Abstract Objective Evaluate autonomic function and low-grade inflammation and characterize the correlation between these variables in schoolchildren with obesity living in the Brazilian northeast region. Methods 84 children with obesity and 41 with normal weight were included in this cross-sectional study. Anthropometry, body composition, blood pressure (BP), inflammatory biomarkers, and heart rate variability (HRV) indexes were analyzed in children aged 7 to 11 years. Results children with obesity had increased systolic (p= 0.0017) and diastolic (p= 0.0131) BP and heart rate (p= 0.0022). The children with obesity displayed significantly lower SDNN, RMSSD, NN50, HF (ms), HF (nu), SD1, SD2, and higher LF (ms), LF (nu), LF/HF, SD1/SD2, DFA-α1, and DFA-α2, compared to normal weight. A lower and higher capacity for producing IL-10 (p= 0.039) and IL-2 (p= 0.009), respectively, were found in children with obesity compared to children with normal weight. Although IL-2, IL-4 and IL17A did not correlate with HRV parameters, IL-6 was positively correlated with SDNN, LF (ms) and SD2, TNF-α was positively correlated with LF/HF and SD1/SD2 ratio, and IFN-γ was positively correlated with SDNN, RMMSSD, NN50, LF (ms), HF (ms), SD1, and SD2. Conclusions The findings suggest that children with obesity have impaired autonomic function and systemic low-grade inflammation compared to children within the normal weight range, the inflammatory biomarkers were correlated with HRV parameters in schoolchildren living in the northeastern region of Brazil.

ABSTRACT: Pineapple is a tropical fruit with high demand by the fruit market in Brazil. Fruits of the cultivar ´Turiaçu` stans out in local consumer markets due to its excellent quality. The objective of this work was to evaluate ecophysiological responses of ´Turiaçu` pineapple plants at the vegetative and reproductive stages to soil fertilization and crop location, and their effects in fruit yield. The study was conducted in the cities of São Luís and Turiaçu, MA, Brazil. Plants under mineral and organic fertilization in two locations, São Luís and Turiaçu, and in two seasons, dry and rainy season, were evaluated during dry and rainy seasons. Chlorophyll index, photochemical efficiency, gas exchange, and fruit yield were evaluated. The pineapple plants presented decrease in the photosynthetic activity, at both developmental stages and in both seasons, when grown in São Luís. The CO2 photosynthetic assimilation decreased. The PSI and PSII activity, according with photosynthetic index, was more sensitive at the reproductive than at the vegetative stage. The organic fertilization was not appropriate for the ´Turiaçu` pineapple crops, regardless of the crop location. The fruit yields were 54.4% and 57.9% lower in São Luís, under mineral and organic fertilization, respectively. Thus, the ecophysiology of ´Turiaçu` pineapple was more affected by water availability than by soil fertility in the municipality of Turiaçu.

RESUMO: O abacaxi é uma fruta tropical com alta demanda pelo mercado de frutas no Brasil. Os frutos da cultivar ´Turiaçu`se destacam nos mercados consumidores locais pela excelente qualidade. O objetivo deste trabalho foi avaliar as respostas ecofisiológicas de plantas de abacaxizeiro ´Turiaçu`nos estádios vegetativo e reprodutivo à adubação do solo e ao local de cultivo, e seus efeitos na produção de frutos. O estudo foi realizado nas cidades de São Luís e Turiaçu, MA, Brasil. Plantas sob adubação mineral e orgânica foram avaliadas durante as estações seca e chuvosa. Foram avaliados teores de clorofila, eficiência fotoquímica, trocas gasosas e produção de frutos. As plantas de abacaxi apresentaram diminuição da atividade fotossintética, em ambas as fases de desenvolvimento e em ambas as estações, quando cultivadas em São Luís. A assimilação fotossintética de CO2 diminuiu. A atividade de PSI e PSII foi mais sensível na fase reprodutiva do que na fase vegetativa. A adubação orgânica não foi adequada para as lavouras de abacaxi ´Turiaçu`, independente do local de cultivo. As produtividades de frutos foram 54,4% e 57,9% menores em São Luís, sob adubação mineral e orgânica, respectivamente. Assim, a ecofisiologia do abacaxi de ´Turiaçu`foi mais afetada pela disponibilidade hídrica do que pela fertilidade do solo no município de Turiaçu.

