Abstract Multiple pregnancies carry an increased risk of preterm birth, mortality and long-term infant morbidity. We report a case of delayed delivery following a trichorionic triamniotic pregnancy. The pregnant woman was hospitalized due to preterm premature rupture of membranes at 26 weeks. Tocolytics and corticosteroids were provided. Despite these efforts, the first fetus was born vaginally, 48 hours later. After delivery, antibiotics and tocolytics were administered to delay the birth of the remaining fetuses, which occurred after two weeks. All three babies are healthy, with normal neurological development, and the postpartum period was uneventful.

Resumo As gestações múltiplas têm um maior risco de parto prematuro e morbimortalidade neonatal. Este artigo descreve um caso de parto diferido numa gravidez tricoriónica e triamniótica. A grávida foi hospitalizada devido à rutura prematura das membranas às 26 semanas, recebendo tocolíticos e corticosteroides. O primeiro feto nasceu por parto eutócico 48 horas depois. Após o parto, foram administrados antibióticos e tocolíticos, protelando em duas semanas o nascimento dos fetos restantes. Os três bebés estão saudáveis, com desenvolvimento neurológico normal, e o pós-parto decorreu sem complicações.

ABSTRACT Introduction: Laryngeal cancer is the most common malignant neoplasia of the aerodigestive tract, representing 4.5% of the organism’s cancers and the 30% of the head and neck cancers. Post-operatory complications of the total laryngectomy are frequent and predisposing factors for them are known. Knowing the prevalence of total laryngectomy’s complications, performed means for its treatment, anatomical site, presence or absence of previous adjuvant treatments were set as objectives. Materials and methods: A descriptive and retrospective study was conducted in the Clinical Hospital, Otorhinolaryngology Area, from 2015 to 2022. The study was constituted by a total of 46 patients admitted with the laryngeal cancer diagnosis, 21.7% (10) of which had a total laryngectomy performed on them. Other surgical techniques were excluded. Results: 10 patients submitted to a total laryngectomy within an age range of 31-70 years old, all males. Supraglottic compromise was of 30%. 70% presented complications. The most frequent complication was pharyngocutaneous fistula, others were immediate post-operatory bleeding and surgical site’s infection. 71.4% of patients with fistula were resolved only with conservative means, 2 required reintervention for the defect’s closure. Conclusion: Total laryngectomy complications are present very frequently, affecting the quality of life, evolution, and post-surgical recovery of the patients.

RESUMEN Introducción: El cáncer de laringe es la neoplasia maligna más común de las vías aerodigestivas, representa el 4,5% de los cánceres del organismo y el 30% del cáncer de cabeza y cuello. Las complicaciones postoperatorias de la laringectomía total son frecuentes y se conocen factores predisponentes para ello. Se estableció como objetivo conocer la prevalencia de las complicaciones de la laringectomía total, las medidas realizadas para su tratamiento, el sitio anatómico, la presencia o ausencia de tratamiento adyuvante previo. Materiales y métodos: Se realizó un estudio descriptivo y retrospectivo en el Hospital de Clínicas, Cátedra de Otorrinolaringología, del 2015 al 2022. El universo estuvo constituido por un total de 46 pacientes ingresados con el diagnóstico de cáncer de laringe, 21,7% (10) de los cuales se les realizó laringectomía total. Se excluyeron otras técnicas quirúrgicas. Resultados: 10pacientes sometidos a laringectomía total con un rango de edad de 31-70 años, todos de sexo masculino. El compromiso de la supraglotis fue del 30%. El 70% presentó complicaciones. La complicación más frecuente fue fistula faringocutánea, otras fueron sangrado en el postoperatorio inmediato e infección del sitio quirúrgico. El 71,4% de los pacientes con fistula se resolvieron únicamente con medidas conservadoras, 2 requirieron reintervención para el cierre del defecto. Conclusiones: Las complicaciones de la laringectomía total se presentan con mucha frecuencia, afectando a la calidad de vida, la evolución y recuperación post quirúrgica del paciente.

