ABSTRACT During the state of immune vulnerability in hematopoietic stem cell transplantation (HSCT), the patient has an increased risk of developing a vast number of complications, including severe problems in the oral cavity. These situations require professional oral care to act in the diagnosis and treatment of these conditions, as well as to develop prevention protocols to minimize patient's complications. Oral mucositis, opportunistic infections, bleeding, specific microbiota, taste, and salivary alterations are complications that can occur during HSCT and interfere with various aspects, such as pain control, oral intake, nutrition, bacteremia and sepsis, days of hospitalization and morbidity. Several guidelines have been published to address the role of professional oral care during the HSCT, we describe a consensus regarding these recommendations.

Abstract Isthmocele is a discontinuation of the myometrium at the uterine scar site in a patient with a previous cesarian section (CS). The cause of isthmocele appears to be multifactorial. Poor surgical technique, low incision location, uterine retroflection, obesity, smoking, inadequate healing of scars, and maternal age are possible related factors. Most patients with this condition are asymptomatic. However, women can present with postmenstrual bleeding, pelvic pain, subfertility, dysmenorrhea, infertility, and scar abscess. Brazil has one of the world s highest cesarean section rates. One of the consequences of the rising rate of CS is the isthmocele, an emerging female health problem. Here we report a case of mucinous cystadenoma arising in a uterine isthmocele, a complication, as far as we could investigate, not yet described in the literature.

Resumo Istmocele é a descontinuidade do miométrio no local da cicatriz uterina em paciente com cesariana anterior. A causa da istmocele parece ser multifatorial. Má técnica cirúrgica, baixa localização da incisão, retroflexão uterina, obesidade, tabagismo, cicatrização inadequada de cicatrizes e idade materna são possíveis fatores relacionados. A maioria dos pacientes com esta condição é assintomática. No entanto, as mulheres podem apresentar sangramento pós-menstrual, dor pélvica, subfertilidade, dismenorreia, infertilidade e abscesso cicatricial. O Brasil tem uma das maiores taxas de cesariana do mundo. Uma das consequências da taxa crescente de cesarianas é a istmocele, um problema emergente de saúde feminina. Aqui relatamos um caso de cistoadenoma mucinoso originado em uma istmocele uterina, uma complicação ainda não descrita, até onde pudemos investigar.

RESUMO Introdução O Hibiscus Sabdariffa (Hs) tem sido amplamente utilizado para emagrecimento e no combate às comorbidades associadas à obesidade. Objetivos Avaliar os efeitos do Hs e do treinamento físico sobre a capacidade funcional de ratos eutróficos e obesos. Métodos Ratos Wistar foram distribuídos em oito grupos experimentais: Controle (C, n = 8), Hibiscus Sabdariffa (Hs, n = 8), treinamento intervalado de alta intensidade (TI, n = 8), treinamento intervalado de alta intensidade + Hibiscus Sabdariffa (TIHs, n = 8), obeso (O, n = 8), obeso + treinamento contínuo aeróbico (OTA, n = 8), obeso+ Hibiscus Sabdariffa (OHs, n = 8), obeso + treinamento contínuo aeróbico + Hibiscus Sabdariffa (OTAHs, n = 8). O extrato de Hibiscus Sabdariffa foi administrado por 60 dias na dose de 150 mg/kg de peso corporal. Foi realizado teste de esforço progressivo máximo (TEPM) em esteira no início e no final do estudo. As variáveis analisadas foram: velocidade máxima (Vmáx), tempo e distância percorrida. O lactato foi mensurado imediatamente depois do TEMP. A capacidade funcional foi avaliada pela distância/índice de adiposidade. Empregou-se ANOVA com post hoc de Bonferroni e correlação de Pearson, adotando-se o nível de significância de 5%. Resultados Depois de ambos os tipos de treinamento, o contínuo em moderada intensidade e o intervalado de alta intensidade realizados em esteira, reduziram o peso corporal final, o ganho de peso e o índice de adiposidade, bem como aumentaram a Vmáx, tempo e distância percorrida no TEPM, além de melhora da capacidade funcional. A suplementação de Hs diminuiu o índice de adiposidade nos ratos eutróficos e obesos. O Hs associado ao treinamento aeróbico reduziu o peso corporal final e aumentou a capacidade funcional. Conclusão A suplementação de Hs promoveu redução no índice de adiposidade em ratos eutróficos e obesos e aumentou a capacidade funcional de ratos obesos treinados. Nível de evidência III; Estudos Terapêuticos - Investigação de Resultados. Estudo caso controle .

