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Abstract Β-lactamases-producing Escherichia coli are a widely distributed source of antimicrobial resistance (AMR), for animals and humans. Little is known about the sensitivity profile and genetic characteristics of E. coli strains isolated from domestic cats. We report a cross-sectional study that evaluated E. coli strains isolated from domestic cats in Panama. For this study the following antibiotics were analyzed: ampicillin, amoxicillin-clavulanate cefepime, cefotaxime, cefoxitin, ceftazidime, aztreonam, imipenem, gentamicin, kanamycin, streptomycin, tetracycline, ciprofloxacin, nalidixic acid, trimethoprim-sulfamethoxazole, and chloramphenicol. The data obtained were classified as resistant, intermediate, or sensitive. MDR strains were established when the strain presented resistance to at least one antibiotic from three or more antimicrobial classes. Forty-eight E. coli isolates were obtained, of which 80% presented resistance to at least one of the antibiotics analyzed, while only 20% were sensitive to all (p = 0.0001). The most common resistance was to gentamicin (58%). Twenty-nine percent were identified as multidrug-resistant isolates and 4% with extended spectrum beta-lactamase phenotype. The genes blaTEM (39%), blaMOX(16%), blaACC (16%) and blaEBC (8%) were detected. Plasmid-mediated resistance qnrB (25%) and qnrA (13%) are reported. The most frequent sequence types (STs) being ST399 and we reported 5 new STs. Our results suggest that in intestinal strains of E. coli isolated from domestic cats there is a high frequency of AMR.

Abstract Background Acute Lymphoblastic Leukemia (ALL) is a neoplasm of the hematopoietic system characterized by a clonal expansion of abnormal lymphocyte precursor cells. ALL is the most common form of cancer in children, but despite advances in treatment, it can still be fatal. Ethnic differences influence survival rates, and genomic ancestry plays an important role, especially in mixed-race populations such as Latin America. This study aims to analyze the influence of genomic ancestry on toxicity in children with ALL in the Amazon region. Methods The study included 171 patients (protocol number 119,649/2012—Ethics Committee) with ALL treated at a pediatric treatment center in Belém do Pará, in the Brazilian Amazon. The patients were submitted to the BFM protocol of induction therapy for ALL. Toxicity was assessed based on laboratory tests and adverse events, classified according to the CTC-NCI guide. Genomic ancestry was determined using autosomal informative markers. Results The majority of children (94.74%) developed some type of toxicity during treatment, 87.04% of which were severe. Infectious toxicity was the most common, present in 84.8% of cases, 77.24% of which were severe. Amerindian ancestry showed an association with the risk of severe general toxicity and severe infectious toxicity, with a contribution of 35.0% demonstrating a significant increase in risk. In addition, post-induction refractoriness and relapse were also associated with an increased risk of death. Conclusion This study highlights the influence of Amerindian genomic ancestry on response to therapy and toxicity in children with ALL in the Amazon region. Understanding these associations can contribute to personalizing treatment and improving clinical outcomes.

High-strength metastable β-titanium alloys like Ti-5553 (Ti–5Al–5Mo–5V–3Cr) are frequently used in highly loaded aerospace components. Such aerospace parts tend to be expensive to traditionally manufacture due to current industry process limitations such as inflexibility for complex geometries, costs related to tooling for large forgings, extended lead times, poor machinability and high material waste. These challenges are leading to increased interest in exploring alternative manufacturing routes. This work investigates the use of additive manufacturing to deposit cost-effective and machinable Ti-64 (Ti–6Al–4V) alloy onto a forged Ti-5553 alloy substrate. The microstructure evolution, microhardness and tensile properties have been investigated for both the as-deposited as well as for stress relief heat-treated conditions. The results confirmed the formation of coarse columnar β grains with a fine basketweave α structure. The heat affected zones (HAZs) developed in the Ti-5553 substrate material from the cyclic thermal fluxes introduced from the melt-pool were characterized by a gradient microstructure of dissolving constituent phases with nearing proximity to the fusion zone. Tensile testing in the as-deposited condition was characterised with a UTS of 884 MPa and a ductility of 15%. Tensile samples extracted across the substrate-deposit interface all failed in the WAAM Ti-64 material and demonstrated comparatively greater strength but poorer ductility. A band of tensile residual stresses was imparted along the substrate, but was adequately stress relieved after heat-treatment at 600 °C. The heat-treatment led to the formation of more homogeneous α-phase laths throughout the HAZ of the Ti-5553 material and provided overall improvements to the strength and ductility.

This study examined family cohesion and conflict as moderators of associations between discrimination stress and adaptation stress and psychological distress among Latinx youth. Participants included 199 Latinx adolescents (M[subscript age] = 13.68). Seventy nine percent were immigrants and 73% had family origins in Mexico. Discrimination stress and adaptation stress had differential associations with psychological distress and with indices of family functioning. Hierarchical regression analysis found significant interactions of family cohesion with both adaptation and discrimination stress. High levels of family cohesion protected against negative effects of discrimination stress. Although high levels of family cohesion were associated with less distress overall, family cohesion appeared to potentiate negative effects of adaptation stress. Results suggest a complex relation of family cohesion with Latinx youths' emotional well-being, pointing to the need for research examining the role of extra-familial support resources for helping those youth overcome acculturative stress.

