ABSTRACT Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as Nonalcoholic fatty liver disease (NAFLD), is one of the most common hepatic diseases in individuals with overweight or obesity. In this context, a panel of experts from three medical societies was organized to develop an evidence-based guideline on the screening, diagnosis, treatment, and follow-up of MASLD. Material and methods: A MEDLINE search was performed to identify randomized clinical trials, meta-analyses, cohort studies, observational studies, and other relevant studies on NAFLD. In the absence of studies on a certain topic or when the quality of the study was not adequate, the opinion of experts was adopted. Classes of Recommendation and Levels of Evidence were determined using prespecified criteria. Results: Based on the literature review, 48 specific recommendations were elaborated, including 11 on screening and diagnosis, 9 on follow-up, 14 on nonpharmacologic treatment, and 14 on pharmacologic and surgical treatment. Conclusions: A literature search allowed the development of evidence-based guidelines on the screening, diagnosis, treatment, and follow-up of MASLD in individuals with overweight or obesity.

SUMMARY OBJECTIVE: The aim of this study was to evaluate the performance of ChatGPT-4.0 in answering the 2022 Brazilian National Examination for Medical Degree Revalidation (Revalida) and as a tool to provide feedback on the quality of the examination. METHODS: A total of two independent physicians entered all examination questions into ChatGPT-4.0. After comparing the outputs with the test solutions, they classified the large language model answers as adequate, inadequate, or indeterminate. In cases of disagreement, they adjudicated and achieved a consensus decision on the ChatGPT accuracy. The performance across medical themes and nullified questions was compared using chi-square statistical analysis. RESULTS: In the Revalida examination, ChatGPT-4.0 answered 71 (87.7%) questions correctly and 10 (12.3%) incorrectly. There was no statistically significant difference in the proportions of correct answers among different medical themes (p=0.4886). The artificial intelligence model had a lower accuracy of 71.4% in nullified questions, with no statistical difference (p=0.241) between non-nullified and nullified groups. CONCLUSION: ChatGPT-4.0 showed satisfactory performance for the 2022 Brazilian National Examination for Medical Degree Revalidation. The large language model exhibited worse performance on subjective questions and public healthcare themes. The results of this study suggested that the overall quality of the Revalida examination questions is satisfactory and corroborates the nullified questions.

ABSTRACT Obesity is a chronic disease associated with impaired physical and mental health. A widespread view in the treatment of obesity is that the goal is to normalize the individual's body mass index (BMI). However, a modest weight loss (usually above 5%) is already associated with clinical improvement, while weight losses of 10%-15% bring even further benefits, independent from the final BMI. The percentage of weight reduction is accepted as a treatment goal since a greater decrease in weight is frequently difficult to achieve due to metabolic adaptation along with environmental and lifestyle factors. In this document, the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of Obesity and Metabolic Syndrome (ABESO) propose a new obesity classification based on the maximum weight attained in life (MWAL). In this classification, individuals losing a specific proportion of weight are classified as having “reduced” or “controlled” obesity. This simple classification – which is not intended to replace others but to serve as an adjuvant tool – could help disseminate the concept of clinical benefits derived from modest weight loss, allowing individuals with obesity and their health care professionals to focus on strategies for weight maintenance instead of further weight reduction. In future studies, this proposed classification can also be an important tool to evaluate possible differences in therapeutic outcomes between individuals with similar BMIs but different weight trajectories.

ABSTRACT Obesity is a chronic disease associated with impaired physical and mental health. A widespread view in the treatment of obesity is that the goal is to normalize the individual's body mass index (BMI). However, a modest weight loss (usually above 5%) is already associated with clinical improvement, while weight losses of 10%-15% bring even further benefits, independent from the final BMI. The percentage of weight reduction is accepted as a treatment goal since a greater decrease in weight is frequently difficult to achieve due to metabolic adaptation along with environmental and lifestyle factors. In this document, the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of Obesity and Metabolic Syndrome (ABESO) propose a new obesity classification based on the maximum weight attained in life (MWAL). In this classification, individuals losing a specific proportion of weight are classified as having “reduced” or “controlled” obesity. This simple classification – which is not intended to replace others but to serve as an adjuvant tool – could help disseminate the concept of clinical benefits derived from modest weight loss, allowing individuals with obesity and their health care professionals to focus on strategies for weight maintenance instead of further weight reduction. In future studies, this proposed classification can also be an important tool to evaluate possible differences in therapeutic outcomes between individuals with similar BMIs but different weight trajectories.

