ABSTRACT Patients undergoing hematopoietic stem cell transplantation (HSCT) might present acute and late toxicities and the oral tissues are frequently affected. With the survival increasing, patients show late and long-term morbidities, and there is an important association between the general and the oral health. The first and second parts of this Consensus have showed the importance of the adequacy of oral health in the pre-HSCT, and the main alterations and oral care during the period of admission for HSCT. This third part aims to review specific themes of post-HSCT dental care, such as graft-versus-host disease (GVHD) and the pediatric patient. It also aims to review pertinent subjects, both during the HSCT period and post-HSCT, concerning quality of life, pain, cost-effectiveness, and remote care. Based on this review, it is evident the importance of the work of the dental surgeon (DS) in the follow-up and treatment of the HSCT patient, always collaborating with the whole multidisciplinary team.

ABSTRACT The oral involvement in the Hematopoietic Stem Cell Transplantation is well described in the literature. The goal of the dental treatment and management of the oral lesions related to the HSCT is to reduce the harm caused by preexisting oral infection or even the worsening of oral acute/chronic GVHD and late effects. The aim of this guideline was to discuss the dental management of patients subjected to HSCT, considering three phases of the HSCT: pre-HSCT, acute phase, and late phase. The literature published from 2010 to 2020 was reviewed in order to identify dental interventions in this patient population. The selected papers were divided into three groups: pre-HSCT, acute and late, and were reviewed by the SBTMO Dental Committee's members. When necessary, an expertise opinion was considered for better translating the guideline recommendations to our population dental characteristics. This manuscript focused on the pre-HSCT dental management. The objective of the pre-HSCT dental management is to identify possible dental situations that On behalf of the Dental Committee of the Brazilian Society of Gene Therapy and Bone Marrow Transplantation (SBTMO) can worsening during the acute phase after the HSCT. Each guideline recommendations were made considering the Dentistry Specialties. The clinical consensus on dental management prior to HSCT provides professional health caregivers with clinical setting-specific information to help with the management of dental problems in patients to be subjected to HSCT.

Abstract Objectives Prominent ear abnormalities affect 5% of the population. A prospective, double-blind study of patients who underwent otoplasty procedures to correct these abnormalities was conducted to compare two surgical techniques. They diverge by the preservation or not of conchal cartilage. Methods The two techniques were compared by measuring the cephalo-auricular and scapho-conchal angles. Measurements were performed in pre and 6-months post-operative periods using alginate molding. Twenty patients were randomly assigned to two groups (with and without cartilage preservation) with 10 participants each. Student’s t-test, Covariance Analysis Model (ANCOVA), and non-parametric Mann-Whitney were used in the statistical analyses. Results A significant reduction in the average of the cephalo-auricular and scapho-conchal angles was observed in both surgical procedures (p < 0.001). However, no significant difference was found between them (p = 0.887). Conclusion The two techniques analyzed in this study fulfilled their objectives. Therefore, further comparative studies are needed to confirm the superiority of one over the other. Level I Evidence obtained from at least one properly designed randomized controlled trial.

This work describes a green synthesis, the characterization, and biological evaluation of silver nanoparticles (AgNPs). The AgNPs suspension was synthesized using aqueous leaf extract of Eucalyptus grandis, which presented a characteristic band at 407 nm in the UV-Vis spectrum. The AgNPs presented a spherical shape and size of 9.7 ± 0.3 nm. The nanoparticles were stable over a month, indicating that E. grandis’ extract is suitable for their preparation and stabilization. The X-ray analysis showed that the crystallinity of AgNPs corresponded to the centered face phase of silver. The antibacterial and leishmanicidal activities of AgNPs were evaluated. The AgNPs presented antibacterial activity on the Gram-negative bacteria Escherichia coli at 53.9 µg mL-1. The leishmanicidal activity evaluation against promastigote forms of Leishmania infantum, Leishmania amazonensis, and Leishmania braziliensis showed that the biological response is dependent on the volume of AgNP suspension. It was demonstrated that L. infantum was more sensitive to the nanoparticle’s treatment than L. amazonensis and L. braziliensis. The treatment of L infantum promastigotes with 150 µL of AgNP suspension reduced parasite growth by 67.9%, a result which was similar to the treatment with 1 (66.7%) or 2 µL (70.6%) of amphotericin B used as a positive control.