Background: In 2009, Portugal ratified the UN CRPD and a turn to a rights-based approach in disability law and policy has intensified since. It thus becomes important to understand whether these legal changes are furthering the social inclusion of adults with intellectual and complex disabilities. Method: Questionnaires were applied to a stratified sample of 127 adults with intellectual and complex disabilities attending social care and vocational training programmes across the country. Results: Participants reported low rates of social participation, and many (49%) were found to live below the poverty line. High rates of discrimination and violence and feelings of loneliness and sadness were also reported, which can be strong indicators of the oppression that many of them daily endure. Conclusion: Adults with intellectual and complex disabilities in Portugal face exclusion, discrimination, and violence. The poverty and isolation in which many of them live compounds their (de)citizenship status in Portuguese society.

ABSTRACTDiarrhea-predominant irritable bowel syndrome (IBS-D), associated with increased intestinal permeability, inflammation, and small intestinal bacterial overgrowth, can be triggered by acute gastroenteritis. Cytolethal distending toxin B (CdtB) is produced by gastroenteritis-causing pathogens and may underlie IBS-D development, through molecular mimicry with vinculin. Here, we examine the effects of exposure to CdtB alone on gut microbiome composition, host intestinal gene expression, and IBS-D-like phenotypes in a rat model. CdtB-inoculated rats exhibited increased anti-CdtB levels, which correlated with increased stool wet weights, pro-inflammatory cytokines (TNFα, IL2) and predicted microbial metabolic pathways including inflammatory responses, TNF responses, and diarrhea. Three distinct ileal microbiome profiles (microtypes) were identified in CdtB-inoculated rats. The first microtype (most like controls) had altered relative abundance (RA) of genera Bifidobacterium, Lactococcus, and Rothia. The second had lower microbial diversity, higher Escherichia-Shigella RA, higher absolute E. coli abundance, and altered host ileal tissue expression of immune-response and TNF-response genes compared to controls. The third microtype had higher microbial diversity, higher RA of hydrogen sulfide (H2S)-producer Desulfovibrio, and increased expression of H2S-associated pain/serotonin response genes. All CdtB-inoculated rats exhibited decreased ileal expression of cell junction component mRNAs, including vinculin-associated proteins. Significantly, cluster-specific microRNA-mRNA interactions controlling intestinal permeability, visceral hypersensitivity/pain, and gastrointestinal motility genes, including several previously associated with IBS were seen. These findings demonstrate that exposure to CdtB toxin alone results in IBS-like phenotypes including inflammation and diarrhea-like stool, decreased expression of intestinal barrier components, and altered ileal microtypes that influenced changes in microRNA-modulated gene expression and predicted metabolic pathways consistent with specific IBS-D symptoms.

Cardiovascular disease and cancer are the leading causes of morbidity and mortality in the US. Despite the significant progress made in cancer treatment leading to improved prognosis and survival, ventricular arrhythmias (VA) remain a known cardiovascular complication either exacerbated or induced by the direct and indirect effects of both traditional and novel cancer treatments. Although interruption of cancer treatment because of VA is rarely required, knowledge surrounding this issue is essential for optimising the overall care of patients with cancer. The mechanisms of cancer-therapeutic-induced VA are poorly understood. This review will discuss the ventricular conduction (QRS) and repolarisation abnormalities (QTc prolongation), and VAs associated with cancer therapies, as well as existing strategies for the identification, prevention and management of cancer-treatment-induced VAs.

A prática de adubação verde, que envolve o cultivo de espécies vegetais com características benéficas para o solo, destaca-se como uma estratégia eficaz para a melhoria da fertilidade do solo. O presente estudo teve como objetivo avaliar a produção de biomassa de três espécies indicadas para utilização como adubação verde (crotalária - Crotalaria juncea; mucuna preta - Mucuna aterrima; estilosante - Stylosanthes macrocephala). O trabalho foi realizado em Santarém, Pará com delineamento experimental em blocos intercalados, com oito repetições. A coleta de dados foi realizada 90 dias após o plantio e incluiu a medição da altura das plantas, massa fresca da parte aérea (MFPA), massa seca da parte aérea (MSPA), massa seca das raízes (MSR), massa seca total (MST), comprimento das raízes e diâmetro do colo da raiz. Observou-se que a crotalária se destacou em relação às demais espécies, apresentando a maior produção de biomassa fresca (1,43 ± 1,2 t/ha) e seca (0,46 t/ha e 0,21 t/ha) na parte aérea da planta. A mucuna preta se destacou para o comprimento de raiz com média de 33,2 cm. Esses resultados são de grande relevância para a agricultura sustentável, pois a adubação verde desempenha um papel fundamental na promoção da saúde do solo, na conservação dos recursos naturais e no aumento da produtividade agrícola. O cultivo de espécies como crotalária e mucuna preta poderá proporcionar benefícios significativos para os cultivos.

