ABSTRACT: To improve the nutritional and functional quality of agro-industrial waste, his study established a ternary mixture of flours made from pineapple, acerola, and passion fruit waste using the simplex-centroid design, as well as to evaluate their effects on the physicochemical and sensory characteristics of edible ice cream. Using mixture planning, nine ternary flour components were applied to edible ice cream formulations to evaluate acceptance scores for taste, texture, and overall impression attributes, as well as physicochemical parameters (pH, acidity, soluble solids, and color parameters) and microbiological parameters (thermotolerant coliforms at 45 ºC, Enterobacteriaceae and Salmonella). The simplex-centroid design demonstrated that the cubic model best predicts the results for the analyzed sensory attributes. The response surface graphs indicated the area of greatest acceptance in the formulations with the maximum percentage established for the flour with acerola waste. The highest level of acceptability was given to the ternary mixture of 60%, 30%, and 10% pineapple, passion fruit, and acerola flours, respectively. The results indicated that sorbet enriched with flour composed of the ternary mixture is a product with the potential for exploitation, as well as contributing to the reduction of environmental impacts generated by the large and improper disposal of agro-industrial fruit processing residues in the ecosystem. ABSTRACT agroindustrial agro industrial pineapple simplexcentroid simplex centroid planning taste texture attributes pH, pH (pH acidity solids thermotolerant 4 ºC Salmonella. Salmonella . Salmonella) 60 60% 30 30% 10 respectively exploitation ecosystem 6 3 1

RESUMO: Visando a qualidade nutricional e funcional dos resíduos agroindustriais, o estudo teve como objetivo estabelecer a mistura ternária de farinhas elaboradas com resíduos de abacaxi, acerola e maracujá utilizando o delineamento simplex-centroide, assim como avaliar seus efeitos nas características físico-químicas e sensoriais em gelados comestíveis. Com o planejamento de misturas, nove componentes ternários das farinhas foram aplicados em formulações de gelados comestíveis para avaliação dos escores de aceitação para os atributos sabor, textura e impressão global, bem como os parâmetros físico-químicos (pH, acidez, sólidos solúveis e parâmetros de cor) e microbiológicos (coliformes termotolerantes a 45 ºC, Enterobacteriaceae e Salmonella). O delineamento simplex-centroide demonstrou que o modelo cúbico melhor prediz os resultados para os atributos sensoriais analisados. Os gráficos de superfície de resposta indicaram a área de maior aceitação nas formulações com o máximo percentual estabelecido para a farinha com os resíduos de acerola. O maior índice de aceitabilidade foi atribuído a mistura ternária constituída com 60%, 30% e 10% para as farinhas de abacaxi, maracujá e acerola, respectivamente. Os resultados indicaram que o sorbet enriquecido com a farinha composta pela mistura ternária é um produto com potencial para exploração, além de contribuir para a redução dos impactos ambientais gerados pelo grande e inadequado descarte de resíduos do processamento agroindustrial de frutas no ecossistema. RESUMO agroindustriais abacaxi simplexcentroide, simplexcentroide simplex centroide, centroide físicoquímicas físico químicas misturas sabor global físicoquímicos químicos pH, pH (pH acidez cor coliformes 4 ºC Salmonella. Salmonella . Salmonella) analisados 60 60% 30 10 respectivamente exploração ecossistema 6 3 1

Resumo A doença renal do diabetes (DRD) permanece como a principal causa de doença renal crônica (DRC) mundialmente. A patogênese da DRD é influenciada por mecanismos funcionais, histopatológicos e imunológicos, incluindo a atividade do inflamassoma NLRP3 e estresse oxidativo. Os inibidores do cotransportador de sódio-glicose 2 (iSGLT2) demonstraram benefícios metabólicos e a capacidade de retardar a progressão da DRD em diversos estudos clínicos ao longo dos anos. Estudos recentes sugerem que a atividade antidiabética também se estende à inibição da resposta inflamatória, incluindo modulação do inflamassoma NLRP3, redução de marcadores pró-inflamatórios e redução do estresse oxidativo. Aqui, avaliamos a eficácia dos iSGLT2 no tratamento da DRC e discutimos o papel da resposta inflamatória no desenvolvimento da DRD, incluindo sua relação com o inflamassoma NLRP3 e o estresse oxidativo. (DRD (DRC mundialmente funcionais imunológicos NLRP oxidativo sódioglicose sódio glicose iSGLT (iSGLT2 anos próinflamatórios pró inflamatórios Aqui (iSGLT

Abstract Diabetic kidney disease (DKD) remains the leading cause of chronic kidney disease (CKD) worldwide. The pathogenesis of DKD is influenced by functional, histopathological, and immune mechanisms, including NLRP3 inflammasome activity and oxidative stress. The sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown metabolic benefits and the ability to slow the progression of DKD in several clinical studies over the years. Recent studies suggest that the antidiabetic activity also extends to inhibition of the inflammatory response, including modulation of the NLRP3 inflammasome, reduction of pro-inflammatory markers and reduction of oxidative stress. Here we review the efficacy of SGLT2i in the treatment of CKD and discuss the role of the inflammatory response in the development of DKD, including its relationship to the NLRP3 inflammasome and oxidative stress. (DKD (CKD worldwide functional histopathological mechanisms NLRP stress sodiumglucose sodium glucose SGLTi SGLT i (SGLT2i years proinflammatory pro