Resumo Introdução: A reorganização dos cuidados de saúde imposta pela pandemia COVID-19 relevou a capacidade de trabalho de todos os profissionais de saúde, espelhando o papel basilar da Medicina Interna. Este trabalho pretende evidenciar a complexidade da gestão do doente COVID-19, pautada muitas vezes pela ausência de suporte teórico/científico face ao desconhecido. Métodos: Avaliação retrospetiva e descritiva de todos os doentes com infeção SARS-CoV-2 internados numa enfermaria do serviço de Medicina Interna, da Unidade Local de Saúde de Viseu Dão-Lafões (ULS Viseu Dão-Lafões), no período compreendido entre janeiro-abril e julho-novembro de 2021 (picos pandémicos de 2021). Resultados: Durante os 9 meses em estudo, foram avaliados 394 doentes, com predomínio do género masculino 56,60% (n = 223) e uma idade média de 70,42 anos. O tempo médio de internamento foi de 13,95 dias. A maioria apresentava pelo menos um fator de risco cardiovascular e apenas 29,44% (n = 116) eram vacinados contra a COVID-19. Quanto à terapêutica, 84,26% (n = 332) realizaram dexametasona e 85,79% (n = 338) necessitaram de oxigenoterapia suplementar; cerca de 22,08% (n = 87) necessitaram de ventilação mecânica não invasiva e 7,61% (n = 30) de ventilação mecânica invasiva. Registaram-se 23,86% (n = 94) óbitos. A infeção SARS-CoV-2 foi o diagnóstico principal na maioria dos doentes, mas muitos foram os diagnósticos secundários. Conclusão: A gravidade e complexidade de uma entidade nosológica totalmente desconhecida num contexto pandémico é de uma enorme exigência profissional e pessoal, como representado através da caracterização desta amostra. Salienta-se o espetro de doentes graves e com necessidade de suporte ventilatório mecânico, numa curva de admissões que se revelou exponencial.

Abstract Introduction: The reorganization of health care imposed by the COVID-19 pandemic revealed the work capacity of all health professionals, mirroring the fundamental role of In-ternal Medicine. This work intended to highlight the complexity of managing the COVID-19 patient, often guided by the absence of theoretical/scientific support in the face of the unknown. Methods: A retrospective and descriptive evaluation of all patients with SARS-COV2 infection admitted to a ward of the Internal Medicine service, Unidade Local de Saúde de Viseu Dão-Lafões (ULS Viseu Dão-Lafões), in the period between January-April and July-November 2021 (pandemic peaks of 2021). Results: During the nine months under study, 394 patients were evaluated, with a predominance of males 56.60% (n = 223) and an average age of 70.42 years. The average length of stay was 13.95 days. Most had at least one cardiovascular risk factor, and only 29.44% (n = 116) were vaccinated against COVID-19. Of the therapy, 84.26% (n=332) received dexamethasone, 85.79% (n =3 38) needed supplemental oxygen therapy; approximately 22.08% (n = 87) required non-invasive mechanical ventilation, and 7.61% (n = 30) underwent invasive mechanical ventilation/high-flow oxygen therapy. There were 23.86% (N = 94) dea-ths. COVID-19 infection was the primary diagnosis in most patients, but many were secondary diagnoses. Conclusion: The severity and complexity of an unknown nosological disease, in the pandemic phase, is of enormous professional and personal demand, as represented by the characterization of this sample. The spectrum of critically ill patients in need of mechanical ventilatory support stands out, in an admissions curve that turned out to be exponential.

Resumo Introdução: A onicomadese é o descolamento da placa ungueal a partir da prega proximal da unha. Esta alteração ungueal autolimitada foi descrita como uma complicação tardia da doença mão-pé-boca, uma infeção viral comum em crianças. Descrição do caso: Criança do sexo feminino de quatro anos, acompanhada pelo pai (representante legal), recorreu a consulta aberta (CA) com um quadro de febre alta, vesículas e pústulas na mucosa oral, língua, períneo, palmas e plantas das mãos e pés. Foi feito o diagnóstico de doença mão-pé-boca. Após três semanas recorre novamente a CA, com resolução completa do quadro viral, mas com alterações ungueais compatíveis com onicomadese. Comentário: A onicomadese secundária à doença mão-pé-boca é uma manifestação relativamente incomum, mas que causa bastante ansiedade aos pais. O reconhecimento desta associação permite orientar os pais sobre a situação transitória e benigna que pode surgir com esta infeção viral, evitando ansiedade, sobreutilização dos cuidados de saúde e tratamentos desnecessários.

