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BACKGROUND AND OBJECTIVE: To compare pain intensity with single-spot versus multispot technique in laser panretinal photocoagulation, using a 532-nm, solid-state laser system. MATERIALS AND METHODS: This was a prospective, interventional, randomized, single-masked comparison trial. Patients received two types of intervention: conventional single-spot technique, with an exposure time of 150 ms, and multispot technique, done with an exposure time of 20 ms, Both techniques used power sufficient to produce visible gray-white burns, and spot size of 20 μm. Participants received both treatments in the same eye, each one in one hemiretina, and were randomized to receive first single- or multispot technique and to the initial site of treatment. We assessed pain intensity using a numerical pain scale immediately after completion of each treatment. RESULTS: A significantly lower pain scale was observed with the multispot when compared with the single-spot technique (coefficient [Coef]: −1.61; 95% CI, −2.49 to −0.74; P < .001), which was not affected by treatment order, the hemiretina treated, or treatment duration ( P > .05). Among demographic characteristics, multiracial patients had a pain scale 1.25 greater than that of White patients (Coef: 1.25; 95% CI, 0.47 to 2.04; P = .002), but there is no effect of age or sex on the pain scale ( P > .05). Regarding treatment duration, a shorter procedure was also observed in the multispot technique (Coef: −1.13; 95% CI, −1.43 to −0.82; P < .001), and it was not affected by order of treatment ( P = .098), hemiretina ( P = .327), pain ( P = .141), or demographic data, such as age, sex, and race ( P > .05). CONCLUSION: The use of the multispot technique, with a short pulse duration (20 ms), is significantly less painful and less time-consuming for patients with proliferative retinopathy compared with the conventional single-spot technique using an exposure time of 150 ms. [ Ophthalmic Surg Lasers Imaging Retina . 2022;53:40–45.]

Background A well-defined jawline is a critical component in the perception of facial attractiveness in both men and women. Dermal fillers offer a nonsurgical, temporary method of correcting mild-to-moderate mandibular bone resorption. Aims The authors discuss pertinent aspects of anatomy, pathophysiology of aging, patient evaluation, gender considerations, injection technique, and complications in jawline augmentation using injectable fillers. Methods A brief review of the literature surrounding jawline augmentation using injectable fillers in both men and women, as well as the authors' experience in this area, is provided. Results Nonsurgical jawline augmentation using injectable fillers can be performed effectively and safely with adequate background knowledge of the regional anatomy and appropriate patient selection. The authors discuss both injection techniques in the published literature and their own approach. Potential complications are also reviewed. Conclusion Jawline rejuvenation is a key component to global facial aesthetic rejuvenation. Therefore, it is important for physicians to understand how to safely and effectively perform nonsurgical jawline rejuvenation using injectable fillers.

This study evaluated whether single nucleotide polymorphisms in the melatonin receptor type 1 A gene are associated with sleep bruxism in a Brazilian population.Individuals with suspected sleep-related problems were evaluated using polysomnography, following the recommendations proposed by the American Academy of Sleep Medicine and the Research Diagnostic Criteria for Temporomandibular Disorders. Deoxyribonucleic acid (DNA) samples were collected, and three single nucleotide polymorphisms in the melatonin receptor type 1 A gene (rs13140012, rs6553010, and rs6847693) were selected and genotyped using real-time polymerase chain reaction (RT-PCR). Chi-square and odds ratio tests were used to analyze genotypes and alleles individually, while using the plink software for haplotypes. A confidence interval of 95% was considered, and statistical significance was set at p 0.05.This study included 48 individuals aged between 21 and 80 years, with 27 males and 21 females. From this sample, 17 individuals were diagnosed with sleep bruxism and 31 without bruxism. No associations were found between sleep bruxism and single nucleotide polymorphisms in either the genotypic, allelic, dominant, or recessive models (p 0.05). Haplotype genetic analysis also did not reveal any association between single nucleotide polymorphisms and sleep bruxism (p 0.05).The genetic polymorphisms rs6553010, rs13140012, and rs6847693 were not associated with sleep bruxism in the studied population.