ABSTRACT Neuroleptic malignant syndrome (NMS) is a neurologic emergency potentially fatal. This rare side effect is most commonly associated with first-generation antipsychotics and less frequently with atypical or second-generation antipsychotics. The diagnosis relies on both clinical and laboratory criteria, with other organic and psychiatric conditions being ruled out. CASE REPORT: A 39-year-old female patient, who is institutionalized and completely dependent, has a medical history of recurrent urinary infections and colonization by carbapenem-resistant Klebsiella pneumoniae. Her regular medication regimen included sertraline, valproic acid, quetiapine, risperidone, lorazepam, diazepam, haloperidol, baclofen, and fentanyl. The patient began experiencing dyspnea. Upon physical examination, she exhibited hypotension and a diminished vesicular murmur at the right base during pulmonary auscultation. Initially, after hospitalization, she developed high febrile peaks associated with hemodynamic instability, prompting the initiation of antibiotic treatment. Despite this, her fever persisted without an increase in blood inflammatory parameters, and she developed purulent sputum, necessitating antibiotherapy escalation. The seventh day of hospitalization showed no improvement in symptoms, suggesting NNMS as a differential diagnosis. All antipsychotic and sedative drugs, as well as antibiotherapy, were discontinued, after which the patient showed significant clinical improvement. CONCLUSION: Antipsychotic agents are commonly employed to manage behavioral changes linked to various disorders. However, their severe side effects necessitate a high degree of vigilance, the cessation of all medications, and the implementation of supportive care measures. A prompt and accurate diagnosis of NMS is crucial to alleviating the severe, prolonged morbidity and potential mortality associated with this syndrome.

Hypertension is one of the primary modifiable risk factors for morbidity and mortality worldwide, being a major risk factor for coronary artery disease, stroke, and kidney failure. Furthermore, it is highly prevalent, affecting more than one-third of the global population. Blood pressure measurement is a MANDATORY procedure in any medical care setting and is carried out by various healthcare professionals. However, it is still commonly performed without the necessary technical care. Since the diagnosis relies on blood pressure measurement, it is clear how important it is to handle the techniques, methods, and equipment used in its execution with care. It should be emphasized that once the diagnosis is made, all short-term, medium-term, and long-term investigations and treatments are based on the results of blood pressure measurement. Therefore, improper techniques and/or equipment can lead to incorrect diagnoses, either underestimating or overestimating values, resulting in inappropriate actions and significant health and economic losses for individuals and nations. Once the correct diagnosis is made, as knowledge of the importance of proper treatment advances, with the adoption of more detailed normal values and careful treatment objectives towards achieving stricter blood pressure goals, the importance of precision in blood pressure measurement is also reinforced. Blood pressure measurement (described below) is usually performed using the traditional method, the so-called casual or office measurement. Over time, alternatives have been added to it, through the use of semi-automatic or automatic devices by the patients themselves, in waiting rooms or outside the office, in their own homes, or in public spaces. A step further was taken with the use of semi-automatic devices equipped with memory that allow sequential measurements outside the office (ABPM; or HBPM) and other automatic devices that allow programmed measurements over longer periods (HBPM). Some aspects of blood pressure measurement can interfere with obtaining reliable results and, consequently, cause harm in decision-making. These include the importance of using average values, the variation in blood pressure during the day, and short-term variability. These aspects have encouraged the performance of a greater number of measurements in various situations, and different guidelines have advocated the use of equipment that promotes these actions. Devices that perform HBPM or ABPM, which, in addition to allowing greater precision, when used together, detect white coat hypertension (WCH), masked hypertension (MH), sleep blood pressure alterations, and resistant hypertension (RHT) (defined in Chapter 2 of this guideline), are gaining more and more importance. Taking these details into account, we must emphasize that information related to diagnosis, classification, and goal setting is still based on office blood pressure measurement, and for this reason, all attention must be given to the proper execution of this procedure.

