ABSTRACT BACKGROUND AND OBJECTIVES: The mechanisms underlying nociplastic pain, such as fibromyalgia (FM), are not fully understood, however, it is believed that altered sensory processing and pain modulation play prominent roles in the maintenance of nociplastic pain. The hypothesis is that changes in the primary somesthetic cortex (S1) contribute to the generalized pain character of FM. The objective of this study was to evaluate the involvement of the primary somesthetic cortex in humans with fibromyalgia, as well as to investigate possible associations between S1 changes and clinical signs and symptoms of FM. CONTENTS: For this integrative review, the following databases were used: Pubmed and Web of Science, including observational studies carried out in humans with FM. In total, 541 studies were identified and four were included. The majority of studies are case-control studies, published between 2016 and 2022. In total, data from 161 individuals were included in this review. It was identified that there are morphological changes, hyperactivation and increased functional connectivity between S1 and periaqueductal gray matter and between S1 and anterior cingulate cortex. CONCLUSION: Patients with FM present morphological changes and hyperactivation in S1, as well as increased functional connectivity between S1 and periaqueductal gray matter and S1 and limbic system. Furthermore, different bilateral somatotropic subregions (legs, chest, fingers, hands, face and back) showed reduced functional connectivity in patients with FM. These regions are often presented as “tender points” in FM.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os mecanismos subjacentes à dor nociplástica, como a fibromialgia (FM), não são totalmente compreendidos, contudo acredita-se que o processamento sensorial e a modulação da dor alterados desempenham papéis proeminentes para a manutenção da dor nociplástica. Com a hipótese de que alterações no córtex somestésico primário (S1) contribuam para o caráter de dor generalizada da FM, o objetivo deste estudo foi avaliar o envolvimento do córtex somestésico primário em humanos com FM, bem como investigar possíveis associações entre alterações de S1 com sinais e sintomas clínicos da FM. CONTEÚDO: Para esta revisão integrativa, foram utilizadas as seguintes bases de dados: Pubmed e Web of Science, incluindo estudos observacionais realizados em humanos com FM. No total, 541 estudos foram identificados e quatro foram incluídos. A maioria dos estudos são do tipo caso-controle, publicados entre 2016 e 2022. Ao todo, dados de 161 indivíduos foram incluídos. Foi identificado que há alterações morfológicas, hiperativação e aumento da conectividade funcional entre S1 e substância cinzenta periaquedutal e entre S1 e córtex cingulado anterior. CONCLUSÃO: Pacientes com FM apresentam alterações morfológicas e hiperativação em S1, bem como aumento da conectividade funcional entre S1 e substância cinzenta periaquedutal e S1 e sistema límbico. Ademais, diferentes sub-regiões somatotrópicas bilaterais (pernas, tórax, dedos, mãos, face e costas) apresentaram redução da conectividade funcional em pacientes com FM. Essas regiões são frequentemente apresentadas como “tender points” na FM.

ABSTRACT In semi-arid regions, where seasonal drought or irregular rainfall distribution are common occurrences, agricultural management techniques or strategies, such as the use of bone meal and/or hydrogel, can mitigate adverse conditions and ensure crop production. This study aimed to evaluate the efects of bone meal doses (0, 250, 500, 750 and 1,000 g pit−1), in association or not with hydrogel (0 and 5 g pit−1, respectively), on the leaf nutrient content of the dwarf cashew cultivar BRS 226. The leaf nutrient contents were evaluated during two growing seasons. For being a good source of macronutrients, the bone meal increased the levels of N, P, Ca, K and Mg in the dwarf cashew leaves. The leaf contents of the micronutrients Zn, Fe and Mn decreased with increasing bone meal doses. The nutrient accumulation in the leaves of the dwarf cashew planted in pits with bone meal and hydrogel has the following order: N > K > Ca > Mg > P > Mn > Fe > Zn > Cu. The application of bone meal at levels close to 600 g pit−1, mainly with the use of hydrogel, is a viable fertilizer alternative for dwarf cashew.