Objective To evaluate the association of single-nucleotide polymorphisms within the catechol-O-methyltransferase and 5-hydroxytryptamine receptor 2 A genes with sleep bruxism in individuals diagnosed with obstructive sleep apnea. Design Sixty-nine individuals with suspected sleep-related problems were evaluated by polysomnography, following the recommendations of the American Academy of Sleep Medicine. Deoxyribonucleic acid (DNA) samples were collected only from 48 of the study participants because of missing polysomnographic data. DNA samples were collected and two single-nucleotide polymorphisms in the 5-hydroxytryptamine receptor 2 A encoding HTR2A gene (rs4941573 and rs6313) and two in the catechol-O-methyltransferase gene (rs165656 and rs174675) were selected to be genotyped using real-time polymerase chain reaction. The association between sleep bruxism and genetic polymorphisms was investigated by recessive and dominant models. Association analyses were performed using a 95% confidence interval and the level of statistical significance was p Results From the 69 study participants, 48 were included in the polymorphism analysis and sleep bruxism was present in 35.4%. No significant differences were observed in the dominant and recessive models (p>0.05). Haplotype and diplotype analyses revealed the predicted four haplotypes and two diplotypes were not associated with sleep bruxism. Conclusion Polymorphisms rs174675 and rs165656 in the catechol-O-methyltransferase gene and rs4941573 and rs6313 in the 5-hydroxytryptamine receptor 2 A gene were not significantly associated with sleep bruxism in individuals with obstructive sleep apnea.

Background Determinants of hospitalisation, intensive care unit (ICU) admission and death are still unclear for COVID-19. Few studies have adjusted for confounding for different clinical outcomes including all reported cases within a country. Aim We used routine surveillance data from Portugal to identify risk factors for severe COVID-19 outcomes, and to support risk stratification, public health interventions, and planning of healthcare resources. Methods We conducted a retrospective cohort study including 20,293 laboratory-confirmed cases of COVID-19 reported between 1 March and 28 April 2020 through the national epidemiological surveillance system. We calculated absolute risk, relative risk (RR) and adjusted relative risk (aRR) to identify demographic and clinical factors associated with hospitalisation, ICU admission and death using Poisson regressions. Results Increasing age (≥ 60 years) was the major determinant for all outcomes. Age ≥ 90 years was the strongest determinant of hospital admission (aRR: 6.1), and 70–79 years for ICU (aRR: 10.4). Comorbidities of cardiovascular, immunodeficiency, kidney and lung disease (aRR: 4.3, 2.8, 2.4, 2.0, respectively) had stronger associations with ICU admission, while for death they were kidney, cardiovascular and chronic neurological disease (aRR: 2.9, 2.6, 2.0). Conclusions Older age was the strongest risk factor for all severe outcomes. These findings from the early stages of the COVID-19 pandemic support risk-stratified public health measures that should prioritise protecting older people. Epidemiological scenarios and clinical guidelines should consider this, even though under-ascertainment should also be considered.

Conventional knee-ankle-foot orthoses (KAFOs) are generally prescribed for children with lower limb muscle weakness and joint instabilities. The main function of KAFOs is to provide stability during gait by locking the knee in full extension. However, walking with the knee joint in a fully extended position requires excessive energy consumption, leading to early fatigue and inducing non-physiological gait patterns. A new generation of KAFOs was developed to allow free knee flexion during the swing phase and to lock the knee joint during the stance phase to provide the required stability. These are commonly labeled as stance-control knee-ankle-foot orthoses (SCKAFOs). Nevertheless, commercial SCKAFOs are not available for the pediatric population. Especially in early ages, children must frequently replace the orthosis due to their growth. Hence, the proposed design presents a solution for a SCKAFO with adjustable length adaptable to children's dimensions ranging from two to six years old.

This study is a report on the anti-Leishmania activity of Morita-Baylis-Hillman (MBH) homodimers adducts against the promastigote and axenic amastigote forms of Leishmania (Leishmania) infantum and Leishmania (Leishmania) amazonensis and on the cytotoxicity of these adducts to human blood cells. Both studied homodimers, MBH 1 and MBH 2, showed activity against the promastigote forms of L. infantum and L. amazonensis, which are responsible for visceral and cutaneous leishmaniasis, respectively. Additionally, the homodimers presented biological activity against the axenic amastigote forms of these two Leishmania species. The adducts exhibited no hemolytic activity to human peripheral blood mononuclear cells or erythrocytes at the tested concentrations and achieved higher selectivity indices than amphotericin B. Evaluation of cell death by apoptosis revealed that the homodimers had better apoptosis/necrosis profiles than amphotericin B in the promastigote forms of both L. infantum and L. amazonensis. In conclusion, these Morita-Baylis-Hillman adducts had anti-Leishmania activity in an in vitro model and may thus be promising molecules in the search for new drugs to treat leishmaniasis.

