Abstract This article presents a formulation for the optimization problem that minimizes the CO2 emission of pile caps with variations of geometry and pile position. The problem is defined by the design variables: concrete pile cap dimensions, rebar ratio, concrete compressive strength, the number of piles, the diameter, and length. The environmental impact was chosen as the objective function, taking CO2 emission as the main parameter. The design procedure was based on the ABNT NBR 6118:2014 (2014), and by the formulation proposed by Blévot & Frémy (1967). Also, the soil structure interaction between the cap and the piles was considered in the optimization problem. The problem was implemented using MATLAB (2016) and solved via a Genetic Algorithm native to the program. Results obtained from numerical examples were compared with structural designs solutions located in the Grande Vitória metropolitan area, Espírito Santo, Brazil and validated with a commercial software. The analyses indicate that design optimizations of pile caps considering the compressive strength of concrete, the diameter and length of piles and the optimal geometry of the pile caps may lead to significant reductions of material consumption, and consequently, a reduction of environmental impacts.

Abstract The flotation mechanism of galena with xanthate as the collector is generally explained based on the mixed potential of the pulp, in which an anodic electron transfer reaction from the collector to the mineral is combined with an O2 cathodic reduction. Sodium sulphide, often used as a mineral activator, strongly influences the pulp's mixed potential, and depending on the dosage applied, it can become a galena depressor reagent. In this way, the current study assesses galena flotability in the absence of collector, as well as in the presence of the collector potassium amyl xanthate (PAX) and sodium sulphide. The effect of an extremely cathodic potential was also studied through the addition of hydrogen peroxide. In addition, the effect of different stages in the oxidation of the galena surface on the flotability was investigated. Moreover, the zeta potential was measured and contact angle (wettability) tests were carried out. The contact angle measurements were taken for a distilled water, PAX solution and for a mixture of PAX and sodium sulphide solution on the oxidized and non-oxidized surface of galena. All the results showed that galena could be floated in all the PAX concentrations tested. It was observed that a moderate oxidation in the galena surface may contribute to an improvement of its flotation with PAX. However, extremely anodic and cathodic potentials cause flotability close to zero. The zeta potential results showed that sodium sulphide affected the interaction between PAX and galena. The measurements of the contact angle corroborated the results obtained in the microflotation tests. pulp O reduction activator pulps s applied reagent way (PAX peroxide investigated Moreover wettability (wettability out water nonoxidized non tested However zero

ABSTRACT This study aimed to evaluate the effects of different colors and management of polypropylene non-woven fabric coverings and two different localized irrigation systems on the physiological characteristics and yield of industrial tomatoes. The experiment was installed in a randomized block design arranged in a split-plot scheme with four replications. Surface and subsurface drip were used in the plots, and five plant cover strategies with non-woven fabric in the subplots: i) without non-woven fabric; ii) coverage with white non-woven fabric; iii) coverage with white non-woven fabric, removed between 30 and 60 days after transplanting the seedlings; iv) coverage with red non-woven fabric; v) coverage with red non-woven fabric, removed between 30 and 60 days after transplanting. Photosynthesis, transpiration, electron transport rate, stomatal conductance, carbon concentration, total fruit yield, and water use efficiency were evaluated. ANOVA and the Scott-Knott test were used. Transpiration is favored by the white non-woven fabric and the stomatal conductance by the white and uninterrupted red one. However, the tomato yield is not influenced by the coverings, except for the red one, removed only between 30 and 60 days after transplanting, which is the worst condition for industrial tomato production. Surface and subsurface irrigation can be used with the same efficiency.

