Abstract Fluoride (F) has been widely used to control dental caries, and studies suggest beneficial effects against diabetes when a low dose of F is added to the drinking water (10 mgF/L). Objectives This study evaluated metabolic changes in pancreatic islets of NOD mice exposed to low doses of F and the main pathways altered by the treatment. Methodology In total, 42 female NOD mice were randomly divided into two groups, considering the concentration of F administered in the drinking water for 14 weeks: 0 or 10 mgF/L. After the experimental period, the pancreas was collected for morphological and immunohistochemical analysis, and the islets for proteomic analysis. Results In the morphological and immunohistochemical analysis, no significant differences were found in the percentage of cells labelled for insulin, glucagon, and acetylated histone H3, although the treated group had higher percentages than the control group. Moreover, no significant differences were found for the mean percentages of pancreatic areas occupied by islets and for the pancreatic inflammatory infiltrate between the control and treated groups. Proteomic analysis showed large increases in histones H3 and, to a lesser extent, in histone acetyltransferases, concomitant with a decrease in enzymes involved in the formation of acetyl-CoA, besides many changes in proteins involved in several metabolic pathways, especially energy metabolism. The conjunction analysis of these data showed an attempt by the organism to maintain protein synthesis in the islets, even with the dramatic changes in energy metabolism. Conclusion Our data suggests epigenetic alterations in the islets of NOD mice exposed to F levels comparable to those found in public supply water consumed by humans.

BACKGROUND A positive Trypanosoma cruzi polymerase chain reaction (PCR) is associated with a worse prognosis in patients with chronic Chagas disease (CD). OBJECTIVES To study the association of clinical, electrocardiographic, and echocardiographic characteristics and biomarker blood levels with positive T. cruzi PCR in chronic CD. METHODS This is a single-centre observational cross-sectional study. Positive T. cruzi PCR association with clinical, electrocardiographic, and echocardiographic characteristics, and biomarker blood levels were studied by logistic regression analysis. p values < 0.05 were considered significant. FINDINGS Among 333 patients with chronic CD (56.4% men; 62 ± 10 years), T. cruzi PCR was positive in 41.1%. Stepwise multivariate logistic regression showed an independent association between positive T. cruzi PCR and diabetes mellitus {odds ratio (OR) 0.53 [95% confidence interval (CI) 0.30-0.93]; p = 0.03}, right bundle branch block [OR 1.78 (95% CI 1.09-2.89); p = 0.02], and history of trypanocidal treatment [OR 0.13 (95% CI 0.04-0.38); p = 0.0002]. Among patients with a history of trypanocidal treatment (n = 39), only four (10%) patients had a positive T. cruzi PCR. MAIN CONCLUSIONS Among several studied parameters, only diabetes mellitus, right bundle branch block, and history of trypanocidal treatment showed an independent association with positive T. cruzi PCR. History of trypanocidal treatment was a strong protective factor against a positive T. cruzi PCR.

Abstract Background Some studies have suggested the HLA-B27 gene may protect against some infections, as well as it could play a benefit role on the viral clearance, including hepatitis C and HIV. However, there is lack of SARS-CoV-2 pandemic data in spondyloarthritis (SpA) patients. Aim To evaluate the impact of HLA-B27 gene positivity on the susceptibility and severity of COVID-19 and disease activity in axial SpA patients. Methods The ReumaCoV-Brasil is a multicenter, observational, prospective cohort designed to monitor immunemediated rheumatic diseases patients during SARS-CoV-2 pandemic in Brazil. Axial SpA patients, according to the ASAS classification criteria (2009), and only those with known HLA-B27 status, were included in this ReumaCov-Brasil's subanalysis. After pairing them to sex and age, they were divided in two groups: with (cases) and without (control group) COVID-19 diagnosis. Other immunodeficiency diseases, past organ or bone marrow transplantation, neoplasms and current chemotherapy were excluded. Demographic data, managing of COVID-19 (diagnosis, treatment, and outcomes, including hospitalization, mechanical ventilation, and death), comorbidities, clinical details (disease activity and concomitant medication) were collected using the Research Electronic Data Capture (REDCap) database. Data are presented as descriptive analysis and multiple regression models, using SPSS program, version 20. P level was set as 5%. Results From May 24th, 2020 to Jan 24th, 2021, a total of 153 axial SpA patients were included, of whom 85 (55.5%) with COVID-19 and 68 (44.4%) without COVID-19. Most of them were men (N = 92; 60.1%) with mean age of 44.0 ± 11.1 years and long-term disease (11.7 ± 9.9 years). Regarding the HLA-B27 status, 112 (73.2%) patients tested positive. There were no significant statistical differences concerning social distancing, smoking, BMI (body mass index), waist circumference and comorbidities. Regarding biological DMARDs, 110 (71.8%) were on TNF inhibitors and 14 (9.15%) on IL-17 antagonists. Comparing those patients with and without COVID-19, the HLA-B27 positivity was not different between groups (n = 64, 75.3% vs. n = 48, 48%, respectively; p = 0.514). In addition, disease activity was similar before and after the infection. Interestingly, no new episodes of arthritis, enthesitis or extra-musculoskeletal manifestations were reported after the COVID-19. The mean time from the first symptoms to hospitalization was 7.1 ± 3.4 days, and although the number of hospitalization days was numerically higher in the B27 positive group, no statistically significant difference was observed (5.7 ± 4.11 for B27 negative patients and 13.5 ± 14.8 for B27 positive patients; p = 0.594). Only one HLA-B27 negative patient died. No significant difference was found regarding concomitant medications, including conventional or biologic DMARDs between the groups. Conclusions No significant difference of COVID-19 frequency rate was observed in patients with axial SpA regarding the HLA-B27 positivity, suggesting a lack of protective effect with SARS-CoV-2 infection. In addition, the disease activity was similar before and after the infection. Trial registration This study was approved by the Brazilian Committee of Ethics in Human Research (CONEP), CAAE 30186820.2.1001.8807, and was registered at the Brazilian Registry of Clinical Trials – REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.

