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: Endoscopic retrograde cholangiopancreatog-raphy (ERCP) in patients with Billroth II gastrectomy is still a challenging procedure. The optimal approach, namely the type of endoscope and sphincter management, has yet to be defined. Aim : To compare the efficacy and safety of forward-viewing gastroscope and the side-viewing duodenoscope in ERCP of patients with Billroth II gastrectomy. Methods: We conducted a retrospective, single-center cohort study of consecutive patients with Billroth II gastrectomy submitted to ERCP in an expert center for ERCP between 2005 and 2021. The outcomes assessed were: papilla identification, deep biliary cannulation, and adverse events (AEs). Multivariate anal-ysis was performed to evaluate potential associations and predictors of the main outcomes. Results: We included 83 patients with a median age of 73 (IQR 65-81) years. ERCP was performed using side-viewing duodenoscope in 52 and forward-viewing gastroscope in 31 patients. Patients’ characteristics were similar in the two groups. The global rate of papilla identification was 66% (n = 55). The rate of deep cannulation was 58% considering all patients and 87% in the subgroup of patients in which the papilla major was identified. Cannulation was performed with standard methods in 65% of cases and with needle-knife fistulotomy in 35%. AEs occurred in 4 patients. There was no difference between duodenoscope and gastroscope in papilla identification (64% [95% CI: 51-77] vs. 71% [55-87]). Although not statistically significant, duodenoscope had a lower deep cannulation rate when considering all patients (52% [15-39] vs. 68% [7-35]) and a higher AEs rate (8% [1-15] vs. 0% [0-1]). In a multivariate analysis, the use of gastroscope significantly increased the deep cannulation rate (OR = 152.62 [2.5-9,283.6]). Conclusion: This study demonstrates that forward-viewing gastroscope is at least as effective and safe as side-viewing duodenoscope for ERCP in patients with Billroth II gastrectomy. Moreover, our study showed that gas-troscope is an independent predictor of successful cannulation.

Resumo Introdução: Colangiopancreatografia retrógrada endoscópica (CPRE) em doentes submetidos previamente a gastrectomia com reconstrução Billroth II é ainda um exame desafiante. A melhor abordagem, nomeadamente tipo de endoscópio e a técnica de canulação biliar, ainda não está definida. Objectivo: Comparar a eficácia e segurança do gastroscópio de visão frontal e do duodenoscópio de visão lateral na CPRE de doentes com gastrectomia com reconstrução Billroth II. Métodos: Conduzimos um estudo de coorte retrospectivo e unicêntrico que incluiu consecutivamente doentes com gastrectomia com reconstrução Billroth II submetidos a CPRE num centro de referência para CPRE entre 2005 e 2021. Os outcomes avaliados foram: identificação da papila, canulação biliar profunda e efeitos adversos (EAs). Regressão logística foi realizada para avaliar possíveis associações e preditores dos outcomes. Resultados: Incluímos 83 doentes com uma idade mediana de 73 (IIQ 65-81) anos. A CPRE foi realizada usando duodenoscópio em 52 doentes e usando o gastroscópio de visão frontal em 31 doentes. As características dos doentes foram semelhantes entre os dois grupos. A taxa global de identificação da papila foi de 66% (n = 55). A taxa de canulação profunda foi de 58% considerando todos os doentes e de 87% considerando apenas o subgrupo de doentes nos quais a papila major foi identificada. A canulação foi realizada usando métodos convencionais em 65% e usando fistulotomia com faca em 35% dos doentes. EAs ocorreram em 4 doentes. Não houve diferenças entre duodenoscópio e gastroscópio relativamente à identificação da papila [64% (95% CI: 51-77) vs 71% (55-87)]. Apesar de estatisticamente não significativo, o uso de duodenoscópio teve uma menor taxa de canulação profunda quando considerados todos os doentes [52% (15-39) vs 68% (7-35)] e uma maior taxa de EAs [8% (1-15) vs 0%(0-1)]. Na regressão logística, o uso de gastroscópio sig-nificativamente aumentou a taxa de canulação profunda [OR = 152.62 (2.5-9,283.6)]. Conclusão: Este estudo demonstra que o uso de gastroscópio de visão frontal é pelo menos igualmente eficaz e seguro ao duodenoscópio na CPRE de doentes com gastrectomia com re-construção Billroth II. Para além disso, o nosso estudo demonstrou que o uso de gastroscópio é um predictor independente para canulação.