Portugal took early action to control the COVID-19 epidemic, initiating lockdown measures on March 16th when it recorded only 62 cases of COVID-19 per million inhabitants and reported no deaths. The Portuguese public complied quickly, reducing their overall mobility by 80%. The aim of this study was to estimate the initial impact of the lockdown in Portugal in terms of the reduction of the burden on the healthcare system.We forecasted epidemic curves for: Cases, hospital inpatients (overall and in intensive care), and deaths without lockdown, assuming that the impact of containment measures would start 14 days after initial lockdown was implemented. We used exponential smoothing models for deaths, intensive care and hospitalizations and an ARIMA model for number of cases. Models were selected considering fitness to the observed data up to the 31st March 2020. We then compared observed (with intervention) and forecasted curves (without intervention).Between April 1st and April 15th, there were 146 fewer deaths (-25%), 5568 fewer cases (-23%) and, as of April 15th, there were 519 fewer intensive care inpatients (-69%) than forecasted without the lockdown. On April 15th, the number of intensive care inpatients could have reached 748, three times higher than the observed value (229) if the intervention had been delayed.If the lockdown had not been implemented in mid-March, Portugal intensive care capacity (528 beds) would have likely been breached during the first half of April. The lockdown seems to have been effective in reducing transmission of SARS-CoV-2, serious COVID-19 disease, and associated mortality, thus decreasing demand on health services.An early lockdown allowed time for the National Health Service to mobilize resources and acquire personal protective equipment, increase testing, contact tracing and hospital and intensive care capacity and to promote broad prevention and control measures. When lifting more stringent measures, strong surveillance and communication strategies that mobilize individual prevention efforts are necessary.Introdução: Portugal tomou cedo medidas para controlar a epidemia de COVID-19, impondo medidas de confinamento a partir de 16 de março, quando registava apenas 62 casos de COVID-19 por milhão de habitantes e nenhuma morte. Os portugueses seguiram as recomendações reduzindo sua mobilidade em 80%. O objectivo deste estudo foi estimar o impacto do confinamento em Portugal com foco na redução do impacto nos serviço de saúde. Material e Métodos: Fizemos previsões para as curvas epidémicas de casos, internamento hospitalares (geral e em unidades de cuidados intensivos) e óbitos sem confinamento, assumindo que o impacto das medidas de contenção começaria 14 dias após o início das medidas. Utilizámos modelos de alisamento exponencial para óbitos, internados em cuidados intensivos e total de internados e um modelo ARIMA para número de novos casos. Os modelos foram selecionados considerando adequação aos dados observados até 31 de março de 2020. Em seguida, comparámos as curvas observadas (com intervenção) e previstas (sem intervenção). Resultados: Entre 1 e 15 de abril houve 146 menos mortes (-25%), 5568 menos casos (-23%) e, em 15 de abril, houve 519 menos internamentos em unidades de cuidados intensivos (-69%) e 508 menos doentes no total de internados (-28%) do que o previsto sem confinamento. Em 15 de abril, o número de pacientes internados na unidades de cuidados intensivos poderia ter atingido 748, três vezes maior que o valor observado (229) se a intervenção tivesse sido adiada. Discussão: Se o confinamento não tivesse sido implementado em meados de março, a capacidade de unidades de cuidados intensivos em Portugal (528 camas) teria provavelmente sido ultrapassada na primeira quinzena de abril. O confinamento parece ter sido eficaz na redução de infeções, doença grave e mortalidade associada, diminuindo a procura de serviços de saúde. Conclusão: Um confinamento antecipado permitiu comprar tempo para o Serviço Nacional de Saúde mobilizar recursos e adquirir equipamentos de proteção individual, aumentar a capacidade de testar e realizar rastreio de contactos, preparar-se para um aumento da procura hospitalar e de unidades de cuidados intensivos e promover amplas medidas de prevenção e controlo. Ao levantar medidas mais restritivas será importante manter uma vigilância epidemiológica e estratégias de comunicaçao robustas que mobilizem comportamentos individuais preventivos.