Mari-mari (Cassia leiandra Benth.) is an Amazonian native fruit that is highly appreciated in the northern region of Brazil, but there are few studies regarding its chemical composition and/or biological properties. A phytochemical study was conducted on the extracts of the pulp, peel and seeds; and their antioxidant, cytotoxic and antimicrobial potential were also determined. Methanol and acetone extracts from different fruit parts were subjected to total phenolic, 2,2-diphenyl-1 picrylhydrazyl (DPPH) radical scavenging and FeIII reducing capacity (FRAP) assays. From the peel extracts, the engeletin and astilbin could also be isolated and characterized based on nuclear magnetic resonance spectroscopy and high-resolution mass spectrometry. A quantification using ultra-fast liquid chromatography of acetone dry crude extracts (DCE) of the peel showed that engeletin was the main compound (532.77 mg g-1 DCE). Astilbin content was also determined (131.53 mg g-1 DCE). The antibacterial and antiproliferative activities were evaluated and the methanol extract of the peel showed higher growth inhibition activity against all tested bacteria. Engeletin showed a relevant antimicrobial effect against Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli. Acetone and methanol peel extracts exhibited a relevant inhibitory effect on the proliferation of breast carcinoma cells (MCF-7), with no toxicity to the normal cell line (NIH/3T3).

ABSTRACT Objective: Intrauterine environment can induce fetal metabolic programming that predisposes to adiposity-related chronic diseases in its lifespan. We examined the associations of parental nutritional status and gestational weight gain with offspring body composition in early adulthood. Materials and methods: This is cross-sectional analysis of female participants of the NutriHS who were submitted to questionnaires, clinical examinations and body composition assessed by DXA. Association of pre-conception parental BMI and maternal gestational weight gain (exposures) with body composition measurements (outcomes) were analyzed using multiple linear models adjusted for Directed Acyclic Graphs-based covariables (maternal and paternal educational level, maternal age, and tobacco, alcohol and/or drugs use). The sample included 124 women (median 28 (24-31) years) with a mean BMI of 25.4 ± 4.7 kg/m2. Results: No association between previous paternal BMI and offspring’s body composition was detected. In the fully adjusted linear regression model, maternal BMI was associated with offspring’s total lean mass (β = 0.66, p = 0.001), appendicular skeletal muscle mass index (ASMI) (β = 0.11, p = 0.003) and fat mass index (FMI) (β = 0.03, p = 0.039). Gestational weight gain was associated with increased offspring’s BMI (OR 1.12 [95% CI 1.02-1.20], p = 0.01). The linear regression model adjusted for maternal age and maternal and paternal education levels showed associations of gestational weight gain with offspring’s ASMI (β = 0.42, p = 0.046), FMI (β = 0.22, p = 0.005) and android-to-gynoid fat ratio (β = 0.09, p = 0.035). Conclusion: Our findings suggest that preconception maternal BMI could influence lean mass and general adiposity of young adult female offspring and that gestational weight gain could be useful for predicting centrally distributed adiposity.

Abstract This study describes the results of an investigation regarding the characteristics of financial education teaching, in one of the teaching units of the Federal Institute of Education, Science, and Technology of Acre (Ifac). In this sense, the objective was to verify and characterize, from the teaching perspective, if and how the transversal practice of financial education occurs in the curriculum of integrated technical courses, observing whether such practices correspond to that established by the new National Common Curricular Base (BNCC). This is a qualitative approach research, of exploratory nature, in which sixteen teachers participated, the data being collected with the application of an organized questionnaire with open and closed questions. The analysis and interpretation of the data were based on the Thematization methodology. The study pointed out that the practice of financial education, in the light of the new BNCC, has not yet been implemented in the locus of study and that no traces yet point to transversal initiatives on the topic, which ends up disfavoring the integral training of students. Finally, the study indicated that stimulating actions to promote financial education in the curriculum of the integrated technical courses of Ifac is necessary, thus favoring the teaching and learning of the theme, which will contribute to an integrative education in the locus of study.

