharmacological activities

Fusarium and allied genera (fusarioid) species are common colonizers of roots and aerial plant parts, or act as phytopathogens in forestry and horticultural or grain crops. However, they can also cause a wide range of infections in humans, including onychomycosis, cutaneous and invasive infections. Fusarioid keratitis is characterized by an infection of the cornea with a suppurative and ulcerative appearance, which may cause damage to vision and permanent blindness. The aim of the present study was to investigate the prevalence of fusarioid species, biofilm formation and antifungal susceptibility profiling of clinical isolates recovered from patients with keratitis and dermatomycoses. The study was performed between March, 2012-December, 2022. Demographic, clinical and epidemiological data of patients were also collected. In the present study, most of the patients with keratitis were male (74%), had a median age of 42 years old, worked with plant material or debris and 26 % of them reported eye trauma. Regarding dermatomycosis, most of patients were female and exhibited toenail lesions. Forty-seven isolates belonged to the genus Neocosmospora (78.33 %), nine to the Fusarium fujikuroi (15%) and four to the Fusarium oxysporum (6.66 %) species complexes. Several strains were moderate biofilm producers, specifically among Fusarium annulatum. Most strains showed increased MICs to amphotericin B and ketoconazole and low MICs to itraconazole. MICs ranged from 0.25 to 16 for amphotericin B, 0.0625 to >16 for ketoconazole and 0.125 to 8 for itraconazole. It is possible to conclude that fusarioid keratitis in Northeastern Brazil is an important and neglected disease, given the high number of cases, increased need for keratoplasty and poor outcome of the disease.

Amyotrophic Lateral Sclerosis (ALS) is a multisystem neurological disease characterized by the degeneration of motor neurons. Malnutrition is common in ALS and evidence-based nutritional interventions promote the optimization of nutritional status, contributing to improved quality of life and survival of patients with ALS. The general objective of this dissertation was to identify and synthesize scientific evidence and recommendations aimed at nutritional interventions in ALS. Thus, three products were developed: 1) a narrative review (article 1); a protocol of systematic review (article 2); and a systematic review (article 3). Each article was developed according to the required methodological specificity. The narrative review (article 1) synthesized relevant information, extracted from several relevant studies published in PubMed/MEDLINE, on intestinal microbiota and neurodegenerative diseases, with an emphasis on ALS. According to the characteristics of this type of review, there was no systematization in the selection or inclusion of studies, but rather a subjective flexibility on the part of the authors in choosing the information shared. The data extracted in this narrative review were arranged in topics covering “intestinal microbiota and human microbiome”, “intestinal microbiota and neuro-immuno-endocrine system”, “intestinal microbiota and ALS” and “modulation of intestinal microbiota in ALS”. The systematic review protocol (article 2) was registered in the PROSPERO database on April 12, 2021 (CRD42021233088) and was developed according to the Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). It encompassed the planning of more than one systematic review to answer three research questions: RQ1- “What are the evidence-based nutritional recommendations to maintain or restore the nutritional status of patients with ALS?”; RQ2 - “What is the effect of a diet rich in energy and protein in people with ALS?”; and RQ3 - “What are the effects of supplementation of isolated micronutrients or bioactive compounds in people with ALS?”. The answer to RQ1 gave rise to the systematic review produced in this dissertation (article 3). This systematic review (article 3) followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and used the following electronic libraries and databases: PubMed/MEDLINE, EMBASE, Scopus, SciELO, Web of Science, LILACS, CENTRAL, ScienceDirect, ProQuest, and Google Scholar. Of a total of 462 records identified, 11 were included, 7 of which were guidelines and 4 were systematic reviews. The quality of the evidence was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). Due to the heterogeneity of the studies, it was not possible to perform a meta-analysis. The summary of nutritional recommendations was organized into five topics: “dysphagia”, “energy”, “protein”, “supplementation”, and “percutaneous endoscopic gastrostomy”. According to the products developed, it was concluded that the intestinal microbiota can modulate several physiological and behavioral activities based on the microbiota-intestine-brain axis. The study of the intestinal microbiota in ALS is an important field of research and its modulation is considered an important therapeutic target for affected patients, since intestinal dysbiosis is related to complications and worse prognoses. The developed protocol demonstrated the importance of adequate planning to prepare the systematic review and highlighted the relevance of using evidence-based nutrition in decision-making related to nutritional therapy in ALS. The evidence and recommendations summarized in the systematic review covered various aspects of the nutritional management of patients with ALS, including energy-protein needs, changes in diet consistency, and use of alternative feeding route. There were also gaps in the literature regarding specific micronutrient needs and recommendations for nutritional supplements in ALS. Finally, the scientific information gathered in this dissertation is relevant for directing safe and effective nutritional interventions in ALS, optimizing the nutritional status and prognosis of affected patients.

Background: Adhesive capsulitis (AC) is one of the primary causes of shoulder girdle dysfunction, whose main characteristics are pain and restricted mobility originating in the glenohumeral joint. There is no consensus concerning adequate treatment, with various clinical and surgical approaches proposed. Objective: The objective

of the present study was to compare the results of AC treatment in patients submitted to suprascapular nerve block (SSNB) associated with physiotherapy (PT) and those who only underwent physiotherapy.

Methods: Patients with AC were randomized into two groups: a block (SSNB + PT) and control group, only with

physiotherapy (PT). Four serial blocks were used with 6 ml of 0.25% bupivacaine, at 15-day intervals. Both groups were analyzed using a visual analog scale (VAS), UCLA score and range of motion (ROM) measured with

digital goniometry (iHandy Level), before treatment (Dzero), at 2, 4 and 6 months. Analyses with 95% confidence

interval and p < 0.05 were considered statistically significant.

 Results: A total of 182 patients, 68 men and 114 women, were assessed. Sixty-nine patients were submitted to nerve block and physiotherapy (SSNB+PT) and 113 were controls (only PT). The t-test showed no statistical difference between the two groups at Dzero, 2, 4 and 6 months (p > 0.05). ANOVA demonstrated that the time factor was statistically significant in improving the parameters analyzed, irrespective of the block (SSNB) occurring (p < 0.05). After 6 months, 15 patients were submitted to surgery. Patients who at the start of the study (Dzero) exhibited flexion arc <130º, were more likely to evolve to surgery, and those who in the second month of study had an external rotation ROM <40º, and/or internal rotation ROM below T12 and/or VAS above 5 and/or UCLA below 20 were also more likely to require surgery

Colorectal cancer is still unmanageable despite advances in target therapy. However, extracellular vesicles (EVs) have shown potential in nanomedicine as drug delivery systems, especially for modulating the immune cells in the tumor microenvironment (TME). In this study, M1 Macrophage EVs (M1EVs) were used as nanocarriers of oxaliplatin (M1EV1) associated with retinoic acid (M1EV2) and Libidibia ferrea (M1EV3), alone or in combination (M1EV4) to evaluate their antiproliferative and immunomodulatory potential on CT-26 and MC-38 colorectal cancer cell lines and prevent metastasis in mice of allograft and peritoneal colorectal cancer models. Tumors were evaluated by qRT-PCR and immunohistochemistry. The cell death profile and epithelial-mesenchymal transition process (EMT) were analyzed in vitro in colorectal cancer cell lines. Polarization of murine macrophages (RAW264.7 cells) was also carried out. M1EV2 and M1EV3 used alone or particularly M1EV4 downregulated the tumor progression by TME immunomodulation, leading to a decrease in primary tumor size and metastasis in the peritoneum, liver, and lungs. STAT3, NF-kB, and AKT were the major genes downregulated by of M1EV systems. Tumor-associated macrophages (TAMs) shifted from an M2 phenotype (CD163) to an M1 phenotype (CD68) reducing levels of IL-10, TGF-β and CCL22. Furthermore, malignant cells showed overexpression of FADD, APAF-1, caspase-3, and E-cadherin, and decreased expression of MDR1, survivin, vimentin, and PD-L1 after treatment with systems of M1EVs. The study shows that EVs from M1 antitumor macrophages can transport drugs and enhance their immunomodulatory and antitumor activity by modulating pathways associated with cell proliferation, migration, survival, and drug resistance.

Aim

Arterial occlusion pressure (AOP) is a relevant measurement for individualized prescription of exercise with blood flow restriction (BFRE). Therefore, it is important to consider factors that may influence this measure. This study aimed to compare AOP measured with 12 cm (medium) and 18 cm (large) cuffs, in different body positions, and explore the predictors for each of the AOP measurements performed. This information may be useful for future studies that seek to develop approaches to improve the standardization of pressure adopted in BFRE, including proposals for equations to estimate AOP.

Methods

Fifty-one healthy volunteers (males, n = 25, females, n = 26; Age: 18 to 40 years old) underwent measurement of thigh circumference (TC), brachial blood pressure, followed by assessments of lower limb AOP with medium and large cuffs in positions supine, sitting and standing positions.

Results:

The large cuff required less external pressure (mmHg) to elicit arterial occlusion in all three-body positions when compared to the medium cuff. The AOP was significantly lower in the supine position, regardless of the cuff used (p<0.05). Systolic blood pressure was the main predictor of AOP determined with the large cuff, while TC was the main predictor of AOP determined with the medium cuff. Body position influenced the strength of the AOP predictors.

Conclusion

Our results indicate that AOP and its predictors are substantially influenced by body position and cuff width. Therefore, these variables should be considered when standardizing the pressure prescribed in BFRE.

Venous Ulcers (VU) are a serious health problem that affect the Quality of Life (QoL). They are evaluated by many different scales in the literature. We aimed to analyze the correlation between the Medical Outcomes Short-Form Health QoL (SF-36) and Charing Cross Venous Ulcer Questionnaire (CCVUQ) scales. This is a cross-sectional study conducted in a Brazilian center specializing in chronic VU of the Primary Health Care (PHC) provided to patients with active VU. The general QoL instrument SF-36 and the CCVUQ, specific for people with VU, were used. Spearman’s Rho Test determined the correlation between the variables analyzed. Our sample had a total of 150 patients. We found a direct correlation between the domestic activities division (CCVUQ) aspect and the SF-36 Physical role functioning (strong), and Physical functioning (moderate) domains. The Social interaction division (CCVUQ) aspect presented moderate correlation with the domains of the SF-36 Physical role functioning and Physical functioning. The Vitality domain (SF-36) showed moderate correlation with the aspects of CCVUQ Cosmesis division and Emotional status division. The greatest forces of direct correlation were observed between the physical, functional and vitality aspects of SF-36 with those represented by domestic activities and social interaction in the CCVUQ.

OBJECTIVES: We aimed to evaluate clinical and histological changes induced by Fractional Radiofrequency (FRF) and microneedling in vulvar tissue. METHODS: Thirty postmenopausal women were randomly divided into G1 (FRF) and G2 (microneedling) groups. Sub-ablative FRF was executed using disposable fractionated electrodes with an intensity of 8 mJ. Microneedling was performed using a derma roller system. We evaluated before and after treatment using the Vaginal Laxity Questionnaire [VLQ], EuroQol five-dimensional [EQ-5D] questionnaire, and the Blatt and Kupperman menopausal index [BKMI]. Additionally, we performed biopsies of the labia majora for histological analysis pre- and post-treatment. Data were expressed as mean (± standard deviation). A paired t-test was used for intra-group comparison (pre- and post-treatment), with an independent t-test used to compare intergroup data (both pre- and post-treatment). RESULTS: In the G1 group, the VLQ values showed differences compared to the pre-treatment values with the data obtained 60 days after the beginning of the sessions (p=0.01). Similarly, the data changes of the G2 group proved to be significant (p=0.001) across the same time interval. In comparing the groups, VLQ values were not different (p>0.05). Regarding histological analysis, FRF demonstrated improvement concerning the number of fibroblasts, blood vessels, and fatty degeneration (p<0.05) compared to the control. Additionally, FRF and microneedling samples showed higher type III collagen and vimentin expression in the immunohistochemical analysis (p<0.05). CONCLUSIONS: The therapies were found to be effective in treating the flaccidity of the female external genitalia. Additionally, histological changes were observed after interventions suggesting collagen remodelling.

Cystic fibrosis (CF) is a serious, multisystem genetic disease caused by mutations in the gene that encodes the cystic fibrosis conductance regulatory protein (CFTR). Although it has been described more than 2.000 CFTR mutations, in heterogeneous populations, such as the Brazilian one, molecular diagnosis is difficult by the lack of knowledge of the panel of mutations specific to the population. Thus, the present study aims to describe the clinical and molecular profiles of patients with CF at a referral center in Rio Grande do Norte, based on the genetic results obtained by high-throughput sequencing, and to correlate them with the correct diagnosis and phenotypes of these patients.

Chagas disease is a neglected tropical disease caused by the protozoan Trypanosoma cruzi. In this scenario, the only drug of choice for treatment in Brazil is Benznidazole (BNZ). Despite its widespread use, this molecule has efficacy problems due to its high toxicity, difficulty in crossing biological barriers, and low solubility in aqueous media. Therefore, the co-delivery of benznidazole together with phytol (FIT), an acyclic monounsaturated diterpene alcohol that expresses promising antitrypanosomal activity, is justified. Nanocarriers have proven ability to cross most biological barriers and intracellular targeting of drugs. The objective of this work was to develop biodegradable hybrid nanocarriers containing benznidazole and phytol, to improve the targeting of the compounds to cells infected by Trypanosoma cruzi. The systems were produced by the nanoprecipitation method. The formulation development and obtaining parameters were optimized by measurements of mean particle size, polydispersity index, zeta potential, atomic force microscopy (AFM), scanning electron microscopy (SEM), infrared absorption spectroscopy with transform Fourier (FTIR-ATR), encapsulation efficiency and in vitro studies. Spherical and stable hybrid nanocarriers below 200 nm were obtained, with encapsulation efficiency greater than 95% for FIT and 30% for BNZ. The in vitro drug release kinetics demonstrated a slow release of the nanocarriers. In vitro assays in normal cells (3T3) and (RAW) showed cytocompatibility and in trypomastigotes (CL-Brenner) showed an increase in the antichagasic activity of nanocarriers containing BNZ-FIT over monoloaded systems and BNZ and free FIT. Thus, the present work systematically addresses the development of a nanotechnological system with innovative potential for increasing the antichagasic response from the association of actives.

Cooking skills (CS) are defined as an individual's confidence, attitude, and application of knowledge to perform culinary tasks. Developing these skills can improve the quality of the diet, as cooking at home can encourage the consumption of vegetables and reduce the use of ultra-processed foods, which can result in benefits to nutritional status. University students are faced with the difficulty of balancing academic activities, studies, social life and work, with little time to be dedicated to cooking. High consumption of ultra-processed foods is common during this period of life, which may be related to low levels of CS and the emergence of overweight/obesity, as observed in some studies. Therefore, it can be suggested that the development of CS in this population becomes essential as a health promotion measure. This study aimed to analyze the association between CS and overweight/obesity in university students. The methodology consisted of a descriptive, observational, and cross-sectional study, with data collected between October/2020 and March/2021 through an online form, with 822 undergraduate students from the Federal University of Rio Grande do Norte. For sociodemographic characterization, a questionnaire with 15 questions was applied and to characterize CS, the Brazilian Cooking Skills and Healthy Eating Questionnaire (BCSQ) with 7 scales was applied. Logistic regressions were used to assess associations of CS with overweight and obesity. Among research participants, 70.3% were female; with a median age of 23 years; 43.6% were overweight while 56.4% were not overweight. As for CS, 0.6% had low CS, 33.4% had medium CS and 65.9% had high CS. Overweight and obesity were shown in the bivariate analysis to be significantly associated with low levels of the CS scales of “cooking self-efficacy” and “self-efficacy in the use of fruits, vegetables and seasonings”. Logistic regressions demonstrated that living with other people and eating out were associated with greater odds of being overweight and obese. Sharing responsibility for preparing meals and high “self-efficacy in the use of fruits, vegetables and seasonings” were associated with lower chances of overweight/obesity. Therefore, the results suggest that CS can be explored in educational programs aimed at reducing overweight/obesity in these students by improving the quality of their diet. The study resulted in an article published in the journal “Nutrients” entitled “Low cooking skills are associated with overweight and obesity in undergraduates”.

Objectives: This study aims to evaluate the impact of Microablative Fractional Radiofrequency (MAFRF) on postmenopausal women with vaginal atrophy. Methods: This was a randomized, controlled clinical trial of postmenopausal women diagnosed with urogenital atrophy. Treatment consisted of three sessions of MAFRF, compared to vaginal estrogen administration and an untreated control group. Assessments occurred at baseline and 30 days after the last session. The primary endpoints were sexual function, evaluated by the Female Sexual Function Index (FSFI), and vaginal health, assessed by the Vaginal Health Index (VHI). Secondary outcomes included Nugent score and Vaginal Maturation Index (VMI). Results: One hundred and twenty patients (40 in each group) were eligible for inclusion. Concerning the FSFI, both treatment groups (median [interquartile range], MAFRF (4.8 [2.4]) and vaginal estrogen (4.8 [2.3]), experienced improved sexual desire when compared to the control group (3.6 [2.4]), (p=0.020 and p=0.014), respectively. Regarding the total score of VHI, we observed an increase in the mean and standard deviation of the MAFRF (25.0 [2.0]) and vaginal estrogen groups (25.0 [3.0]) when compared to the control (15.0 [5.8]), (p < 0.01), for both groups. There was a decrease in the mean of the Nugent score in MAFRF (0.00) and vaginal estrogen groups (0.00), (p < 0.01), for both groups. Lastly, for the VMI, there were significant differences in the mean score of MAFRF (52.25) and vaginal estrogen (53.00) when compared to the control group (48.00), (p < 0.01 and p < 0.001), respectively. No significant differences were observed between the MAFRF and vaginal estrogen groups in any studied variables. Conclusions: Despite promising results found in this trial about the use of MAFRF in vaginal atrophy treatment, it is important to point out that larger and longer series regarding long-term safety are lacking.

Introduction: The spread of Trypanosoma cruzi infection is directly related to its form of transmission and the primordial control actions are those that prevent or hinder the contact of the parasite with humans and domestic animals. For this, it is essential to understand the socioepidemiological characteristics of each region, so that specific measures are established for each cycle of transmission of the parasite. Objective: To determine the epidemiological profile of individuals with suspected acute Chagas disease in northern Brazil and to evaluate the entomological control of T. cruzi vectors in an endemic area of the state of Rio Grande do Norte. Methods: The epidemiological profile of individuals with suspected acute Chagas disease (ACD) was evaluated in the municipality of Breves, Pará State (PA), Brazil. The data obtained by DATASUS-Municipal Health Department were used from 2007 to 2017 and analyzed using simple descriptive statistics. The entomological data analysis was performed in the Agreste mesoregion of the state of Rio Grande do Norte, regarding entomological surveillance for the period from 2005 to 2015 and made available by the State Department of Public Health of the State of Rio Grande do Norte. The evaluation of the activities was carried out through the active search for triatomines in the housing units and the chemical control of these infested dwellings. The quantitative analysis of household units surveyed on the entomological indicators was performed using the random effects linear regression test (p <0.05). Results: The analysis of the epidemiological profile of individuals with suspected ACD in the municipality of Breves, PA, showed that the majority of them were male (54.7%-145/265), aged between 10 and 19 years (23%-61/265), low education level (74.4%-197/265) and residents in rural areas (58.9%-156/265). A total of 265 individuals were reported as suspected cases of ACD, of which 64.1% (170/265) had laboratory confirmation for chagasic infection. The main route of transmission of T. cruzi was oral (98.1%-260/265), probably through the consumption of food contaminated with viable forms of the parasite. This route of contamination occurred mainly in the domiciliary environment (96.2%-255/265) with higher incidence between the months of August and December. From 2005 to 2015, 92,156 household units were investigated in the rural mesoregion of RN and the presence of triatomines was recorded in 4,639 (5.0%). Only 53.1% (2,463/4,639) of the infested household units were submitted to chemical control. In addition, there was a decrease in the total number of units surveyed over time associated with an increase in the index of intradomiciliary colonization (p = 0.004). A total of 4,653 specimens of triatomines were captured and the species recorded were Triatoma pseudomaculata (n = 1,775), Triatoma brasiliensis (n = 1,569), Rhodnius nasutus (n = 741) and Panstrongylus lutzi (n = 568), with natural infection index by T. cruzi of 2.2% (90/4,104). Conclusões: The results showed that oral transmission of T. cruzi has become increasingly high in the northern region of Brazil, highlighting the need to implement actions aimed at health education as strategies to ensure the improvement of food handling practices in natura. In addition, we identified that entomological surveillance in the Agreste mesoregion of the state of RN was discontinued and, the data signal for more effective and continuous public policies, mainly regarding the chemical control of vectors to avoid exposure of domestic animals and humans to the risk of acquiring infection by T. cruzi.