Abstract Introduction: Iron (Fe) and manganese (Mn) are bioessential micronutrients for plants but can impair the energetic metabolism when present at high levels. Objective: To assess the photosynthetic performance and oxidative damages in Rhizophora mangle L. leaf tissues at low and high concentrations of Fe (74 and 195 mg kg-1; Feleaf) and Mn (65 and 414 mg kg-1; Mnleaf). Methods: Photosynthetic pigments, chlorophyll a fluorescence, leaf CO2 assimilation and gas exchange and DPPH• radical scavenging capacity were sampled in R. mangle growing in estuarine forests in the North region of Espírito Santo State and the extreme South of Bahia State (Brazil) showing low and high Feleaf and Mnleaf. Results: Effects of high Fe and Mn were not identified on pigment levels. The increase in Feleaf and Mnleaf at the levels observed in this assessment had a positive effect on the number of reaction centers and on the efficiency of the oxygen-evolving complex, evaluated as K-band, while no changes were found in the parameters related to the excitation trapping efficiency at the active center of photosystem II. Distinct interference patterns of Fe and Mn on the functional processes of photosynthesis were identified, especially on CO2 assimilation and reactive oxygen species metabolism, with major effects on CO2 assimilation and carboxylation efficiency of Rubisco at high Mnleaf. Conclusion: These findings demonstrate the efficiency of R. mangle in positively regulating the electron transport chain in response to high Fe and Mn, at least in terms of the preservation of structure and functionality of the plant photosynthetic apparatus. Moreover, interference of high Mnleaf in R. mangle occurs at non-stomatal and biochemical levels. There is an antagonistic interference of these trace elements with the physiology of R. mangle, which is a dominant species in Brazilian mangroves.

Resumen Introducción: El hierro (Fe) y el manganeso (Mn) son micronutrientes bioesenciales para las plantas, pero pueden afectar el metabolismo energético cuando están presentes en niveles altos. Objetivo: Evaluar el desempeño fotosintético y los daños oxidativos en tejidos foliares de Rhizophora mangle L. a bajas y altas concentraciones de Fe (74 y 195 mg kg-1; Feleaf) y Mn (65 y 414 mg kg-1; Mnleaf). Métodos: Se muestrearon pigmentos fotosintéticos, fluorescencia de clorofila a, asimilación e intercambio de gases de CO2 foliar y capacidad de eliminación de radicales DPPH• en R. mangle que crece en bosques de estuarios en la región Norte del estado de Espírito Santo y el extremo Sur del Estado de Bahía (Brasil) mostrando Feleaf y Mnleaf bajos y altos. Resultados: No se identificaron efectos de niveles elevados de Fe y Mn en los niveles de pigmento. El aumento de Feleaf y Mnleaf en los niveles observados en esta evaluación tuvo un efecto positivo en el número de centros de reacción y en la eficiencia del complejo generador de oxígeno, evaluado como banda K, mientras que no se encontraron cambios en los parámetros relacionados con la eficiencia de atrapamiento de excitación en el centro activo del fotosistema II. Se identificaron distintos patrones de interferencia de Fe y Mn en los procesos funcionales de la fotosíntesis, especialmente en la asimilación de CO2 y el metabolismo de las especies reactivas de oxígeno, con efectos importantes en la asimilación de CO2 y la eficiencia de carboxilación de Rubisco a niveles altos de Mnleaf. Conclusión: Los hallazgos demuestran la eficiencia de R. mangle en la regulación positiva de la cadena de transporte de electrones en respuesta a los altos niveles de Fe y Mn, al menos en términos de preservación de la estructura y funcionalidad del aparato fotosintético de la planta. Además, la interferencia de Mnleaf alto en R. mangle se presenta a niveles no estomáticos y bioquímicos. Hay interferencia antagónica de estos oligoelementos con la fisiología de R. mangle, que es una especie dominante en los manglares brasileños.

Abstract The temporomandibular joint (TMJ) is a mobile synovial joint that articulates the temporal bone, particularly the articular tubercle and the glenoid fossa, with the condyle of the mandibular bone. Inside it, there is an articular disc that divides the cavity into two compartments, which act as a functional unit. To correctly evaluate the status of the TMJ, it is necessary to know its normal anatomy and function. In addition, one must be familiar with the imaging findings present in magnetic resonance imaging (MRI), which must be correlated with the physical examination and clinical symptoms, to reach an accurate diagnosis. Temporomandibular disorders (TMD) are a heterogeneous set of pathologies that involve the TMJ complex and adjacent bone and muscular structures. MRI is considered the gold-standard imaging technique to evaluate TMD. This technique provides information on the anatomical and functional characteristics, in addition to adequately characterizing the different pathological processes and the response to treatment.