ABSTRACT Introduction Hibiscus sabdariffa (Hs) has been widely used for weight loss and in the fight against obesity-associated comorbidities. Objective To evaluate the effects of Hs and physical training on the functional capacity of normal-weight and obese rats. Methods Wistar rats were distributed into eight experimental groups: control (C, n = 8) , Hibiscus Sabdariffa (Hs, n = 8), high-intensity interval training (IT, n = 8), high-intensity interval training + Hibiscus Sabdariffa (ITHs, n = 8), obese (O, n = 8), obese + continuous aerobic training (OAT, n = 8), obese + Hibiscus Sabdariffa (OHs, n = 8), , and obese + continuous aerobic training + Hibiscus Sabdariffa (OATHs, n = 8). Hibiscus Sabdariffa extract was administered for 60 days in a dose of 150 mg/kg of body weight. The maximum progressive effort test (MPET) was performed on a treadmill at the beginning and end of the study. The variables analyzed were maximum speed Vmáx time, and distance covered. Lactate was measured immediately after the MPET. Functional capacity was evaluated by the distance/adiposity index. The ANOVA with Bonferroni post hoc and Pearson’s correlation tests were used at a 5% significance level. Results After both types of training, moderate-intensity continuous and high-intensity interval performed on the treadmill, final body weight, weight gain, and the adiposity index decreased, and Vmax, time, and distance covered in the MPET increased, in addition to an improvement in functional capacity. Hs supplementation reduced the adiposity index in normal-weight and obese rats. Hs associated with aerobic training reduced final body weight and increased functional capacity. Conclusion Hs supplementation promoted a reduction in the adiposity index in normal-weight and obese rats and an increase in the functional capacity of trained obese rats. Level of Evidence III; Therapeutic Studies - Outcome Investigation. Case study – control.

RESUMEN Introducción El Hibiscus Sabdariffa (Hs) ha sido ampliamente utilizado para promover la pérdida de peso y tratar las comorbilidades asociadas a la obesidad. Objetivos Evaluar los efectos del Hs y el entrenamiento físico sobre la capacidad funcional de ratas eutróficas y obesas. Métodos Se distribuyeron ratas Wistar en ocho grupos experimentales: Control (C, n=8), Hibiscus Sabdariffa (Hs, n=8), , entrenamiento de intervalos de alta intensidad (EI, n=8)), entrenamiento de intervalos de alta intensidad + Hibiscus Sabdariffa (EIHs, n=8), obeso (O, n=8)), obeso + entrenamiento continuo aeróbico (OEA, n=8), obeso + Hibiscus Sabdariffa (OHs, n=8), obeso + entrenamiento continuo aeróbico + Hibiscus Sabdariffa (OEAHs, n=8). Se administró extracto de Hibiscus Sabdariffa durante 60 días a una dosis de 150 mg / kg de peso corporal. Se realizó una prueba de esfuerzo progresivo máximo (PEPM) en una cinta rodante al principio y al final del estudio. Las variables analizadas fueron: velocidad máxima Vmáx, tiempo y distancia recorrida. El nivel de lactato se midió inmediatamente después de la PEPM. La capacidad funcional se evaluó mediante el índice de distancia / adiposidad. Se empleó el método ANOVA con post hoc de Bonferroni y las pruebas de correlación de Pearson, a un nivel de significancia del 5%. Resultados Después de ambos tipos de entrenamiento, el entrenamiento continuo a intensidad moderada y el entrenamiento de intervalos de alta intensidad realizados en cinta rodante, las ratas presentaron disminución del peso corporal final, aumento de peso e índice de adiposidad, así como aumentaron la Vmax, el tiempo y la distancia recorrida en la PEPM, y mejoraron la capacidad funcional. La suplementación con Hs disminuyó el índice de adiposidad en ratas eutróficas y obesas. El Hibiscus asociado al entrenamiento aeróbico redujo el peso corporal final y aumentó la capacidad funcional. Conclusión La suplementación con Hs redujo el índice de adiposidad en ratas eutróficas y obesas y aumentó la capacidad funcional de ratas obesas entrenadas. Nivel de Evidencia III; Estudios Terapéuticos - Investigación de Resultados. Estudio de caso – control.

