RESUMO Objetivo. Descrever a experiência brasileira na resposta a emergências de saúde pública em 2023, bem como a estrutura organizacional e as características epidemiológicas. Métodos. Foram analisadas três emergências (estudos de casos) ocorridas durante o ano do estudo de acordo com as ações empreendidas durante a resposta e os impactos na população. As emergências de saúde pública foram resumidas e analisadas por meio de pesquisas em documentos e sites oficiais do Ministério da Saúde e de autoridades sanitárias municipais. Resultados. Caso 1 – Emergência devido à falta de assistência: considerada pelo governo brasileiro uma emergência de saúde pública de importância nacional, exigiu a mobilização de um Centro de Operações de Emergência em Saúde Pública (COE) para a resposta devido à complexidade das ações. Caso 2 – Emergência devido a zoonoses (arbovírus e influenza aviária): a estrutura de resposta do COE foi usada para desenvolver atividades para interromper o surgimento de arbovírus e evitar uma emergência de influenza aviária no país. Caso 3 – Emergências devido a desastres: exigiram estruturas de resposta municipais e uso do COE para coordenar ações com o apoio do governo federal. Conclusões. A experiência brasileira destaca a importância dos seguintes fatores: coordenação intra e intersetorial na gestão das ações de resposta; monitoramento e comunicação constantes para aprimorar as medidas de resposta; apoio nacional aos esforços municipais de resposta; e adaptação da estrutura do COE aos diferentes contextos e complexidades das emergências enfrentadas.

RESUMEN Objetivo. Describir la experiencia de la respuesta a emergencias de salud pública en Brasil en el 2023, su estructura organizativa y sus características epidemiológicas. Métodos. Se analizaron tres emergencias (estudios de casos) ocurridas durante el año de estudio en lo que respecta a las medidas aplicadas durante la respuesta y su impacto en la población. Las emergencias de salud pública se resumieron y analizaron mediante la investigación de los documentos y sitios web oficiales del Ministerio de Salud y de las autoridades de salud locales. Resultados. En el caso 1, una emergencia por falta de asistencia que el gobierno brasileño consideró una emergencia de salud pública de importancia nacional, fue necesario un centro de operaciones de emergencia (COE) para la respuesta debido a la complejidad de las medidas. En el caso 2, una emergencia debida a varias zoonosis (infecciones por arbovirus y gripe aviar), se utilizó la estructura de respuesta del COE para llevar a cabo actividades destinadas a detener el surgimiento de los arbovirus y prevenir una emergencia de gripe aviar en el país. Por último, en el caso 3, las emergencias debidas a catástrofes requirieron estructuras de respuesta locales y utilizaron el COE para coordinar las medidas aplicadas, con el apoyo del gobierno federal. Conclusiones. La experiencia brasileña destaca la importancia de la coordinación intra e intersectorial en la gestión de las medidas de respuesta, el seguimiento y la comunicación constantes para mejorar esas medidas, el apoyo nacional a las actividades locales de respuesta y la adaptación de la estructura del COE a los diferentes contextos y complejidades de las emergencias afrontadas.

ABSTRACT Objective. To describe the Brazilian experience of responding to public health emergencies in 2023, the organizational structure, and epidemiological characteristics. Methods. Three emergencies (case studies) that occurred during the study year were analyzed according to the actions implemented during the response and the impacts on the population. The public health emergencies were summarized and analyzed through research on official documents and websites of the Ministry of Health and local health authorities. Results. Case 1 – Emergency due to lack of assistance, considered by the Brazilian government to be a public health emergency of national importance, required an Emergency Operations Center (EOC) for the response due to the complexity of the actions. Case 2 – Emergency due to zoonoses (arboviruses and avian influenza) used the EOC response structure to develop activities aimed at stopping the emergence of arboviruses and preventing an avian influenza emergency in the country. Finally, case 3 – Emergencies due to disasters required local response structures and used the EOC to coordinate their actions with the federal government’s support. Conclusions. The Brazilian experience highlights the importance of intrasectoral and intersectoral coordination in managing response actions, constant monitoring and communication to improve response measures, national support for local response efforts, and adaptation of the EOC structure to the different contexts and complexities of the emergencies faced.

Resumo Objective: To evaluate the accordance of prognostic medicines prescription (PMP), for persons with chronic heart failure with reduced ejection fraction (P-CHFrEF), attended in primary health care units in Central Portugal, with the European Society of Cardiology (ESC) 2021 August, guidelines. To know about mean age, median time since the diagnosis and last echocardiogram performance in P-CHFrEF. Methods: Observational, cross-sectional study of a random size representative sample, 95% confidence interval, and 8% error margin of the P-CHFrEF of a population on 31st December 2021. Age, gender, year of International Classification for Primary Care-2 (ICPC-2, K-77) problem classification input data, years since the last echocardiogram, ongoing PMP and the use of other chronic heart failure (CHF) drugs were gathered. Data were obtained from 11 Portugal Primary Health Care Units, invited by convenience, after an Ethics Committee approval. Results: From a universe of n=2,381 persons with CHF, n=453 (19.0%) P-CHFrEF was found. A size representative sample of P-CHFrEF of n=133 (5.6%), n=95 males (71.4%) was studied. Prescription of a renin-angiotensin system inhibitor (RAAS-I) was ongoing in 91.0%, beta-blocker (BB) in 75.2%, mineralocorticoid antagonists (MRA) in 40.6%, inhibitors of the sodium-glucose cotransporter-2 (SGLT2i) in 44.4%, neprilisine inhibitors 38.3% and loop diuretics in 72.2%. The optimized medical quadruple therapy was established in 28 patients (21.1%) and the triple one in 38 (28.6 %). Mean age was of 74.3±11.6 years, males 73.4±11.0 and females 76.6±12.9, p=0.088. The median time since the diagnosis was 6.0 for men and 4.0 for women, p=0.031. The median time since the last echocardiogram was 3.0, p=0.750 between genders. Conclusion: According to the 2021 ESC guidelines, prognostic modifying medicines were underused for 50.4% of P-CHFrEF. Even with these results, a reflection must be made, on the barriers physicians encounter, to comply with the ESC guidelines in such patients.