Resumen La articulación temporomandibular (ATM) es una articulación sinovial móvil que articula el hueso temporal, particularmente el tubérculo articular y la fosa glenoidea, con el cóndilo del hueso mandibular. En su interior existe un disco articular que divide la cavidad en dos compartimentos, los cuales actúan como una unidad funcional. Para evaluar correctamente el estado de la ATM es necesario conocer su anatomía normal y funcionamiento. Además, se debe estar familiarizado con los hallazgos imagenológicos presentes en la resonancia magnética (RM), los cuales deben ser correlacionados con el examen físico y la clínica, para así llegar a un diagnóstico certero. Los trastornos temporomandibulares (TTM) son un conjunto heterogéneo de patologías que involucran al complejo de la ATM y las estructuras óseas y musculares adyacentes. La RM se considera la técnica imagenológica de preferencia para evaluar los TTM. Esta proporciona información sobre las características anatómicas y funcionales, además de caracterizar adecuadamente los diferentes procesos patológicos y la respuesta al tratamiento.

Antecedentes: Durante la práctica clínica se ha observado que los casos de vólvulo sigmoideo pueden tener complicaciones posteriores a su tratamiento correspondientes al síndrome de pseudoobstrucción colónica aguda (ACPO, por sus siglas en inglés) y crónica (CIPO, por sus siglas en inglés), siendo mucho más frecuente su forma aguda también llamado síndrome de Ogilvie. No se comprende completamente la causa y el mecanismo subyacente al desarrollo de estas condiciones. Aunque se han descrito posibles causas en otros estudios, la investigación enfocada en el estado de las células ganglionares y el microbioma del paciente es limitada. Este estudio tiene como objetivo aportar a la literatura médica el conteo de las células ganglionares y la diversidad microbiana de seis pacientes diagnosticados con pseudoobstrucción colónica aguda y crónica observada en pacientes de la zona altoandina del sur del Perú. Presentación de caso: El antecedente común que caracteriza y agrupa a los casos reportados es la sigmoidectomía previa por vólvulo de sigmoides, junto con la presencia de signos y síntomas de un cuadro obstructivo funcional agudo y crónico. En todos los casos, el diagnóstico clínico posterior al tratamiento de vólvulo sigmoideo fue ACPO o CIPO. Estos diagnósticos fueron confirmados mediante radiografía de abdomen y tomografía. Se inició un tratamiento médico conservador con Neostigmina. La falta de respuesta al tratamiento conllevó a realizar diversas técnicas quirúrgicas. Conclusión: Todos los pacientes mostraron hipoganglionosis. Según el análisis del microbioma, en cuatro de ellos, el filo predominante fue Firmicutes y el enterotipo predominante fue Prevotella. En los otros dos pacientes, se observó un porcentaje elevado de Proteobacterias, con Bacteroides como enterotipo predominante. La relación de Firmicutes/Bacteroidetes promedio fue de 4.9. Nuestro estudio muestra la existencia de disbiosis bacteriana en dos pacientes con hipoganglionosis colónica, que podría estar relacionada con la fisiopatología del ACPO y del CIPO. Adicionalmente, reportamos alteraciones en la frecuencia relativa de bacterias asociadas al metabolismo de flavonoides.

Background: During clinical practice, it has been observed that cases of sigmoid volvulus can develop complications post-treatment corresponding to acute colonic pseudo-obstruction (ACPO) and chronic intestinal pseudo-obstruction (CIPO), with the acute form, also known as Ogilvie's syndrome, being more common. The cause and underlying mechanism for the development of these conditions are not fully understood. Although potential causes have been described in other studies, research focused on the status of ganglion cells and the patient's microbiome is limited. This study aims to contribute to the medical literature by examining the ganglion cell content and microbial diversity in six patients diagnosed with acute and chronic colonic pseudo-obstruction observed in patients from the high Andean region of southern Peru. Case Presentation: The common background characterizing and grouping the reported cases is the previous sigmoidectomy for sigmoid volvulus, along with the presence of signs and symptoms of an acute and chronic functional obstructive condition. In all cases, the clinical diagnosis following the treatment of sigmoid volvulus was ACPO or CIPO. These diagnoses were confirmed by abdominal X-ray and tomography. A conservative medical treatment with Neostigmine was initiated. The lack of response to this treatment led to various surgical techniques being performed. Conclusion: All patients presented with hypoganglionosis. According to microbiome analysis, in four of them, the predominant phylum was Firmicutes and the predominant enterotype was Prevotella. In the other two patients, a high percentage of Proteobacteria was observed, with Bacteroides as the predominant enterotype. The average Firmicutes/Bacteroidetes ratio was 4.9. Our study shows the existence of bacterial dysbiosis in two patients with colonic hypoganglionosis, which could be related to the pathophysiology of ACPO and CIPO. Additionally, we report alterations in the relative frequency of bacteria associated with flavonoid metabolism.