Abstract Introduction There is growing interest in the fields of psychiatry and psychology in investigating the relationship between personality and psychopathology. The Big-5 is a model developed to investigate five personality dimensions: Extroversion, Agreeableness, Conscientiousness, Neuroticism, and Openness. In the present study, we describe the process of translation into Brazilian Portuguese and adaptation of a free tool to evaluate the Big-5 model: The Big-5 Inventory (BFI). The instrument has 44 items with a Likert response scale ranging from 1 to 5. Objectives To translate and adapt the BFI into Brazilian Portuguese. Methods The adaptation was conducted in the following steps: 1) Translation, 2) Evaluation Committee, 3) Back-translation, 4) Pilot study, 5) Evaluation Committee, and 6) Application. The sample comprised 490 participants from various regions of Brazil. The participants’ ages ranged from 18 to 71 years, most of them had completed high school (62.9%), and the majority were women (75%). Results A model with the following fit indexes was found: χ2/df: 1.954; goodness fit index (GFI): 0.924; comparative fit index (CFI): 0.920; and root mean square error of approximation (RMSEA): 0.044. Conclusion The results are suggestive that the Brazilian version of this instrument has good psychometric properties and represent a cost-free option for investigating associations with the Big-5 in psychiatry.

Abstract Encapsulating peritoneal sclerosis is an uncommon but serious complication of peritoneal dialysis. In most cases, the symptoms appear after peritoneal dialysis withdrawal, which hampers its diagnosis. We present the case of a 44-years-old Caucasian male who had been on peritoneal dialysis for 6 years and 3 months and was switched to hemodialysis due to ultrafiltration failure. During his last months on peritoneal dialysis, he developed anorexia and asthenia, which were initially attributed to dialysis inadequacy. After hemodialysis induction, the patient developed abdominal pain, increased abdominal volume, obstipation alternating with diarrhea, and weight loss. Computed tomography showed de novo ascites. A diagnosis of early encapsulating peritoneal sclerosis was considered, and treatment was promptly initiated with nutritional support, oral prednisolone, and tamoxifen for one year. The patient progressed with resolution of the symptoms. One month after the end of the treatment, he underwent a successful kidney transplant and remain without any major intercurrences. A high level of clinical suspicion is crucial for the early diagnosis of encapsulating peritoneal sclerosis as the disease can be fatal in advanced stages. This case highlights that with early treatment, kidney transplantation can be successfully performed after an episode of encapsulating peritoneal sclerosis.

Resumo A esclerose peritoneal encapsulante é uma complicação incomum, mas grave, da diálise peritoneal. Na maioria dos casos, os sintomas aparecem após a suspensão da diálise peritoneal, o que dificulta seu diagnóstico. Apresentamos o caso de um homem caucasiano de 44 anos de idade que esteve em diálise peritoneal por 6 anos e 3 meses e foi transferido para hemodiálise devido a falha de ultrafiltração. Durante seus últimos meses em diálise peritoneal, ele desenvolveu anorexia e astenia, que foram inicialmente atribuídas à inadequação da diálise. Após a indução de hemodiálise, o paciente desenvolveu dor abdominal, aumento do volume abdominal, obstipação alternada com diarreia, e perda de peso. A tomografia computadorizada mostrou ascite de novo. Foi considerado um diagnóstico de esclerose peritoneal encapsulante precoce, e o tratamento foi prontamente iniciado com suporte nutricional, prednisolona oral e tamoxifeno por um ano. O paciente progrediu com resolução dos sintomas. Um mês após o término do tratamento, ele foi submetido a um transplante renal bem-sucedido e permanece sem maiores intercorrências. Um alto nível de suspeita clínica é crucial para o diagnóstico precoce da esclerose peritoneal encapsulante, uma vez que a doença pode ser fatal em estágios avançados. Este caso destaca que, com tratamento precoce, o transplante renal pode ser realizado com sucesso após um episódio de esclerose peritoneal encapsulante.