La hipertensión arterial (HTA) es uno de los principales factores de riesgo modificables para la morbilidad y mortalidad en todo el mundo, siendo uno de los mayores factores de riesgo para la enfermedad de las arterias coronarias, el accidente cerebrovascular (ACV) y la insuficiencia renal. Además, es altamente prevalente y afecta a más de un tercio de la población mundial. La medición de la presión arterial (PA) es un procedimiento OBLIGATORIO en cualquier atención médica o realizado por diferentes profesionales de la salud. Sin embargo, todavía se realiza comúnmente sin los cuidados técnicos necesarios. Dado que el diagnóstico se basa en la medición de la PA, es claro el cuidado que debe haber con las técnicas, los métodos y los equipos utilizados en su realización. Debemos enfatizar que una vez realizado el diagnóstico, todas las investigaciones y tratamientos a corto, mediano y largo plazo se basan en los resultados de la medición de la PA. Por lo tanto, las técnicas y/o equipos inadecuados pueden llevar a diagnósticos incorrectos, subestimando o sobreestimando valores y resultando en conductas inadecuadas y pérdidas significativas para la salud y la economía de las personas y las naciones. Una vez realizado el diagnóstico correcto, a medida que avanza el conocimiento sobre la importancia del tratamiento adecuado, con la adopción de valores de normalidad más detallados y objetivos de tratamiento más cuidadosos hacia metas de PA más estrictas, también se refuerza la importancia de la precisión en la medición de la PA. La medición de la PA (descrita a continuación) generalmente se realiza mediante el método tradicional, la llamada medición casual o de consultorio. Con el tiempo, se han agregado alternativas a través del uso de dispositivos semiautomáticos o automáticos por parte del propio paciente, en salas de espera o fuera del consultorio, en su propia residencia o en espacios públicos. Se dio un paso más con el uso de dispositivos semiautomáticos equipados con memoria que permiten mediciones secuenciales fuera del consultorio (AMPA; o MRPA) y otros automáticos que permiten mediciones programadas durante períodos más largos (MAPA). Algunos aspectos en la medición de la PA pueden interferir en la obtención de resultados confiables y, en consecuencia, causar daños en las decisiones a tomar. Estos incluyen la importancia de usar valores promedio, la variación de la PA durante el día y la variabilidad a corto plazo. Estos aspectos han alentado la realización de un mayor número de mediciones en diversas situaciones, y diferentes pautas han abogado por el uso de equipos que promuevan estas acciones. Los dispositivos que realizan MRPA o MAPA, que además de permitir una mayor precisión, cuando se usan juntos, detectan la hipertensión de bata blanca (HBB), la hipertensión enmascarada (HM), las alteraciones de la PA durante el sueño y la hipertensión resistente (HR) (definida en el Capítulo 2 de esta guía), están ganando cada vez más importancia. Teniendo en cuenta estos detalles, debemos enfatizar que la información relacionada con el diagnóstico, la clasificación y el establecimiento de objetivos todavía se basa en la medición de la presión arterial en el consultorio, y por esta razón, se debe prestar toda la atención a la ejecución adecuada de este procedimiento.

A hipertensão arterial (HA) é um dos principais fatores de risco modificáveis para morbidade e mortalidade em todo o mundo, sendo um dos maiores fatores de risco para doença arterial coronária, acidente vascular cerebral (AVC) e insuficiência renal. Além disso, é altamente prevalente e atinge mais de um terço da população mundial. A medida da PA é procedimento OBRIGATÓRIO em qualquer atendimento médico ou realizado por diferentes profissionais de saúde. Contudo, ainda é comumente realizada sem os cuidados técnicos necessários. Como o diagnóstico se baseia na medida da PA, fica claro o cuidado que deve haver com as técnicas, os métodos e os equipamentos utilizados na sua realização. Deve-se reforçar que, feito o diagnóstico, toda a investigação e os tratamentos de curto, médio e longo prazos são feitos com base nos resultados da medida da PA. Assim, técnicas e/ou equipamentos inadequados podem levar a diagnósticos incorretos, tanto subestimando quanto superestimando valores e levando a condutas inadequadas e grandes prejuízos à saúde e à economia das pessoas e das nações. Uma vez feito o diagnóstico correto, na medida em que avança o conhecimento da importância do tratamento adequado, com a adoção de valores de normalidade mais detalhados e com objetivos de tratamento mais cuidadosos no sentido do alcance de metas de PA mais rigorosas, fica também reforçada a importância da precisão na medida da PA. A medida da PA (descrita a seguir) é habitualmente feita pelo método tradicional, a assim chamada medida casual ou de consultório. Ao longo do tempo, foram agregadas alternativas a ela, mediante o uso de equipamentos semiautomáticos ou automáticos pelo próprio paciente, nas salas de espera ou fora do consultório, em sua própria residência ou em espaços públicos. Um passo adiante foi dado com o uso de equipamentos semiautomáticos providos de memória que permitem medidas sequenciais fora do consultório (AMPA; ou MRPA) e outros automáticos que permitem medidas programadas por períodos mais prolongados (MAPA). Alguns aspectos na medida da PA podem interferir na obtenção de resultados fidedignos e, consequentemente, causar prejuízo nas condutas a serem tomadas. Entre eles, estão: a importância de serem utilizados valores médios, a variação da PA durante o dia e a variabilidade a curto prazo. Esses aspectos têm estimulado a realização de maior número de medidas em diversas situações, e as diferentes diretrizes têm preconizado o uso de equipamentos que favoreçam essas ações. Ganham cada vez mais espaço os equipamentos que realizam MRPA ou MAPA, que, além de permitirem maior precisão, se empregados em conjunto, detectam a HA do avental branco (HAB), HA mascarada (HM), alterações da PA no sono e HA resistente (HAR) (definidos no Capítulo 2 desta diretriz). Resguardados esses detalhes, devemos ressaltar que as informações relacionadas a diagnóstico, classificação e estabelecimento de metas ainda são baseadas na medida da PA de consultório e, por esse motivo, toda a atenção deve ser dada à realização desse procedimento.