Resumo Este estudo descreve os resultados de uma investigação a respeito das características do ensino da educação financeira, em uma das unidades de ensino do Instituto Federal de Educação, Ciência e Tecnologia do Acre (Ifac). Nesse sentido, objetivou-se verificar e caracterizar, sob a perspectiva docente, se e como ocorre a prática transversal da educação financeira no currículo dos cursos técnicos integrados, observando se tais práticas correspondem ao estabelecido pela nova Base Nacional Comum Curricular (BNCC). Trata-se de uma pesquisa com abordagem qualitativa e de caráter exploratório, da qual participaram dezesseis docentes. Os dados foram coletados via aplicação de um questionário organizado com perguntas abertas e fechadas. A análise e interpretação dos dados baseou-se na metodologia de tematização. O estudo mostrou que a prática de educação financeira, à luz da nova BNCC ainda não foi implementada no lócus de estudo e que ainda não há vestígios que apontem para iniciativas de inserção transversal da temática, o que acaba por desfavorecer a formação integral dos estudantes.

Abstract Introduction Myocardial revascularization surgery is associated with high morbidity and mortality, due to factors like the general anesthesia and the surgical procedure itself. Physiotherapy, combined with early mobilization (EM), can provide the patient with better functional parameters. Objective To review, identify and describe the effectiveness of EM in the prevention and rehabilitation of functional parameters of coronary artery bypass graft surgery. Methodology This is a systematic review conducted between February 2020 and 2021 of randomized clinical trials (RCTs) published in the Cochrane databases Library, LILACS, Scielo and Medline / PubMed. The Physiotherapy Evidence Database (PEDro) scale was used for assessment of the methodological quality of studies included. Results Four studies were reviewed. Two articles assessed functional capacity, one using the cycle ergometer and one with inspiratory muscle training (IMT) together with active exercises and early walking. One article reported a reduction in the incidence of atelectasis and pleural effusion with EM and one article reported improvements in the alveolus-artery gradient and inspiratory muscle power using an inspiratory muscle trainer combined with EM. Conclusion EM is effective in the prevention and rehabilitation of functional parameters after CABG surgery, by improving functional capacity, respiratory muscle power, quality of life and gas exchange, and reducing the incidence of atelectasis and pleural effusion.

SUMMARY OBJECTIVE: The aim of this study was to examine the impact of symptom-based screening on the prevalence and outcomes of neonatal coronavirus disease 2019 in pregnant women admitted for delivery. METHODS: A retrospective observational study was conducted from June to August 2020 at Gonzaga Mota of Messejana Hospital, Fortaleza, CE, Brazil. All pregnant women were screened for coronavirus disease 2019 based on symptoms. Reverse transcription-polymerase chain reaction or immunology assays for severe acute respiratory syndrome coronavirus 2 were performed when a patient reported a symptom. All newborns of symptomatic patients were submitted for Reverse transcription-polymerase chain reaction. Newborns were divided into groups according to the Reverse transcription-polymerase chain reaction results to identify the relationship between maternal symptoms and neonatal coronavirus disease 2019. RESULTS: A total of 55 (55/1,026, 5.4%) and 50 (50/1,026, 4.8%) pregnant women reported symptoms and had a positive confirmatory test, respectively. The most common symptom of coronavirus disease 2019 among the pregnant women with positive confirmatory test was cough (n=23, 46%). Seven newborns (7/50, 14%) of symptomatic mothers had positive Reverse transcription-polymerase chain reaction. Upon birth, no newborn had serious complications. CONCLUSION: Universal screening of pregnant women admitted for delivery can reduce the perinatal transmission of coronavirus disease 2019. Symptom-based screening can be an alternative for regions with a low prevalence of the disease where a better allocation of financial resources is necessary.