Abstract Objetivo: Avaliar a concordância da terapêutica com medicamentos modificadores de prognóstico (MMP) em pessoas com insuficiência cardíaca crónica com fração de ejeção reduzida (P-CICFEr), em cuidados de saúde primários (CSP) na região Centro de Portugal, com as diretrizes da Sociedade Europeia de Cardiologia (ESC) de agosto de 2021. Métodos: Estudo observacional transversal de uma amostra representativa do tamanho, intervalo de confiança de 95% e margem de erro de 8%, da população com CICFEr em 31/dezembro/2021. Foram estudados idade, sexo, ano de diagnóstico da introdução da Classificação Internacional para Cuidados Primários-2 (ICPC-2, K-77), anos desde o último ecocardiograma, MMPs para P-CICFEr e outras terapêuticas para P-CICFEr. Participaram, convidadas por conveniência, 11 Unidades de Saúde Familiar após parecer positivo da Comissão de Ética. Resultados: Num universo de n=2.381 pessoas com insuficiência cardíaca (PCIC) encontraram-se n=453 (19,0%) (P-CICFEr) estudando-se uma amostra representativa de n=133 (5,6%), n=95 homens (71,4%). Verificou-se prescrição de medicamentos inibidores do sistema renina-angiotensina-aldosterona (iSRAA) 91,0%, de betabloqueadores em 75,2%, de antagonistas mineralocorticoides em 40,6%, de inibidores da SGLT2 em 44,4%, de inibidores da neprilisina em 38,3% e de diuréticos de ansa em 72,2%. A terapêutica farmacológica quádrupla verificou-se em n=28 (21,1%) P-CICFEr e a tripla em n=38 (28,6%). Verificou-se idade média de 74,3±11,6 anos, 75,1±4,0 no homem e 76,6±6,0 na mulher, p=0,088. A mediana de tempo desde o diagnóstico ICPC-2 foi de 6,0 anos no homem e de 4,0 anos na mulher, p=0,031. O tempo mediano desde o último ecocardiograma foi de três anos, p=0,750. Conclusão: Os medicamentos modificadores de prognóstico, segundo as diretrizes mais recentes da ESC para a CICFEr, estavam subutilizados em 50,4% dos casos. Apesar dos resultados encontrados é necessária reflexão acerca das barreiras que os médicos possam encontrar para aplicar as diretrizes em P-CICFEr.

Resumen Objetivo: Evaluar si el tratamiento con ácido hialurónico reticulado bifásico de lesiones osteocondrales promovería la regeneración del tejido cartilaginoso, favoreciendo así la reparación de la lesión. Materiales y Métodos: Quince conejos hembra adultos fueron divididos aleatoriamente en tres grupos: grupo 1, de control; grupo 2 y grupo 3, sometidos a una estrategia quirúrgica de lesión osteocondral en la rodilla derecha (4 mm de diámetro, 5 mm de profundidad), el grupo 3 recibió tratamiento con 0,2 ml de ácido hialurónico por vía intrarticular después de la cirugía. Se realizaron controles clínicos, bioquímicos, histopatológicos y estudios por imágenes. Resultados: Se detectaron menos casos de dolor a la palpación en el grupo 3 que en el grupo 2 a partir de los 45 días. En la resonancia magnética, casi todas las muestras del grupo 3 tenían signos de regeneración del tejido cartilaginoso en el sitio de la lesión, sin edema óseo, ni derrame articular significativo. Los estudios histopatológicos de las muestras del grupo 3 indicaron un aumento de la matriz extracelular propia de tejido cartilaginoso, comparada con la del grupo 2, con hipercelularidad, dada por condrocitos, los que formaban grupos isogénicos axiales y coronales. Conclusiones: Este estudio brinda evidencias de que el tratamiento con ácido hialurónico reticulado bifásico en unidades experimentales de conejos con lesión osteocondral no tuvieron dolor en etapas tempranas después de la lesión, a diferencia de las unidades intervenidas y sin dicho tratamiento. A su vez, los estudios por imágenes e histopatológico mostraron la reparación del tejido dañado.

