Abstract Background Garlic is an herbal medicinal plant with several pharmacological properties used for the management of various ailments. However, its potential in the reversal of ischemic heart disease induced by combined oral contraceptive pills is not well reported. Objective This study investigated the cardioprotective potential of aqueous garlic extract against cardiotoxicity induced by oral contraceptive pills. Methods Forty-six rats were used for this study. Six were used to determine the lethal dose (LD50), and 40 rats were divided randomly into 5 groups of 8 rats each. Group A received feed and distilled water. Group B received 0.6 mg/kg of oral contraceptive pills. Group C received 500 mg/kg of garlic extract. Group D received 0.6 mg/kg of oral contraceptive pills + 500 mg/kg garlic extract. Group E received 0.6 mg/kg of oral contraceptive pills + 700 mg/kg garlic extract. The animals were sacrificed, and blood and tissue samples were collected for biochemical and histological analysis. Statistical analysis was done using SPSS, and p values < 0.05 were considered significant. Results The acute toxicity dose of combined oral contraceptive pills was 1.5 mg/kg for albino rats. Combined oral contraceptive pills induced ischemic necrosis as revealed by the photomicrographs, in addition to elevation of serum cardiac troponin-1, lactate dehydrogenase, creatine kinase, and malondialdehyde levels. Treatment with garlic extract demonstrated significant reduction in cardiac troponin-1 (p = 0.000), lactate dehydrogenase (p = 0.002), creatine kinase (p = 0.001), and malondialdehyde (p = 0.001) levels, as well as restoration of the cardiac cytoarchitecture changes caused by the combined oral contraceptive pills. Conclusion This study has demonstrated that aqueous garlic juice can reverse ischemic heart disease, lessen cytoarchitectural alterations of the heart caused by combined oral contraceptive pills, and thus ameliorate cardiac dysfunction.

Mercury is a highly toxic heavy metal that may cause neurological, respiratory, gastrointestinal and dermatological illnesses. Previously described neurological manifestations of mercury toxicity are symmetrical, and include a pancerebellar syndrome, generalised seizures and encephalopathy. Mercury is used in the gold mining process, and in artisanal or illicit gold mining, often without necessary protection. Here we describe the cases of two artisanal gold miners from western Johannesburg, South Africa, who presented with atypical neurological manifestations of mercury toxicity. Patient 1 presented with focal seizures, an asymmetrical cerebellar syndrome and an acute encephalopathy. Patient 2 had unilateral cerebellar ataxia. Both patients had toxic mercury levels, with no other cause identified for their symptoms. Patient 1 responded well to chelation therapy, but patient 2 refused admission and further medical treatment. The neurological manifestations of mercury toxicity are typically symmetrical, whereas our two patients presented with markedly asymmetrical features. It is important to maintain a high index of suspicion for mercury poisoning, even in patients with atypical and unilateral or asymmetrical presentations. A prompt diagnosis and the commencement of early chelation therapy have the potential to produce good outcomes.

Abstract This in vitro study evaluated the effect of an experimental varnish containing 20% nano-hydroxyapatite (nHAP) associated with 5% stannous chloride (SnCl2) against erosive-abrasive wear on bovine dentin. Samples of bovine cervical dentin were pre-eroded (0.3% citric acid, pH 2.6 for 10 minutes) and randomized into 4 groups (n=10): Control group - experimental varnish without active ingredient (CG); experimental varnish containing 20% nHAP (nHG); experimental varnish containing 5% SnCl2 (24.800 ppm Sn2+) (SnG); experimental varnish containing 20% nHAP associated with 5% SnCl2 (18.300 ppm Sn2+) (nHSnG). After applying the materials, the erosive-abrasive challenges were performed for five days. Erosive dentin loss and analysis of the pattern of dentinal obliteration were performed by 3D confocal laser microscopy. A one-way ANOVA/Bonferroni test was performed to analyze the data (α=0.05). The SnG and nHSnG experimental groups presented more effectiveness in preventing erosive wear when compared to the other groups (p<0.05). There was no statistically significant difference between the SnG and nHSnG groups (p = 0.731) in tooth structure dentin loss. Regarding the amount of open dentinal tubules, the highest amount of obstructed dentinal tubules was demonstrated in SnG and nHSnG (p < 0.05) when compared to the others. Between SnG and nHSnG there was no significant difference (p = 0.952) in the amount of closed dentinal tubules in the dentin. Experimental varnishes containing 5% SnCl2 associated or not with 20% nHAP showed to be a promising strategy in preventing erosive-abrasive wear of dentin. In addition, nHSnG was able to obliterate dentinal tubules.