CHEMICAL COMPOSITION AND PHOTOPROTECTIVE AND ANTIRADICAL ACTIVITIES OF THE BRANCHES OF Platonia insignis (CLUSIACEAE). The chemical study of the branches of Platonia insignis enabled the isolation of the biflavonoid morelloflavone and the identification, by mass spectrometry, of over 9 polyphenols, including eight biflavonoids, one benzophenone, and one xanthone. The in vitro biological tests of solar photoprotection and antiradical activities against the crude extract and Hex and AcOEt fractions showed relevant results, which confirm the high pharmaceutical potential of the species.

RESUMO As mudanças no uso e cobertura da terra são os principais fatores de influência humana no processo erosivo. Dessa forma, o trabalho teve como objetivo avaliar o efeito das mudanças de uso e cobertura da terra ao longo de 30 anos sob a erosão hídrica em uma sub-bacia tropical no sudeste do Brasil. Foi testada a hipótese de que a expansão das áreas de café e reflorestamento diminuíram as perdas de solo por erosão hídrica. Utilizou-se o Método de Erosão Potencial (EPM) para estimar a erosão hídrica em 1988, 1998, 2008 e 2018. Nas duas primeiras décadas, o uso da terra predominante na sub-bacia era o milho, enquanto em 2008 e 2018, o café e as áreas de reflorestamento se tornaram as principais classe de uso da terra da área. A aquisição dos parâmetros de entrada do EPM e a análise dos dados foi realizada por meio de técnicas de sensoriamente remoto e Sistema de Informações Geográficas. Entre 1988 e 1998, a perda total de solo aumentou 50,36 Mg ano-1 devido à conversão de pastagens em plantações de café e o aumento do desmatamento. Entre 1998 e 2018, houve uma redução nas perdas de solo de 660,21 Mg ano-1 (-37,46%). A conversão de áreas de pastagem e milho em cultivos de café com adoção de práticas conservacionistas e a expansão de áreas de reflorestamento entre 1988-2018 contribuíram para a diminuição das taxas de erosão do solo.

ABSTRACT Land use and land cover changes are the main factors of human influence on the erosive process. Thus, this work aimed to evaluate the effect of land use and land cover changes over 30 years on water erosion in a tropical subbasin in southeastern Brazil. The hypothesis was tested that the expansion of coffee and reforestation areas decreased soil losses due to water erosion. The Potential Erosion Method (EPM) was used to estimate water erosion in 1988, 1998, 2008 and 2018. In the first two decades, the predominant land use in the subbasin was corn, while in 2008 and 2018, coffee and reforestation areas became the main land use class in the area. The acquisition of EPM input parameters and data analysis was performed using remote sensing techniques and the Geographic Information System. Between 1988 and 1998, the total soil loss increased by 50.36 Mg year-1 due to the conversion of pasturelands to coffee plantations and the increase of deforestation. However, between 1998 and 2018, there was a soil loss reduction of 660.21 Mg year-1 (-37.46%), once the conversion of pasture and corn areas to coffee with the adoption of conservation practices, and the expansion of reforestation areas among 1988 - 2018, contributed to the decrease of soil erosion rates.

RESUMO A erosão hídrica nas condições climáticas tropicais é um dos principais processos que alteram o equilíbrio entre as entradas e saídas de carbono orgânico do solo (SOC). A modelagem da erosão hídrica usando o Método do Potencial de Erosão (EPM) pode ser usada como uma alternativa para auxiliar no entendimento da dinâmica do carbono do solo e na sua interação com o processo erosivo. Nesse contexto, o objetivo do trabalho foi estimar as perdas de carbono por erosão hídrica em uma bacia hidrográfica com alta diversidade de uso da terra. A modelagem foi realizada com base no teor de matéria orgânica do solo (SOM) na área e nas perdas de solo estimadas, de acordo com o EPM. Para a determinação do SOM, foram coletadas amostras de solo em 50 pontos (0-0.2 m) distribuídos na bacia. A análise dos dados foi realizada por meio de técnicas de sensoriamento remoto e Sistema de Informações Geográficas, que também foi utilizado para interpolar o conteúdo do SOM, por meio da técnica de krigagem ordinária. Os resultados demostraram que do total de carbono perdido (126,53 Mg ano-1), 111,60 Mg ano-1 foram depositados em depressões do relevo, enquanto 14,93 Mg ano-1 atingiram os cursos hídricos. A metodologia aplicada representa um método econômico e relativamente rápido para estimar a perda de carbono orgânico do solo por erosão hídrica e permite a determinação das áreas que mais necessitam de intervenção, com o objetivo de diminuir o impacto da agricultura nas emissões de gases de efeito estufa. A principal vantagem desse método é o pequeno requisito de dados de entrada, o que aumenta a possibilidade de aplicação em regiões pouco estudadas.