The worldwide emergence of viral diseases such as Zika, Dengue, Chikungunya, West Nile and Yellow Fever urge the search for solutions to eliminate their common vector, the Aedes aegypti mosquito. This paper describes the quantitative structure-activity relationship (QSAR) and docking studies of a series of nine 3-(3-aryl-1,2,4-oxadiazol-5-yl)propionic acids (AOPA), 1-9, previously published by our group. Additionally, three new 1,2,4-oxadiazoles, 10-12, have also been synthesized, characterized and studied. The QSAR and docking studies of all compounds, 1-12, clearly indicate that larger hydrophobic substituents such as biphenyl groups attached on position 3 in 1,2,4-oxadiazoles improve the larvicidal activity. It is worthwhile to mention that nanocapsulation of compounds 10-12 were necessary to help their dissolution in water and these three new 1,2,4-oxadiazoles also exhibited approximately equal or higher larvicidal activities compared to the former prototypes at stage L4.

ABSTRACT The use of echocardiography by physicians who are not echocardiographers has become common throughout the world across highly diverse settings where the care of acutely ill patients is provided. Echocardiographic evaluation performed in a point-of-care manner can provide relevant information regarding the mechanism of causes of shock, for example, increasing the rates of correct diagnosis and allowing for faster informed decision-making than through evaluation methods. Considering that the accurate diagnosis of life-threatening situations is essential for professionals working with acutely ill patients, several international associations recommend that physicians responsible for critically ill patients acquire and develop the ability to perform bedside ultrasound examinations, including echocardiographic examinations. However, there is no consensus in the literature regarding which specific applications should be included in the list of skills for nonechocardiographer physicians. Taking into account the multiplicity of applications of echocardiography in different scenarios related to acutely ill patients; the differences in the published protocols, with regard to both the teaching methodology and competence verification; and the heterogeneity of training among highly diverse specialties responsible for their care at different levels, this consensus document aimed to reflect the position of representatives of related Brazilian medical societies on the subject and may thus serve as a starting point both for standardization among different specialties and for the transmission of knowledge and verification of the corresponding competencies.

RESUMO O emprego da ecocardiografia por médicos não ecocardiografistas tem se tornado comum em todo o mundo nos mais diversos ambientes em que se dá o cuidado do paciente agudamente doente. A avaliação ecocardiográfica realizada de forma point-of-care pode fornecer informações pertinentes em relação ao mecanismo das causas de choque, por exemplo, incrementando as taxas de diagnóstico correto e possibilitando a tomada de decisão fundamentada de forma mais rápida do que por meio dos métodos tradicionais de avaliação. Considerando que o diagnóstico preciso de situações ameaçadoras à vida é indispensável a profissionais atuando junto a pacientes agudamente enfermos, diversas entidades associativas internacionais recomendam que médicos responsáveis por pacientes gravemente doentes devam adquirir e desenvolver a habilidade para realizar exames ultrassonográficos à beira do leito, inclusive ecocardiográficos. Entretanto, não há consenso na literatura acerca de quais aplicações específicas devam compor o rol de habilidades do médico não ecocardiografista. Levando-se em consideração a multiplicidade de aplicações da ecocardiografia em diversos cenários relativos ao paciente agudamente enfermo; as diferenças nos protocolos publicados, tanto no que diz respeito à metodologia de ensino como de verificação de competências, bem como a heterogeneidade da formação entre as mais diversas especialidades responsáveis pelo seu cuidado em diferentes níveis, este documento de consenso teve o objetivo de refletir o posicionamento de representantes de sociedades médicas brasileiras afins acerca do tema, podendo, assim, servir de ponto de partida para a uniformização entre diferentes especialidades, bem como para a transmissão de conhecimento e a verificação das competências correspondentes.

