Lantana caatingensis Moldenke (Verbenaceae) is an endemic plant from northeastern Brazil. However, its chemical composition is almost unknown. This study aimed to characterize the chemical compounds found in L. caatingensis and investigate the antileishmanial potential of its hydroalcoholic extract and polar fractions. Compounds present in the hydroalcoholic extract obtained from L. caatingensis leaves and its polar fractions (ethyl acetate and methanolic) were analyzed by liquid chromatography with a photodiode-array detector coupled to electrospray ionization quadrupole time-of-flight mass spectrometry. An antileishmanial assay was performed in a 96-well plate against Leishmania major promastigotes using resazurin on a plate spectrophotometer and the results were expressed as percentage of growth inhibition. Nine compounds were determined in the investigated extract and fractions, classified as flavonoids, flavonoid C-glycosides and phenylethanoid glycosides. The antileishmanial activity revealed that the hydroalcoholic extract and the ethyl acetate fraction were active against L. major promastigotes with inhibitory concentration of 71.78 and 26.86 µg mL-1, respectively, while the methanolic fraction was inactive (478.40 µg mL-1). This is the first report on the chemical composition and antileishmanial activity of L. caatingensis extracts. These results contribute to further knowledge of species belonging to the Lantana genus. Verbenaceae (Verbenaceae Brazil However unknown L photodiodearray photodiode array timeofflight time flight spectrometry 96well well 96 inhibition flavonoids Cglycosides C glycosides 7178 71 78 71.7 2686 26 86 26.8 mL1, mL1 mL 1, 1 mL-1 respectively 478.40 47840 478 40 (478.4 mL1. . mL-1) extracts genus 9 717 7 71. 268 2 8 26. mL- 478.4 4784 47 4 (478. 478. (478 (47 (4 (

Resumo Objetivo Analisar a relação entre o índice de vulnerabilidade social e condição de fragilidade física e o delirium em idosos hospitalizados. Métodos Estudo transversal e analítico desenvolvido com idosos em um hospital no Sul do Brasil. Foram empregados os instrumentos de coleta questionário sociodemográfico, índice de vulnerabilidade social, marcadores do fenótipo de fragilidade física e Confusion Assessement Method. Utilizou-se estatística descritiva e inferencial. Resultados Dos 305 idosos avaliados, 59,4% eram do sexo feminino, 40,9% com idade superior a 80 anos e 92,6% com morbidades. Houve associação entre hospitalização e sexo feminino com baixa e média vulnerabilidade (64,8%; IC95% 55,9-72,7 e 63%; IC95% 53,2-71,8, respectivamente, com p=0,0262). O delirium foi observado em 29,5% (IC95% 22,3-38,4) dos idosos com idade superior a 60 anos com baixa vulnerabilidade, 17% (10,9-25,5) média, 14,5% (8,6-23,9) alta, com p=0,0151. Acima de 80 anos, não se observou associação entre delirium e o índice de vulnerabilidade, com p=0,235. A ocorrência de delirium atingiu 44,3% (32,5-56,7) idosos com baixa vulnerabilidade, 35% (22,1-50,5) média e 25% (12-44,9) alta. Não houve associação entre fragilidade e vulnerabilidade social, com p=0,927. Em idosos com 80 anos ou mais, prevaleceram os frágeis nos três estratos de vulnerabilidade (baixa 59,7%; média 57,5% e alta 56%), p=0,788. Conclusão A hospitalização e o delirium se associaram a mulheres mais jovens, pré-frágeis e provenientes de baixa e média vulnerabilidade social. A condição de fragilidade não se correlacionou à vulnerabilidade social. Destaca-se a necessidade de melhor compreensão dos fatores biopsicossociais que podem aumentar o delirium em idosos hospitalizados com baixa vulnerabilidade social. Brasil sociodemográfico Method Utilizouse Utilizou inferencial 30 avaliados 594 59 4 59,4 409 40 9 40,9 8 926 92 6 92,6 morbidades 64,8% 648 64 (64,8% IC95 IC 55,972,7 559727 55,9 72,7 55 72 7 55,9-72, 63% 63 53,271,8, 532718 53,2 71,8, 53 2 71 53,2-71,8 respectivamente p=0,0262. p00262 p p=0,0262 . 0 0262 p=0,0262) 295 29 5 29,5 (IC95 22,338,4 223384 22,3 38,4 22 3 38 22,3-38,4 17 10,925,5 109255 10,9 25,5 10 25 (10,9-25,5 145 14 14,5 8,623,9 86239 8,6 23,9 23 (8,6-23,9 p00151 0151 p=0,0151 p0235 235 p=0,235 443 44 44,3 32,556,7 325567 32,5 56,7 32 56 (32,5-56,7 35 22,150,5 221505 22,1 50,5 1 50 (22,1-50,5 1244,9 12449 12 44,9 (12-44,9 p0927 927 p=0,927 59,7% 597 575 57 57,5 56%, 56% , 56%) p0788 788 p=0,788 jovens préfrágeis pré Destacase Destaca 59, 40, 92, 64,8 (64,8 IC9 972 55,972, 55972 559 55, 727 72, 55,9-72 271 53,271,8 53271 532 53, 718 71,8 53,2-71, p0026 p=0,026 026 29, (IC9 338 22,338, 22338 223 22, 384 38, 22,3-38, 925 10,925, 10925 109 10, 255 25, (10,9-25, 14, 623 8,623, 8623 86 8, 239 23, (8,6-23, p0015 015 p=0,015 p023 p=0,23 44, 556 32,556, 32556 325 32, 567 56, (32,5-56, 150 22,150, 22150 221 505 50, (22,1-50, 1244 1244, 449 (12-44, p092 p=0,92 59,7 57, p078 78 p=0,78 64, (64, 97 55,972 5597 55,9-7 27 53,271, 5327 71, 53,2-71 p002 p=0,02 02 (IC 33 22,338 2233 22,3-38 10,925 1092 (10,9-25 62 8,623 862 (8,6-23 p001 01 p=0,01 p02 p=0,2 32,556 3255 (32,5-56 15 22,150 2215 (22,1-50 124 (12-44 p09 p=0,9 p07 p=0,7 (64 55,97 55,9- 53,271 53,2-7 p00 p=0,0 22,33 22,3-3 10,92 (10,9-2 8,62 (8,6-2 p0 p=0, 32,55 (32,5-5 22,15 (22,1-5 (12-4 (6 53,27 53,2- 22,3- (10,9- (8,6- p=0 (32,5- (22,1- (12- ( (10,9 (8,6 p= (32,5 (22,1 (12 (10, (8, (32, (22, (1 (10 (8 (32 (22 (3 (2