Verlorenvlei is a globally important RAMSAR wetland on the arid west coast of South Africa. A prolonged drought between 2016 and 2021 and increasing competition for water from the agricultural sector resulted in extremely low water levels. We used historical aerial and satellite imagery from 1942 and rainfall and water level data for the past 50 years, to assess habitat changes within the estuarine functional zone of the Verlorenvlei Estuarine Lake. Prior to the drought, lake water levels and water surface area remained stable (1113 ± 27 ha (SE)). Since then, there has been a 64% decrease in open water area, exposing 193 ha of sandbanks, of which 190.9 ha were hyper-sulfidic pyrite-rich. The water in the lower lake was hypersaline (>100), and in the middle, it was acidic (pH<3). The low water level plus sediment and nutrient input from surrounding agriculture resulted in a localised increase in reeds. Additional pressures, such as fires, have reduced the above-ground biomass of reeds and sedges, potentially altering surface morphology and reducing stored carbon. Despite flooding and filling up in June 2023, the lake remained in an acidic state (3.9-4.3). Similar low-lake level, hypersaline and acidic conditions are predicted to become more common under future climate change scenarios where aridity and extreme weather events are anticipated. Inflow of fresh water into the estuary and control of farming practices are required to keep the Verlorenvlei in a functional state, with long-term monitoring necessary to assess the ecological condition in response to restoration actions. SIGNIFICANCE: We assessed the habitat changes in Verlorenvlei, an estuarine lake on the arid west coast of South Africa. Estuarine lakes are scarce, and an extended drought greatly reduced the water surface area, exposing hyper-sulfidic pyrite-rich soils, leading to lake acidification and a negative response from biota. Competition for water from agribusiness and the burning of reeds are added pressures. Subsequent heavy rains have been slow to buffer lake acidity, and the impacts thereof serve as a warning for the management of similar ecosystems and their ecological water requirements, especially under climate change where extreme weather conditions, increased aridity and competition for water are realities.

Abstract: Urinary tract infections (UTIs) are one of the most frequent bacterial conditions in children, being enterobacteria the predominant etiologic agents. Streptococcus pneumoniae is an exceptional cause of UTI in the pediatric population. Objective: To report the case of a UTI caused by Streptococcus pneumoniae, and to discuss the need for urinary tract imaging studies based on a literature review. Clinical Case: A 2-year-old girl with megaureter and left hydronephrosis diagnosed in the context of a recurrent UTI, with poor adherence to prophylactic treatment, was hospitalized due to a new episode of febrile UTI without response to outpatient treatment with a broad-spectrum antibiotic. Streptococcus pneumoniae was isolated in the urine culture. She received parenteral therapy with ceftriaxone with good clinical course and, due to UTI caused by an atypical germ added to her history of renal malformation, prophylaxis was reinitiated and imaging studies were completed. Voiding cystourethrogram showed left grade V vesicoureteral reflux. Renal scintigraphy showed severe functional compromise of the left kidney, thus, surgical indication was considered. This case, along with 16 additional cases identified in a literature review, revealed that 12 of them (70%) showed concomitant renal-urological conditions. Conclusion: UTIs caused by Streptococcus pneumoniae are frequently associated with renal-urological alterations, which suggest the need to study the urinary tract in these patients.

Resumen: Las infecciones del tracto urinario (ITU) constituyen una de las afecciones bacterianas más frecuentes en pediatría, siendo las enterobacterias los agentes etiológicos predominantes. El Streptococcus pneumoniae es una causa excepcional de ITU en la población pediátrica. Objetivo: Comunicar un caso de ITU por Streptococcus pneumoniae, y discutir la necesidad de realizar estudios de imágenes de la vía urinaria en base a una revisión narrativa. Caso Clínico: Niña de 2 años portadora de megauréter e hidronefrosis izquierda diagnosticados en contexto de estudio de ITU recurrente, con poca adherencia al tratamiento profiláctico, que se hospitalizó por nuevo episodio de ITU febril sin respuesta a tratamiento ambulatorio con antibiótico de amplio espectro. En el urocultivo se aisló Streptococcus pneumoniae. La paciente fue tratada con ceftriaxona parenteral con buena evolución clínica y por el hallazgo del germen atípico sumado a su antecedente de malformación renal se reinició profilaxis y se completaron los estudios de imágenes. La cistouretrograña miccional mostró reflujo vesicoureteral izquierdo grado V. El centellograma renal mostró el riñón izquierdo con grave compromiso funcional, por lo que se planteó la indicación quirúrgica. El presente caso, junto a los 16 casos adicionales identificados en la revisión bibliográfica, reveló que 12 de ellos (70%) presentaban afecciones nefrourológicas concomitantes. Conclusión: Las ITUs por Streptococcus pneumoniae se asocian con alta frecuencia a alteraciones nefrourológicas, lo que sugiere la necesidad de estudiar la vía urinaria en estos pacientes.

Abstract Gastroparesis is a chronic disorder of gastric motility that results in marked impairment of quality of life and significant costs to health care systems. Medical therapies are limited in their management, thus, the reason for a growing enthusiasm for pylorus-targeted therapies. The functional luminal imaging probe (FLIP) is a useful diagnostic tool for assessing pylorus characteristics, especially in refractory cases, which could lead to a better management strategy and, in many cases, predict clinical response.