Introduction, Evidence suggests that the built environment can influence the intensity of physical activity. However, despite the importance of the geographic context, most of the studies do not consider the spatial framework of this association. We aimed to assess individual spatial dependence of objectively measured moderate and vigorous physical activity (MVPA) and describe the characteristics of the built environment among spatial clusters of MVPA., Methods, Cross-sectional data from the second follow-up (2014-2017) of CoLaus vertical bar PsyCoLaus, a longitudinal population-based study of the Lausanne area (Switzerland), was used to objectively measure MVPA using accelerometers. Local Moran's I was used to assess the spatial dependence of MVPA and detect geographic clusters of low and high MVPA. Additionally, the characteristics of the built environment observed in the clusters based on raw MVPA and MVPA adjusted for socioeconomic and demographic factors were compared., Results, Data from 1,889 participants (median age 63, 55% women) were used. The geographic distribution of MVPA and the characteristics of the built environment among clusters were similar for raw and adjusted MVPA. In the adjusted model, we found a low concentration of individuals within spatial clusters of high MVPA (median: 38.5mins; 3% of the studied population) and low MVPA (median: 10.9 mins; 2% of the studied population). Yet, clear differences were found in both models between clusters regarding the built environment; high MVPA clusters were located in areas where specific compositions of the built environment favor physical activity., Conclusions, Our results suggest the built environment may influence local spatial patterns of MVPA independently of socioeconomic and demographic factors. Interventions in the built environment should be considered to promote physically active behaviors in urban areas.

To retrospectively evaluate the rate of adverse events after hand volumizing procedures using a calcium hydroxylapatite product and to investigate the relationship between injector used (i.e., needle versus cannula) and technique applied (i.e., bolus, tenting, proximal-to-distal fanning, distal-to-proximal single line).Two hundred twenty individuals, including 214 women (97.3 percent) aged 52.3 ± 11.4 years, treated bilaterally for hand rejuvenation were investigated between the years 2006 and 2017. Cadaveric dissections (n = 12), fluoroscopic (n = 4), ultrasound (n = 22), and computed tomographic (n = 4) imaging were also performed to guide conclusions.Thirty-two of 440 hands (7.3 percent) developed adverse events within the first 15 days, with swelling in 11 (5 percent), pain in four (1.8 percent), erythema in three (1.4 percent), and discoloration in one (0.5 percent). Using a needle (versus a cannula) was significantly related to the occurrence of adverse events (OR, 7.57; 95 percent CI, 3.76 to 15.24; p0.001). The proximal-to-distal fanning technique with access to the dorsal superficial lamina was identified as a safer application technique, with each of the other techniques having a significantly increased odds ratio for adverse events: bolus technique (OR, 26.9; 95 percent CI, 6.87 to 105.2; p0.001), tenting technique (OR, 24.73; 95 percent CI, 7.48 to 81.76; p0.001), and single-line technique (OR, 26.68; 95 percent CI, 7.45 to 95.48; p0.001).The results of this study support the use of cannula versus needle and the proximal-to-distal fanning technique. The underlying anatomy supports the positioning of the material into the subdermal space, which can be identified less than 1 mm deep to the skin surface, and is termed the dorsal superficial lamina.

CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Outra Agência The main goal of the present study was to evaluate the metabolic profile, inflammatory markers and the gene expression of the renin–angiotensin system (RAS) components in the visceral adipose tissue of eutrophic, obese and malnourished individuals and mice models of obesity and food restriction. Male Swiss mice were divided into eight groups and fed different levels of food restriction (20%, 40%, or 60%) using standard or high-fat diet. Metabolic profile and adipose tissues were assessed. The expression of AGT (Angiotensinogen), ACE (Angiotensin-converting enzyme), ACE2 (Angiotensin-converting enzyme 2), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in the mice epididymal adipose tissue and the human visceral adipose tissue was assessed. The main findings showed reduced body weight, improved metabolism, decreased adipose tissues weight and reduced adipocyte area in mice submitted to food restriction. Diminished expression of IL-6, TNF-α, AGT, AT1 and ACE was detected in the 20% and 40% food restriction animal groups, although they were increased in the 60% malnourished group. Increased expression of IL-6, TNF-α, AGT and ACE in obese and malnourished individuals was observed. Adipocytes size was increased in obese individuals and reduced in malnutrition. In conclusion, we found that food restriction of 20% and 40% improved the metabolic profile, ameliorated the inflammatory status and down-regulated the RAS in mice. Severe 60% food restriction (malnutrition), however, stimulated a proinflammatory state and increased AGT and ACE expression in the adipose tissue of mice. A similar profile was observed in the adipose tissue of obese and malnourished humans, supporting the critical role of inflammation and RAS as mediators of metabolic disorders.