RESUMO Em regiões semiáridas, onde a seca sazonal ou a distribuição irregular de chuvas são ocorrências comuns, técnicas ou estratégias de manejo agrícola, como o uso de farinha de osso e/ou hidrogel, podem mitigar condições adversas e garantir a produção agrícola. Objetivou- se avaliar os efeitos de doses de farinha de osso (0, 250, 500, 750 e 1,000 g cova−1), em associação ou não com hidrogel (0 e 5 g cova−1, respectivamente), sobre o teor de nutrientes foliares da cultivar de cajueiro-anão BRS 226. Os teores de nutrientes nas folhas foram avaliados durante duas safras. Por ser boa fonte de macronutrientes, a farinha de osso aumentou os níveis de N, P, Ca, K e Mg nas folhas do cajueiro anão. Os teores foliares dos micronutrientes Zn, Fe e Mn diminuíram com o aumento das doses de farinha de osso. O acúmulo de nutrientes nas folhas do cajueiro anão plantado em covas com farinha de osso e hidrogel tem a seguinte ordem: N > K > Ca > Mg > P > Mn > Fe > Zn > Cu. A aplicação de farinha de osso em níveis próximos a 600 g cova−1, principalmente com o uso de hidrogel, é uma alternativa viável de fertilizante para cajueiro-anão.

ABSTRACT Luis Tavares revolutionized cardiac surgery, always bringing the most modern instruments and equipment from his travels to England - surgical forceps, scissors, scalpels, etc. He always insisted that he was not just a thoracic surgeon, for his work extended over a wide field and created three important cardiac surgery centers which promoted a great development of cardiology. He carried out the first open heart surgery (atrial septal defect) employing extracorporeal circulation and closure of a ventricular septal defect with deep surface hypothermia of north and northeast Brazil. He promoted an intense scientific exchange program between Recife and England, resulting in significant advances in medicine, and participated directly in the creation of HEMOPE), leading to radical changes and improvements in blood therapy in the whole country. The PROCAPE, inaugurated in 2006, was the result of the cardiac center created by him in early 1970 at Hospital Oswaldo Cruz and can be considered the second largest public-university cardiology center in Brazil. He is thus widely regarded as an outstanding name in medicine in the 20th century and one of the fathers of modern cardiac surgery in Brazil.

Abstract Background: respiratory insufficiency is a syndrome with a great impact on hospital admissions, morbidity and mortality. The applicability of High-flow nasal oxygen has been the subject of interest in critically ill patients. Objective: to know the effectiveness of High-flow nasal oxygen as a treatment for respiratory insufficiency in adult patients admitted to the intensive care units. Methods: systematic reviews of effectiveness using the PICO strategy and recommendations from the Joanna Briggs Institute. The survey was carried out in august 2021 using the PubMed and EBSCOhost access platforms. Results: 583 results were identified. Six randomized clinical trials were analyzed. The selection was made after elimination of duplicates; title reading, abstract reading and full text reading according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram. Conclusion: high-flow nasal oxygen proved to be comfortable, tolerable and effective in the treatment of hypoxemic and hypercapnic respiratory insufficiency. It was effective when compared with conventional oxygen therapy in the post-extubation of hypoxemic patients and in reducing partial pressure of carbon dioxide when compared with Non-Invasive Ventilation in hypercapnic patients.

Resumen Marco contextual: la insuficiencia respiratoria es un síndrome que tiene un gran impacto en los ingresos hospitalarios, la morbilidad y mortalidad. La aplicabilidad del oxígeno nasal de alto flujo ha sido objeto de interés en pacientes críticos. Objetivo: conocer la efectividad del oxígeno nasal de alto flujo en el tratamiento de la insuficiencia respiratoria en adultos en unidades de cuidados intensivos. Métodos: revision sistemática de efectividad utilizando la estrategia PICO y recomendaciones del Instituto Joanna Briggs. La búsqueda se llevó a cabo en agosto de 2021 utilizando las plataformas de acceso PubMed y EBSCOhost. Resultados: se identificaron 583 resultados. Se analizaron seis ensayos clínicos aleatorios. La selección se realizó después de la eliminación de duplicados; lectura de títulos, de resúmenes y de texto completo siguiendo el diagrama Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Conclusión: el Oxígeno nasal de alto flujo demostró ser cómodo, tolerable y eficaz en el tratamiento de la insuficiencia respiratoria hipoxémica e hipercápnica. Fue eficaz en comparación con la oxigenoterapia convencional en la postextubación de pacientes hipoxémicos y en la reducción de la presión parcial de dióxido de carbono en comparación con la Ventilación No Invasiva en pacientes hipercápnicos.