Abstract Objective To analyze the relationship between the social vulnerability index and physical frailty condition and delirium in hospitalized older adults. Methods Cross-sectional analytical study of older adults developed in a hospital in southern Brazil. The collection instruments used were a sociodemographic questionnaire, the social vulnerability index, physical frailty phenotype markers and the Confusion Assessment Method. Descriptive and inferential statistics were used. Results Of the 305 older adults evaluated, 59.4% were female, 40.9% were aged over 80 years and 92.6% had morbidities. There was an association between hospitalization and female sex with low and medium vulnerability (64.8%; 95%CI 55.9-72.7 and 63%; 95%CI 53.2-71.8, respectively, with p=0.0262) . Delirium was observed in 29.5% (95%CI 22.3-38.4) of older adults over 60 years of age with low vulnerability, 17% (10.9-25.5) medium, 14.5% ( 8.6-23.9) high, with p=0.0151. There was no association between delirium and the vulnerability index in older adults aged over 80 years, with p=0.235. Delirium affected 44.3% (32.5-56.7) of older adults with low vulnerability, 35% (22.1-50.5) with medium and 25% (12-44.9) high. There was no association between frailty and social vulnerability, with p=0.927. Among older adults aged 80 years or over, frail people prevailed in the three vulnerability strata (low 59.7%; medium 57.5% and high 56%), p=0.788. Conclusion Hospitalization and delirium were associated with younger, pre-frail women from low and medium social vulnerability. The condition of frailty did not correlate with social vulnerability. The need to better understand the biopsychosocial factors that can increase delirium in hospitalized older adults with low social vulnerability is highlighted. Crosssectional Cross sectional Brazil questionnaire Method 30 evaluated 594 59 4 59.4 409 40 9 40.9 8 926 92 6 92.6 morbidities 64.8% 648 64 (64.8% 95CI CI 95 55.972.7 559727 55.9 72.7 55 72 7 55.9-72. 63% 63 53.271.8, 532718 53.2 71.8, 53 2 71 53.2-71.8 respectively p=0.0262 p00262 p 0 0262 295 29 5 29.5 22.338.4 223384 22.3 38.4 22 3 38 22.3-38.4 17 10.925.5 109255 10.9 25.5 10 25 (10.9-25.5 145 14 14.5 8.623.9 86239 8.6 23.9 23 8.6-23.9 p00151 0151 p=0.0151 p0235 235 p=0.235 443 44 44.3 32.556.7 325567 32.5 56.7 32 56 (32.5-56.7 35 22.150.5 221505 22.1 50.5 1 50 (22.1-50.5 1244.9 12449 12 44.9 (12-44.9 p0927 927 p=0.927 59.7% 597 575 57 57.5 56%, 56% , 56%) p0788 788 p=0.788 younger prefrail pre highlighted 59. 40. 92. 64.8 (64.8 972 55.972. 55972 559 55. 727 72. 55.9-72 271 53.271.8 53271 532 53. 718 71.8 53.2-71. p=0.026 p0026 026 29. 338 22.338. 22338 223 22. 384 38. 22.3-38. 925 10.925. 10925 109 10. 255 25. (10.9-25. 14. 623 8.623. 8623 86 8. 239 23. 8.6-23. p0015 015 p=0.015 p023 p=0.23 44. 556 32.556. 32556 325 32. 567 56. (32.5-56. 150 22.150. 22150 221 505 50. (22.1-50. 1244 1244. 449 (12-44. p092 p=0.92 59.7 57. p078 78 p=0.78 64. (64. 97 55.972 5597 55.9-7 27 53.271. 5327 71. 53.2-71 p=0.02 p002 02 33 22.338 2233 22.3-38 10.925 1092 (10.9-25 62 8.623 862 8.6-23 p001 01 p=0.01 p02 p=0.2 32.556 3255 (32.5-56 15 22.150 2215 (22.1-50 124 (12-44 p09 p=0.9 p07 p=0.7 (64 55.97 55.9- 53.271 53.2-7 p=0.0 p00 22.33 22.3-3 10.92 (10.9-2 8.62 8.6-2 p0 p=0. 32.55 (32.5-5 22.15 (22.1-5 (12-4 (6 53.27 53.2- 22.3- (10.9- 8.6- p=0 (32.5- (22.1- (12- (10.9 p= (32.5 (22.1 (12 (10. (32. (22. (1 (10 (32 (22 (3 (2

