Abstract Systemic Arterial Hypertension is a multifactorial clinical condition associated with severe outcomes such as stroke and death. One of the main modifiable risk factor for hypertension is an unhealthy diet, often characterized by the consumption of ultraprocessed foods such as sweetened beverages. We aimed to investigate the relationship between the consumption of sweetened beverages, both sugar-sweetened and artificially sweetened, and the prevalence of hypertension in adults. A cross-sectional, household, population-based study with 1,162 adults from two Brazilian cities were carried out. The consumption of food groups and sweetened beverages was obtained by food frequency questionnaire and other data were self-reported. Weight, height, and waist circumference were measured. The association between sweetened beverages consumption and hypertension was analyzed using Poisson regression models, expressed as Prevalence Ratio. The prevalence of hypertension was 16.7%, with no significant difference between genders. The prevalence of consumption of sweetened beverages was 70.3% in men and 54.6% in women, being significantly higher in men. Women who consumed sugar-sweetened and artificially sweetened beverages 6 to 7 days per week had 92% higher prevalence of hypertension compared to those who did not consume or consumed at a lower frequency. Furthermore, women who consumed artificially sweetened beverages at least 1 time per week had 3.36 times higher prevalence of hypertension. The habitual consumption of sweetened beverages may be an important risk factor for hypertension, especially the consumption of diet beverages, which are often marketed as healthier than sugar-sweetened beverages.

Resumen La Hipertensión Arterial Sistémica es una condición clínica multifactorial asociada a resultados graves como el ictus y la muerte. Uno de los principales factores de riesgo modificables de la hipertensión es una dieta poco saludable, a menudo caracterizada por el consumo de alimentos ultraprocesados como las bebidas endulzadas. Nuestro objetivo fue investigar la relación entre el consumo de bebidas endulzadas, tanto azucaradas como edulcoradas artificialmente, y la prevalencia de hipertensión en adultos. Se realizó un estudio transversal, domiciliario y poblacional con 1,162 adultos de dos ciudades brasileñas. El consumo de grupos de alimentos y bebidas endulzadas se obtuvo mediante cuestionario de frecuencia de alimentos y los demás datos fueron autoinformados. Se midieron el peso, la talla y el perímetro de la cintura. La asociación entre el consumo de bebidas endulzadas y la hipertensión se analizó mediante modelos de regresión de Poisson, expresados como Ratio de Prevalencia. La prevalencia de hipertensión fue del 16,7%, sin diferencias significativas entre géneros. La prevalencia de consumo de bebidas endulzadas fue del 70,3% en los hombres y del 54,6% en las mujeres, siendo significativamente mayor en los hombres. Las mujeres que consumían bebidas azucaradas y edulcoradas artificialmente entre 6 y 7 días a la semana tenían 92% mayor prevalencia de hipertensión que las que no consumían o consumían con una frecuencia menor. Además, las mujeres que consumían bebidas edulcoradas al menos 1 vez por semana tenían una prevalencia de hipertensión 3,36 veces mayor. Así pues, el consumo habitual de bebidas endulzadas puede ser un importante factor de riesgo de hipertensión, especialmente el consumo de bebidas dietéticas, que a menudo se comercializan como más saludables que las bebidas azucaradas.

ABSTRACT The use of residues resulting from the processing of agricultural products is an widely studied topic, which is justified by the need to reduce costs and by the search for productive sustainability, which has as one of its principles the full use production, reducing waste and therefore increasing the amount of products extracted per unit of area. Residual seeds, resulting from the production of fruit pulps, are rich in nutrients and with the potential to be further improved by the application of germination, increasing the protein content and the content of bioactive compounds. However, in the germination process, the product acquires a high water content, requiring immediate drying and control of the water adsorption kinetics after dehydration. Therefore, the objective of this study was to determine the water adsorption isotherms of germinated seeds flours from pumpkins of three varieties at temperatures of 15, 25 and 35 °C, to obtain the most appropriate mathematical model to describe the hygroscopic behavior and to determine the thermodynamic properties of water adsorption, through the values of the integral isosteric heat, differential entropy, differential enthalpy and Gibbs free energy for the studied conditions. The GAB and Peleg models fit the experimental data well. With increasing water activity, there was a reduction in isosteric heat and entropy. The enthalpy-entropy compensation theory was confirmed. Gibbs free energy was negative for all temperatures, increasing with increasing equilibrium water content, demonstrating that it is a spontaneous process.