Neglected Tropical Diseases (NTDs) remain a public health problem in Brazil. Rare genetic diseases are similar to NTDs, due to the low interest of the pharmaceutical industry and the small number of people impacted to justify the investment in clinical research. Both represent a significant challenge for global public health, where the promotion of comprehensive health has been understood as a multifaceted phenomenon, including education. One of these rare diseases, congenital lipodystrophy (CGL), is characterized by severe impairment of adipose tissue. Its prevalence is 3 cases/million, but it is significantly present in Rio Grande do Norte (RN), with 32.3 cases/million. Therefore, this thesis contains two approaches (divided into two articles): (1) the study of cells isolated from CGL individuals to examine whether the disruption of lipid metabolism influences the infection of intracellular pathogens, using Leishmania infantum as a model, causal agent of the NTD visceral leishmaniasis, and (2) the intervention study of digital literacy to help, ultimately, in the battle against NTDs in the RN and thus bring a proposal of education as a factor of transformation in health. Article (1) RNA-seq analysis for monocyte-derived macrophages from CGL individuals showed a discernible transcriptomic signature associated with impaired membrane trafficking when responding to in vitro infection by L. infantum. L. infantum also showed changes in its gene expression for genes related to membrane interaction, such as decreased expression of amastins. It is concluded that there is an interruption in the response to infection in CGL cells by intracellular pathogens and that the candidate pathways to explain this interruption are related to membrane traffic (endocytosis), collagen metabolism (fibrosis), immunological synapse, and irregular biosynthesis of phosphoglycerides, mainly, phosphatidylinositol. This study points out that in vitro infection of CGL cells can be a model approach to studying lipid metabolism and its relationship with infectious processes. Article (2) Around half of the world's population remains without access to the internet or essential digital skills. An educational intervention of 8 classes focused on digital technology, digital culture, and computational thinking was carried out in Pureza/RN. Although some students had no previous contact with computers, their digital tasks increased throughout the classes, regardless of family income and digital culture at home. Students improved their interaction with the computer and their self-confidence in the digital environment. Their scores on the logic/math assessment showed significant improvement in these skills. This was not observed in the control group, demonstrating the importance of this intervention. Here, a viable solution to the digital divide in which children live is presented, with potential earning opportunities in their future. Digital education can be an effective means of improving access to information about disease and prevention, as well as providing training for local health professionals. Therefore, this thesis contributes to the scientific production of neglected and rare diseases, and also to inclusive digital education in an endemic region for NTDs.

The objective of this study was to analyze the association and correlation between pain and QoL in people with VU treated in a Brazilian Primary Health Care (PHC) lesions treatment center. This is an observational, cross-sectional study with a quantitative approach, carried out in a service specialized in the treatment of chronic injuries, linked to 29 PHC units. Sociodemographic and health characterization instruments were used. The Short Form Health Survey-36 (SF-36) and Visual Analogue Pain Scale (VAPS) also were used. The Kruskal-Wallis test verified the association between the scalar variables of QoL and pain intensity. With Spearman's correlation test, we verified the level of correlation between the scales applied. A total of 103 patients participated in the study. Higher QoL scores associated with moderate pain were found, especially in the Physical role functioning, Physical functioning, and Vitality domains. Correlation analysis showed its greatest (moderate) strength in the interaction between the highest scores in the Physical role functioning and Emotional role functioning domains with the lowest pain levels.

Interprofessional health education (IPE) can contribute to the formation of health professionals who are more capable of collaboration and focused on the health needs of populations. In Brazil, policies and strategies have been formulated in recent decades, with the aim of positively impacting health education and improving the quality of care, such as PET-Health. This study aimed to analyze projects, reports and instruments generated by the PET-Health Interprofessionality projects and their implications for the induction and strengthening of interprofessionality in education and work in health. This is a descriptive-exploratory study, part of the project “Scientific Evidence on the implications of PET-Health Interprofessionality in health education”. The design of documentary research and a descriptive study were used, which combined methods of qualitative and quantitative approach. Between March and May 2021, partial reports of six and twelve months of execution of the 120 PET-Health Interprofessionality Projects were analyzed. Aspects that interfere with the adoption and strengthening of interprofessionality in education and work in health and future recommendations were organized into relational, procedural, organizational and contextual dimensions. Between July and September 2021, 143 IPE initiative plans from different PET-Health Interprofessionality projects were analyzed. Most plans cited powerful methodologies and scenarios for IPE but did not detail these strategies in relation to developing interprofessional competences. Assessment of learning and IPE initiatives need to be deepened. Between November 2021 and February 2022, the 120 projects approved and completed electronically on FormSUS were analyzed. The issue most cited as a justification for strengthening interprofessionality was the lack of IPE formalization in curricula. In the fourth stage of the investigation, the online evaluation forms answered by the participants of the Update Course in Teacher Development for EIP were analyzed. The course was an important strategy for the sustainability of EIP programs in the country, enabling an increase in qualified institutional leaders to lead and support EIP plans. The online format, mediated by tutors, represented a powerful strategy. The PET-Health Interprofessionality represents a Brazilian effort to qualify the EIP and CP, to boost leadership that supports this strengthening and to strengthen the scientific evidence around interprofessionality, capillarizing interprofessional experiences in all regions of the country and involving 6.369 people. The teaching-service-community articulation as the basic axis of PET-Health Interprofessionality represents a powerful strategy for the early insertion of students from different professions in PHC and communities, enabling interprofessional learning in real scenarios of health work.

Obesity is one of the health problems that grows the most throughout the world during adolescence, being a disease that is difficult to control, with multifactorial etiology. Understanding the social determinants and environmental conditions that lead to overweight and obesity in adolescence is essential for developing strategies for their control and treatment. Objective: To evaluate the factors associated with overweight and obesity in adolescents, considering Social Network Analysis. Methods: This thesis was developed through two studies: 1) a cross-sectional study with adolescents in a rural school in Rio Grande do Norte - RN; 2) a systematic review to evaluate the influence of social networks on food consumption habits and physical activity practices and their relationship with overweight and obesity in adolescents aged 12 to 19 years. For the cross-sectional study, n = 90 students from a rural school in Ielmo Marinho participated and answered questionnaires about sociodemographic characteristics, food consumption, physical activity, and social networks. Social networks were built based on students’ social ties. Principal Component Analysis was performed to determine dietary patterns and logistic models to investigate variables associated with overweight/obesity. The systematic review was registered in PROSPERO and followed the PRISMA guidelines. Searches were carried out in PubMed, Scopus, EMBASE, PsycINFO, and Web of Science databases for publications from 2009 to 2022. To evaluate the methodological quality of the studies found, the Newcastle-Ottawa scale was used. Results: The results of the cross-sectional study showed that the majority of participants were girls (62.9%) and the proportion of overweight/obesity was 30% among adolescents. The students cited 2,070 people from their networks (family, friends at school, friends outside of school, and others). Among them, the family had the greatest degree of influence (61%) in the network and shared more meals with teenagers (47%). Adolescents' perception of the body size of their family members with obesity, compared to normal weight or underweight, was prevalent (51%). Adolescents with unhealthy eating patterns were 72% more likely to be classified as overweight/obese, and eigenvector centrality was also associated with overweight/obesity. For the systematic review, after screening, 7 studies were identified and carried out in countries in Europe, North America, the Chinese Republic, and the Oceanic continent. The age of the participants ranged from 12 to 18 years old, with females being the most prevalent. Of the studies found, 3 were cross-sectional, 3 longitudinal, and 1 cohort. Three studies found evidence that adolescents' weight was influenced by their friendship ties and that friends at school can influence their BMI and physical activity. These 3 studies also showed that in the friendship networks of adolescents of both sexes, behaviors related to obesity are similar in some leisure activities and eating habits. Conclusion: This study showed the need to understand the different social networks shared by adolescents, as these are associated with their behaviors and habits, especially those closest to them, such as family and friends. There is also a need for greater depth to understand the influences that the structure and function of social networks have on health behaviors among adolescents who participate in different types of networks (family, school friends, friends outside of school, among others).

Microemulsions are nanoscale systems, particularly between 10 and 100 nm, capable of transporting natural oils and improving their organoleptic characteristics. The fixed oil obtained from Passiflora setacea stands out among others for its composition rich in unsaturated fatty acids of the omega family, endowed with therapeutic potential, such as wound healing. Thus, the aim of this work was to use the ideals of QbD for the development of a formulation based on microemulsified systems. Initially, the fixed oil from P. setacea seeds was extracted using the Soxhlet method and had its chemical composition characterized using GC-MS. Then, designs of experiments were used to identify the ideal composition of oil, surfactants, and ratio of surfactants in relation to hydrodynamic droplet diameter, polydispersity index and visual classification. The exploratory linear planning models were not significant, indicating the possible presence of curvature. The Box-Behnken design was satisfactory in predicting the influence of factors and their interactions, the model has r2 of 0.99, 0.91 and 0.97, for hydrodynamic diameter, PDI and visual classification, respectively. Through the response surface and the desirability profile, it was possible to develop an optimized system, followed by its improvement for the topical route. These systems retained their physicochemical stability for 60 days, with a good prognosis to be further investigated for activity and toxicity.

Duchenne muscular dystrophy (DMD) is a neuromuscular disease characterized by progressive muscle weakness. Increased total fat mass and reduced lean body mass are side effects of the disease. The methods of assessing the nutritional status of boys with DMD may be imprecise, and the techniques applied in the general population are inadequate and difficult to interpret due to their altered body composition. Zinc is an essential mineral for lean body mass synthesis. Data on zinc content in adipose tissue in obesity are still limited. Zinc supplementation affects body composition, however, this increase occurs especially in children with pre-existing growth deficits. To date, there are no studies evaluating body composition in boys with DMD before and after zinc supplementation. Therefore, three studies were conducted. Study 1 was descriptive and cross-sectional, evaluating 49 boys through anthropometric parameters and body composition. For Study 2, an integrative review on zinc and body composition was conducted to understand what the literature had on the subject. And Study 3 composed a clinical trial that evaluated dietary, biochemical, and body composition parameters before and after zinc supplementation of boys with DMD. We observed an increase in fat mass and decreased lean body mass as age/disease progressed. In previous studies, zinc and body composition were associated, despite the methodological heterogeneity. Zinc supplementation in our population was not enough to preserve lean mass, and it was possible to observe only maintenance of lean and fat muscle mass in boys with the previous deficiency of serum zinc.

In the present study, we aimed to evaluate the therapeutic effect of Passiflora edulis fruit peel aqueous (AFA) extract as an adjuvant to insulin to confer nephroprotection against streptozotocin-induced diabetes. Male Wistar rats were divided into four groups based on treatment received for 60 days: diabetic (DB), control (CTL), insulin (INS), and insulin + AFA extract (INS+AFA). mRNA and protein expression levels of podocyte (nephrin, podocin, and WT1) and tubular (megalin) proteins were measured in kidney tissue specimens and urine. Biochemical parameters and kidney histopathology were also examined. Herein, the INS+AFA group showed superior glycemic control, which resulted in the reduction of urinary albumin/creatinine ratio, maintenance of baseline levels of Nphs1, Nphs2, Wt1, and Lrp2 mRNA expression, prevention of protein loss from the kidney tissue into the urinary space, along with the maintenance of glomerular basement membrane thickness, hyalinization, glomerular and tubulointerstitial fibrosis at values approximating those of the CTL group and significantly lower than those in the DB group. Therefore, these results suggest that, as an anti-diabetic agent, the AFA extract adjuvant to insulin could reduce and potentially prevent diabetic kidney disease.

Down Syndrome or Trisomy 21 is the result of the presence of an extra copy of genetic material and is the most common chromosomal alteration in humans. It was clinically described for the first time in England and is one of the most common causes of intellectual disability in the population. Several studies around the world support the hypothesis that genetic polymorphisms involved in folate metabolism may be related to maternal risk for DS. Many studies were performed to assess the role of MTHFR C677T and/or A1298C polymorphisms as a maternal risk factor for DS, however, the results of these studies produced conflicting and/or inconclusive data. We performed a systematic review and meta-analysis to clarify the associations between the frequency of C677T and/or A1298C polymorphisms of the MTHFR gene with maternal risk for DS. The search strategy selected 41 eligible case-control studies containing 3918 cases and 5232 controls. The association between MTHFR C677T and maternal risk for DS showed statistically significant differences according to genotype models when all studies were included. Subgroup analysis by region revealed a significant association in the Asian population for all genetic models investigated. Significant associations were also found in the dominant model (TT+CT) vs CC from the North American and South American regions. No statistically significant difference was found for the investigated genetic models regarding A1298C polymorphism and maternal risk for DS. The results of this meta-analysis support that the MTHFR C677T polymorphism is associated with maternal risk for SD, but there was no significant association with the MTHFR A1298C polymorphism. Regarding the combined genotypes, our results showed no significant association between the 677CT/1298AC genotype and the maternal risk of having a child with DS.

Introduction: Glycated Hemoglobin A1c refers to a blood marker that reflects glucose levels in the body for up to 3 months prior to assessment. The relationship between Hemoglobin A1c (HbA1c) and physical performance in older people has been discussed, but has not yet been clearly established. The evaluation of some measures becomes fundamental in the global assessment of the health of the older people, especially with regard to physical functioning. The International Mobility in Aging Study (IMIAS) offers a valuable opportunity to analyze the relationship between HbA1c levels and physical performance in older people, as it holds a range of information obtained from biochemical and functional analyses. Objectives and Hypotheses: This study aimed to evaluate the longitudinal relationship between HbA1c and physical performance scores in different epidemiological contexts of aging. Our hypothesis is that high levels of HbA1c may cause decreased physical performance in this population, considering possible influences of gender and sociodemographic aspects. Methods: Longitudinal data of 1,337 older people from three countries (Canada, Brazil and Colombia) from IMIAS were used to assess the relationship between HbA1c and Short Physical Performance Battery (SPPB) scores between 2012 and 2016. Linear Mixed Models grouped by sex and adjusted by Age, Study site, Chronic Conditions, Anthropometric Measures, and Inflammatory Level were used to estimate the influence of HbA1c and covariates on SPPB scores. Results: At the IMIAS baseline, Latin American (LA) cities had higher HbA1c averages compared to Canadian cities, with Natal (Brazil) being the city with the highest HbA1c averages in men and women (6.32 ± 1.49; 6,56 ± 1.70 respectively). SPPB scores were significantly lower in LA cities, and older people in Natal had lower SPPB averages in men (9.67 ± 2.38; p-value < 0.05) and women (8.52 ± 2.33; p-value <0.05). In the multivariate mixed linear models of longitudinal analyses, HbA1c was significantly associated with lower SPPB scores in men (β = -0.25, 95% CI: -0.39 to -0.12, p-value = 0.02) but not in women. Conclusions: High HbA1c levels at IMIAS baseline were longitudinally associated with reductions in SPPB scores of older people from different countries, however this association was observed only in men and not in women in the fully adjusted regression models. This study highlights a possible influence of gender on this relationship.

The in vivo ability of thermosensitive nanogel containing ibuprofen for bioadhesion on the surface of teeth submitted to bleaching and drug delivery through dentinal tubules to the dental pulp are evaluated in Wistar rats. Drug-loaded self-assembled oil in water nanoemulsions present droplet size < 150 nm and negative zeta potential. Nanoemulsions containing poloxamer 407 in the aqueous phase exhibit reduced droplet size, improved physical stability, controlled the thermosensitive viscosity, and slow drug release. Different treated animals’ groups included a control group (CTRL); bleached animals (BLE) (37.5% H₂O₂, Pola Office Plus®, SDI); bleached animals treated with a conventional ibuprofen-loaded hydrogel (BLE+IBF-GEL), and bleached animals treated with thermosensitive ibuprofen-loaded nanogel (BLE+IBF-NEG). Compared to the BLE+IBF-GEL group, scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) images show the superior ability of BLE+IBF-NEG group to offer a physical barrier on the tooth surface, pores occlusion, and transport the fluorescent dye rhodamine B to dental pulp. Morphological analysis revealed the lowest inflammatory infiltrate scores and absence of necrosis for BLE+IBF-NEG group after 24 hours and 14 days. Immunohistochemical studies reinforced this hypothesis. The experimental data presented in this study confirm the incredible potential for topical and easy application of a novel and smart nanogel, as analgesic and anti-inflammatory treatment for bleaching procedure. The multidisciplinary nature of the study enabled its development and improvement of the results obtained.

The COVID-19 pandemic brought social, economic and health impacts, which required rapid adaptation of health systems not only from a quantitative point of view, but also in terms of quality. In this context, digital health has gained strength in Primary Health Care (PHC) and has significantly highlighted the importance of timely and accurate information as a decision-making instrument for short, medium and long-term needs. This study aimed to highlight the scope of digital health strategies and relevant aspects for their evaluation in PHC, from the COVID-19 pandemic. With the development of a literature review of the scoping review type, and a methodological study with a qualitative approach, we sought to apprehend the state of the art of digital health and its impact on the quality of care in PHC in the world, and to develop a model for its evaluation in Brazil. The scoping review was based on the Joanna Briggs Institute manual, guided by the PRISMA Extension for Scoping Reviews. A systematic and comprehensive, three-step search was performed in June and July 2021 in multidisciplinary health sciences and gray literature databases and eligible data were analyzed using thematic analysis. The methodological study, carried out between June 2021 and March 2022 followed the steps of literature review, model elaboration, model validation and elaboration of the indicator matrix. The review included 44 studies. Six thematic groupings were identified: Characterization and geographical distribution of studies; Nomenclatures of the adopted digital strategies; Types of Information and Communication Technologies; Characteristics of digital strategies in Primary Health Care; Impacts on the quality of care; Benefits, limitations and challenges of digital strategies in Primary Health Care. The results revealed positive and negative impacts of remote strategies on the quality of care in PHC, but above all some inability to take advantage of the potential of technologies, which can demonstrate differences in the organization of the rapid and emergency implementation of digital strategies in the world. The modeling took as assumptions the context, antecedents in digital health, delimitation of the evaluative research and qualifying attributes of PHC. It incorporated into its activities, technical (scope of actions and accuracy), organizational (organization of care and management) and relational (interpersonal) dimensions in the care and management processes of care. Thus, given the importance of digital health in the current global health situation, and the possibility of integrating and advancing this strategy after the pandemic, primary care must strengthen its response capacity, expand the use of information and communication technologies, managing changeable challenges in an adaptive and evidence-based way. It is reinforced that the guidance, planning and execution of actions that gear digital health need to be evaluated in order to reach an understanding of how decisions, actions and investments are contributing to the improvement of access and quality of services and the health of populations.

Objective: To analyze the trajectory of changes in mobility during walking (i.e., maintenance and recovery) of institutionalized older adults and verify the incidence and risk factors for mobility decline.

Methods: A two-year longitudinal prospective study was conducted with 358 participants aged ≥ 60 years and institutionalized in ten nursing homes in Natal-RN (Brazil). Mobility was assessed using the "walking" item of the Barthel index. Sociodemographic, institution-related, and health-related variables were considered at baseline. Poisson regression was used to build a multiple model.

Results: The incidence of mobility decline during walking was 10.6% (95% confidence interval [95% CI] = 7.4 to 13.8) after 12 months and 37.7% (95% CI = 18.0 to 26.6) after 24 months. Age ≥ 83 years (relative risk = 1.58; 95% CI = 1.24 to 2.02; p < 0.001) and hospitalization (relative risk = 3.16; 95% CI = 1.55 to 6.45; p = 0.002) were predictors of mobility decline. The rate of mobility maintenance was 31.8% after 12 months (95% CI = 31.8 to 42.9) and 23.2% after 24 months (95% CI = 26.8 to 38.5). Also, the rate of recovery was 2.5% (95% CI = 1.0 to 5.0) and 1% (95% CI = 0.2 to 2.6) after 12 and 24 months, respectively.

Conclusion: The trajectory of mobility during walking of institutionalized older adults in northeastern Brazil was dynamic (i.e., increasing incidence of mobility decline after 24 months) and associated with advanced age and hospitalization. The chances of recovering walking performance are minimal, and maintenance of independent mobility is challenging.