Abstract Objectives: This work aimed to evaluate and compare the surface roughness, contact angle, and C. albicans adhesion in three materials for removable denture bases: polymethylmethacrylate and the thermoplastic resins polypropylene and polyolefin. Methods: Nine samples were manufactured, three of each material (n=3): polypropylene, polyolefin, and polymethylmethacrylate (control group). The thermoplastic resins were fabricated by injection technique and the polymethylmethacrylate by compression technique. After laboratory polishing, the surface roughness (Ra and Rz) was assessed with the 3D optical roughness meter NPFLEX, and the contact angle was measured with the optical tensiometer Contact angle system OCA15. C. albicans adhesion was assessed through colony- forming unit assays (n=9). ANOVA and Kruskal-Wallis tests were done to compare groups, considering a significance level of 0.05. Results: All values obtained for the control group were lower than those obtained for the thermoplastic resins. Statistically significant differences were found: for Ra between polypropylene (0.15±0.072 μm) and polymethylmethacrylate (0.03±0.006 μm) (p=0.045); for the contact angle between the three groups (p<0.001) - polymethylmethacrylate (26.57±6.719°), polypropylene (57.57±11.098°), and polyolefin (69.06±8.955°); and for C. albicans adhesion between polymethylmethacrylate and polypropylene (p=0.007) and polymethylmethacrylate and polyolefin (p=0.013). Conclusions: In the tested conditions and for the materials assessed, polymethylmethacrylate showed the lowest roughness, contact angle, and C. albicans adhesion, thus exhibiting better properties for removable denture bases than the thermoplastic materials.

Resumo Objetivos: Este trabalho pretende avaliar e comparar os parâmetros de rugosidade de superfície, ângulo de contacto e adesão de C. albicans em três materiais de base para próteses removíveis: o polimetilmetacrilato e as resinas termoplásticas polipropileno e poliolefina. Métodos: Foram confecionados 9 espécimes, 3 de cada um dos seguintes materiais (n=3): polipropileno, poliolefina e polimetilmetacrilato (grupo controlo). As resinas termoplásticas foram produzidas por técnica de injeção, e o polimetilmetacrilato por técnica de compressão. Após o polimento laboratorial, avaliou-se a rugosidade de superfície (Ra e Rz) com o rugosímetro ótico 3D NPFLEX e o ângulo de contacto com o tensiómetro ótico Contact angle system OCA15. A adesão de C. albicans foi avaliada por quantificação das unidades formadoras de colónias (n=9). Os testes ANOVA e Kruskal-Wallis foram utilizados para comparação dos resultados entre os grupos, com um nível de significância de 0,05. Resultados: Todos os valores obtidos para o grupo de controlo foram inferiores aos das resinas termoplásticas. Verificaram-se diferenças estatisticamente significativas: na Ra, entre o polipropileno (0,15±0,072 μm) e o polimetilmetacrilato (0,03±0,006 μm) (p=0,045); no ângulo de contacto, entre os 3 grupos (p<0,001) - PMMA (26,57±6,719°), polipropileno (57,57±11,098°) e poliolefina (69,06±8,955°); e na adesão de C. albicans, entre o polimetilmetacrilato e a polipropileno (p=0,007), e entre o polimetilmetacrilato e a poliolefina (p=0,013). Conclusões: Nas condições testadas e para os materiais estudados, o polimetilmetacrilato apresentou menor rugosidade, menor ângulo de contacto e menor adesão de C. albicans, evidenciando melhores características para base de prótese removível do que os materiais termoplásticos.