Abstract Objective To assess two cervicovaginal collection techniques to sample suitability and the other findings of Pap smear. Methods The study was conducted from September 2018 to July 2019, in a school health center located in the city of Fortaleza - Ceará. The sample consisted of 365 women randomly divided, with 184 participants in the Control Group (technique in which the ectocervix smear was placed on the slide before endocervical material was collected) and 181 in the Comparison Group (in which the vaginal ectocervix smear was placed on the slide only after collecting the material from the endocervix). An instrument containing sociodemographic, clinical, sexual, reproductive and findings in cytopathological report was used. Women aged between 18 and 64 years, who had already started their sexual life and who underwent the cervical cancer prevention test during the data collection period, were included. Chi-square, Fisher and Kruskal-Wallis tests were used. Results There was no statistical association between cytopathological sample suitability for the two cervicovaginal collection techniques used and for the other clinical, sexual, reproductive and other variables related to the other findings in cytopathological report, obtaining a value of p>5% in all associations performed. Conclusion The two techniques for collecting cervical cells described in official manuals did not differ for obtaining an adequate cell sample, being equally effective and providing the guarantee of an accurate and timely Pap smear. Brazilian Clinical Trial Registry (ReBEC): RBR-2H4MPN.

Resumen Objetivo Evaluar dos técnicas de toma de muestra cervicovaginal con la adecuación de la muestra y con los demás resultados del informe colpocitológico. Métodos El estudio fue realizado durante el período de septiembre de 2018 a julio de 2019, en un centro de salud-escuela, ubicado en el municipio de Fortaleza, estado de Ceará. La muestra estaba compuesta por 365 mujeres divididas aleatoriamente, de las cuales 184 participantes estaban en el Grupo Control (técnica por la que el frotis del ectocérvix fue colocado en la lámina antes de la toma del material del endocérvix) y 181 en el Grupo Comparación (en el que el frotis del ectocérvix vaginal fue colocado sobre la lámina únicamente después de la toma del material del endocérvix). Se utilizó un instrumento con variables sociodemográficas, clínicas, sexuales, reproductivas y relativas a los resultados del informe citológico. Fueron incluidas mujeres del grupo de edad de 18 a 64 años, que ya habían empezado su vida sexual y que realizaron la prueba de prevención de cáncer de cuello uterino durante el período de la recopilación de datos. Se utilizaron las pruebas χ2 de Pearson, Fisher y Kruskal-Wallis. Resultados No hubo asociación estadística entre la adecuación de la muestra citológica con las dos técnicas de toma cervicovaginal utilizadas y con las demás variables clínicas, sexuales, reproductivas y referentes a los demás resultados del informe citológico, y se obtuvo un valor de p>5 % en todas las asociaciones realizadas. Conclusión Las dos técnicas de toma de células cervicales que se describen en manuales oficiales no difirieron en la obtención de una muestra celular adecuada y son igualmente eficaces y favorecen la garantía de un informe colpocitológico preciso y oportuno.

Resumo Objetivo Avaliar duas técnicas de coleta cervicovaginal à adequabilidade da amostra e aos demais achados do laudo colpocitopatológico. Métodos O estudo foi realizado no período de setembro de 2018 a julho de 2019, em um centro de saúde-escola, localizado no município de Fortaleza - Ceará. A amostra foi composta por 365 mulheres divididas aleatoriamente, sendo 184 participantes no Grupo Controle (técnica na qual o esfregaço da ectocérvice foi disposto na lâmina antes da coleta do material da endocérvice) e 181 no Grupo Comparação (no qual o esfregaço da ectocérvice vaginal foi disposto na lâmina apenas após a coleta do material da endocérvice). Utilizou-se um instrumento contendo variáveis sociodemográficas, clínicas, sexuais, reprodutivas e referentes aos achados no laudo citopatológico. Incluíram-se mulheres na faixa etária de 18 a 64 anos, que já tinham iniciado vida sexual e que realizaram o exame de prevenção do câncer de colo uterino no período da coleta de dados. Os testes do qui-quadrado, Fisher e Kruskal-Wallis foram utilizados. Resultados Não houve associação estatística entre a adequabilidade da amostra citopatológica às duas técnicas de coleta cervicovaginal empregadas e às demais variáveis clínicas, sexuais, reprodutivas e referentes aos demais achados no laudo citopatológico, obtendo-se valor de p>5% em todas as associações realizadas. Conclusão As duas técnicas de coleta de células cervicais descritas em manuais oficiais não diferiram para a obtenção de uma amostra celular adequada, sendo igualmente eficazes e propiciando a garantia de um laudo colpocitopatológico preciso e oportuno. Registro Brasileiro de Ensaios Clínicos (ReBEC): RBR-2H4MPN.