RESUMO O objetivo deste estudo foi avaliar os efeitos de diferentes colorações e manejos de coberturas de tela não-tecida, e de dois diferentes sistemas de irrigação localizada sobre características fisiológicas e produção de frutos do tomateiro industrial. O experimento foi instalado em delineamento de blocos ao acaso, com 4 repetições, em parcelas subdivididas. Gotejamentos superficial e subterrâneo foram utilizados nas parcelas; e 5 estratégias de cobertura da planta com tela não-tecida nas subparcelas: i) sem cobertura; ii) cobertura com tela não-tecida branca; iii) tela não-tecida branca, retirado entre 30 e 60 dias após o transplante; iv) tela não-tecida vermelha; v) tela não-tecida vermelha, retirado entre 30 e 60 dias após o transplante. Avaliou-se: taxa fotossintética, de transpiração e de transporte de elétrons; condutância estomática; concentração de carbono; produção total de frutos e eficiência do uso da água. Foram utilizados ANOVA e teste de Scott-Knott. A transpiração é favorecida pelas coberturas brancas, a condutância estomática, pelas coberturas brancas e vermelha ininterrupta, porém a produtividade não é influenciada pelas coberturas, exceto a vermelha, retirada entre 30 e 60 dias após transplante, que é a pior condição para o tomate industrial. Irrigações superficial e subterrânea podem ser utilizadas com mesma eficiência.

ABSTRACT Integrated management is considered the best strategy to mitigate the damage caused by plant-parasitic nematodes. However, there is still limited information regarding some integrated techniques. Thus, this study aimed to assess the effects of genetic management associated with chemical control of Meloidogyne javanica in soybean (Glycine max (L.) Merr.) The experiment was installed in a greenhouse according to an 8×4 factorial design with eight replicates. The first factor was soybean cultivar (HO Juruena IPRO, resistant; Foco IPRO, HO Maracaí IPRO, and CZ 58B28 IPRO, moderately resistant; HO Mamoré IPRO, moderately susceptible; and Extrema IPRO, CZ 48B32 IPRO, and HO Aporé IPRO, susceptible). The second factor consisted of an untreated control and commercial nematicides based on abamectin, thiodicarb+imidacloprid, and fluopyram. Plants were inoculated with 2000 nematode eggs, and nematode and vegetative variables were evaluated at 65 d after inoculation. There was an interaction effect on nematode variables. Furthermore, there was an additive effect of genetic management and chemical control, mainly in resistant cultivars treated with thiodicarb+imidacloprid or fluopyram with controls of up to 69.90% and 96.86%, respectively. The application of fluopyram and the use of ‘HO Juruena IPRO’, ‘Foco IPRO’, or ‘HO Maracaí IPRO’ also contributed to the control of M. javanica. Vegetative variables were studied by analyzing product effects separately, but results were inconclusive.

Resumo Relatos da medicina popular costumam atuar como referencial para o desenvolvimento de novos fármacos a partir de moléculas naturais com ações terapêuticas para doenças de alta gravidade e prevalência como o câncer. Bromelia antiacantha Bertol. é uma espécie da família Bromeliaceae, considerada uma planta alimentícia não convencional (PANC), encontrada nas regiões sul e centro-oeste do Brasil. Apesar do alto teor nutritivo e potencial farmacológico de seus frutos, poucos estudos científicos relatam suas ações biológicas. Desta forma, este estudo avalia o perfil fitoquímico de extratos aquoso e etanólico obtidos de frutos de B. antiacantha, bem como a sua possível ação antioxidante, antitumoral e citotóxica. O extrato aquoso apresentou compostos fenólicos e flavonoides, enquanto os extratos etanólicos apontam a presença de flavonóides e cumarina em sua composição, independente da região de coleta. O extrato etanólico demonstrou efeito antioxidante mais promissor do que o extrato aquoso e também induziu uma inibição significativa na viabilidade de células humanas de câncer cervical da linhagem SiHa. Além disso, o tratamento com ambos extratos não alterou a viabilidade de células não tumorais da linhagem de queratinócitos humanos imortalizados (HaCaT). Estes dados trazem novas informações sobre extratos obtidos de uma espécie vegetal nativa, comestível e já utilizada tradicionalmente, mas abrindo novas perspectivas quanto a possíveis aplicações terapêuticas.