Abstract Introduction: Onychomadesis is the detachment of the nail plate from the proximal crease of the nail. This self-limited nail change has been described as a late complication of hand-foot-and-mouth disease, a common viral infection in children. Case description: A 4-year-old female child, accompanied by her father (legal representative), presented to an urgent appointment with high fever, vesicles, and pustules on the oral mucosa, tongue, perineum, palms, and soles of the hands and feet. The diagnosis of hand-foot-mouth disease was made. After three weeks, she returned to another appointment, with complete resolution of the viral picture, but with nail changes consistent with onychomadesis. Comment: Onychomadesis secondary to hand-foot-and-mouth disease is a relatively uncommon manifestation, but one that causes considerable anxiety to parents. Recognition of this association makes it possible to guide parents on the transient and benign situation that can arise with this viral infection, avoiding anxiety, overuse of health care, and unnecessary treatments.

ABSTRACT Bulk density (BD) is a soil physical property used as a soil quality indicator and variations in this measurement influence soil water content and carbon stock estimates. This study aims to compile a database of samples of bulk density, textural fractions, and organic carbon values, as well as evaluate the accuracy of published pedotransfer functions (PTF) that predict bulk density, and propose a hierarchical PTF to predict the bulk density of Brazilian Soils. The performance of eleven PTFs and the newly proposed PTFs were evaluated and compared using the root mean square error (RMSE) and coefficient of determination (R2) based on a testing soil database collected from the literature. We noticed a slight improvement in accuracy when organic carbon and coarse and fine sand fractions were included as predictors alongside silt and clay. The best results with existing PTFs were obtained by PTF-A in Tomasella and Hodnett (1998) (RMSE = 0.20 g cm–3) and PTF-F in Benites et al. (2007) (RMSE = 0.17 g cm–3). Our proposed PTFs use textural fractions and organic carbon as predictors in a hierarchical form. The proposed PTF-4, which uses fine sand, coarse sand, clay, and organic carbon, presented the lowest value for RMSE (0.14 g cm–3) for BD prediction. (BD estimates values (PTF Soils R2 R (R2 literature clay PTFA A 1998 (1998 020 0 20 0.2 cm–3 cm3 cm 3 PTFF F al 2007 (2007 017 17 0.1 cm–3. . form PTF4, PTF4 4, 4 PTF-4 0.14 014 14 (0.1 prediction (R 199 (199 02 2 0. cm– 200 (200 01 1 PTF- (0. 19 (19 (20 (0 (1 (2 (

Resumo O Brasil tem se firmado como o maior produtor mundial de sementes de urucum (Bixa orellana L.). Felizmente, o aumento da produção nacional tem sido acompanhado por uma melhoria da qualidade dessa matéria-prima. O urucum é uma cultura típica de pequenos produtores, que em geral usa seu conhecimento empírico para avaliar a qualidade do material que está produzindo. A observação visual da cor das sementes de urucum tem sido considerada padrão de qualidade por muitos produtores. Para avaliar as evidências científicas, o presente estudo avaliou amostras de sementes de urucum de 51 acessos do banco de germoplasma do Instituto Agronômico de Campinas (IAC), para determinar se existe correlação entre as concentrações de pigmentos com a cor das sementes e a influência da umidade nessa correlação. Foram avaliadas também as correlações entre as concentrações de pigmentos, umidade, lipídios e a cor (L*, a*, b*). Para a avaliação da cor, utilizamos um colorímetro com a medida da cor pelo sistema CIE L*, a*, b*. Apenas a correlação simples entre as variáveis Umidade e Lipídios foi considerada forte, pela classificação usada neste estudo. Quando se remove o efeito da Umidade (correlação parcial), apenas as variáveis bixina e a* apresentaram correlação significativa, considerada fraca pela classificação utilizada. Portanto, mesmo considerada fraca, há uma correspondência entre a cor vermelha das sementes de urucum com a concentração de bixina das amostras estudadas. Contudo, a diferença da cor (ΔEab) entre as amostras com maior e menor teor de bixina foi de apenas 1,44. Essa diferença indica que grandes variações nas concentrações de bixina nas sementes de urucum podem levar a pequenas variações de cor, dificultando o uso desse critério para o controle de qualidade desses grãos. Bixa L.. L L. . L.) Felizmente matériaprima. matériaprima matéria prima. prima matéria-prima produtores produzindo científicas 5 IAC, IAC , (IAC) (L* b b* b*) L* forte parcial, parcial parcial) significativa utilizada Portanto estudadas Contudo ΔEab (ΔEab 144 1 44 1,44 grãos (IAC (L 14 4 1,4 1,