Resumo Este estudo teve como objetivo comparar padrões de mortalidade por câncer entre os imigrantes colombianos nos EUA e colombianos em sua terra natal. Dados de 2008 a 2012 foram coletados, e foram calculadas taxas de mortalidade por câncer de colombianos residindo em seu país natal e colombianos residindo em Califórnia, Flórida e Nova York, bem como taxas específicas de mortalidade por idade e sexo por cada 100.000 pessoas. Para comparar as duas populações, tanto antes como após a correção pela escolaridade, as razões de taxas de mortalidade (MRR) foram estimadas por modelo de regressão binomial negativa. Foi descoberto que colombianos em sua terra natal apresentam taxas de mortalidade por câncer mais altas quando comparados aos que residem nos EUA (MRR masculino 1,4 (IC 95%: 1,2-1,5), MRR feminino 1,5 (IC 95%: 1,3-1,7)). Essas diferenças persistem para a maioria dos tipos de câncer, mesmo após correção pela escolaridade. Os colombianos em sua terra natal apresentaram taxa de mortalidade por câncer gástrico (MRR masculino 2,6; feminino 2,8) e cervical (MRR 5,0) significativamente mais alta em comparação com os que residem nos EUA. As desigualdades educacionais na mortalidade por câncer foram mais acentuadas para aqueles que moram em sua terra natal. A menor taxa de mortalidade por câncer observada entre os colombianos nos EUA, porém, não pode ser atribuída às diferenças de escolaridade, um indicador de status socioeconômico. Em vez disso, provavelmente ocorre devido à maior acessibilidade aos serviços de saúde preventivos e curativos nos EUA.

Abstract We aim to compare cancer mortality rates of USA Colombian migrants (USA Colombians) to Colombians in their country of origin (CO Colombians). Using Colombian national mortality data and data on cancer deaths among Colombians residing in the states of California, Florida, and New York (USA Colombians) for the period 2008-2012, we estimated sex-specific and age-standardized mortality rates (ASMR), expressed per 100,000 persons. For comparisons between the two populations before and after adjustment for educational level, negative binomial regression models were used to compute Mortality Rate Ratios (MRR). CO Colombians had higher cancer mortality rates compared with USA Colombians (male MRR 1.4 [95%CI: 1.2-1.5], female MRR 1.5 [95%CI: 1.3-1.7]). These differences persisted for most cancers even after adjustment for education. CO Colombians had significantly higher mortality from gastric (MRR 2.6 in males and 2.8 in females) and cervical cancer (MRR 5.0) compared with US Colombians. Educational inequalities in cancer mortality were more pronounced among CO Colombians than among USA Colombians. Lower cancer mortality observed among USA Colombians cannot be attributed to differences in education, an indicator of socio-economic status. Rather, it is likely due to better access to preventive and curative healthcare in the USA.

The conjunction of the mental health reform and health reform make Brazil a unique setting in overcoming hegemonic biomedical paradigm and in the radicality of deinstitutionalization across the territory. The aim of this study was to analyze the perceptions of primary and specialist care workers about sharing mental health care in a medium-sized municipality in the state of São Paulo. We conducted a qualitative study using the hermeneutic-dialectic method of inquiry based on data from the narratives of focus group meetings with 15 workers held in 2022. Permanent education, professional training, network integration, worker’s mental health and confronting the dismantling of policies were considered essential to shared care. It is imperative that the field of mental health is prioritized and sufficient resources are made available so that practices are increasingly oriented towards the psychosocial paradigm.

La conjunción de la Reforma Psiquiátrica y de la Reforma Sanitaria hace que Brasil sea un escenario único en la superación del Paradigma Biomédico hegemónico y en la radicalidad de la desinstitucionalización en el territorio. El objetivo de este artículo es analizar la percepción de los trabajadores de la Atención Básica y de la Atención Especializada sobre la compartición del cuidado en salud mental en un municipio de mediano porte del estado de São Paulo. Se constituye como una investigación cualitativa, de abordaje hermenéutico-dialéctico, cuyos datos se produjeron a partir de narrativas de grupos focales narrativos-hermenéuticos realizados en 2022 con quince trabajadores. La educación permanente, la formación profesional, la integración de la red, la salud mental del trabajador y el enfrentamiento de las políticas de desmonte se consideraron fundamentales para el cuidado compartido. Se muestra imperativo que se priorice el Campo de Salud Mental y que no falten recursos para que, cada vez más, las prácticas puedan orientarse hacia el Paradigma Psicosocial.