Abstract The N-(n-butyl) thiophosphoric triamide (NBPT), a urease inhibitor, has been reported as one of the most promising compounds to reduce losses by volatilization, and to maximize the use of urea nitrogen (N) in agricultural systems. A field study was carried out to examine urease inhibitors' potential about volumetric density and forage mass grass (Brachiaria brizantha cv. Xaraés) to N application. The experiment was carried out from September 2017 to September 2018. The experimental design used was complete randomized blocks in the 3×2×4 factorial array, considering: three periods of the year (wet season, dry season, and the transition), two sources of urea (conventional urea and NBPT-treated urea), and four N rates (0, 80, 160 and 240 kg N ha-1 yr-1), replicated three times. Nitrogen sources promoted a positive effect (P<0.0001) on bulk density, forage mass, and in the grazing stratum during the wet season and the transition season, with increasing N rates in pastures. The leaf: stem ratio decreased linearly (P<0.0045) as increased N rates, and the higher ratio during the wet season and lower in the dry season of the year. For the rates of 80 kg N ha-1 yr-1, there was a significant difference (P=0.0042) between sources, with greater (P=0.0006) forage mass of 0-30 cm, post-grazing forage mass (P=0.0042) and forage volumetric density (P=0.0006), when utilized the conventional urea. The application of N, regardless of the source, provides an increase in forage mass and volumetric density in Xaraés grass pastures up to a dose of 240 kg N ha-1 yr-1, in the transition season and wet season.

Resumen La N-(n-butil) triamida tiofosfórica (NBPT) es un inhibidor de la ureasa usado en los sistemas agrícolas para reducir las pérdidas por volatilización de NH3 y maximizar el uso del nitrógeno ureico (N). Se realizó un estudio de campo para evaluar el efecto de la urea tratada con NBPT sobre la densidad volumétrica y la masa de forraje en el pasto Brachiaria brizantha cv. Xaraés. El periodo experimental fue de un año (septiembre 2017 a septiembre 2018). El diseño experimental fue de bloques completamente aleatorios con un arreglo factorial de 3×2×4: tres estaciones del año (lluvia, sequía y transición), dos fuentes de urea (convencional y tratada con NBPT), y cuatro tasas de N (0, 80, 160 y 240 kg N ha-1 año-1). Se hicieron tres réplicas. Ambas fuentes de nitrógeno tuvieron un efecto positivo (P<0.0001) sobre la densidad aparente, la masa de forraje y el estrato de pastoreo durante la estación de lluvia y la de transición. También produjeron aumentos de N en los pastos. La relación hoja:tallo disminuyó linealmente (P<0.0045) a medida que aumentaron las tasas de N; la relación mayor fue durante la estación de lluvia y la menor en la estación de sequía. A la tasa de 80 kg N ha-1 año-1, hubo una diferencia (P=0.0042) entre las fuentes de N. A esta tasa la urea convencional produjo una mayor (P=0.0006) masa de forraje total, masa de forraje pospastoreo (P= 0.0042) y densidad volumétrica del forraje (P=0.0006). En las estaciones de lluvia y de transición, la aplicación de N, cual sea la fuente, resultó en un aumento en la masa y la densidad volumétrica del forraje en praderas de pasto Xaraés hasta la tasa de 240 kg N ha-1 año-1.