Abstract Brazil has emerged as the world's largest producer of annatto seeds (Bixa orellana L.). Fortunately, the increase in national production has been accompanied by an improvement in the quality of this raw material. Annatto is a typical crop of small producers who usually use their empirical knowledge to evaluate the quality of the crop. Thefore, the visual observation of the color of annatto seeds has been considered a quality standard by many producers. To evaluate the scientific evidence, the present study evaluated annatto seeds from 51 accessions of the germplasm bank of the Agronomic Institute (Instituto Agronômico de Campinas - IAC) to determine a possible correlation between the pigment’s contents and the color of annatto seeds as well as the influence of humidity on this correlation. The correlations between the concentrations of pigments, humidity, lipids, and color (L*, a*, b*) were also evaluated. The color was evaluated using a colorimeter with measurements of the CIE L*, a*, b* scale. Only the correlation between the variables moisture and lipids was considered strong through the simple correlation, while the variables bixin content and coordinate a* presented a significant correlation while eliminating the effect of moisture (partial correlation). Thus, a correlation between the red color and the bixin concentration of annatto seeds was observed even though it was a weak correlation. In turn, the color difference (ΔEab) between the samples with higher and lower bixin contents was only 1.44. This difference indicates that large variations in the bixin concentrations may lead to small color changes in the annatto seeds, impairing the use of this criterion for quality control of these seeds. worlds world s Bixa L.. L L. . L.) Fortunately material Thefore evidence 5 Instituto IAC pigments pigment (L* b L* scale partial correlation) Thus turn ΔEab (ΔEab 144 1 44 1.44 (L 14 4 1.4 1.

Abstract Background A cost of illness (COI) study aims to evaluate the socioeconomic burden that an illness imposes on society as a whole. This study aimed to describe the resources used, patterns of care, direct cost, and loss of productivity due to systemic lupus erythematosus (SLE) in Brazil. Methods This 12-month, cross-sectional, COI study of patients with SLE (ACR 1997 Classification Criteria) collected data using patient interviews (questionnaires) and medical records, covering: SLE profile, resources used, morbidities, quality of life (12-Item Short Form Survey, SF-12), and loss of productivity. Patients were excluded if they were retired or on sick leave for another illness. Direct resources included health-related (consultations, tests, medications, hospitalization) or non-health-related (transportation, home adaptation, expenditure on caregivers) hospital resources. Costs were calculated using the unit value of each resource and the quantity consumed. A gamma regression model explored cost predictors for patients with SLE. Results Overall, 300 patients with SLE were included (92.3% female, mean [standard deviation (SD)] disease duration 11.8 [7.9] years), of which 100 patients (33.3%) were on SLE-related sick leave and 46 patients (15.3%) had stopped schooling. Mean (SD) travel time from home to a care facility was 4.4 (12.6) hours. Antimalarials were the most commonly used drugs (222 [74.0%]). A negative correlation was observed between SF-12 physical