Abstract Objective: To demonstrate whether treatment with biphasic cross-linked hyaluronic acid in osteochondral lesions promotes the regeneration of cartilage tissue. Materials and Methods: Fifteen adult female rabbits were randomly assigned to three groups. G1 was the control group, whereas G2 and G3 underwent surgery to treat an osteochondral injury in the right knee (4mm diameter, 5mm depth). G3 received treatment with 0.2 ml of hyaluronic acid intrarticularly after surgery. Clinical, biochemical, histopathological controls and imaging studies were performed. Results: Clinically, G3 exhibited less pain on palpation than G2 after 45 days. In G3, almost all samples showed evidence of cartilage tissue regeneration at the injury site, with neither bone edema or considerable joint effusion detected on MRI. The histological tests of G3 samples revealed an increase in the extracellular matrix of cartilaginous tissue when compared to G2, with hypercellularity caused by chondrocytes that formed axial and coronal isogenic groups. Conclusions: This study provides evidence that treatment with biphasic cross-linked hyaluronic acid in experimental units of rabbits with osteochondral injuries did not cause pain in the early stages of the injury. In turn, imaging and histopathological studies revealed that the injured tissue had been repaired.

Resumo Objetivo: Reportar a experiência de um centro no tratamento de paragangliomas do osso temporal com radiocirurgia robótica. Desenho do Estudo: Análise retrospetiva unicêntrica Material e Métodos: Entre 2017 e 2021, 8 doentes com paragangliomas do osso temporal receberam tratamento com Cyberknife no Serviço de Radioterapia do Instituto CUF Porto. Resultados: Metade dos doentes apresentavam recidiva tumoral após cirurgia +/- embolização. O tempo de seguimento médio foi de 33 meses. Relativamente à resposta clínica, 4 doentes melhoraram dos sintomas pré-radiocirurgia, 2 mantiveram-se assintomáticos e 2 apresentaram estabilidade neurológica. Todos os tumores revelaram regressão (n=5) ou estabilidade dimensional (n=3) - seguimento com ressonância magnética (RM), com um controlo local de 100%. Não foi reportada toxicidade aguda grau ≥3 ou tardia. Conclusões: Na presente análise, a radiocirurgia robótica parece demonstrar ser uma abordagem terapêutica útil na gestão dos paragangliomas do osso temporal, quer nas recidivas após cirurgia e/ou embolização, quer como tratamento radical único.

Abstract Objective: To report the experience of a single center in the treatment of temporal bone paragangliomas with Robotic Radiosurgery. Study Design: Single-center retrospective analysis Material and Methods: Between 2017 and 2021, 8 patients with temporal bone paragangliomas were treated with Cyberknife in the Department of Radiation Oncology of Instituto CUF Porto. Results: Half of the patients were diagnosed with recurrent tumors after surgery +/- embolization. The median follow-up was 33 months. Regarding clinical outcomes, 4 patients showed improvement in pre-radiosurgery symptoms, 2 remained symptom-free and 2 demonstrated neurological stability. All tumors revealed regression (n=5) or stable dimension (n=3) during follow-up MRI, with local control of 100%. There was no grade ≥3 or late toxicities. Conclusion: Robotic Radiosurgery seems to be a helpful therapeutic approach in the management of temporal bone paragangliomas, either after surgery and/or embolization recurrences or as a single and radical treatment.

Abstract To date, hydroxyurea is the only effective and safe drug that significantly reduces morbidity and mortality of individuals with Sickle cell disease. Twenty years of real-life experience has demonstrated that hydroxyurea reduces pain attacks, vaso-occlusive events, including acute chest syndrome, the number and duration of hospitalizations and the need for transfusion. The therapeutic success of hydroxyurea is directly linked to access to the drug, the dose used and adherence to treatment which, in part, is correlated to the availability of hydroxyurea. This consensus aims to reduce the number of mandatory exams needed to access the drug, prioritizing the requesting physician's report, without affecting patient safety. date disease reallife real life attacks vasoocclusive vaso occlusive events syndrome transfusion which part physicians physician s report safety

ABSTRACT The physical and chemical attributes of coffee beans have a direct relation with the sensory quality of the beverage and the commodity’s market value. The coffee berry borer is a pest that causes a worldwide harm, and its infestation compromises bean health and composition. The objective of this study was to analyze the effect of infestation levels on beans physical and chemical parameters. Coffee samples were collected, and the damaged beans present in the samples were classified as to infestation level. The centesimal composition, color, quantification of bioactive compounds, and organic acids were evaluated. The L* and b* parameters of the CIELab color system were found to be significantly different between infestation levels. For chemical parameters, beans with major levels of infestation were found to differ from the others in the content of sugars, lipids, soluble solids, total titratable acidity, electrical conductivity, potassium leaching, succinic acid, and acetic acid. The presence of pests did not affect the bioactive compounds present in the coffee beans. commoditys commodity s value harm composition collected level evaluated L b sugars lipids solids acidity conductivity leaching acid