RESUMO: Eurytrema coelomaticum são trematódeos que parasitam bovinos, bubalinos, caprinos, ovinos e camelídeos, e de forma acidental, humanos e felinos. O animal acometido geralmente apresenta doença pancreática subclínica, mas os danos causados à saúde e produção animal são subestimados. Atualmente, o praziquantel é o único medicamento comprovadamente eficaz contra este parasita, mas não há formulações contendo esse medicamento disponíveis para ruminantes no mercado brasileiro. O objetivo deste trabalho foi avaliar separadamente a atividade anti-helmíntica in vitro de praziquantel (PZQ) e nitazoxanida (NTZ) frente ao E. coelomaticum pela avaliação de motilidade após três, 12 e 15 horas de incubação e posterior exame histopatológico dos parasitos. Exemplares de E. coelomaticum foram obtidos do pâncreas de bovinos naturalmente infectados, coletados em animais abatidos na cidade de Concórdia, SC, Brasil. Incubados em placas com meio de cultura (n = 60 por grupo), adicionados de 80µg/ml de PZQ (grupo controle positivo) ou 61,5µg/ml de NTZ (grupo tratado) ou UNT (grupo controle sem tratamento). Em 12h de incubação todos os parasitos dos grupos NTZ e PZQ estavam imóveis ou mortos, enquanto no grupo controle negativo 91,67% (55/60) apresentaram motilidade normal após 15h de incubação (P < 0.001). Por exame histopatológico observou-se danos graves em glândula vitelogênica, intestino, parênquima, tegumento e testículo em ambos os grupos tratado e controle positivo. Concluiu-se que PZQ e NTZ apresentaram ação anti-helmíntica in vitro contra o parasito Eurytrema coelomaticum, pois causaram lesões significativas nos órgãos avaliados e diminuíram a motilidade do parasito.

ABSTRACT: Eurytrema coelomaticum are trematodes that parasitize cattle, buffaloes, goats, sheep, and camelids, and, accidentally, humans and cats. The affected animal usually has a subclinical pancreatic disease, but the damage caused to health and animal production is underestimated. Currently, praziquantel is the unique drug proven effective against this parasite, but no formulations containing this drug are available for ruminants in Brazilian market. The objective of the present study was to separately evaluate in vitro anthelmintic activity of praziquantel (PZQ) and nitazoxanide (NTZ) against E. coelomaticum by assessing motility after 3, 12, and, 15 hours of incubation and subsequent histopathological examination of the parasites. E. coelomaticum specimens were obtained from the pancreas of naturally infected cattle, collected from animals slaughtered in the city of Concordia-SC, Brazil. The specimens were incubated in plates with a culture medium (n = 60 per group), with 80µg/ml of PZQ (positive control group), or 61,5µg/ml of NTZ (treated group), or UNT (untreated control). After 12 hours of incubation all parasites of the NTZ and PZQ groups were motionless or dead, while in the negative control group, 91.67% (55/60) presented normal motility after 15 hours of incubation (P < 0.001). Histopathological examination showed severe damage in vitellogenic gland, intestine, parenchyma, integument, and testicle in both treated and positive control groups. It was concluded that PZQ and NTZ showed in vitro anthelmintic action against the parasite Eurytrema coelomaticum, as they caused significant lesions in the evaluated organs and reduced the parasite’s motility.

Abstract Background Dental anesthetic management in implantable cardioverter defibrillator (ICD) recipients with cardiac channelopathies (CCh) can be challenging due to the potential risk of life-threatening arrhythmias and appropriate ICD therapies during procedural time. Objectives The present study assessed the hypothesis that the use of local dental anesthesia with 2% lidocaine with 1:100,000 epinephrine or without a vasoconstrictor can be safe in selected ICD and CCh patients, not resulting in life-threatening events (LTE). Methods Restorative dental treatment under local dental anesthesia was made in two sessions, with a wash-out period of 7 days (cross-over trial), conducting with a 28h - Holter monitoring, and 12-lead electrocardiography, digital sphygmomanometry, and anxiety scale assessments in 3 time periods. Statistical analysis carried out the paired Student’s t test and the Wilcoxon signed-rank test. In all cases, a significance level of 5% was adopted. All patients were in stable condition with no recent events before dental care. Results Twenty-four consecutive procedures were performed in 12 patients (9 women, 3 men) with CCh and ICD: 7 (58.3%) had long QT syndrome (LQTS), 4 (33.3%) Brugada syndrome (BrS), and 1 (8.3%) Catecholaminergic polymorphic ventricular tachycardia (CPVT). Holter analysis showed no increased heart rate (HR) or sustained arrhythmias. Blood pressure (BP), electrocardiographic changes and anxiety measurement showed no statistically significant differences. No LTE occurred during dental treatment, regardless of the type of anesthesia. Conclusion Lidocaine administration, with or without epinephrine, can be safely used in selected CCh-ICD patients without LTE. These preliminary findings need to be confirmed in a larger population with ICD and CCh.