component and SLE Disease Activity Index (- 0.117, p = 0.042), Systemic Lupus International CollaboratingClinics/AmericanCollegeofRheumatology Damage Index (- 0.115, p = 0.046), medications/day for multiple co-morbidities (- 0.272, p < 0.001), SLE-specific drugs/day (- 0.113, p = 0.051), and lost productivity (- 0.570, p < 0.001). For the mental component, a negative correlation was observed with medications/day for multiple co-morbidities (- 0.272, p < 0.001), SLE-specific medications/day (- 0.113, p = 0.051), and missed appointments (- 0.232, p < 0.001). Mean total SLE cost was US$3,123.53/patient/year (median [interquartile range (IQR)] US$1,618.51 [$678.66, $4,601.29]). Main expenditure was medication, with a median (IQR) cost of US$910.62 ($460, $4,033.51). Mycophenolate increased costs by 3.664 times (p < 0.001), and inflammatory monitoring (erythrocyte sedimentation rate or C-reactive protein) reduced expenditure by 0.381 times (p < 0.001). Conclusion These results allowed access to care patterns, the median cost for patients with SLE in Brazil, and the differences across regions driven by biological, social, and behavioral factors. The cost of SLE provides an updated setting to support the decision-making process across the country. (COI whole (SLE Brazil 12month, 12month month 12 month, 12-month crosssectional, crosssectional cross sectional, sectional cross-sectional ACR 199 Criteria questionnaires (questionnaires records covering profile morbidities 12Item Item Survey SF12, SF12 SF , SF-12) healthrelated health related consultations, consultations (consultations tests medications hospitalization nonhealthrelated non transportation, transportation (transportation adaptation caregivers consumed Overall 30 92.3% 923 92 3 (92.3 female standard SD 118 11 8 11. 7.9 79 7 9 [7.9 years, years years) 10 33.3% 333 33 (33.3% SLErelated 4 15.3% 153 15 (15.3% schooling (SD 44 4. 12.6 126 6 (12.6 hours 222 (22 74.0%. 740 74.0% . 74 0 [74.0%]) SF-1 ( 0117 117 0.117 0.042, 0042 0.042 042 0.042) CollaboratingClinicsAmericanCollegeofRheumatology CollaboratingClinics AmericanCollegeofRheumatology 0115 115 0.115 0.046, 0046 0.046 046 0.046) medicationsday day comorbidities co 0272 272 0.272 0.001, 0001 0.001 001 0.001) SLEspecific specific drugsday 0113 113 0.113 0.051, 0051 0.051 051 0.051) 0570 570 0.570 0.001. 0232 232 0.232 US312353patientyear USpatientyear US 123 53 year interquartile IQR US161851 1 618 51 US$1,618.5 $678.66, 67866 678 66 [$678.66 $4,601.29. 460129 $4,601.29 601 29 $4,601.29]) medication (IQR US91062 910 62 US$910.6 $460, 460 ($460 $4,033.51. 403351 $4,033.51 033 $4,033.51) 3664 664 3.66 erythrocyte Creactive C reactive protein 0381 381 0.38 biological social factors decisionmaking decision making country 19 SF1 92.3 (92. 7. [7. 33.3 (33.3 15.3 (15.3 12. (12. 22 (2 74.0 [74.0%] SF- 011 0.11 004 0.04 04 027 27 0.27 000 0.00 00 005 0.05 05 057 57 0.57 023 23 0.23 patientyear 5 US16185 61 US$1,618. $678.66 6786 67 [$678.6 46012 $4,601.2 60 2 $4,601.29] US9106 91 US$910. $460 ($46 40335 $4,033.5 03 366 3.6 038 38 0.3 92. (92 [7 33. (33. 15. (15. (12 74. [74.0% 01 0.1 0.0 02 0.2 0.5 US1618 US$1,618 $678.6 [$678. 4601 $4,601. US910 US$910 $46 ($4 4033 $4,033. 36 3. 0. (9 [ (33 (15 (1 [74.0 US161 US$1,61 $678. [$678 $4,601 US91 US$91 $4 ($ 403 $4,033 (3 [74. US16 US$1,6 $678 [$67 $4,60 US9 US$9 $ 40 $4,03 [74 US1 US$1, $67 [$6 $4,6 US$ $4,0 US$1 $6 [$ $4,