ABSTRACT Introduction: Considering the rising occurrence of posttranplant diabetes and the elevated cardiovascular burden among transplant recipients, the utilization of SGLT2 inhibitors (SGLT2i) in this group is appealing because of their cardiovascular and renoprotective benefits. Nevertheless, there is a scarcity of evidence for diabetic kidney transplant recipients (DKTRs) owing to concerns about potential renal graft damage and adverse effects. Methods: This retrospective study was devised to assess the effectiveness and safety of SGLT2i in kidney transplant recipients (KTRs). The main focus was on evaluating their impact on parameters such as haemoglobin A1c levels, body mass index (BMI), lipid panel, haemoglobin levels, renal allograft function (estimated glomerular filtration rate) and urirnary protein-to-creatinine ratio. Results: A total of 75 renal transplant patients were included in this investigation. The study spanned a median observation period of 18 (2.0–71.0) months. Median estimated glomerular filtration rate at baseline was 61,9 (26–120) mL/min/1.73 m2 and remained stable throughout the follow-up. Median HbA1cdecreased from 7.5 to 7.0% (95% CI; p<0,002). A significant improvement in BMI (95% CI; p<0,001) and lipid panel (95% CI; p<0,05) were also observed. Median haemoglobin rate at baseline was 13,5g/dL and modestly improved at end of follow-up to 13,7g/dL (p=0,12). Regarding urinary protein:creatinine ratio, levels slightly but not significantly rose [+0.05 g/g (p=0,9)]. In a post-hoc subgroup analysis, the rate of urinary tract infections was low (10%). No other side effects were observed during the treatment course. Conclusions: This study demonstrates that the administration of SGLT2i is viable and well-tolerated, with no notable side effects observed in KTRs. However, the question of whether SGLT2i can effectively lower cardiovascular mortality and enhance allograft survival in these patients remains to be explored in subsequent studies. Introduction SGLT SGLTi i (SGLT2i benefits Nevertheless DKTRs (DKTRs Methods KTRs . (KTRs) Ac c BMI, , (BMI) proteintocreatinine protein creatinine ratio Results 7 investigation 1 2.0–71.0 20710 2 0 71 (2.0–71.0 months 619 61 9 61, 26–120 26120 26 120 (26–120 mLmin173 mLmin mL min 73 mL/min/1.7 m followup. followup follow up. up HbAcdecreased HbA cdecreased 5 7. 70 7.0 95% 95 (95 CI p<0,002. p0002 p p<0,002 002 p<0,002) p<0,001 p0001 001 p<0,05 p005 05 135gdL gdL 13 5g dL g 137gdL 7g p=0,12. p012 p=0,12 12 (p=0,12) proteincreatinine +0.05 005 [+0.0 gg p=0,9. p09 p=0,9 (p=0,9)] posthoc post hoc analysis 10%. 10 10% (10%) course Conclusions welltolerated, welltolerated well tolerated, tolerated well-tolerated However studies (KTRs (BMI 2.0–71. 2071 (2.0–71. 6 26–12 2612 (26–12 mLmin17 mL/min/1. (9 p000 p<0,00 00 p<0,0 p00 p01 p=0,1 (p=0,12 +0.0 [+0. p0 p=0, (p=0,9) (10% 2.0–71 207 (2.0–71 26–1 261 (26–1 mLmin1 mL/min/1 ( p<0, (p=0,1 +0. [+0 p=0 (p=0,9 (10 2.0–7 20 (2.0–7 26– (26– mL/min/ p<0 (p=0, +0 [+ p= (1 2.0– (2.0– (26 mL/min p< (p=0 + [ 2.0 (2.0 (2 (p= 2. (2. (p

RESUMO Introdução: Considerando o aumento da incidência de diabetes pós-transplante e o elevado impacto cardiovascular entre os receptores de transplantes, este facto faz com que o uso de inibidores de SGLT2 nesse grupo seja atrativo devido aos seus benefícios cardiovasculares e renoprotetores. No entanto, há escassez de evidência nos receptores de transplante renal com diabetes devido a preocupações com possíveis danos ao enxerto renal e efeitos adversos. Métodos: Este estudo retrospectivo foi elaborado para avaliar a eficácia e segurança dos inibidores de SGLT2 em receptores de transplante renal (KTRs). O foco principal foi avaliar o seu impacto em parâmetros como níveis de hemoglobina A1c, índice de massa corporal (IMC), perfil lipídico, níveis de hemoglobina, função do enxerto renal (taxa de filtração glomerular estimada) e relação proteína/creatinina urinária. Resultados: Um total de 75 pacientes receptores de transplante renal foram incluídos em nossa investigação. O estudo abrangeu um período de observação mediano de 18 (2,0–71,0) meses. A taxa média de filtração glomerular estimada no início foi de 61,9 (26–120) mL/min/1,73 m2 e permaneceu estável durante o acompanhamento. A mediana da HbA1c diminuiu de 7,5 para 7,0% (IC 95%; p<0,002). A melhora significativa no IMC (IC 95%; p<0,001) e no perfil lipídico (IC 95%; p<0,05) também foram observados. A taxa média de hemoglobina no início foi de 13,5g/dL e melhorou modestamente no final do acompanhamento para 13,7g/dL (p=0,12). Em relação à relação proteína/creatinina urinária, os níveis aumentaram ligeiramente, mas não significativamente [+0,05 g/g (p=0,9)]. Numa análise de subgrupo post-hoc, a taxa de infecções do trato urinário foi baixa (10%). Nenhum outro efeito colateral foi observado durante o curso do tratamento. Conclusões: Este estudo demonstra que a administração de inibidores de SGLT2 é viável e bem tolerada, sem efeitos colaterais notáveis em receptores de transplante renal. No entanto, a questão de saber se a inibição do SGLT2 pode efetivamente reduzir a mortalidade cardiovascular e melhorar a sobrevida do enxerto nesses pacientes permanece a ser explorada em estudos subsequentes. Introdução póstransplante pós transplantes SGLT renoprotetores entanto adversos Métodos KTRs. KTRs . (KTRs) A1c Ac c IMC, , (IMC) proteínacreatinina proteína creatinina urinária Resultados 7 investigação 1 2,0–71,0 20710 2 0 71 (2,0–71,0 meses 619 61 9 61, 26–120 26120 26 120 (26–120 mLmin173 mLmin mL min 73 mL/min/1,7 m HbAc HbA 5 7, 70 7,0 IC 95% 95 p<0,002. p0002 p p<0,002 002 p<0,002) p<0,001 p0001 001 p<0,05 p005 05 observados 135gdL gdL 13 5g dL g 137gdL 7g p=0,12. p012 p=0,12 12 (p=0,12) ligeiramente +0,05 005 [+0,0 gg p=0,9. p09 p=0,9 (p=0,9)] posthoc, posthoc post hoc, hoc post-hoc 10%. 10 10% (10%) tratamento Conclusões tolerada subsequentes (KTRs (IMC 2,0–71, 2071 (2,0–71, 6 26–12 2612 (26–12 mLmin17 mL/min/1, p000 p<0,00 00 p<0,0 p00 p01 p=0,1 (p=0,12 +0,0 [+0, p0 p=0, (p=0,9) (10% 2,0–71 207 (2,0–71 26–1 261 (26–1 mLmin1 mL/min/1 p<0, (p=0,1 +0, [+0 p=0 (p=0,9 (10 2,0–7 20 (2,0–7 26– (26– mL/min/ p<0 (p=0, +0 [+ p= (1 2,0– (2,0– (26 mL/min p< (p=0 + [ ( 2,0 (2,0 (2 (p= 2, (2, (p