Resumo Enquadramento: a insuficiência respiratória é uma síndrome com grande impacto nos internamentos, na morbilidade e mortalidade. A aplicabilidade do oxigénio nasal de alto fluxo tem sido alvo de interesse no doente crítico. Objetivo: conhecer a efetividade do oxigénio nasal de alto fluxo no tratamento da insuficiência respiratória no adulto em unidades de cuidados intensivos. Métodos: revisão sistemática de efetividade que utiliza a estratégia PICO e recomendações do Joanna Briggs Institute. A pesquisa foi realizada em agosto de 2021 com recurso às plataformas de acesso PubMed e EBSCOhost. Resultados: identificaram-se 583 resultados. Foram analisados seis ensaios clínicos randomizados. A seleção foi feita após eliminação de duplicados; leitura do título, resumos e textos integrais de acordo com o diagrama Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Conclusão: o oxigénio nasal de alto fluxo revelou-se confortável, tolerável e eficaz no tratamento da insuficiência respiratória hipoxémica e hipercápnica. Foi eficaz quando comparado com oxigenoterapia convencional na pós-extubação de doentes hipoxémicos e na redução da pressão parcial de dióxido de carbono quando comparado com a Ventilação Não Invasiva nos doentes hipercápnicos.

ABSTRACT Introduction: Medical students are vulnerable to psychological distress and face a number of stressors such as academic pressures, economic concerns, and difficulties in interpersonal relationships. The quality of their educational training may also impact their mental health and subjective well-being. Objective: to describe their perception of subjective well-being and the impact of medical training on their own mental health. Methods: We surveyed 119 medical students and administered the “Perception survey on vocation, living and recreational habits, training and professional attitudes,” the CAGE questionnaire, the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-2 (PHQ-2). Results: Students’ mean age was 22.5±2.28 years old and 59.7 % of participants were women, their lifestyle habits were scored as acceptable, and the employment of cell-phones and social networks ranged 76-99%; 24.1 % recognized a problematic alcohol, 67.2 % reported anxiety according to the GAD-7, and 49.6 % depression according to PHQ-2. Symptoms of anxiety were frequent among females and were higher when the perceived quality of training and student/teacher ratio were lower. Discussion: Students’ perceptions of lower quality of training and resources seemed to be associated with higher levels of anxiety, which may suggest that educational policies and resources should be carefully revised and implemented to improve students’ health and well-being.

RESUMEN Introducción: los estudiantes de medicina son vulnerables al malestar psicológico y se enfrentan a una serie de factores estresantes como las presiones académicas, las preocupaciones económicas y las dificultades en las relaciones interpersonales. La calidad de su formación educativa también puede influir en su salud mental y bienestar subjetivo. Objetivo: describir su percepción de bienestar subjetivo y el impacto de la formación médica en su propia salud mental. Metodología: se encuestó a 119 estudiantes de medicina y se les administró la "Encuesta de percepción sobre vocación, hábitos de vida y recreación, formación y actitudes profesionales", el cuestionario CAGE, el Trastorno de Ansiedad Generalizada-7 (TAG-7) y el Cuestionario de Salud del Paciente-2 (PHQ-2). Resultados: la edad media de los estudiantes fue de 22,5±2,28 años y el 59,7 % de los participantes eran mujeres; sus hábitos de vida se calificaron como aceptables, y el empleo de teléfonos móviles y redes sociales osciló entre el 76 y el 99 %; el 24,1 % reconoció un consumo problemático de alcohol, el 67,2 % manifestó ansiedad según el TAG-7, y el 49,6 % depresión según el PHQ-2. Los síntomas de ansiedad eran frecuentes entre las mujeres y eran mayores cuando la calidad percibida de la formación y la proporción alumnos/profesor eran menores. Discusión: la percepción por parte de los estudiantes de una menor calidad de la formación y de los recursos parecía estar asociada a mayores niveles de ansiedad, lo que puede sugerir que las políticas y los recursos educativos deberían revisarse y aplicarse cuidadosamente para mejorar la salud y el bienestar de los estudiantes.

Pectis brevipedunculata is native species and widely available in dry and semi-arid ecosystems showing high biotechnological potential. The objective of this study was to evaluate the circadian and seasonal chemical variation of the essential oil (EO) of P. brevipedunculata, as well as its acaricide effect on Rhipicephalus microplus larvae. Aerial parts were collected and submitted to the hydrodistillation process, and the chemical composition was determined by gas chromatography mass spectrometry (GC-MS). For the assays with R. microplus, the larval immersion test was performed. The main constituents were citral (75% of the EO), followed by α-pinene and limonene. In the seasonality analysis, the highest yields were in the months of April (2.08%) and August (2.05%), while in the study of circadian rhythm, the percentage was 2.0% at 6 p.m. in the rainy season, and 1.2%, dry season at 6 p.m. Concerning acaricidal activity (50% lethal concentration (LC50)), the April (1.17 mg mL-1), March (1.28 mg mL-1), June (1.37 mg mL-1), and October (1.27 mg mL-1) oils obtained were the most active and assays performed with circadian rhythm revealed in the rain season (April) at 6 p.m. and dry season (September) at 12 a.m. LC50 values of 1.75 and 1.75 mg mL-1, respectively. Additionally, this EO is selective to non-target organisms, i.e., ladybeetles and lacewing.