ABSTRACT Water erosion under tropical climate conditions is one of the main processes that change the balance between the inputs and outputs of soil organic carbon (SOC). Water erosion modeling using the Erosion Potential Method (EPM) can be used as an alternative to assist in understand soil carbon dynamics and its interaction with the erosive process. In this context, the objective of the study was to estimate carbon losses by water erosion in a watershed with a wide land-use diversity. The modelling was performed based on the soil organic matter content (SOM) of the area, and the estimated soil losses, according EPM. To the SOM determination, soil samples were collected 50 points (0-0.2 m) distributed in the watershed. The data analysis was performed using remote sensing techniques and a Geographic Information System, which was also used to interpolate the SOM content, through the use of the ordinary kriging. The results showed that from 126.53 Mg year-1 of the total eroded organic carbon estimated, 111.60 Mg year-1 were deposited in relief depressions, while 14.93 Mg year-1 reached the water body system. The applied methodology represents a cost-effective and relatively fast method to estimate the soil organic carbon loss by water erosion and allows the determination of the areas that most need intervention, aiming to decrease the impact of agriculture on greenhouse gas emissions. The main advantage of this method is the little input data requirement, which increases the possibility of application in poorly studied regions.

ABSTRACT Water erosion is one of the main problems faced by the Furnas Lake Surrounding Watershed, located in southeast Brazil. The erosive process is intensified by inadequate land occupation of the lake margins where should be riparian forests, or permanent preservation areas (APP), in order to protect water resources. In this context, our work aimed to estimate the soil losses of this watershed using the Revised Universal Soil Loss Equation (RUSLE) in two different scenarios: I - considering the actual occupation of the area, and II - building an alternative scenario where permanent preservation areas were present. Therefore, we considered physical, edaphoclimatic, and land use and management factors. To simulate the presence of preservation areas, we based it on the Brazilian Forest Code (Bill no. 12.651/2012). In the real scenario (I), the total soil loss estimated was 31,580,907.47 Mg.year-1 (32% over the Soil Loss Tolerance) with an average loss of 19.00 Mg.ha-1.year-1, while in the conservationist scenario (II), there was 10% decrease, which means the mitigation of the erosion process as well as of the negative environmental impacts that can be generated by soil degradation.

RESUMO O uso de lodo de esgoto como fonte de nutrientes e matéria orgânica para solos agrícolas é uma prática bem estabelecida. Entretanto, poucos estudos destacam o efeito dos nutrientes e elementos potencialmente tóxicos fornecidos pela aplicação de resíduos orgânicos nos parâmetros fisiológicos da planta, como atividade fotossintética e condutividade estomática. Neste estudo, foi realizado um experimento em casa de vegetação com milho cultivado em um Latossolo Vermelho distrófico com adubação mineral e aplicação de diferentes concentrações de lodo de esgoto, com os seguintes objetivos: i) avaliar a translocação e distribuição de nutrientes e captação de metais em plantas de milho e ii) avaliar a relação entre os parâmetros fisiológicos e indicadores de produção das plantas nas condições do estudo. A aplicação do lodo de esgoto aumentou a matéria orgânica do solo, o pH e as quantidades de Ca, S e Mg disponíveis, em comparação ao tratamento com fertilizantes minerais. As plantas promovem maior translocação de macronutrientes para a parte aérea nos tratamentos com aplicação de lodo de esgoto, o que resulta em maior atividade fotossintética, condutividade estomática e parâmetros de produção de milho. Além disso, os elementos traços, que podem causar toxicidade em pequenas concentrações, foram encontrados principalmente nas raízes, o que indica um mecanismo de defesa das plantas.

ABSTRACT The use of sewage sludge as a source of nutrients and organic matter for agricultural soils is a well-established practice. However, few reports highlight the effect of the nutrients and potentially toxic elements provided by organic wastes application on the plant physiological parameters, such as photosynthetic activity and stomatal conductivity. We performed a greenhouse experiment with maize exposed to a dystrophic red Latosol amended with mineral fertilizer and different rates of sewage sludge with the following objectives: i) assess the nutrients and metal uptake translocation and distribution in plants and ii) evaluate the relationship between plant physiological parameters and yield indicators under the study conditions. The application of sewage sludge increased the soil organic matter, pH, and the amounts of available Ca, S, and Mg, comparing to the mineral fertilizer treatment. The plants promote a higher translocation of macronutrients to the shoots in the sewage sludge treatments, which results in higher photosynthetic activity, stomatal conductivity, and maize yield parameters. Moreover, the trace elements, which can cause toxicity in small concentrations, were founded mainly in the roots, which indicates a plant defense mechanism.