SUMMARY OBJECTIVE: This study aimed to compare the effects of therapeutic ultrasound and paraffin with or without vacuum massage on the biomechanical properties of grafted skin after a burn. METHODS: A total of 44 patients with deep second- and third-degree burns, with a mean age of 35.89 (±11.53) years, who visited the Hospital Burn Unity, were included in the study. The therapeutic interventions were randomly defined by drawing lots, with a crossover design (crossover), and a minimum interval of 7 days (washout) between interventions. Skin biomechanical parameters such as distensibility (R0) and viscoelasticity (R6) were noninvasively evaluated by Cutometer before and after 0, 10, 20, and 30 min of intervention with therapeutic ultrasound and paraffin alone, as well as associated with negative pressure therapy of the skin (vacuum therapy). In this study, all groups showed increased distensibility (R0) in the period immediately after the application of the resources and a progressive reduction in the effects in the consecutive tests. Participants with skin grafts showed a decrease in viscoelasticity (R6) in all groups, except therapeutic paraffin and therapeutic ultrasound and vacuum massage. CONCLUSION: The biomechanical properties of grafted skin after a burn are altered after therapeutic intervention with ultrasound alone or associated with vacuum massage, such as intervention with paraffin associated with vacuum massage, for both parameters evaluated, skin distensibility (R0) and skin viscoelasticity (R6). However, the same did not occur for the intervention with isolated paraffin. There was no significant difference between the interventions therapeutic ultrasound and therapeutic paraffin.

Several recent studies have investigated if support for Jair Bolsonaro in the presidential election of 2018 is positively associated with COVID-19 infections and deaths in Brazil. In these studies, COVID-19 outcomes in 2020 and 2021 are the dependent variables, and votes for Jair Bolsonaro in the 2018 presidential election (as a proxy for ideology) are the key explanatory variable. This article discusses why ecological research designs are difficult to test empirically. We discuss why correlations between vote shares and COVID-19 outcomes using aggregate data can produce biased inferences, and we specifically focus on measurement error, aggregation bias, and spatial and temporal dynamics.

Resumo Objetivo Opresente estudotemcomo objetivo obter informações demográficas básicas, o nível de interesse e de treinamento em ginecologia oncológica entre obstetras e ginecologistas (OB-GYNs) brasileiros para criar um perfil destes profissionais. Métodos Umquestionário online foi enviado a 16.008 ginecologistas filiados à Federação Brasileira de Associações de Ginecologia e Obstetrícia (FEBRASGO). Nós consideramos ginecologistas dedicados à oncologia ginecológica (OB-GYNsONCO) aqueles que referiram atuar em > 50% de sua prática diária com o tratamento do câncer feminino. Resultados Um total de 1.608 (10%) dos 16.008 membros da FEBRASGO responderam ao questionário. Os OB-GYNs estão concentrados nos estados do sul e sudeste do Brasil. A oncologia ginecológica foi considerada a 8ª área de maior interesse em ginecologia entre os OB-GYNs. Um total de 95 (5,9%) dos OB-GYNs foram considerados ginecologistas dedicados à oncologia ginecológica (OB-GYNs ONCO). Obstetras e ginecologistas estão ativamente envolvidos no tratamento do câncer: > 60% deles dedicam até 25% de sua prática diária à oncologia. O papel dosmédicos na triageme na prevenção, no diagnóstico, no tratamento de lesões pré-cancerosas e em procedimentos cirúrgicos de baixa complexidade é notavelmente alto. Ginecologistas dedicados à oncologia ginecológica no Brasil têm umperíodo de treinamento emoncologia ginecológica heterogêneo, não padronizado e curto. Estes profissionais tiveram um papel mais significativo na realização de operações de média e alta complexidade em comparação com OB-GYNs (65,2% versus 34%, e 47,3% versus 8,4%, respectivamente). Conclusão Os papéis dos OB-GYN e dos OB-GYNs ONCO parecem ser complementares. Os OB-GYNs frequentemente atuam emtriageme prevenção e em procedimentos cirúrgicos de baixa complexidade, enquanto os OB-GYNs ONCO estão mais envolvidos em casos demais alta complexidade. Estratégias para elevar os padrões de treinamento em oncoginecologia e incentivar o reconhecimento da oncologia ginecológica como uma subespecialidade devem ser adotadas no Brasil.