Syzygium cumini seeds are recalcitrant, thus cannot tolerate drying and storage. The aim of this study was to evaluate the longevity of these seeds under different storage conditions and to assess the effect of osmotic treatment with polyethylene glycol (PEG) and abscisic acid (ABA) on reducing sensitivity to desiccation and increasing the longevity of these seeds. Seeds were desiccated until they reached preestablished moisture contents (40, 35, 30, 25 and 15%) and allowed to germinate. With 25% moisture content, germination was approximately 40%, and, with 15%, germination did not occur anymore. In the treatments aimed at reducing sensitivity to desiccation, seeds were incubated for 15 days in a solution of PEG (-1.88 MPa) or PEG (-1.88 MPa) + ABA (10-4 M), desiccated until they reached the preestablished moisture contents mentioned above, and then allowed to germinate. Five conditions were tested for storage: plastic bag in a cold room (8-10 °C; 45% RH); plastic bag in an air-conditioned room (20 °C; 60% RH); paper bag at room temperature; PEG solution at -1.88 MPa at 20 °C; and PEG solution at -1.88 MPa + ABA 10-4 M at 20 °C. Germination tests were carried out after 15, 30 and 90 days of storage. The best storage condition was in a plastic bag in an air-conditioned room, which was capable to keep a germinate rate close to 100% for up to 90 days. Under the conditions tested, osmotic treatment with or without ABA did not reduce sensitivity to desiccation and did not prolong seed longevity.

O ovo é um alimento altamente nutritivo rico em proteínas e vitaminas, porém como todos os produtos de origem animal o ovo perde qualidade rapidamente na ausência de adequados métodos de conservação, nesse sentido foi conduzido um experimento com o objetivo de avaliar a qualidade de ovos de codorna não refrigerados, submetidos ao tratamento superficial da casca utilizando solução de geoprópolis da espécie Melipona interrupta. Os parâmetros de qualidade analisados foram: perda de peso; gravidade específica; pH da gema e pH do albúmen. Foi realizada análise de variância usando um modelo incluindo os efeitos do tratamento superficial da casca, do tempo de estocagem, e da interação entre esses fatores. Como não houve interação entre os tratamentos e o tempo de estocagem, as médias do tratamento superficial da casca dos ovos foram comparadas pelo teste T a 5% de probabilidade e as médias dos efeitos do tempo de estocagem foram comparadas pelo teste SNK (Student Newman-Keuls) a 5% de probabilidade. Com o aumento do tempo de estocagem, os ovos apresentaram redução na gravidade específica e aumento na perda de peso, pH da gema e pH do albúmen, independente de terem recebido ou não o tratamento superficial na casca. O revestimento superficial da casca de ovos de codornas com solução de geoprópolis a 10% não é eficaz em manter a qualidade interna dos ovos ao longo de 55 dias de armazenamento.

RESUMO Este estudo objetivou desenvolver um modelo analítico teórico-descritivo sobre o trabalho realizado na linha de frente assistencial durante a pandemia da covid-19, considerando as formas de enfrentamento e as repercussões na saúde dos profissionais envolvidos. Trata-se de uma pesquisa qua litativa com referencial metodológico da Teoria Fundamentada nos Dados na abordagem estruturalista de Strauss e Corbin, realizada em um hospital universitário. Com amostragem da população e formação de dois grupos amostrais, participaram 24 profissionais, entre enfermeiros, fisioterapeutas, médicos e técnicos de enfermagem. Realizou-se a coleta de dados com entrevistas em profundidade. A análise dos dados ocorreu por meio da codificação aberta, axial e seletiva, com uso do software Atlas Ti 22.0. Os resultados alcançados permitiram elucidar o modelo teórico com a categoria central ‘Trabalhando em linha de frente assistencial na pandemia da COVID-19’, sustentado por cinco categorias, conforme as circunstâncias paradigmáticas das condições de ação/interação e suas consequências. O modelo teórico desenvolvido poderá contribuir para o planejamento e desenvolvimento de estratégias institucionais de enfrentamento a períodos críticos, caracterizados por aumento da demanda por serviços de saúde, presença de agente etiológico de alta transmissibilidade e, principalmente, impacto na saúde dos profissionais, com sofrimentos e adoecimentos nos envolvidos na linha de frente assistencial.