ABSTRACT Synthetic chemical insecticides are widely used in population control of pests. Aedes aegypti is the primary vector of dengue, Zika, chikungunya and yellow fever to humans, and has proven resistance to chemical insecticides. As an alternative vector control method, the ethanolic extract of the leaves of Piper peltatum L. (Piperaceae) showed larvicidal activity against Ae. aegypti. Despite the wide medicinal use of this plant, the biological activity of its isolated constituents remains unexplored. In this sense, we isolated, identified and evaluated the larvicidal activity of 4-nerolidylcatechol (4-NC) from P. peltatum against Ae. aegypti, Culex quinquefasciatus and Anopheles darlingi, focusing on the larvicidal, adulticidal and genotoxic potential of 4-NC on Ae. aegypti. Larvae were captured in the city of Manaus, Amazonas state, Brazil. 4-NC was isolated from the extract of the leaves of P. peltatum via silica gel chromatography. This was identified using nuclear magnetic resonance spectroscopy and tested in Artemia franciscana (6.25, 12.5, 25, 50, 100 and 200 µg/mL). In the toxicity bioassay, Ae. aegypti larvae were exposed to 30, 50, 70, 90, and 110 µg/mL of 4-NC, while Cx. quinquefasciatus and An. darlingi were exposed to 6.25, 12.5, 25, 50 and 100 µg/mL. Ae. aegypti larvae were also subjected to 40 and 60 µg/mL of 4-NC (genotoxicity bioassay), and adult females to 62.5 to 1,000 µg/mL (adulticidal bioassay). The results of the 4-NC toxicity assays showed that there was 100% mortality in larvae of Ar. franciscana at the concentration of 200 µg/mL, with an LC50 of 8.0 μg/mL. In the larvae of Ae. aegypti, mortality was 100%, with an LC50 of 62 μg/mL. In larvae of Cx. quinquefasciatus, 97% mortality occurred, with an LC50 of 52.3 μg/mL, and in An. darlingi larvae there was an 83% mortality rate, with an LC50 of 55.8 μg/mL. In adults of Ae. aegypti, however, there was no adulticidal activity. In the larvae of Ae. aegypti, the genotoxic effect of 4-NC (40 and 60 µg/mL) showed significant frequency (p < 0.05) of cellular abnormalities (micronuclei, budding and nuclear bridges) of interphasic nuclei of neuroblasts and oocytes in relation to the negative control. This result may be associated with a decrease in oviposition of females, which was observed in two generations. We can confirm that 4-NC has larvicidal activity against Ae. aegypti, Cx. quinquefasciatus and An. darlingi. Although it does not present adulticidal activity in Ae. aegypti, it reduced the oviposition of females. Therefore, 4-NC seems to be a strong candidate for the development of an alternative method for the control of these mosquitoes in the immature phase. pests dengue Zika humans L Piperaceae (Piperaceae Ae plant unexplored sense 4nerolidylcatechol nerolidylcatechol 4 4NC NC (4-NC P Manaus state Brazil chromatography 625 6 25 (6.25 125 12 5 12.5 10 20 µgmL . µg mL bioassay 30 70 90 11 4NC, NC, Cx An 6.25 genotoxicity , bioassay) 62. 1000 1 000 1,00 bioassay. Ar LC LC5 80 8 0 8. μgmL μg μg/mL 97 occurred 523 52 3 52. 83 rate 558 55 55. however (4 p 0.05 005 05 micronuclei, micronuclei (micronuclei bridges generations Therefore phase 2 (6.2 12. 7 9 6.2 00 1,0 ( 0.0 (6. 6. 1, 0. (6