Resumo Este estudo in vitro avaliou o efeito de um verniz experimental contendo 20% de nano-hidroxiapatita (nHAP) associado a 5% de cloreto estanoso (SnCl2) contra o desgaste erosivo-abrasivo da dentina bovina. As amostras de dentina cervical bovina foram pré-erodificadas (0,3% de ácido cítrico, pH 2,6 durante 10 minutos) e aleatorizadas em 4 grupos (n=10): Grupo controle - verniz experimental sem ingrediente ativo (GC); verniz experimental contendo 20% nHAP (GnH); verniz experimental contendo 5% SnCl2 (24.800 ppm Sn2+) (GSn); verniz experimental contendo 20% nHAP associado a 5% SnCl2 (18.300 ppm Sn2+) (GnHSn). Após a aplicação dos materiais, os desafios erosivo-abrasivos foram realizados durante cinco dias. Perda de dentina erosiva e análise do padrão de obliteração dentinária foram realizadas por microscopia laser confocal 3D. Foi realizado o teste ANOVA/Bonferroni unidireccional para analisar os dados (α=0,05). Os grupos experimentais GSn e GnHSn apresentaram maior eficácia na prevenção do desgaste erosivo quando comparados com os outros grupos (p<0,05). Não houve diferença estatisticamente significativa entre os grupos GSn e GnHSn (p = 0,731) na perda de dentina da estrutura dentária. Relativamente à quantidade de túbulos dentinários abertos, a maior quantidade de túbulos dentinários obstruídos foi demonstrada em GSn e GnHSn (p < 0,05) quando comparada com os outros grupos. Entre GSn e GnHSn, não houve diferença significativa (p = 0,952) na quantidade de túbulos dentinários fechados na dentina. Os vernizes experimentais contendo 5% de SnCl2 associados ou não a 20% de nHAP mostraram ser uma estratégia promissora na prevenção do desgaste erosivo-abrasivo da dentina. Além disso, o GnHSn conseguiu obliterar os túbulos dentinários.

Abstract This study aimed to evaluate the tissue repair capacity of four bioceramic endodontic sealers by quantifying type I and III collagen fibers. The following sealers were tested: EndoSequence BC Sealer (Brasseler, Brasseler, Savannah, USA), Bio C Sealer (Angelus, Londrina, Brazil), Bioroot RCS (Septodont, Santa Catarina, Brazil), and Sealer Plus BC (MKLife, Porto Alegre, Brazil). Polyethylene tubes 1.5 mm in diameter and 1 cm in length containing the endodontic sealers were implanted in the subcutaneous tissue of five rats (Rattus norvegicus albinus, Wistar lineage). After 14 days, the animals were euthanized, and collagen fibers were quantified from the histological tissue sections. Given a non-normal distribution of the data, a gamma regression with log link function was employed and implemented through the generalized linear models module, was used to test whether there was a significant difference between the sealers. The pairwise comparison was performed using Least significant difference. There were significant differences between the sealers for type I (p=0.001), type III (p=0.023), and total collagen (p=0.002). Overall, Bioroot sealer was statistically superior to the other sealers, except in the analysis of type III collagen, in which there was no difference between the Bioroot sealer and Bio C Sealer sealer and the control group (p>0.05). Bioroot RCS bioceramic endodontic sealer stimulates a greater production of collagen.