Abstract Hemophagocytic lymphohistiocytosis (HLH) is a rare genetic hyperinflammatory syndrome that occurs early in life. Macrophage activation syndrome (MAS) usually refers to a secondary form of HLH associated with autoimmunity, although there are other causes of secondary HLH, such as infections and malignancy. In this article, we reviewed the concepts, epidemiology, clinical and laboratory features, diagnosis, differential diagnosis, prognosis, and treatment of HLH and MAS. We also reviewed the presence of MAS in the most common autoimmune diseases that affect children. Both are severe diseases that require prompt diagnosis and treatment to avoid morbidity and mortality. (HLH life (MAS autoimmunity malignancy article concepts epidemiology features prognosis children mortality

ABSTRACT Diversifying pastures with forage legumes may reduce nitrogen fertilization due to biological N fixation. This study aimed to quantify forage accumulation rate and macronutrients extraction and to identify the best intercropping combination between butterfly pea (Clitoria ternatea) – a legume, and three warm-season forage grasses of different growth habits (signalgrass – Urochloa decumbunes, Guinea grass - Mega thyrsus maximus, and bermudagrass Cynodon dactylon). Treatments consisted of mixes of perennial herbaceous legume, butterfly pea (twining stem), with grasses, signalgrass (decumbent stem) and Guinea grass (erect stem), and bermudagrass (stoloniferous/rhizomatous). The experiment was arranged in a randomized complete block design, with three treatments and three replications. There was interaction between the intercropping combinations and cutting cycles for forage accumulation rate (FAR) and N, P, K, Ca, Mg, and S uptake. Phosphorus and K uptake was reduced from the second cycle onwards, except for the signalgrass-butterfly pea intercropping, whose reduction was only from the third cycle. Conversely, the signalgrass-butterfly pea and bermudagrass-butterfly pea intercropping did not differ from each other in relation to total N concentration in soil, but the signalgrass-butterfly pea intercropping showed total N concentration in soil higher than that of Guinea grass-butterfly pea intercropping. A higher predominance of the N-NH4+ form was observed in the soil. Grass-legume intercropping increased the demand for nutrients, which makes it indispensable to verify the export of macronutrients to know when to supply these nutrients removed from the soil solution. fixation Clitoria ternatea legume warmseason warm season decumbunes maximus dactylon. dactylon . dactylon) twining stem, stem , decumbent erect stoloniferous/rhizomatous. stoloniferousrhizomatous stoloniferous/rhizomatous stoloniferous rhizomatous (stoloniferous/rhizomatous) design replications FAR (FAR P Ca Mg onwards signalgrassbutterfly Conversely bermudagrassbutterfly grassbutterfly NNH4+ NNH4 NNH NH4+ NH4 NH N-NH4 Grasslegume Grass solution (stoloniferous/rhizomatous N-NH

Abstract Immunodiagnostic tests for detecting dengue virus infections encounter challenges related to cross-reactivity with other related flaviviruses. Our research focuses on the development of a synthetic multiepitope antigen tailored for dengue immunodiagnostics. Selected dengue epitopes involved structural linearity and dissimilarity from the proteomes of Zika and Yellow fever viruses which served for computationally modeling the three-dimensional protein structure, resulting in the design of two proteins: rDME-C and rDME-BR. Both proteins consist of seven epitopes, separated by the GPGPG linker, and a carboxy-terminal 6 × -histidine tag. The molecular weights of the final proteins rDME-C and rDME-BR are 16.83 kDa and 16.80 kDa, respectively, both with an isoelectric point of 6.35. The distinguishing factor between the two proteins lies in the origin of their epitope sequences, where rDME-C is based on the reference dengue proteome, while rDME-BR utilizes sequences from prevalent Dengue genotypes in Brazil from 2008 to 2019. PyMol analysis revealed exposure of epitopes in the secondary structure. Successful expression of the antigens was achieved in soluble form and fluorescence experiments indicated a disordered structure. In subsequent testing, rDME-BR and rDME-C antigens were assessed using an indirect Elisa protocol against Dengue infected serum, previously examined with a commercial diagnostic test. Optimal concentrations for antigens were determined at 10 µg/mL for rDME-BR and 30 µg/mL for rDME-C, with serum dilutions ranging from 1:50 to 1:100. Both antigens effectively detected IgM and IgG antibodies in Dengue fever patients, with rDME-BR exhibiting higher sensitivity. Our in-house test showed a sensitivity of 77.3 % and 82.6 % and a specificity of 89.4 % and 71.4 % for rDME-C and rDEM-BR antigens. No cross-reactivity was observed with serum from Zika-infected mice but with COVID-19 serum samples. Our findings underscore the utility of synthetic biology in crafting Dengue-specific multiepitope proteins and hold promise for precise clinical diagnosis and monitoring responses to emerging Dengue vaccines. crossreactivity cross reactivity flaviviruses immunodiagnostics threedimensional three dimensional structure rDMEC rDME C rDMEBR. rDMEBR BR. BR linker carboxyterminal carboxy terminal histidine tag 1683 16 83 16.8 1680 80 respectively 635 35 6.35 proteome 200 2019 testing 1 µgmL µg mL 3 rDMEC, C, 150 50 1:5 1100. 1100 100. 100 1:100 patients inhouse house 773 77 77. 826 82 82. 894 89 4 89. 714 71 71. rDEMBR rDEM Zikainfected COVID19 COVID 19 COVID-1 samples Denguespecific specific vaccines 168 8 16. 63 6.3 20 201 15 5 1: 110 1:10 7 COVID1 COVID- 6. 2 11 1:1