RESUMO Os indicadores de desempenho são ferramentas capazes de expor características mensuráveis e gerar informações relevantes das operações florestais, sendo considerados pilares para uma tomada de decisão ágil e assertiva por parte dos gestores. A extração florestal com forwarder deve ser aperfeiçoada, compreendendo os fatores que afetam os custos desta máquina, como produtividade (TP), consumo de combustível (TC), eficiência operacional (EO) e qualidade da operação. Dessa forma, o objetivo estudo foi avaliar a implementação do indicador Eficiência Global de Máquinas Florestais (EGMF) na gestão dos dados da extração florestal com uso de forwarders. Os dados foram coletados durante a extração florestal de cinco frotas em operação, em plantios comerciais de Eucalipto, em regimes de alto fuste e talhadia, nos estados da Bahia e Espírito Santo. O indicador foi expresso em percentual, calculado por: E G M F = ( ( 4 ∗ T P ) + ( 3 ∗ T C ) + ( 3 ∗ E O ) ) / 10. O desempenho das máquinas foi avaliado com um modelo estocástico de simulação dinâmica de sistemas em oito cenários, propondo melhorias no volume médio individual colhido, consumo de combustível e paradas mecânicas ou operacionais. As análises foram realizadas com o software PowerSim Studio 9. O EGMF de duas das cinco frotas estudadas foi maior que a meta estabelecida de 95,17%, com 95,72% e 97,44%, respectivamente. O indicador EGMF se mostrou útil na gestão da extração florestal com informações adequadas e de fácil entendimento a partir de uma grande quantidade e variedade de dados. O modelo de simulação estocástico foi eficiente para estudar o impacto na eficiência global (EGMF) e no fluxo de extração de madeira pelo forwarder.

ABSTRACT Performance indicators are tools capable of exposing measurable characteristics and generating relevant information on forest operations, thus being considered pillars for managers to make agile and assertive decisions. Forest extraction with a forwarder must be improved, understanding the factors that affect the costs of this machine, such as productivity (PR), fuel consumption (FC), operational efficiency (OE), and quality of operation. Thus, the objective of this study was to evaluate the implementation of the Overall Efficiency of Forest Machines (OEFM) indicator in the management of forest extraction data using forwarders. Data were collected during forest harvesting from five operating fleets, in commercial eucalypt plantations, in full-tree and coppice regimes, in the states of Bahia and Espírito Santo. The indicator was expressed as a percentage calculated by OEFM = ( ( 4 ∗ PR ) + ( 3 ∗ FC ) + ( 3 ∗ OE ) ) / 10. The performance of the machines was evaluated by a stochastic model of dynamic simulation of systems in eight scenarios, proposing improvement for the average individual volume harvested, fuel consumption, and mechanical or operational stops. Analyzes were performed using PowerSim Studio 9 software. The OEFM of two fleets was higher than the established target of 95.17%, with 95.72% and 97.44%. The OEFM indicator proved to be useful in the management of forest extraction with adequate and easy-to-understand information from a large amount and variety of data. The stochastic simulation model was efficient to study the impact on the global efficiency and the flow of wood extraction by the forwarder.

Abstract Changes in the population's eating habits have expanded the French fries market. However, the need for refrigerated storage to supply sprouts and maintain a constant supply to the industry has led to a reduced number of cultivars suitable for processing due to the accumulation of sugars and browning after frying. Because of this, the objective of this study was to evaluate the suitability of the Donata and BRS F132 cultivars for use in the pre-fried potato processing industry. The tubers were stored at 6 and 8 °C for up to 180 days and the analysis of sprouting, total soluble sugar (TSS), reducing sugar (RS), non-reducing sugar (NRS), post-frying color by scale visual color used by the industry and L* and b* parameters. The sprouting was higher at 8 °C and in the BRS F 132 cultivar. The sugar content was high in both cultivars, however, the color remained adequate. It is concluded that the Donata and BRS F132 cultivars are suitable for the potato processing industry, and Donata presented better quality parameters. Conditioning at 8 °C is recommended in both cultivars that maintained the quality for 180 days.