ABSTRACT Background: The current treatments for Chagas disease (CD) include benznidazole and nifurtimox, which have limited efficacy and cause numerous side effects. Triazoles are candidates for new CD treatments due to their ability to eliminate T. cruzi parasites by inhibiting ergosterol synthesis, thereby damaging the cell membranes of the parasite. Methods: Eleven synthetic analogs of the kinase inhibitor SRPIN340 containing a triazole core (compounds 6A-6K) were screened in vitro against the Tulahuen strain transfected with β-galactosidase, and their IC50, CC50, and selectivity indexes (SI) were calculated. Compounds with an SI > 50 were further evaluated in mice infected with the T. cruzi Y strain by rapid testing. Results: Eight compounds were active in vitro with IC50 values ranging from 0.5-10.5 µg/mL. The most active compounds, 6E and 6H, had SI values of 125.2 and 69.6, respectively. These compounds also showed in vivo activity, leading to a reduction in parasitemia at doses of 10, 50, and 250 mg/kg/day. At doses of 50 and 250 mg/kg/day, parasitemia was significantly reduced compared to infected untreated animals, with no significant differences between the effects of 6E and 6H. Conclusions: This study identified two new promising compounds for CD chemotherapy and confirmed their activity against T. cruzi. Background (CD nifurtimox T synthesis parasite Methods SRPIN SRPIN34 6A6K AK 6A 6K A K 6A-6K βgalactosidase, βgalactosidase β galactosidase, galactosidase β-galactosidase IC CC50 CC (SI calculated 5 testing Results IC5 0.510.5 05105 0.5 10.5 0 10 0.5-10. µgmL µg mL µg/mL E 6H H 1252 125 2 125. 696 69 6 69.6 respectively 25 mgkgday mg kg day mg/kg/day animals Conclusions SRPIN3 CC5 510 0.510. 0510 05 0. 105 10. 1 0.5-10 12 69. 51 0.510 051 0.5-1 0.51 0.5-

Resumo Objetivo: Estudar as características de contexto das pessoas com insuficiência cardíaca da Região Centro de Portugal e a maneira como o diagnóstico foi feito. Método: Estudo observacional transversal em amostra representativa e aleatória de pessoas sofrendo de insuficiência cardíaca (PCIC), em 2022, com dados em anonimato de unidades de saúde em cuidados de saúde primários (CSP) convidadas em conveniência na Região de Saúde do Centro. Para cada PCIC estudaram-se: sexo, idade, número de problemas crónicos de saúde, índice de Graffar, tipo de família, formação académica, economia familiar, calculando-se o Socioeconomic Deprivation Index (SEDI) e o modo de realização do diagnóstico. Realizou-se estatística descritiva, inferencial adaptada e correlacional. Resultados: Em amostra de n=350 PCIC, 151 (43,1%) do sexo masculino, 84,0% em classes Graffar média e média-baixa, 61,8% com formação académica baixa e 44,0% com insuficiência económica, o valor médio de SEDI foi de 4,3 [3 a 6], verificou-se multimorbilidade em 97,4%, média de 9±4 problemas crónicos de saúde, bem como diferenças significativas entre sexos quanto ao tipo de família, formação académica, economia familiar, idade, nível SEDI, data de diagnóstico e ano da primeira ecocardiografia registada, piores e com mais tempo no sexo feminino. Verificaram-se correlações fracas, mas significativas (ρ=0,156, p=0,003), entre a idade e o número de doenças crónicas e entre a data de diagnóstico de IC e o ano da primeira ecocardiografia registada (ρ=0,375, p<0,001). Discussão: Adequados conhecimento e gestão das variáveis de contexto das PCICs podem e devem ser consideradas pelos médicos por influenciarem o curso da doença, o prognóstico e os custos para as PCIC, suas famílias e serviços de saúde. Conclusão: As PCICs da Região Centro de Portugal Continental são idosas, com multimorbilidade, com estatuto socioeconómico desfavorável e formação académica baixa. O diagnóstico foi confirmado sobretudo por ecocardiografia.

Abstract Objective: To study the context and clinical and context characteristics of persons suffering from Cardiac Insufficiency (PCHF) in the central region of Portugal, and how they were diagnosed in 2022. Methods: Observational cross-sectional study in a random representative sample of PCHF in 2022, with anonymous data from conveniently invited Primary Health Units in central Portugal. For every PCHF gender, age, number of chronic health problems, Graffar Index, type of family, academic level, family income, calculating the socio-economic deprivation index (SEDI) and how they were diagnosed. Descriptive, inferential, and correlational statistics were performed. Results: In a sample of n=350 PCHF, 151 (42.9%) males, 84.0% in Graffar middle and low-middle classes, 61.8% with low academic level and 44,0% with economic insufficiency, SEDI mean level was of 4.3 [3 to 6], multimorbidity was present in 97.4%, with a 9±4 mean number of chronic health problems and significant differences between genders for family type (p<0.001), academic level (p=0.001), economic insufficiency (p=0.015) age (p<0.001), SEDI mean level (p<0.001), diagnostic date (p=0.007) and year of first registered echocardiogram (p=0.045), worst and older in females. Weak but significant correlations were observed between age and number of chronic health problems (ρ=0.156, p=0.003) and date of diagnosis and year of first registered echocardiogram (ρ=0.375, p<0.001). Discussion: Adequate knowledge and management of the context and clinical variables of PCHF, must be considered by doctors, for they influence the course of the disease, the prognostics, and the costs for PCHF, their families, and health services. Conclusion: PCHF from central Portugal, are old, have multimorbidity, economic unfavourable socio-economic context, and low academic level. The diagnosis was mainly confirmed by an echocardiogram.