SUMMARY: The COVID-19 pandemic caused several changes in the teaching of human anatomy, among them the use of different teaching methodologies based on E-learning. However, studies evaluating electronic tools have not provided clear evidence of effective student learning. Thus, this was the first study to evaluate medical students after completing human anatomy courses in the E- learning modality. We recruited first term (Group A, n=25) and second term (Group B, n=13) medical students. We applied a practical assessment based on 50 human anatomy markingson real anatomical specimens and cadavers, to be completed in Questionnaire 01 (Phase I). After detecting low scores on Questionnaire 01 by both groups, we applied a practical and face-to-face tutoring system for 14 days (Phase II). Afterwards, we re-evaluated both groups by repeating the same scores (Questionnaire 02, Phase III). According to the paired analysis of questionnaires 01 and 02 by Student's T-test, both groups showed significant increase in the final scores obtained in questionnaire 02 (Phase III). The evidence showed that the remote format lecture system weakened the learning and retention process of basic anatomical knowledge by medical students. On the other hand, in-person practical teaching proved to be efficient in the formative process of the students, a fact proven by the significant increase in the scores of the students in the 02 questionnaire, for both groups.

RESUMEN: La pandemia por COVID-19 provocó varios cambios en la enseñanza de la anatomía humana, entre ellos el uso de diferentes metodologías de enseñanza basadas en E-learning. Sin embargo, los estudios que evalúan las herramientas electrónicas no han proporcionado evidencia clara de un aprendizaje efectivo de los estudiantes. Este fue el primer estudio que evaluó a estudiantes de medicina luego de cursar cursos de anatomía humana en la modalidad E-learning. Reclutamos estudiantes de medicina de primer término (Grupo A, n=25) y segundo término (Grupo B, n=13). Se aplicó una evaluación práctica basada en 50 marcas de anatomía humana sobre especímenes anatómicos reales y cadáveres, para ser completado en el Cuestionario 01 (Fase I). Tras detectar puntuaciones bajas en el Cuestionario 01 por parte de ambos grupos, se aplicó un sistema de tutorías prácticas y presenciales durante 14 días (Fase II). Posteriormente, reevaluamos ambos grupos repitiendo las mismas puntuaciones (Cuestionario 02, Fase III). Según el análisis apareado de los cuestionarios 01 y 02 por la prueba T de Student, ambos grupos mostraron aumento significativo en los puntajes finales obtenidos en el cuestionario 02 (Fase III). La evidencia mostró que el sistema de conferencias en formato remoto debilitó el proceso de aprendizaje y retención de conocimientos anatómicos básicos por parte de los estudiantes de medicina. Por otro lado, la docencia práctica presencial demostró ser eficiente en el proceso formativo de los alumnos, hecho que demuestra el aumento significativo de las puntuaciones de los alumnos en el cuestionario 02, para ambos grupos.

Abstract Background: prone Position is a well-established evidence-based clinical practice in patients with Acute Respiratory Distress Syndrome undergoing invasive mechanical ventilation. Little evidence in non-intubated patients is known. Due to the increasing rate of acute respiratory distress syndrome, the need to know the effectiveness in non-intubated patients has emerged. Objective: to know the effectiveness of prone position in the treatment of acute respiratory distress syndrome in non-intubated adults. Methodology: Systematic reviews based on the manual of Joanna Briggs Institute and carried out using PICO strategy. Research conducted in August 2021 in the access platforms Web of Science, PubMed, and EBSCO Host. Selection was done after elimination of duplicates, title reading, reading of abstracts, and full texts according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram. Results: 741 results were identified, and seven were included in the review. Conclusion: Early prone position is advantageous in non-intubated patients with mild and moderate acute respiratory distress syndrome. A risk intervention in non-intubated patients with Severe Acute Respiratory Distress Syndrome. Mortality/survival, physiological/clinical, adverse events/effects and functioning outcomes were identified as predictors of success/failure of prone position.

