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To preserve food from moisture and oxygen, polymers, such as ethylene vinyl alcohol (EVOH) are used in multilayer structures to provide oxygen barrier, while low‐density polyethylene (LDPE) is used for a water vapor barrier. While this material combination is functionally ideal, it may not comply with the new packaging recycling guidelines. Some European markets have implemented rules that limit the weight percentage of EVOH in LDPE films. One way to increase recyclability is by reducing the amount of EVOH in the film structure while maintaining the packaging's oxygen barrier properties. To achieve this, it is necessary to improve the barrier properties of EVOH. With this objective in mind, this study evaluated the incorporation of nanoclays (NC), cellulose microcrystals (MCC), silicon dioxide nanoparticles (SiO2), and cellulose nanocrystals (CNC) into an EVOH matrix. The results indicate that NC and MCC facilitate a stable blown film extrusion process and have a better dispersion in the EVOH matrix. Based on this finding, three‐layer films (with an ABA configuration) consisting of LDPE (A) and EVOH (7 μm layer) with 0.5 or 1 wt.% MCC or NC (B) were produced to protect the EVOH from moisture and enable blown film processing. The oxygen transmission rate (OTR) values were lowest for 0.5 wt.% NC and 1 wt.% MCC incorporation. Although the films with micro and nanoparticles had increased haze, this did not affect the visibility of the packaged food. [ABSTRACT FROM AUTHOR]

Multilayer films are widely used in the food industry because they allow the combination of properties of different materials to increase product shelf life without sacrificing product value. Despite the associated benefits, these films are difficult to recycle due to material immiscibility and difficult layer separation. Thus, the purpose of this research is to investigate the feasibility of incorporating recycled plastic material from the multi‐material film industry into extruded films for food packaging. To simulate the thermomechanical recycling, two different post‐industrial polymeric wastes of low‐density polyethylene (LDPE) (with linear low‐density polyethylene (LLDPE) or with ethylene vinyl alcohol (EVOH)), were reprocessed four times in a single‐screw extruder. Moreover, these polymeric wastes were blended with virgin LDPE to improve the extrusion process control and to assess their effect on the blend properties. The extrusion experiments demonstrate that reprocessing of multilayer films and processing of their blends with virgin LDPE is feasible. Moreover, the mechanical and thermal properties of the corresponding films are not negatively affected when compared with those of virgin LDPE films. Nevertheless, the optical properties of recycled EVOH films, were lower than those of virgin LDPE or recycled LLDPE, with high haze and low gloss. Highlights: Two multilayer film scraps were reprocessed and blended with virgin LDPE.Thin film samples were produced by blown film extrusion.Films containing EVOH presented the worst optical properties.The presence of EVOH did not negatively affect the extrusion process.Mechanical and thermal properties were not significantly affected. [ABSTRACT FROM AUTHOR]

Introduction: Ischemic stroke is a significant global health concern, with reperfusion therapies playing a vital role in patient management. Neuronspecific enolase (NSE) has been suggested as a potential biomarker for assessing stroke severity and prognosis, however, the role of NSE in predicting long-term outcomes in patients undergoing reperfusion therapies is still scarce. Aim: To investigate the association between serum NSE levels at admission and 48 h after reperfusion therapies, and functional outcomes at 90 days in ischemic stroke patients. Methods: This study conducted a prospective cross-sectional analysis on consecutive acute ischemic stroke patients undergoing intravenous fibrinolysis and/or endovascular thrombectomy. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 90 days post-stroke and two groups were defined according to having unfavorable (mRS3-6) or favorable (mRS0-2) outcome. Demographic, clinical, radiological, and laboratory data were collected, including NSE levels at admission and 48 h. Spearman's coefficient evaluated the correlation between analyzed variables. Logistic regression analysis was performed to verify which variables were independently associated with unfavorable outcome. Two ROC curves determined the cut-off points for NSE at admission and 48 h, being compared by Delong test. Results: Analysis of 79 patients undergoing reperfusion treatment following acute stroke revealed that patients with mRS 3-6 had higher NIHSS at admission (p < 0.0001), higher NIHSS at 24 h (p < 0.0001), and higher NSE levels at 48 h (p = 0.008) when compared to those with mRS 0-2. Optimal cut-off values for NSE0 (>14.2 ng/mL) and NSE48h (>26.3 ng/mL) were identified, showing associations with worse clinical outcomes. Adjusted analyses demonstrated that patients with NSE48h > 26.3 ng/mL had a 13.5 times higher risk of unfavorable outcome, while each unit increase in NIHSS24h score was associated with a 22% increase in unfavorable outcome. Receiver operating characteristic analysis indicated similar predictive abilities of NSE levels at admission and 48 h (p = 0.298). Additionally, a strong positive correlation was observed between NSE48h levels and mRS at 90 days (r = 0.400 and p < 0.0001), suggesting that higher NSE levels indicate worse neurological disability post-stroke. Conclusion: Serum NSE levels at 48 h post-reperfusion therapies are associated with functional outcomes in ischemic stroke patients, serving as potential tool for patient long-term prognosis. [ABSTRACT FROM AUTHOR]