Resumo: O presente estudo analisou o papel preditor das dimensões cognitivas, sociais, emocionais e comportamentais de crianças avaliadas aos 4 anos e meio de idade, bem como das variáveis tradicionalmente associadas à prontidão escolar académica antes da entrada no ensino primário, no desempenho da Matemática no final do 1.º ano. Participaram neste estudo longitudinal um total de 58 crianças Portuguesas e respetivos pais. As correlações iniciais demonstraram associações significativas entre o quociente de inteligência (QI) da criança, controlo inibitório, flexibilidade cognitiva, perfil de desregulação, prontidão escolar académica e o seu desempenho subsequente na Matemática. Através de uma análise de regressão hierárquica verificou-se que o controlo inibitório aos 4 anos e meio previu significativamente o desempenho na Matemática no final do 1.º ano, superando o efeito da prontidão escolar académica antes da entrada no ensino primário. Estes resultados contribuem para a literatura existente, salientando o impacto do funcionamento executivo da criança, avaliado durante a idade pré-escolar, no desempenho posterior na Matemática nos primeiros anos do ensino formal.

Abstract: This study examined the predictive role of child cognitive, social, emotional, and behavioural dimensions assessed at the age of 4½, as well as of the traditional variables related to academic school readiness before the entry to primary school, on mathematics achievement at the end of Year 1. A sample of 58 Portuguese children and their parents participated in this longitudinal study. Initial correlations indicated significant associations between child intelligence quotient (IQ), inhibitory control, set-shifting, dysregulation profile, academic school readiness, and their subsequent performance in mathematics. A hierarchical regression analysis showed that inhibitory control at 4½ years significantly predicted mathematics achievement at the end of Year 1 over and above the effect of academic school readiness before entering primary school. These results add to the existing literature by highlighting the impact of child executive functioning assessed during the preschool years on subsequent mathematics performance in early school years.

Resumo Introdução: Calcula-se que, em Portugal, 94% das mulheres usam algum método contracetivo. A contraceção hormonal combinada tem sido a escolha de eleição pela maioria das mulheres. Estes métodos contracetivos apresentam diversos benefícios para a saúde além da contraceção, mas também acarretam alguns riscos. Assim, é de interesse avaliar se as utilizadoras estão cientes dos mesmos. Método: Através da aplicação de um questionário a 150 utilizadoras de contraceção hormonal combinada com idades compreendidas entre os 18 e os 50 anos, acompanhadas nas consultas dos centros de saúde da Cova da Beira, pretendeu-se avaliar a literacia das utentes acerca dos benefícios e riscos do seu método contracetivo hormonal combinado. Resultados: No total das 13 questões relativas aos benefícios e riscos da contraceção hormonal combinada, em oito verificou-se uma percentagem de mulheres que admitiram não saber a resposta superior a 50%. A questão respondida mais acertadamente foi relativa aos ciclos menstruais, a mais erradamente foi relativa às cefaleias e aquela onde as mulheres mais frequentemente admitiram não saber a resposta foi a do cancro do endométrio. Do total da amostra, 142 mulheres apontaram a recomendação do médico/enfermeiro como principal motivo de escolha do método contracetivo. Discussão: O elevado grau de desconhecimento dos benefícios e riscos do método contracetivo pode dever-se à informação insuficiente providenciada pelos profissionais de saúde e/ou ao desinteresse manifestado pelas utentes. Conclusão: As utilizadoras de contraceção hormonal combinada não estão devidamente esclarecidas sobre os benefícios e riscos inerentes à sua utilização. Desta forma, é necessário encontrar métodos de intervenção que melhorem a literacia das mulheres face à sua medicação contracetiva. Para isso poder-se-ia proceder à entrega de folhetos informativos aquando da entrega do mesmo. Também poder-se-iam criar grupos de discussão nas redes sociais aproveitando as vantagens das tecnologias.

Abstract Introduction: It is estimated that, in Portugal, 94% of women use some contraceptive method. Combined hormonal contraception has been the preferred choice for most women. These contraceptive methods have several health benefits in addition to contraception, but they also carry some risks. Thus, it is of interest to assess whether the users are aware of them. Methods: Through the application of a questionnaire to 150 users of combined hormonal contraception aged between 18 and 50 years, being followed in consultations at primary health care units in Cova da Beira, the aim was to assess the literacy about the benefits and risks of their combined hormonal contraceptive method. Results: In the total of 13 questions about the benefits and risks of combined hormonal contraception, eight of them presented a percentage of women who admitted not knowing the answer greater than 50%. The most correctly answered question by women was related to the menstrual cycles, the most wrongly answered was related to headaches, and the one where women more often admitted not knowing the answer was the one about endometrial cancer. Of the total sample, 142 women indicated the doctor/nurse’s recommendation as the main reason for choosing the contraceptive method. Discussion: The high degree of ignorance of the benefits and risks of the contraceptive method may be due to insufficient provision of information by health professionals and/or lack of interest on the part of users. Conclusion: Users of combined hormonal contraception are not fully informed about the benefits and risks inherent to its use. In this way, it is necessary to find interventions that improve women’s literacy in relation to their contraceptive medication.