Resumo Enquadramento: o decúbito ventral é uma prática clínica baseada na evidência que se encontra bem estabelecida em pacientes com Acute Respiratory Distress Syndrome submetidos a ventilação mecânica invasiva. Porém, existe parca evidência em pacientes não intubados. Face ao aumento da taxa de Acute Respiratory Distress Syndrome, emergiu a necessidade de conhecer a sua eficácia em pacientes não intubados. Objetivo: conhecer a efetividade do decúbito ventral no tratamento da Acute Respiratory Distress Syndrome em adultos não intubados. Metodologia: revisão sistemática fundamentada no manual de Joanna Briggs Institute, com recurso à estratégia PICO. Pesquisa realizada em agosto de 2021, nas plataformas de acesso Web of Science, PubMed e EBSCO Host. Seleção realizada após eliminação de duplicados, leitura do título, de resumos e textos integrais de acordo com o diagrama Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Resultados: identificaram-se 741 resultados, sendo sete os incluídos na revisão. Conclusão: O decúbito ventral precoce revelou-se vantajoso em pacientes não intubados com Acute Respiratory Distress Syndrome ligeira e moderada. É uma intervenção de risco em pacientes não intubados com Acute Respiratory Distress Syndrome grave. Foram identificados indicadores de mortalidade/ sobrevida, fisiológicos/ clínicos, de eventos/ efeitos adversos e indicadores funcionais como preditores de sucesso/ insucesso do decúbito ventral.

Resumen Marco contextual: posición prona es una práctica clínica, basada en evidencia, conocida en pacientes con Síndrome de Dificultad Respiratoria Aguda con ventilación mecánica invasiva. Hay poca evidencia en pacientes no entubados. La creciente tasa de síndrome de distrés respiratorio agudo originó la necesidad de desarrollar esfuerzos para conocer su efectividad en pacientes no intubados. Objetivo: conocer la efectividad del decúbito prono en el tratamiento del síndrome de distrés respiratorio agudo en adultos no intubados. Metodología: revisión sistemática basadas en el manual del Instituto Joanna Briggs y mediante la estrategia PICO. La búsqueda ocurrió en agosto 2021 en las plataformas de acceso Web of Science, PubMed y EBSCO Host. Selección realizada por previa eliminación de duplicados, lectura de títulos, resúmenes y textos completos de acuerdo con el diagrama Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Resultados: se identificaron 741 resultados, siete incluyeron la revisión. Conclusión: la posición prona temprana demostró ser ventajosa en pacientes no intubados con Síndrome de Dificultad Respiratoria Aguda leve y moderado. Intervención riesgosa en pacientes no intubados con Síndrome de Dificultad Respiratoria Aguda grave. Indicadores de mortalidad/supervivencia, fisiológicos/clínicos, de eventos/efectos adversos e indicadores funcionales, fueron identificados como predictores de éxito/fracaso de la posición prono.

ABSTRACT Introduction: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown positive renal outcomes in diabetic patients. There is also emerging evidence in non-diabetic patients. This review was conducted to analyse the renal outcomes of SGLT2i in patients without diabetes mellitus (DM). Methods: A systematic review was performed in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) compliant manner. We included only randomized trials that examined the effect of SGLT2i on renal outcomes in non-diabetic patients. Results: A total of ten randomized trials were included with a combined cohort of 26 298 patients. There was a tendency for lesser risk of adverse renal outcomes in heart failure (HF) patients with reduced ejection fraction (EF) (hazard ratio (HR) 0.50-0.71). Lesser effect on adverse renal outcomes was seen in HF patients with preserved EF (HR 0.95). For both preserved and reduced EF HF, there was a statistically significant reduction in the rate of decline in estimated glomerular filtration rate (eGFR) (p<0.001). On a short follow-up, there was a significant reversible reduction in GFR. In the long term, chronic kidney disease (CKD) proteinuric patients had a statistically significant lesser risk of adverse renal outcomes (p<0.001) and a significant reduction in albuminuria (p=0.0016). CKD patients, including non-proteinuric, had a significant reduction in the rate of kidney disease progression (HR = 0.71). Conclusion: Treatment with SGLT2i significantly reduces the rate of kidney disease progression in CKD non-diabetic patients with eGFR ≥ 20 mL/min/1.73 m2. Benefit seems greater in proteinuric patients. Benefit for eGFR < 20 mL/min/1.73 m2, dialysis and kidney transplant patients is yet to be defined.

ABSTRACT Rituximab, a monoclonal antibody with the ability to bind itself to CD20, leads to a rapid depletion of B-cells (in around 24-72 hours), limiting antibody formation. The marker CD20 does not exist in any other cell type, which makes the action of rituximab specific. This antibody has been used in autoimmune entities such as rheumatoid arthritis and in hematological malignancies, but recently it has gained popularity as an important immunosuppressor in selected kidney diseases. In nephrology, this anti-CD20 antibody had its first indication in anti-neutrophil cytoplasmic antibody-associated vasculitis, but can now be used in primary membranous nephropathy, minimal change disease, lupus nephritis and others. There is also some data that indicates rituximab might have a promising role in other glomerular diseases in the future, but to date evidence is still lacking to recommend its widespread use. The aim of this document is to compile the most recent scientific evidence as to when rituximab should be used in the treatment of various glomerular diseases, and which other may come to benefit from it in the future.