A conjunção da Reforma Psiquiátrica e da Reforma Sanitária torna o Brasil um cenário único na superação do Paradigma Biomédico hegemônico e na radicalidade da desinstitucionalização no território. Este artigo objetiva analisar a percepção dos trabalhadores da Atenção Básica e da Atenção Especializada sobre o compartilhamento do cuidado em Saúde Mental em um município paulista de médio porte. Constitui-se como uma pesquisa qualitativa, de abordagem hermenêutico-dialética, cujos dados foram produzidos por narrativas de grupos focais narrativo-hermenêuticos realizados em 2022, com 15 trabalhadores. A Educação Permanente, a formação profissional, a integração da rede, a Saúde Mental do trabalhador e o enfrentamento das políticas de desmonte foram considerados fundamentais para o cuidado compartilhado. Mostra-se imperativo que o campo da Saúde Mental seja priorizado e não faltem recursos para que, cada vez mais, as práticas possam se orientar pelo Paradigma Psicossocial.

Abstract Background: Our objective was to compare the safety and efficacy of Target-Controlled Infusion (TCI) versus intermittent bolus of propofol for colonoscopy sedation. Methods: We conducted a randomized (1:1), single-blind, parallel-group superiority trial with fifty ASA I or II patients, both sexes, aged 18 to 65 years, Body Mass Index ≤ 30 kg.mr-2, undergoing colonoscopy, allocated to receive propofol by TCI (effect-site, 2 μg.mL-1 plus 0.5 μg.mL-1 until unconsciousness and as necessary for agitation) or intermittent bolus (1 mg.kg-1 plus 0.5 mg.kg-1 every 5 minutes or as above). The primary safety outcome was the need for airway maneuvers and the primary efficacy outcome was the need for interventions to adjust the level of sedation. Secondary outcomes included incidence of agitation, propofol dose, and time to recovery. Results: The median (IQR) number of airway maneuvers and interventions needed to adjust sedation was 0 (0-0) vs. 0 (0-0) (p = 0.239) and 1 (0-1) vs. 3 (1-4) (p < 0.001) in the TCI and control groups, respectively. Agitation was more common in the intermittent bolus group - 2 (0-2) vs. 1 (0-1), p < 0.001. The mean ± SD time to recovery was 4.9 ± 1.4 minutes in the TCI group vs. 2.3 ± 1.6 minutes in the control group (p < 0.001). The total propofol dose was higher in the TCI group (234 ± 46 μg.kg-1.min-1 vs. 195 ± 44 μg.kg-1.min-1 (p = 0.040)). Conclusions: During colonoscopy, TCI is as safe as intermittent bolus of propofol while reducing the incidence of agitation and the need for dose adjustments. However, intermittent bolus administration was associated with lower total propofol dose and earlier recovery.

ABSTRACT Objectives: To verify the association between the ABO blood type and the risk of SARS-CoV-2 infection and COVID-19 disease severity. Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), using the 2020 PRISMA Checklist and flow diagram, and articles selected for review were analyzed using the Newcastle-Ottawa Quality Rating Scale. The research question was: "Would the ABO blood group influence the risk of infection and clinical course of patients infected with SARS-CoV-2?", The following databases were used: Embase, PubMed, Virtual Health Library (VHL), Web of Science, Science-Direct and Scopus. The protocol for this review was registered in the Prospective Register of Systematic Reviews (PROSPERO), number CRD42021245945. Results: We found 798 articles across PubMed, Embase, Scopus, Web of Science, Science Direct and Virtual Health Library and 54 articles were included in the final analysis. Among 30 studies evaluating the risk of COVID-19 infection, 21 found significant correlations with ABO blood groups, 14 of them revealing an increased risk in blood group A and 15 studies showing a decreased risk in blood group O. Most studies found no significant correlation with disease severity or mortality. Conclusion: The qualitative assessment of available information suggests that blood group A may be a risk factor for COVID-19 infection and that blood group O may have a protective effect. We were unable to determine a clear association between the ABO blood group and mortality. These conclusions are based on highly heterogenous evidence.