RESUMO Dentre os parâmetros considerados pela Equação Universal de Perda de Solo Revisada (RUSLE) a cobertura e manejo do solo (C) é o principal fator de influência humana na estimativa da erosão hídrica, e um dos mais sensíveis a variações espaço - temporais. Consequentemente, este estudo tem como objetivo comparar a eficiência das estimativas do fator C obtidas na literatura para cada classe de uso da terra (Clit) e por cálculo com base no Índice de Vegetação por Diferença Normalizada (CNDVI). Testamos a hipótese de que as estimativas de perda de solo com base na abordagem CNDVI são mais precisas do que aquelas baseadas no Clit. A erosão hídrica foi estimada com base nas propriedades morfológicas, físicas e químicas do solo, além de clima, relevo, práticas de manejo e uso e cobertura da terra. As etapas da modelagem foram realizadas com a ajuda do Sistema de Informações Geográficas. Os resultados foram validados utilizando os dados do sedimento total transportado com descarga de água e escoamento diário. RUSLE subestimou as perdas do solo em 0,64 Mg ha-1 ano-1 usando Clit e 0,45 Mg ha-1 ano-1 com CNDVI, o que corresponde aos respectivos erros de 21,05% e 14,80%. Portanto, os resultados do fator CNDVI são mais precisos. Ambas as metodologias identificaram áreas com altas taxas de erosão, onde a adoção de medidas mitigadoras deve ser priorizada.

ABSTRACT Among the parameters considered by the Revised Universal Soil Loss Equation (RUSLE), the soil cover and management factor (C) is the main human influenced factor affecting the estimation of water erosion, and one of the most sensitive to spatiotemporal variations. Consequently, this study aims to compare the efficiency of C factor estimates obtained from the literature for each land-use class (Clit) and by calculation based on the Normalized Difference Vegetation Index (CNDVI). We test the hypothesis that soil loss estimates based on CNDVI approach are more accurate than those based on Clit. Water erosion was estimated based on soil morphological, physical, and chemical properties in addition to climate, relief, management practices, and land use and cover. The modeling steps were realized with the help of the Geographic Information System. The results were validated using the data of total sediment transported with water discharge and daily runoff. RUSLE underestimated soil losses by 0.64 Mg ha-1 year-1 using Clit and 0.45 Mg ha-1 year-1 with CNDVI, which corresponds to errors of 21.05% and 14.80%, respectively. Therefore, the CNDVI factor results are more accurate. Both methodologies identified areas with high erosion rates where the adoption of mitigation measures should be prioritized.

Resumo A erosão hídrica é o principal processo de degradação dos solos tropicais e seus efeitos podem ser mensurados por técnicas de modelagem. A modelagem fornece um diagnóstico sobre as taxas erosivas e é capaz de auxiliar no planejamento de práticas de conservação do solo. No Brasil, são aplicados principalmente modelos com baixa exigência de dados, como a Equação Universal de Perda de Solo Revisada (RUSLE) e, mais recentemente, o Método de Erosão Potencial (EPM). Desta forma, o objetivo do trabalho foi estimar as perdas de solo por erosão hídrica em uma sub-bacia hidrográfica tropical, localizada no sudeste brasileiro, utilizando o EPM e a RUSLE e comparar os seus resultados. A aplicação dos modelos considerou as características físicas, edafloclimáticas, o uso de solo e as práticas de manejo da sub-bacia. A precisão dos métodos foi verificada usando dados de sedimentos totais transportados e de descarga de água e realizou-se a análise de correlação entre os resultados, utilizando o coeficiente de correlação de Pearson, com 5% de significância. Na sub-bacia ocorreu predomínio de erosão em intensidade moderada com perda de solo média de 1,17 e 1,46 Mg ha-1 ano-1, mensuradas pelo EPM e RUSLE, respectivamente. O modelo EPM subestimou as perdas de solo em 15,27% e a RUSLE superestimou em 19,08%, apontando maior porcentagem de áreas com elevadas taxas erosivas (4,60%). Os modelos apresentaram resultados com ordem de grandeza distintas, porém com correlação significativa indicando que ambos os métodos apontam maiores e menores taxas erosivas, nas mesmas áreas da sub-bacia.