The aim of the current study was the valorization of hesperidin, the dominant flavonoid in citrus processing waste, by microwave-assisted synthesis of hesperidin-Mg complex, improving its antioxidant activity and insecticidal potential. Here we show, for the first time, that microwave-assisted synthesis of [Mg(hesp)2(phen)]OAc (1) (hesp: hesperidin, phen: phenanthroline) improve the reaction rate and yield. The nuclear magnetic resonance (NMR) experiments proved to be powerful tools for the identification of three isomers in metal complexes. Moreover, we explore the insecticidal potential of 1 and [Mg(phen)2(Isov)]OAc (2) (Isov : isovanillic acid) complexes against three insects. Complex 1 killed 80% of adults whitefly at 0.14 μmol L-1, and 2 76% at 0.36 μmol L-1. There was a total mortality of Spodoptera frugiperda with 2 at 0.39 μmol L-1, and 83% with 1 at 0.14 μmol L-1. Both have similar activity, and represent a novel group of insecticide for Bemisia tabaci and S. frugiperda; nevertheless, the benefits of both as Myzus persicae repellent require further evaluation.

Resumo Fundamento A válvula aórtica bicúspide (VAB) atinge de 0,5 a 2% da população e está associada a alterações valvares e de aorta. Há carência de estudos sobre o perfil desses pacientes na população brasileira. Objetivo Descrever o perfil de pacientes com VAB submetidos à cirurgia valvar e/ou de aorta em um centro cardiológico terciário, assim como os desfechos relacionados à intervenção. Métodos Coorte retrospectiva incluindo 195 pacientes (idade média 54±14 anos, 73,8% do sexo masculino) com diagnóstico de VAB submetidos à abordagem cirúrgica (valvar e/ou de aorta) no período de 2014 a 2019. Foram avaliados dados clínicos, ecocardiográficos e tomográficos, além das características da intervenção e eventos em 30 dias. O valor de p<0,05 foi considerado estatisticamente significante. Resultados Encontramos alta prevalência de aneurisma de aorta (56,5%), com diâmetro médio de 46,9±10,2 mm. Insuficiência aórtica importante foi encontrada em 25,1% e estenose aórtica importante em 54,9%. Cirurgia isolada em valva aórtica foi realizada em 48,2%, cirurgia isolada de aorta em 6,7% e cirurgia combinada em 45,1%. A mortalidade em 30 dias foi de 8,2%. Na análise multivariada, os fatores preditores de desfecho combinado em 30 dias (morte, fibrilação atrial e reoperação) foram idade (OR 1,044, IC 95% 1,009-1,081, p=0,014) e o índice de massa do ventrículo esquerdo (OR 1,009, IC 95% 1,000-1,018, p=0,044). Conclusão Pacientes com VAB abordados no nosso serviço apresentam uma maior incidência de aortopatia, com a necessidade adicional de avaliação da aorta com tomografia computadorizada ou ressonância magnética.

Abstract Background The bicuspid aortic valve (BAV) affects 0.5 to 2% of the population and is associated with valve and aortic alterations. There is a lack of studies on the profile of these patients in the Brazilian population. Objective To describe the profile of patients with BAV undergoing valve and/or aortic surgery in a tertiary cardiology center, in addition to the outcomes related to the intervention. Methods Retrospective cohort including 195 patients (mean age 54±14 years, 73.8% male) diagnosed with BAV who underwent surgical approach (valvular and/or aorta) from 2014 to 2019. Clinical data, echocardiographic and tomographic studies were evaluated, as well as characteristics of the intervention and events in 30 days. A value of p<0.05 was considered statistically significant. Results We found a high prevalence of aortic aneurysm (56.5%), with a mean diameter of 46.9±10.2 mm. Major aortic regurgitation was found in 25.1% and major aortic stenosis in 54.9%. Isolated aortic valve surgery was performed in 48.2%, isolated aortic surgery in 6.7% and combined surgery in 45.1%. The 30-day mortality was 8.2%. In the multivariate analysis, the predictors of the combined outcome at 30 days (death, atrial fibrillation and reoperation) were age (OR 1.044, 95% CI 1.009-1.081, p=0.014) and left ventricular mass index (OR 1.009, 95% CI 1.000-1.018, p=0.044). Conclusion Patients with BAV approached in our service have a higher incidence of aortopathy, with the additional need to evaluate the aorta with computed tomography or magnetic resonance imaging.