ABSTRACT Afforestation of sites disturbed after bauxite mining is the favorite technique to restore all ecosystem functions. The nature of the tree species used for revegetation of post-mining land can accelerate the recovery of soil organic matter and nutrient cycles. This study aimed to determine the litterfall production, decomposition rate and nutrient content from three types of forest cover ( Eucalyptus , Anadenanthera peregrina , mixed plantation of 16 native species) planted in a bauxite mining area in recovery. Litterfall production was evaluated monthly over 30 months, and the litter mass was assessed twice a year (dry and rainy periods). Total nutrient content was determined from samples grouped by period (dry and rainy). The annual average values for litterfall dry mass and litter mass were higher in Eucalyptus and mixed native. The period (dry or rainy) did not influence litterfall rates in A. peregrina , but Eucalyptus and mixed native presented higher amounts for litterfall during the rainy and dry periods, respectively. Litter accumulation in Eucalyptus was not affected by the season of the year, but mixed native and A. peregrina presented higher litter accumulation in the dry season. Apparent decomposition rates of A. peregrina and mixed native were higher in the rainy season, highlighting the A. peregrina with the highest values compared with the other forest covers. The mixed native presented the highest leaf content of P, K, Ca and Mg in both the litterfall and litter mass, while Eucalyptus had the lowest P, K, Ca, S and N content and the highest C content in the litterfall. Litterfall production is important in degraded areas to ensure the nutrient return to the soil. The data obtained suggest that the cultivation of a mixed of 16 native trees contribute for produce the higher annual litterfall yields, besides produces leaf litterfall of better nutritional quality in relation to P, K, Ca, Mg and S. Therefore, mixed of native trees can be a promising option for reactivation of nutrient cycling and organic matter formation in mined area of bauxite in the Brazilian Atlantic Forest.

Abstract Background Major advances have been seen in techniques and devices for performing percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs), but there are limited real-world practice data from developing countries. Objectives To report clinical and angiographic characteristics, procedural aspects, and clinical outcomes of CTO PCI performed at dedicated centers in Brazil. Methods Included patients underwent CTO PCI at centers participating in the LATAM CTO Registry, a Latin American multicenter registry dedicated to prospective collection of these data. Inclusion criteria were procedures performed in Brazil, age 18 years or over, and presence of CTO with PCI attempt. CTO was defined as a 100% lesion in an epicardial coronary artery, known or estimated to have lasted at least 3 months. Results Data on 1196 CTO PCIs were included. Procedures were performed primarily for angina control (85%) and/or treatment of moderate/severe ischemia (24%). Technical success rate was 84%, being achieved with antegrade wire approaches in 81% of procedures, antegrade dissection and re-entry in 9%, and retrograde approaches in 10%. In-hospital adverse cardiovascular events occurred in 2.3% of cases, with a mortality rate of 0.75%. Conclusions CTOs can be treated effectively in Brazil by using PCI, with low complication rates. The scientific and technological development observed in this area in the past decade is reflected in the clinical practice of dedicated Brazilian centers.

Resumo Fundamento Tem sido observado um grande avanço nas técnicas e nos dispositivos para a realização de intervenções coronárias percutâneas (ICP) em oclusões totais coronarianas crônicas (OTC), mas existem poucos dados da prática do mundo real em países em desenvolvimento. Objetivos Relatar as características clínicas e angiográficas, os aspectos dos procedimentos e os resultados clínicos da ICP de OTC em centros dedicados a esse procedimento no Brasil. Métodos Os pacientes incluídos foram submetidos à ICP de OTC em centros participantes do LATAM CTO Registry, um registro multicêntrico latino-americano dedicado à coleta prospectiva desses dados. Os critérios de inclusão foram procedimentos realizados no Brasil, idade acima de 18 anos e presença de OTC com tentativa de ICP. A definição de OTC foi lesão de 100% em uma artéria coronária epicárdica, conhecida ou estimada como tendo pelo menos 3 meses de evolução. Resultados Foram incluídos dados de 1.196 ICPs de OTC. Os procedimentos foram realizados principalmente para controle da angina (85%) e/ou tratamento de uma grande área isquêmica (24%). A taxa de sucesso técnico foi de 84% e foi alcançada com técnicas de fios anterógrados em 81%, dissecção/reentrada anterógrada em 9% e retrógrada em 10% dos procedimentos. Os eventos cardiovasculares adversos intra-hospitalares ocorreram em 2,3% dos casos, sendo a mortalidade de 0,75%. Conclusões As OTC podem ser tratadas no Brasil por intervenção coronária percutânea de forma efetiva e com baixas taxas de complicações. O desenvolvimento científico e tecnológico observado nessa área na última década reflete-se na prática clínica de centros brasileiros dedicados a essa técnica.