Introdução: A população idosa tem crescido consideravelmente nos últimos anos no Brasil e no mundo, e continua com tendência crescente para as próximas décadas. O envelhecimento é um processo fisiológico e biológico progressivo, com experiências singulares individuais e familiares. Objetivo: compreender as vivências que refletem aspectos da saúde mental dos idosos no contexto da covid-19 em um município do sertão central do Ceará no nordeste do Brasil. Método: Trata-se um estudo qualitativo, ancorado na hermenêutica crítica. Foi realizado junto a 15 idosos atendidos em serviços da Atenção Primária à Saúde de um município do sertão do estado do Ceará, nordeste do Brasil. Os dados foram coletados no período de agosto a outubro de 2021, por meio de entrevista semiestruturada, versando sobre vivências cotidianas na pandemia e repercussões na saúde mental, e estratégias de promoção de saúde realizadas no período de isolamento social. O estudo foi aprovado pelo comitê de ética em pesquisa de uma instituição pública do Estado do Ceará. Resultados: os achados foram organizados em duas categorias, definidas em: Sentimentos e saúde mental frente a covid-19 e, Promoção da saúde do idoso em tempos de covid-19. Os sentimentos foram expressos em incertezas, medo, luto e aflição. As medidas de prevenção, pautadas no isolamento social, causaram a sensação de prisão, e desconforto psicoemocional. Para a promoção da saúde, os idosos realizavam atividades domésticas, artesanatos e cultivo de horta, além de fortalecer a espiritualidade. Durante o relaxamento das medidas de isolamento, passaram a realizar caminhadas e visitas a igreja. Conclusão: As medidas de isolamento, o medo e os desconfortos afetaram a saúde mental dos idosos, sendo que às estratégias de promoção da saúde foram relevantes para o autocuidado e o apoio psicossocial.

Introduction: The elderly population has grown considerably in recent years in Brazil and in the world, and continues to grow in the coming decades. Aging is a progressive physiological and biological process, with unique individual and family experiences. Objective: to understand the experiences that reflect aspects of the mental health of the elderly in the context of covid-19 in a municipality in the central hinterland of Ceara in northeastern Brazil. Method: This is a qualitative study, anchored in critical hermeneutics. It was carried out with 15 elderly people assisted in Primary Health Care services in a municipality in the hinterland of the state of Ceara, northeastern Brazil. Data were collected from August to October 2021, through a semi-structured interview, dealing with everyday experiences in the pandemic and repercussions on mental health, and health promotion strategies carried out during the period of social isolation. The study was approved by the research ethics committee of a public institution in the State of Ceara. Results: the findings were organized into two categories, defined as: Feelings and mental health in the face of covid-19 and, Health promotion for the elderly in times of covid-19. Feelings were expressed in uncertainties, fear, mourning and distress. Prevention measures, based on social isolation, caused a feeling of imprisonment and psycho-emotional discomfort. For the promotion of health, the elderly carried out domestic activities, handicrafts and garden cultivation, in addition to strengthening their spirituality. During the relaxation of isolation measures, they began to take walks and visit the church. Conclusion: Isolation measures, fear and discomfort affected the mental health of the elderly, and health promotion strategies were relevant for self-care and psychosocial support.

The study of the spatial distribution of Brazilian prisons is one of the ways to understand the mass incarceration phenomenon. By using the Penitentiary Census of the Ministry of Justice, 2014, we analyse punitive patterns around the country. The results show the existence of five punitive spatial clusters: two of which are prominent, in the Southeast region and the other centred in the Northeast region (between the states of Pernambuco and Ceará). Methodologically, we structured models for point patterns considering the geographic location (latitude and longitude), in addition, we introduced into the models the prisons’ characteristics, such as occupancy rate and prison capacity. As a result, it is possible to observe a statistical regularity that shows a differential punitive pattern in the São Paulo state. There are many units with large capacities, higher than other states' prisons. The statistical inference was made under the Bayesian paradigm, which allows characterizing the uncertainties of the models in a probabilistic way and circumventing the problems of scientific decision-making based on the p-value. The present paper is the first one to identify punitive groups in Brazil and to statistically verify the existence of different spatial patterns in São Paulo’s prisons, contributing to the debate on punitive policies in the country.

Uma das maneiras de compreender o fenômeno do encarceramento em massa no Brasil é através do estudo da distribuição das unidades prisionais em seu território. A partir do Censo Penitenciário realizado pelo Ministério da Justiça, em 2014, foi feita uma análise de estatística espacial para identificar os padrões punitivos no país. Os resultados mostram a existência de cinco agrupamentos punitivos, sendo dois principais: um na região sudeste, centrado no estado de São Paulo, e outro no Nordeste, com centro entre os estados de Pernambuco e Ceará. Metodologicamente, modelos estruturados para padrões de pontos foram expandidos introduzindo características do fenômeno, além das geográficas (latitude e longitude), tais como: taxa de ocupação e capacidade dos presídios. Como resultado, foi possível observar uma regularidade estatística que mostra um padrão punitivo diferenciado em São Paulo. Observa-se grande quantidade de unidades com capacidade superior à de seus pares na região. A inferência estatística foi feita sob o paradigma bayesiano que permite caracterizar as incertezas dos modelos de forma probabilística e contornar os problemas de tomada de decisão científica baseada no p-valor. Este trabalho é o primeiro a identificar os agrupamentos punitivos no país e verificar estatisticamente a existência de padrões diferenciados nas unidades prisionais de São Paulo, contribuindo para o debate sobre o punitivismo no Brasil.