Objetivos: O estudo buscou realizar o mapeamento e a territorialização da rede de captação de doadores de sangue dos municípios da V Regional de Saúde (GERES) de Pernambuco, a partir da formação de agentes multiplicadores. Material e Métodos: A estratégia utilizou o método da pesquisa-ação, com uma ação participativa onde houve implicação na realidade estudada, no conhecimento do problema, mobilização, na sensibilização e conscientização para captação e fidelização de doadores. A pesquisa-ação tem um caráter participativo no processo de construção e ação para solução de problemas. Foi desenvolvida pelo Hemocentro de Garanhuns, da hemorrede de Pernambuco, tendo como público-alvo representantes definidos pelos secretários de saúde dos 21 municípios da V GERES. No Colegiado Intergestores Regional (CIR) foi apresentada a necessidade de coparticipação dos municípios para captação de doadores de sangue e fortalecimento dos estoques, além da pactuação da formação de agentes multiplicadores dos municípios e do apoio aos passeios solidários. Resultados: Na pactuação, em maio de 2024, estiveram presentes representantes de 13 municípios que aprovaram a formação de agentes multiplicadores. No curso, dos 21 municípios, houve a participação de 16, o que representa 76% de adesão. Dos 16 municípios participantes do curso, 13 conseguiram efetivar a captação de doadores de sangue através de passeios solidários. Discussão: O incentivo dos secretários para o desenvolvimento da territorialização a partir do curso de agentes multiplicadores revela o início da conscientização da necessidade de uma contribuição ativa do município para doação de sangue. O curso foi desenvolvido na perspectiva participativa, buscando envolver os participantes na compreensão do ciclo do sangue, na desmitificação dos estigmas, sensibilização para a doação, bem como promoveu uma construção de estratégias de captação nos cenários municipais. Pensar na doação de sangue enquanto educação libertadora desperta na sociedade a cor-responsabilização, com a compreensão da cidadania, ética, justiça e solidariedade . A partir da construção realizada e com o apoio dos gestores foram promovidos passeios solidários, onde o agente multiplicador, em sua localidade, desenvolveu estratégias de sensibilização, conscientização e captação, além da viabilização para o deslocamento até o hemocentro. Os municípios que não alcançaram o objetivo nesse momento inicial, referiram dificuldade em disponibilidade de transporte. A Confederação Nacional dos Municípios, destaca que a falta de conscientização da população, os mitos, a deficiência de estrutura da hemorrede, a dificuldade de acesso, os critérios de inaptidão e a desinformação, são fatores limitadores no processo da doação de sangue. Considerações finais: Reconhecer o território em sua diversidade e possibilidades, é entender a necessidade de buscar estratégias de captação a partir da aproximação da realidade local, através de pactuações, sensibilização, educação, informação e acessibilidade. Partilhar responsabilidades e informação é construir extensões e ampliar a equipe de fomento a política do sangue, que são geradores de vida e esperança.

Introdução: Os serviços de imuno-hematologia enfrentam diariamente desafios na identificação de anticorpos irregulares, sobretudo se envolve anticorpos contra antígenos de alta frequência. Este estudo compartilha a experiência de um laboratório de imuno-hematologia na identificação de anticorpos contra antígenos de alta frequência e a colaboração entre instituições em prol do atendimento ao paciente. Relato de caso: Paciente de 52 anos, portadora de anemia falciforme, deu entrada em Hospital atendido pelo Hemocentro São Lucas (HSL) com hemoglobina de 4 g/dL, sendo solicitada a transfusão de 4 unidades de Concentrado de Hemácias (CH). Registros de 2019 identificavam anticorpos anti-Hy, anti-E, anti-K e anti-S no soro da paciente. Contudo, no painel de hemácias, o resultado foi de positividade em todas as hemácias cuja intensidade foi de quatro cruzes. Após testes adicionais como tratamento com DTT e Pesquisa de sub-classe de IgG, identificou-se alto risco de hemólise, porém sem especificar o anticorpo. Na impossibilidade de concluir a investigação iniciamos contato com laboratórios de apoio. Na Fundação Pró-Sangue, foram utilizadas hemácias de fenótipo raro e realizada genotipagem. O resultado do fenótipo deduzido foi Hy- e Jo(a-). Para confirmar a presença do anti-Joa, o soro foi testado com hemácias Hy- e Jo(a+), cujo resultado foi positivo. Concluiu-se que a paciente possui anticorpos anti-E e anti-Joa,em associação com os anticorpos anti-K, anti-S e anti-Hy. A Pró-Sangue apontou a presença de um doador em seu banco com o fenótipo requerido, porém a liberação seria somente em 3 dias. Entretanto, como a paciente evoluiu com queda nos níveis de hemoglobina para 3,7 g/dL e transferência da paciente para UTI, iniciamos busca estendida de doadores para o Brasil através da Política Nacional de Sangue e Hemoderivados do Ministério da Saúde (MS), porém o único doador compatível com a paciente era o da Fundação Pró-Sangue. Em paralelo, diante da demora em obter doação de sangue compatível, foi realizado o Ensaio de Monocamada de Monócitos Modificado (MMA) para tentar uma transfusão incompatível, porém o resultado de 7% indicou alto risco de hemólise. Até o comparecimento do doador a paciente recebeu tratamento alternativo com eritropoetina e suporte intensivo, sendo finalmente transfundida após 2 dias, respondendo com melhora nos níveis de hemoglobina (5,7 g/dL). A paciente permaneceu em observação por mais oito dias e recebeu alta hospitalar com 6,8 g/dL de hemoglobina. Conclusão: O sistema Dombrock consiste em oito antígenos eritrocitários, sendo que seis deles são antígenos de alta frequência. Estes antígenos estão presentes em mais de 99% da população, sendo que os fenótipos Hy- e Jo(a-) são encontrados em amostras associadas com múltiplos anticorpos. Concluímos que a resolução de casos complexos de pacientes com múltiplos anticorpos direcionados contra antígenos de alta frequência demanda proficiência técnica, porém a estrutura integrada de serviços de diferentes instituições é essencial para efetivo atendimento às necessidades transfusionais dos pacientes.