In this work, alpha-tocopherol (α-TOC) was encapsulated in poly(lactic acid) nanoparticles (PLA NPs) and added to low-density polyethylene (LDPE) films with the aim of producing an active film for food packaging applications. PLA NPs loaded with α-TOC were produced through nanoprecipitation and dried using two methods (freeze-dryer and oven). LDPE-based films with final polymeric matrix concentrations of 10 and 20 g/kg were then produced through blow extrusion. The results showed that LDPE-based films loaded with α-TOC can be produced using blow extrusion, and a good distribution of PLA NPs can be obtained within the LDPE matrix as observed using scanning electron microscopy (SEM). The mechanical properties were affected by the incorporation of α-TOC and PLA NPs loaded with α-TOC, with the observation of a decrease in tensile strength and Young's Modulus values and an increase in elongation at break. Regarding water vapor permeability, the films showed a reduction in the values with the addition of α-TOC and PLA NPs loaded with α-TOC compared to the LDPE film (control). Films with α-TOC in the free state and loaded in PLA NPs showed antioxidant activity, but their behavior was affected by the encapsulation process. [ABSTRACT FROM AUTHOR]

Background: Saliva modulates the environment of the oral biofilm through pH buffer, microbial attachment to host surfaces, and nutritional source. The ecology of stress occurs when a physical factor adversely impacts an ecosystem or its biotic components. Therefore, reduced salivary flow can affect oral-host balance. The leading causes of hyposalivation include disease-associated Sjögren's syndrome (SS) and menopausal women as aging-associated. However, little is known about the oral microbiome integrated with sex hormones in hyposalivation. This study aimed to characterize the hyposalivation microbiome caused by aging or disease affecting the salivary glands in women. Methods: We included 50 women older than 40 years of age in any menopausal phase. We collected stimulated saliva from 25 women diagnosed with SS (SS) and 25 without SS (non-SS). The bacterial profile of the patients was obtained by 16S rRNA sequencing. Bioinformatics analysis used machine learning to analyze the cohort's signs, symptoms, and bacterial profile. Salivary estradiol as a sex hormone variation level was determined. Results: We obtained that 79% of the SS group, and 52% of the non-SS group had hyposalivation. We found a negatively correlated Prevotella-age and Rothiaestradiol in the SS group. Highlight, we found that the cause of the hyposalivation in the study did not explain differences in microbial diversity comparing non-SS and SS groups. Therefore, microbial communities found in hyposalivation but not related to systemic conditions suggest that changes in the oral environment might underpin host-microbial balance. Conclusion: The salivary microbiome was similar in women with and without SS. However, hyposalivation showed two distinctive clusters associated with the bacterial population profiles. Our study suggests that local ecological disturbances could drive the change in the microbiome. [ABSTRACT FROM AUTHOR]

This study focuses on the development of low-density polyethylene matrix nanocomposite films for food packaging industry and aims at improving low-density polyethylene oxygen barrier properties while maintaining other relevant characteristics, such as processability, easy post-processing, optical and mechanical properties. low-density polyethylene nanocomposites, with 1 and 2.5 wt.% nanoclay (NC) and also compatibilized with 5 wt.% polyethylene grafted with maleic anhydride (PE-g-MA), were prepared and used to produce blown films. The nanocomposites were characterized in terms of their morphology, thermal, rheological, mechanical, barrier and optical properties, through scanning electron microscopy (SEM), X-ray diffraction (XRD), differential scanning calorimetry (DSC), rheological measurements, tensile tests, water vapor transmission, oxygen permeability tests and spectrophotometry. The results demonstrated good NC dispersion in the polymer matrix and decreased oxygen permeability in the compatibilized nanocomposite films. All the other properties did not significantly change when compared to neat low-density polyethylene. Overall, the film properties were improved with the added nanoclay and PE-g-MA and, have potential for food packaging. [ABSTRACT FROM AUTHOR]