Resumen La suplementación surge como una estrategia simple para mejorar la productividad animal en sistemas que adoptan praderas diferidas de pasto como dieta básica. Este estudio tuvo como objetivo evaluar el efecto de los niveles de suplementación de harina de vaina de mezquite sobre la ingesta, la digestibilidad de los nutrientes y la ganancia de peso corporal (PC) de caprinos en pastoreo diferido. Treinta y cinco (35) caprinos machos (24.0 ± 2.9 kg PC) se distribuyeron en un diseño completamente al azar, con cinco tratamientos y siete repeticiones. Los tratamientos consistieron en un control de suplemento (0.05 % de PC de sal proteico-mineral) y niveles crecientes a 0.5; 1.0; 1.5 y 2.0 % de PC de suplementación con harina de vaina de mezquite. La ingesta de materia seca y nutrientes del forraje y la dieta total aumentaron linealmente (P<0.0001) en función de los niveles del suplemento. Se observó un efecto cuadrático (P<0.0001) para las variables de digestibilidad, excepto para el extracto etéreo y los carbohidratos no fibrosos, que presentaron un efecto lineal creciente (P<0.0001). Los niveles de suplementación aumentaron linealmente las variables de rendimiento (P<0.05). Se recomienda la suplementación del concentrado al 2.0 % de PC con harina de vaina de mezquite al 30 % en su composición para promover la reducción del ciclo productivo de los caprinos en praderas diferidas de pasto Urochloa.

Abstract Supplementation emerges as a simple strategy to improve animal productivity in systems that adopt deferred grass pasture as the basic diet. This study aimed to evaluate the effect of levels of supplementation of mesquite pod meal on intake, digestibility of nutrients, and body weight (BW) gain of goats in grazing deferred. Thirty-five (35) goat males (24.0 ± 2.9 kg BW) were distributed in a completely randomized design, with five treatments and seven replications. Treatments constituted a supplement control (0.05% BW of protein-mineral salt) and increasing levels at 0.5; 1.0; 1.5, and 2.0% BW of supplementation with mesquite pod meal. Dry matter intake and nutrients of the forage and total diet increased linearly (P<0.0001) as a function of the levels of the supplement. A quadratic effect was observed (P<0.0001) for the digestibility variables, except for ethereal extract and non-fiber carbohydrates, which presented an increasing linear effect (P<0.0001). Supplementation levels increased linearly on the performance variables (P<0.05). It is recommended the concentrate supplementation at 2.0% BW with mesquite pod meal at 30 % in its composition for promoting the reduction of the productive cycle of goats in deferred Urochloa grass pastures.

ABSTRACT Introduction: Pregnancy-related complications may impact women’s reproductive cycle and health through their lives. The objective of this study was to evaluate the sociodemographic, clinical, and obstetric history of women undergoing hemodialysis. Methods: We performed a cross-sectional study in a specialized health facility with four hemodialysis units. Sociodemographic characteristics, clinical and personal history, obstetric and perinatal results of women with pregnancies before hemodialysis were evaluated. Prevalence, bivariate, and logistic regression analyses were performed. Results: We included 208 (87.76%) women. Hypertension was the main cause of chronic kidney disease (CKD) (128 women). Rates of adverse perinatal outcomes, including prematurity, low birth weight, miscarriage, fetal death, and neonatal death, were 19.3%, 14.5%, 25.5%, 12.1%, and 5.3%, respectively. Hypertensive syndromes during pregnancy occurred in 37.0% of women, with 12.5% reporting preeclampsia and 1.4% reporting eclampsia. Up to 1 year after birth, 45.2% of women reported hypertension. Hemodialysis due to hypertension was associated with a history of hypertension during pregnancy (OR 2.33, CI 1.27 – 4.24), gestational hypertension (2.41, CI 3.30 – 4.45), and hypertension up to one year after birth (OR 1.98, CI 1.11 – 3.51). Logistic regression showed that gestational hypertension was independently associated with CKD due to hypertension (aOR 2.76, CI 1.45 – 5.24). Conclusion: Women undergoing hemodialysis due to hypertension were more likely to have gestational hypertension or hypertension up to one year after birth. To delay end-stage renal disease, it is necessary to identify women at risk of kidney failure according to their reproductive history.