Objetivo: Determinar a prevalência de anticorpos antieritrocitários em pacientes com doença falciforme (DF) que realizaram transfusão nos hospitais do Acre. Material e métodos: Trata-se de um estudo observacional retrospectivo, realizado de 01/09/17 a 01/07/24, abrangendo 84 pacientes com DF que receberam hemocomponentes no período. As investigações imunohematológicas se inciaram com a Pesquisa de Anticorpos Irregulares (PAI). Amostras positivas para a PAI foram submetidas a um painel com 11 hemácias de fenótipo conhecido para identificação de anticorpos irregulares utilizando o método Gel Centrifugação em cartão de Liss/Coombs. Todos os estudos imunohematológicos do Acre são realizados no hemocentro coordenador do estado. Resultados: Dos 84 pacientes com DF que receberam concentrado de hemácias, 14 (16,7%) apresentaram PAI positivo, dos quais 8 (57%) apresentaram anticorpos únicos e 6 (43%) apresentaram múltiplos anticorpos. Foram identificados 22 anticorpos, com as seguintes prevalências de especificidade: Anti-E 10 (45,4%), Anti-C 3 (13,6%), Anti-c 3 (13,6%), Anti-Kell 2 (9,1%), Anti-M 1 (4,5%), Anti-D 1 (4,5%), Anti-S 1 (4,5%) e Anti-Jkb 1 (4,5%). Discussão: Estudos com pacientes com DF no Brasil mostram prevalências variáveis de aloimunização. Em São Paulo, 22,6% dos pacientes com DF desenvolveram anticorpos irregulares, sendo o anti-Kell o mais frequente. Em Salvador, a taxa foi de 51,9%, sendo o anti-E, o aloanticorpo mais prevalente. Em Alagoas, a aloimunização foi de 12,7%, com 70% dos anticorpos pertencentes aos sistemas Rh e Kell. O desenvolvimento de aloanticorpos pode causar reações transfusionais, sejam elas agudas ou tardias. Além disso, sua ocorrência dificulta a disponibilização de hemácias compatíveis em futuras transfusões. O risco de aloimunização depende da imunogenicidade do antígeno, da resposta imune do receptor, da diferença no padrão antigênico do doador e do receptor e da frequência de transfusões. Pacientes com DF homozigotos frequentemente necessitam de múltiplas transfusões de concentrado de hemácias, expondo-os a diversos antígenos eritrocitários. Embora seja difícil estimar a prevalência de aloimunização na população geral que já recebeu transfusão, espera-se que pacientes com DF tenham prevalências mais altas, devido às transfusões frequentes. Em Rio Branco, a prevalência de aloimunização está dentro da descrita nacionalmente, sendo o Anti-E o mais prevalente, assim como em Salvador. Além do grupo E, foram encontradas altas prevalências para os anticorpos Anti-C e Anti-c. Anticorpos Anti-E, Anti-c, Anti-Kell, Anti-D e Anti-S estão associados a reações transfusionais hemolíticas tardias. O grupo E é considerado altamente imunogênico e relevante clinicamente, embora não seja comum na população em geral. Devido ao surgimento desses anticorpos nos pacientes com DF, seriam necessários mais estudos sobre o padrão fenotípico dos doadores do Acre, para melhor caracterização das idiossincrasias fenotípicas regionais e melhor manejo de hemocomponentes para os pacientes com DF. Conclusão: Embora a prevalência de aloimunização varie no Brasil, o Hemocentro do Acre apresenta dados que se alinham com os extremos registrados no país. A preocupação com aloimunizações é relevante para reduzir as reações transfusionais, melhorar o manejo dos hemocomponentes e proporcionar um tratamento de melhor qualidade para esses pacientes.