Abstract Reports from popular medicine usually act as a basis for the development of new drugs from natural compounds with therapeutic actions for serious diseases and prevalence such as cancer. Bromelia antiacantha Bertol. is a species of the Bromeliaceae family, considered an unconventional food plant, found in the south and midwest regions of Brazil. Despite the high nutritional content and pharmacological potential of its fruits, few scientific studies report its biological actions. Thus, this study evaluates the phytochemical profile of aqueous and ethanol extracts obtained from B. antiacantha fruits, as well as their possible antioxidant, antitumor, and cytotoxic activities. The aqueous extract exhibited phenolic compounds and flavonoids, while ethanol extracts indicated the presence of flavonoids and coumarin in their composition, regardless of the region of collection. The ethanolic extract demonstrated a more promising antioxidant effect than the aqueous extract and also induced a significant inhibition in the viability of human cervical cancer cells of the SiHa strain. In addition, treatment with both extracts did not alter the viability of non-tumor cells of the immortalized human keratinocyte lineage (HaCaT). These results bring new data about extracts obtained from a native plant, edible and traditionally used in popular medicine, opening new perspectives for its possible therapeutic application.

Resumo O Brasil é o maior produtor de figos da América do Sul, porém o cultivo comercial brasileiro da figueira baseia-se na plantação de uma única cultivar, o Roxo-de-Valinhos, resultando em sérios problemas relativos a pragas e doenças. Uma vez que há variações epigenéticas na interação planta-patógeno, principalmente por meio da regulação gênica, o presente trabalho objetiva realizar a caracterização in vivo de acessos de figo, por meio da análise de incidência natural de nematoides formadores de galha e de incidência natural de ferrugem, correlacionada ao seu perfil epigenômico, a fim de subsidiar trabalhos de conservação, melhoramento genético e produção da cultura. A análise dos componentes principais dos dados da caracterização dos acessos foi realizada por meio da matriz de correlação residual obtida pela análise de variância conjunta utilizando o programa GENES. Pôde-se constatar que todas as plantas foram atacadas por este patógeno, evidenciando que são suscetíveis ao mesmo. Já a análise conjunta dos dados demonstrou que a metilação e a incidência de ferrugem em folhas, quando observadas na mesma fase fenológica da planta, se correlacionam, apresentando evidências iniciais de mesmas cargas fatoriais de pressão nos genótipos, com a premissa de comportamento semelhante nos mesmos, indicando que, além do fator genético, fatores abióticos também são responsáveis pelas alterações no fenótipo das plantas, evidenciando a plasticidade fenotípica das mesmas.

Abstract Commercial fig tree cultivation in Brazil involves a single cultivar, ‘Roxo-de-Valinhos’. The use of a single cultivar results in serious diseases and related problems. The aim of this study was to characterize fig accessions by analyzing the natural root-knot nematode and leaf rust incidence in relation to the epigenomic profile of the plant, since epigenetic variations affect plant–pathogen interactions. All plants were attacked by nematodes, indicating susceptibility; Meloidogyne incognita was the root-knot nematode species involved. Joint analysis of data showed that methylation and leaf rust incidence were correlated when observed in the same phenological phase, presenting initial evidence of the same factorial pressure loads in genotypes, suggesting similar behavior within these genotypes.

Screener, a board game supplemented with online resources, was introduced and distributed by the Brazilian Society of Pharmacology and Experimental Therapeutics to postgraduate programs as an instructional tool for the process of drug discovery and development (DDD). In this study, we provided a comprehensive analysis of five critical aspects for evaluating the quality of educational games, namely: 1) description of the intervention; 2) underlying pedagogical theory; 3) identification of local educational gaps; 4) impact on diverse stakeholders; and 5) elucidation of iterative quality enhancement processes. We also present qualitative and quantitative assessments of the effectiveness of this game in 11 postgraduate courses. We employed the MEEGA+ online survey, comprising thirty-three close-ended unipolar items with 5-point Likert-type response scales, to assess student perceptions of the quality and utility of Screener. Based on 115 responses, the results indicated a highly positive outlook among students. In addition, we performed a preliminary evaluation of learning outcomes in two courses involving 28 students. Pre- and post-quizzes were applied, each consisting of 20 True/False questions directly aligned with the game's content. The analysis revealed significant improvement in students' performance following engagement with the game, with scores rising from 8.4 to 13.3 (P<0.0001, paired t-test) and 9.7 to 12.7 (P<0.0001, paired t-test). These findings underscore the utility of Screener as an enjoyable and effective tool for facilitating a positive learning experience in the DDD process. Notably, the game can also reduce the educational disparities across different regions of our continental country.