Nuclear abnormalities (micronuclei and meta-nuclear changes) have been used as biomarkers to identify cell damages. As children are more vulnerable to the adverse effects of pollution when compared to adults, assessing genetic damage caused by environmental influences is of great interest. As such, the objective was to determine metanuclear (karyolysis, pycnosis, karyorrhexis, binucleated cells, chromosome bridges and micronuclei) in cells from the oral mucosa of children associated with the school environment, gender, exposure to cigarette smoke and vehicular traffic. Analyses of nuclear abnormalities were performed in exfoliated buccal cells of children from two public schools located in Dourados - MS. The data were analyzed through Kruskal-Wallis test considering a significance level of 5% (p .05). The results showed that children exposed to cigarette smoke presented higher levels of nuclear abnormalities than children who were not usually exposed to this type of mutagenic and genotoxic agent, suggesting that such contaminants are related to clastogenic and aneugenic effects on DNA. Moreover, female children had higher amounts of nuclear abnormalities when compared to male children. With regards to the school environment, the study results indicated statistical differences in of term chromosomal abnormalities for schools A and B. Thus, it was possible to determine that children exposed to cigarette smoke are susceptible to further genetic damage than unexposed children, and female children may be more susceptible to genotoxic and mutagenic agents. This study contributes to the current knowledge on the mutagenic characteristics of human cells, supporting the adoption of preventive Public Health measures.

Background: Although the safety profile of hyaluronic acid fillers is favorable, adverse reactions can occur. Clinicians and patients can benefit from ongoing guidance on adverse reactions to hyaluronic acid fillers and their management. Methods: A multinational, multidisciplinary group of experts in cosmetic medicine convened the Global Aesthetics Consensus Group to review the properties and clinical uses of Hylacross and Vycross hyaluronic acid products and develop updated consensus recommendations for early and late complications associated with hyaluronic acid fillers. Results: The consensus panel provided specific recommendations focusing on early and late complications of hyaluronic acid fillers and their management. The impact of patient-, product-, and technique-related factors on such reactions was described. Most of these were noted to be mild and transient. Serious adverse events are rare. Early adverse reactions to hyaluronic acid fillers include vascular infarction and compromise; inflammatory reactions; injection-related events; and inappropriate placement of filler material. Among late reactions are nodules, granulomas, and skin discoloration. Most adverse events can be avoided with proper planning and technique. Detailed understanding of facial anatomy, proper patient and product selection, and appropriate technique can further reduce the risks. Should adverse reactions occur, the clinician must be prepared and have tools available for effective treatment. Conclusions: Adverse reactions with hyaluronic acid fillers are uncommon. Clinicians should take steps to further reduce the risk and be prepared to treat any complications that arise.

Threatening cues and surrounding contexts trigger specific defensive response patterns. Potential threat evokes attentive immobility; attack evokes flight when escape is available and immobility when escape is blocked. Tonic immobility installs when threat is overwhelming and life-risky. In humans, reduced body sway characterizes attentive and tonic immobility, the former with bradycardia, and the later with expressive tachycardia. Here, we investigate human defensive strategies in the presence or absence of an escape route. We employed pictures depicting a man carrying a gun and worked with participants exposed to urban violence. In pictures simulating more possibility of escape, the gun was directed away from the observer; in those simulating higher risk and less chance of escape, the gun was directed toward the observer. Matched control pictures depicted similar layouts, but a non-lethal object substituted the gun. Posturographic and electrocardiographic recordings were collected. Amplitude of sway and heart rate were higher for gun directed-away and lower for gun direct-toward. Compared to their respective matched controls, there was a general increase in the amplitude of sway for the gun directed-away pictures; and a reduction in back-and-forth sway and in heart rate for gun directed-toward pictures. Taken together, those measures suggest that, when exposed to threat invading their margin of safety in a context indicating possible escape route, humans, as non-human species, engage in active escape, resembling the flight stage of the defensive cascade. When facing threat indicating less possibility of escape, humans present an immobile response with bradycardia.