Antioxidant compounds decrease the amount of intracellular reactive oxygen species (ROS) and, consequently, reduce the deleterious effects of ROS in osteoblasts. Here, we modified a 21 kDa fucoidan (FucA) with gallic acid (GA) using the redox method, to potentiate its antioxidant/protective capacity on pre-osteoblast-like cells (MC3T3) against oxidative stress. The 20 kDa FucA-GA contains 37 ± 3.0 mg GA per gram of FucA. FucA-GA was the most efficient antioxidant agent in terms of total antioxidant capacity (2.5 times), reducing power (five times), copper chelation (three times), and superoxide radical scavenging (2 times). Exposure of MC3T3 cells to H2O2 increased ROS levels and activated caspase-3 along with caspase-9. In addition, the cell viability decreased approximately 80%. FucA-GA also provided the most effective protection against oxidative damage caused by H2O2. Treatment with FucA-GA (1.0 mg/mL) increased cell viability (~80%) and decreased intracellular ROS (100%) and caspase activation (~80%). In addition, Fuc-GA (0.1 mg/mL) abolished H2O2-induced oxidative stress in zebra fish embryos. Overall, FucA-GA protected MC3T3 cells from oxidative stress and could represent a possible adjuvant for the treatment of bone fragility by counteracting oxidative phenomena

Associations between vitamin D deficiency and metabolic syndrome (MS) have been reported; however, the underlying biological mechanisms remain controversial. The aim of this study was to investigate the associations of CYP2R1 and VDR variants with MS and MS components in non-diabetic Brazilian adolescents. This cross-sectional study included 174 adolescents who were classified as overweight/obesity. Three CYP2R1 variants and four VDR variants were identified by allelic discrimination. The CYP2R1 polymorphisms, rs12794714 (GG genotype) (odds ratio [OR] = 3.54, 95% confidence interval [CI] = 1.24-10.14, p = 0.023) and rs10741657 (recessive model – GG genotype) (OR = 3.90, 95%CI = 1.18-12.92, p = 0.026), were significantly associated with an increased risk of MS and hyperglycemia, respectively. The AG + GG genotype (dominant model) of the rs2060793 CYP2R1 polymorphism was associated with hyperglycemia protection (OR = 0.28, 95%CI = 0.08-0.92, p = 0.037). Furthermore, the CC genotype (recessive model) of the rs7975232 VDR polymorphism was significantly associated with a risk of hypertension (OR = 5.91, 95%CI = 1.91-18.32, p = 0.002). In conclusion, the CYP2R1 rs12794714 polymorphism could be considered a possible new molecular marker for predicting the risk of MS; CYP2R1 rs10741657 polymorphism and  VDR rs7975232 polymorphism  are associatd with an increased risk of diabetes and hypertension in adolescents with overweight/obesity.

Background: Character in all countries is urgently needed for the world, but it does not prepare for this change, which makes this issue a problem of public investigation, causing a need for investigation in a public way to provide a gift of the age of active way. Objective: of the problem, this research aims to evaluate the presence of the association of health needs (functional, nutritional and nutritional) with quality of elderly people assisted in primary health care in Brazil. Methods: Observational, comparative, cross-sectional study from Brazil and preserved from Portugal, with elderly people and cognitive status, enrolled in primary health care. The sample consisted of 150 elderly people, 100 from Brazil and 50 from Portugal. The collection of nutritional data took place through interviews, using instruments that evaluated the functionality, the presence of depressive data and the quality of life of this population. Data were not analyzed descriptively and parametric statistical tests were performed. A p-value less than 0.005 was considered significant. Results: Health demands showed up in most of the sample, especially in Brazilians. The Portuguese achieve the best total quality of life score. Among the associations of demands and quality of life, the impairment in the risk of functional decline and in nutrition was mainly related to the physical components and the perception of well-being in Brazilians. The group from Portugal showed association and presence of nutritional disorders with nutritional domains, Social Function and Mental Health. Conclusion: The physical health project: physical component that the main aspects of QOL that are associated with health needs and physical dimension, perception of health and general physical dimension (health aspect and physical dimension) and social function (mental and social aspect).

The aim of this thesis was to investigate the association between volume and intensity of daily steps with indicators of cardiometabolic health in community-dwelling older adults. Three cross-sectional studies were developed, including older adults aged between 60–80 years, without diagnosed cardiovascular disease and mobility limitation. In study 1 (n=222) the association with arterial stiffness was investigated, in study 2 (n=248) with a continuous cardiometabolic risk score (cMetS) and in study 3 (n=252) with body fat and abdominal fat. The number of steps per day (volume) and peak 30-min cadence were measured by accelerometer for one week. Arterial stiffness was measured by aortic pulse wave velocity (aPWV). The cMetS was calculated considering blood pressure, waist circumference, HDL-cholesterol, triglycerides, and fasting glucose. Body fat and abdominal fat were measured by dual energy X-ray absorptiometry (DXA). The participants were categorized according to the number of steps/day (inactive <5000; low active 5000–7499; active 7500–9999; highly active 10000+), and steps/min (lowest, < 40; low, 40–59; average, 60–79; high, 80–99; highest, 100+). Generalized linear models were used for data analyses with adjustments for confounders. The active and highly active groups had lower aPWV (β = −0.34 m/s; β = −0.51 m/s; p < 0.05, respectively), cMetS (β = –0.29; β = –0.40; p < 0.05, respectively), body fat (β= –2.2%; β= –4.3%; p<0.05; respectively) and abdominal fat (β= –3.6%; β= –5.4%; p<0.05; respectively) compared to the inactive group. Every increment of 1000 steps/day was associated with a decrease of 0.05 m/s in aPWV (p ˂ 0.001), of 0.06 in the cMetS (p <0.001), 0.5% of total body (p <0.001) and 0.7% abdominal fat (p = 0.001). Every increment of 10 steps/min in peak 30-min cadence was associated with a decrease of 0.05 m/s in aPWV (p = 0.018), of 0.07 in cMetS (p = 0.003), 0.8% of body fat (p <0.001) and 1.0% abdominal fat (p < 0.001). The average, the high, and the highest groups had lower cMetS (β = –0.37; β = –0.42; β = –0.81; p < 0.05, respectively), and lower body fat (β= –2.4%; β= –4.8%; β= –4.9%; p <0.05; respectively) compared to the lowest group. The high and highest groups of peak cadence had lower abdominal fat (β= –5.5%; β= –5.4%; p<0.05; respectively) compared to the lowest group. In conclusion, older adults with greater volume and intensity of daily have better indicators of cardiometabolic health. A volume of more than 7,500 steps per day and a peak cadence of more than 80 steps per minute were consistently associated with lower aPWV, cMetS, body fat and abdominal fat in this population. The results of this thesis may help guide recommendations on daily step volume and intensity to improve cardiometabolic health in older adults aged 60 to 80 years without mobility limitation.

Summary: Our systematic review with meta-analysis of randomized controlled trials (RCTs) observed significant effects of whole-body vibration (WBV) on bone mineral density (BMD) in postmenopausal women, particularly for the lumbar spine (in 10 analyses) and trochanter (in six analyses) regions.

Purpose: Our objective was to update a previous systematic review with meta-analysis to observe the effects of WBV on BMD in postmenopausal women.

Methods: For meta-analysis, the weighted mean difference between WBV and control groups, or WBV and conventional exercise, was used for the area of bone mineral density (aBMD) of the lumbar spine, femoral neck, total hip, trochanter, intertrochanter, and Ward's area; or volumetric trabecular bone mineral density (vBMDt) of the radius and tibia. Methodological quality was assessed using the PEDro scale.

Results: In total, 23 studies were included in the systematic review and 20 in the meta-analysis. Thirteen studies showed high methodological quality (PEDro ≥ 6). WBV compared with control groups showed significant effects on aBMD in the primary analysis (lumbar spine and trochanter), sensitivity (lumbar spine), alternating side vibration (lumbar spine and trochanter), synchronous vibration (lumbar spine), low frequency and high magnitude (lumbar spine and trochanter), high frequency and low magnitude (lumbar spine), high frequency and high magnitude (lumbar spine, trochanter, and Ward's area), high cumulative dose and low magnitude (lumbar spine), low cumulative dose and high magnitude (lumbar spine and trochanter), and positioning with semi-flexed knees (lumbar spine and trochanter).

Conclusions: The bone region most responsive to WBV training was the lumbar spine, followed by the trochanter. Practitioners prescribing WBV to improve BMD in postmenopausal women should primarily consider side-alternating vibration type, with high magnitude, and semi-bent knee positioning. Future RCTs should prioritize these parameters in order to confirm the results presented herein.

Originating in Africa and first isolated in 1952, the Chikungunya virus (CHIKV) belongs to the genus Alphavirus and has mosquitoes of the genus Aedes as its main vectors. Chikungunya vírus infection is an acute and self-limited febrile syndrome caused by this arbovirus and affects people of all age groups, causing different symptoms that can last a few days or even years, which represents a serious problem for public health. This study aimed to describe the epidemiological, immunological and clinical aspects of chikungunya fever from the epidemic that occurred in 2016 in the state of Rio Grande do Norte. A total of 284 suspected cases of CHIKV infection submitted to the qRT-PCR technique were analyzed, from which 125 cases were positive (44.4%). The highest number of positive cases occurred in the first quarter of the year, being March the most representative month, reaching 48 positive cases. The city of Natal up the highest number sum of confirmed cases, accounting for 87 among the positive samples. Women represented the highest (52%) frequency, of which 9.2% of them were pregnant. Positive neonates represented 5.6%.The mean age of positive cases was 34 years and the age group above 61 years was one of the most affected by CHIKV. Most positive cases were detected from serum samples (41.2%). Based on the time of symptoms onset and viremia, it was found that the highest viral load occurred in the acute phase of the infection. CHIKV was detected in ten individuals 23 days after the onset of symptoms. CHIKV-negative samples were also tested for DENV and ZIKV viruses using RT-PCR and qRT-PCR techniques, respectively. In addition, to investigate the possibility of flavivirus infection, a total of 120 suspected cases of CHIKV qRT-PCR negative were further tested for anti-Flavivirus and anti-Chikugunya IgM using the ELISA method of those, 57 sera (47.5%) were anti-Chikungunya IgM detectable. Among the anti-Chikungunya IgM negative sera, 21 (21.7%) were positive for anti-Flavivirus IgM and 54 presented IgM to both Chikungunya and Flavivirus simultaneously. With regards to the clinical features of CHIKV cases, it was noticed that symptoms such as fever, arthralgia and conjunctivitis were the most common of which, the first symptom represented 91% of the cases. Skin blisters were a sign found in all seven newborns studied and positive for CHIKV. However, although four adults also presented that sign, only one was positive. Myalgia, arthralgia, fever, and back pain were the most reported symptoms on the first day of diseases, but fever and arthralgia remained more constant after the fifth day. These results aim to contribute and build up knowledge on the clinical and epidemiological characteristics of CHIKV transmission and assist the clinical diagnosis of the infection.

Gestational diabetes mellitus (GDM) is a major complication in pregnancy. GDM is associated with a higher risk for adverse maternal-fetal outcomes. Associations between movement behavior, including physical activity (PA) and sedentary behavior (SB) with maternal-fetal outcomes are still unclear. The objective of this study was to investigate associations between movement behavior with adverse maternal-fetal outcomes in women with GDM. A total of 68 women with GDM (20-35 weeks; 32.1±5.8 years) were included in this pilot case-control study. The cases were defined by the presence of an adverse composite maternal-fetal outcome (preterm birth, newborn large-for-gestational-age, and neonatal hypoglycemia). Controls were defined as no adverse maternal-fetal outcome. PA intensities and domains, steps/day (pedometer), and SB were analyzed. A total of 35.3% of participants showed adverse maternal-fetal outcomes (n=24). The controls showed a higher moderate-intensity PA level than the cases (7.5, 95%CI 3.6–22.9 vs. 3.1, 95%CI 0.4–10.3 MET-h/wk; p=0.04). The moderate-intensity PA level was associated with lower risk for adverse maternal-fetal outcomes (OR 0.21, 95%CI 0.05–0.91). No significant associations were observed for other PA and SB measures (p > 0.05). In conclusion, moderate-intensity PA during pregnancy seems to have a protective role against adverse maternal-fetal outcomes in women with GDM.

Hematopoietic stem cell transplantation (HSCT) procedures are increasing in endemic areas for human visceral leishmaniasis (VL) in Brazil and elsewhere. In addition, the number of VL cases is increasing in immunosuppressed individuals and these cases tend to present a higher case-fatality rate. We reviewed the registry of HSCT subjects in a highly VL endemic area in Northeast Brazil and performed a cross sectional study to determine their rate of Leishmania infantum infection. Among the 337 subjects transplanted in the state of Rio Grande do Norte, between 2009 and 2016, there were no prior VL cases associated with the transplant. We studied 73 (21.6%) individuals who were over 2 years after HSCT. Twelve of 73 (16.4%) had positive anti- Leishmania antibodies and 11 of 66 (16.6%) tested positive when using Leishmania qPCR assay. After a median follow up of 16 months, none progressed to VL and they became anti- Leishmania antibody negative. We conclude that transplanted subjects residing in VL endemic areas can frequently become infected with Leishmania. Although none progressed to active disease, it would be wise to follow up those individuals since there is a risk of Leishmania persistence and eventual risk of VL due to the post-transplant management therapy.

Herein, we explored the associations of pre-pandemic COVID-19 physical activity (PA), sedentary behavior (SB) and cardiorespiratory fitness (CRF) with mental health and quality of life in older adults with hypertension. Objectively measured PA and SB, perceived stress, depression symptoms, and quality of life were assessed before and during the pandemic in seventeen older adults with hypertension. CRF was assessed before the pandemic by cardiopulmonary exercise testing. Longitudinal and cross-sectional associations were analyzed using the mixed linear model. Pre-pandemic light PA (positive association) and SB (negative association) were associated with quality of life during the pandemic. Higher pre-pandemic CRF was associated with less negative changes in perceived stress, depression symptoms, and quality of life during the pandemic.  Our preliminary findings suggest that a healthier pre-pandemic movement behavior (more PA, less SB) and better CRF can mitigate the negative impact of the COVID-19 pandemic on mental health and quality of life in older adults with hypertension.

Sporotrichosis is a worldwide subcutaneous mycosis caused by Sporothrix spp. In the past, this infection was associated with armadillo hunting, horticulturists, miners, and gardeners, being considered an implantation mycosis acquired by plant debris injury. Nevertheless, since the late nineties, it has been considered a zoonotic disease in Brazil. Here we report a case series of 121 patients with cat-transmitted sporotrichosis seen in Northeast Brazil. Patient’s demographic, clinical data, and length of treatment were recorded. In addition, a mycological examination and further PCR confirmation of species identification were performed. One hundred and twenty two patients were diagnosed with subcutaneous sporotrichosis from October 2016 to December 2019, while PCR revealed that 71 of them were due to S. brasiliensis. The majority of the individuals were female (n = 86; 70.5%). Patient’s age ranged from 5 to 87 years old. The clinical forms found were lymphocutaneous (58.2%) and fixed cutaneous (39.4%). Interestingly, 115 patients reported previous contact with cats diagnosed with sporotrichosis. Patients were successfully treated with itraconazole and potassium iodide. Our study adds important contributions for the investigation of the spread of cat-transmitted subcutaneous sporotrichosis in Brazil, specifically towards the Northeast region of a continental-size country. It will also help clinicians to be aware of the existence and importance to accurately diagnose sporotrichosis and treat patients with this infectious disease in the lowest income region of Brazil.

Adverse events related to the use of antiretrovirals have undergone significant changes with advances in clinical research. It is believed that the side effects of ARVs, together with the pathogenesis of the virus itself and lifestyle can have a significant negative impact on treatment adherence. We sought to identify the psychosocial processes competing for adherence to treatment for HIV / AIDS. This was an exploratory observational study with assessment of adherence to treatment in PLWHA. Participants were men (53%) and women (47%), with an average age of 44.7 years, an average body weight of 66.4 kg and an average income of 1.2 minimum wages. In the first stage of the study, they were divided into groups regarding the time of ART use: Group 1 less than 1 year of treatment (9.4%), Group 2 less than 5 years of treatment (32.1%), and Group 3 more than 5 years of treatment (58.5%). When applying CEAT-HIV, it was observed that 84.9% were promising in their treatments regarding adherence and the Self-Efficacy Expectation instrument corroborated the results found. In the results of the ANOVA test and the “t” test, performed to verify differences between the means of adherence to the expectation of self-efficacy according to the items of the CEAT-HIV instrument of patients with HIV, at the significance level of 5%, it was observed that there is a difference between the averages of the assessment items. In the second stage, where interviews were conducted aimed at applying the intervention using the Theory of Planned Action (TAP), 64% of the sample made themselves available to participate in the group intervention and 36% opted for individual assistance. At the end of this stage, only 7 (13.2%) patients attended individual interviews, the groups did not occur, the sample loss was around 86.8%. However, there was a positive relationship between the levels of adherence and the Expectation of Self-efficacy, as it seeks strategies for the patient to develop personal skills and abilities to control the circumstances that may hinder the regular follow-up of drug treatment for the patient. HIV, the central mechanism of actions taken intentionally.

INTRODUCTION Many countries are employing strategies intended to reduce maldistribution of health workers and inequities. The purpose of this study was to analyse the impact of expansion policies of medical schools on regional inequalities in the distribution of undergraduate class sizes, and the capacity to attract and retain doctors and to expand health facilities.

METHODS We conducted a descriptive analysis to compare the distribution of undergraduate places in 2007 and 2016 to determine the impact of targeted expansion policies on inequalities in access to medical education in Brazil. A group of municipalities with new medical schools (n = 54) and a control group without medical schools   (n = 408) were  compared to analyse impacts of expansion in the health sector. We compared the increase in the number of physicians per 1000 inhabitants and health establishments per inhabitants between 2007 and 2016 based on these two groups. We also analysed the relationship between geographic distance from the state capital and capacity to attract physicians.

RESULTS There was a decrease in the regional inequalities of undergraduate places in medical schools; the greatest increase in the places per 1000 inhabitants was in municipalities of between 50 000 and 100 000 inhabitants. Municipalities with new medical schools showed an increase in physicians per 1000 inhabitants and in health establishments per inhabitant ratio, demonstrating the potential to attract and retain doctors, as well as strengthening the health infrastructure. Municipalities more distant from state capitals showed a greater increase in physician : inhabitant ratio.

DISCUSSION Countries with health workforce shortages and inequalities in their distribution might consider public financing and regulation policies for expansion of medical schools as a strategy to attract and retain professionals. Early results in Brazil showed that such strategies could strengthen service networks in deprived areas, supporting implementation of Universal Healthcare Coverage.

Introduction: Differents training protocols with exercises have been carried out with women with Polycystic Ovary Syndrome (PCOS), in different contexts and applicability, showing positive results on the clinical and metabolic alterations related to PCOS. However, there are some gaps in the psychological and clinical responses derived from high-intensity interval training (TIAI). Objective: To investigate the effects of High Intensity Interval Training (TIAI) and detraining on the quality of life and mental health of women with Polycystic Ovary Syndrome (PCOS), and to describe the psychophysiological responses (i.e, subjetive perception of effort and response affective) of this population throughout the TIAI sessions. Methods: This study was conducted in two stages: in the first, it was characterized as a cross-sectional and descriptive study, in which 12 women with PCOS participated (mean age 26.2 ± 4.1); and the second included a pilot randomized clinical trial with 23 women with PCOS (mean age 26.0 ± 3.92) who were allocated to a control group (n = 11) and a supervised TIAI group (n = 12). Women with PCOS were included; no use of medications for at least 3 months; without exercising in the past six months or sedentary. Exclusion criteria were: pregnant women; cardiovascular diseases; positive response on PAR-Q; and any other contraindication for the practice of physical activity. Anamnesis, physical activity level questionnaires (IPAQ), health-related quality of life (SF-36), depression, anxiety and stress scale (DASS-21), perceived exertion assessment (PSE, Borg CR scale) were applied. -10) and affective responses (FS, feeling scale), body composition (DXA), anthropometry and metabolic profile analysis. The interventions consisted of 10 50-min TIAI running sessions [intervals of 10 x 1 min at 90% of maximum heart rate (HRmax) interspersed with 3 min of active recovery periods at 70% of HRmax], including 5 minutes of warm-up and cool down at 48 hour intervals (first step). In the second stage, the TIAI intervention lasted 12 weeks and 4 weeks of detraining (30 days). Results: Participants were classified as overweight, had a high percentage of body fat and irregular menstrual cycles (amenorrhea). The TIAI group showed improvements in the domains of functional capacity (P = 0.022; ES = 1.7), physical aspects (P = 0.027; ES = 1.7), general status (P = 0.021; ES = 3.1), anxiety (P = 0.025; ES = 1.0,) and depression (P = 0.031; ES = 1.7) (pre-post). We observed that improvements were not maintained after the 30-day detraining period in the quality of life domains. Conclusion: The TIAI program promoted an improvement in the quality of life and mental health in women with PCOS; additionally, it was observed that after 4 weeks of detraining there was a reduction in quality of life, however, the mental health domains (anxiety and depression) presented stability in the TIAI group, differents from the control group.