Resumo Este estudo visou avaliar a capacidade de reparação de tecidos de quatro cimentos endodônticos biocerâmicos através da quantificação de fibras colágenas de tipo I e III. Foram testados os seguintes cimentos: EndoSequence BC Sealer (Brasseler, Brasseler, Savannah, EUA), Bio C Sealer (Angelus, Londrina, Brasil), Bioroot RCS (Septodont, Santa Catarina, Brasil), e Sealer Plus BC (MKLife, Porto Alegre, Brasil). Foram implantados tubos de polietileno de 1,5 mm de diâmetro e 1 cm de comprimento contendo os cimentos endodônticos no tecido subcutâneo de cinco ratos (Rattus norvegicus albinus, linhagem Wistar). Após 14 dias, os animais foram eutanasiados e as fibras colágenas foram quantificadas a partir de cortes histológicos do tecido. Diante de uma distribuição não-normal dos dados, uma regressão gama com função de ligação log, implementada por meio do módulo de modelos lineares generalizados, foi empregada para testar se havia diferença significativa entre os cimentos. A comparação dois a dois foi realizada utilizando Least significant difference. Houve diferença significativa entre os cimentos para os colágenos tipo I (p=0,001), tipo III (p=0,023) e colágeno total (p=0,002). No geral, o cimento Bioroot foi estatisticamente superior aos demais cimentos, com exceção na análise do colágeno tipo III na qual não houve diferença entre o cimento Bioroot e o cimento Bio C Sealer e o grupo controle (p>0,05). O cimento endodôntico biocerâmico Bioroot RCS foi capaz de estimular uma maior produção de colágeno.

RESUMO O uso da irrigação desempenha papel fundamental no avanço das fronteiras agrícolas e no aumento da produtividade nas áreas de cultivo, principalmente em ambientes semiáridos que apresentam alta variação espaço-temporal de chuvas. Essa prática é sugerida até mesmo para cultivos adaptados como palma forrageira (Opuntia sp.) e sorgo (Sorghum bicolor). Assim, objetivou-se avaliar a rentabilidade do uso da irrigação no sistema solteiro e sistema consorciado palma-sorgo no semiárido. O delineamento experimental foi em blocos casualizados em esquema fatorial 5 × 3: cinco lâminas de irrigação por gotejamento (0, 25, 50, 75 e 100% da evapotranspiração de referência - ET0) e três sistemas de cultivo (palma forrageira solteira, sorgo solteiro e consórcio palma-sorgo), com quatro repetições. O tratamento 0% ET0 correspondeu à condição de sequeiro com uma lâmina de 355 mm. Foi conduzido um ciclo de palma e dois de sorgo (planta e rebrota) compreendidos de novembro 2014 a novembro de 2015. Verificou-se que os maiores custos para implantação dos sistemas de cultivo em condições irrigadas se devem à aquisição do sistema de irrigação e insumos, representando 85,3% do custo operacional efetivo. O sistema sorgo solteiro e o sistema palma forrageira-sorgo proporcionaram as maiores produtividades de matéria fresca (62.013,05 e 60.075,36 kg ha-1), respectivamente. Com base em indicadores econômicos, a adoção de lâminas de irrigação (25, 50, 75 e 100% ET0) promoveu lucros para os sistemas (solteiro e consorciado) a partir do segundo ano de implantação.

ABSTRACT Irrigation plays a fundamental role in advancing agricultural frontiers and increasing crop productivity, especially in semi-arid environments, because they exhibit high spatiotemporal rainfall variation. This practice is suggested even for adapted crops, such as forage cactus (Opuntia sp.), sorghum (Sorghum bicolor), and single or intercropping systems. In this study, aimed to evaluate the profitability of using irrigation in a single and intercropping forage cactus-sorghum system in a semi-arid region. The experimental design was in randomized blocks in a 5 × 3 factorial arrangement: five drip irrigation depths (0, 25, 50, 75, and 100% of the reference evapotranspiration - ET0) and three cropping systems (single forage cactus, single sorghum, and intercropping forage cactus-sorghum), with four replicates. The 0% ET0 treatment corresponded to rainfed conditions at a depth of 355 mm. A cycle of forage cactus and two sorghum cultivars (plant and regrowth) was conducted between November 2014 and November 2015. It was verified that the highest costs for implantation of the crop systems in irrigated conditions are due to the acquisition of irrigation and input systems, representing 85.3% of the effective operational cost. The single sorghum and forage cactus-sorghum systems provided the highest fresh matter productivity (62,013.05 and 60,075.36 kg ha-1, respectively). Based on economic indicators, the adoption of irrigation depths (25, 50, 75, and 100% ET0) promoted profits for the systems (single and intercropping) from the second year of implementation.