Resumo O objetivo deste trabalho foi avaliar a precisão experimental de dez estatísticas, na avaliação de caracteres relacionados à qualidade tecnológica, em linhagens de feijão-comum (Phaseolus vulgaris). Dezessete experimentos foram realizados, entre 2010 e 2019, com 116 genótipos de feijão de diferentes tipos de grãos. A qualidade tecnológica foi quantificada para os seguintes caracteres: massa de 100 grãos, valor de luminosidade do grão (L*), absorção e tempo de cozimento. Obteve-se um efeito de genótipo significativo em 100% dos experimentos quanto ao valor de L* e à massa de 100 grãos, em 76,92% quanto à absorção e em 94,12% quanto ao cozimento. O valor de L* e a massa de 100 grãos foram determinados com alta precisão experimental por todas as estatísticas. A absorção e o tempo de cozimento mostraram alta precisão experimental, quando analisados pelas seguintes estatísticas: valor do teste F para genótipo (Fc), coeficiente de variação genética (CVG), coeficiente de variação relativa (CVR), herdabilidade (h2) e acurácia seletiva (AS). As estatísticas Fc, CVG, CVR, h2 e AS propiciaram alta precisão experimental na avaliação de caracteres da qualidade tecnológica em linhagens de feijão. A acurácia seletiva é a estatística mais apropriada, para selecionar linhagens de feijão superiores quanto à qualidade de grãos e de cozimento em programas de melhoramento.

Abstract The objective of this work was to evaluate the experimental precision of ten statistics in the evaluation of characters related to the technological quality of common bean (Phaseolus vulgaris) lines. Seventeen experiments were carried out between 2010 and 2019, with 116 common bean genotypes of different types of grain. Technological quality was determined for the following characters: mass of 100 grains, grain lightness value (L*), absorption, and cooking time. A significant genotype effect was obtained in 100% of the experiments for L* value and mass of 100 grains, in 76.92% for absorption, and in 94.12% for cooking time. The L* value and mass of 100 grains were determined with a high experimental precision by all statistics. Absorption and cooking time showed a high experimental precision, when analyzed by the following statistics: F-test value for genotype (Fc), genetic variation coefficient (GVC), relative variation coefficient (RVC), heritability (h2), and selective accuracy (SA). The statistics Fc, GVC, RVC, h2, and SA provided a high experimental precision in the evaluation of the characters related to technological quality in common bean lines. Selective accuracy is the most appropriate statistics to select superior common bean lines for grain and cooking quality in breeding programs.

Resumo O fósforo (P) é um dos nutrientes mais exigidos pelas plantas, principalmente, na fase inicial, no entanto, existem espécies cujos efeitos de crescimento promovidos pelo fósforo ainda são desconhecidos. Portanto, este trabalho teve como objetivo testar se níveis crescentes de fósforo influenciam no comportamento fisiológico e morfológico e na qualidade das mudas de Guazuma ulmifolia. Para tanto, as mudas foram cultivadas em substrato produzido apenas com LATOSSOLO VERMELHO distrófico, em delineamento inteiramente casualizado e submetido a cinco níveis de fósforo (0, 100, 200, 300 e 400 mg dm-3 ). Aos 120 dias, as avaliações biométricas e fisiológicas foram realizadas, e os índices de clorofila, biomassa, relações alométricas, Índice de Qualidade de Dickson e o teor de fósforo foram determinados. Os dados foram submetidos à análise de variância pelo teste F e posteriormente à análise de regressão e correlação linear de Pearson. A fertilização com fósforo promoveu ganhos significativos (p ? 0,05) à todas as variáveis morfológicas e fisiológicas, exceto para a área foliar específica e relações alométricas. O conteúdo de fósforo foi positivamente correlacionado com todas as variáveis testadas. Com base nos resultados obtidos, conclui-se que as mudas responderam positivamente à fertilização com fósforo. Além disso, a fertilização com fósforo promoveu melhor desempenho fisiológico e morfológico e maior qualidade das mudas.

Abstract Phosphorus (P) is one of the nutrients most required by plants, especially in the initial phase, however, there are species whose growth effects promoted by phosphorus are still unknown. Therefore, this study aimed to test whether increasing levels of phosphorus influence the physiological and morphological behavior and the quality of seedlings of Guazuma ulmifolia. For that purpose, the seedlings were grown in a substrate produced only with Dystrophic RED LATOSOL (Oxisol) under a completely randomized design and subjected to five levels of phosphorus (0, 100, 200, 300, and 400 mg dm-3 ). At 120 days, the biometric and physiological evaluations were performed, and the chlorophyll indices, biomass, allometric relationships, Dickson Quality Index, and the phosphorus content were determined. The data were subjected to analysis of variance by the F-test and subsequently to regression analysis and Pearson’s linear correlation. Phosphorus fertilization promoted significant gains (p ? 0.05) for all variables morphological e physiological, except for the specific leaf area and allometric relationships. The phosphorus content was positively correlated with all tested variables. Based on the results obtained, it is concluded that the seedlings responded positively to phosphorus fertilization. Furthermore, phosphorus fertilization promoted better physiological and morphological performance and higher seedling quality.