Abstract This study analyzes the clinical-epidemiological profile of children assisted by the palliative care services of a reference hospital in Ceará, Brazil. A retrospective, quantitative, case series cohort study was conducted with 56 patients aged up to 2 years, 11 months and 29 days. Nervous system and circulatory system diseases, congenital malformations, deformities, and chromosomal anomalies were the most common illnesses. Severe and non-progressive disabling conditions were the main criteria for inclusion in palliative care. As for family conference, the mother was present in 94.6% of the cases. Death (58.9%) was the main outcome, being associated with circulatory system and nervous system diseases, use of respiratory device and mechanical ventilation, requesting sector and palliative care. In conclusion, pediatric palliative care aimed at non-cancer patients has generated new hospital demands, requiring a trained team sensitive to this new reality.

Resumen Este artículo pretende analizar el perfil clínico-epidemiológico de los niños bajo cuidados paliativos en un hospital pediátrico de referencia en Ceará (Brasil). Este es un estudio de cohorte retrospectivo, cuantitativo, de tipo serie de casos, realizado con 56 pacientes de hasta 2 años, 11 meses y 29 días de edad. Las enfermedades más prevalentes fueron las del sistema nervioso y circulatorio, malformaciones congénitas, malformaciones y anomalías cromosómicas. Las condiciones incapacitantes severas y no progresivas fueron el criterio principal para incluir en paliación. En la conferencia familiar, la madre estuvo presente en el 94,6% de las ocasiones. El desenlace predominante fue la muerte (58,9%) asociada significativamente con enfermedades del sistema circulatorio, sistema nervioso, uso de aparato respiratorio y ventilación mecánica, sector demandante y cuidados paliativos. Los cuidados paliativos pediátricos no relacionados con niños con cáncer generan una nueva demanda a nivel hospitalario, requiriendo un equipo capacitado y sensible a esta nueva realidad.

Resumo O objetivo deste artigo é analisar o perfil clínico-epidemiológico de crianças acompanhadas por um serviço de cuidados paliativos em um hospital pediátrico de referência no Ceará. Trata-se de estudo de coorte retrospectivo, quantitativo, do tipo série de casos, realizado com 56 pacientes de até 2 anos, 11 meses e 29 dias de idade. As doenças mais comuns foram as do sistema nervoso, circulatório, malformações congênitas, deformidades e anomalias cromossômicas. As condições incapacitantes graves e não progressivas foram o principal critério para inclusão na paliação. Na conferência familiar, a mãe esteve presente em 94,6% das ocasiões. O desfecho predominante foi óbito (58,9%), apresentando associação significativa com as doenças do aparelho circulatório, sistema nervoso, uso de dispositivo respiratório e ventilação mecânica, setor solicitante e cuidados paliativos. Conclui-se que os cuidados paliativos pediátricos não relacionados a crianças com câncer têm gerado uma nova demanda a nível hospitalar, exigindo uma equipe capacitada e sensível a essa nova realidade.

Abstract: The thermoinhibition of lettuce seed germination causes important losses for producers, who do not have thermotolerant commercial cultivars. One of the obstacles has been the scarcity of optimizing techniques capable of efficiently discriminating thermotolerant and thermosensitive cultivars. The aim of this work was to evaluate the use of neural networks to discriminate different levels of thermoinhibition in lettuce seeds. Seeds of 18 cultivars were evaluated for thermoinhibition considering the characteristics of the first and last germination count and germination speed index, in seeds subjected to temperatures of 20, 25, 30 and 35 °C. The remaining seeds, which did not germinate, were subjected to the tetrazolium test. Analyses were performed immediately after seed harvesting and repeated after six months of storage. Discriminant analysis was performed and the Kohonen’s Self-Organizing Map (SOM) was created using Artificial Neural Networks (ANNs). Neural networks discriminate lettuce cultivars and organizes them in terms of seed thermoinhibition tolerance through Kohonen’s Self-Organizing Map. Discriminant analysis consistently identifies the Everglades and Luiza genotypes as tolerant to thermoinhibition.

Resumo: A termoinibição causa perdas importantes para os produtores, os quais não dispõem de cultivares comerciais com sementes termotolerantes. Há escassez de técnicas otimizadoras capazes de discriminar cultivares termotolerantes e termosensíveis com eficiência. Objetivou-se avaliar o uso de redes neurais para discriminar diferentes níveis de termoinibição em sementes de alface. Foram avaliadas sementes de 18 cultivares quanto à termoinibição considerando às características de primeira e última contagem de germinação e índice de velocidade de germinação, em sementes submetidas às temperaturas de 20, 25, 30 e 35 °C. As sementes remanescentes, que não germinaram, foram submetidas ao teste de tetrazólio. As análises foram realizadas imediatamente após a colheita das sementes e repetidas após seis meses de armazenamento. Uma análise discriminante e o Mapa Auto-Organizável de Kohonen (SOM) por Redes Neurais Artificiais (RNA’s) foram realizados. As redes neurais discriminam as cultivares de alface e as organiza quanto a tolerância a termoinibição das sementes por meio do Mapa Auto-Organizável de Kohonen. A análise discriminante indentifica de maneira coerente o genótipo Everglades e Luiza como tolerantes a termoinibição.