Abstract Objective The present study aims to obtain basic demographic information, the level of interest and of training in gynecology oncology among Brazilian obstetricians and gynecologists (OB-GYNs) to create a professional profile. Methods An online questionnaire was sent to 16,008 gynecologists affiliated to the Brazilian Federation of Associations of Gynecology and Obstetrics (FEBRASGO, in the Portuguese acronym). We considered gynecologists dedicated to gynecologic oncology (OB-GYNs ONCO) those who self-reported that > 50% of their daily practice consists in working with women’s cancer care. Results A total of 1,608 (10%) of 16,008 FEBRASGO members responded. The OBGYNs are concentrated in the southern and southeastern states of Brazil. Gynecologic oncology was considered the 8th greatest area of interest in gynecology among the OBGYNs. A total of 95 (5.9%) of the OB-GYNs were considered OB-GYNs ONCO. Obstetricians and gynecologists are actively engaged in cancer care: > 60% of them dedicate up to 25% of their daily practice to oncology. The role of the physicians in screening and prevention, diagnosis, in the treatment of precancerous lesions, and in low complexity surgical procedures is notably high. Gynecologists dedicated to gynecologic oncology in Brazil have a heterogeneous, nonstandardized and short training period in gynecologic oncology. These professionals had a more significantly role in performing medium- and high-complexity operations compared with OB-GYNs (65.2% versus 34%, and 47.3% versus 8.4%, respectively). Conclusion The role of OB-GYNs and of OB-GYNs ONCO appears to be complementary. Obstetricians and gynecologists actmore often in screening and prevention and in low-complexity surgical procedures, whereas OB-GYNs ONCO are more involved in highly complex cases. Strategies to raise standards in cancer training and to encourage the recognition of gynecologic oncology as a subspecialty should be adopted in Brazil.

OBJECTIVES: Despite the number of surgical advances and innovations in techniques over time, radical vulvectomy frequently results in substantial loss of tissue that cannot be primarily closed without tension, the mobilization of surrounding tissues or even the rotation of myocutaneous flaps. The aim of this study was to evaluate the feasibility of leaving the surgical vulvar open wound for secondary healing in situations where primary closure of the vulvar wound is not possible. METHODS: This case-control pilot study analyzed 16 women with a diagnosis of squamous cell carcinoma of the vulva who first underwent inguinofemoral lymphadenectomy, 6-week sessions of chemotherapy and 25 daily sessions of radiotherapy. Afterward, excision of the vulvar lesion with free margins was performed between January 2011 and July 2017. Twelve patients underwent primary closure of the wound (control), and in 4 patients, the surgical wound was left open for secondary healing by means of a hydrofiber (case). The inclusion criteria were a) FIGO-2009 stage II up to IIIC; b) squamous cell carcinoma; and c) no evidence of pelvic or extrapelvic disease or pelvic nodal involvement. The exclusion criteria were extrapelvic disease or pelvic nodal involvement, another primary cancer, or a poor clinical condition. ClinicalTrials.gov: NCT02067052. RESULTS: The mean age of the patients at the time of the intervention was 62.1. The distribution of the stages was as follows: II, n=6 (37 %); IIIA, n=1 (6%), IIIB, n=1 (6%) and IIIC, n=8 (51%). The mean operative time was 45 minutes. The hospital stay duration was 2 days. Full vulvar healing occurred after an average of 30 days in the control group and after an average of 50 days in the case group. CONCLUSION: A secondary healing strategy may be an option for the treatment of vulvar cancer in situations of non-extensive surgical wounds when primary closure of the wound is not possible.