RESUMO OBJETIVO Investigar os fatores associados ao hábito de beber e dirigir, bem como estimar as variações nas prevalências desse comportamento entre os anos de 2013 e 2019, por meio das informações das duas edições da Pesquisa Nacional de Saúde (PNS). MÉTODOS A PNS é um estudo transversal, de âmbito nacional e base domiciliar. Nos anos de 2013 e 2019, foram entrevistados, respectivamente, 60.202 e 85.854 indivíduos. Para investigar a associação entre o indicador “beber e dirigir” e as variáveis do estudo, as razões de chances (RC) brutas e ajustadas foram estimadas por meio de modelos de regressão logística. Para a comparação das prevalências entre os anos estudados, foi utilizado o teste Qui-Quadrado de Pearson ajustado pela correção de Rao-Scott (que leva em consideração o efeito do plano de amostragem) e convertido em uma estatística F, testada no nível de significância de 5%. RESULTADOS A prevalência do hábito de beber e dirigir foi maior entre os homens no ano de 2013 (27,4%; IC95% 25,6–29,3%) e no ano de 2019 (20,5%; IC95% 19,4–21,7%) do que entre as mulheres (11,9%; IC95% 9,9–14,2% e 7,2%; IC95% 6,7–9,0%, respectivamente). Estimativas significativamente mais altas foram apresentadas por pessoas de 30 anos a 39 anos, que vivem sem companheiro(a), residentes em áreas rurais e condutores de motocicleta. Maiores prevalências de beber e dirigir foram encontradas entre homens que possuem maior rendimento. Entre os anos de 2013 e 2019, foi observado um decréscimo significativo no ato de beber e dirigir. Quanto ao envolvimento em acidentes de trânsito, as RC foram significativas (p < 0,01) nos anos estudados em ambos os sexos. DISCUSSÃO Os resultados mostram a necessidade de dar continuidade às políticas de fiscalização de alcoolemia e educação no trânsito, com ações específicas dirigidas às áreas rurais e aos condutores de motocicletas.

ABSTRACT OBJECTIVE To assess factors associated with the habit of drinking and driving and estimating the variations in the prevalence of this behavior in 2013 and 2019, considering information from the two editions of the Pesquisa Nacional de Saúde (PNS – National Survey of Health). METHODS PNS is a nationwide cross-sectional home-based study. In 2013 and 2019, 60,202 and 85,854 individuals were interviewed, respectively. To assess the association between the indicator “drinking and driving” and the study variables, crude and adjusted odds ratios (ORs) were estimated using logistic regression models. To compare the prevalence between the studied years, a Pearson’s chi-squared test adjusted by the Rao-Scott correction (which considers the effect of the sampling plan) and converted into an F statistic, tested at a 5% significance level, was used. RESULTS The prevalence of drinking and driving was higher among men in 2013 (27.4%; 95%CI 25.6–29.3%) and 2019 (20.5%; 95%CI 19.4–21.7%) than among women (11.9%; 95%CI 9.9–14.2% and 7.2%; 95%CI 6.7–9.0%, respectively). Inidviduals aged 30 to 39, who lived without a partner, in rural areas, and were motorcycle drivers had significantly higher estimates. Men with higher income had higher prevalence of drinking and driving. From 2013 to 2019, the act of drinking and driving significantly decreased. Regarding traffic accidents, ORs were significant (p < 0.01) in the studied years for both men and women. DISCUSSION Results show the need to continue policies to monitor blood alcohol level and traffic education, with specific actions directed to rural areas and motorcycle drivers.

ABSTRACT OBJECTIVE To assess factors associated with the habit of drinking and driving and estimating the variations in the prevalence of this behavior in 2013 and 2019, considering information from the two editions of the Pesquisa Nacional de Saúde (PNS – National Survey of Health). METHODS PNS is a nationwide cross-sectional home-based study. In 2013 and 2019, 60,202 and 85,854 individuals were interviewed, respectively. To assess the association between the indicator “drinking and driving” and the study variables, crude and adjusted odds ratios (ORs) were estimated using logistic regression models. To compare the prevalence between the studied years, a Pearson’s chi-squared test adjusted by the Rao-Scott correction (which considers the effect of the sampling plan) and converted into an F statistic, tested at a 5% significance level, was used. RESULTS The prevalence of drinking and driving was higher among men in 2013 (27.4%; 95%CI 25.6–29.3%) and 2019 (20.5%; 95%CI 19.4–21.7%) than among women (11.9%; 95%CI 9.9–14.2% and 7.2%; 95%CI 6.7–9.0%, respectively). Inidviduals aged 30 to 39, who lived without a partner, in rural areas, and were motorcycle drivers had significantly higher estimates. Men with higher income had higher prevalence of drinking and driving. From 2013 to 2019, the act of drinking and driving significantly decreased. Regarding traffic accidents, ORs were significant (p < 0.01) in the studied years for both men and women. DISCUSSION Results show the need to continue policies to monitor blood alcohol level and traffic education, with specific actions directed to rural areas and motorcycle drivers.