Introduction: The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has been increasing and has become a public health emergency. There is limited evidence on the outcomes of COVID-19 in patients when associated with other clinical conditions.

Objective: To detect clinical, laboratory, therapeutic and prognostic guidelines, through evidence-based medicine, in situations involving patients infected with SARV-COV-2 associated with other clinical conditions.

Methods: These are seven systematic reviews and meta-analyses, which followed the guidelines of PRISMA and MORSE, being registered in PROSPERO. PubMed, Web of Science, Embase, CINAHAL, LILACS, clinictrials.gov, SCOPUS, Google Scholar, and Cochrane, was the study bases used for articles published from December 2019 to February 2021. The primary outcomes were morbidity and mortality. Three independent reviewers selected the studies and extracted data from the original publications. The risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and RoB 2 for a randomized clinical trial. To assess the strength of evidence of the data included, the Assessment, Development, and Assessment of Classification of Recommendation (GRADE) method were used. Data synthesis was performed qualitatively. To assess heterogeneity, he calculated I2 (Higgins test). When applicable, quantitative synthesis was performed using R statistical software.

Result: COVID-19 and Pregnancy: 70 articles were included involving 10047 pregnant women with COVID-19. The most common symptoms were: fever, cough, chest pain, dyspnea, nasal congestion, sore throat, headache, myalgia, anosmia, ageusia, nausea, vomiting, diarrhea, tachypnea, tachycardia, fatigue and oxygen desaturation. The main type of delivery was cesarean (42% [CI 95%; 0.38; 0.47]; I2 = 92%). There were 108 deaths (2% [CI 95%, 0.01; 0.03]; I2 = 46%) and 50 abortions (15% [CI 95%; 0.11; 0.21]; I2 = 73%] Ventilatory support, ICU admission, and pneumonia were unfavorable outcomes. Lymphopenia, increased CRP, and liver were complications during pregnancy. Of the neonatal outcomes: fetal distress (11% [CI 95%; 0.06; 0.19; I2 = 91 %], birth weight (15% [CI 95%; 0.10; 0.21; I2 = 76%]; APGAR less than 7 (9% [CI 96%; 0.03; 0.27; I2 = 26%], admission to the NICU (25% [CI 95%; 0.15; 0.39; I2 = 90%] and fetal stress (11% [CI 95%; 0.06; 0.19; I2 = 91 %] were more prevalent. There is no evidence of COVID-19 in placenta, breast milk, umbilical cord, and amniotic fluid.

COVID-19 and HIV/AIDS: Chest CT has been observed in patients with SARS-CoV-2 pneumonia with findings of multiple ground-glass opacities (GGO) in the lungs, requiring supplemental oxygenation. One patient developed complicated encephalopathy and tonic-clonic seizures; four patients were transplanted (two liver; two kidneys), one patient developed severe SARS-CoV-2 pneumonia, and 30 patients died (mortality rate, 11%).

COVID-19 and Guillain Bare Syndrome (GBS): The main manifestations were fever, cough, dyspnea, sore throat, ageusia, anosmia, and respiratory failure, in addition to upper and lower limb anesthesia, tetraparesis, facial diplegia, coldness, asthenia, mastoid pain, back pain, dizziness and back pain.

Conclusion: The outcomes of COVID-19 in patients when associated with other clinical conditions (Pregnancy, HIV, and GBS) are similar to healthy individuals. However, there are relevant differences in morbidity and mortality.

Duchenne Muscular Dystrophy (DMD) is a neuromuscular disease that results in progressive muscle atrophy. The available therapy to slow the progression of DMD is the use of steroids. However, this therapy has side effects, including changes in body composition, growth deficit and bone demineralization. Methods for assessing the nutritional status of the healthy population may be imprecise and inapplicable for the population with DMD. In addition, the assessment and management of bone health is important for the population with DMD. Zinc is an important micronutrient for bone health and no studies were found involving zinc supplementation in patients with DMD. Given these health demands of the population with DMD, this doctoral thesis had as its main objectives: to verify the validity of the BIA as a practical method for assessing body composition in patients with DMD and to investigate the effect of supplementation with zinc on the serum zinc and bone parameters in this population. To this end, two studies were carried out: the first observational cross-sectional study including 46 patients with DMD (Study 1) and the second study with an interventional design nested within a cohort including 34 patients with DMD (Study 2). The studies were carried out at Neurology Outpatient facility at HUOL in Natal/RN. The main finding of Study 1 was that BIA is a viable method to estimate % fat-free mass (%FFM) in children and adolescents with DMD. Among the eight predictive equations evaluated, five equations were accurate to estimate %FFM by BIA in patients with DMD, respecting the age range of each equation. The main findings of Study 2 were that oral zinc supplementation increased serum zinc levels in DMD patients who had prior deficiency. However, zinc supplementation had no effect on bone density and mineral content of patients with DMD. These studies will serve as a basis for the assessment of body composition using BIA in patients with DMD and for possible interventions with zinc in patients with DMD who are deficient in this micronutrient.

Cryptococcosis is an infectious disease of worldwide distribution, caused by encapsulated yeasts belonging to the phylum Basidiomycota. The genus Cryptococcus includes several species distributed around the world. The C. gattii/neoformans species complex is largely responsible for most cases of cryptococcosis. However, clinical series have been published of infections caused by Papiliotrema (Cryptococcus) laurentii and Naganishia albida (Cryptococcus albidus), among other related genera. Here, we examined the pathogenic potential and antifungal susceptibility of Cryptococcus spp. and related genera isolated from environmental and clinical samples. P. laurentii and Naganishia spp. strains produced higher levels of phospholipase and hemolysins, whereas the C. gattii/C. neoformans species complex strains had markedly thicker capsules, produced more biofilm biomass and melanin, which are known virulence attributes. Interestingly, more strains of non-C. gattii/C. neoformans species complex exhibited non-wild type phenotypes in response to fluconazole, itraconazole and amphotericin B. Finally, all the non-C. gattii/C. neoformans clinical isolates produced more melanin and this might reflect their particularly enhanced need for melanin during in vivo protection. It is very clear that clades I and II strains, in general, show more similar virulence phenotypes among each other when compared to clades III to V isolates and vice versa. These findings, together with the fact that P. laurentii and Naganishia spp. strains were collected from the outside of a University Hospital, may be important for environmental and patient colonization and further risk for infections.

The aim of this thesis was to investigate the movement behavior and life-space mobility during different moments of the new Coronavirus pandemic (COVID-19) in older adults with hypertension and their associations with housing characteristics. Thirty-five participants were included in this exploratory longitudinal study. The evaluations occurred at three moments over 18 months: i) before the first case of COVID-19 in Natal-RN (January-March, 2020); ii) during the social distancing policy and without vaccination (June, 2020); iii) ~2 months after the vaccination (July, 2021). Physical activity (PA) and sedentary behavior (SB) were measured by accelerometry. Life-space mobility was assessed by the Life-Space Assessment Questionnaire. The following housing characteristics were assessed: housing type, housing surface area, and household size. Generalized linear mixed model was used for data analyses, with adjustment for age, sex, education and accelerometer wear use. During the social distancing policy without vaccination there was a decrease in steps/day (β = –886, p = 0.018), in moderate-vigorous PA (β = –0.4 %, p = 0.001), and in light PA (β = –3.7 %, p = 0.004), in addition to an increase in SB (β = 4.1 %, p = 0.001). The magnitude of changes was greater on the weekend, mainly for steps/day (β= –1,739, p < 0.001) and SB pattern (more time in prolonged bouts and less breaks). Older adults who resided in apartment and row housing showed a greater decrease in PA and a greater increase in SB compared to those who resided in detached house (p < 0.05). After the vaccination, older adults who resided in apartment and row housing showed an increase in life-space mobility and PA, in addition to a decrease in SB (p < 0.05). In conclusion, the movement behavior and life-space mobility of older adults with hypertension seem to change during the COVID-19 pandemic, especially in those who reside in limited houses. While the social distancing policy without vaccination is associated with a reduction in PA and an increase in SB, the immunization is associated with an increase in life-space mobility and PA, in addition to a reduction in SB.

This study aims to analyze the health conditions of the black population in chronic non-communicable diseases and inequalities evidenced in the Covid-19 pandemic. It is divided into 3 productions of scientific articles, adopting two different elaboration methodologies. The first two productions refer to the development of systematic review protocols that have been published in international journals. The two protocols were registered in the International Prospective Register of Systematic Reviews Platform (PROSPERO) obtaining a favorable opinion for publication and development of the reviews. The first systematic review protocol was designed to assess racial differences in illness and death from Covid-19, while the second protocol aims to carry out a systematic review to assess the prevalence of Covid-19 in black people cared for in primary care units. health care units, hospital units and intensive care units. The development of the two reviews will be in accordance with the declaration of items in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), respecting each step of the development of a review. The third article aimed to analyze the prevalence of chronic non-communicable diseases in Brazil according to race/skin color based on the results of the National Health Survey. To analyze the outcomes, issues related to chronic diseases were considered. Race/skin color was determined as the dependent variable and sociodemographic variables as adjustment variables. Poisson regression was applied to estimate the prevalence ratio (PR) and the respective 95% confidence interval (95%CI) using the sample weight and incorporating the effect of the sample design. The results showed a higher prevalence of arterial hypertension and multimorbidity. Black race/skin color was shown to be a risk factor for hypertension, diabetes and stroke. Socioeconomic inequalities, structural racism, and cultural differences can result in immediate and long-term barriers to adequate health care for these populations. Policy makers in all nations must formulate policies and strategies that can reach this population, thus making health care equitable for all.

A defesa ocorrerá em ambiente virtual, utilizando a ferramenta de conferência do Google Meet, acessando a Sala Virtual pelo link https://conferenciaweb.rnp.br/webconf/eduardo-60.
 
Será permitido o acesso considerando o seguinte cronograma:
30 minutos antes: o aluno e orientador, para organizar virtualmente a atividade;
10 minutos antes, os membros da banca;
5 minutos antes, o público externo (vagas limitadas).

Purpose: We analyzed the heart rate (HR), rating of perceived exertion (RPE) and affective response of inactive older women with hypertension during two self-selected exercise (SSE) intensity sessions. Moreover, we assessed the reproducibility of these responses. Methods: Thirteen participants (64.5 ± 4.1 years) performed two 30-minute SSE sessions outdoors. HR reserve, RPE and affective response were assessed. Paired t-test, intraclass correlation coefficient (ICC) and typical error (TE) were used for the analyzes. Results: Twelve participants (92%) exercised at moderate-vigorous intensity (≥ 40% of HR reserve) and all participants reported RPE light-moderate and positive affective response during both SSE sessions. No differences between sessions were found for HR (56.5 ± 8.0% vs. 59.1 ± 10.6% of HR reserve), RPE (11.3 ± 1.1 vs. 11.0 ± 1.5) and affective response (3.5 ± 1.1 vs. 3.4 ± 1.2) (p > 0.05). RPE presented excellent reliability (ICC = 0.82; 95% CI: 0.42 to 0.94; p < 0.01), but there was no reliability for HR (ICC = 0.40; 95% CI: -0.97 to 0.82; p = 0.43) and affective response (ICC = 0.19; 95% CI: -2.10 to 0.76; p = 0.37) between sessions. The TE between sessions for HR, RPE, and affective response were 8.1 bpm, 0.8 a.u. and 1.1 a.u., respectively. Conclusion: Inactive hypertensive older women choose a moderate-vigorous intensity when they exercise at a self-selected pace and report it as light-moderate and pleasant. These results seem to support the use of the SSE intensity as a simple approach to encourage an active lifestyle in this population.

Studies have reported an increase in cardiometabolic risk among workers assisted by the Brazilian Worker’s Food Program (WFP), the only Public Food and Nutritional Security Policy aimed at this public in country, due to a higher frequency of overweight and greater waist circumference (WC) in these individuals. Thus, the aim of this study was to estimate the prevalence of Metabolic Syndrome (MetS) and its individual components among manufacturing workers and their relationship to the WFP. To this end, we conducted a prospective cross-sectional two-stage survey comparative of manufacturing workers from companies adherent and non-adherent to the WFP stratified by sector of activity and company size. After written informed consent, workers were interviewed at the workplace, where socioeconomic, bio-demographic and anthropometric data were collected, in addition to health information and blood pressure measurement. Blood samples were taken (12h fasting) to determine serum glucose, triglycerides and HDL-cholesterol. Mixed effects multilevel logistic regression was used to compare WFP and non-WFP groups separately in each sex. The survey included 332 workers from 16 WFP companies and 344 workers from 17 non-WFP companies. The general prevalence of MetS was high, but without statistical differences between the sexes (39.8% in females versus 28.5% in males, p = 0.16). When comparing groups, men in the WFP group had a significantly higher prevalence of MetS (33.0% versus 23.9% non-WFP, p = 0.008) and for the individual components, a higher prevalence of increased WC (47.0% versus 29.4% non-WFP, p <0.001) and high fasting blood glucose (8.9% versus 6.3% non-WFP, p <0.001) was also observed. For women, no statistically significant results were observed in the prevalence of MetS and its individual components between groups. Thus, it is concluded that food assistance programs are associated with an increase in the prevalence of MetS in male workers, but possibly not in women, suggesting an influence of food insecurity on the effects of food assistance programs in low-income populations.

Background

Sexual risk behaviors, pregnancy, and sexually transmitted infections are diseases related to female sexual expression. The use of mobile apps can help women in gynecological and sexual health care. We developed the GynecoCare mobile app.

Methods

The development of GynecoCare was divided into three stages. The first was to understand the problem, survey the needs of women about maternity in high-risk pregnancies, define the objectives and functions of the application. The second stage involved the preparation, production of informative content, selection of the form of media, the definition of the navigation structure, and the design of the interface. In the third stage, GynecoCare was developed.

Results

GynecoCare was developed for the management of gynecological health, menstrual cycle, contraceptive methods, sex, sexually transmitted infections, and access to emergency gynecological services by users. Data can be registered and receive tips on the topics of the application.

GynecoCare aims to improve monitoring of intimate and sexual health care, preventing unwanted pregnancies, risky sexual behavior and sexually transmitted infections

Conclusion

It can be a powerful technological tool and used to assist in the management of intimate health, health promotion, as well as in adherence to appropriate behaviors, improving the quality of life of users. 

The water-in-water emulsion method has been reported as a technique able to prepare microparticles without using harmful solvents. However, there are few reports showing the encapsulation of small molecules into microparticles produced within this technique. The probable reason relays on the rapid diffusion of these molecules from the discontinuous phase to the continuous phase. In the present study, xylan microparticles containing mesalamine were produced and the doubled crosslinking approach, used to promote higher encapsulation rates, which was disclosed. To achieve this goal, a 23 full factorial design was carried out. The results revealed that all formulations presented spherical-shaped microparticles. However, at specific conditions, only few formulations reached up to 50% of drug loading. In addition, the new xylan-based microparticles formulation retained almost 40% of its drug content after 12 hours of a dissolution assay likely due to the degree of crosslinking. Thus, the doubled crosslinking approach used was effective on the encapsulation of mesalamine and may pave the way to successfully produce other polysaccharide-based carriers for clinical use.

Background: Mammographic breast density is an important predictor of breast cancer, but its measurement has limitations related to subjectivity of visual evaluation or to difficult access for automatic volumetric measurement methods. Herein, we describe the design and clinical validation of Aguida, a software program for automated quantification of breast density from flat mammography images.

Materials and methods: The software program was developed in MatLab. After image segmentation separating the background from the breast image, the operator positions a cursor defining a region of interest on the pectoralis major muscle from the mediolateral oblique view. Then, in the craniocaudal view, the threshold for separation of the dense tissue is based on the optical density of the pectoral muscle, and the proportion of dense tissue is calculated by the program. Mammograms obtained from 2 different occasions in 291 women were used for clinical evaluation.

Results: The intraclass correlation coefficient (ICC) between breast density measurements by the software and by a radiologist was 0.96, with a bias of only 0.67 percentage points and a 95% limit of agreement of 13.5 percentage points; the ICC was 0.94 in the interobserver reliability assessment by two radiologists with different experience; and the ICC was 0.98 in the intraobserver reliability assessment. The distribution among the density classes was close to the values obtained with the volumetric software.

Conclusions: Measurement of breast density with the Aguida program from flat mammography images showed high agreement with the visual determination by radiologists, and high inter- and intra-observer reliability.

Objectives: This study aimed to search for scientific evidence concerning the accuracy of computer-assisted analysis for diagnosing maxillofacial radiolucent lesions. Methods: A systematic review was conducted according to the statements of PRISMAP and considering ten databases, including the grey literature. Protocol was registered in PROSPERO (CRD [Blinding]). The PICO strategy was used to define the eligibility criteria and only diagnostic test studies were included. Their risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal tool. Random-effects model metaanalysis was performed and heterogeneity among the included studies was estimated using the I2 statistic. The GRADE tool assessed the quality of evidence and strength of recommendation across included studies. Results: Out of 715 identified citations, four papers, published between 2009 and 2017, fulfilled the criteria and were included in this systematic review. A total of 191 lesions, classified as periapical granuloma and cyst, dentigerous cyst, or keratocystic odontogenic tumor, were analyzed. All selected articles scored low risk of bias. The pooled accuracy estimation, regardless of the classification method used, was 88.75%

(95% CI = 85.19-92.30). Heterogeneity test reached moderate values (I2 = 57.89%).

According to the GRADE tool, the analyzed outcome was classified as having low level of certainty. Conclusions: The overall evaluation showed all studies presented high accuracy rates of computer-aided diagnosis systems in classifying radiolucent maxillofacial lesions compared to histopathological biopsy. However, due to the moderate heterogeneity found among the studies included in this meta-analysis, a pragmatic recommendation about the use of computer-assisted analysis is not possible.

Acquired syphilis is a sexually transmitted infection that affects the general population and has been growing exponentially in recent years, making it one of the most neglected in Brazil. This study is part of a larger project aimed at tackling syphilis in the country from the project called “No Syphilis”. A study was developed to analyze the factors that are related to the acquired syphilis trends in Brazil, from 2011 to 2018. This is an ecological study that used secondary data from the national notification systems of the 5570 Brazilian municipalities and a database of 37,350 primary health care teams, besides municipal socioeconomic and demographic indicators. Trends in municipally acquired syphilis were calculated from log-linear regression, intersecting them with indicators of primary health care and socioeconomic and demographic factors. Finally, it was building a multiple model from logistic regression. Data were analyzed using SPSS 20.0 software, respecting a level of statistical significance of 95%. After the analysis, the predictor variables for ascending acquired syphilis were statistically significant in the multiple model: not all primary health care teams apply penicillin (RPaj = 1.13; 1.02-1.25); higher proportion of primary health care teams with poor / fair grades (RPaj = 1.18; 1.07-1.30); population size> 100000 inhabitants (RPaj = 1.98; 1.52-2.57); partially available female condom (RPaj = 1.10; 1.01-1.20). Thus, it is concluded that the fragility of primary health care linked to the structure in large municipalities are the main factors that favor the growth of the acquired syphilis epidemic in Brazilian municipalities.

Background: Dural arteriovenous fistulas (DAVFs) are abnormal, acquired arteriovenous connections within the dural leaflets.  Symptoms may be mild or severe and are related to the patient’s venous anatomy.