Resumen La gastroparesia es un trastorno crónico de la motilidad gástrica que genera un deterioro marcado de la calidad de vida y costos significativos en los sistemas de salud. Las terapias médicas son limitadas para su manejo, por lo cual ha surgido un entusiasmo creciente en las terapias dirigidas al píloro. La sonda de imagen luminal funcional (FLIP) ha demostrado ser una herramienta diagnóstica útil para evaluar las características del píloro, especialmente en casos refractarios, en los que podría guiar hacia una mejor estrategia de manejo y, en muchos casos, predecir la respuesta clínica.

Abstract Celiac disease (CD) is an immune-mediated enteropathy with systemic compromise in genetically susceptible individuals, caused by an immune response to ingested gluten. The only therapy for CD is a gluten-free diet (GFD). A case of a 55-year-old woman who reported to the emergency room for early satiety, intolerance to legumes, abdominal distension, and chronic diarrhea, including paresthesias in the upper and lower limbs, was presented. In addition, she described a functional decline due to dyspnea and involuntary weight loss of approximately 20 kilograms in the last 2 years. An esophagogastroduodenoscopy with CD protocol was performed, along with serology for CD, which confirmed the initial diagnostic suspicion. Treatment with a gluten-free diet and nutritional supplementation was indicated, which yielded a significant improvement in the clinical picture.

Resumen La enfermedad celiaca (EC) es una enteropatía inmunomediada con compromiso sistémico en individuos genéticamente susceptibles, causada por una respuesta inmunitaria al gluten ingerido. La única terapia para la EC es una dieta libre de gluten (DLG). Se presenta el caso de una mujer de 55 años que acudió al servicio de urgencias por saciedad precoz, intolerancia a las leguminosas, distensión abdominal y diarrea crónica, además de parestesias en los miembros superiores e inferiores. Adicionalmente, describió una disminución de la clase funcional por disnea y pérdida involuntaria de aproximadamente 20 kilogramos de peso en los últimos 2 años. Se realizó una esofagogastroduodenoscopia con protocolo para EC, junto con serología para la misma, lo cual confirmó la sospecha diagnóstica inicial. Se indicó tratamiento con dieta libre de gluten y suplementación nutricional, que produjo una mejoría significativa del cuadro clínico.

Abstract Knee osteoarthritis (OA) is an inflammatory and degenerative condition resulting in articular cartilage destruction and functional loss. Its prevalence has grown considerably due to increased life expectancy and obesity, and its diagnosis relies on evaluation, medical examination, and confirmation by supplementary radiographic images. Knee OA is multifactorial and influenced by several local, systemic, and external aspects. In addition, its progress and therapeutic responses highly depend on the characteristics of each subject. The initial recommendation is drug treatment and alternative therapies to improve quality of life. However, if these treatments are unsuccessful, one must consider surgical treatment. Surgical options include arthroscopies, osteotomies, and partial and total arthroplasties, while non-surgical treatments include medications and alternative therapies such as infiltrations, acupuncture, and physical exercise. It is worth highlighting that biomarkers can be a significant strategy for early disease detection, assessment of disease activity, prediction of prognosis, and monitoring a better response to therapy. Nevertheless, this topic must be the focus of further research to confirm its findings. (OA loss obesity evaluation examination images local systemic aspects addition subject However unsuccessful arthroscopies osteotomies arthroplasties nonsurgical non infiltrations acupuncture exercise detection activity prognosis therapy Nevertheless findings

Resumo A osteoartrite (OA) do joelho é uma doença inflamatória e degenerativa que ocasiona a destruição da cartilagem articular e leva à perda de funções. Sua prevalência vem crescendo consideravelmente devido ao aumento da expectativa de vida e da obesidade, e o diagnóstico pode ser feito por meio de avaliação e exames médicos, e é confirmado em imagens radiográficas complementares. Uma condição multifatorial, a OA do joelho pode ser influenciada por diversos aspectos locais, sistêmicos e externos; além disso, a sua evolução e as respostas aos tratamentos dependem muito das características de cada indivíduo. Inicialmente, recomenda-se proceder a um tratamento medicamentoso e a terapias alternativas que melhorem a qualidade de vida do paciente; mas, a partir do momento em que se verifica que tais terapias não estão proporcionando resultados satisfatórios, um tratamento cirúrgico deve ser considerado. Entre os tratamentos cirúrgicos, as artroscopias, as osteotomias e as artroplastias parciais e totais são destacadas; os métodos não cirúrgicos incluem o uso de medicamentos e de terapias alternativas, como infiltrações, acupuntura e prática de exercícios físicos. Vale ressaltar ainda que a utilização de biomarcadores pode ser uma importante estratégia para detectar precocemente a doença, avaliar sua atividade, prever um prognóstico e monitorar uma melhor resposta à terapia; porém, esse tema ainda deve ser foco de mais estudos para que os seus resultados sejam comprovados. (OA funções obesidade médicos complementares multifatorial locais externos disso indivíduo Inicialmente recomendase recomenda paciente mas satisfatórios considerado artroscopias destacadas infiltrações físicos atividade terapia porém comprovados