RESUMO OBJETIVO Investigar os fatores associados ao hábito de beber e dirigir, bem como estimar as variações nas prevalências desse comportamento entre os anos de 2013 e 2019, por meio das informações das duas edições da Pesquisa Nacional de Saúde (PNS). MÉTODOS A PNS é um estudo transversal, de âmbito nacional e base domiciliar. Nos anos de 2013 e 2019, foram entrevistados, respectivamente, 60.202 e 85.854 indivíduos. Para investigar a associação entre o indicador “beber e dirigir” e as variáveis do estudo, as razões de chances (RC) brutas e ajustadas foram estimadas por meio de modelos de regressão logística. Para a comparação das prevalências entre os anos estudados, foi utilizado o teste Qui-Quadrado de Pearson ajustado pela correção de Rao-Scott (que leva em consideração o efeito do plano de amostragem) e convertido em uma estatística F, testada no nível de significância de 5%. RESULTADOS A prevalência do hábito de beber e dirigir foi maior entre os homens no ano de 2013 (27,4%; IC95% 25,6–29,3%) e no ano de 2019 (20,5%; IC95% 19,4–21,7%) do que entre as mulheres (11,9%; IC95% 9,9–14,2% e 7,2%; IC95% 6,7–9,0%, respectivamente). Estimativas significativamente mais altas foram apresentadas por pessoas de 30 anos a 39 anos, que vivem sem companheiro(a), residentes em áreas rurais e condutores de motocicleta. Maiores prevalências de beber e dirigir foram encontradas entre homens que possuem maior rendimento. Entre os anos de 2013 e 2019, foi observado um decréscimo significativo no ato de beber e dirigir. Quanto ao envolvimento em acidentes de trânsito, as RC foram significativas (p < 0,01) nos anos estudados em ambos os sexos. DISCUSSÃO Os resultados mostram a necessidade de dar continuidade às políticas de fiscalização de alcoolemia e educação no trânsito, com ações específicas dirigidas às áreas rurais e aos condutores de motocicletas.

Abstract Hepatitis B is considered an important public health problem worldwide because it is a chronic infection with a risk factor for cirrhosis and cellular hepatocellular carcinoma. In Brazil, the Rondônia State ranks first in the Northern region regarding the number of deaths due to hepatitis B. In the Amazon basin, genotype F is considered specific to the Americas identified in native populations. But few data on HBV genotyping and phylogenetic analysis are available. The objective of this study was to evaluate the genotypes and subgenotypes of the hepatitis B virus in indigenous people chronic carriers residing in cities of Guajará Mirim and Nova Mamoré in state of Rondônia/Brazil, on the border with Bolivia. A fragment of 417 bp (S gene) was amplified by PCR and submitted to nucleotide sequencing. The genotypes and subgenotypes of the HBV strains were determined through phylogenetic inference using genomic sequences from 197 representatives of the genotypes (A-H). Of the 41 chronic hepatitis B patients enrolled in this study, 27 were HBV-DNA positive. Of the 27 DNA-HBV positives, 39% (17/41) had individual HBV infection and 27% (10/41) were coinfected with HDV. The frequency of genotypes was 40.7% (11/27) for genotype D (HBV-D), 33.3% (9/27) for genotype F (HBV-F) and 25.9% (7/27) for genotype A (HBV-A) with circulating subgenotypes F2, F4, D2, D3, A1, and A2. We characterized the genotypes and subgenotypes of HBV circulating among in indigenous in the State of Rondônia shows for the first time the HBV/D genotype whit greater frequency circulating in nativos of state Rondônia. In conclusion, our findings showed a diversity of HBV genotypes, which is also found in other Brazilian geographical regions.

Abstract Background Religiosity is a system of worship and doctrine that is shared by a group, and spirituality is the individual search for the meaning of life. The relationship between spirituality/religiosity (S/R) and health has a long history, and a positive correlation between spirituality and chronic diseases has been described in scientific literature, showing a decrease in morbidity and mortality in general. Objective To evaluate the association between S/R and the quality of life of patients with diabetes and/or systemic arterial hypertension. Method An observational, analytical, cross-sectional, quantitative study was conducted with a sample consisting of 40 patients treated at the hypertension and diabetes outpatient clinic of a medical center in Recife. The collection used three assessment instruments (SSRS, Duke-DUREL scale, and WHOQOL-BREF). Data from the questionnaires were analyzed using descriptive (frequency and percentage) and inferential statistics (chi-square test and F test) using the R software, version 3.4.3. The level of significance in all analyses was 5%. The study was approved by CEP/IMIP, according to report no. 2.890.126. Result All four domains of the quality-of-life scale (WHOQOL-BREF) showed a positive relationship when correlated with the religiosity scale (DUREL), with statistical significance in the relationship between organizational religiosity and the environmental domain. When correlated with the spirituality scale (SSRS), WHOQOL-BREF also showed a positive relationship, except in the physical domain. Conclusion A positive relationship between quality of life and S/R was shown, thus confirming its importance for patients with diabetes and SAH.