Introdução: A leucemia de grandes linfócitos granulares (LGLG) é uma doença proliferativa da linhagem linfocítica T ou de células NK. Dentro das patologias linfoproliferativas crônicas é uma condição rara, sendo a epidemiologia nos EUA entre 2 a 5%. Seu tratamento é indicado para casos de neutropenia severa ou moderada acompanhada por infecções recorrentes, anemia sintomática ou necessária transfusão, condições autoimunes associadas ou trombocitopenia severa. A concomitância de doenças autoimunes associadas já é estabelecida, sendo a artrite reumatóide a mais comum, porém a Púrpura Trombocitopênica Imune (PTI) pode estar presente com a característica de anticorpos antiplaquetários presentes e contagem de megacariócitos na medula óssea sem alteração, o que justifica o tratamento da LGLG. Este relato busca discutir sobre as possíveis relações da LGLG e o tratamento da PTI refratária. Objetivo: Relatar um caso de paciente com histórico prévio de PTI refratária ao uso de corticoide mantendo trombocitopenia severa e diagnosticado com LGLG. Material e métodos: Relato de caso de LGLG associada a PTI através de análise de prontuário eletrônico e exames laboratoriais, além de revisão da literatura utilizando as plataformas SciELO, PubMed e Google Acadêmico. Relato: Paciente masculino, 78 anos, hipertenso, DM 2, ex-tabagista e ex-etilista, dá entrada no serviço referindo mialgia em membros inferiores há 4 meses com piora na última semana. Relata história de plaquetopenia há 2 anos com resposta à corticoterapia, apresentando 7000 plaquetas na entrada. Inicialmente entendido como recidiva do quadro autoimune, foi medicado com prednisona 1mg/kg. Sem resposta 14 dias após início da medicação e tendo-se observado linfocitose próxima a 8.000 cel/mm³no exame de entrada, foi solicitada imunofenotipagem em sangue periférico que demonstrou 4.92% de células linfóides T clonais, sendo a morfologia e imunofenotipagem sugestiva de LGLG. Com esse novo diagnostico, a terapia com metrotrexato 10 mg/m2 por semana foi iniciada com resposta progressiva, tento o paciente recebido alta para desmame de corticoterapia ambulatorial com 26.000 plaquetas. Atualmente se mantem estável, com redução da linfocitose e incremento gradual nos níveis plaquetários aproximando 1 mês do início de tratamento. Discussão: De manifestação usualmente indolente, a LGLG está muitas vezes associada a doenças imunomediadas. Nesses casos, o tratamento da doença de base é fundamental para controle das manifestações associadas. Embora a LGLG seja indolente, e muitas vezes, como a leucemia linfocítica crônica não necessite tratamento, deve se suspeitar de quadros desse tipo frente manifestações imunomediado com respostas frustas ou inadequadas e, particularmente, em pacientes com alterações da série linfocítica, em hemograma. Conclusão: Frente a quadros imunomediados refratários, o reconhecimento e diagnostico de doenças linfoproliferativas crônicas como a LGLG é parte fundamental o tratamento adequado. Esperamos que o estudo desse caso aumente o interesse e conhecimento sobre essa doença subdiagnosticada.

BackgroundThe increased incidence of breast cancer implies the appearance of frequent symptoms associated with disease and treatments, such as pain. For the management of this issue, auricular therapy has been used in a complementary manner, especially for its safety and analgesic action. ObjectiveThis systematic review aims to summarize available evidence on the effects of auricular therapy on pain in women undergoing breast cancer treatment. MethodsThis is a systematic review that includes randomized controlled trials that evaluated the effects of auricular therapy on pain in women with breast cancer, as compared with other interventions (sham or placebo auricular therapy, other nonpharmacological interventions, and routine pain treatments) during the treatment of the disease. Pain, whether induced or not by cancer treatments, is the main outcome to be evaluated. The search for the studies was performed in the following databases: MEDLINE through PubMed, CINAHL, CENTRAL, Embase, Web of Science, Scopus, VHL, TCIM Americas Network, CNKI, and Wanfang Data. The reviewers have independently evaluated the full texts, and in the near future, they will extract the data and assess the risk of bias in the included studies. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), and a meta-analysis will be carried out to evaluate the intervention, considering the homogeneity of the results, using the Cochran Q test and quantified by the Higgins inconsistency index. The guidelines of the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) have been respected in the elaboration of this protocol. ResultsThe records screening stage has been completed, and the synthesis and meta-analysis were conducted in February 2024. We hope to have finished the preparation of the paper for publication by September 2024. Review reporting will follow standard guidelines for reporting systematic reviews. The results will be published in peer-reviewed scientific journals. ConclusionsThis review will compile the strength of evidence for the use of auricular therapy in the management of pain in women with breast cancer during the treatment of the disease, identifying gaps in the available evidence as well as assisting health professionals in indicating the intervention for clinical practice. Trial RegistrationPROSPERO CRD42022382433; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=382433 International Registered Report Identifier (IRRID)DERR1-10.2196/55792

Telocytes are CD34+ interstitial cells that have long cytoplasmic projections (called telopodes), and have been detected in several organs, including those of the male reproductive system. In this brief review we evaluate the role of telocytes in tissue organization of the different organs of the male reproductive system in which these cells were studied. In general terms, telocytes act in the tissue organization through networks of telopodes that separate the epithelia from the stroma, as well as dividing the stroma into different compartments. In addition to this contribution to the structural integrity, there is direct and indirect evidence that such “walls” formed by telocytes also compartmentalize paracrine factors that they or other cells produce, which have a direct impact on morphogenesis and the maintenance of organ cell differentiation, as well as on their normal physiology. Moreover, alterations in telocytes and telopode networks are correlated with pathological conditions in the male reproductive system, in response to profound changes in structural organization of the organs, in inflammation, hyperplasia and cancer. Further studies are necessary to evaluate the molecular pathways telocytes employ in different contexts of physiology and disease.