Abstract Objective Evaluate autonomic function and low-grade inflammation and characterize the correlation between these variables in schoolchildren with obesity living in the Brazilian northeast region. Methods 84 children with obesity and 41 with normal weight were included in this cross-sectional study. Anthropometry, body composition, blood pressure (BP), inflammatory biomarkers, and heart rate variability (HRV) indexes were analyzed in children aged 7 to 11 years. Results children with obesity had increased systolic (p= 0.0017) and diastolic (p= 0.0131) BP and heart rate (p= 0.0022). The children with obesity displayed significantly lower SDNN, RMSSD, NN50, HF (ms), HF (nu), SD1, SD2, and higher LF (ms), LF (nu), LF/HF, SD1/SD2, DFA-α1, and DFA-α2, compared to normal weight. A lower and higher capacity for producing IL-10 (p= 0.039) and IL-2 (p= 0.009), respectively, were found in children with obesity compared to children with normal weight. Although IL-2, IL-4 and IL17A did not correlate with HRV parameters, IL-6 was positively correlated with SDNN, LF (ms) and SD2, TNF-α was positively correlated with LF/HF and SD1/SD2 ratio, and IFN-γ was positively correlated with SDNN, RMMSSD, NN50, LF (ms), HF (ms), SD1, and SD2. Conclusions The findings suggest that children with obesity have impaired autonomic function and systemic low-grade inflammation compared to children within the normal weight range, the inflammatory biomarkers were correlated with HRV parameters in schoolchildren living in the northeastern region of Brazil.

ABSTRACT BACKGROUND: Stroke is a major cause of mortality worldwide. Renal dysfunction is an important risk factor for stroke. Brazilian studies on stroke knowledge are generally population based. Studies stratifying stroke knowledge according to comorbidities are rare. Scientific data are essential to guide the awareness of stroke. OBJECTIVE: To assess stroke knowledge in patients with chronic kidney disease (CKD) on hemodialysis. DESIGN AND SETTING: Cross-sectional analytical study of patients with CKD on hemodialysis in north-eastern Brazil. METHODS: A self-administered questionnaire survey on stroke awareness was administered to patients with CKD on hemodialysis between April and November 2022. The chi-square test and other descriptive statistics were used. Univariate and multivariate analyses were performed using logistic regression. RESULTS: A total of 197 patients were included in the analysis. The Brazilian acronym for stroke was used by 53.5% of the participants. Less than 10.0% of the sample showed optimal decision-making ability regarding stroke. Of the participants, 29.9% knew at least one risk factor and one symptom; however, this was considered as having below the minimum capacity because they did not know the emergency service call number. In the analysis adjusted for income and education, females (odds ratio [OR], 0.40%; 95% confidence interval [CI], 0.20-0.82), older patients (OR, 0.24%; 95% CI, 0.09-0.63) and having at most one comorbidity (OR, 0.48%; 95% CI, 0.23-0.98) were factors for lower levels of knowledge or ideal decision-making capacity against stroke. CONCLUSIONS: Patients on hemodialysis, especially women and older people, have little knowledge about stroke.

ABSTRACT BACKGROUND: Managing cervical intraepithelial neoplasia grade 2 (CIN2) is challenging, considering the CIN2 regression rate, perinatal risks associated with excisional procedures, and insufficient well-established risk factors to predict progression. OBJECTIVES: To determine the ability of p16INK4a and Ki-67 staining in biopsies diagnosed with CIN2 to identify patients with higher-grade lesions (CIN3 or carcinoma). DESIGN AND SETTING: Cross-sectional study conducted at a referral center for treating uterine cervical lesions. METHODS: In 79 women, we analyzed the correlation of p16INK4a and Ki-67 expression in CIN2 biopsies with the presence of a higher-grade lesions, as determined via histopathology in surgical specimens from treated women or via two colposcopies and two cytological tests during follow-up for untreated women with at least a 6-month interval. The expression of these two biomarkers was verified by at least two independent pathologists and quantified using digital algorithms. RESULTS: Thirteen (16.8%) women with CIN2 biopsy exhibited higher-grade lesions on the surgical excision specimen or during follow-up. p16INK4a expression positively and negatively predicted the presence of higher-grade lesions in 17.19% and 86.67% patients, respectively. Ki-67 expression positively and negatively predicted the presence of higher-grade lesions in 40% and 88.24% patients, respectively. CONCLUSIONS: Negative p16INK4a and Ki67 immunohistochemical staining can assure absence of a higher-grade lesion in more than 85% of patients with CIN2 biopsies and can be used to prevent overtreatment of these patients. Positive IHC staining for p16INK4a and Ki-67 did not predict CIN3 in patients with CIN2 biopsies.