Supplemental Digital Content is available in the text., Background: Combination of fillers and botulinum toxin for aesthetic applications is increasingly popular. Patient demographics continue to diversify, and include an expanding population receiving maintenance treatments over decades. Methods: A multinational panel of plastic surgeons and dermatologists convened the Global Aesthetics Consensus Group to develop updated guidelines with a worldwide perspective for hyaluronic acid fillers and botulinum toxin. This publication considers strategies for combined treatments, and how patient diversity influences treatment planning and outcomes. Results: Global Aesthetics Consensus Group recommendations reflect increased use of combined treatments in the lower and upper face, and some midface regions. A fully patient-tailored approach considers physiologic and chronologic age, ethnically associated facial morphotypes, and aesthetic ideals based on sex and culture. Lower toxin dosing, to modulate rather than paralyze muscles, is indicated where volume deficits influence muscular activity. Combination of toxin with fillers is appropriate for several indications addressed previously with toxin alone. New scientific data regarding hyaluronic acid fillers foster an evidence-based approach to selection of products and injection techniques. Focus on aesthetic units, rather than isolated rhytides, optimizes results from toxin and fillers. It also informs longitudinal treatment planning, and analysis of toxin nonresponders. Conclusions: The emerging objective of injectable treatment is facial harmonization rather than rejuvenation. Combined treatment is now a standard of care. Its use will increase further as we refine the concept that aspects of aging are intimately related, and that successful treatment entails identifying and addressing the primary causes of each. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Background: Botulinum toxin type A injection remains the leading nonsurgical cosmetic procedure worldwide, with a high rate of efficacy and patient satisfaction. Methods: A multinational, multidisciplinary group of plastic surgeons and dermatologists convened the Global Aesthetics Consensus Group to develop updated consensus recommendations with a worldwide perspective for botulinum toxin and hyaluronic acid fillers. This publication on botulinum toxin type A considers advances in facial analysis, injection techniques, and avoidance and management of complications. Results: Use of botulinum toxin has evolved from the upper face to also encompass the lower face, neck, and midface. The Global Aesthetics Consensus Group emphasizes an integrative, diagnostic approach. Injection dosage and placement are based on analysis of target muscles in the context of adjacent ones and associated soft and hard tissues. The indication for selection of botulinum toxin as a primary intervention is that excessive muscular contraction is the primary etiology of the facial disharmony to be addressed. Global Aesthetics Consensus Group recommendations demonstrate a paradigm shift toward neuromodulation rather than paralysis, including lower dosing of the upper face, more frequent combination treatment with hyaluronic acid fillers, and intracutaneous injection where indicated to limit depth and degree of action. Conclusions: The accumulation of clinical evidence and experience with botulinum toxin has led to refinements in treatment planning and implementation. The Global Aesthetics Consensus Group advocates an etiology-driven, patient-tailored approach, to enable achievement of optimal efficacy and safety in patient populations that are rapidly diversifying with respect to ethnicity, gender, and age. CLINCAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Background: One month after the first COVID-19 infection was recorded, Portugal counted 18,051 cases and 599 deaths from COVID-19. To understand the overall impact on mortality of the pandemic of COVID-19, we estimated the excess mortality registered in Portugal during the first month of the epidemic, from March 16 until April 14 using two different methods. Methods: We compared the observed and expected daily deaths (historical average number from daily death registrations in the past 10 years) and used 2 standard deviations confidence limit for all-cause mortality by age and specific mortality cause, considering the last 6 years. An adapted Auto Regressive Integrated Moving Average (ARIMA) model was also tested to validate the estimated number of all-cause deaths during the study period. Results: Between March 16 and April 14, there was an excess of 1255 all-cause deaths, 14% more than expected. The number of daily deaths often surpassed the 2 standard deviations confidence limit. The excess mortality occurred mostly in people aged 75+. Forty-nine percent (49%) of the estimated excess deaths were registered as due to COVID-19, the other 51% registered as other natural causes. Conclusion: Even though Portugal took early containment measures against COVID-19, and the population complied massively with those measures, there was significant excess mortality during the first month of the pandemic, mostly among people aged 75+. Only half of the excess mortality was registered as directly due do COVID-19., KEY POINTS • An Excess Mortality (EM) of 1255 deaths were estimated 1 month after the first death classified by COVID-19, and it would probably be more if the government had not taken early action. • The age group where a significant increase in mortality was noted was above 75 years. • 51% of the EM was due to natural causes other than COVID-19.

It is reported here the synthesis of novel Homodimers 12-19 of Morita-Baylis-Hillman adducts (MBHA) from one-pot Morita-Baylis-Hillman Reaction (MBHR) between aromatic aldehydes as eletrophiles and ethylene glycol diacrylate as Michael acceptor (35-94% yields) using cheap and green conditions. The bioactivities were evaluated against promastigote form of Leishmania donovani. All homodimers showed to be more potent than corresponding monomers. It is worth highlighting that the halogenated homodimers 17 and 18 (0.50μM) is almost 400 times more active than the corresponding monomer 10 and 1.24 times more potent than the second-line drug amphotericin B (0.62μM). Moreover, the selectivity index to 18 is very high (SIrb>400) far better than amphotericin B (SIrb=18.73). This is the first report of twin drugs strategy applied on Morita-Baylis-Hillman adducts.