Background The domesticated turkey (Meleagris gallopavo) is a species of significant agricultural importance and is the second largest contributor, behind broiler chickens, to world poultry meat production. The previous genome is of draft quality and partly based on the chicken (Gallus gallus) genome. A high-quality reference genome of M. gallopavo is essential for turkey genomics and genetics research and the breeding industry. Results By adopting the trio-binning approach, we were able to assemble a high-quality chromosome-level F1 assembly and 2 parental haplotype assemblies, leveraging long-read technologies and genome-wide chromatin interaction data (Hi-C). From a total of 40 chromosomes (2n = 80), we captured 35 chromosomes in a single scaffold, showing much improved genome completeness and continuity compared to the old assembly build. The 3 assemblies are of higher quality than the previous draft quality assembly and comparable to the chicken assemblies (GRCg7) shown by the largest contig N50 (26.6 Mb) and comparable BUSCO gene set completeness scores (96–97%). Comparative analyses confirm a previously identified large inversion of around 19 Mbp on the Z chromosome not found in other Galliformes. Structural variation between the parent haplotypes was identified, which poses potential new target genes for breeding. Conclusions We contribute a new high-quality turkey genome at the chromosome level, benefiting turkey genetics and other avian genomics research as well as the turkey breeding industry. [ABSTRACT FROM AUTHOR]

The search for new forms to extend foodstuffs' shelf-life through the use of natural compounds and extracts continues to grow among researchers and the industry. In this line of thought, the main objective of this work was to develop, characterize and evaluate the effectiveness of an active food packaging based on polylactic acid (PLA) and incorporated with natural extracts obtained from grape and/or pomegranate by-products. In vitro, antioxidant methods were applied to evaluate the antioxidant capacity of three extracts: wort extract, freeze-dried pomegranate peels extract (PPE-FD), and natural pomegranate peels (PPE-N). Punicalagin (A + B) and ellagic acid were determined in PPE-FD, PPE-N, and active films by UHPLC-DAD. New PLA-based active packaging with PPE-FD (PLA/3PPE) and pomegranate peels (PLA/3PP) were developed, and their chemical, mechanical, and barrier properties were evaluated. Moreover, the effectiveness of the new film was carried out through the study of lipid oxidation state and microbial contamination of two high-fat content foodstuffs, almonds and beef meat. PPE-FD presented high antioxidant capacity and high content in total phenolics and flavonoid compounds. The PLA/3PPE and PLA/3PP prevented the lipid oxidation of meat and presented antimicrobial activity against Staphylococcus aureus. The addition of the PPE-FD and the pomegranate peels to the PLA did not affect the morphology of the polymer. Although both PPE-FD and pomegranate peels presented punicalagin (A + B) and ellagic acid, only ellagic acid was identified and quantified in the active PLA. Active PLA films were not effective in delaying the lipid oxidation of almonds, but they showed to be significantly effective in delaying the lipid oxidation of beef meat and reducing the microbial growth in this food matrix over time. [ABSTRACT FROM AUTHOR]

Active food packaging is a dynamic area where the scientific community and industry have been trying to find new strategies to produce innovative packaging that is economically viable and compatible with conventional production processes. The materials used to develop active packaging can be organized into scavenging and emitting materials, and based on organic and inorganic materials. However, the incorporation of these materials in polymer-based flexible packaging is not always straightforward. The challenges to be faced are mainly related to active agents' sensitivity to high temperatures or difficulties in dispersing them in the high viscosity polymer matrix. This review provides an overview of methodologies and processes used in the production of active packaging, particularly for the production of active flexible films at the industrial level. The direct incorporation of active agents in polymer films is presented, focusing on the processing conditions and their effect on the active agent, and final application of the packaging material. Moreover, the incorporation of active agents by coating technologies and supercritical impregnation are presented. Finally, the use of carriers to help the incorporation of active agents and several methodologies is discussed. This review aims to guide academic and industrial researchers in the development of active flexible packaging, namely in the selection of the materials, methodologies, and process conditions. [ABSTRACT FROM AUTHOR]