Objective: Our hypothesis is that the patient’s venous anatomy determines development of symptoms. The aim is to identify which venous anatomy elements are important in the development of major symptoms in patients with a DAVF. Methods: Multicenter study based on the retrospective analysis of cerebral angiographies with systematic assessment of brain drainage pathways (including fistula drainage) in patients over 18 years of age with single DAVF. The patients were divided into two groups, with minor  (group 1, n=112) and with major symptoms (group 2, n=89). Group 2 was subdivided into 2a – hemorrhage (n=47) and 2b- severe non-hemorrhagic symptoms (n=42). Results: The prevalence of stenosis in DAVF venous drainage and identification of tiny anastomoses between venous territories was significantly higher in group 2 (32.6% and 19.1%, respectively) when compared to group 1 (2.68% and 5.36%, respectively). Stenosis of DAVF venous drainage was significantly more frequent in group 2a than in group 2b (51.1% vs. 11.9%, p<0.001). Group 2b patients had increased prevalence of shared use of the cerebral main drainage pathway (85.0% vs. 53.2%, p=0.002), absence of an alternative route (45.0% vs. 17.0%, p=0.004) and presence of contrast stagnation (62.5% vs. 29.8%, p=0.002) when compared to group 2a. In patients with high-grade fistula the group with major symptoms had increased prevalence of a single draining direction (31.3% vs. 8.33%, p=0.003), stenosis in the draining vein (35.0% vs. 6.25%, p=0.000), absence of an alternative pathway for brain drainage (31.3% vs. 12.5%, p=0.017) and presence of contrast stagnation (48.8% vs. 22.9%, p=0.004). Conclusions: Major symptoms were observed when normal brain tissue venous drainage was impaired by competition with DAVF (predominance in group 2b) or when DAVF venous drainage had anatomical characteristics that hindered drainage, with consequent venous hypertension on the venous side of the DAVF (predominance in group 2a). The same findings were observed when comparing two groups of patients with high-grade lesions, those with major versus those with minor symptoms.

Inflammation associated with type 1 Diabetes mellitus (T1DM), contribute to the development of micro and macrovascular complications. In this context, chloroquine (CQ), an anti-inflammatory drug, appears as a potential adjunctive treatment in control inflammation. In addition, the use of this drug incorporated in nanoparticles will increase its bioavailability, improving the pharmacological response. This study aimed to evaluate the effect of CQ and chloroquine nanoparticles (CQ NP) on proinflammatory cytokine mRNA expressions in peripheral blood mononuclear cells (PBMC) of T1DM patients. Twenty-five normoglycemic individuals and 25 T1DM patients both aged 10-16 years were selected. Then PBMC of all of the individuals were isolated, and divided into 2 groups: normoglycemic (NG) and diabetic type 1 (T1DM). Successively, T1DM was subdivided into 3 groups: untreated (NT), CQ treated (CQ) and treated with CQ NP (CQ NP). Subsequently the cells were incubated for a period of 48 hours and up to 24 hours the mRNA expressions of IL1B, IFNG, TNFA, IL12 and IL10 were determined by relative quantification in real time PCR. Analysis of cytokine mRNA expression showed that administration of CQ reduced gene expression of inflammatory cytokines. In conclusion, CQ and CQ NP has been shown to be an adjuvant in the treatment of T1DM.

Aging causes a series of psychological, biological and social changes in the life of individuals. Constantly, a decline in cognitive functions is observed, which can be a possible risk factor for the development of Alzheimer’s disease (AD). For the diagnosis of AD one of the resources used by clinicians has been cognitive screening tests. The use of clinical interviews and behavioural inventories are also seen as relevant, in this aspect, an instrument of Spanish origin stands out, naming Prefrontal Symptoms Inventory (PSI). Therefore, the aim of this study was to adapt this instrument to Brazilian Portuguese and to look for evidences of validity for the elderly population with and without dementia. For this, the PSI-20 was initially adapted idiomatically and culturally and subsequently applied to 256 elderly with and without the diagnosis of probable AD, aged over 60 years of both sexes, and at least one year of formal schooling. The participants also answered a clinical interview, the Mini Mental State Examination (MMSE), the Frontal Assessment Battery (FAB) and the Geriatric Depression Scale (GDS). The results showed satisfactory adjustment indexes and adequate reliability (Ω of 0.83 and α = 0.80) for the unifactorial model. The non clinical group exhibited significant correlations between the PSI-16, the GDS-15, the MMSE, the FAB and their six subtests, however in the clinical group there were negative correlation only among the PSI-16, the MMSE, the BAF and the conceptualization subtest. In the comparison between the groups, statistic differences were found, with the clinical sample showing higher punctuation in the PSI-16. When checking the accuracy of the PSI to the diagnosis of probable AD. In the total sample, the cutting point of the PSI-16 was >19 points, with sensibility (SE) of 72%, and specificity (ES) of 68% (moderate). The accuracy of the FAB was similar to the one of the PSI-16 and the MMSE displayed SE (80%) and ES (72%) higher. The accuracy, the SE and the ES in the group with high schooling level was superior for all the instruments, when compared with the low schooling level. Regarding the division between the ages of the participants, the accuracies of the PSI-16 and of the MMSE remained similar, the SE of all the instruments increased and the ES obtained a decline, considering elderly people aged more than 70 years old. Therefore, the PSI-16 may be used as a valid and reliable tool for the clinical use in the population of elderly people with and without pathology, being a self report suitable instrument to track behavioural problems related to the prefrontal cortex.

Acute myeloid leukemia (AML) is a clonal disease of hematopoietic tissue and accounts for 80% of leukemia cases in adults. It is divided into seven subtypes (M0 to M7), according to the classification of the Franco-American-British group. Despite great advances in chemotherapy, there are still cases of acute leukemias refractory to treatment or recurrence of the disease, triggered by mechanisms of multiple drug resistance (MDR), with the extrusion of chemotherapy agents by drug efflux pumps, one of the main mechanisms. The analysis of glycoprotein P (PgP) and protein associated with resistance to multiple drugs (MRP), by flow cytometry, was the target of this study, which showed that both the expression of both was prevalent in older patients and the incidence was showed greater in cases of refractoriness, recurrence and secondary disease when compared to cases of AML “de novo”. The use of these markers as a parameter of the MDR profile helps in the diagnosis and treatment of acute leukemias, in addition to being a prognostic marker for patients with AML.

Scorpion stings are major cause of envenoming by animals for endemic countries, like Brazil. The antivenom is a neutralizing drug to protect susceptible people, but its production is subject of improvements, like adjuvant innovations and the difficulty of venom extraction from captive animals and its toxicity. Scorpion venom has a complex composition and an adjuvant for crude venom presents a challenge that can be possibly fulfilled with drug delivery systems based on nanotechnology. In this research, we seek for innovation developing new nanoemulsion formulations to act as drug delivery system for Tityus serrulatus scorpion venom and to evaluate immunizing Balb/C mice. The nanotechnology development covered features that positively affected adjuvant activity. We demonstrated that low energy techniques for obtainment nanoemulsions allowed long term stability to the formulations with reduced and uniform droplet size (below 200 nm). The developed formulations were also robust to pH and saline adjustment and to cationic covering with poly(ethyleneimine) (PEI) maintaining stability. The formulations demonstrated capable to nonspecifically adsorb crude venom, as showed through FTIR spectroscopy technique as intermolecular interactions between nanoemulsions and crude venom. Nanoemulsions venom-load also could reduce toxicity related to venom hemolytic activity and to present low toxicity against macrophage cells (RAW 264.7). Adjuvant activity was demonstrated in comparison with aluminum hydroxide adjuvant, which scored for nanotechnology feature of act as crude venom adjuvant more efficiently to induce specific anti-IgG immunoglobulins using PEI-covered nanoemulsions.

The presence of the vitamin D receptor in various human cells and tissues, relating vitamin D to several non-skeletal physiological processes has been generating interest in research that helps to better understand this relationship.  In addition, prophylactic supplementation with this nutrient is growing every day, in all age groups. Thus, the aim of this study was to evaluate the effect of vitamin D3 supplementation on VDR gene expression, body composition, cardiorespiratory fitness and muscle strength in healthy adults. It was a study carried out in adult monozygotic twins, of the longitudinal randomized clinical trial type, divided into two groups: control group (without treatment) and supplemented group (with individual daily supplementation of 2000 IU / day of vitamin D3 for 60 days). Biochemical analyzes, body composition analyzes were performed using double beam absorptiometry, analysis of cardiorespiratory fitness in a Cortex Ergospirometer, evaluation of muscle strength by the handgrip and scapular strength test and gene expression by real-time PCR.  The statistical analysis was performed using the statistical software IBM SPSS version 20.0 for Windows. Our results showed that there was a significant increase in serum vitamin D levels in the supplemented group compared to those who did not use the supplement. (65% increase), as well as the expression of the VDR gene (p = 0.001). We observed improvements in physical fitness parameters, with reduced body fat and increased VO2max after supplementation. Thus, we conclude that the increase in serum vitamin D levels above 30 ng / mL can bring benefits to the health of the population.

Xylan is an important biopolymer that can be extracted from several agro-wastes in the world and has been receiving a great attention in the production of colon drug delivery systems. This polymer has the ability to pass through the digestive tract unchanged and its complex structure requires enzymes that are produced specifically by the human colonic microflora, which makes it an interesting raw material in the production of targeted drug delivery systems. In this work, xylan extracted from corn cobs was used to produce mesalamine-loaded xylan microparticles (XMP5-ASA) by cross-linking polymerization using a non-hazardous cross-linking agent. The microparticles were characterized by thermal analysis (DSC/TG), X-ray diffraction (XRD), Infrared spectroscopy (FTIR-ATR) and scanning electron microscopy (SEM). A comparative study of the in vitro drug release from XMP5-ASA and from gastro-resistant capsules filled with XMP5-ASA (XMPCAP5-ASA) or 5-ASA was also performed. NMR, FTIR-ATR, XRD and DSC/TG studies indicated molecularly dispersed drug in the microparticles with increment on drug stability. The release studies showed that XMPCAP5-ASA allowed more efficient drug retention in the simulated gastric fluid and a prolonged drug release lasting up to 24 h. XMPCAP5-ASA retained approximately 48 % of its drug content after 6 h on the drug release assay. Thus, the encapsulation of 5-ASA into xylan microparticles together with gastro-resistant capsules allowed a better release control of the drug during different simulated gastrointestinal medium.

A low molecular weight (LMW) heterofucan (named fucan B) was obtained from the brown seaweed Spatoglossum schröederi and its activity as inhibitor on endothelial cell (EC) capillary-like tube formation was analyzed. Chemical, infrared and electrophoresis analysis confirmed the fucan B identity. In contrast to other LMW fucans, the fucan B (from 0.012 to 0.1 mg/mL) was able to inhibit EC capillary-like tube formation in a dose-dependent way. In addition, fucan B (from 0.01 to 0.05 mg/mL) did not affect EC proliferation. Fucan B also inhibits EC migration when fibronectin was substrate, but fail when laminin or collagen was substrate. This fucan was biotinylated and used as a probe to identify its action sites. When biotinylated fucan was assayed in confocal experiments, it did not show binding to the cell surface, but rather only to fibronectin. We suggested that fucan B inhibits EC capillary-like tube formation and EC migration because binds directly to fibronectin, and blocking fibronectin sites that are recognized by cell surface ligands. Our data indicate that further studies are needed to evaluate the in vivo effect of fucan B.  

Background: Impaired inhibitory control has been related in individuals with substance use disorder (SUD). Cardiorespiratory fitness has been shown to improve cognition in different populations. Aims: Investigate the relationship between cardiorespiratory fitness and inhibitory control.  Methods: Sixty-two male participants under treatment for SUD performed a general and drug-specific inhibitory control test (Go/No go) and a cardiorespiratory fitness test. Results: Cardiorespiratory fitness, age and time of use of substance were inversely associated with reaction time for both specific (r=-0.472, p<0.001) and general inhibitory control (r=-0.430, p<0.001). Regressions sho w that cardiorespiratory fitness controlling for age and time of drug use predicts specific [F (8.7; 3); t = -3.22; β = -0.420; p < 0.002] and general inhibitory control [F (6.6; 3); t = -3.06; β = -0.415; p < 0.003]. Conclusions: These findings suggest that cardiorespiratory fitness is an independent predictor of cognitive inhibitory control in individuals with SUD.

Purpose: To compare the physiological and psychological responses during and following (24 and 48 h) a single session of low-volume high-intensity interval exercise (HIIE) and moderate-intensity continuous exercise (MICE) in overweight/obese inactive adults. Methods: Twenty males (29.0 ± 5.0 years, 29.0 ± 3.7 kg.m^-2) performed a single session of HIIE and MICE with one-week interval in a randomized and crossover order: i) HIIE (10 x 1 min at 85% of VO_2max, 1 min passive recovery); ii) MICE (20 min at 40-60% of VO_2max). The exercise sessions were isocaloric. During the exercise sessions the rating of perceived exertion (RPE), basic affect, perceived activation, self-efficacy, and oxygen uptake (VO₂) were assessed. Immediately post-exercise the attentional focus, enjoyment, and future intention to engage in HIIE and MICE were measured. Before, 24 h, and 48 h post-exercise creatine kinase (CK), lactate dehydrogenase (LDH), interleukin-6 (IL-6), IL-10, and tumor necrosis factor alpha (TNF-α), pain threshold, tolerance and intensity in rectus femoris, biceps femoris, and gastrocnemius were assessed. Results: During the exercise, RPE, perceived activation, VO₂, and distress thoughts were higher in the HIIE than in the MICE (P ≤ 0.02). Basic affect and self-efficacy were lower in the HIIE than in the MICE (P < 0.01). There was no difference in the enjoyment (P = 0.30) and future intention to engage in HIIE and MICE (P = 0.26). Also, there were no diferences in CK, LDH, IL-6, IL-10, TNF-α, and pain threshold, tolerance and intensity in all muscle analyzed 24 and 48 h post-exercise between HIIE and MICE (P ≥ 0.19). Conclusion: HIIE elicits aversive psychological responses in overweigth/obese adults, which does not occur during MICE. However, 24 and 48 h the muscle damage, inflammatory response, and delayed-onsed muscle soreness is similar between HIIE and MICE in these individuals.

The aim of this work was to investigate the in vitro cytotoxic effect of previously developed nanocapsules, nanoemulsion and microemulsion systems based on bullfrog oil (BFO) against human melanoma cells (A2058). The nanosystems were produced as described in previous studies and characterized according to droplet/particle distribution and zeta potential. The biocompatibility was evaluated by the determination of the hemolytic potential against human erythrocytes. The cytotoxicity assessment was made based on MTT and cell death assays, determination of the Reactive Oxygen Species (ROS) levels and cell uptake. The three nanosystems were successfully reproduced and showed hemolytic potential smaller than 10 % at all oil concentrations (50 and 100 µg.mL-1 ). The MTT assay revealed that the nanosystems decreased the mitochondrial activity up to 92 ± 2 %. The study showed that the free BFO induced cell apoptosis, while all nanostructured systems caused cell death by necrosis, associated to a ROS overproduction and increased ability to deliver the BFO across all cellular compartments (membrane, cytoplasm and nucleus). Finally, these results elucidate the in vitro BFO nanosystems cytotoxic effect against human melanoma cells, suggesting that these systems can be further investigated as safe and promising pharmaceutical products able to improve the therapeutic arsenal against melanoma.

The increase in population and life expectancy, coupled with the broad expansion and strengthening of Primary Health Care, competes for new aspects of longitudinal and integral care to be drawn, and in the meantime, mention is made of the construction and validation of an instrument that presents characteristics peculiar to the area of women's health and that is guiding to a public assistance with quality in the primary services in Brazil. This study aimed to gather evidence of validity based on the content of the text, the response process, the internal structure and the reliability of the Women's Health Assessment Tool in Primary Care, in order to be used by health professionals and researchers to evaluate important indicators of women's health and, through public management, for the purpose of planning and evaluating actions aimed at the public. For that, a validation study was conducted, whose guidelines and methodology were anchored in the Standards for Educational and Psychological Testing. The Instrument for Assessment of Women's Health in Primary Care presented acceptable psychometric properties of content validity and response process, which shows its conceptual and semantic quality, is valid and the answers are reliable for women in the age group of 18 to 69, since it was designed to assess the health needs of women within the organization logic of Primary Health Care, which considers the essential attributes and derivatives.

Candidemia has been considered a persistent public health problem with great impact on hospital costs and high mortality. We aimed to evaluate the epidemiology and prognostic factors of candidemia in a tertiary hospital in Northeast Brazil from January 2011 to December 2016. Demographic and clinical data of patients were retrospectively obtained from medical records and the antifungal susceptibility profile was performed using the broth microdilution method. A total of 68 episodes of candidemia were evaluated. We found an average incidence of 2.23 episodes /1000 admissions and a 30-day mortality rate of 55.9%. The most prevalent species were Candida albicans (35.3%), Candida tropicalis (27.4%), Candida parapsilosis (21.6%) and Candida glabrata (11.8%). The main predisposing factors were the previous use of antibacterial agents (97.1%), the presence of central venous cateter (79.4%), corticosteroid therapy (55.9%) and previous surgery (55.9%). Higher mortality rates were observed in cases of candidemia due to C. albicans (61.1%) and C. glabrata (100%), especially in relation to C. parapsilosis (27.3%). Some variables significantly increased the probability of death at univariate analysis: older age (P = 0.022; odds ratio [OR] = 1.041), severe sepsis (P < 0.001; OR = 8.571), septic shock (P = 0.035; OR = 3.792), hypotension (P = 0.003; OR = 9.120), neutrophilia (P = 0.046; OR = 3.080), thrombocytopenia (P = 0.002; OR = 6.800), mechanical ventilation (P = 0.009; OR = 8.167) and greater number of surgeries (P = 0.037; OR = 1.920). At multivariate analysis, older age (P = 0.040; OR = 1.055), severe sepsis (P = 0.009; OR = 9.872) and hypotension (P = 0.031; OR = 21.042) were independently associated with worse prognosis. There was no resistance to amphotericin B, micafungin or itraconazole and a low rate of resistance to fluconazole (5.1%). However, 20.5% of the Candida isolates were susceptible dose-dependent (SDD) to fluconazole and 7.7% to itraconazole. In conclusion, our results could assist in the adoption of strategies to stratify patients at higher risk for developing candidemia and worse prognosis, in addition to improve antifungal management.

Species of the genus Passiflora sp. have the ability to produce a variety of neuroactive flavonoids and antioxidants,

 which can prevent brain damage caused by disorders depressive. However, due to the low bioavailability, 

clinical application of these assets is still a challenge for pharmaceutical technology. Within this context, 

we highlight the Passiflora edulis fo. flavicarpa (Passifloraceae), popularly known as yellow passion fruit. 

So the objectives of this paper are: i. develop a method of obtaining an extract rich in flavonoids (FRE) 

from the Passiflora edulis fo. flavicarpa; ii. purify and characterize flavonoids from FRE extract; iii. 

develop a FRE extract loaded nanoparticles system; iv. evaluate the biocompatibility and antidepressant 

activity of FRE extract in free and nanoparticulate form. The leaves used in the study were collected at the place 

of cultivation and dried for use in optimization of extraction by surface response methodology. 

FRE extract was used to isolate the substances majority by HPLC-UV-DAD-Prep. Subsequently, 

it was a system of charged cationic nanoparticles of FRE extract produced with polymethyl methacrylate

 polymer (PMMA), which was characterized by size measurement, zeta potential, encapsulation 

efficiency, ATR-FTIR and AFM microscopy. Additionally, the biocompatibility (through acute oral toxicity model)

 and antidepressant effect (using swim models open field) after oral administration of FRE extract

in free and nanoparticulate form and the substance isoorientina, in in vivo models. 

Quantitative analysis showed that the FRE extract has total flavonoid content of 11.42 mg / g 

and a content of 5.21 mg / g isoorientine. 13 identified glycosylated flavonoids derived from luteoline,

 chrysin and apigenin by HPLC-ESI-IT-MS / MS analysis. Subsequently, the content of the flavonoids vicenin-2 

was evaluated. (5.20 mg / g), orientin (0.59 mg / g), vitexin (0.20 mg / g) and isovitexin (0.96 mg / g) in

 the FRE extract by analysis by CLAE-QqQ-MS / MS system. Physicochemical analysis showed that FRE extract

 loaded nanoparticles are spherical with positive surface charge, size 65.6 nm, positive zeta potential and 

high encapsulation efficiency of isoorientin (E.E = 100%) and stable over six months. At histopathological

 and biochemical analyzes of tissues and serum of animals showed the biocompatibility of nanoparticles in

 white, free FRE extract (2 g / kg kg; p.o.) and nanoparticulate (5 mg / kg; p.o.). The antidepressant-like

 effect after administration oral route of free FRE extract (50 and 100 mg / kg; P <0.01 and P <0.001)

 and nanoparticulate (5 mg / kg; P <0.01) and isoorientine (1-10 mg / kg, P <0.001) was investigated 

in the swim test and similar to the nortriptyline antidepressant, promoted a reduction in the immobility

 time of the animals. Thus, the extraction method optimization increased by 10 times the antidepressant 

potential e. encapsulation promoted the maintenance of antidepressant activity with the reduction of

 extract dose in 10 times. Also, this work was the first to demonstrate the antidepressant effect of the 

substance isoorientina, suggesting a marker. The experiments confirm that active pharmaceutical ingredients 

in free and edulis leaf nanoparticles are a strategy promising for herbal medicine production with action 

antidepressant.