INTRODUCTION: Clinical utility is an important attribute in selecting an assessment tool. The study aimed to determine the perceptions of South African occupational therapists of the clinical utility of Modular Arrangement of Predetermined Time Standards (MODAPTS) work samples when assessing a client's work ability. The research objectives were to determine whether MODAPTS is perceived to be credible, practical, useful, and easy to use. METHODOLOGY: A quantitative, cross-sectional, descriptive research design was used. Non-probability sampling with elements of voluntary response- and snowball sampling was used to recruit respondents. An electronic questionnaire was developed using Qualtrics, which was distributed electronically via the Occupational Therapy Association of South Africa, WhatsApp and Telegram. RESULTS: Data were based on 52 completed questionnaires, analysed through descriptive statistics MODAPTS was perceived as practical, useful, credible, and asy to use in practice. Main barriers to the use of MODAPTS included the timeliness of developing work samples, lack of MODAPTS training, and having other more useful and reliable assessment tools. Experienced occupational therapists used MODAPTS more often than inexperienced occupational therapists. CONCLUSION: Clinical utility of work samples developed using MODAPTS has been confirmed. This supports the use of work samples developed using MODAPTS as part of work assessments as a cost-effective, practical tool. IMPLICATIONS FOR PRACTICE: • Development of contextually relevant work samples. •Use of MODAPTS work samples as an outcome measure during intervention. • Application during rehabilitation goal setting. • Cost effective application of MODAPTS work samples in a variety of settings.

ABSTRACT In this paper, the results carried out about a study over the possibilities of the Predictive Functional Control (PFC) are presented. The French professor Jacques Richalet and his collaborators developed the PFC. The results presented were obtained, when PFC is applied to industrial processes with complex dynamics such as high order, integral effects in the direct step that make the process asymptotically unstable in open loop and the undesirable phenomena of delay and inverse response. The main objective of the study is to demonstrate the potential offered by the PFC algorithm, in its simplest form, for the control of such processes. To this end, a methodology for synthesizing the PFC controller is developed based on the postulates and principles proposed by the precursors of the method, applied to several real case studies. In all cases, completely satisfactory results were obtained by means of simulation in Simulink-MatLab and finally the results of applying the method to the temperature control of the TCLab minilaboratory developed at the University of Utah are compared. This verifies the real possibilities of the FPC as a prominent alternative to control of real process.

RESUMEN En el presente artículo se exponen los resultados de un estudio realizado sobre las posibilidades que brinda el Control Predictivo Funcional (PFC en inglés) creado por el profesor francés Jacques Richalet y sus colaboradores, cuando el mismo es aplicado a procesos industriales con dinámicas complejas como son: el alto orden, efectos integrales en el paso directo que hacen que el proceso resulte asintóticamente inestable a lazo abierto y los fenómenos indeseables del retardo y la respuesta inversa. Como propósito del trabajo se pretende demostrar la potencialidad que brinda el algoritmo PFC, en su forma más simple, para el control de tales procesos. Para ello se elabora una metodología de síntesis del controlador PFC a partir de los postulados y principios planteados por los precursores del método, aplicada a varios casos de estudio reales. Se obtiene, en todos los casos, resultados totalmente satisfactorios, los cual se demuestra mediante simulación en Simulink-MatLab y finalmente se comparan los resultados de aplicar el método al control de temperatura del minilabortario TCLab elaborado en la Universidad de Utah. Queda así verificada la potencialidad del PFC como alternativa prominente para control real de procesos.

ABSTRACT Excess body weight has become a global epidemic and a significant risk factor for developing chronic diseases, which are the leading causes of worldwide morbidities. Adipose tissue (AT), primarily composed of adipocytes, stores substantial amounts of energy and plays a crucial role in maintaining whole-body glucose and lipid metabolism. This helps prevent excessive body fat accumulation and lipotoxicity in peripheral tissues. In addition, AT contains endothelial cells and a substantial population of immune cells (constituting 60-70% of non-adipocyte cells), including macrophages, T and B lymphocytes, and natural killer cells. These resident immune cells engage in crosstalk with adipocytes, contributing to the maintenance of metabolic and immune homeostasis in AT. An exacerbated inflammatory response or inadequate immune resolution can lead to chronic systemic low-grade inflammation, triggering the development of metabolic alterations and the onset of chronic diseases. This review aims to elucidate the regulatory mechanisms through which immune cells influence AT function and energy homeostasis. We also focus on the interactions and functional dynamics of immune cell populations, highlighting their role in maintaining the delicate balance between metabolic health and obesity-related inflammation. Finally, understanding immunometabolism is crucial for unraveling the pathogenesis of metabolic diseases and developing targeted immunotherapeutic strategies. These strategies may offer innovative avenues in the rapidly evolving field of immunometabolism. (Rev Invest Clin. 2024;76(2):65-79)