Resumen Objetivo Analizar la relación entre el índice de vulnerabilidad social y la condición de debilidad física y el delirium en personas mayores hospitalizadas. Métodos Estudio transversal y analítico llevado a cabo con personas mayores en un hospital del sur de Brasil. Se emplearon los siguientes instrumentos para la recopilación: cuestionario sociodemográfico, índice de vulnerabilidad social, marcadores del fenotipo de debilidad física y Confusion Assessement Method. Se utilizó la estadística descriptiva e inferencial. Resultados De las 305 personas mayores evaluadas, el 59,4 % era de sexo femenino, el 40,9 % de más de 80 años y el 92,6 % con morbilidades. Se observó asociación entre hospitalización y sexo femenino con vulnerabilidad baja y mediana (64,8 %; IC95 % 55,9-72,7 y 63 %; IC95 % 53,2-71,8, respectivamente, con p=0,0262). El delirium se observó en el 29,5 % (IC95 % 22,3-38,4) de las personas mayores de más de 60 años con vulnerabilidad baja, el 17 % (10,9-25,5) mediana y el 14,5 % (8,6-23,9) alta, con p=0,0151. No se observó relación entre delirium e índice de vulnerabilidad en personas de más de 80 años, con p=0,235. La incidencia de delirium llegó al 44,3 % (32,5-56,7) de personas mayores con vulnerabilidad baja, 35 % (22,1-50,5) mediana y 25 % (12-44,9) alta. No se observó asociación entre debilidad y vulnerabilidad social, con p=0,927. Entre las personas mayores de 80 años o más, prevalecieron los débiles en las tres categorías de vulnerabilidad (baja 59,7 %; mediana 57,5% y alta 56%), p=0,788. Conclusión La hospitalización y el delirium se asociaron a mujeres más jóvenes, predébiles y con vulnerabilidad social baja y mediana. La condición de debilidad no se correlacionó con la vulnerabilidad social. Se resalta la necesidad de una mejor comprensión de los factores biopsicosociales que pueden aumentar el delirium en personas mayores hospitalizadas con vulnerabilidad social baja. Brasil recopilación sociodemográfico Method inferencial 30 evaluadas 594 59 4 59, 409 40 9 40, 8 926 92 6 92, morbilidades 64,8 648 64 (64, IC IC9 55,972,7 559727 55,9 72,7 55 72 7 55,9-72, 53,271,8, 532718 53,2 71,8, 53 2 71 53,2-71,8 respectivamente p=0,0262. p00262 p p=0,0262 . 0 0262 p=0,0262) 295 29 5 29, (IC9 22,338,4 223384 22,3 38,4 22 3 38 22,3-38,4 1 10,925,5 109255 10,9 25,5 10 (10,9-25,5 145 14 14, 8,623,9 86239 8,6 23,9 23 (8,6-23,9 p00151 0151 p=0,0151 p0235 235 p=0,235 443 44 44, 32,556,7 325567 32,5 56,7 32 56 (32,5-56,7 22,150,5 221505 22,1 50,5 50 (22,1-50,5 1244,9 12449 12 44,9 (12-44,9 p0927 927 p=0,927 597 575 57 57,5 56%, 56% , 56%) p0788 788 p=0,788 jóvenes 64, (64 972 55,972, 55972 559 55, 727 72, 55,9-72 271 53,271,8 53271 532 53, 718 71,8 53,2-71, p0026 p=0,026 026 (IC 338 22,338, 22338 223 22, 384 38, 22,3-38, 925 10,925, 10925 109 10, 255 25, (10,9-25, 623 8,623, 8623 86 8, 239 23, (8,6-23, p0015 015 p=0,015 p023 p=0,23 556 32,556, 32556 325 32, 567 56, (32,5-56, 150 22,150, 22150 221 505 50, (22,1-50, 1244 1244, 449 (12-44, p092 p=0,92 57, p078 78 p=0,78 (6 97 55,972 5597 55,9-7 27 53,271, 5327 71, 53,2-71 p002 p=0,02 02 33 22,338 2233 22,3-38 10,925 1092 (10,9-25 62 8,623 862 (8,6-23 p001 01 p=0,01 p02 p=0,2 32,556 3255 (32,5-56 15 22,150 2215 (22,1-50 124 (12-44 p09 p=0,9 p07 p=0,7 ( 55,97 55,9- 53,271 53,2-7 p00 p=0,0 22,33 22,3-3 10,92 (10,9-2 8,62 (8,6-2 p0 p=0, 32,55 (32,5-5 22,15 (22,1-5 (12-4 53,27 53,2- 22,3- (10,9- (8,6- p=0 (32,5- (22,1- (12- (10,9 (8,6 p= (32,5 (22,1 (12 (10, (8, (32, (22, (1 (10 (8 (32 (22 (3 (2