Sustainable natural product-based microstructured systems and biopolymers are strong candidates for use in crop protection. Lignin and gelatin microcapsules loaded with orange essential oil were developed with spray-drying in order to enhance its potential. We evaluated the microparticle controlled release mechanisms, biological effects, structural and thermal properties. A quantitative method using headspace-gas chromatography was developed and evaluated for the controlled release of the essential oils. Controlled release studies showed a linear relationship between the biopolymer and essential oil concentrations when retaining volatile compounds. Thermal analyses demonstrated increases in essential oil stability when microencapsulated, especially for lignin as a biopolymer. These results showed that biopolymer type was the main factor influencing quality analysis parameters. Finally, microcapsules loaded with orange essential oil were applied in a bioassay, and showed gains in toxicity against Spodoptera frugiperda compared to non-encapsulated oil.

RESUMO: Objetivou-se com o presente trabalho avaliar o efeito do pré-resfriamento da água usada no molhamento de placas porosas de sistemas de resfriamento evaporativo (SRE) sobre o ambiente térmico. O experimento foi realizado em dois modelos físicos construídos em escala reduzida e distorcida que simularam instalações agrícolas fechadas, equipadas com SRE composto por painéis porosos de celulose. Em um modelo físico, o molhamento das placas foi realizado por meio de água resfriada (SRAR) e o outro por meio de água natural à temperatura ambiente (SRAN). Mensurou-se a temperatura de bulbo seco do ar (tbs), temperatura de globo negro (tgn) e umidade relativa do ar (UR) no interior dos modelos físicos e no ambiente externo em intervalos de 10s. Posteriormente, foram calculados índices ambientais, a efetividade de resfriamento do SRAN e fator de desempenho do SRAR. O pré-resfriamento da água usada no molhamento de placas porosas de SRE propiciou maior redução nas variáveis térmicas e índices de conforto em relação ao molhamento com água à temperatura ambiente, sendo proposta uma equação empírica para a estimativa do fator de desempenho de resfriamento aplicada ao SRAR em função da temperatura da água, da tbs e da temperatura de bulbo úmido do ar.

ABSTRACT: This study assessed the ways the thermal environment is influenced by pre-cooling the water employed in wetting the porous plates present in the evaporative cooling systems (ECS). The experiment was performed using two physical models constructed on a distorted and reduced scale, which simulated closed agricultural facilities equipped with ECS made up of porous cellulose panels. In one physical model, the plates were made wet using chilled water (ECScw), while in the other they were moistened using natural water, at environment temperature (ECSnw). Both inside the physical models and outside, in the external environment, the air dry-bulb temperature (tdb), black globe temperature (tbg) and air relative humidity (RH) were measured, at 10 sec intervals. Later, the environmental indices, ECSnw cooling effectiveness and ECScw performance factor were assessed. When the porous ECS plates were thoroughly wet using pre-cooled water, lowering of the thermal variables and comfort indices was seen to be greater than when wetting the plates was done using water at room temperature. An empirical equation was proposed to determine the cooling performance factor applied to the ECScw related to water temperature, tdb and air wet-bulb temperature.