ABSTRACT BACKGROUND: Research on the economic burden of sedentary behavior and abdominal obesity on health expenses associated with cardiovascular diseases is scarce. OBJECTIVE: The objective of this study was to verify whether sedentary behavior, isolated and combined with abdominal obesity, influences the medication expenditure among adults with cardiovascular diseases. DESIGN AND SETTING: This cross-sectional study was conducted in the city of President Prudente, State of São Paulo, Brazil in 2018. METHODS: The study included adults with cardiovascular diseases, aged 30-65 years, who were treated by the Brazilian National Health Services. Sedentary behavior was assessed using a questionnaire. Abdominal obesity was defined by waist circumference. Medication expenditures were verified using the medical records of each patient. RESULTS: The study included a total of 307 adults. Individuals classified in the group with risk factor obesity combined (median [IQ] USD$ 29.39 [45.77]) or isolated (median [IQ] USD$ 27.17 [59.76]) to sedentary behavior had higher medication expenditures than those belonging to the non-obese with low sedentary behavior group (median [IQ] USD$ 13.51 [31.42]) (P = 0.01). The group with combined obesity and sedentary behavior was 2.4 (95%CI = 1.00; 5.79) times more likely to be hypertensive. CONCLUSION: Abdominal obesity was a determining factor for medication expenses, regardless of sedentary behavior, among adults with cardiovascular diseases.

ABSTRACT BACKGROUND: Specific types of violence such as intimate partner sexual violence and intimate partner homicide occur more frequently in rural areas. OBJECTIVE: This study aimed to systematically review the literature on the knowledge and attitudes of rural healthcare providers regarding cases of domestic violence against women. DESIGN AND SETTING: Systematic review developed at Universidade Federal de Uberlândia. METHODS: We conducted an electronic search of six databases, which only included observational studies, regardless of the year, language, or country of publication, except for studies that used secondary data and were exclusively qualitative. Two reviewers performed the selection, data extraction, and risk of bias assessment using a specific Joanna Briggs Institute tool. RESULTS: Six studies met the inclusion criteria. All the studies had a low risk of bias. Approximately 38% of these professionals identified injuries caused by violence in patients. When asked about knowing the correct attitude to take in cases of confirmed violence, between 12% and 64% of rural healthcare providers answered positively; most of them would refer to specialized institutions and promote victim empowerment and counseling. The number of professionals with an educational background in the field ranged from 16% to 98%. CONCLUSIONS: The evident disparity across studies shows that some professionals have suboptimal knowledge and require training to adopt the correct attitude when identifying female victims of domestic violence in clinical practice. SYSTEMATIC REVIEW REGISTRATION: This systematic review was registered in the Open Science Framework Database under the registration http://doi.org/10.17605/OSF.IO/B7Q6S.