RESUMO Introdução: Complicações relacionadas à gestação podem afetar o ciclo reprodutivo e a saúde das mulheres ao longo de suas vidas. Este estudo visou avaliar histórico sociodemográfico, clínico e obstétrico de mulheres em hemodiálise. Métodos: Realizamos estudo transversal em unidade de saúde especializada com quatro unidades de hemodiálise. Avaliou-se características sociodemográficas, histórico clínico e pessoal, resultados obstétricos e perinatais de mulheres com gestações anteriores à hemodiálise. Foram realizadas análises de prevalência, bivariadas e regressão logística. Resultados: Incluímos 208 (87,76%) mulheres. Hipertensão foi a principal causa de doença renal crônica (DRC) (128 mulheres). Taxas de desfechos perinatais adversos, incluindo prematuridade, baixo peso ao nascer, aborto espontâneo, óbito fetal e neonatal, foram de 19,3%, 14,5%, 25,5%, 12,1% e 5,3%, respectivamente. Síndromes hipertensivas durante a gestação ocorreram em 37,0% das mulheres, com 12,5% relatando pré-eclâmpsia e 1,4% relatando eclampsia. Até 1 ano após o parto, 45,2% das mulheres relataram hipertensão. Hemodiálise devido à hipertensão foi associada ao histórico de hipertensão na gestação (OR 2,33; IC 1,27 - 4,24), hipertensão gestacional (2,41; IC 3,30 - 4,45), e hipertensão até um ano após o parto (OR 1,98; IC 1,11 - 3,51). A regressão logística mostrou que hipertensão gestacional foi independentemente associada à DRC devido à hipertensão (ORa 2,76; IC 1,45 - 5,24). Conclusão: Mulheres submetidas à hemodiálise por hipertensão foram mais propensas a apresentar hipertensão gestacional ou hipertensão até um ano após o parto. Para retardar a doença renal em estágio terminal, deve-se identificar mulheres em risco de insuficiência renal de acordo com sua história reprodutiva.

Abstract Background: Conventional dental care is often impossible in patients with Autism Spectrum Disorder (ASD). Non-collaborative behaviors, sometimes associated with aggressiveness, are usual justifications for premedication in this population. Thereby, this research focuses on the effects of oral midazolam versus oral ketamine plus midazolam as preanesthetic medication in ASD. Methods: The sample included 64 persons with ASD, aged 2-59 years, scheduled for dental care under general anesthesia. The primary objective of this study was to compare degrees of sedation between two parallel, double-blinded, equally proportional groups randomized to receive oral midazolam (0.5 mg.kg−1, maximum 15 mg) or oral midazolam (0.5 mg.kg−1) associated with oral S(+)-ketamine (3 mg.kg−1, maximum 300 mg). The secondary outcomes were the need of physical stabilization to obtain intravenous line, awakening time, and occurrence of adverse events. Results: According to the dichotomous analysis of sedation level (Ramsay score 1 and 2 versus Ramsay ≥ 3), oral association of S(+)-ketamine and midazolam improved sedation, with increased probability of Ramsay ≥ 3, Relative Risk (RR) = 3.2 (95% Confidence Interval [95% CI] = 1.32 to 7.76) compared to midazolam alone. Combined treatment also made it easier to obtain venous access without physical stabilization, RR = 2.05 (95% CI = 1.14 to 3.68). There were no differences between groups regarding awakening time and the occurrence of adverse events. Conclusion: The association of oral S(+)-ketamine with midazolam provides better preanesthetic sedation rates than midazolam alone and facilitates intravenous line access in patients with autism.

Abstract Objective: this study aimed to evaluate if there is an association of intake of coffee and its polyphenols with mammographic findings in women treated at a breast care service unit of the Unified Health System (SUS), Brazil. Research methods and procedures: this was a cross-sectional study with 532 women treated at a health service. The participants were divided according to their mammographic reports into two groups: without and with altered findings. Two 24-h dietary recalls were applied and coffee consumption was categorized into three groups (less than 1 cup, 1 to 3 cups, and more than 3 cups). Phenolic acids were determined using the Phenol Explorer program. The intake of polyphenols was calculated by adding the values obtained from the total amount of coffee consumed during the day. The Multiple Source Method (MSM) was applied to analyze the usual intake. Results: of the 532 women, 178 (33.5 %) had altered mammographic findings. The participants' average daily coffee intake was 193.4 mL. No significant association was found between coffee consumption and mammographic findings. However, it was found that the second tertile of polyphenols was a protective factor for breast changes. Conclusion: coffee polyphenols are protective against breast changes in the group evaluated and, thus, can help prevent breast cancer.