A 70-year- old man was admitted to our COVID-19 ward with thoracalgia, productive mucus cough, fatigue and erythematous–violaceous macules on the inner side of feet and interdigital regions. The patient was started on oxygen and dexamethasone. On the day of discharge, he maintained the skin changes despite the resolution of COVID-19 symptoms. A 57-year- old woman initially presented with diffuse urticarial rash on the cervical and chest region. Oral cetirizine was started, and pruritus improved. Thirty days after the discharge, the patient maintained the rash, but without pruritus. A 49-year- old man was admitted with thoracalgia, shortness of breath, dry cough and urticarial rash on the cervical and chest region. The patient was treated with cetirizine. The pruritus improved, and 5 days after discharge, the urticarial areas completely disappeared. [ABSTRACT FROM AUTHOR]

This article explores the potential of geotagged data from social networks to analyse visitors' behaviour in national parks, taking the Teide National Park as a study area. Given its unique landscape and characteristics, plus the fact that it is the most visited national park in Spain, Teide National Park presents itself as a suitable candidate to explore new sources of data for studying visitors' behaviour in national parks. Through data from a social photo-sharing website (Flickr) and GPS tracks from a web platform (Wikiloc), we outline several visitors' characteristics such as the spatial distribution of visitors, the points of interest with the most visits, itinerary network, temporal distribution and visitors' country of origin. Additionally, we propose a practical use of geotagged data for determining optimal locations for new facilities such as information stands. Results show that data from social networks is suitable to analyse visitor behaviour in protected areas. [ABSTRACT FROM AUTHOR]

Pulmonary arteriovenous malformation (PAVM) is well recognised as a cause of paradoxical brain embolism. The authors report the case of an older woman with a medical history of arterial hypertension who was found unconscious and was discovered to have pulmonary thromboembolism and ischaemic stroke related to a PAVM. [ABSTRACT FROM AUTHOR]

A retrospective study was conducted of the records and panoramic radiographs of 35 patients treated with bisphosphonates (BP) and diagnosed with MRONJ. Panoramic radiography was used for evaluation, by two examiners, the following findings were subject of search: osteolysis (OT), cortical bone erosion (EC), bone sclerosis focal (FS) and diffuse (DS), bone sequestration (BS), thickening of lamina dura (TD), prominence of the inferior alveolar nerve canal (IAN), persisting alveolar sockets (SK), and the presence of a pathological fracture (PF). Medical information and staging were also recorded in order to correlate with radiographic findings. Bone sclerosis was the most frequent alteration, followed by OT and TD. The mandible was more affected than the maxilla. There was no significant difference between genders or significant correlation between the number of injuries with age and duration of BP usage. Considering the association between the radiographic findings and MRONJ staging, EC was predominant in stage 3 and DS in stage 2. IAN and PF demonstrated greater association with stage 3. In conclusion, the higher the clinical staging, the greater the severity of the bone alteration. Panoramic radiographic examination is a useful screening tool in patients submitted to antiresorptive therapy. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess the capacity of three-dimensional ultrasound (3DUS) for predicting lethality in fetuses with skeletal dysplasia. Methods: Twenty-four fetuses between 20 and 32 weeks of gestation were assessed. Bilateral lung volume scans were performed three times in each fetus during one ultrasound session. The virtual organ computer-aided analysis method was used to obtain a sequence of six sections of each lung around a fixed axis, and a rotation angle of 30° was adopted. Fetal lung volume measurements were analyzed according to the reference range. After birth, lung hypoplasia was diagnosed considering clinical and radiological criteria. Results: Of all cases of skeletal dysplasia, 18 (75%) were lethal. Among the lethal cases, after postnatal diagnosis, four were osteogenesis imperfecta type II, three were thanatophoric dysplasia and two were campomelic dysplasia. The remaining nine cases remained without a definitive diagnosis. The accuracy of 3DUS in predicting lethality in fetuses with skeletal dysplasia was high, with a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100% and negative predictive value of 66.7%. The kappa index of 0.174 showed a good agreement between the possibility of lethality when the 3DUS volume measurement was altered and real lethality after birth (p < 0.001). Conclusion: This study suggests that the 3DUS lung volume measurement is a good predictor of lethal pulmonary hypoplasia in fetuses with skeletal dysplasia, with high accuracy. [ABSTRACT FROM AUTHOR]