ABSTRACT Cardiovascular disease continues to be the most frequent cause of death in peritoneal dialysis patients and an important obstacle for the improvement of technique survival. Heart failure diagnosis and management is particularly challenging among dialysis patients, and this condition remains underdiagnosed and undertreated in this population. The most common phenotype of heart failure among peritoneal dialysis patients is heart failure with preserved ejection fraction, diastolic disfunction and left ventricular hypertrophy. Unfortunately, unlike what happens with heart failure with reduced ejection fraction, there is lack of evidence to support a specific drug regimen to treat heart failure with preserved ejection fraction. Several conditions associated with end stage kidney disease, such as anemia, hyperphosphatemia, secondary hyperparathyroidism, inflammation, and insulin resistance seem to be involved in the pathogenesis of heart failure with preserved ejection fraction and for this reason, the term uremic cardiomyopathy has been proposed. There is a lack of evidence regarding the optimal heart failure treatment for peritoneal dialysis patients and more studies are needed to assess the efficacy and safety of the new drugs available for heart failure treatment. This review explores the spectrum of heart failure on peritoneal dialysis, its pathogenesis, risk factors and possible therapeutic and preventive measures.

Resumo Fundamentos A síndrome de Heyde é a associação de estenose aórtica importante com episódio de sangramento gastrointestinal por lesões angiodisplásicas. Pouco é conhecido sobre os fatores associados a novos sangramentos e desfechos em longo prazo. Além disso, a maioria dos dados é restrita a relatos de casos e pequenas séries. Objetivo Avaliar o perfil clínico, laboratorial e ecocardiográfico de pacientes com síndrome de Heyde submetidos a intervenção valvar ou tratamento medicamentoso. Métodos Coorte prospectiva de 24 pacientes consecutivos entre 2005 e 2018. Foram avaliados dados clínicos, laboratoriais, ecocardiográficos e relacionados à intervenção valvar e a desfechos após o diagnóstico. Valor de p<0,05 foi considerado estatisticamente significante. Resultados Metade dos 24 pacientes apresentou sangramento com necessidade de transfusão sanguínea na admissão. Angiodisplasias foram encontradas mais frequentemente no cólon ascendente (62%). Intervenção valvar (cirúrgica ou transcateter) foi realizada em 70,8% dos pacientes, e 29,2% foram mantidos em tratamento clínico. Novos episódios de sangramento ocorreram em 25% dos casos, e não houve diferença entre os grupos clínico e intervenção (28,6 vs. 23,5%, p=1,00; respectivamente). A mortalidade no seguimento de 2 e 5 anos foi de 16% e 25%, sem diferença entre os grupos (log-rank p = 0,185 e 0,737, respectivamente). Conclusões Pacientes com síndrome de Heyde tiveram alta taxa de sangramento com necessidade de transfusão sanguínea na admissão, sugerindo ser uma doença grave e com risco elevado de mortalidade. Não encontramos diferenças entre os grupos submetidos ao tratamento clínico e à intervenção valvar em relação a taxas de ressangramento e mortalidade tardia.

Abstract Background Heyde’s syndrome is the association of severe aortic stenosis with episodes of gastrointestinal bleeding due to angiodysplastic lesion. Little is known about the factors associated with new episodes of bleeding and long-term outcomes. Furthermore, most data are restricted to case reports and small case series. Objective To assess the clinical, laboratory and echocardiography profile of patients with Heyde’s syndrome who underwent valve intervention or drug therapy. Methods Prospective cohort of 24 consecutive patients from 2005 to 2018. Clinical, laboratory and echocardiography data were assessed, as well as those related to valve intervention and outcomes after diagnosis. A P <0.05 was used to indicate statistical significance. Results Half of the 24 patients presented with bleeding requiring blood transfusion on admission. Angiodysplasias were more frequently found in the ascending colon (62%). Valve intervention (surgical or transcatheter) was performed in 70.8% of the patients, and 29.2% remained on drug therapy. News episodes of bleeding occurred in 25% of the cases, and there was no difference between clinical and intervention groups (28.6 vs 23.5%, p = 1.00; respectively). Mortality at 2-year and 5-year was 16% and 25%, with no difference between the groups (log-rank p = 0.185 and 0.737, respectively). Conclusions Patients with Heyde’s syndrome had a high rate of bleeding requiring blood transfusion on admission, suggesting that it is a severe disease with high mortality risk. No difference was found between clinical and intervention group regarding the rate of rebleeding and late mortality.