Abstract This study evaluated the effect of different firing protocols on the surface roughness and flexural strength of CAD/CAM lithium disilicate glass-ceramic (LD) after aging methods. Forty-two LD bars of 16 x 4 x 2 mm (IPS e-max CAD, Ivoclar) were randomly separated into two groups according to firing protocols: Single firing-Staining, glazing, and crystallization in a single step; Multiple firings-Crystallization+First staining+Firing+Second staining+Firing+Glazing+Firing. After protocols, initial surface roughness readings were taken (Surfcorder SE1700, Kosakalab). Samples were then randomly separated into three groups (n=7) according to the aging methods they were submitted: Thermomechanical cycling (TMC, ER System, Erios, 1,200,000 cycles, 0.3 MPa, 2 Hz and 5°C/37°C/55°C, 30 s swell time); Simulated toothbrushing (STB, Pepsodent, MAVTEC, 73,000 cycles), and Control (no aging). Final surface roughness readings were done, and samples were submitted to a three-point bending test (OM100, Odeme Dental Research) and fractographic analysis by scanning electron microscopy (EVO-MA10, ZEISS). Data were analyzed (2-way ANOVA, (α=.05). There was no difference (p>.05) in the flexural strength between the firing protocols, regardless of the aging method. STB decreased the flexural strength of samples submitted to multiple firings, different from control (p<.05). Without aging (Control), before TMC, and after STB, LD had lower surface roughness when submitted to multiple firings than to single firing (p<.05). The firing protocols did not affect the flexural strength or the surface roughness of the lithium disilicate glass-ceramic, even after aging. However, toothbrushing negatively affected the flexural strength and smoothed the surface of the ceramic submitted to multiple firings.

Resumo Este estudo avaliou o efeito de diferentes protocolos de queima na rugosidade de superfície e resistência à flexão de uma cerâmica vítrea de dissilicato de lítio (DL) para CAD/CAM, após métodos de envelhecimento. Quarenta e dois barras de DL (IPS e-max CAD, Ivoclar) de 16 x 4 x 2 mm foram separadas aleatoriamente em dois grupos de acordo com os protocolos de queima: Single firing-Pigmentação, glazeamento e cristalização em única etapa. Multiple firings-Cristalização+Primeira camada do pigmento+Queima+Segunda camada do pigmento+Queima+Glazeamento+Queima. Após os protocolos, foram realizadas leituras iniciais de rugosidade de superfície (Surfcorder SE1700, Kosakalab). As amostras foram então separadas aleatoriamente em três grupos (n=7) segundo o método de envelhecimento a que foram submetidas: Ciclagem termomecânica (CTM, Sistema ER, Erios, 1.200.000 ciclos, 0.3 MPa, 2 Hz e 5°C/37°C/55°C, 30 s de imersão), Escovação simulada (ES, Pepsodent, MAVTEC, 73.000 ciclos) e Controle (sem envelhecimento). Leituras finais de rugosidade foram realizadas, e as amostras foram submetidas ao ensaio de resistência à flexão em três pontos (OM100, Odeme Dental Research) e à análise fractográfica por microscopia eletrônica de varredura (EVO-MA10, ZEISS). Os dados foram analisados (ANOVA de dois fatores, (α=.05). Não houve diferença (p>.05) na resistência à flexão entre os protocolos de queima, independente do envelhecimento. ES diminuiu a resistência à flexão das amostras submetidas a multiple firings, diferente do controle (p<.05). Sem envelhecimento (Controle), antes da CTM e após ES, LD apresentou menor rugosidade de superfície quando submetido a multiple firings do que a single firing (p<.05). Os protocolos de queima não afetaram a resistência à flexão nem a rugosidade de superfície da cerâmica vítrea de dissilicato de lítio, mesmo após envelhecimento. No entanto, a escovação afetou negativamente a resistência à flexão e poliu a superfície da cerâmica submetida a multiple firings.

Objectives: To summarize evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The literature on CBT interventions for adult OCD, including BT and exposure and response prevention, was systematically reviewed to develop updated clinical guidelines for clinicians, providing comprehensive details about the necessary procedures for the CBT protocol. We searched the literature from 2013-2020 in five databases (PubMed, Cochrane, Embase, PsycINFO, and Lilacs) regarding study design, primary outcome measures, publication type, and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association. Results: We examined 44 new studies used to update the 2013 American Psychiatric Association guidelines. High-quality evidence supports CBT with exposure and response prevention techniques as a first-line treatment for OCD. Protocols for Internet-delivered CBT have also proven efficacious for adults with OCD. Conclusion: High-quality scientific evidence supports the use of CBT with exposure and response prevention to treat adults with OCD.

Abstract Objectives: To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: 1) Diagnosis – audiologic and radiologic; 2) Treatment – hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI). Conclusions: The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.