Pharmacovigilance is responsible for monitoring the safety of medicines in normal clinical use and during clinical trials. Legal requirements for pharmacovigilance in some Latin American countries (Argentina, Brazil, Chile, Paraguay and Uruguay) were reviewed. Disparities in the legal framework among the countries are observed being those for marketing authorization holders one of the most evident. The active rol of the universities and drug information centers for/of pharmacovilance seems to be a positive common point. Legal requirements regarding pharmacovigilance of biosimilar medicines, is still a point to be developed. [ABSTRACT FROM AUTHOR]

Graph Dr Jorge Martins died on 12 February 2020 at the age of 65. From an early age, Dr Martins started his interest in clinical immunology when he worked in 1984 at the Internal Medicine Service II of Hospital Curry Cabral at Lisbon. In Dr Martins' words, 'NEDAI has always had a soul, and the body has been getting ready. [Extracted from the article]

Visitor data is essential for decision-making, policy formulation, and monitoring of protected areas. In this context, the data on the temporal distribution of visitors is essential to characterize influx and seasonality, and even to measure the carrying capacity of a site. However, obtaining information from visitors often involves high costs and long production times. Moreover, traditional visitor data has a limited level of detail. New sources of data can provide valuable information regarding the timing of visits. In this study, we tested the use of geotagged data to infer the temporal distribution of visitors to 15 Spanish national parks, and we identified temporal patterns of the visits at three levels: monthly, weekly, and daily. By comparing official monthly visitor counts and geotagged photographs from Flickr, we observed that the number of monthly users who upload photos significantly reflects the number of monthly visitors. Furthermore, the weekly and daily distributions of the Flickr data provided additional information that could contribute to identifying the periods of highest visitor pressure, design measures to manage the concentration of visitors, and improve the overall visitor experience. The results obtained indicate the potential of new data sources for visitor monitoring in protected areas and to open opportunities for future research. Moreover, monitoring tourism in protected areas is crucial to ensure the sustainability of their resources and to protect their biodiversity. [ABSTRACT FROM AUTHOR]

Introduction: Ischemic stroke is a significant global health concern, with reperfusion therapies playing a vital role in patient management. Neuron-specific enolase (NSE) has been suggested as a potential biomarker for assessing stroke severity and prognosis, however, the role of NSE in predicting long-term outcomes in patients undergoing reperfusion therapies is still scarce., Aim: To investigate the association between serum NSE levels at admission and 48 h after reperfusion therapies, and functional outcomes at 90 days in ischemic stroke patients., Methods: This study conducted a prospective cross-sectional analysis on consecutive acute ischemic stroke patients undergoing intravenous fibrinolysis and/or endovascular thrombectomy. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 90 days post-stroke and two groups were defined according to having unfavorable (mRS3-6) or favorable (mRS0-2) outcome. Demographic, clinical, radiological, and laboratory data were collected, including NSE levels at admission and 48 h. Spearman's coefficient evaluated the correlation between analyzed variables. Logistic regression analysis was performed to verify which variables were independently associated with unfavorable outcome. Two ROC curves determined the cut-off points for NSE at admission and 48 h, being compared by Delong test., Results: Analysis of 79 patients undergoing reperfusion treatment following acute stroke revealed that patients with mRS 3-6 had higher NIHSS at admission ( p  < 0.0001), higher NIHSS at 24 h ( p  < 0.0001), and higher NSE levels at 48 h ( p  = 0.008) when compared to those with mRS 0-2. Optimal cut-off values for NSE 0 (>14.2 ng/mL) and NSE 48h (>26.3 ng/mL) were identified, showing associations with worse clinical outcomes. Adjusted analyses demonstrated that patients with NSE 48h  > 26.3 ng/mL had a 13.5 times higher risk of unfavorable outcome, while each unit increase in NIHSS 24h score was associated with a 22% increase in unfavorable outcome. Receiver operating characteristic analysis indicated similar predictive abilities of NSE levels at admission and 48 h ( p  = 0.298). Additionally, a strong positive correlation was observed between NSE 48h levels and mRS at 90 days ( r  = 0.400 and p  < 0.0001), suggesting that higher NSE levels indicate worse neurological disability post-stroke., Conclusion: Serum NSE levels at 48 h post-reperfusion therapies are associated with functional outcomes in ischemic stroke patients, serving as potential tool for patient long-term prognosis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Freitas, Costa, Neves, Barros, Martins, Freitas, Noronha, Freitas, Faria, Borges, Freitas, Henriques and Sousa.)