Abstract Introduction: Hyperkalemia (HK) is characterized by elevated serum potassium levels and is common in patients with chronic kidney disease, diabetes mellitus and cardio-vascular diseases. Severe hyperkalemia increases the risk of cardiac disturbances and mortality. Real-world studies and international expert groups highlight the urgent need to optimize hyperkalemia management however, consensus in this area is lacking, especially concerning new drugs. We aim to establish a consensus among healthcare professionals in Portugal regarding the effective management of HK in emergency settings. Additionally, we aim to provide recommendations for the adoption of best practices in emergency care. Methods: This qualitative study was based on Delphi consensus. A panel of experts collaboratively identified and discussed five main topics related to HK management and defined 25 treatment statements. An online questionnaire was distributed to doctors who frequently handle emergencies between July and August 2023. A consensus was defined when at least 65% of respondents indicated agreement or strong agreement with a statement. The initial round produced high agreement levels, obviating the need for additional survey rounds. Results: A total of 63 specialist doctors participated in the online questionnaire. There was a very high consensus, with over 90% of participants either agreeing or strongly agreeing with 19 of the 25 statements. These establish that HK is a critical concern for patients with chronic kidney disease, particularly those with a lower estimated glomerular filtration rate (eGFR), elderly population and patients on medications such as inhibitor renin-angiotensin-aldosterone system (iRAAS), angiotensin II receptor blockers ( ARBs), mineralocorticoid-receptor antagonists (MRAs), or potassium-sparing diuretics. They also agree that HK is associated with higher mortality risk, which increases in individuals with underlying conditions or prolonged HK. Statements regarding potassium management involving sodium zirconium cyclosilicate (SZC), patiromer, scavengers in patients on iRAAS, and related to insulin treatment had the lowest consensus levels. Conclusion: A robust consensus among Portuguese healthcare professionals regarding effective HK management in emergency settings was achieved. Experts collaboratively formulated recommendations covering key aspects of the management of HK in emergency settings. Implementing these recommendations will enhance the delivery of harmonized evidence-based medical care and the improvement of clinical outcomes.