Introduction/objectivesThe precise location of the tumor site is essential for the success of surgical treatment. Neoadjuvant chemotherapy (NAC) is a challenge for preoperative tumor and node localization. Thus, the knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology (SBM) regarding breast and axilla marking were evaluated and a consensus regarding management and treatment was reached.MethodsThis was an online survey conducted between June and December 2022. All 1,742 active mastologists affiliated to the SBM were invited anonymously. The online form contained 28 objective questions, of which 22 were formulated on a Likert scale. These questions addressed relevant aspects related to breast and axilla marking in the neoadjuvant setting. Responses that reached 70% agreement were considered consensual. Statistical analysis was performed using the SPSS program version 26.0. Post hoc analysis was performed when appropriate and the significance level was set at p < 0.05. Polychoric regression analyses were conducted using `VGAM` packageResultsIn total, 468 mastologists answered the questionnaire (26.8%), with a predominance of professionals aged between 40–49 years (32.1%). Most professionals were board-certified (84,8%). The indication of tumor marking in the breast prior to NAC was consensual (96.4%) and the metal clip was the preferred method (69.7%). There was no consensus regarding the indication of pre-NAC histologically positive lymph node marking (49.8% disagree and 42.8% agree). However, there was consensus that the clinical and imaging evaluation was insufficient for staging the axilla as N1 (71.6%). The contraindication of breast and node marking in T4b tumors (71.2%) was consensual. There was consensus on the indication of sentinel lymph node biopsy (SLNB) for initially cN1 (92.3%) or cN2 (72.7%) tumors that became cN0 after NAC, with 67.5% opting for dual staining with technetium and patent blue. When

ABSTRACT The study examined the effects of mandatory International Financial Reporting Standards (IFRS) adoption on the quality of accounting information from three perspectives: the ability of accounting figures to explain credit ratings and their evolution after IFRS adoption; the difference in information gains from mandatory IFRS adoption between emerging and developed countries; and the identification of aspects of national governance capable of explaining these information gains. This article differs from the existing literature in three respects: it uses a more comprehensive and heterogeneous sample of emerging and developed countries; it uses the bootstrapping resampling method for a consistent analysis of the results; and it examines the heterogeneity of the effects of IFRS adoption as a function of country-level development and governance characteristics. The study reinforces the relevance of accounting information for analyzing companies' credit risk and makes new contributions to the literature on the heterogeneity of the effects of IFRS adoption. By using a multi-country sample, the article has potential implications for national and international accounting and finance literature, and is also useful for regulators and international portfolio managers. The analyses were based on the ratings and annual accounting data of 566 companies domiciled in 36 countries over the period from 2005 to 2017, using a bootstrapping resampling method. This article documented that mandatory IFRS adoption increased the ability of accounting data to explain the credit ratings assigned by rating agencies. Moreover, it was found that this relationship is, on average, more pronounced in emerging economies. The analysis also showed a positive relationship between the control of corruption and the information gain associated with IFRS adoption.

Introduction: Renal colic is the most common non-obstetric cause of abdominal pain during pregnancy and is associated with a higher risk of complications in these women. When invasive treatment is required, options are temporary drainage with ureteral stent (JJ) or percutaneous nephrostomy (PCN), or immediate definitive treatment with ureteroscopy (URS). Our goal was to review the safety and efficacy of these procedures in treating urolithiasis during pregnancy. Methods: Adhering to the PRISMA checklist guidelines, we searched PubMed, Embase, and Scopus databases for articles on the efficacy and complications of the three procedures in pregnant women. The quality of evidence and risk of bias were evaluated using the Critical Appraisal Skills Programme and the Institute of Health Economics tools. Results: We included 45 articles, totaling 3424 interventions in pregnant women - 2188 URS, 719 JJ, and 517 PCN. URS was the most assessed procedure, with stone-free rates comparable to the non-pregnant patients. The most frequent complications were lower urinary symptoms and infections independently of the intervention. Obstetric complications for all interventions included 167 cases of preterm labor, resulting in 24 premature births. No statistically significant differences in post-operative complications were reported between the procedures in the few comparative studies. Conclusions: Despite the absence of high-quality studies, current evidence suggests that URS, JJ, and PCN are all safe and effective during pregnancy. As most patients submitted to temporary drainage require a second procedure post-delivery, primary URS appears more efficient. Therefore, it is the preferred option unless there are indications for temporary drainage.