Innovative techniques such as the "omics" can be a powerful tool for the understanding of intracellular pathways involved in homeostasis maintenance and identification of new potential therapeutic targets against endocrine-metabolic disorders. Over the last decades, proteomics has been extensively applied in the study of a wide variety of human diseases, including those involving the endocrine system. Among the most endocrine-related disorders investigated by proteomics in humans are diabetes mellitus and thyroid, pituitary, and reproductive system disorders. In diabetes, proteins implicated in insulin signaling, glucose metabolism, and β-cell activity have been investigated. In thyroid diseases, protein expression alterations were described in thyroid malignancies and autoimmune thyroid illnesses. Additionally, proteomics has been used to investigate the variations in protein expression in adrenal cancers and conditions, including Cushing's syndrome and Addison's disease. Pituitary tumors and disorders including acromegaly and hypopituitarism have been studied using proteomics to examine changes in protein expression. Reproductive problems such as polycystic ovarian syndrome and endometriosis are two examples of conditions where alterations in protein expression have been studied using proteomics. Proteomics has, in general, shed light on the molecular underpinnings of many endocrine-related illnesses and revealed promising biomarkers for both their detection and treatment. The capacity of proteomics to thoroughly and objectively examine complex protein mixtures is one of its main benefits. Mass spectrometry (MS) is a widely used method that identifies and measures proteins based on their mass-to-charge ratio and their fragmentation pattern. MS can perform the separation of proteins according to their physicochemical characteristics, such as hydrophobicity, charge, and size, in combination with liquid chromatography. Other proteomics techniques include protein arrays, which enable the simultaneous identification of several proteins in a single assay, and two-dimensional gel electrophoresis (2D-DIGE), which divides proteins depending on their isoelectric point and molecular weight. This chapter aims to summarize the most relevant proteomics data from targeted tissues, as well as the daily rhythmic variation of relevant biomarkers in both physiological and pathophysiological conditions within the involved endocrine system, especially because the actual modern lifestyle constantly imposes a chronic unentrained condition, which virtually affects all the circadian clock systems within human's body, being also correlated with innumerous endocrine-metabolic diseases., (© 2024. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Background: Fibromyalgia is a syndrome characterized by generalized chronic pain and tenderness in specific areas. Photobiomodulation therapy (PBMT) using low-level laser therapy and/or light emitting diode therapy is an electrophysical agent that can be used alone or together with a static magnetic field (PBMT-sMF) to promote analgesia in several health conditions. Little evidence exists regarding the effects of using PBMT and PBMT-sMF in patients with fibromyalgia; this evidence is conflicting., Aim: We aimed to investigate the effects of using PBMT-sMF versus a placebo on reduction of the degree-of-pain rating, impact of fibromyalgia, pain intensity, and satisfaction with treatment in patients with fibromyalgia., Design: A prospectively registered, monocentric, randomized placebo-controlled trial, with blinding of patients, therapists, and assessors, was performed., Setting: The study was conducted at the Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT) in Brazil, between March and October 2020., Population: Ninety female patients with fibromyalgia were randomized to undergo either PBMT-sMF (N.=45) or placebo (N.=45) treatment., Methods: Patients from both groups received nine treatment sessions, three times a week, for 3 weeks. Clinical outcomes were collected at baseline, the end of treatment, and at the follow-up appointment 4 weeks post-treatment. The primary outcome was the degree-of-pain rating, measured by the reduction of the tender point count., Results: A decrease in the degree-of-pain rating was observed in patients allocated to the PBMT-sMF group, decreasing the number of tender points when compared to placebo group at the end of treatment (P<0.0001) and at the follow-up assessment (P<0.0001). Patients did not report any adverse events., Conclusions: PBMT-sMF is superior to placebo, supporting its use in patients with fibromyalgia., Clinical Rehabilitation Impact: PBMT-sMF might be considered an important adjuvant to the treatment regimens of patients with fibromyalgia.

Exfoliative dermatitis (ED) is a rare and life-threatening dermatological emergency caused by a wide range of cutaneous or systemic conditions, such as inflammatory dermatosis, drug reactions, and malignancies. We report a case of a 77-year-old man who developed ED five days after starting nitrofurantoin. The drug was withdrawn, and the patient was treated with topical corticosteroid and supportive care, after which there was a full recovery within a week. This report describes an uncommon entity with a guarded prognosis that requires proper diagnosis and management., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Morna et al.)