Resumo Introdução: A hipercalemia (HK) é caracterizada por níveis serológicos elevados de potássio e é frequente em doentes com doença renal crónica, diabetes mellitus e doenças cardiovasculares, aumentando o risco de complicações cardíacas e morte. Estudos de evidência em mundo real sublinham a necessidade de otimizar a gestão da hipercalemia, no entanto, não existe consenso nesta área, especialmente em relação a novos medicamentos. O nosso objetivo é estabelecer um consenso entre profissionais de saúde em Portugal relativamente à gestão eficaz da HK em situações de urgência e fornecer recomendações para a adoção de melhores práticas. Métodos: Este estudo qualitativo baseou-se no método Delphi. Especialistas identificaram cinco tópicos relacionados com a gestão da HK e definiram 25 afirmações sobre o seu tratamento. Entre julho e agosto de 2023, foi distribuído um questionário online com as afirmações por médicos que atuam frequentemente no serviço de urgência. O consenso foi definido quando pelo menos 65% dos inquiridos indicaram concordância ou forte concordância com cada afirmação. O inquérito inicial obteve resultados consistentes, obviando a necessidade de rondas suplementares. Resultados: Participaram 63 médicos especialistas. Observou-se um consenso muito elevado, de mais de 90% dos participantes a concordarem ou a concordarem fortemente com 19 das 25 afirmações. Estas estabelecem que a HK é uma condição crítica para os doentes com doença renal crónica, particularmente para os com taxa de filtração glomerular inferior, idosos e doentes que medicados com inibidores do sistema renina-angiotensina-aldosterona e bloqueadores dos recetores da angiotensina II, entre outros. Houve concordância também sobre o aumento de risco de mortalidade associado à HK, que acresce em doentes com comorbilidades ou HK prolongada. As afirmações relativas ao ciclossilicato de zircónio de sódio, o patirómero e tratamento com insulina tiveram os níveis de consenso mais baixos. Conclusão: Foi alcançado um consenso entre profissionais de saúde em Portugal relativamente à gestão eficaz da HK. Os especialistas formularam recomendações que destacam aspetos fundamentais para a gestão da HK em situações de urgência. A implementação destas recomendações poderá melhorar a prestação de cuidados médicos harmonizados e baseados na evidência, bem como os resultados clínicos.

A transmissão do vírus Oropouche (OROV) para novas regiões, juntamente com um aumento de casos e o surgimento de formas graves, anteriormente não suspeitas, expressas preocupações de saúde pública. Uma fazendeira grávida de 40 anos, com 30 semanas de gestação, desenvolvimento de febre, mialgia e dor de cabeça, com infecção por OROV confirmada por RT-qPCR. as avaliações maternas e fetais não foram inicialmente concluídas. No entanto, na semana seguinte, um paciente notou diminuição dos movimentos fetais, e o ultrassom confirmou a morte fetal. O diagnóstico molecular detectou o RNA do OROV em vários espécimes fetais. Este caso de transmissão vertical ressalta a necessidade urgente de proteger as mulheres grávidas, incorporar o OROV no diagnóstico diferencial de doenças febris e investigar mais profundamente os potenciais mecanismos patogênicos do vírus.

A transmissão do vírus Oropouche (OROV) para novas regiões, juntamente com um aumento de casos e o surgimento de formas graves, anteriormente não suspeitas, expressas preocupações de saúde pública. Uma fazendeira grávida de 40 anos, com 30 semanas de gestação, desenvolvimento de febre, mialgia e dor de cabeça, com infecção por OROV confirmada por RT-qPCR. as avaliações maternas e fetais não foram inicialmente concluídas. No entanto, na semana seguinte, um paciente notou diminuição dos movimentos fetais, e o ultrassom confirmou a morte fetal. O diagnóstico molecular detectou RNA do OROV em vários espécimes fetais. Este caso de transmissão vertical ressalta a necessidade urgente de proteger as mulheres grávidas, incorporar o OROV no diagnóstico diferencial de doenças febris e investigar mais profundamente os potenciais mecanismos patogênicos do vírus.

A propagação do vírus Oropouche (OROV) em novas regiões, junto com um aumento de casos e o aparecimento de formas graves não reconhecidas anteriormente, suscitou preocupações importantes de saúde pública. Uma granjera embarazada de 40 anos em 30 semanas de gestação apresentou febre, mialgia e dor de cabeça, e a infecção por OROV foi confirmada por RT-qPCR. As avaliações maternas e fetais não foram avaliadas inicialmente. No entanto, na semana seguinte, o paciente notou uma diminuição dos movimentos fetais e a ecografia confirmada a morte fetal. Os diagnósticos moleculares detectam ARN de OROV em múltiplas amostras fetais. Este caso de transmissão vertical justifica a necessidade urgente de proteger as mulheres embaraçadas, incorporar o OROV no diagnóstico diferencial de doenças febris e investigar mais o fundo dos possíveis mecanismos patogênicos do vírus.