Resumen Objetivo: este estudio tuvo como objetivo evaluar si existe una asociación de la ingesta de café y sus polifenoles con los hallazgos mamográficos de mujeres tratadas en una unidad de patología mamaria del Sistema Unificado de Salud (SUS), Brasil. Métodos y procedimientos de investigación: este fue un estudio transversal con 532 mujeres tratadas en un servicio de salud. Las participantes se dividieron de acuerdo con sus informes mamográficos en dos grupos: sin y con hallazgos alterados. Se aplicaron dos registros dietéticos de 24 horas y el consumo de café se clasificó en tres grupos (menos de 1 taza, 1 a 3 tazas y más de 3 tazas). Los ácidos fenólicos se determinaron utilizando el programa Phenol Explorer. La ingesta de polifenoles se calculó sumando los valores obtenidos de la cantidad total de café consumido durante el día. Se aplicó el método de fuentes múltiples (MSM) para analizar la ingesta habitual. Resultados: de las 532 mujeres, 178 (33,5 %) tenían hallazgos mamográficos alterados. La ingesta diaria promedio de café de los participantes fue de 193,4 ml. No se encontró una asociación significativa entre el consumo de café y los hallazgos mamográficos. Sin embargo, se encontró que el segundo tercil de polifenoles era un factor protector para los cambios mamarios. Conclusión: los polifenoles del café son protectores contra los cambios mamarios en el grupo evaluado y, por lo tanto, podrían ayudar a prevenir el cáncer de mama.

Abstract In order to establish a link between the evolutionary history and the photochemical attributes, measurements of chlorophyll (Chl) a fluorescence were made in Cattleya warneri, C. shofieldiana and C. harrisoniana exposed to high irradiance for 5, 35, and 120 min (hereafter referred to as treatments T5, T35, and T120, respectively). The following questions are addressed: (1) Is the increased energy dissipation enough to counterbalance the excess energy that drives photosynthesis at different times of high irradiance exposure? (2) Is there an influence of the incidence and duration of light radiation on Cattleya species in full sunlight, compared to Cattleya species submitted to low irradiance? Higher relative variable fluorescence at the J-step (Vj) values followed by the lower quantum yield of electron transport (ψEo) indicate the accumulation of reduced Quinone A (QA) proportionally of sunflecks exposure time in C. warneri. The higher performance index (PIABS) and plasticity index values in C. schofieldiana indicate higher efficiency in modulating the photosynthetic apparatus under sunflecks. C. harrisoniana shows the lowest plasticity index, suppression of maximum fluorescence (Fm), and no recovery of PIABS after sunflecks. This study evidences the importance of physiological plasticity in the current geographic distribution of Cattleya in response to light pulses in species derived from fragmented habitats and the maintenance of shade to species of more primitive clades.

Resumo Com o objetivo de estabelecer uma ligação entre a história evolutiva e os atributos fotoquímicos, medidas de fluorescência da clorofila (Chl) a foram feitas em Cattleya warneri, C. shofieldiana e C. harrisoniana expostas à alta irradiância por 5, 35 e 120 min (T5, T35 e T120, respectivamente). As seguintes questões são abordadas: (1) O aumento da dissipação de energia é suficiente para contrabalançar o excesso de energia que impulsiona a fotossíntese em diferentes tempos de exposição à alta irradiância? (2) Existe influência da incidência e duração da radiação luminosa em espécies de Cattleya a pleno sol, em comparação com espécies de Cattleya submetidas a baixa irradiância? A maior fluorescência variável relativa no ponto J (Vj) seguida do menor rendimento quântico do transporte de elétrons (ψEo) indicam o acúmulo de Quinona A (QA) reduzida proporcionalmente ao tempo de exposição às manchas solares em C. Waeneri. Os maiores valores de índice de desempenho (PIABS) e do índice de plasticidade em C. schofieldiana indicam maior eficiência na modulação do aparato fotossintético em resposta às manchas solares. C. harrisoniana apresenta menor índice de plasticidade, supressão da fluorescência máxima (Fm) e nenhuma recuperação de PIABS após exposição às manchas solares. Este estudo evidencia a importância da plasticidade fisiológica na distribuição geográfica atual de Cattleya em resposta a pulsos de luz em espécies derivadas de habitats fragmentados e a manutenção do sombreamento para espécies de clados mais primitivos.