RESUMO Introdução: O mesotelioma maligno é uma neoplasia das membranas serosas, cuja variante mais comum afeta a pleura, estando amplamente evidenciada a sua associação à exposição ao amianto. Em Portugal, a utilização/comercialização de amianto e produtos que o contenham foi proibida no início do século XXI. Apesar disto, até ao presente, continua a existir em vários contextos, o que, aliado ao longo período de latência até ao surgimento das primeiras manifestações de doença, tem mantido a relevância do estudo desta associação etiológica e da história natural das patologias associadas. Caso clínico: Neste artigo apresentamos o caso de um indivíduo de 80 anos, com asbestose pulmonar de etiologia ocupacional, conhecida e acompanhada em consulta de Pneumologia, que desenvolveu sintomatologia de enfartamento abdominal e vómitos, no contexto de mesotelioma peritoneal. Discussão/Conclusão: Apresenta-se uma resumida revisão sobre os aspetos clínicos do mesotelioma maligno peritoneal, destacando-se a importância do reconhecimento da história profissional para um diagnóstico atempado. Neste aspeto, enfatiza-se o papel da Saúde Ocupacional não só pela vigilância dos trabalhadores expostos, como pela monitorização dos postos de trabalho, identificando e endereçando as situações de risco, procurando minimizá-lo ao máximo, sob uma perspetiva salutogénica e preventiva.

ABSTRACT Introduction: Malignant mesothelioma is a neoplasm of the serous membranes whose most common variant affects the pleura, and its association with exposure to asbestos is amply evidenced. In Portugal, the utilization/commercialization of asbestos and its related products was forbidden in the early 21st century. Despite this, to this day, asbestos still exist in many contexts, which in combination with its long latency period until presentation with the first signs of disease, has kept the study of this etiologic association and the natural history of the resulting illnesses relevant. Case-study: In this article we present the case of an eighty-year-old male, with known occupational pulmonary asbestosis, usually followed in Pneumology consultation, that developed early satiety and vomiting, in the context of a peritoneal mesothelioma. Discussion/Conclusion: We present a resumed revision on the clinical aspects of the malignant peritoneal mesothelioma, highlighting the importance of acknowledging the patient’s previous professional history for an early diagnosis. In this aspect, we emphasize Occupational Health’s role, not only in the surveillance of exposed workers, but also in monitoring the workplaces, identifying and addressing risk situations, trying to minimize it as much as possible, under a salutogenic and preventive perspective.

Resumo Introdução: Os resultados após revascularização de membro inferior, quando estratificados por sexo, são piores no sexo feminino, particularmente após procedimentos convencionais. As mulheres parecem ter maior probabilidade de complicações do procedimento, amputação e morte quando comparadas com os homens. Este estudo pretende identificar as diferenças nas características demográficas, apresentação clínica e principais outcomes após revascularização de membro inferior, entre doentes do sexo masculino e feminino. Métodos: Este estudo unicêntrico retrospetivo observacional incluiu todos os membros inferiores sem revascularização prévia em doentes com diagnóstico de DAP, que foram submetidos a um procedimento terapêutico vascular num hospital terciário, entre Janeiro de 2017 e Dezembro de 2018. O grupo do sexo feminino (Grupo F) foi comparado com o grupo do sexo masculino (Grupo M). O endpoint primário foi a amputação major e os endpoints secundários foram a restenose/oclusão diagnosticada, reintervenção vascular e sobrevida. A análise de subgrupos foi realizada após estratificação em procedimentos convencionais, endovasculares ou híbridos. Resultados: O Grupo M incluiu 324 membros inferiores de doentes do sexo masculino, com uma idade média de 67,5 anos. O Grupo F incluiu 96 membros inferiores de doentes do sexo feminino, com uma idade média de 71,7 anos (p<0,001). Não foi encontrada diferença estatisticamente significativa nos fatores de risco cardiovascular entre os grupos, com exceção de uma maior prevalência de tabagismo no Grupo M e de hipertensão no Grupo F (p<0.001). 83% dos procedimentos no Grupo F e 79% dos procedimentos no grupo M foram realizados devido a isquemia crónica com compromisso do membro (ICCM; p=0,321). Não foi encontrada diferença estatisticamente significativa no que diz respeito ao grau de ferida ou infeção (WIfI) e ao estadiamento anatómico de doença femoropopliteia ou abaixo do tornozelo (GLASS). O Grupo M apresentou maior prevalência de doença aorto-ilíaca (p=0,014) e da artéria femoral comum (p=0.001) e o Grupo F apresentou doença abaixo-do-joelho mais grave (p=0,012). No Grupo F observou-se uma maior proporção de procedimentos endovasculares (p<0.001). A taxa de amputação do Grupo M e no Grupo F foi de 8±2% e 7±3% a 1 mês, 14±2% e 16±4% a 1 ano, e 15±2% e 19±4% a 2 anos, respetivamente (p=0,564). Não houve diferenças significativas nas taxas de restenose/oclusão entre os grupos (p=0,395). As taxas de reintervenção no Grupo M e no Grupo F foram 13±2% e 13±3% a 1 mês, 21±2% e 20±4% a 1 ano, e 25±3% e 24±5% a 2 anos, respetivamente (p=0,74). A sobrevida no Grupo M e no Grupo F foi de 97±1% e 93±3% a 1 mês, 84±2% e 84±4% a 1 ano, e 77±3% e 72±5% a 2 anos, respetivamente (p=0,443). Estratificando de acordo com o tipo de procedimento vascular (convencional, endovascular ou híbrido), não se verificou diferença estatisticamente significativa entre os grupos nos endpoints acima mencionados. Conclusão: De acordo com este estudo, as doentes do sexo feminino apresentam idade mais avançada e doença abaixo-do-joelho mais grave. São mais frequentemente submetidas a procedimentos endovasculares. Contudo, não parecem existir diferenças importantes nos outcomes de membro para as mulheres submetidas a procedimentos de revascularização de membro inferior.