Abstract Objective: Enuresis is associated with attentional and emotional comorbidities in 20 to 30 % of cases. The Short Screening Instrument for Psychological Problems in Enuresis (SSIPPE) is a questionnaire that allows the initial screening of these comorbidities. This study aimed to translate, culturally adapt, and validate the SSIPPE for Brazilian children and adolescents (SSIPPE-Br). Methods: Six steps were performed for translation and cross-cultural adaptation: translation, synthesis of translations, back-translation, preparation of the pre-final version of the translated instrument, test of comprehensibility of the pre-final version of the tool, and elaboration of the instrument cross-culturally adapted for Brazil, named 13-itens version SSIPPE-Br. To validate the SSIPPE-Br, a cross-sectional study was carried out, in which the validated Brazilian version of the Child and Adolescent Behavior Inventory (CABI) was used. Results: Validation was performed on 127 children and adolescents with a mean age of 9.7 ± 2.8 years, 48 % male. The reliability was estimated using Cronbach’s alpha, ranging from 0.86 to 0.89, indicating good internal consistency. The factorial analysis had a good agreement adjustment (KMO 0.755, Bartlett’s test < 0.001) and explained 70.5 % of the data variability. In the reproducibility analysis, the Kappa coefficient ranged from 0.94 to 1, which can be considered almost perfect. A highly significant (p-value < 0.001) and direct correlation existed between the three SSIPPE-Br domains and all evaluated CABI domains. Conclusion: The SSIPPE-Br is a valid and reliable tool for emotional problems screening and ADHD symptoms in children and adolescents with enuresis whose first language is Brazilian Portuguese. Objective 2 3 cases (SSIPPE translate adapt SSIPPEBr. SSIPPEBr Br . (SSIPPE-Br) Methods crosscultural cross cultural adaptation translations backtranslation, backtranslation back back-translation prefinal pre final crossculturally Brazil 13itens itens 13 Br. SSIPPEBr, Br, crosssectional sectional out (CABI used Results 12 97 9 7 9. 28 8 2. years 4 male Cronbachs Cronbach s alpha 086 0 86 0.8 089 89 0.89 consistency KMO 0755 755 0.755 Bartletts Bartlett 0.001 0001 001 705 70 5 70. variability 094 94 0.9 1 perfect pvalue p value Conclusion Portuguese (SSIPPE-Br 08 0. 075 75 0.75 0.00 000 00 09 07 0.7 0.0

ABSTRACT Neuroleptic malignant syndrome (NMS) is a neurologic emergency potentially fatal. This rare side effect is most commonly associated with first-generation antipsychotics and less frequently with atypical or second-generation antipsychotics. The diagnosis relies on both clinical and laboratory criteria, with other organic and psychiatric conditions being ruled out. CASE REPORT: A 39-year-old female patient, who is institutionalized and completely dependent, has a medical history of recurrent urinary infections and colonization by carbapenem-resistant Klebsiella pneumoniae. Her regular medication regimen included sertraline, valproic acid, quetiapine, risperidone, lorazepam, diazepam, haloperidol, baclofen, and fentanyl. The patient began experiencing dyspnea. Upon physical examination, she exhibited hypotension and a diminished vesicular murmur at the right base during pulmonary auscultation. Initially, after hospitalization, she developed high febrile peaks associated with hemodynamic instability, prompting the initiation of antibiotic treatment. Despite this, her fever persisted without an increase in blood inflammatory parameters, and she developed purulent sputum, necessitating antibiotherapy escalation. The seventh day of hospitalization showed no improvement in symptoms, suggesting NNMS as a differential diagnosis. All antipsychotic and sedative drugs, as well as antibiotherapy, were discontinued, after which the patient showed significant clinical improvement. CONCLUSION: Antipsychotic agents are commonly employed to manage behavioral changes linked to various disorders. However, their severe side effects necessitate a high degree of vigilance, the cessation of all medications, and the implementation of supportive care measures. A prompt and accurate diagnosis of NMS is crucial to alleviating the severe, prolonged morbidity and potential mortality associated with this syndrome. (NMS fatal firstgeneration first generation secondgeneration second criteria out REPORT 39yearold yearold 39 year old dependent carbapenemresistant carbapenem resistant pneumoniae sertraline acid quetiapine risperidone lorazepam diazepam haloperidol baclofen fentanyl dyspnea examination auscultation Initially instability treatment parameters sputum escalation symptoms drugs discontinued CONCLUSION disorders However vigilance medications measures 3

Abstract We investigated the Biogran on bone repair and metabolism at several time-intervals upon grafting into rat tibia artificial defects. The biomaterial was thoroughly characterized in vitro, and its dissolution behavior upon immersion was assessed in simulated body fluid (SBF) solution for 1, 3, 7, 14, and 30 days. Biogran was also assessed by in vitro hydroxyapatite formation in SBF solution, which is a marker for bioactive behavior. In vivo, distal and proximal bone defects were performed in the Wistar rat's right tibia and filled according to the experimental groups: I) negative control, no filling; II) positive control, 10 mg of autogenous bone; and III) 10 mg of Biogran. Animals were euthanized at 1, 2, 3, 4, 7, and 10 weeks. Bone neoformation was analyzed using histomorphometry (proximal defect), and local levels of bone morphogenetic protein 2 (BMP-2) were measured using the ELISA assay (distal defect). In vitro, the Biogran sample showed a fast dissolution rate within the first 7 days, parallel to the formation of the hydroxyapatite layer. In vivo, the sample was progressively resorbed at a higher rate within the first month until it became almost absent at week 10th. The sample presented similar or higher bone neoformation concerning the autogenous bone. BMP-2 levels were sustained in the Biogran group (around 200 pg/mg) and detected until the last experimental time with a significant difference compared with the controls. Results suggest Biogran is a candidate for hard tissue engineering even in highly active bone remodeling sites. timeintervals intervals (SBF 1 3 14 days vivo rats s groups I control filling II III 4 weeks defect, defect , defect) BMP2 BMP (BMP-2 defect. . layer 10th th BMP- around 20 pg/mg pgmg pg controls sites (BMP- (BMP