The aliphatic polyesters are widely used in biomedical applications since they are susceptible to hydrolytic and/or enzymatic chain cleavage, leading to alpha-hydroxyacids, generally metabolized in the human body. This is particularly useful for many biomedical applications, especially, for temporary mechanical supports in regenerative medical devices. Ideally, the degradation should be compatible with the tissue recovering. In this work, the evolution of mechanical properties during degradation is discussed based on experimental data. The decrease of tensile strength of PLA-PCL fibers follows the same trend as the decrease of molecular weight, and so it can also be modeled using a first order equation. For each degradation stage, hyperelastic models such as Neo-Hookean, Mooney-Rivlin and second reduced order, allow a reasonable approximation of the material behavior. Based on this knowledge, constitutive models that describe the mechanical behavior during degradation are proposed and experimentally validated. The proposed theoretical models and methods may be adapted and used in other biodegradable materials, and can be considered fundamental tools in the design of regenerative medical devices where strain energy is an important requirement, such as, for example, ligaments, cartilage and stents.

This bibliographic review is focused on ligament tissue rehabilitation, its anatomy-physiology, and, mainly, on the dimensioning considerations of a composite material solution. The suture strength is problematic during the tissue recovering, implying reduction of mobility for several months. However, early postoperative active mobilization may enable a faster and more effective recovering of tissue biomechanical functions. As the risk of tendon rupture becomes a significant concern, a repair technique must be used to withstand the tensile forces generated by active mobilization. However, to avoid stress shielding effect on ligament tissue, an augmentation device must be designed on stiffness basis, that preferably will decrease. Absorbable biocomposite reinforcements have been used to allow early postoperative active mobilization and avoid the shortcomings of current repair solutions. Tensile strength decrease of the repair, during the initial inflammatory phase, is expected, derived from oedema and tendon degradation. In the fibroblastic phase, stiffness and strength will increase, which will stabilize during the remodeling phase. The reinforcement should be able to carry the dynamic load due to locomotion with a mechanical behavior similar to the undamaged natural tissue, during all rehabilitation process. Moreover, the degradation rate must also be compatible with the ligament tissue recovering. The selection and combination of different biodegradable materials, in order to make the biocomposite reinforcement functionally compatible to the damaged sutured tissue, in terms of mechanical properties and degradation rate, is a major step on the design process. Modelling techniques allow pre-clinical evaluation of the reinforcement functional compatibility, and the optimization by comparison of different composite solutions in terms of biomechanical behavior.

Glucocorticoids have a key role in stress responses. There are, however, substantial differences in cortisol reactivity among individuals. We investigated if affective trait and mood induction influence the reactivity to psychological stress in a group of 63 young adults, male (n = 27) and female (n = 36), aged ca. 21 years. On the experimental day the participants viewed either a block of pleasant or unpleasant pictures for 5 min to induce positive or negative mood, respectively. Then, they had 5 min to prepare a speech to be delivered in front of a video-camera. Saliva samples were collected to measure cortisol, and questionnaire-based affective scales were used to estimate emotional states and traits. Compared to basal levels, a cortisol response to the acute speech stressor was only seen for those who had first viewed unpleasant pictures and scored above the average on the negative affect scale. There were no sex differences. In conclusion, high negative affect associated with exposure to an unpleasant context increased sensitivity to an acute stressor, and was critical to stimulation of cortisol release by the speech stressor.

With aging, anatomical changes are observed in the face. In the lower third, these changes are expressed as ptosis of the angle of the mouth, lip enhancement groove mentalis; decrease in concavity between the jaw and neck and very noticeable platysmal banding. The repeated contraction of muscles of the lateral-chin together with the band platysmal side form what are called a marionette groove. Treating the whole lateral-chin area can result in a more harmonious aspect of the face when compared with treatment of a marionette groove in isolation. In this paper we describe combined treatment of the lateral chin area using botulinum toxin and fillers. Com o envelhecimento observamos mudanças anatômicas na face. No terço inferior essas mudanças se expressam como ptose do ângulo da boca; acentuação do sulco lábio mentoniano; diminuição da concavidade entre a mandíbula e o pescoço e formação de bandas platismais bem evidentes. A contração repetida dos músculos da região latero-mentoniana juntamente com a banda platismal lateral, forma o que chamamos de sulco de marionette. Ao tratarmos toda região latero-mentoniana conseguimos um resultado mais harmônico, quando comparado com o tratamento isolado do sulco de marionette. Nesse artigo apresentamos o tratamento combinado da região latero mentoniana com o uso de toxina botulínica e preenchedores.