Aging causes changes in the stomatognathic system which influence the masticatory function, and promote disorders that may affect the eating process, oral phase of swallowing, and nutrition status, compromising the older adult population quality of life. Thus, this study aims to construct and validate the instrument for screening for masticatory disorders in older adults (SMDOA). This is a non-randomized and sectional validation study, and the method followed the traditional guidelines of the Standards for Educational and Psychological Testing. The study population consisted of older adults of both genders, aged 60 or over, recruited by convenience. In the first stage of the study, the validity evidence based on the content was obtained through a panel of four experts who defined the construct and content of the instrument and considered the evaluation of 28-experts-committee in relation to the representativeness and relevance of the items of the construct on the first version of SMDOA with 16 questions. The analysis performed through the Content Validity Index by Items (CVI-I) and the Content Validity Index (CVI) was satisfactory. Only one question has been deleted. The second version of SMDOA with 15 items was applied to the target population of 40 older adults to obtain validity evidence based on response processes. After quantitative and qualitative analysis of the answers, it was found that the instrument was well evaluated by the older adults requiring minor morphosyntax adjustments. The third version of RAMI, still with 15 questions, was applied to 295 older adults to obtain validity evidence based on the internal structure. Confirmatory factor analysis was performed to adjust the model. The SMDOA was adjusted in its internal structure, resulting in the model of 9 questions in two factors, masticatory function and perception (c2 = 48,7, p = 0,004, c2/gl =1,76, RMSEA = 0,05, WRMR = 0,75, CFI = 0,98 e TLI = 0,98). The fourth version of SMDOA was submitted to obtaining validity evidence based on relation to other variables in a population of 196 older adults and considered the analysis of Spearman's correlation coefficient (r). The convergent validity was confirmed by the moderate correlation between SMDOA results and four validated instruments with outcomes related to temporomandibular disorders (r= 0,330; p<0,001), hyposalivation (r= 0,442; p<0,001), oropharyngeal dysphagia (r= 0,456; p<0,001) and oral health (r= -0,681; p<0,001). Discriminant validity was confirmed by the weak correlation between SMDOA and a validated self-esteem scale (r= -0,269; p<0,001). Reliability analysis was performed by applying the test-retest in 124 elderly, through weighted Kappa, intraclass correlation coefficient (ICC), standard error of measurement (SEM), smallest real difference (SRD) and Cronbach's alpha. A significance level of 5% was considered. The 9-question SMDOA has good reliability indices (ICC = 0,87, IC 0,82-0,91, p <0,001; SEM = 1,90; SRD = 5,25) and high internal consistency (a = 0,93). SMDOA presented valid and reliable responses to identify masticatory disorders in community-dwelling older adults.

Nanoparticles have the ability to improve pharmacological properties of molecules such as chloroquine (CQ) and phytol (PHY). Organic nanoparticles can be made from polymers or lipids. Polymeric nanoparticles (NP) and solid lipid nanoparticles (SLN) have been widely studied as a source of an alternative therapeutic for viral and fungal diseases. Herpes simplex virus type 1 (HSV-1) and Candida yeast are known to be microorganisms that cause severe infections in immunocompromised patients and can lead to fatalities. The aim of our study was to develop and monitor chloroquine-loaded poly (lactic acid) (PLA) NP (CQ-NP) to improve the effectiveness of CQ in anti-HSV-1 activity; as well as, phytol-loaded NLS (SLN-PHY) produced from the lipid naturally occurring 1,3-distearyl-2-oleyl glycerol (TG1) and then evaluate anti-Candida activity by determining minimum inhibitory concentration (MIC). The nanoparticles produced were monitored using dynamic light scattering (DLS), atomic force microscopy (AFM) and encapsulation efficiency (EE) of CQ and PHY. As results we have that all systems size is <300 nm, PdI <0.2 and encapsulation efficiency> 60%. Antiviral tests were performed by plaque reduction assay using acyclovir (ACV) as positive control. The anti-Candida assays were performed against seven reference strains and eight clinical strains and fluconazole was used as a positive control. Antiviral tests revealed greater efficacity of CQ-NP compared to CQ and ACV at concentrations less than 20 µg/m (p <0.001). MIC tests revealed that SLN-PHY were able to improve phytol activity and MIC 100% were achieved at concentrations ranging from 0.24 and 0.40 µg/mL for both types of strains. Therefore, it can be inferred that the formulation of different nanoparticles was successfully employed, and that NP-CQ being able to increase CQ antiviral activity and SLN-PHY being able to increase phytol's anti-Candida activity.

Interest in immunoglobulin G / A (IgG / IgA) antibodies has greatly increased since human papillomavirus (HPV) vaccines became available worldwide. The objectives of the studies were to describe the course of the IgG / IgA immune response in women immunized with divalent vaccine and those infected with HPV and to describe the course of IgG / IgA responses in cervical and serum secretions one year after the first dose of the vaccine. intramuscular administration of the adjuvant vaccine HPV16 / 18 AS04. Serum and cervical mucus samples were collected for detection of anti-HPV / VLP IgG / IgA by enzyme linked immunosorbent assay (ELISA). The results found show that anti-HPV-VLP IgG in immunized serum was higher (p <0.01), while anti-HPV-VLP-IgA was detected in cervical mucus of virus-infected (p <0.01). Detection of serum antibodies coincides with the induction of high levels of post-vaccine IgG antibodies. IgA antibodies in unvaccinated women were characterized as a possible transudation of the systemic circulation to the cervical mucosa. IgG is a long-term response to any viral infection; thus, anti-HPV-VLPIgG proves the efficacy of the divalent vaccine in protecting against HPV infection. We also observed that immune responses were significant one year after immunization but decreased in cervical and serum samples when compared to levels observed one month after the last dose. This suggests that a vaccine booster may be required to increase antibody titers.

Objective: to describe the clinical-epidemiological and cardiological profile of a group of patients with oral slit (FO) of Rio Grande do Norte. Project: analysis of clinical evaluation data with pediatric cardiologist and complementary exams. Scenario: Multidisciplinary Attendance Program for Patients with Fissures Labiopalatais of Hospital Universitário Onofre Lopes. Patients: FO patients seen in the Program and evaluated by a pediatric cardiologist, from March / 2013 to September / 2014. Interventions: clinical, electrocardiographic and echocardiographic evaluation. Main results: patients were evaluated for age, gender, type of FO, clinical evidence of probability of heart disease (complaints, comorbidities, antecedents) and echocardiographic findings. Results: Of 81 patients included, we observed an age range varying from neonate to 35 years; 50 (61.7%) were male and 45 (55.6%) of the patients had a cleft lip and palate. 42 (51.9%) patients had more than one consultation with a pediatric cardiologist, with 31 (38.3%) having complaints at the time of the consultation. Comorbidities were present in 38 (46.9%) patients. Positive gestational history was observed in 47 (58%) patients, neonatal in 25 (30.9%), family in 54 (66.7%), and personal in 22 (27.2%). Among the family history, the most frequent were Arterial Hypertension (24 / 20,1%), Dyslipidemia (19/16%) and Diabetes Mellitus (15 / 12,6%); and personal, respiratory (20 / 57.1%) and neurological (4 / 11.4%). There was one case of atrioventricular block. Echocardiogram was performed in 74 (91.4%) patients, of which 46 (62.2%) were normal and 28 (37.8%) were altered. A case of mitral valve prolapse by rheumatic carditis was confirmed. Conclusions: A complete cardiologic evaluation (clinical, electrocardiographic and echocardiographic) is suggested as one of the diagnostic criteria complementary to patients with FO, due to the susceptibility to cardiovascular malformations in this group of patients. In this way, improvements in the care of patients with FO are obtained by intervening in their evolutionary history and prognosis, with a positive impact on their overall health, and therefore on public health.

This study aimed to elucidate the anti-inflammatory, anti-oxidant and antifibrotic effects of gold nanoparticles (GNPs) in rats subjected to liver injury with ethanol and Methamphetamine (METH). The liver injury was induced by gavage administrations of 55 30% alcoholic solution (7 g/kg) once a day during 28 days, followed by METH (10 mg/kg) on the 20th and 28th days of treatment. GNPs treatment (724.96 µg/kg) during the ethanol and METH exposure was associated with reduced steatosis, hepatic cord degeneration, fibrosis and necrosis. Furthermore, there was a reduction in biochemical markers of liver damage and oxidative stress, and pro-inflammatory cytokines IL-1β and TNF-α, compared to ethanol + METH group alone. A decrease of FGF, SOD-1 and GPx-1 expression was also observed. GNPs down-regulated the activity of Kupffer cells and hepatic stellate cells affecting the profile of their pro-inflammatory cytokines, oxidative stress and fibrosis through modulation of signaling pathways AKT/PI3K and MAPK in ethanol + METH induced liver injury in a rat model

Hydrophobin II (HFBII) is a protein able to produce emulsion systems that could be applied in the cancer therapy. This study reports the production of HFBII-stabilized oil-in-water nanoemulsion containing copaiba oil by the spontaneous emulsification method. HFBII was extracted by CO₂, isolated by RP-HPLC, and characterized by electrophoresis, mass spectrometry and surface tension analyses. A 2³ full factorial design was used to optimize the formulation, using HFBII, copaiba oil and organic-to-aqueous phase ratio as independent variables. The short-term stability of the nanoemulsion was investigated under different ionic strength and pH. In vitro cellular uptake of the nanoemulsion was evaluated in the human breast cancer (MCF-7) cells by flow cytometry. Isolated HFBII showed a molar mass of 7 kDa with a specific surface activity of 46.5 mN.m^-1.µg^-1. Optimal nanoemulsion formulation with droplet size of 154.2 ± 2.6, PDI of 0.153 ± 0.025 and zeta potential of -29.1 ± 3.2 was obtained using 0.005 wt% HFBII, 0.02 wt% copaiba oil and 10% _(v/v) organic-to-aqueous phase ratio. Nanoemulsion was stable at low salt concentration (<25 mM) and pH close to neutrality. The HFBII-stabilized nanoemulsion was significantly internalized by MCF-7 cells. Moreover, HFBII is a promising biopolymer to stabilize nanoemulsion systems for the cancer therapy purposes.

Cardiovascular diseases (CVD) are the leading cause of death worldwide among women, resulting in 8.6 million deaths annually. Computed tomography (CT) has been used to evaluate the coronary arteries calcifications by quantifying the Coronary Calcium Score (CCS), validated as marker of cardiovascular risk. Additionally, mammography is the only method for population screening of breast cancer, but also could identify atherosclerosis, known as breast vascular calcification (BVC). We verified if there is an association between the BVC and high CCS, thus predicting cardiovascular risk in women whose mammograms revealed BVC.

An observational, analytical study included women submitted to mammography and CCS-CT. Patients with incomplete exams or interval over 12 months were excluded. A systematic random sampling was employed to select the 51 patients, retrieved and reassessed for the presence of BVC and CCS. Being pilot study, sample size was based on convenience, preserving randomness. Aggravating factor of cardiovascular risk was considered to be a CCS greater than 100 (Agatston Score) and/or percentile above 75%. Being pilot study, sample size was based on convenience, preserving randomness. Aggravating factor of cardiovascular risk was considered to be a CCS greater than 100 (Agatston Score) and/or percentile above 75%. The mean age was 56.47(±9.16) years. Of the 51 patients, 16(31.4%) presented and 35(68.6%) did not present BVC on mammograms. In regard to the CCS evaluation, 14(27.4%) of patients presented values> 100 and/or percentile> 75%, and 37(72.6%) presented CCS below this cut off. In patients who did not present BVC, it was observed that 29(83.0%) presented CCS compatible with low cardiovascular risk. In patients with BVC, there was equal distribution between the CCS considered low and high cardiovascular risk (8 subjects each group). The prevalence of high cardiovascular risk among exposed individuals (BVC present) was 50.0%, while the prevalence among the non-exposed (BVC absent) was 17.1%, with a prevalence ratio=2.91 and prevalence OR=4.83 (P=0.015, CI95%=1.07-22.1), confirming the positive association. Additionally, specificity of 82.9% was observed, together with negative predictive value of 78.4%, and accuracy of 72.5%. In our preliminary study, positive association between mammary vascular calcifications and the coronary calcium score is evident. Absence of BVC is statistically associated with low cardiovascular risk and may directly reflect a less intense atherosclerotic process.

Even though it is widely known that Cryptococcus spp. may transmit cryptococcosis trough aerosol formed when dried birds (mainly pigeons) droppings are dispersed and become airborne, little is known about the role of these birds in harboring other pathogenic yeasts in their gastrointestinal tract, feathers and beaks, specifically because these animals often stay and reproduce close or even above air conditioner units. Here we evaluated the prevalence of pathogenic yeasts isolated from pigeon droppings collected in the outside area of a University Hospital in Brazil. We also aimed to investigate the pathogenic potential and antifungal susceptibility of Candida species of medical interest isolated from these samples. Therefore, we performed the evaluation of virulence factors attributes expression in vitro, including the ability to adhere to human buccal epithelial cells and biofilm formation and to produce lytic enzymes, such as phospholipases, proteinases and hemolysins. Antifungal susceptibility testing against fluconazole, itraconazole, amphotericin and micafungin was also performed. The Candida genus was the most prevalent in our study, with several medically important species being isolated. Of note, these strains were able to express several virulence factors in vitro, clearly showing their pathogenic potential. Our study was able to demonstrate that Candida spp. isolated from pigeon droppings may express virulence factors in the same manner of clinical isolates, suggesting a pathogenic potential for these yeasts. The fact these strains were collected from the outside area of a tertiary hospital may be of interest, because they may be a source of infection, specifically to immunocompromised hosts.

-Objective: The aim of this study was to evaluate the 100% rapid review (100%-RR) as an effective tool for internal quality control (IQC) in gynecological cytopathology services. Study Design: A total of 8,677 swabs were analyzed; the negative results were submitted to 100%-RR. Divergent cases were discussed in a consensus meeting to reach a conclusion on the final diagnosis. The data were entered into SAS statistical software, and the agreement of the 100%-RR results with the final diagnosis was tested with the weighted kappa statistic. Results: Of the 8,155 smears characterized as negative, 255 (3.13%) were abnormal smears, and 552 (6.77%) unsatisfactory smears were deemed negative. Regarding the results on the 8,155 smears subjected to 100%-RR when compared with the final diagnosis, there was agreement in 7,063 (86.60%) of them, and there were 1,092 (13.40%) discordant results (65.6%, unsatisfactory; 5.47%, atypical squamous cells of undetermined significance [ASC-US]). The κ index had an agreement of 0.867, with κ = 0.734 ( p < 0.0001).Compared with the final diagnosis, the sensitivity of 100%-RR was 99.91% and its specificity was 99.4% for severe abnormalities. The sensitivity for high-grade squamous intraepithelial lesions was 88.2%, with a specificity of 100.00%. For abnormalities considered borderline, such as ASC-US, the sensitivity was 94.50% and the specificity was 99.5%. Conclusion: The 100%-RR was considered efficient when used as an IQC method

Different types of biomaterials have been developed over the years with various biomedical applications mainly for bone regeneration purposes. Technological evolution has led to the development of new and better biomaterials. Among the various types of biomaterials currently available, the nano and microstructured surfaces and nano and micrometric scale materials have gained prominence. LASER beam treatment is a controllable and flexible approach to modifying surfaces that creates a complex nano and micro-structured topography and thanks to its properties various types of particles have been widely developed. Although many studies have been conducted to evaluate the response to differentiation, little attention was paid to the genotoxic potential during this process. Therefore, assays to evaluate biocompatibility, including genotoxic studies, should be performed. The behavior of human mesenchymal stem cells was analyzed after exposure to surface modified laser discs and hydroxyapatite particles. Titanium disks were evaluated by electron microscopy, x-ray diffraction and contact angle measurement. The surface generated by the creep of 235 J / cm2 was used in the biological assays: MTT, mineralization, alkaline phosphatase activity and qRT-PCR for osteogenic markers. The nanoparticles (nanoXIM • HAp102®, Fluidinova, S.A.) and commercially available hydroxyapatite microparticles (Biotal Plasma) at concentrations of 0.1, 1 and 10 μg / ml were used and analyzed after 1, 3 and 7 days. The analysis of the data of the modified laser titanium a cell type dependent behavior reducing the proliferation of the mesenchymal stem cells and increasing the expression of the osteogenic markers and alkaline phosphatase activity in these cells. Particle evaluation showed that these did not affect the viability of hMSC (p <0.05), however, the higher concentrations used seem to induce an early osteogenic differentiation. This was evidenced by anticipation of the expected maximum levels of alkaline phosphatase activity (p <0.05) and extracellular matrix mineralization (p <0.01). No significant changes were observed in the oxidative state and the evaluated genotoxic potential. Interestingly, the frequencies of nucleoplasmic bridges (NPB) and DNA damage by the comet test were higher after 7 days under control conditions, suggesting that these bridges are characteristic of isolated hMSCs and tend to disappear during the differentiation process. Our findings show that laser irradiated titanium can modulate cell behavior in a cell type dependent manner and stimulate osteogenic differentiation. In addition, particle data suggest that the exposure induces a sufficient cellular response to prevent genetic instability and does not have prolonged genotoxic effects during osteogenic differentiation. Thus, the analyzed biomaterials demonstrate potential for its use in regenerative medicine and insofar as the particles appear to be safe in relation to genotoxicity

Although more than 14 loci may be involved with the development of Nonsyndromic Cleft lip and/or palate, the precise etiology has not been fully elucidated and there is a confounding with syndromic forms. The traditional genetic mapping strategies have recently been complemented by the powerful tool of array-CGH, able to scan the whole genome at once and detect copy-number variants (CNVs). Although previous studies report that common benign CNVs are often smaller in size, with the majority of benign CNVs smaller than 20 kb here we reveal exonic small CNVs based on the importance of the encompassed genes to CLP. Array-CGH analysis of 15 DNA samples from oral cleft individuals identified 11 exonic CNVs affecting at least one exon of the candidate genes. Thirteen candidate genes (COL11A1, IRF6, MSX1, TERT, MIR4457, CLPTM1L, ESR1, GLI3, FGFR1, TBX1, OFD1, PHF8, and FLNA) were overlapped with the CNVs identified. Taking into account criteria such as size, number of markers and frequency in our-house control group and in DGV database, the microdeletions that encompass the MSX1 gene; the microduplications over the three genes TERT, MIR4457, CLPTM1L; and the microduplication on PHF8 gene stood out. The individual significance of genome-wide small CNVs has not been well elucidated in a clinical context, in oral clefts studies, little is known about the importance of small CNVs detected by array-CGH for genetic diagnosis and gene discovery. Our findings represent an initial search of the clinical significance of small CNVs and its relationship with genes implicate in the development of Nonsyndromic Cleft lip and/or palate.

Nanostructured-lipid-carriers (NLC) can improve the encapsulation rate and the stability of drugs. The aim of this study was to develop an amphotericin B (AmB)-containing NLC (AmB-NLC). An experimental design was applied in order to determine the component concentration within the final formulation. The prepared NLC had their stability assessed on the basis of particle size, polydispersity index (PDI), zeta potential, and AmB recovery rate. NLC were also lyophilized (LYO) and optimized in order to improve their shelf-life. The experimental design presented the optimal component concentration as 7:3 (w/w) solid:liquid lipid ratio and 3% of surfactants. The produced NLC were white translucent, becoming yellow translucent when AmB was incorporated. For lyophilization, maltose was the best cryoprotectant using a 48 h freeze-drying cycle. Both the LYO-AmB-NLC and LYO-NLC were readily dispersible in water. The dried systems had slightly different physicochemical properties; however, they maintained their high encapsulation efficiency of above 90%. Additionally, DSC and XRD exhibited the crystallinity state of the particles. The in vitro release profile, assessed 24 h after particle preparation, fitted the Baker-Lonsdale model. In conclusion, all the results together revealed that the developed NLC can be an available alternative as a drug delivery system for AmB.