ABSTRACT Background: Observational studies have described a high prevalence of depression and anxiety in rheumatoid arthritis: major depressive disorders are detected in 17 % of patients with the pathology, and local and systemic inflammation play an important role in anxiety and depression. Objectives: The overall objective of this research was to determine the frequency of anxiety, depression, and vulnerability to stress in patients diagnosed with rheumatoid arthritis. Materials and methods: This was an observational, descriptive, temporally prospective, cross-association study. Sampling was non-probabilistic of consecutive cases. We included adults with a diagnosis of rheumatoid arthritis who consulted at the Rheumatology Department of the Hospital de Clínicas between August and October 2022. The following instruments were used for psychiatric diagnosis: Generalized Anxiety Scale (GAD-7), Patient Health Questionnaire (PHQ-2) and Smith and Miller's Stress Vulnerability Scale. Results: Thirty-six patients, all women, aged between 20 and 77 years, were included in the study. The 27.8 % had depression, according to the cut-off points of the PHQ-2. Anxiety was present in 22.2 %, according to the GAD-7 cut-off points. Regarding stress, 22.2 % were vulnerable to stress and 5.6 % were seriously vulnerable. Conclusion: Depression, anxiety and vulnerability to stress are frequently observed comorbidities in patients with rheumatoid arthritis. Specific mental health interventions are required to address these issues and improve the quality of life of affected patients.

RESUMEN Antecedentes: Estudios observacionales han descrito una alta prevalencia de depresión y ansiedad en la artritis reumatoidea: los trastornos depresivos mayores se detectan en el 17 % de los pacientes con la patología, y la inflamación local y sistémica desempeña un papel importante en la ansiedad y la depresión. Objetivos: El objetivo general de esta investigación fue determinar la frecuencia de ansiedad, depresión y vulnerabilidad al estrés en pacientes con diagnóstico de artritis reumatoidea. Materiales y métodos: Este fue un estudio observacional, descriptivo de asociación cruzada y temporalmente prospectivo. El muestreo fue no probabilístico de casos consecutivos. Se incluyó a personas adultas con diagnóstico de artritis reumatoide que consultaron en el Departamento de Reumatología del Hospital de Clínicas, entre agosto y octubre del 2022. Para el diagnóstico psiquiátrico se utilizaron los siguientes instrumentos: Escala de Ansiedad Generalizada (GAD-7), Patient Health Questionnaire (PHQ-2) y Escala de Vulnerabilidad al Estrés de Smith y Miller. Resultados: Se incluyó a 36 pacientes, todas mujeres, con edades comprendidas entre los 20 y 77 años. El 27,8 % tenía depresión, según los puntos de corte del PHQ-2. El 22,2 % presentaba ansiedad, según los puntos de corte de GAD-7. En cuanto al estrés, el 22,2 % tenía vulnerabilidad a este y el 5,6 % era seriamente vulnerable. Conclusión: Depresión, ansiedad y vulnerabilidad al estrés son comorbilidades frecuentemente observadas en pacientes con artritis reumatoidea. Se requieren de intervenciones específicas de salud mental para abordar estas cuestiones y mejorar la calidad de vida de los pacientes afectados.

ABSTRACT INTRODUCTION: Menus are tools to promote food education, essential to meet nutritional needs. Popular Restaurants, in turn, are mechanisms for promoting the Human Right to Adequate Food, mainly, for socially vulnerable populations. OBJECTIVES: Evaluate the menu composition of 2 (two) popular restaurants in a city in the interior of São Paulo, Brazil, using the Qualitative Assessment of Menu Preparations method. METHODOLOGY: The Qualitative Assessment of Menu Preparations method was used to evaluate the 24-day menu between the end of August and September 2022. The aspects evaluated were color monotony (three or more foods of the same color), presence of leafy vegetables (one or more raw leafy vegetables) and fruits (one or more), types of meat (fatty meat), sulfur content (two or more foods), presence of fried foods, candies and simultaneous association of fried foods with candies. The relative frequency of each Qualitative Assessment of Menu Preparations method criterion was calculated, classifying the “negative aspects” (equal colors, preparations rich in sulfur, fatty meats, candies, fried foods and the combination of candies and fried foods) as “great” (<25.0% ), “good” (11.0 to 25.0%), “regular” (26.0 to 50.0%), “poor” (51.0 to 75.0%) or “terrible” (>75.0%) and the “positive aspects” (offering fruits and leafy vegetables) as “excellent” (≥90.0%), “good” (75.0 to 89.0%), “regular” (50.0 to 74.0%), “poor” (25.0 to 49.0%) or “terrible” (<25.0%). RESULTS: There was a 70.0% occurrence of color monotony on the menu. Leafy and fruit offerings occurred on 66.0% and 58.0% of the days, respectively. The presence of fatty meats occurred on 16.0% of the days, as well as preparations rich in sulfur. The presence of candies was verified in 41.7% of the days. The menu did not show the occurrence of fried foods and, consequently, there was no association of fried foods with candies (0.0%). CONCLUSIONS: The menu needs adjustments, mainly in the monotony of colors, but it has a great potential for offering nutrients, considering the occurrence of fruits and leafy vegetables and the absence of fried foods and associated fried foods and candies.