Abstract Objective To assess the Pediatric Alert Score (EPA) accuracy, usefulness, reproducibility and applicability in identifying clinical deterioration in hospitalized children and adolescents. Methods This is a prospective diagnostic test study, carried out between October/2018 and October/2019, to measure EPA diagnostic accuracy in a sample of 240 children, and its reproducibility and applicability in a sample of 60 children. Data were processed and analyzed on MedCalc and VassarStats.net. Results At cut-off point ≥ 3, the score had a sensitivity of 73.6%, specificity of 95.7%, positive predictive value of 83%, negative predictive value of 92.7, area under the ROC curve of 93.6%, estimated prevalence of 19.6%, positive probability ratio of 17.1, positive post-test probability of 77.8%, simple Kappa of 0.946. Conclusion The study provides evidence on EPA high accuracy, usefulness and reproducibility in identifying clinical deterioration in a Brazilian pediatric hospital setting, and considered the instrument applicable in the context of the research.

Resumen Objetivo Evaluar la precisión, utilidad, reproducibilidad y aplicabilidad del Sistema de Alerta Precoz Infantil (SAPI) en la identificación del deterioro clínico en niños y adolescentes hospitalizados. Métodos Estudio de prueba diagnóstica, prospectiva, realizada entre octubre de 2018 y octubre de 2019, para medir la precisión diagnóstica del SAPI en una muestra de 240 niños y su reproducibilidad y aplicabilidad en una muestra de 60 niños. Los datos fueron procesados y analizados en MedCalc y VassarStats.net. Resultados En el punto de corte ≥ 3, el puntaje presentó una sensibilidad del 73,6 %, especificidad del 95,7 %, valor predictivo positivo del 83 %, valor predictivo negativo de 92,7, área bajo la curva ROC del 93,6 %, prevalencia estimada por la prueba del 19,6 %, razón de probabilidad positiva 17,1, probabilidad posprueba positiva del 77,8 %, kappa simple de 0,946. Conclusión El estudio presenta evidencias sobre la elevada precisión, utilidad y reproducibilidad del SAPI en la identificación del deterioro clínico en un escenario hospitalario pediátrico brasileño, por lo que el instrumento se consideró aplicable en el contexto de la investigación.

Resumo Objetivo Avaliar a acurácia, utilidade, reprodutibilidade e aplicabilidade do Escore Pediátrico de Alerta (EPA) na identificação da deterioração clínica em crianças e adolescentes hospitalizados. Métodos Estudo de teste diagnóstico, prospectivo, realizado entre outubro/2018 a outubro/2019, para medir a acurácia diagnóstica do EPA em uma amostra de 240 crianças, e sua reprodutibilidade e aplicabilidade em uma amostra de 60 crianças. Os dados foram processados e analisados no MedCalc e VassarStats.net. Resultados No ponto de corte ≥ 3, o escore apresentou sensibilidade de 73,6%, especificidade de 95,7%, valor preditivo positivo de 83%, valor preditivo negativo de 92,7, área sob a curva ROC de 93,6%, prevalência estimada pelo teste de 19,6%, razão de probabilidade positiva 17,1, probabilidade pós-teste positivo de 77,8%, kappa simples de 0,946. Conclusão O estudo fornece evidências sobre a elevada acurácia, utilidade e reprodutibilidade do EPA na identificação da deterioração clínica em um cenário hospitalar pediátrico brasileiro, e considerou o instrumento aplicável no contexto da pesquisa.