Abstract Medical rescuers are the frontline for COVID-19 and their psychological experience and health are major concerns to our society and healthcare system. This study aims to understand how medical rescuers psychologically experienced this pandemic and explore the contributing variables to COVID-19 anxiety. Portuguese medical rescuers (n = 203) answered questions about their COVID-19 experience, the COVID-19 Anxiety Scale, Patient-Health Questionnaire, Perceived Stress Scale, Obsessive-Compulsive Inventory, and Well-Being Questionnaire. Rescuers presented low COVID-19 anxiety and low-moderate levels of fear. Most already faced or were facing changes in their job-related tasks, did not change household and did not feel stigma/discrimination. COVID-19 workplace security measures were considered moderately adequate and low anxiety, depression and obsessive-compulsive symptoms, low to moderate stress and moderate well-being were found. Only COVID-19 fear and security measures, anxiety, depression and obsessive-compulsive symptoms explained COVID-19 anxiety. Overall, findings showed these rescuers were psychologically well adjusted during the pandemic’s initial stages.

Resumo Introdução e objetivos: A doença hepática avançada (DHA) é uma causa importante de morbilidade e mortalidade, comparável em grande medida a outras insuficiências de órgão. A necessidade de cuidados paliativos (CP) em doentes com DHA é elevada. Em Portugal, no único estudo identificado até ao momento, mais de 80% dos doentes hospitalizados com DHA apresentavam critérios para CP. Não foram especificadas que necessidades de CP nem a perspetiva de transplante dos referidos doentes, que com o presente estudo se pretende ajudar a esclarecer. Métodos: Estudo prospectivo observacional incluindo 54 doentes com DHA assistidos num hospital universitário e centro de transplante, entre novembro de 2019 e setembro de 2020. Avaliação das necessidades de CP por meio da aplicação do NECPAL CCOMS-ICO© e IPOS, considerando a sua perspectiva de transplante. Resultados: Dos 54 doentes, cinco (9,3%) estavam em lista de espera ativa para transplante e oito (14,8%) em avaliação. O NECPAL CCOMS-ICO© identificou 23 doentes (n = 42,6%) que beneficiariam de CP. A avaliação das necessidades de CP por médicos, os marcadores funcionais e as comorbidades significativas foram os critérios mais frequentes (47,8%, n = 11). O IPOS também revelou diversas necessidades de CP: em média, cada doente identificou cerca de 9 necessidades (8,9 + -2,8). Entre os sintomas identificados, destacaram-se a fraqueza (77,8%), a mobilidade reduzida (70,3%) e a dor (48,1%), bem como os sintomas psicoemocionais de depressão (66,7%) e ansiedade (77,8%). Não houve diferenças significativas entre os subgrupos de doentes analisados. Apenas 4 doentes (7,4%) foram acompanhados pela equipa intra-hospitalar de CP. Conclusão: Todos os doentes com DHA incluídos, independentemente do grupo a que pertenciam, apresentaram necessidades de CP. Não foram identificadas diferenças significativas entre os subgrupos de doentes, confirmando que mesmo os doentes com perspectiva de transplante têm importantes necessidades de CP.

Abstract Background and Aims: End-stage liver disease (ESLD) is an important cause of morbidity and mortality, comparable to a large extent to other organ insufficiencies. The need for palliative care (PC) in patients with ESLD is high. In Portugal, in the only identified study, more than 80% of patients hospitalized with ESLD had criteria for PC. No results specified which needs they identified or their transplantation prospect status. Methods: Prospective observational study including 54 ESLD patients who presented to a university hospital and transplantation center, between November 2019 and September 2020. Assessment of their PC needs through the application of NECPAL CCOMS-ICO© and IPOS, considering their transplantation perspective status. Results: Of the 54 patients, 5 (9.3%) were on active waiting list for transplantation and 8 (14.8%) under evaluation. NECPAL CCOMS-ICO© identified 23 patients (n = 42.6%) that would benefit from PC. Assessment of PC needs by clinicians, functional markers and significant comorbidities were the most frequent criteria (47.8%, n = 11). IPOS also revealed a different sort of needs: on average, each patient identified about 9 needs (8.9 ±2.8). Among the symptoms identified, weakness (77.8%), reduced mobility (70.3%), and pain (48.1%) stood out, as well as the psychoemotional symptoms of depression (66.7%) and anxiety (77.8%). There were no significant differences between the subgroups of patients analyzed. Only 4 patients (7.4%) were followed by the PC team. Conclusion: All the ESLD patients included, independently of the group they belonged to, presented with PC needs. No significant differ-ences between the subgroups of patients were identified, confirming that even patients with a transplantation pros-pect have important needs for PC.