RESUMO INTRODUÇÃO: Os menus são ferramentas de promoção de educação alimentar, fundamentais para suprir as necessidades nutricionais dos indivíduos. Os Restaurantes Populares, por sua vez, são estabelecimentos de promoção do Direito Humano à Alimentação Adequada, principalmente, para populações socialmente vulneráveis. OBJETIVOS: Avaliar a composição do menu de 2 (dois) Restaurantes Populares de um município do interior de São Paulo, Brasil, pelo método de Avaliação Qualitativa das Preparações do Cardápio. METODOLOGIA: Utilizou-se o método de Avaliação Qualitativa das Preparações do Cardápio para avaliação do menu de 24 dias decorridos entre final de agosto e setembro de 2022. Analisou-se monotonia de cores (três ou mais alimentos de cores iguais), presença de vegetais folhosos crus (um ou mais) e frutas (uma ou mais), tipos de carnes (carnes gordurosas), teor de enxofre (dois ou mais alimentos), presença de frituras, de doces e associação simultânea de frituras com doces. Calculou-se a frequência relativa de cada critério do método de Avaliação Qualitativa das Preparações do Cardápio, classificando os “aspetos negativos” (cores iguais, preparações ricas em enxofre, carnes gordurosas, doce, fritura e concomitância de doce e fritura) como “ótimo” (<25,0%), “bom” (11,0 a 25,0%), “regular” (26,0 a 50,0%), “ruim” (51,0 a 75,0%) ou “péssimo” (>75,0%) e os “aspetos positivos” (oferta de frutas e folhosos) como “ótimo” (≥90,0%), “bom” (75,0 a 89,0%), “regular” (50,0 a 74,0%), “ruim” (25,0 a 49,0%) ou “péssimo” (<25,0%). RESULTADOS: Verificou-se 70,0% de ocorrência de monotonia de cores. A oferta de folhosos e frutas ocorreu em 66,0% e 58,0% dos dias, respetivamente. A presença de carnes gordurosas ocorreu em 16,0% dos dias, assim como a de preparações ricas em enxofres. A presença de doces foi verificada em 41,7% dos dias. O menu não apresentou ocorrência de frituras e, consequentemente, apresentou ausência de associação de frituras com doces (0,0%). CONCLUSÕES: O menu apresenta necessidade de ajustes, principalmente, no critério monotonia de cores, porém nota-se grande potencial de oferta de nutrientes, diante da ocorrência “regular” de frutas e folhosos e ausência de frituras e de frituras associadas com doces.

Abstract Objective: To evaluate the positive predictive value (PPV) of amorphous calcifications and to analyze the imaging variables that could alter the risk of malignancy associated with this finding. Materials and Methods: This was a retrospective study of 138 stereotactically guided percutaneous vacuum-assisted biopsies of amorphous calcifications, performed between January 2012 and December 2017. All of the patients included were referred for radiological follow-up for a minimum of one year (if the histopathology showed a benign lesion) or for surgical treatment (if the histopathology showed malignancy or a lesion of uncertain malignant potential). Results: We found that the PPV of amorphous calcifications was 9.42%. However, most of the malignant amorphous calcifications were in cases of invasive carcinoma or high-grade ductal carcinoma in situ, indicating clinically relevant disease. The relative risk of malignancy associated with amorphous calcifications was 6.15 times higher in patients with a family or personal history of breast or ovarian cancer. Neither being postmenopausal nor having dense breasts was found to be predictive of malignancy in patients with amorphous calcifications. Conclusion: Amorphous calcifications in the breast had a PPV for malignancy of 9.42%, indicating the possibility of placing the finding in subcategory 4a, which requires histopathological analysis. Our finding that the risk of malignancy associated with this subtype of calcifications is up to 6.15 times higher in patients with a family or personal history of breast cancer warrants greater concern regarding the clinical, radiologic, and histopathologic correlations after biopsy.