Resumo Introdução: Algumas características peculiares da Síndrome de Down (SD), como a frouxidão ligamentar, hipotonia, atraso na aquisição da marcha, dentre outras, podem gerar alterações na distribuição das pressões plantares, modificando o apoio plantar. Objetivo: Verificar se existem diferenças na avaliação da distribuição das pressões plantares, na postura de pé, entre os instrumentos de mensuração Baropôdometro, SAPO e Radiografia. Método: Estudo transversal que avaliou dez crianças com SD e dez crianças com desenvolvimento normal (DN), com idade entre dois e cinco anos. Para avaliação da distribuição das pressões plantares foram utilizados a biofotogrametria, baropodometria e radiografia dos pés. Foi utilizado a análise Kappa para avaliar o índice de concordância entre os diferentes instrumentos. Resultados: As crianças com SD e DN apresentaram maior prevalência de pés pronados nos três instrumentos, havendo concordância de pobre a substancial entre os instrumentos. Conclusão: Houve maior prevalência de pés pronados nos dois grupos de acordo com os instrumentos utilizados neste estudo. Foram encontradas diferenças na avaliação da distribuição das pressões plantares na postura de pé entre o Baropôdometro, SAPO e Radiografia, devendo estes instrumentos serem usados de forma complementar, já que se propõem a avaliar aspectos distintos do alinhamento dos pés.

Abstract Introduction: Some peculiar features of Down Syndrome (DS), such as ligament laxity, hypotonia, delay in gait acquisition, among others, may generate alterations in the distribution of plantar pressures, modifying the plantar support. Objective: To verify whether there are differences in the evaluation of plantar pressure distributions in standing posture between the measurement instruments (Baropodometer, SAPO, and Radiography). Method: This was a cross-sectional study, evaluating ten children with SD and ten children with normal development (ND), aged from two to five years old. Bio-photogrammetry, baropodometry, and foot radiography were used to assess the plantar pressure distribution. Kappa analysis was used to evaluate the agreement index between the different instruments. Results: Children with DS and ND had a higher prevalence of pronated feet in all three instruments, with poor to substantial agreement among the instruments. Conclusion: According to this study instruments, there was a greater prevalence of pronated feet in the two groups . Differences in the evaluation of the distribution of plantar pressures in the standing posture between the Baropodometer, SAPO, and radiography were observed. These instruments should be used in a complementary manner, as they propose to evaluate different aspects of the feet alignment.

Resumen Introducción: Algunas características peculiares del Síndrome de Down (SD), como la flojedad ligada, hipotonía, retraso en la adquisición de la marcha, entre otras, pueden generar alteraciones en la distribución de las presiones plantares, modificando el apoyo plantar. Objetivo: Verificar si existen diferencias en la evaluación de la distribución de las presiones plantares, en la postura de pie, entre los instrumentos de medición Baropôdometro, SAPO y Radiografía. Método: Estudio transversal que evaluó diez niños con SD y diez niños con desarrollo normal (DN), con edad entre dos y cinco años. Para la evaluación de la distribución de las presiones plantares se utilizaron biofotogrametría, baropodometría y radiografía de los pies. Se utilizó el análisis Kappa para evaluar el índice de concordancia entre los diferentes instrumentos. Resultados: Los niños con SD y DN presentaron mayor prevalencia de pies pronados en los tres instrumentos, habiendo concordancia de pobre a sustancial entre los instrumentos. Conclusión: Hubo una mayor prevalencia de pies pronados en los dos grupos de acuerdo con los instrumentos utilizados en este estudio. Se encontraron diferencias en la evaluación de la distribución de las presiones plantares en la postura de pie entre el Baropôdometro, SAPO y Radiografía, debiendo estos instrumentos ser utilizados de forma complementaria, ya que se proponen a evaluar aspectos distintos de la alineación de los pies.