BACKGROUND Leishmaniasis, a neglected disease caused by the parasite Leishmania, is treated with drugs associated with high toxicity and limited efficacy, in addition to constant reports of the emergence of resistant parasites. In this context, snake serums emerge as good candidates since they are natural sources with the potential to yield novel drugs. OBJECTIVES We aimed to show the antileishmanial effects of γCdcPLI, a phospholipase A2 inhibitor from Crotalus durissus collilineatus snake serum, against Leishmania (Leishmania) amazonensis. METHODS Promastigotes forms were exposed to γCdcPLI, and we assessed the parasite viability and cell cycle, as well as invasion and proliferation assays. FINDINGS Despite the low cytotoxicity effect on macrophages, our data indicate that γCdcPLI has a direct effect on parasites promoting an arrest in the G1 phase and reduction in the G2/M phase at the highest dose tested. Moreover, this PLA2 inhibitor reduced the parasite infectivity when promastigotes were pre-treated. Also, we demonstrated that the γCdcPLI treatment modulated the host cell environment impairing early and late steps of the parasitism. MAIN CONCLUSIONS γCdcPLI is an interesting tool for the discovery of new essential targets on the parasite, as well as an alternative compound to improve the effectiveness of the leishmaniasis treatment. Leishmaniasis efficacy context A serum (Leishmania amazonensis cycle assays macrophages G G2M GM G2 M tested Moreover PLA pretreated. pretreated pre treated. pre-treated Also parasitism

RESUMO Objetivo Avaliar a eficácia de exercícios mioterápicos no aumento da pressão e da força lingual. Buscou-se, de forma secundária, analisar quais os tipos de exercícios utilizados, os parâmetros de treinamento e os resultados funcionais obtidos. Estratégia de pesquisa Revisão sistemática da literatura guiada conforme as diretrizes do protocolo Prisma. Critérios de seleção Foram incluídos ensaios clínicos que avaliaram efeitos do treinamento muscular da língua, sem limite quanto ao idioma ou ano de publicação. Análise dos dados Incluiu as etapas de eliminação de artigos duplicados; leitura de resumos e exclusão de estudos que não contemplaram os critérios de elegibilidade; leitura na íntegra dos artigos selecionados com extração de informações importantes, reunidas em tabela; e metanálise, realizada por meio do método do inverso da variância. A avaliação da qualidade metodológica dos estudos foi realizada pela ferramenta do Joanna Briggs Institute. A qualidade da evidência foi avaliada pelo Sistema Grading of Recommendations Assessment, Development and Evaluation. Resultados A metanálise indicou aumento significativo da pressão máxima anterior e posterior como efeito do treinamento. O exercício mais utilizado foi pressão de língua contra o palato, mas os parâmetros de treinamento variaram entre estudos, não sendo possível afirmar que exercícios isolados promovem melhora funcional. A qualidade da evidência foi considerada baixa. Conclusão Os exercícios mioterápicos promovem o aumento da pressão anterior e posterior da língua de indivíduos adultos, porém a qualidade dessa evidência é baixa. Há variabilidade quanto aos tipos de exercícios utilizados e parâmetros de treinamento. Não é possível afirmar que os exercícios promovem melhora funcional. lingual Buscouse, Buscouse Buscou se, se Buscou-se secundária obtidos Prisma publicação duplicados elegibilidade importantes tabela variância Institute Assessment Evaluation palato funcional baixa adultos

ABSTRACT Purpose To assess the effectiveness of myotherapy exercises in increasing tongue pressure and strength. A secondary aim was to analyze the exercise types, training parameters, and functional results. Research strategies This systematic literature review was based on the Prisma protocol guidelines. Selection criteria The review included clinical trials that assessed the effects of tongue muscle training, with no restriction on the language or year of publication. Data analysis The steps included eliminating duplicates; reading abstracts and excluding studies that did not meet the inclusion criteria; reading selected articles in full text, extracting important data, and gathering them in a table; and meta-analysis, using the inverse variance method. The methodological quality of the studies was assessed with the Joanna Briggs Institute’s tool. The quality of evidence was assessed with the Grading System of Recommendations Assessment, Development and Evaluation. Results The meta-analysis indicated a significant increase in maximum anterior and posterior pressure as an effect of training. The most performed exercise was tongue pressure against the palate. However, training parameters varied between studies, and whether exercises alone led to functional improvement cannot be stated. The quality of the evidence was considered low. Conclusion Myotherapy exercises increased anterior and posterior tongue pressure in adults, but the quality of this evidence is low. The studies used various exercise types and training parameters. It cannot be stated whether exercises alone led to functional improvement. strength results guidelines publication duplicates text data table metaanalysis, metaanalysis meta analysis, method Institutes Institute s tool Assessment Evaluation palate However low adults