In the last 30 years, 4 distinct theoretical approaches have been described for early childhood science education. The approaches are, empiricist, Piagetian, socio-cognitive and socio-cultural. Drawing on the differences among these approaches regarding the theoretical framework adopted in teaching, the role that is assigned to the teacher during the activity and the actions that are expected from the children, we aimed to serve 2 purposes with this research. Firstly, to elicit the in-service pre-school teachers' beliefs about teaching practices for natural sciences and to record the approaches that these beliefs match. To fulfil this purpose, a new instrument was developed. Secondly, to examine the instrument's validity and reliability. The participants in the study were 94 pre-school teachers who served in public schools in 2 prefectures in Greece. Research findings suggest that pre-school teachers tend to state that they mainly adopt practices that fit the empiricist approach while practices that fit the socio-cognitive approach are not used so often. Finally, they seem to rarely follow practices that fit the socio-cultural and Piagetian approaches.

This article explored Henri Nouwen's well-known concept, the wounded healer. After investigating its origins, Henri Nouwen's use of the term was examined. The article proposed that Henri Nouwen was mainly influenced by Anton Boisen and Vincent van Gogh in his use of the concept of the wounded healer. Nouwen's interest in these persons was considered to glean how they shaped his thoughts before focusing on he used a model of pastoral analysis, the living document model to autobiographically explore his own wounds, to access them, and to offer what he learned as a means of healing for his audiences. Nouwen recognised himself as wounded and became for his readers a wounded healer. Nolte and Dreyer's view that the wounded healer concept was a welcome corrective to prevailing models of pastoral care, and De Jong's view that the wounded healer is a pathway to self-actualisation were used as a bridge to Nouwen's views on personal spiritual transformation. Finally, Nouwen's thoughts on transformation involving a movement from loneliness to solitude were investigated, showing that the outcome was a move towards a considered and deeper interaction with the world. INTRADISCIPLINARY AND/OR INTERDISCIPLINARY IMPLICATIONS: This article contributed to scholarship in Christian spirituality by considering the work of Henri J. M. Nouwen and the sources of his concept, the wounded healer. It also considered connections with and implications for pastoral psychology and practical theology

BACKGROUND: Workplace-based learning (WBL) provides authentic learning opportunities to develop fit-for-practice healthcare workers. Different types of WBL opportunities have been described in high-income countries, but the opportunities in the district health systems of sub-Saharan Africa have not been characterised AIM: This study explored family physicians' (FPs) and registrars' perceptions of WBL opportunities in a decentralised postgraduate family medicine registrar training programme SETTING: The study was conducted at five decentralised training sites across two provinces affiliated with the University of the Witwatersrand in South Africa METHODS: This instrumental case study involved semi-structured qualitative interviews with 11 FPs and 11 registrars purposively sampled across the training sites. The verbatim transcripts were thematically analysed using Braun and Clark's six-step approach RESULTS: Workplace-based learning opportunities were grouped into four themes: Learning from interpersonal interactions, learning from district activities, self-directed learning and contextual influences on learning opportunities. Registrars learnt from patients, peers, FPs and other professionals. Feedback, self-reflection, portfolio use, involvement in various district events, such as student and staff teaching, and continuous medical education augmented learning. Contextual influences originated from health facilities, resource availability, district management and university support, excessive workload and a need for standardised district learning opportunities CONCLUSION: Registrars are exposed to several types of WBL opportunities in district health systems. Effective engagement with available opportunities and addressing contextual challenges could enhance registrar learning CONTRIBUTION: Maximising learning opportunities to promote registrars' acquisition of required skills and competencies to efficiently address community needs in a middle-income country such as South Africa