Resumo: Introdução: O uso de prednisona e reabilitação musculoesquelética e respiratória foi descrito no tratamento de pacientes com COVID-19 grave ou crítico. O papel destas intervenções e o momento ideal para o seu início não estão claramente estabelecidos. Este trabalho mostra os resultados da Unidade de Reabilitação Hospitalar do Banco de Seguro del Estado que implementou um programa abrangente de reabilitação e uso de corticosteroides na fase subaguda de pacientes graves ou críticos pós-COVID-19, com uma abordagem sistematizada, trabalhando de forma interdisciplinar e centrada no paciente. São relatados os achados na admissão, a necessidade de oxigênio, a escala de Barthel, os padrões tomográficos, o uso de corticosteroides, a resposta ao tratamento e as complicações. Os resultados desta abordagem sobre variáveis clínicas, respiratórias e funcionais são descritos. Material e métodos: Estudo descritivo e retrospectivo de pacientes pós-COVID-19 que completaram reabilitação na Unidade de Reabilitação do Hospital Banco de Seguros del Estado (URHBSE) no período de abril a agosto de 2021. Os dados foram obtidos dos prontuários de pacientes com posterior análise estatísticas usando PRISM (v8.2.1). Resultados: 84 pacientes completaram o programa de reabilitação. No momento da admissão na URHBSE, 55% apresentavam dependência total ou grave da escala de Barthel. 48% não conseguiam se mover. 89,2% necessitaram oxigênio com saturação média de 90,3 ± 4,8. 25% dos pacientes foram internados necessitando máscara com reservatório. Todos os pacientes que ingressaram no programa estavam na fase subaguda da doença (4 a 12 semanas) e receberam um plano de reabilitação abrangente e individualizado. O objetivo era alcançar uma situação funcional semelhante à que apresentavam antes da COVID-19. O tempo de permanência na URHBSE foi de 23,5±13,8 dias. A tomografia de tórax de alta resolução (TCAR) foi realizada em 76 pacientes (90,5%); os resultados foram patológicos em 96,1%. O vidro fosco predominou em 49,3% deles, a consolidação em 8,23% e o padrão fibroso em 30,13%. Alterações tomográficas “atípicas” de danos pós-COVID (derrame pleural, nódulos cavitados, cavidades apicais, etc.) foram detectadas em 11,8% dos exames tomográficos. Aspergilose pulmonar foi encontrada em 2,6% dos pacientes e tromboembolismo pulmonar em 6,6%. 44 pacientes (52,3%) receberam prednisona. Em 63,4% a oferta de oxigênio foi suspensa nos primeiros 15 dias após o início da mesma. Encontramos associação entre o padrão tomográfico em vidro fosco e a suspensão precoce da oferta de oxigênio desde o início da administração da prednisona (p = 0,047). Apesar do alto grau de colonização, mesmo naqueles que usaram prednisona, não observamos infecções. Em relação às variáveis respiratórias, só temos dados sobre a presença de dispneia nos primeiros 35 pacientes; destes, 83% apresentavam dispneia na admissão, enquanto apenas 17% a apresentavam na alta (p< 0,0001). Observou-se também diferenças significativas na necessidade de O2 entre a admissão e a alta (p< 0,0001) e no grau de dependência medido pela escala de Barthel, com 55% dos pacientes apresentando dependência total ou grave na admissão e apenas 3,4% na alta. Conclusões: As intervenções realizadas na fase subaguda da doença foram associadas a melhorias significativas nas variáveis de interesse clínico. São necessários mais estudos para definir o papel e o momento exato do início dos corticosteroides e da reabilitação neste grupo de pacientes.

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Abstract: Introduction: In patients with severe or critical COVID-19, the use of prednisone and musculoskeletal and respiratory rehabilitation has been described. The role of these interventions and the optimal time for their initiation are not clearly established. This study presents the results of the Rehabilitation Unit of the Banco de Seguro del Estado Hospital, which implemented a comprehensive rehabilitation program and the use of corticosteroids in the subacute stage of patients with severe or critical post-COVID-19, with a systematic approach, working interdisciplinary and centered on the person being treated. Findings at admission, oxygen requirement, Barthel scale, tomographic patterns, use of corticosteroids, their response, and complications are reported. The results of this approach on clinical, respiratory, and functional variables are described. Method: Descriptive, retrospective study of post-COVID-19 patients who completed rehabilitation at the Rehabilitation Unit of the Banco de Seguros del Estado Hospital (URHBSE) in the period April-August 2021. Data obtained from review of medical records, statistical analysis with PRISM (v8.2.1). Results: Eighty-four patients completed the rehabilitation program. Upon admission to the URHBSE, 55% had total or severe dependence on the Barthel scale. Forty-eight percent were unable to walk. Eighty-nine-point two percent required oxygen, with a mean saturation of 90.3 ± 4.8. Twenty-five percent of patients were admitted requiring a reservoir mask. All patients who entered the program were in the subacute phase of the disease (4 to 12 weeks) and received a comprehensive and individualized rehabilitation plan. The objective was to achieve a functional situation similar to what they had before COVID-19. The length of stay at the URHBSE was 23.5 ± 13.8 days. A total of 76 patients (90.5%) underwent high-resolution chest tomography (HRCT), which was pathological in 96.1% of cases. The predominant findings were ground-glass opacity in 49.3% of cases, consolidation in 8.23%, and a fibrosis-like pattern in 30.13%. “Non-typical” post-COVID damage tomographic alterations were detected (pleural effusion, cavitary nodules, apical cavities, etc.) in 11.8% of the tomographies. In 2 patients (2.6%), pulmonary aspergillosis was found, and in 6.6%, pulmonary thromboembolism. Forty-four patients (52.3%) received prednisone. In 63.4% of cases, oxygen supplementation was discontinued within the first 15 days from the start of prednisone. We found an association between the ground-glass opacity tomographic pattern and early discontinuation of oxygen supplementation from the start of prednisone (p = 0.047). Despite the high degree of colonization, we did not observe infections by colonizing microorganisms, even in those who used prednisone. Comparing admission and discharge, statistically significant differences were found in the following parameters: degree of dyspnea, oxygen requirement (only one patient was discharged with oxygen), saturation, degree of instrumentation (tracheostomy, nasogastric tube, etc.), and the Barthel dependency scale. Regarding respiratory variables, we only have data on the presence of dyspnea in the first 35 patients. Of these, 83% had dyspnea at admission, while only 17% had it at discharge (p < 0.0001). There were also significant differences in the oxygen requirement between admission and discharge (p < 0.0001) and in the degree of dependency measured on the Barthel scale. Fifty-five percent of patients had total or severe dependence at admission, compared to only 3.4% at discharge. Conclusions: The interventions carried out in the subacute stage of the disease were associated with significant improvements in clinical variables of interest. More studies are needed to define the role and the exact timing of the initiation of corticosteroids and rehabilitation in this group of patients.