Diffuse alveolar hemorrhage (DAH) is a rare, acute, and life-threatening condition that in most cases is associated with pulmonary-renal syndromes, connective tissue disorders, infections, and drugs. We report a case of a 45-year-old male who developed a diffuse pulmonary hemorrhage after taking 500 mg of acetylsalicylic acid for a month in the context of acute lower back pain. The prolonged use of this acetylsalicylic acid dose led to an increased risk of bleeding. This report describes a rare bleeding site that clinicians should be aware of when managing patients who were exposed to prolonged high dose acetylsalicylic acid., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Gomes et al.)

Type A aortic dissection is a surgical emergency occurring when an intimal tear in the aorta creates a false lumen in the ascending aorta. The authors report the case of an older woman with a medical history of arterial hypertension, atrial fibrillation, dyslipidemia, heart failure, and osteoarticular spinal pathology, presenting with sudden and persistent retrosternal pain, who was initially misdiagnosed with a lower airway infection and was discovered to have an acute type A aortic dissection. The authors intend to draw attention to medical errors and emphasize the importance of early diagnosis in pathology with a potentially fatal prognosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Luís et al.)

A 70-year-old man was admitted to our COVID-19 ward with thoracalgia, productive mucus cough, fatigue and erythematous-violaceous macules on the inner side of feet and interdigital regions. The patient was started on oxygen and dexamethasone. On the day of discharge, he maintained the skin changes despite the resolution of COVID-19 symptoms. A 57-year-old woman initially presented with diffuse urticarial rash on the cervical and chest region. Oral cetirizine was started, and pruritus improved. Thirty days after the discharge, the patient maintained the rash, but without pruritus. A 49-year-old man was admitted with thoracalgia, shortness of breath, dry cough and urticarial rash on the cervical and chest region. The patient was treated with cetirizine. The pruritus improved, and 5 days after discharge, the urticarial areas completely disappeared., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Studies have shown sodium restriction to have a beneficial effect on blood pressure (BP) of hypertensive patients., Objective: To evaluate the impact of light salt substitution for regular salt on BP of hypertensive patients., Methods: Uncontrolled hypertensive patients of both sexes, 20 to 65 years-old, on stable doses of antihypertensive drugs were randomized into Intervention Group (IG - receiving light salt) and Control Group (CG - receiving regular salt). Systolic BP (SBP) and diastolic BP (DBP) were analyzed by using casual BP measurements and Home Blood Pressure Monitoring (HBPM), and sodium and potassium excretion was assessed on 24-hour urine samples. The patients received 3 g of salt for daily consumption for 4 weeks., Results: The study evaluated 35 patients (65.7% women), 19 allocated to the IG and 16 to the CG. The mean age was 55.5 ± 7.4 years. Most participants had completed the Brazilian middle school (up to the 8th grade; n = 28; 80.0%), had a family income of up to US$ 600 (n = 17; 48.6%) and practiced regular physical activity (n = 19; 54.3%). Two patients (5.7%) were smokers and 40.0% consumed alcohol regularly (n = 14). The IG showed a significant reduction in both SBP and DBP on the casual measurements and HBPM (p < 0.05) and in sodium excretion (p = 0.016). The CG showed a significant reduction only in casual SBP (p = 0.032)., Conclusions: The light salt substitution for regular salt significantly reduced BP of hypertensive patients.

Xanthelasma might be a clinical manifestation of dyslipidemia, a recognized risk factor for coronary artery disease. We investigated the association of apolipoprotein E (APOE HhaI), apolipoprotein B (APOB XbaI and Ins/Del) and LDL receptor (LDLR AvaII and HincII) gene polymorphisms with lipid profiles in 100 Brazilians with xanthelasma and 100 controls. Allele frequencies were similar in both groups. APOE, APOB and LDLR genotypes were not correlated with differences in the serum lipid profile. In individuals with xanthelasma, the APOB D allele was associated with less chance of having increased LDL-cholesterol (O.R. = 0.16, CI95% = 0.03-0.94, p = 0.042). In the control group, the APOB X+ allele was associated with less chance of having both increased total cholesterol (O.R. = 0.16, CI95% = 0.03-0.78, p = 0.023) and increased LDL-cholesterol (O.R. = 0.10, CI95% = 0.02-0.60, p = 0.012). Moreover, there was a significantly higher frequency of control individuals (68%) with elevated serum triglyceride levels, compared to patients (48%, p = 0.008). On the other hand, triglyceride levels in controls also seemed to be influenced by all other gene polymorphisms studied, an effect that might be enhanced by environmental factors.