Abstract Objective To develop a mobile application with a standardized routine, to be used by general otolaryngologists for evaluating patients with chronic rhinosinusitis. Methods A systematic review was made to identify outcomes, recommendations and what tests that would be used in the routine evaluation of patients with chronic rhinosinusitis; establish an expert consensus on items to be included in this routine evaluation of patients with chronic rhinosinusitis using the Delphi method; development of an application for use on a mobile device, with the routine evaluation of patients with chronic rhinosinusitis. Results Based on the systematic review, the outcomes used in studies about chronic rhinosinusitis were identified, as well as guidelines recommendations, which showed discrepancies between them. These recommendations and outcomes were presented to specialists in chronic rhinosinusitis, until a consensus was reached. As a result of the Delphi method, the flowchart of the routine evaluation of patients with chronic rhinosinusitis was defined, and then was used for the development of the mobile application. Conclusion The creation of the mobile application for evaluating patients with chronic rhinosinusitis followed an adequate methodology of elaboration made by specialists in the field of chronic rhinosinusitis, standardizing the investigation of these patients. Level of evidence: Level 5. method device identified them reached defined evidence 5

ABSTRACT High-sugar dehydrated foods have strong hygroscopicity, which can be avoided by using drying aids. One way to assess the hygroscopic behavior is through sorption isotherms. The objective of this work was to evaluate the influence of maltodextrin concentration on sorption isotherms of powdered cajá-manga pulp in spray-dryer, lyophilization and fluidized bed spray drying processes. The dryings were carried out in a spray-dryer, lyophilizer and fluidized bed, with 10%, 20% and 30% of maltodextrin. Adsorption isotherms were determined by the static gravimetric method using salt solutions for a relative humidity range of 21% to 90%. The GAB, BET, Henderson, and Oswin models were adequate to the experimental data. The relative deviation between the experimental values and the estimated values was calculated for each curve, in order to assess which equation best fit the experimental data. The mean relative error value of less than 10% was considered one of the criteria for selecting the models. The BET (A), BET (B) and GAB (C) models had the lowest error means, 3.35%, 3.35% and 5.28%, for cajá-manga powders obtained by spray-dryer, lyophilization and fluidized bed spray drying processes, respectively, and coefficients of determination above 0.99. It is concluded that the type of drying process did not influence the behavior of the adsorption isotherms, and that increases in maltodextrin concentration and temperature are significant in reducing equilibrium moisture contents. Highsugar High sugar hygroscopicity aids cajámanga cajá manga spraydryer, spraydryer dryer, dryer spray-dryer processes 10 20 30 21 90 90% Henderson data curve A, A , (A) B (B C (C means 335 3 35 3.35 528 5 28 5.28% respectively 099 0 99 0.99 contents 1 2 9 (A 33 3.3 52 5.28 09 0.9 3. 5.2 0. 5.

Abstract Cancer is a complex and multifactorial disease characterized by uncontrolled cell growth and is one of the main causes of death in the world. This work aimed to evaluate a small series of 10 different indole-thiosemicarbazone compounds as potential antitumor agents. This is a pioneering study. For this, the antioxidant and cytotoxic capacity against normal and tumor cells was evaluated. The results showed that the compounds were able to promote moderate to low antioxidant activity for the ABTS radical scavenging assay. ADMET in silico assays showed that the compounds exhibited good oral bioavailability. As for toxicity, they were able to promote low cytotoxicity against normal cells, in addition to not being hemolytic. The compounds showed promising in vitro antitumor activity against the T47D, MCF-7, Jurkat and DU-145 strains, not being able to inhibit the growth of the Hepg2 strain. Through this in vitro study, it can be concluded that the compounds are potential candidates for antitumor agents. world 1 indolethiosemicarbazone indole thiosemicarbazone agents study evaluated assay bioavailability toxicity hemolytic T47D TD T D MCF7, MCF7 MCF 7, 7 MCF-7 DU145 DU 145 DU-14 strains Hepg strain MCF- DU14 14 DU-1 DU1 DU-