Introduction: The Social Projects for Sport, destined for the young people from the lower economic group financed both by private and governmental institutions, looks to ensure safety measures for the adolescents that are subjected daily to situations of risk and vulnerability. The resilience refers to the adaptive capability of the subject due to daily events and consist of individual variations in response to risk factors. Objective: The main objective of this research is to evaluate the resilience of adolescent participants in social projects for sport. Materials and Methods: Cross-section Study, comparative and analytical, covered 134 adolescents, from ages 12 to 17, domiciled in a social zone of high vulnerability located in a Northeastern Brazilian city. The data collect was obtained through structured interviews and a questionnaire/ resilience scale, developed by Wagnild and Young (1993), instrument used to measure the positive psychosocial adaptation levels in the face of determined life events. The descriptive and inferential statistical analysis were utilized, especially the Student ‘T’ Test for the independent samples and the chi-square test. In both cases, the statistical significance level adopted was p<0.05. Results: Among the subjects of the research, 53.7% were participants in social projects for sport and 46.3% of non- participants in social projects for sport. A significant statistical difference was found of the resilience between boys and girls, not representing significant statistical differences of resilience among participants, and non-participants, the girls have almost 57% higher risks of lower resilience and 
the younger (up to age 14) have approximately 77% higher risk of low resilience when compared to young people of 15 and older. Final Considerations: The adolescents presented a high level of resilience as an overall group, but it was not observed differences between the participant and non-participants groups of Social Projects for Sport.

Objective: To compare the quantitative expression of T lymphocytes and subsets T-helper

(CD3+/CD4) and T-cytotoxic (CD3+/CD8+), B lymphocytes (CD19+) as well as NK cells
(CD16-56+) and NKT (CD3/CD16-56+) cells in HPV-infected woman’s, correlated with the
presence of low-risk and oncogenic HPV-DNA. Methods: Were analyzed 30 healthy women
and 30 patients with Low Squamous Intraepithelial Lesions undergoing HPV genotype
detection by hybrid capture. The presence of T lymphocytes (CD4 and CD8 subsets), CD19,
NK, and NKT cells were investigated by flow cytometry immunophenotyping. The average
number of cells in each group was verified using the Student t-test. A significance level of 5%
was adopted in all the tests carried out. The graph pad statistical program was used to
calculate the values. Results: We found a sharp increase in TCD8+ T lymphocytes among
patients with oncogenic HPV DNA and a statistically significant reduction in the expression of
NK and NKT cells in all groups of patients analyzed when compared with the healthy control
group. Furthermore, the quantitative evaluation of the CD19 was normal in patients exhibiting
LSIL and HPV when compared with the healthy control group. Conclusions: These
preliminary data suggest a correlation between the increased number of TCD8 lymphocytes
and oncogenic HPV DNA.

Objective: To evaluate the influence of curcumin supplementation on the substrate oxidation at rest, body composition and lipid profile of people living with HIV/AIDS (PLHA) under antiretroviral therapy.  Methods: This double-blind, crossover, randomized clinical trial was comprised by 20 subjects arranged in experimental group (EG) and control group (CG), receiving 1,000mg curcumin/day and placebo, respectively, during 30 days. The substrate oxidation at rest was assessed by indirect calorimetry, the body composition was measured by Dual-energy X-ray Absorptiometry, and the lipid profile was evaluated by biochemical tests. Data analysis was performed by independent samples and paired t-tests to compare the difference between groups and times. A p value < 0.05 was accepted as significant.  Results: There was no difference between groups regarding substrate oxidation at rest and body composition. Regarding the lipid profile, an increase in serum triglyceride levels was observed after curcumin supplementation (182 vs. 219mg/dL; p=0.004). Conclusion: Curcumin supplementation (1.000mg/day during 30 days) promoted elevation of serum triglyceride levels in PLHA. Considering the scientific evidence of the potential anti-inflammatory and antioxidant properties of curcumin and its positive effect on the modulation of serum triglycerides, we highlighted the need for additional studies to better understand the impact of curcumin supplementation and its effects on metabolic pathways of lipid metabolism on PLHA. 

In this study, we investigated whether there was transovarial transmission of dengue virus in Aedes aegypti and Aedes albopictus in Natal, Rio Grande do Norte, Brazil. Mosquito larvae were sampled monthly from April 2011 to March 2012. Viral RNA was extracted from 140 µL original suspension of mosquito larvae by the QIAamp Viral RNA Mini Kit and RT-PCR for detecting and typing DENV was performed. During the study period, 1,333 larvae were collected—1,186 (89%) Ae. aegypti and 147 (11%) Ae. albopictus. Dengue virus type 4 was identified in 4 pools of Aedes aegypti larvae in four districts of Natal, Brazil. DENV infection rate in Ae. aegypti larvae was expressed as minimum infection rate (MIR=3.37). Dengue viruses were not identified in Aedes albopictus larvae. This finding further confirms the importance of larval control since the immature stages may become the reservoir of the virus during the inter-epidemic periods as well as the main reservoir of the virus.

O envelhecimento da população brasileira, ou a nomeada transição demográfica, tem sido enunciada nas últimas décadas. A ciência acompanha esta premissa a partir das demandas socioculturais, políticas e econômicas. Assim sendo, estudos que visam evidenciar fatores associados ou correlacionados a um determinado agravo têm aumentado. A depressão no idoso tem sido considerada um importante tema, por agregar nuances filosóficas e bio-psicológicas, relacionando desde o sofrimento da proximidade do fim da vida até a alta prevalência de doenças crônicas não transmissíveis. Sabe-se que a depressão é uma doença com sintomatologia psíquica e física, oriunda de alterações em nível de neurotransmissores, bem como alterações inflamatórias. Ainda, está relacionada à perda de autonomia e incapacidades, quedas e hospitalizações, diminuindo a qualidade de vida. Além da depressão, a síndrome de fragilidade tem sido cada vez mais estudada, inclusive por apresentar forte impacto nas vivências de idosos. Objetivou-se estudar a associação entre os indicadores da fragilidade e a depressão no idoso, avaliando a magnitude através das razões de prevalência (RP). Trata-se de um estudo seccional, derivado de um estudo multicêntrico- Rede FIBRA (Fragilidade em idosos brasileiros) - em um município no interior do nordeste brasileiro. Foi utilizada uma amostra de idosos domiciliares com mais de 65 anos de idade que pontuassem acima do ponto de corte em exame cognitivo. Utilizou-se análise bivariada de Poisson, bem como análise multivariada. Observou-se que características sóciodemográficas como ser viúvo e não ser alfabetizado apresentam associação significativa com os sintomas depressivos. Dentre os indicadores de fragilidade, perda de peso, fadiga e falta de atividade física apresentaram p inferior a 0,05. Estas observações permitem observar a sobreposição entre os sintomas depressivos e indicadores de fragilidade, o que suscita a conjectura acerca da suficiência de apenas indicadores físicos serem utilizados para a constatação de fragilidade, sem a inclusão de um indicador que avalie aspectos afetivos. Percebe-se que muitos estudos ainda necessitam ser realizados, especialmente com metodologia que permita inferência de causalidade.

As plantas medicinais são usadas para os cuidados de saúde primários através de um conhecimento que passa ao longo das gerações. Assim, as espécies Turnera subulata e Spondias mombin × Spondias tuberosa estão incluídas neste contexto, devido ao seu uso pela medicina popular no Nordeste brasileiro para o tratamento de várias doenças. Dessa forma, o objetivo deste estudo foi avaliar as propriedades genotóxicas de extratos foliares dessas espécies pelo teste SMART em células somáticas de asas de Drosophila melanogaster. Assim, os experimentos foram realizados utilizando o cruzamento padrão (ST) e o cruzamento de alta bioativação (HB) com três concentrações diferentes do extrato aquoso (EAT e EAS) a 5,0; 10,0 e 20,0 mg/mL, extrato etanólico (EET e EES) e fração de acetato de etilo (FAET e FAES) a 0,625; 1,25 e 2,5 mg/mL. Os resultados indicaram que os extratos e as frações induziram frequências espontâneas de manchas mutantes em ambos os cruzamentos com D. melanogaster. No entanto, as concentrações mais elevadas dos agentes vegetais testados foram os responsáveis pelo efeito genotóxico estatisticamente significativo. Portanto, T. subulata e S. mombin × S. tuberosa apresentaram efeito genotóxico sob as condições experimentais. Estes dados são importantes porque indicam o efeito deletério, bem como o efeito adverso, considerando o uso indiscriminado de extratos destas plantas para o tratamento de doenças.

O câncer colorretal tem se destacado por ser um dos tumores mais frequentes, com índices de morbidade e mortalidade expressivos. Na descoberta de novas drogas, produtos derivados de plantas se destacam por ser uma fonte segura e capaz de originar compostos de alta eficiência. Bastante conhecida na medicina popular brasileira, Libidibia ferrea (Mart. ex Tul.) L.P. Queiroz var. ferrea, tem sido utilizada no tratamento de um amplo espectro de condições e na prevenção do câncer. Nesse estudo, extratos bruto de L. ferrea (EF20T, EF40T, EF60T e EF80T) foram avaliados por 24 h e/ou 48 h pela capacidade de inibição da proliferação celular; indução de apoptose através da avaliação de Bcl-2, caspase-3 e Apaf-1; atividade antioxidante e efeito sobre alvos importantes relacionados a proliferação celular (EGFR e AKT) na linhagem colorretal humana HT-29, por meio de metodologias que envolveram ensaios de citometria de fluxo, espectrofotometria e RT-qPCR. Os resultados demostram que os extratos tiveram grande potencial antiproliferativo comparado ao controle, indução de apoptose através da via intrínseca e provável ação de inibição tumoral com a mediação de alvos importantes na tumorigênese. Além disso, possui efeito antioxidante e anti-peroxidação lipídica, bem como quimioprotetor nas células saudáveis. Portanto, derivados de L. ferrea possuem importantes efeitos anticâncer podendo ser considerados candidatos moleculares promissores para inovação do tratamento do câncer colorretal.

The significant change in the demographic profile of the world shows an accelerated process of global aging. To obtain an active and healthy aging is necessary to maintain a good physical, psychological and social functioning along to this, one should invest in interventions to reduce the incidence of health demands and propitiate the quality of life. The research objective is to develop multidimensional interventions from health demands, to improve the quality of life of elderly enrolled in the Family Health Strategy. This is a quantitative, descriptive and methodological study, involving elderly enrolled in the Health Family Strategy Christmas and Santa Cruz, both in Rio Grande do Norte. The sample consisted of 120 elderly individuals who met the inclusion criteria. The study was developed in three phases. Data collection, data analysis and planning of multidimensional and multidisciplinary interventions. Non-parametric tests (Chi-square, Mann Whitney and Spearman's correlation) were used to analyze the data. The research was approved by the Research Ethics Committee of the University Hospital Onofre Lopes and asked the participants to sign the Informed Consent Term. It was observed that the elderly present three main health demands (functional, nutritional and depressive symptoms, respectively) and their total QOL score was considered satisfactory. However, the main health demands that correlated with QoL were depressive symptoms, followed by functional health demand. From these health demands it was possible to plan multidimensional and multidisciplinary interventions. It was planned six strategies (market simulation, exercise, nutrition lecture, bingo food, introduction to technology, use of technology involving nutrition and physical activity evolving) for use in the group with an average of an hour and a half. It was verified the importance of intervention with the elderly to keep them active, independent, with social and healthy contact. In order to do this, it is necessary to increase the involvement of Family Health Strategies, since it is the gateway to health services that aims to promote health and prevent injuries.

This dissertation aims to analyze the training of ESF and NASF to meet the needs of the elderly. It is of a qualitative research, carried out in two stages and with different methodological procedures. In the first stage, to analyze how the approach of the subject of human aging occurs the training of professionals working in the ESF and NASF through the documentary research. The second step consisted in understanding, with the focus groups, the perception of the elderly about their needs, as well as to understand their perception of the professional skills required for care that this portion of the population needs under the ESF and the NASF. The results of the documental research revealed that professional training for care with the health of the elderly is based exclusively on the care and of chronic-degenerative diseases, as well as in the identification and prevention of harm to health. In addition, the operationalization of the perception of the elderly people participating in the study. study on their needs, classifying them into two themes: The need for good living conditions and the need for access to health services. According to the participants, the professionals of the ESF and the NASF are well qualified to serve them, however, they do not have autonomy to solve the needs listed. For the resolution of needs, qualify the managers (municipal, state and local federal) of the health sector would be the priority path. With the study, it is noticed that the discussion about the theme of aging in the process of training human resources in health is still incipient and disassociated with the health needs of the elderly. Thus, if makes it necessary to prepare people who pay adequate attention to the population, as well as to formulate and manage public policies for the population that is a SUS user.

Aim. Pelvic floor muscle (PFM) force seems to be associated to better performance in sexual response in women. However, the benefits for a short intervention using training program for FPM on sexual response of young healthy women are not yet demonstrated. Therefore, the aim of this study was to evaluate the sexual response in young healthy women before and 4 and 8-weeks after a training program of pelvic floor muscles (PFM) evaluated by three psychometric instruments.

Methods. Thirty –one in young healthy women were Training program includes 4 contexts (bipedal, dorsal laying, quadrupedal and seated postures) but participants best performed bipedal exercises (adherence varies from 100% to 54%) and only this type was considered for analysis. Data for pelvic musculature was collected using PERFECT method in the initial and final sessions, and analyzed by T-paired test. Sexual response questionnaires, FSFI, SQ-F and GRISS, were completed before and after 4 and 8 weeks the introduction of training program and tested by ANOVA, for both individual domains and total scores. For the three instruments were also analyzed the accuracy measured by the area under the ROC curve (AUC) for individual domains within each questionnaire as well as to estimate the cross accuracy, two-by-two, for the three instruments.

Results. Participants showed a better performance in PERFECT after 8- week’s period of training program comparing to initial performance, for both fast and slow switch fibers (T-Value= -15.39, p< 0.001; T-Value= -4.23; p < 0.001). They also showed a positive impact on the sexual function (ANOVA, p<0.02; FSSI: desire, excitation and orgasm/SQ-F: sexual interest, preliminaries/GRISS: orgasm). All three questionnaires showed a fair-good-optimal accuracy (ROC analysis) in assessing the domains (IFSF:AUC = 0,74-0,891 in six domains; GRISS:AUC=  0,706- 0,933 in seven domains and SQ-F:AUC = 0,882-0,821, but poor agreement for two domains= 0.594 and 0.580. ROC curve to compare the predictive value for one instrument in relation to the other show the best accuracy for FSFI x SQ-F (AUC= 0.891). 

Conclusion.  Many evidences are available showing a growing body of data to support the involvement of PFM in the improvement of sexual female response. This study shows the positive impact of a training program for PFM with the increase of force in both fast and slow switch perineal muscle fibers although performed during 8-weeks period. Also, the program also improved some scores evaluated by the  three different instruments (FSSI, SQF-F and GRISS) analysis showing significant differences associate to optimal- good accuracy across the monitoring. These data are promising to build short-term physical therapy Programs to young healthy women contributing for increase their pelvic functions, and quality of life.

Key Words.; Pelvic Floor Muscles; Physical Therapy; Dyspareunia; Orgasm; FSSI; SQ-F; GRISS

As fendas orais constituem um problema de saúde publica atingindo cerca de 15% de todas as malformações, caracterizando-se pela formação incompleta das estruturas que separam a cavidade nasal e a cavidade oral com fatores genéticos e ambientais que contribuem para sua etiologia. Atualmente, estudos de microarray, utilizando pacientes fissurados identificaram diversas regiões de susceptibilidade para o desenvolvimento das fendas orais não-sindrômicas, dentre essas alguns estudos demonstraram a região do gene IRF6 associado ao aumento de risco para o desenvolvimento das fendas. O objetivo do presente trabalho é pesquisar polimorfismos do gene IRF6 e as possíveis correlações com o desenvolvimento das fendas orais não-sindrômicas. Para isso, um total de 368 individuos (186 pacientes FL/P e 182 controles) foram selecionados no Serviço de Atendimento ao Paciente Fissurado - HUOL/UFRN. Amostras de sangue foram coletadas para extração do DNA e análise dos polimorfismos do gene IRF6 (rs2235371, rs642961, rs2236907, rs861019, e rs1044516) por PCR em tempo real. . Os pacientes foram classificados nos grupos CLP, CL e CP e foi observada uma associação significativa de rs2235371 (OR: 11,24, 95% CI: 1.97-64.22, p = 0,016) no grupo com a fendas palatinas isoladas (CP). Além disso, a análise da combinação alélica mostrou um aumento do risco de fendas associado aos polimorfismos rs1044516 e rs2236907, uma vez que estavam presentes em todas as combinações significativas. Assim, a associação do rs2235371 com pacientes do grupo CP mostra-se como um fator de risco para CP em nossa população. A análise das combinações alélicas mostram a influência de polimorfismos do IRF6 combinadas, principalmente (rs1044516 e rs2236907) sugerem que cada polimorfismo pode contribuir minimamente para aumentar o risco de desenvolver fendas orais não-sindrômicas em uma população brasileira de Rio Grande do Norte .

The increasing incidence of systemic fungal infections along with the growth of clinical isolates resistant to first line clinical treatment is a challenging epidemiological scenario in clinical practice. The development of new strategies is of paramount importance for the control of this rampant problem. Micellar amphotericin B (AmB-D) has a satisfactory activity profile, but its toxicity is pronounced. An alternative to reduce its toxicity is the controled heating of AmB-D resulting in superaggregates (AmB-H). Aiming a new therapeutic alternative, it was evaluated as structural modifications of AmB-H by accessing its physico-chemical characteristics, “in vitro” toxicity profile in red blood cells, “in vitro” activity in Candida sp strains and designed a semi-mechanistic PKPD model. A spectroscopy screening showed that there is a blue shift at the aggregate band from 327nm to 323nm, AmB-D and AmB-H respectively. The dilution study showed that AmB-H acts as the reservoir for the amphotericin B monomeric forms. Red blood cell toxicity studies have demonstrated that at high concentrations of AmB-H (5mg.L-1 and 50mg.L-1) presents around 2% of hemoglobin leakage whereas AmB-D presents the 100%, proving the profile of low toxicity by this experiment model. The activity evaluation, the AmB-H presented similar results to AmB-D against C. albicans and C. parapsiloses. The evaluation of the critical steps of the freeze-drying process, AmB-H has proven no changing during the process making it a good manufacturing strategy. Regarding the pharmacometrics, the semi-mechanistic PKPD model demonstrated that AmB-H is about 25% more potent than AmB-D and the model also provides quantitative parameters estimates that corroborate with a scientific literature and it provides a support to the development of clinical trials. All these data demonstrate that AmB-H is a promising system and together with scientific literature, it produces solid scientific subsidies to initiate clinical trials and finally the development of a new therapeutic strategy.

Introduction As people get older remains a challenge maintaining functional
capacity. Functional capacity defined as the ability to perform self-care
activities (i.e. activities of daily living - ADLs) is classified inside the level of
“activity and participation” of the International Classification of Functioning,
Disability and Health (ICF). Previous studies have identified different risk
factors for worsening functional capacity during hospitalization, including older
age, sociodemographic characteristics, preexisting disability, comorbidity,
cognitive loss and depression. In-hospital mobility has received particular
attention due to its important relation to loss of functional capacity. Few
studies about hospitalization effects on older adults were done in Brazil and in
an attempt to fill this gap this study was developed. Identify older adults at risk
for loss in functional capacity during hospitalization will help researchers and
clinicians in order to make informed decisions. Objectives This study has
three objectives. First: to provide an updated review to identify and appraise
relevant instruments for the measurement of older adults’ mobility based on
the ICF conceptual framework in the context of an acute care or intensive
geriatric rehabilitation unit and to appraise and compare their measurement
properties. Second: to evaluate if in-hospital mobility assessed at admission is 

predictive of loss in functional capacity during hospitalization of older adults.
Third: to assess functional changes since pre admission (baseline) until
discharge of hospitalized older adults and identify predictors of loss in
functional capacity. Methods This cohort prospective study was conducted at
University Hospital Onofre Lopes (HUOL), Natal/RN, Brazil, between January
1, 2014 and April 30, 2015. The study enrolled all consecutive patients aged
60 years and older who were acutely admitted and fill the following inclusion
criteria: 1) ability to provide informed consent; 2) admitted directly from the
community; 3) screening for study eligibility performed in first 24 hours of
admission. Independent variables included personal characteristics, domestic
live activities (i.e. instrumental activities of daily living – IADL) evaluated by
Lawton and Brody´s scale, cognition evaluated by Leganés cognitive test,
depression assessed by Geriatric Depression Scale (GDS-15), in-hospital
mobility evaluated by Short Physical Performance Battery (SPPB). The
dependent variable functional capacity was assessed by Katz scale. Those
instruments were applied at two different times: at admission (within first 24
hours) and at discharge (12-24 hours before). Analysis included descriptive
statistics, bivariate and multivariate, by means of frequencies, means ±
standard error, receiver-operating characteristic (ROC), logistic binary
regression and Generalized Estimating Equation (GEE). Data were entered
into the Statistical Package for Social Sciences (SPSS) version 18.0 for
Windows. Results At discharge from the 1256 included 65 (5.1%) died during
the hospitalization and final sample consisted of 1191 older adults. The mean
age was 70.02 (±7.34), 684 (57.4%) participants were men and 790 were
married (66.3%). The mean length of hospital stay was 7.65 days (±9.94). Our
sample had a high prevalence of surgery (˃70%). Regarding to the best
instruments to assess mobility De Morton Mobility Index (DEMMI) and SPPB
presented the best balance between mobility coverage, measurement
properties and applicability to acute care and intensive geriatric rehabilitation
units. SPPB cutoff point of 6.5 (62% sensitivity, 54% specificity) identified 593
(49.8%) patients at risk for loss in functional capacity. In logistic regression
SPPB alone presented statistically significant prediction loss of functional
capacity between admission and discharge. Finally regarding to changes in
functional capacity 52.5% of the older adults were discharged with worse
functional capacity than baseline. Be dependent in domestic life activities,
presence of depressive symptons, low levels of cognition and in-hospital
mobility were risk factors for greater loss in functional capacity after a
hospitalization event. Conclusion We concluded that DEMMI and SPPB
were the best instruments to assess mobility in hospitalized older adults.