ABSTRACT Introduction: Peritoneal dialysis patients are at increased risk of developing abdominal wall complications, including hernias. This study aimed to determine the incidence of hernias in peritoneal dialysis patients, identify risk factors, and evaluate their impact on technique survival. Methods: A retrospective cohort study was conducted, including prevalent peritoneal dialysis patients in a single center, from January 2010 to October 2020. Data on baseline characteristics, previous abdominal surgeries, and hernia history were collected. Patients with diagnosed hernias during peritoneal dialysis were compared to a control group. Results: Among 155 peritoneal dialysis patients, hernias occurred in 29% (n=45) of the population, with an incidence rate of 0.09 hernias/patient/year. Umbilical hernias were the most common subtype. Autosomal dominant polycystic kidney disease (OR (odds ratio) 3.925; 95% confidence interval (CI), 1.208 - 12.75) history of surgical repaired hernias (OR 5.586; 95% CI 1.540 - 20.255) and a higher number of previous abdominal surgeries (OR 1.680; 95% CI 1.025 - 2.752) were independent predictors of hernia development. Surgical treatment was performed in 59.3% of cases, with a 18.8% recurrence rate. Higher daytime infusion volumes were associated with hernia recurrence (p=0.045). Peritoneal dialysis technique survival did not differ significantly between the hernia and control groups (p=0.700). Conclusion: Hernias are frequent in peritoneal dialysis patients, with autosomal dominant polycystic kidney disease, previous abdominal surgeries, and history of surgically repaired hernias as identified risk factors. Hernias do not significantly interfere with peritoneal dialysis technique survival, but comprehensive management strategies, including early surgical repair and peritoneal dialysis prescription adaptations, can optimize outcomes.

Abstract Introduction: Fibromyalgia is a syndrome characterized by generalized, chronic musculoskeletal pain of unknown etiology, with a high impact on quality of life and high consumption of health resources. Although there are no recommendations that support the use of opioids in fibromyalgia, they are widely used. Thus, there is a need to find pharmacological alternatives with a favorable risk-benefit profile. Cannabinoids are currently the subject of great scientific interest, in particular because of their potential analgesic effect. Methodology: A literature search was carried out in PubMed, Cochrane, and NICE databases, of studies published in the last 5 years, using the MeSH terms: fibromyalgia, cannabinoids, and cannabis. To stratify the level of evidence and strength of recommendation, the SORT scale was used. Results: Nine articles were selected, including a guideline, four systematic reviews, two meta-analyses and a randomized clinical trial. Conclusion: Cannabinoids have therapeutic potential as an adjunctive treatment for chronic pain.

Resumo Introdução: A fibromialgia é uma síndrome caracterizada por dor musculoesquelética generalizada, que tem um elevado impacto na qualidade de vida e um grande consumo de recursos de saúde. Apesar de não existirem recomendações que suportem a utilização de opioides na fibromialgia, estes são largamente utilizados. Assim, há a necessidade de encontrar alternativas farmacológicas eficazes e com perfil de risco-benefício favorável. Os canabinoides são atualmente alvo de grande interesse científico, em particular devido ao seu efeito analgésico. Metodologia: Realizou-se uma pesquisa bibliográfica nas bases de dados PubMed, Cochrane e NICE, de estudos publicados nos últimos 5 anos, utilizando os termos MeSH: fibromyalgia, cannabinoids e cannabis. Para estratificar o nível de evidência e a força de recomendação, foi utilizada a escala SORT. Resultados: Foram selecionados nove artigos, incluindo uma guideline, quatro revisões sistemáticas, duas MAs e um ensaio clínico randomizado. Conclusão: Os canabinoides têm potencial terapêutico como tratamento adjuvante na dor crónica.

ABSTRACT Background: Hypersensitivity reactions during chemotherapy have been increasingly documented in children. Drug desensitization is an unknown procedure for most oncologists, despite allowing patients to be treated with first-line agents, affecting the final prognosis. Currently, there are no guidelines for drug desensitization in pediatric age, and the general principles adopted for adults have been applied to children. Objective: To describe the experience of an Immunoallergology department of a central hospital in the desensitization to carboplatin and methotrexate in pediatric age. Results: Desensitizations were performed on carboplatin in 17 patients, in a total of 112 procedures, and on methotrexate in 4 children, with a success rate of 88% for carboplatin and 100% for methotrexate. Conclusion: As far as the authors are aware, this is the largest European series of desensitizations to chemotherapy in pediatric age, including procedures in infants and in non-immediate reactions.