Abstract Background: Cardiac resynchronization therapy (CRT) has been established as an effective therapy for heart failure with reduced ejection fraction. Randomized clinical trials have shown its impact on mortality and HF hospitalizations, as well as improvement of symptoms and quality of life. Objectives: Finding clinical, electrocardiographic, and echocardiographic variables that may predict the response to cardiac resynchronization therapy (CRT). Methods: We performed a single-center, observational, analytic, and retrospective study that included 102 patients with heart failure (HF) diagnosis who underwent CRT according to guideline-directed therapy from January 2010 to April 2020 in a third-level center. CRT response was defined as an improvement of New York Heart Association functional class in at least 1 category associated with a recovery of ≥ 5% in the left ventricular ejection fraction (LVEF). Results: Our study population was 102 patients of which 61 (59.8%) were men. The mean age at HF diagnosis was 54 ± 18.7 years. Ischemic heart disease was the etiology in 37 (36.3%) cases. Fifty-one (50%) patients were classified as responders. Responders had wider QRS, and lower LVEF and right ventricular fractional area change at baseline. After CRT, responders had a greater reduction of QRS duration, and improvement in LVEF, global longitudinal strain, and echocardiographic dyssynchrony parameters. Multivariate regression analysis showed that left bundle branch block (LBBB), left ventricular end-diastolic volume (LVEDV), tricuspid annular plane systolic excursion (TAPSE), and baseline difference of pre-ejection periods were predictors of a positive response to CRT in this population. Conclusions: LBBB, TAPSE, LVEDV, and pre-ejection time difference are independent variables that can predict adequate response to CRT.

Resumen Antecedentes: La terapia de resincronización cardíaca (TRC) se ha establecido como una terapia efectiva para la insuficiencia cardíaca con fracción de eyección reducida. Ensayos clínicos aleatorizados han demostrado su impacto en la mortalidad y hospitalizaciones por insuficiencia cardíaca, así como la mejora de los síntomas y la calidad de vida. Objetivos: Determinar las variables clínicas, electrocardiográficas y ecocardiográficas que puedan predecir la respuesta a la terapia de resincronización cardíaca (TRC). Método: Estudio unicéntrico, observacional, analítico, retrospectivo, que incluyó 102 pacientes con diagnóstico de IC sometidos a TRC y terapia dirigida por guías, de enero de 2010 a abril de 2020, en un centro de tercer nivel. La respuesta a TRC fue definida como mejoría de la clase funcional de la New York Heart Association en al menos 1 categoría, asociado con una recuperación ≥ 5% en la fracción de expulsión del ventrículo izquierdo (FEVI). Resultados: Incluimos a 102 pacientes, 61 (59.8%) fueron hombres. El promedio de edad al diagnóstico de IC fue 54 ± 18.7 años. La cardiopatía isquémica fue la etiología en 37 (36.3%) pacientes. 51 (50%) pacientes, fueron clasificados como respondedores. Los respondedores presentaron QRS amplio, menor FEVI y menor fracción de acortamiento del ventrículo derecho al inicio del estudio. Después de la TRC, los respondedores tuvieron una mayor reducción en la duración del QRS, mejoría en la FEVI, strain longitudinal global y parámetros de disincronía ecocardiográfica. El análisis de regresión multivariado mostró que el bloqueo de rama izquierdo (BRI), el volumen telediastólico del ventrículo izquierdo (VTDVI) la excursión sistólica del plano anular tricuspídeo (TAPSE) y la diferencia basal del período expulsivo fueron predictores de respuesta positiva a TRC. Conclusiones: BRI, TAPSE, VTDVI y la diferencia basal de períodos preexpulsivos son variables independientes que predicen respuesta adecuada a TRC.