A youthful and attractive face is characterized by a well-contoured, anteriorly projected cheek; with aging, this area gradually looses volume, principally because of the reduction of the malar fat pad and to a minor degree because of malar bone reabsorption. We describe an innovative technique to restore lost volume in this area using a highly cohesive, viscous hyaluronic acid volumizing filler created for facial sculpting. The result is a harmonic and natural look, because the technique respects the physiologic alterations occurring during aging. It focuses on restoring the lost volume of the malar fat pad region (Figure 1), recreating the anterior projection of the cheek without changing the lateral diameter of the face.

To enhance lips ageing rejuvenation with specific microcannula and hyaluronic acid.Clinical review was conducted from December 2010 to December 2011 among 46 patients complaining of predictable changes on lips and perioral region such as deficiency in contour definition, volume and projection. Lips rejuvenation injections were made using the hyalurostructure technique.Forty-two patients (92%) with a 6-month follow-up were satisfied or very satisfied with the aesthetic results after the hyalurostructure of the lips and the perioral region rejuvenation. The use of the specially designed cannula led to fewer complications. We noticed 40 oedemas (87%) that appeared 24-48 h after the injection and seven patients (15.2%) with haematomas. We noted fewer surface irregularities and a better distribution of the product. Patients' records showed the procedure was painless.The hyalurostructure technique reduces the number of punctures compared to that of the conventional method. The microcannula's blunt tip reduces the risks of intravascular injection of the substance and of reach and disruption of the key structures like vessels and nerves. Results revealed that the hyalurostructure used for lips rejuvenation and helps to maintain a natural effect and avoids pain.

Background Research on human emotion shows that pictures drive the activity of specialised brain networks affecting attitude and behaviour. Pictorial warnings on cigarette packages are considered one of the most effective ways to convey information on the health consequences of smoking. However, few studies have evaluated the effectiveness of warning labels to elicit avoidance of smoking. Objectives To investigate the impact of pictorial health warnings conveyed by the Brazilian tobacco control programme through a well-established psychometric tool designed for studies on emotion and behaviour. Methods Graphic Brazilian cigarette warnings labels were evaluated. They consisted of the two sets of warning pictures displayed in 2002-4 (n = 9) and 2004-8 (n = 10). Pleasant, unpleasant and neutral pictures selected from a standard catalogue were used as controls. Undergraduate students (n = 212, 18% smokers) evaluated the emotional content of each picture in two affective dimensions: hedonic valence and arousal. Participants were not provided with the sources of distinction between control and warning pictures. Results The judgements of hedonic content of the warning pictures ranged from neutral to very unpleasant. None was classified as highly arousing. Smokers judged warning pictures representing people smoking significantly more pleasant than pictures without smoking scenes, and significantly more so than non-smokers. No significant differences between smokers and non-smokers were found for warning pictures without these smoking scenes. Conclusion Previous studies have shown that the most threatening and arousing pictures prompt the greatest evidence of defensive activation. Emotional ratings of Brazilian warning pictures described them as unpleasant but moderately arousing. To intensify avoidance of the packages, future graphic warnings should therefore generate more arousal. The ratings for the Brazilian warning pictures indicated that, except for those depicting people smoking, judgements by smokers and non-smokers were similar, suggesting a potential applicability in both prevention and cessation. Smoking cues, however, should be avoided.

The need of didactic material is increasing in medical science nowadays. The lack of anatomical specimens, and the toxicity of conservators, have originated an intense search for alternative ways of demonstrating the human anatomy. As a solution for this difficulty, three-dimensional (3-D) images may be used, facilitating the learning process. This study aims at comparing and describing two techniques of reproduction of bi-dimensional images into three dimensions, which is called stereoscopy. The methods evaluated are filter of colors (anaglyphic) and polarized light. Techniques were analyzed for clearness and 3-D effect. Fourteen images were evaluated by 5 people, with scores ranging from 0 to 4. Total mean scores of polarized light was superior compared to the anaglyphic technique. Both methods use the codification of the image, which means separation and exclusivity with each eye seeing its corresponding image. After several photographic essays and gradual adaptation to a better technique, based on optical physics, photography and neuroanatomical knowledge, we concluded that both techniques are suitable means for production of 3-D images. The best technique, however, considering the final quality of image was polarized light, which did not alter the natural color of the specimen, conserving clearness of images with lower cost.