This article explored Henri Nouwen's well-known concept, the wounded healer. After investigating its origins, Henri Nouwen's use of the term was examined. The article proposed that Henri Nouwen was mainly influenced by Anton Boisen and Vincent van Gogh in his use of the concept of the wounded healer. Nouwen's interest in these persons was considered to glean how they shaped his thoughts before focusing on he used a model of pastoral analysis, the living document model to autobiographically explore his own wounds, to access them, and to offer what he learned as a means of healing for his audiences. Nouwen recognised himself as wounded and became for his readers a wounded healer. Nolte and Dreyer's view that the wounded healer concept was a welcome corrective to prevailing models of pastoral care, and De Jong's view that the wounded healer is a pathway to self-actualisation were used as a bridge to Nouwen's views on personal spiritual transformation. Finally, Nouwen's thoughts on transformation involving a movement from loneliness to solitude were investigated, showing that the outcome was a move towards a considered and deeper interaction with the world. INTRADISCIPLINARY AND/OR INTERDISCIPLINARY IMPLICATIONS: This article contributed to scholarship in Christian spirituality by considering the work of Henri J. M. Nouwen and the sources of his concept, the wounded healer. It also considered connections with and implications for pastoral psychology and practical theology.

BACKGROUND: HIV infection causes immune dysregulation affecting T-cell and monocyte function, which may alter coronavirus disease 2019 (COVID-19) pathophysiology. OBJECTIVES: We investigated the associations among clinical phenotypes, laboratory biomarkers, and hospitalisation outcomes in a cohort of people hospitalised with COVID-19 in a high HIV prevalence area. METHOD: We conducted a prospective observational cohort study in Tshwane, South Africa. Respiratory disease severity was quantified using the respiratory oxygenation score. Analysed biomarkers included inflammatory and coagulation biomarkers, CD4 T-cell counts, and HIV-1 viral loads (HIVVL). RESULTS: The analysis included 558 patients, of whom 21.7% died during admission. The mean age was 54 years. A total of 82 participants were HIV-positive. People living with HIV (PLWH) were younger (mean age 46 years) than HIV-negative people; most were on antiretroviral treatment with a suppressed HIVVL (72%) and the median CD4 count was 159 (interquartile range: 66-397) cells/µL. After adjusting for age, HIV was not associated with increased risk of mortality during hospitalisation (age-adjusted hazard ratio = 1.1, 95% confidence interval: 0.6-2.0). Inflammatory biomarker levels were similar in PLWH and HIV-negative patients. Detectable HIVVL was associated with less severe respiratory disease. In PLWH, mortality was associated with higher levels of inflammatory biomarkers. Opportunistic infections, and other risk factors for severe COVID-19, were common in PLWH who died. CONCLUSION: PLWH were not at increased risk of mortality and those with detectable HIVVL had less severe respiratory disease than those with suppressed HIVVL. WHAT THIS STUDY ADDS: This study advances our understanding of severe COVID-19 in PLWH.

ABSTRACT BACKGROUND: The coronavirus disease (COVID-19) pandemic has adversely affected the health of the global population, with sleep quality being one of the affected parameters. OBJECTIVES: To evaluate sleep quality and its associated factors in adults during the COVID-19 pandemic in Brazil. DESIGN AND SETTING: A population-based cross-sectional serological survey of 1,762 adults in the Iron Quadrangle region of Brazil. METHODS: The Pittsburgh Sleep Quality Index was used to assess sleep quality. Sociodemographic variables, health conditions, health-related behaviors, anxiety, vitamin D levels, weight gain/loss, and pandemic characteristics were assessed using a structured questionnaire. Univariate and multivariate analyses using Poisson regression with robust variance were performed to identify factors associated with sleep quality. RESULTS: More than half of the participants reported poor sleep quality (52.5%). Multivariate analysis revealed that the factors associated with poor sleep quality included living alone (prevalence ratio [PR] = 1.34; 95% confidence interval [CI]: 1.04–1.73), anxiety disorder (PR = 1.32; 95% CI: 1.08–1.62), 5.0% weight loss (PR = 1.21; 95% CI: 1.02–1.44), 5.0% weight gain (PR = 1.27; 95% CI: 1.03–1.55), vitamin D deficiency (PR = 1.16; 95% CI: 1.01–1.35), and COVID-19 symptoms (PR = 1.29; 95% CI: 1.10–1.52). CONCLUSIONS: Our study revealed that more than half of the participants experienced poor sleep quality during the COVID-19 pandemic. Factors associated with poor sleep quality included vitamin D deficiency and weight changes related to the pandemic.