Regarding to functional capacity half of the sample presented loss in
functioning between baseline and discharge and in-hospital mobility evaluated
by SPPB can predict loss of function in hospitalized older adults. In addition to
in-hospital mobility, dependence for domestic life activities, low levels of
cognition and depression improve the detection of cases at risk of loss in
functional capacity.

Resuscitation and treatment of shock and sepsis are controversial and challenging. The objective of this study was to examine the effects of coconut water + 3% NaCl + simvastatin on resuscitation in a murine model of sepsis and hemorrhagic shock. Adult male Wistar rats were submitted to sepsis by ligature and cecal puncture and hemorrhagic shock, divided into four hydroelectrolytic replacement groups. 1. 0.9% saline solution; 2. coconut water + 3% NaCl; 3. coconut water + 3% NaCl + simvastatin (microemulsion) 10 mg / kg i.v; 4. Normal coconut water. Clinical scores, histology, and lung fluorescence were evaluated in this study. Serum cytokine levels of TNF-α, IL-1β and IL-6 and leukocyte counts were determined. Treatment with coconut water + NaCl 3% + simvastatin resulted in significantly better survival, biochemical and histopathological results compared to the animals submitted to the other treatments. In conclusion, i.v. use of coconut water with 3% NaCl + simvastatin had a positive effect on the treatment of rats with hemorrhagic shock and sepsis in all parameters studied. The clinical implication of anti-inflammatory effects in the treatment of inflammation associated with sepsis and hemorrhagic shock needs to be better evaluated in future studies.

Primary Health Care (PHC) is the first level of care within the of the health system, and has four essential attributes: first contact, continuity and integrality of care, and coordination of the assistance. It also adds three other characteristics (attributes derivatives), which qualify actions in PHC: family-centered attention, community orientation, and cultural competence. Identifying the presence and extension of these attributes is important in order to define a service as really oriented towards PHC, and allows to verify the association between these and he results - effectiveness - of the health care of the population. In this way, the evaluative process acquires an essential role for the effectiveness and quality of health actions and services, and consists of the initial stage of the qualification process and should be followed by development of interventions and strategies aimed at improving quality indicators. Within this context, this The purpose of this study was to evaluate the attributes of PHC in a Northeast of Brazil; identify health quality indicators; and describe strategies used at the national and international levels to improvement of services. First, a descriptive cross-sectional study with the purpose of evaluating the presence and extension of APS attributes, instrument of PCATool-Brazil. In a second At the same time, a systematic review was carried out, in the period from 2011 to 2015, describing international experiences related to advances and improvements in PHC; identify which indicators are used to qualify the APS; and to describe interventions or strategies used in Brazil to improve the quality of results. The analysis of the attributes showed that the The mean total score was 6.88 ± 0.91. The average score for the attribute essential was 6.61 ± 0.91 and for the derived attribute was 7.80 ± 1.30. O first-contact component showed low mean (3.76 ± 1.11), whereas the information coordination system presented the highest average score (8.06 ± 1.60). The review of strategies used in several countries showed that the majority of the studies were related to coordination of care, programs or models to manage practices, and technology tools. As for the quality indicators, compiled 18 domains. Interventions or strategies related to quality indicators were, for the most part, directed towards promotion of health and prevention of diseases, using health education, pharmaceutical and nutritional guidance and technological resources. It was concluded that the evaluation of the attributes showed a strong orientation towards primary health care, considering accessibility as a major challenge of APS in Brazil. The review of international practices and experiences has proved to be a relevant mechanism to identify possible solutions for overcome obstacles and achieve better results. The recognition of quality indicators essential for improving care delivery It also provides additional support for monitoring the quality of the APS. It highlights the multidisciplinarity involved in studies that health systems, and a broader view of planning, quality of services, public policies, health process, among others, for a better understanding of reality.

Exposure to the environment, elevated xenobiotic levels in the diet and even the biochemical reactions performed
 by human metabolism, increase the generation of reactive oxygen species (ROS) and nitrogen (RN) .
This increase in ROS and RNA creates an oxidative stress, and it can generate a series of pathophysiological
problems. Biochemical studies report that dietary antioxidants have benefits in the prevention of diseases, 
fruits are distinguished by the large amount of bioactive substances with this beneficial activity. 
it is not possible to know its chemical components (nutrients) and their effects on the metabolism after its 
ingestion. Therefore, it is very important to understand the mechanisms of the reaction of the antioxidants 
present in the atemoia fruit with the reactive species, of which the formation of aqueous extract and flour of
 the parts of the sem proteins, carbohydrates and phenolic compounds, as well as the evaluation of the
 presence of inhibitors of proteases and hemagglutinins, in addition to the antioxidant tests; total antioxidant 
capacity (CAT), hydroxyl radical sequestration (SRH), superoxide radical scavenging (SRS), metal chelation 
(QM), and oxidative stress evaluation by biochemical and histological parameters in animals fed the atemoia
 parts. The presence of protease inhibitors and agglutinins in atemoia extracts have been detected. These
 substances have the potential to be used in the biotechnology or biomedical area, helping to prevent diseases
 or even to improve the genetic quality of fruits. The extracts present proteins, carbohydrates and phenolic 
compounds in their composition, a fact that suggests a synergy between these compounds in the
 antioxidant effect, it is worth mentioning that the study supposes the presence of other substances not 
known, which may be influencing these effects. In vivo studies, however, show a nontoxic effect of the 
extracts. The best in vivo results were obtained with seed extract. Thus, it is proposed that the extracts of
 atemoia have functional properties. And future studies should be carried out in order to elucidate specific
 pathways and compounds that can act on these benefits.

Objetivo: Examinar se a colectomia associada à hepatectomia 70% influencia a regeneração do fígado em ratos. Métodos: Foram utilizados 18 ratos Wistar distribuídos em 3 grupos (6 animais cada). No grupo I (sham) foi realizada laparotomia; no grupo II colectomia + hepatectomia 70%; no grupo III apenas hepatectomia 70%. No 6° dia pós-operatório colhido sangue por punção cardíaca sob anestesia, seguido de eutanásia. Realizadas dosagens séricas de ALT, AST, fosfatase alcalina, albumina, fator de crescimento de hepatócitos (HGF), fator de crescimento transformador-α (TGF-α). A regeneração do fígado foi calculada pela fórmula: (razão peso do fígado por 100g do peso corporal no momento da eutanásia/peso do fígado no pré-operatório projetado por 100g de peso corporal)×100. Os testes ANOVA e Tukey foram usados, significância p<0,05. Resultados: Os níveis de ALT e AST foram significativamente menores no grupo II comparados com o grupo III (p<0,001). A albuminemia mostrou níveis significativamente mais elevados no II que no III. Os níveis de HGF (408±18,2 pg/mL) e TGF-α (3,8±0,3 ng/mL) no grupo II foram significativamente mais elevados que no grupo III HGF (360±58,6 pg/mL), TGF-α (2,3±0,4 ng/mL), respectivamente (p<0,001). O percentual de regeneração hepática foi significativamente mais elevado no grupo II, do que no grupo III (p=0,003). Conclusão: O estudo demonstrou que a colectomia realizada simultaneamente à hepatectomia 70% influenciou positivamente na regeneração do fígado em ratos. Pesquisas adicionais são necessárias para revelar os mecanismos moleculares deste efeito e para caracterizar a influência do cólon na fisiologia do fígado. 

Infection by Helicobacter pylori affects half of the world`s population and persistence of this pathogen is the main cause of gastric diseases, and eventual cancer development. There are several virulent factors associated with H. pylori outcome. The purpose of the study was to estimate the prevalence of H. pylori infection in an adult population in northeast Brazil and to identify the risk factors for dyspeptic symptoms. We evaluated 200 subjects from Campina Grande, a city in Northeast Brazil. All subjects presented with dyspeptic complaints. They underwent physical examination and endoscopy, followed by Gastric biopsies. Urease test wasperformed for all participants. Fragments of biopsies were examined for histology and DNA was extracted from all fragments. DNA samples were tested for H. pylori by Polymerase Chain Reaction. Females composed 72.5% (145/200) of subjects. Only 17.5% (35/200) of the elderly were exposed to infection and 65% (78/200) used city water. Lack of hand washing, exposure to city water and smoking were considered risk factors for H. pylori infection. Belching was the most common symptom associated with infection and gastritis, regardless of grade. Presence of H. pylori increased the severity of gastritis. Prevalence of H. pylori infection was higher in people with symptoms of gastritis and the severity of symptoms was associated with infection.

Introduction: Visceral leishmaniasis (VL) is a serious disease and the risks of its development are associated with factors related to co morbidities, environmental transformations and socioeconomic aspects of the geographical area of occurrence. The understanding of these factors is crucial for the redesign of intervention measures to control this endemic disease. General objective. To analyze the epidemiological pattern of Visceral Leishmaniasis in "time space" and the factors associated with the occurrence of the disease, in the period from 1990 to 2014, identify in the State Microregions the social and environmental factors of greatest risk for the occurrence of VL, and propose a intervention protocol for specific areas in order to contribute to the eventual control of the disease. Methodology. A quantitative and retrospective ecological study was carried out with space-time analysis of the existence of spatial dependence of social and environmental factors influencing the incidence of VL. Results: LV settled in the microregions of Natal, Macaíba and Litoral Norte from 1990 to 1994. Between 2000 and 2004, it spread to other microregions of the State, establishing itself between 2010 and 2014 in the microregions of Mossoró and Açu. Concomitant to the increase in endemic areas for LV, HIV-AIDS spread in the NB in a disordered manner, with areas of HIV-AIDS and LV overlapping, favoring the correlation of LV / HIV-AIDS coinfection between 1990 and 1994 ( p = 0.0006) and 2010 to 2014 (p = 0.0094), respectively.

A negative association was observed in the incidence of VL with increased garbage collection. At the same time, it was observed that the incidence of HIV-AIDS is positively associated with better levels of income, education and population density. Conclusion: The incidence of VL is decreasing, but it prevails in male adults, in areas with low litter collection coverage and good water supply. There was reduction in children associated with the improvement of the Nutritional Status Index and the vaccine coverage. The spread of LV and HIV-AIDS determined the setting up of LV / HIV-AIDS coinfection. The incidence of HIV is increasing and its dispersion is associated with microregions with urbanized profile with good coverage of social indicators of garbage collection, public cleanliness, education, income and high population density.

The purpose of this study was to assess the risk of abnormal anal cytology in women with known genital squamous intraepithelial lesion (SIL). This study evaluated 200 women with and without genital SIL who were recruited for anal Pap smears. Women who had abnormal results on equally or over atypical squamous cells of undetermined significance were classified as having abnormal anal cytology. A multiple logistic regression analysis (stepwise) was performed to identify the risk for developing abnormal anal cytology. Data were analyzed using the SPSS 20.0 program. The average age was 41.09 (±12.64). Of the total participants, 75.5% did not practice anal sex, 91% did not have HPV-infected partners, 92% did not have any anal pathology, and 68.5% did not have anal bleeding. More than half (57.5%) had genital SIL and a significant number developed abnormal anal cytology: 13% in the total sample and 17.4% in women with genital SIL. A significant association was observed between genital SIL and anal SIL (PR=2.46; p=0.03). In the logistic regression model, women having genital intraepithelial lesion were more likely to have abnormal anal Pap smear (aPR=2.81; p=0.02). This report shows that women with genital SIL must be more closely screened for anal cancer.

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As lesões orais potencialmente malignas (LOPMs) são objeto de estudos realizados pela Organização Mundial de Saúde (OMS) e, no Brasil, pelo Instituto Nacional do Câncer (INCA). Dentre esses estudos, as LOPMs são classificadas como desordens clinicamente evidentes, sendo as principais: leucoplasia, eritroplasia e queilite actínica. Neste estudo descritivo, exploratório, quantitativo do tipo seccional, objetivou-se estimar a prevalência de lesões orais potencialmente malignas e malignas e verificar associações entre estas e os fatores de risco e aspectos sócio-demográficos, exposição a fatores etiológicos como o fumo, álcool e o grau de exposição ao sol em um grupo de trabalhadores rurais da Região do Seridó/RN. Para a pesquisa de campo utilizou-se um questionário previamente validado e uma ficha clínica empregada na anamnese dos trabalhadores atendidos. Foram realizados exames clínicos bucais para identificação de lesões suspeitas e malignas na população alvo. Aqueles trabalhadores acometidos de lesões suspeitas foram encaminhados para biópsia, tanto na Faculdade de Odontologia da UFRN, quanto na UERN e também para um consultório odontológico particular situado em Currais Novos, onde um odontólogo colaborador desse projeto atendeu gratuitamente os trabalhadores residentes em municípios circunvizinhos a esta cidade. De 1.385 trabalhadores pesquisados, 53,2% eram do sexo feminino e 48,8% do sexo masculino, com média de idade igual a 53 anos; 57% destes não estudaram ou cursaram até o primário; 73,2% tinha renda familiar mensal de aproximadamente 300 dólares. A maioria exibiu pele clara (49,2%). A prevalência de LOPMs foi igual a 29,6% (27,2; 32,0). Os resultados obtidos na análise bivariada evidenciaram associação estatisticamente significativa entre a variável presença de lesão e as variáveis independentes: sexo, idade, escolaridade, cor da pele, exposição acumulada aos raios solares, uso de proteção, a condição de ex-fumantes e consumidores de bebidas alcoólicas. Todas essas variáveis que apresentaram significância estatística ingressaram no modelo logtístico múltiplo que, através do método Backward-Stepwise, revelou apenas 3 (três) variáveis que permaneceram com significância, independentemente das outras variáveis: sexo, cor da pele e tempo de exposição prolongada aos raios solares. Os achados deste estudo reforçam a importância da promoção de políticas públicas em saúde bucal e a disseminação de informações que levem indivíduos que trabalham expostos aos raios solares a se protegerem adequadamente para minimizar a prevalência das lesões orais potencialmente malignas e malignas e consequentemente reduziu a incidência do câncer oral. 

Superfícies de Ti foram modificadas termoquimicamente por plasma em atmosfera de N2+H2 (nitretação) e Ar+N2+O2 (oxinitretação), com o objetivo de avaliar as respostas biológicas sobre as mesmas.  Após o tratamento por plasma, as superfícies foram caracterizadas quanto às fases cristalinas, topografia, rugosidade e molhabilidade. A partir de ensaios in vitro foram determinadas a adesão, proliferação, formação de biofilme e viabilidade bacteriana. As condições que resultaram na maior resistência ao crescimento bacteriano foram utilizadas para estudo de cultura de células e determinação da adesão e proliferação celular. Dentre estas condições está a superfície nitretada durante 1 h.  Os resultados mostraram que não houve formação de grumos ou microcolónias mas também o número de células aderentes é baixo. Já na superfície oxinitretada, foi observado que existe uma concentração ideal de O₂ para o qual, além do crescimento microbiano não ocorrer, as bactérias dispersam, sem a presença de um estresse químico (tal como antibiótico), o que significa que o ambiente formado após o tratamento termoquímico da superfície não é favorável ao crescimento e desenvolvimento de um biofilme. Por outro lado, amostras tratadas nessas condições teve adesão celular bastante significativa. Verificou-se que em apenas 15 min de cultivo de células osteoblásticas, essas amostras oxinitretadas já apresentavam muitas células aderidas à superfície. Além disso, os resultados indicaram que essas superfícies apresentaram maior proliferação no tempo de 24h em relação às amostras sem tratamento. Foi observado que a porcentagem de sobrevivência celular é maior nas amostras tratadas. Os discos tratados não apresentaram células em necrose, apesar da amostra sem tratamento possuir uma baixíssima porcentagem de células nesse estágio. Isso infere que o titânio não é citotóxico e que as alterações superficiais causadas pela formação de nitreto e de oxinitreto de titânio apresentaram um papel fundamental na adesão e proliferação celular. Estes resultados são relevantes para a prática clínica, pois mostra o potencial de aplicação destes tratamentos em superfícies de Ti com interesse biomédico anti-infectivos. Desse modo, essa pesquisa de caráter multidisciplinar tem permitido novas estratégias de análises alternativas nessa área, onde a participação do profissional da área de ciências exatas, engenharias e biomédica se faz importante para o sucesso no desenvolvimento de novos biomateriais.

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The multifunctional protein APE1/REF-1 plays an important role in the oxidative stress due to its DNA repair and transcriptional regulatory activities. Several studies have identified APE1/REF-1 related to cell growth, apoptosis, DNA damage, intracellular redox state, mitochondrial function, and cytoskeletal structure. However, it still remains a gap in the literature about how APE1/REF-1 regulates each activity. To identify genes preferentially regulated by redox function of APE1/REF-1, in this study was performed an extensive genome-wide survey using the high throughput RNA-Seq analysis of the LPS-stimulated U937 cells and subsequently treatment with E3330, a known inhibitor of the redox function of APE1/REF-1. Comparative transcriptome analysis revealed 1250 gene expression changes, 620 downregulated and 630 upregulated genes with absolute fold change ≥3 or ≤-3. The downregulated genes were found to be primarily involved in the regulation of ribosome biogenesis, gene expression and immune response, while the upregulated genes showed to be related with cellular response to stress, DNA repair and positive regulation of apoptosis. Further, the treatment with E3330 also promoted the reduction of several inflammatory modulators during time kinetics and cell viability decrease after 48 hours of treatment. Altogether, data point out a set of new purposes associated to the redox inhibition of APE1/REF-1 by E3330, such as difficulties the processing of rRNA, decreased transcription of RelA(p65), c-Myc, ribossomal genes leading to deficiency of ribosomal biogenesis and consequent growth arrest.

Acute leukemias are a heterogeneous group of hematologic diseases characterized by rapid and abnormal proliferation of blood precursors in the bone marrow. The objective of this study was to analyze a group of 338 patients with Acute Myeloid Leukemia (AML), based on morphological, clinical and immunophenotypic criteria by flow cytometry, as well as investigate the correlation between these data and the subtypes of AML. Of the 338 patients studied, 182 (53.8%) were male and 156 patients (46.2%) females, aged 1-90 years. The splenomegaly was predominantly clinical manifestations compared with 270 cases. Leukocytosis was present in 298 (88.1%) and 302 (89.3%) had platelet counts below 100,000 / mm3. Hemoglobin ranged from 2.5g / dL to 12g / dL. Regarding the subtypes of AML, 4 (1.2%) were AML-M0, 110 (32.5%) were AML-M1, 82 (24.3%) AML-M2, 38 (11.2%) AML-M3, 53 (15.7%) AML -M4, 35 (10.3%) AML-M5 9 (2.7%) AML-M6 and 7 (2.1%) AML-M7. The expression of aberrant phenotypes was observed with positivity for lymphoid antigens such as CD7 in 34 (10.6%) patients and CD19, present in 22 (6:53%). The analysis of the worldwide incidence of leukemia subtypes showed significant changes in relation to the geographical distribution, gender, age, ethnicity and socioeconomic status, suggesting that there are multiple etiological factors. These data demonstrate the importance of differential diagnosis and characterization of AML to provide better treatment and monitoring of this neoplasm.