Abstract Patient Blood Management (PBM) is a holistic approach to managing blood as a resource of each patient; it is a multimodal strategy that is implemented using a set of techniques that can be applied in individual cases. In fact, the overall result of the implementation of PBM cannot be fully appreciated or explained by simply summing up the effects of the individual strategies and techniques used, since they can only produce the expected ideal result if combined. Implementing a PBM program in healthcare offers several benefits including improved patient safety, better outcomes, cost savings, conservation of resources, evidence-based practice, transfusion alternatives, improved quality of care, compliance with accreditation standards, patient-centered care, and professional education and training. (PBM cases fact used combined safety outcomes savings resources evidencebased evidence based practice alternatives care standards patientcentered centered training

Abstract Managing the patient's blood and hematopoietic system is like managing any of the other organs and organ systems during patient care. Specialists control the heart, kidneys, endocrine system, etc. and the patient's blood requires similar clinical treatment. The hematopoietic system and its circulatory products are fundamental for the healthy functioning of the human body. In simple terms, Patient Blood Management (PBM) is an organized, patient-centered approach in which the entire healthcare team coordinates efforts to improve outcomes by managing and preserving the patient's own blood. By reducing dependence on blood transfusions, PBM seeks to improve clinical outcomes, reduce the risks and costs associated with transfusions, and improve the safety and quality of patient care. Essentially, the concept of PBM is about the holistic management and preservation of the patient's own blood in the medical and surgical context. patients s care heart kidneys etc treatment body terms (PBM organized patientcentered centered transfusions Essentially context

Abstract Patient Blood Management (PBM) is a multidimensional approach that seeks to optimize the use of blood and its components in patients. This matter emerged as a response to the need to reduce unnecessary exposure to blood transfusions and their potential risks. In the past, blood transfusion was often overused resulting in complications and high costs. The advent of Patient Blood Management has caused a paradigm shift, highlighting anemia prevention, bleeding control and maximizing the production of blood cells by the organism itself. Patient Blood Management guidelines include the early identification of anemia, strategies to minimize blood loss during surgery, intraoperative blood conservation techniques, preoperative hemoglobin optimization and evidence-based approaches to the rational use of blood transfusions. Aiming to improve clinical outcomes, decrease transfusion-related complications and reduce associated costs, this multidisciplinary approach counts on doctors, nurses, pharmacists and other healthcare professionals. Based on research and clinical evidence, Patient Blood Management continues to evolve thereby promoting safer, more effective patient-centered practices. Its implementation has proven beneficial in various medical contexts thereby contributing to improvements in the quality of care provided to patients. Our goal with this Consensus is to present readers with a broad and diverse view of Patient Blood Management so that they have the building blocks to implement this new technique. PBM (PBM patients risks past costs shift prevention itself surgery techniques evidencebased evidence based outcomes transfusionrelated related doctors nurses professionals safer patientcentered patient centered practices technique

Abstract Thiosemicarbazones are promising classes of compounds with antitumor activity. For this study, six 2,4-dihydroxy-benzylidene-thiosemicarbazones compounds were synthesized. These compounds were submitted to different assays in silico, in vitro and in vivo to evaluate the toxicological, antioxidant and antitumor effects. The in silico results were evaluated by the SwissADME and pkCSM platforms and showed that all compounds had good oral bioavailability profiles. The in vitro and in vivo toxicity assays showed that the compounds showed low cytotoxicity against different normal cells and did not promote hemolytic effects. The single dose acute toxicity test (2000 mg/kg) showed that none of the compounds were toxic to mice. In in vitro antioxidant activity assays, the compounds showed moderate to low activity, with PB17 standing out for the ABTS radical capture assay. The in vivo antioxidant activity highlighted the compounds 1, 6 and 8 that promoted a significant increase in the concentration of liver antioxidant enzymes. Finally, all compounds showed promising antitumor activity against different cell lines, especially MCF-7 and DU145 lines, in addition, they inhibited the growth of sarcoma 180 at concentrations lower than 50 mg/kg. These results showed that the evaluated compounds can be considered as potential antitumor agents. study 2,4dihydroxybenzylidenethiosemicarbazones 24dihydroxybenzylidenethiosemicarbazones dihydroxybenzylidenethiosemicarbazones 2,4 dihydroxy benzylidene thiosemicarbazones 2 4 synthesized toxicological effects profiles 2000 (200 mg/kg mgkg mg kg mice PB PB1 assay 1 enzymes Finally lines MCF7 MCF 7 MCF- DU DU14 addition 18 5 agents 4dihydroxybenzylidenethiosemicarbazones 24 2, 200 (20 DU1 20 (2 (