Resumo Objetivo: Avaliar o valor preditivo positivo (VPP) das calcificações amorfas e possíveis variáveis clínicas e de imagem que possam influenciar no risco de malignidade deste achado de imagem. Materiais e Métodos: Foram revisados, retrospectivamente, 138 resultados de biópsias percutâneas estereotáxicas a vácuo de calcificações amorfas, entre janeiro de 2012 e dezembro de 2017. Todas as pacientes incluídas apresentavam seguimento radiológico mínimo de um ano (histopatológico benigno) ou tratamento cirúrgico (histopatológico maligno). Resultados: O VPP das calcificações amorfas foi de 9,42%. As lesões malignas corresponderam predominantemente a carcinomas invasivos, indicando doença clinicamente relevante. O risco relativo de malignidade das calcificações amorfas foi 6,15 vezes maior em pacientes com história familiar ou pessoal de neoplasia de mama ou ovário. Status pós-menopausa e mamas densas não foram preditores de malignidade nessas pacientes. Conclusão: As calcificações amorfas na mama apresentaram VPP de malignidade de 9,42%, sugerindo possibilidade de classificação do achado na subcategoria 4a, com necessidade de investigação histopatológica. Em pacientes com história familiar ou pessoal de câncer de mama, o risco de malignidade deste subtipo de calcificações pode ser até 6,15 vezes maior, justificando maior preocupação na correlação clínica, radiológica e histopatológica após biópsia.

RESUMO Considerando a relevância do cajueiro e a limitação imposta pelo estresse salino em regiões semiáridas, o uso de alternativas capazes de mitigar os efeitos deletérios em decorrência da salinidade são de grande importância ao setor produtivo. O uso de plantas enxertadas, principalmente com porta-enxertos de materiais tolerantes, influencia no acúmulo de íons tóxicos nas folhas das mudas enxertadas. Assim, o objetivo deste trabalho foi avaliar características morfofisiológicas e concentração foliar de Na+, K+, Ca+2 de combinações de copa e porta-enxerto de cajueiro anão precoce, contrastantes à salinidade. O experimento foi realizado em delineamento inteiramente casualizado, com cinco repetições, tendo os tratamentos dispostos em arranjo fatorial de 4 × 3, correspondentes a quatro combinações de mudas enxertadas (auto-enxerto CCP 09/CCP 09, CCP 09/CCP 76, auto-enxerto CCP 76/CCP 76 e CCP 76/CCP 09) e a três concentrações de NaCl (0-controle, 50 e 100 mM L-1). Foram avaliados altura, número de folhas, área foliar, massa seca, índice de tolerância e concentração foliar de Na+, K+ e Ca+2 após 30 dias da aplicação das concentrações de NaCl. A combinação copa/porta-enxerto CCP 76/09 apresentou tolerância à salinidade de 50 mM L-1, devido ao aumento da área foliar e número de folhas. A combinação copa/porta-enxerto CCP 76/09 foi mais adequada, pois manteve a concentração foliar de K+ e o menor concentração de Na+.

ABSTRACT Considering the cashew tree’s relevance and the limitations imposed by salinity stress in semi-arid regions, the use of alternatives capable of mitigating the harmful effects due to salinity is of great importance to the production sector. The use of grafted plants, especially with rootstock made of tolerant materials, influences the accumulation of toxic ions in leaves of grafted seedlings. Thus, the objective of this work was to evaluate morphophysiological characteristics and leaf concentrations of Na+, K+ and Ca+2 of combinations of scion and rootstock of early dwarf cashew, contrasting in terms of salinity tolerance. The experiment was carried out in a completely randomized design with five replicates, in a 4 × 3 factorial arrangement, corresponding to four dwarf cashew scion/rootstock combinations (self-graft CCP 09, CCP 09/CCP 76, self-graft CCP 76, and CCP 76/CCP 09) and three NaCl concentrations (0, 50, and 100 mM L-1). Height, number of leaves, leaf area, dry matter, tolerance index and leaf concentrations of Na+, K+ and Ca+2 were evaluated after 30 days of application of NaCl concentrations. The scion/rootstock combination CCP 76/09 showed tolerance to 50 mM L-1, due to the increase of leaf area and number of leaves. The scion/rootstock combination CCP 76/09 was more suitable, as it kept the leaf K+ concentration and had the lowest Na+ concentration.