Resumen Objetivo: evaluar los efectos de un suplemento especializado en el control de la glucosa (GTSS) frente a un desayuno estándar sobre la glucemia posprandial (PPG). Metodología: es un estudio cruzado, prospectivo, aleatorizado en el que se incluyeron a pacientes con diabetes tipo 2 (T2D) con control subóptimo de la glucemia (HbA1c entre 6,5 y 8,5 %) utilizando monoterapia con metformina. El desayuno estandarizado fue isocalórico en comparación con el GTSS y solamente la distribución calórica fue diferente. Ambas intervenciones se utilizaron una vez al día por la mañana, reemplazando cada una el desayuno durante 7 días consecutivos (14 días de observación). Se utilizó el sistema de monitoreo continuo de glucosa (isCGM) para determinar las diferencias entre las intervenciones con respecto al área bajo la curva (iAUC) de glucosa postprandial (PPG) (3 horas después de la intervención) como variable principal o primaria; las variables secundarias fueron la diferencia entre las intervenciones con respecto al pico glicémico, la excursión de glucosa posprandial (PPGE), la glucosa media en sangre (MBG) y el rango de tiempo (TIR). Resultado: se incluyeron treinta y un pacientes con T2D con edades entre 39 y 69 años. El grupo del GTSS tuvo un área bajo la curva (iAUC) significativamente más baja de la PPG en comparación con el grupo del desayuno estandarizado (33,3 [15,0 a 54,0] frente a 46,8 [27,3 a 75,1] mg/dL), mientras que también presentó una PPG significativamente más baja (26,4 + 17,2 vs. 44,8 + 24,4 mg/dL). No hubo diferencia entre los períodos de intervención con respecto a la MBG, el TIR y eventos hipoglucémicos. Conclusión: el nuevo GTSS, como sustituto del desayuno, produjo una reducción de la iAUC de la PPG del 25 %, según el isCGM, en comparación con un desayuno isocalórico normalizado.

Abstract Objective: to evaluate the effects of a new glycemia targeted specialized supplement (GTSS) compared to a standard breakfast on postprandial blood glucose (PPG). Methods: patients with type 2 diabetes (T2D) and suboptimal control (A1C between 6.5 and 8.5 %) in monotherapy with metformin were included to this prospective, randomized, crossover trial. The standardized breakfast was isoenergetic compared to the GTSS, differing on macronutrients distribution. Both interventions were used once a day in the morning, each replacing breakfast for 7 consecutive days (14 days of observation). Intermittent scanning continuous glucose monitoring system (isCGM) determined the difference between the interventions regarding the incremental area under the curve (iAUC) of the PPG (3 hours after intervention), as a primary endpoint; secondary endpoints were the difference between the interventions regarding the glycemic peak, postprandial glucose excursion (PPGE), mean blood glucose (MBG) and time in range (TIR). Results: thirty-one T2D patients with ages between 39 and 69 years-old were enrolled. GTSS group had significantly lower iAUC of the PPG compared to standardized breakfast (33.3 [15.0 to 54.0] vs 46.8 [27.3 to 75.1] mg/dL), while also presenting a significantly lower PPG excursion (26.4 ± 17.2 vs 44.8 ± 24.4 mg/dL). There was no difference between the intervention periods regarding MBG, TIR and hypoglycemic events. Conclusion: the new GTSS, as a meal replacement in the breakfast, produced a 25 % reduction in the iAUC of the PPG, as accessed by isCGM, in comparison with an isocaloric-standardized meal.

Abstract Background Compound A is generated by sevoflurane when it reacts with carbon dioxide absorbers with strong bases at minimal fresh gas flow (FGF) and is nephrotoxic in animals. No conclusive data has shown increased risk in humans. The aim of this study was to investigate if minimal FGF promotes an increase in the incidence of acute kidney injury (AKI) when compared to high FGF in patients undergoing on-pump cardiac surgery under sevoflurane anesthesia. Methods Two hundred and four adult patients scheduled for on-pump cardiac surgery under sevoflurane anesthesia were randomly allocated to two groups differentiated by FGF: minimal FGF (0.5 L.min−1) or high FGF (2.0 L.min−1). Baseline creatinine measured before surgery was compared daily to values assayed on the first five postoperative days, and 24-hour urinary output was monitored, according to the KDIGO (Kidney Disease Improving Global Outcomes) guideline to define postoperative cardiac surgery-associated acute kidney injury (CSA-AKI). Creatinine measurements were also obtained 20 and 120 days after hospital discharge. Results Postoperative AKI occurred in 55 patients, 26 patients (29.5%) in the minimal FGF group and 29 patients (31.5%) in the high FGF group (p= 0.774). Twenty days after discharge, 11 patients (6.1%) still had CSA-AKI and 120 days after discharge only 2 patients (1.6%) still had CSA-AKI. Conclusions When compared to high FGF, minimal FGF sevoflurane anesthesia during on-pump cardiac surgery is not associated with increased risk of postoperative AKI in this population at high risk for renal injury.