Abstract Water erosion is the principal degradation process of tropical soils, and its effects can be measured by modeling techniques. Erosion models provide a diagnosis of the soil loss intensity and can support the planning of soil conservation practices. Models with low data requirements, such as the Revised Universal Soil Loss Equation (RUSLE) and, more recently, the Erosion Potential Method (EPM), are mainly applied in Brazil. Thus, the objective of this work was to estimate water erosion soil-loss rates using the EPM and RUSLE models on a tropical subbasin, followed by a comparison of their outcomes. The models’ application considered soil physical parameters, edaphoclimatic conditions of the area, land use, and subbasin management practices. The accuracy of the methods was verified using total transported sediment and water discharge data. We compared the models using Pearson's correlation analyses, considering a 5% of significance. We found a predominance of moderate-intensity erosion with average soil loss of 1.17 and 1.46 Mg ha-1 year-1, measured by EPM and RUSLE, respectively. The EPM model underestimated soil losses by 15.27%, and RUSLE overestimated by 19.08%, indicating a higher percentage of areas with high erosion rates (4.60%). The models presented results with a different order of magnitude, but with significant correlations, indicating that both methods pointed out similar zones of intense and light-erosion rates.

Abstract Tuberculosis is one of the most common infections worldwide with particularly high incidence rates in countries with unfavorable socioeconomic conditions and among persons with impaired immune systems. While most patients with this disease will present with pulmonary tuberculosis, immunocompromised individuals also commonly present with extrapulmonary manifestations. We report the case of a 28-year-old male patient with end-stage renal disease who presented with long-standing systemic symptoms and genitourinary manifestations, who was diagnosed with urogenital tuberculosis both by clinical and microbiologic criteria. Clinicians should always suspect tuberculosis in patients with chronic symptoms, especially in those with immunosuppression.

RESUMO A erosão hídrica é um dos principais problemas enfrentados na cafeicultura, pois promove a degradação ambiental e a diminuição da produção agrícola. As estimativas da erosão auxiliam no planejamento de práticas e sistemas de manejo conservacionistas e permitem aferir as taxas de perdas do solo. Assim, o objetivo do trabalho foi estimar a perda de solo por erosão hídrica pelo Método de Erosão Potencial em uma sub-bacia hidrográfica com cultivo predominante de café e, então, comparar com os limites de Tolerância de Perda do Solo. A área de estudo correspondente a uma Sub-bacia Hidrográfica do Córrego Coroado, Município de Alfenas, sul de Minas Gerais, Brasil. O Método de Erosão Potencial apresentou o Coeficiente de Intensidade da Erosão de 0,272, indicando predomínio da erosão de fraca intensidade. A perda potencial total de solo foi de 1.772,01 Mg ano-1 com média estimada em 1,74 Mg ha-1 ano-1. Os limites de Tolerância de Perda do Solo variaram de 4,75 a 7,26 Mg ha-1 ano-1 e segundo o Método de Erosão Potencial apenas 1,0% da sub-bacia apresentou perdas acima do limite de tolerância. As maiores taxas de perdas de solo se encontram nas áreas com maiores declividades e presença de solo exposto e devem ser priorizadas na adoção de medidas mitigadoras. O Método de Erosão Potencial estimou as perdas de solo nas condições edafoclimáticas tropicais de forma rápida, eficiente e com baixo custo, subsidiando a adoção de práticas agronômicas conservacionistas.

ABSTRACT Water erosion is one of the main problems faced in coffee cultivation, as it promotes environmental degradation and crop yield decrease. Erosion estimates support the planning of conservation management practices and allowing determining the rates of soil losses. Thus, the objective of this paper was to estimate the soil loss by water erosion using the Erosion Potential Method in a sub-basin predominantly covered by coffee cultivation and then to compare the results with the Soil Loss Tolerance limits. The study area is the Coroado Stream Sub-basin, located at Alfenas Municipality, south of Minas Gerais, Brazil. The sub-basin presented an Erosion Coefficient of 0.272, indicating a predominance of low-intensity erosion. The total soil loss estimate was 1,772.01 Mg year-1 with an estimated average of 1.74 Mg ha-1 year-1. Soil Loss Tolerance limits range from 4.75 to 7.26 Mg ha-1 year-1 and, according to the Erosion Potential Method, only 1.0% of the sub-basin presented losses above the limits. The areas with the highest slopes and bare soil concentrated the highest losses rates and should be prioritized in the adoption of mitigation measures. The Erosion Potential Method estimated soil losses in tropical edaphoclimatic conditions in a fast, efficiently and at low cost, supporting the adoption of conservation management practices.