Abstract Introduction: Sex-specific data on outcomes after lower limb revascularization associate the female gender with worse surgical outcomes, particularly after open procedures. Women were found to be more likely to suffer from procedure complications, limb loss, and mortality than their male counterparts. This study aims to identify differences in demographic characteristics, clinical presentation and all major outcomes after lower limb revascularization between female and male patients. Methods: This retrospective, single-center study comprises all never-revascularized lower limbs in patients with clinically diagnosed PAD who underwent a lower limb therapeutic vascular intervention in a tertiary hospital between January 2017 and December 2018. Women&apos;s limbs Group (F) was compared against men&apos;s limbs Group (M). The primary endpoint was major amputation, and the secondary endpoints were restenosis/occlusion, vascular reintervention and overall survival. Subgroup analysis was undertaken considering open, endovascular or hybrid procedures. Results: Group M included 324 male lower limbs; patients had a mean age of 67,5 years. Group F included 96 female lower limbs; patients had a mean age of 71,7 years (p<0,001). There were no significant differences in cardiovascular risk factors between groups, aside from a higher prevalence of smoking in Group M and hypertension in Group F (p<0.001). 83% of Group F procedures and 79% of procedures in Group M were performed due to CLTI (p=0,321). We found no statistically significant difference between groups regarding wound or infection grading (WIfI) and femoropopliteal or BTA anatomic disease staging (GLASS). Group M was more likely to have aortoiliac (p=0,014) and common femoral artery disease (p=0.001), and Group F to have more severe BTK disease (p=0,012). Group F had a higher proportion of endovascular procedures (p<0.001). Amputation rates in Group M and Group F were 8±2% and 7±3% at 1 month, 14±2% and 16±4% at 1 year, 15±2% and 19±4% at 2 years, respectively (p=0,564). There were no significant differences in rates of procedure restenosis/occlusion between groups (p=0,395). Reintervention rates in Group M and Group F were 13±2% and 13±3% at 1 month, 21±2% and 20±4% at 1 year, 25±3% and 24±5% at 2 years, respectively (p=0,74). Overall survival in Group M and Group F was 97±1% and 93±3% at 1 month, 84±2% and 84±4% at 1 year, 77±3% and 72±5% at 2 years, respectively (p=0,443). Stratifying according to the type of vascular procedure (open, endovascular or hybrid), we found no significant difference between groups in the outcomes mentioned above. Conclusion: Overall, women were more likely to be older, to have more severe BTK disease, and to undergo endovascular procedures. However, this study suggests no major differences in limb outcomes for women who undergo lower limb revascularization procedures.

SUMMARY The most common neurodegenerative disease in the world is Alzheimer’s Disease (AD). Ten percent of Alzheimer patients experience symptoms before the age of 65, and almost all of them present genetic features of autosomal dominant inheritance nature, and penetrance of 92 to 100%. In the present review, we searched for genetic variants associated with early onset Alzheimer's disease (EOAD), emphasizing the most important characteristics and the main mutations. The genes most commonly related to the onset of EOAD are APP, PSEN1, PSEN2 and MAPT, whose mutations affect the metabolism and structure of these proteins. This process results in accumulations of Aβ peptide that leads to activation of the microglia and release of neurotoxic and pro-inflammatory factors that accelerate neurodegeneration. The PSEN1 gene is responsible for 70% of the known mutations in EOAD, while L166P is associated with below 30 years as the starting age of occurrence. APP mutations lead to protein aggregation in neurodegenerative plaques. All of the mutations described for MAPT are associated with an increase in neurofibrillary tangles. The E4 polymorphism of Apolipoprotein E (APOE) influences an increased risk of EOAD increasing up to three times the chances for heterozygous, and between eight and ten times for homozygotes carriers. Only 5% of the mutations associated with EOAD are known; new studies will show other candidate genes, as well as the importance of epigenetic factors changes in the etio-pathogenesis of this disease.