Abstract The aim of this study was to quantify the force exerted by tandem archwires in a specific system of passive self-ligating bracket. Forty-eight thermo-activated nickel-titanium orthodontic archwires were separated into four groups (n = 12): G1 – two .014” + .014” round archwires; G2 – two .014” + .016” round archwires; G3 – .014” x .025” rectangular archwire; and. G4 – .016” x .022” rectangular archwire. Brackets were fixed onto teeth 1.5 to 2.5 using a device that represented the upper teeth, maintaining an interbracket distance of 6.0 mm. The deflection tests were performed using the structure representative of tooth 1.1 as support on the Instron testing machine at a speed of 2.0 mm/min. The archwires were evaluated at deflections of 0.5 mm, 1.0 mm, and 1.5 mm. The data were analyzed by a generalized linear model, considering values at different deflections as repeated measurements in the same experimental unit (α = 0.5%). At 0.5 mm, higher forces were observed in G2 and G3, which did not differ significantly (p > 0.05). The lowest force was observed in G4 (p < 0.05). At 1.0 mm and 1.5 mm, the highest force was observed in G3, followed by G4 and G2 (p < 0.05). The lowest force was observed in G1 (p < 0.05). In general, tandem archwires (same or different calibers) in a specific passive self-ligating bracket exerted lower force when compared with rectangular archwires.

ABSTRACT Echocardiography in critically ill patients has become essential in the evaluation of patients in different settings, such as the hospital. However, unlike for other matters related to the care of these patients, there are still no recommendations from national medical societies on the subject. The objective of this document was to organize and make available expert consensus opinions that may help to better incorporate echocardiography in the evaluation of critically ill patients. Thus, the Associação de Medicina Intensiva Brasileira, the Associação Brasileira de Medicina de Emergência, and the Sociedade Brasileira de Medicina Hospitalar formed a group of 17 physicians to formulate questions relevant to the topic and discuss the possibility of consensus for each of them. All questions were prepared using a five-point Likert scale. Consensus was defined a priori as at least 80% of the responses between one and two or between four and five. The consideration of the issues involved two rounds of voting and debate among all participants. The 27 questions prepared make up the present document and are divided into 4 major assessment areas: left ventricular function, right ventricular function, diagnosis of shock, and hemodynamics. At the end of the process, there were 17 positive (agreement) and 3 negative (disagreement) consensuses; another 7 questions remained without consensus. Although areas of uncertainty persist, this document brings together consensus opinions on several issues related to echocardiography in critically ill patients and may enhance its development in the national scenario.

RESUMO A ecocardiografia do paciente grave tem se tornado fundamental na avaliação de pacientes em diferentes cenários e ambientes hospitalares. Entretanto, ao contrário de outras áreas relativas ao cuidado com esses pacientes, ainda não existem recomendações de sociedades médicas nacionais acerca do assunto. O objetivo deste documento foi organizar e disponibilizar opiniões de consenso de especialistas que possam auxiliar a melhor incorporação dessa técnica na avaliação de pacientes graves. Dessa forma, a Associação de Medicina Intensiva Brasileira, a Associação Brasileira de Medicina de Emergência e a Sociedade Brasileira de Medicina Hospitalar compuseram um grupo de 17 médicos para formular questões pertinentes ao tópico e debater a possibilidade de consenso de especialistas para cada uma delas. Todas as questões foram elaboradas no formato de escala Likert de cinco pontos. Consenso foi definido, a priori, como um somatório de, ao menos, 80% das respostas entre um e dois ou entre quatro e cinco. A apreciação das questões envolveu dois ciclos de votação e debate entre todos os participantes. As 27 questões elaboradas compõem o presente documento e estão divididas em 4 grandes áreas de avaliação: da função ventricular esquerda; da função ventricular direita; diagnóstica dos choques e hemodinâmica. Ao fim do processo, houve 17 consensos positivos (concordância) e 3 negativos (discordância); outras 7 questões persistiram sem consenso. Embora persistam áreas de incerteza, este documento reúne opiniões de consenso para diversas questões relativas à ecocardiografia do paciente grave e pode potencializar seu desenvolvimento no cenário nacional.

Abstract Objective To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). Conclusions Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group.