RESUMO Fundamentos: As reações de hipersensibilidade durante a quimioterapia em crianças têm sido documentadas de forma crescente. A dessensibilização a fármacos é um procedimento desconhecido por grande parte dos oncologistas, apesar de permitir que os doentes sejam tratados com agentes de primeira linha, afetando o prognóstico final. Atualmente, ainda não existem normas de orientação de dessensibilização a fármacos em idade pediátrica e os princípios gerais adotados para os adultos têm sido aplicados em crianças. Objetivo: Descrever a experiência de um serviço de imunoalergologia de um hospital central na dessensibilização à carboplatina e ao metotrexato em idade pediátrica. Resultados: Foram realizadas dessensibilizações à carboplatina em 17 crianças, num total de 112 procedimentos, e ao metotrexato em 4 crianças, com uma taxa de sucesso de 88% para a carboplatina e de 100% para o metotrexato. Conclusão: Tanto quanto é do conhecimento das autoras, esta é a maior série europeia de dessensibilizações a quimioterápicos em idade pediátrica, tendo sido realizadas, inclusivamente, procedimentos num lactente e numa reação não imediata.

Resumo O objetivo deste artigo é avaliar inter-relações de fatores associados a sintomas depressivos (SD) em professores, considerando a insatisfação com o trabalho docente como possível mediador. Estudo transversal utilizando dados de 700 professores da rede pública de ensino de um município brasileiro. O desfecho de interesse foi SD aferido pelo Inventário de Depressão de Beck (BDI). Foram testadas inter-relações diretas e indiretas entre o desfecho e insatisfação com o trabalho, idade, renda, estilo de vida e adiposidade. Essas variáveis compuseram modelo operacional testado por meio de modelagem de equações estruturais. A maior idade (β=0,12) e a maior insatisfação com o trabalho (β=0,12) associaram-se diretamente aos SD. Já o estilo de vida mais favorável (β=-0,60) e a adiposidade (β=-0,10), associaram-se a menor ocorrência de SD. As variáveis estilo de vida (β=-0,06) e adiposidade (β=-0,02) também apresentaram efeitos indiretos negativos nos SD, mediados pela insatisfação com o trabalho. O modelo de equação estrutural testado identificou inter-relações que influenciaram os SD. A insatisfação com o trabalho docente associou-se aos SD e mediou a relação de outros fatores sobre tais sintomas. interrelações inter relações (SD mediador 70 brasileiro BDI. BDI . (BDI) renda estruturais β=0,12 β012 β 0 12 (β=0,12 associaramse associaram se β=0,60 β060 β= 0,60 60 (β=-0,60 β=0,10, β010 0,10 , 10 (β=-0,10) β=0,06 β006 0,06 06 (β=-0,06 β=0,02 β002 0,02 02 (β=-0,02 associouse associou 7 (BDI β=0,1 β01 1 (β=0,1 β=0,6 β06 060 0,6 6 (β=-0,6 β=0,10 010 0,1 (β=-0,10 β=0,0 β00 006 0,0 (β=-0,0 002 β=0, β0 (β=0, 0, (β=-0, 01 (β=-0,1 00 β=0 (β=0 (β=-0 (β= (β=- (β

Abstract The objective of this article is to evaluate the interrelationships of factors associated with depressive symptoms (DS) in teachers, considering dissatisfaction with the teaching job as a possible mediator. This was a cross-sectional study using data from 700 teachers from the public school system of a Brazilian municipality. The outcome of interest was DS, as assessed using the Beck Depression Inventory (BDI). Direct and indirect interrelationships between the outcome and dissatisfaction with work, age, income, lifestyle and adiposity were tested. These variables composed the operational model tested by structural equation modelling. Older age (β=0.12) and greater dissatisfaction with work (β=0.12) were directly associated with DS. A more favourable lifestyle (β=-0.60) and adiposity (β=-0.10) were associated with a lower occurrence of DS. The variables lifestyle (β=-0.06) and adiposity (β=-0.02) also had negative indirect effects on DS, mediated by job dissatisfaction. The structural equation model tested identified interrelationships that influenced DS. Dissatisfaction with teaching work was associated with DS and mediated the relationship of other factors with such symptoms. (DS mediator crosssectional cross sectional 70 municipality BDI. BDI . (BDI) income modelling β=0.12 β012 β 0 12 (β=0.12 β=0.60 β060 β= 0.60 60 (β=-0.60 β=0.10 β010 0.10 10 (β=-0.10 β=0.06 β006 0.06 06 (β=-0.06 β=0.02 β002 0.02 02 (β=-0.02 7 (BDI β=0.1 β01 1 (β=0.1 β=0.6 β06 060 0.6 6 (β=-0.6 010 0.1 (β=-0.1 β=0.0 β00 006 0.0 (β=-0.0 002 β=0. β0 (β=0. 0. (β=-0. 01 00 β=0 (β=0 (β=-0 (β= (β=- (β