RESUMO A doença neurodegenerativa mais comum no mundo é a doença de Alzheimer (DA), e 10% dos casos apresentam sintomas antes dos 65 anos, quase todos com associação genética, com hereditariedade autossômica dominante e penetrância entre 92 a 100% dos portadores. Na presente revisão, realizamos uma busca sobre as variantes genéticas associadas à doença de Alzheimer de início precoce (DAIP), enfatizando as características associadas mais importantes e as principais mutações já descritas. Os genes mais comumente relacionados com o surgimento da DAIP são APP, PSEN1, PSEN2 e MAPT, e mutações nestes afetam o metabolismo e a estrutura destas proteínas, resultando em acúmulos de peptídeo Aβ que causam inflamação e toxicidade no cérebro, levando à ativação da micróglia e promovendo a liberação de fatores neurotóxicos e pró-inflamatórios que aceleram a neurodegeneração. O gene PSEN1 é responsável por 70% das mutações conhecidas da DAIP, sendo a L166P associada à idade de ocorrência da doença abaixo dos 30 anos. Mutações em APP levam à agregação da proteína em placas neurodegenerativas. Todas as mutações descritas para MAPT estão associadas a um aumento dos emaranhados neurofibrilares. O polimorfismo E4 da Apolipoproteína E (APOE) influencia o aumento no risco de DAIP elevando as chances em três vezes para portadores heterozigotos e entre oito a dez vezes para os homozigotos. Apenas 5% das mutações associadas à DAIP são conhecidas, e novos estudos apresentam outros genes candidatos, bem como a importância de alterações epigenéticas na gênese desta doença.

Resumo: O artigo busca avaliar a relação entre condição socioeconômica ao longo da vida e índice de massa corporal (IMC) aos 22 anos de idade, de acordo com as hipóteses geradas pelos modelos de acúmulo de riscos, período crítico e mobilidade social. Este é um estudo prospectivo de base populacional, na coorte de nascimentos de 1993 de Pelotas, Rio Grande do Sul, Brasil. Os modelos de acúmulo de riscos, período crítico e mobilidade social foram testados em relação a um model saturado, e comparados através de um teste F parcial. Após escolher o melhor modelo, a análise de regressão linear foi realizada para determinar os coeficientes de regressão, brutos e ajustados, da associação entre a condição socioeconômica ao longo da vida e o IMC aos 22 anos. A amostra consistia em 3.292 indivíduos (53,3% mulheres). Foram identificados efeitos de dose-resposta em homens e mulheres, embora os efeitos fossem opostos. Entre os homens, um aumento na pontuação baixa no modelo de acúmulo de condição socioeconômica levou a um IMC médio mais baixo aos 22 anos de idade; enquanto isso, nas mulheres, um aumento na pontuação baixa no modelo de acúmulo de condição socioeconômica levou a um aumento no IMC aos 22 anos de idade.

Abstract: This article aims to assess the relationship between an individual’s socioeconomic status over their life-course and their body mass index (BMI) at 22 years of age, according to the hypotheses generated by risk accumulation, critical period, and social mobility models. This was a population-based prospective study based on the Pelotas (Brazil) 1993 birth cohort. The risk accumulation, critical period, and social mobility models were tested in relation to a saturated model and compared with a partial F-test. After the best model was chosen, linear regression was carried out to determine the crude and adjusted regression coefficients of the association between socioeconomic status over the life-course and BMI at 22 years of age. The sample was comprised of 3,292 individuals (53.3% women). We found dose-response effect for both men and women, although the results were opposite. Among men, a lower score in socioeconomic status accumulation model led to a lower BMI average at 22 years of age; whereas among women, a lower score in socioeconomic status accumulation model caused an increase in BMI at 22 years of age.

Resumen: El objetivo de este artículo es evaluar la relación entre el estatus socioeconómico a lo largo del ciclo vital y el índice de masa corporal (IMC) con 22 años de edad, según las hipótesis generadas por riesgo de acumulación, período crítico y modelos de movilidad social. Se trata de un estudio prospectivo de base poblacional con la cohorte de nacimiento de 1993 en Pelotas, Rio Grande do Sul, Brasil. Se probaron tanto el riesgo de acumulación, como el período crítico y modelos de movilidad social, en relación con un modelo saturado y comparado mediante un F-test parcial. Tras haber elegido el mejor modelo, se llevó a cabo una regresión lineal para determinar los coeficientes de asociación crudos y ajustados entre estatus socioeconómico, a lo largo del ciclo vital, e IMC a los 22 años de edad. La muestra estuvo compuesta por 3.292 individuos (53,3% mujeres). Se encontraron efectos dosis-respuesta para ambos hombres y mujeres, a pesar de que los efectos fueron opuestos. Entre hombres, el aumento en la puntación del modelo de acumulación en el estatus socioeconómico bajo condujo a un promedio más bajo de IMC a los 22 años de edad, mientras que, entre mujeres, el aumento en la puntuación del modelo de acumulación en el estatus socioeconómico bajo provocó un incremento en el IMC a los 22 años de edad.