Background: Concerns have been raised about cardiac inflammation in patients with long COVID-19, particularly those with myocardial injury during the acute phase of the disease. This study was conducted to examine myopericardial involvement, detected by cardiac magnetic resonance (CMR) imaging in patients hospitalized for COVID-19. Methods: Adult patients hospitalized with COVID-19 who presented myocardial injury or increased D-dimers were enrolled in this prospective study. All patients were invited to undergo CMR imaging examination after discharge. During follow-up, patients with nonischemic myocardial or pericardial involvement detected on the first CMR imaging examination underwent second examinations. CMR imaging findings were compared with those of a control group of healthy patients with no comorbidity. Results: Of 180 included patients, 53 underwent CMR imaging examination. The mean age was 58.4 ± 18.3 years, and 73.6 % were male. Myocardial and pericardial LGE was reported in 43.4 % and 35.8 % of patients, respectively. Nonischemic myocardial or pericardial involvement was reported in 26 (49.1 %) patients. The prevalence of pericardial LGE was associated inversely with the interval between hospital discharge and CMR. COVID-19 survivors had higher end-systolic volume indices (ESVis) and lower left-ventricular ejection fractions than did healthy controls. Seventeen patients underwent follow-up CMR imaging; the end-diastolic volume index, ESVi, and prevalence of pericardial LGE, but not that of nonischemic LGE, were reduced. Conclusion: Among COVID-19 survivors with myocardial injury during the acute phase of the disease, the incidences of nonischemic myocardial and pericardial LGE and CMR imaging–detected signs of cardiac remodeling, partially reversed during follow-up, were high.

Purpose: To evaluate the efficacy and safety of the combination of olaparib plus trastuzumab in patients with HER2-positive advanced breast cancer (ABC) and germinal BRCA mutations (gBRCAm). Methods: OPHELIA (NCT03931551) was a single-arm, open-label, phase 2 clinical trial. Patients aged ≥18 years diagnosed with HER2-positive ABC with germinal deleterious mutations in BRCA1 or BRCA2 who had received at least one prior systemic regimen for advanced disease were enrolled. Patients received olaparib plus trastuzumab until disease progression, unacceptable toxicity, or consent withdrawal. The primary endpoint was investigator-assessed clinical benefit rate for at least 24 weeks as per RECIST v.1.1. Key secondary endpoints included overall response rate (ORR) and safety profile. Results: A total of 68 pre-treated HER2-positive ABC patients were screened. Due to slow accrual the trial was stopped after enrolling 5 patients instead of the planned sample size of 20. Four patients achieved clinical benefit (80.0 %, 95 % CI; 28.4–99.5, p

Smart contracts have gained significant attention in the software development community because they are the mechanism for building blockchain applications. This work provides a distributed software architecture and an implementation for accessing a smart contract, called NFT-Vehicle, implemented on the Ethereum blockchain platform. The main idea behind NFT-Vehicle is the digitization process of a motorized vehicle in a digital asset. The architecture outlines two security protocols, one from the stakeholders who connect towards the back-end, and the other internally. The back-end includes mainly two parts: an API-gateway and the smart contract located in a blockchain. We report the acquired experiences and a list of identified errors found during the unit tests that are difficult to notice with simple requests. Our solution can be used as a base for real implementations of tokenizing physical cars into digital assets.

RESUMO Objetivo Identificar a presença de sintomas vocais e dor musculoesquelética em não profissionais da voz, verificar se há relação entre essas variáveis e comparar o desempenho entre mulheres e homens. Métodos Estudo transversal observacional. Participaram 59 indivíduos não profissionais da voz. Os dados foram coletados no meio on-line e aplicou-se questionário de caracterização e os seguintes protocolos de autoavaliação: Escala de Sintomas Vocais e Questionário de Investigação da Dor Musculoesquelética. Foi realizada análise estatística descritiva. A estatística inferencial comparou as variáveis entre mulheres e homens e realizou-se análise de correlação entre as variáveis de ambos os protocolos de autoavaliação por meio do teste de Spearman. Resultados Para todo o grupo estudado, observaram-se valores médios do escore total da Escala de Sintomas Vocais acima do ponto de corte do questionário, indicando risco para disfonia. Houve presença de dor nas regiões avaliadas, porém, em frequência baixa e intensidade leve. Verificou-se correlação positiva entre a frequência de dor nas regiões de pescoço, temporal, abaixo do queixo e laringe/garganta e a Escala de Sintomas Vocais. Mulheres apresentaram maior frequência de dor nos ombros, na região temporal e na laringe, quando comparadas aos homens. Conclusão A população de não profissionais da voz deste estudo apresentou escores elevados de sintomas de alteração vocal. A dor musculoesquelética foi pouco presente, com intensidade leve, porém, mais frequente em mulheres nas regiões próximas à laringe. Houve relação entre os sintomas vocais e a dor musculoesquelética, especialmente nas regiões proximais à laringe, de maneira que quanto maior a frequência da dor, maior a presença de sintomas vocais.

Abstract Objective To evaluate early complications in prepectoral breast reconstruction. Methods A retrospective cohort study including 180 consecutive cases of nipple-sparing mastectomy, comparing immediate breast reconstruction with subpectoral to prepectoral mammary implants in 2012-2022. Clinical and demographic characteristics and complications in the first three months following surgery were compared between the two techniques. Results The prepectoral technique was used in 22 cases (12.2%) and the subpectoral in 158 (87.8%). Median age was higher in the prepectoral group (47 versus 43.8 years; p=0.038), as was body mass index (25.1 versus 23.8; p=0.002) and implant volume (447.5 versus 409 cc; p=0.001). The prepectoral technique was more associated with an inframammary fold (IMF) incision (19 cases, 86.4% versus 85, 53.8%) than with periareolar incisions (3 cases, 13.6% versus 73, 46.2%); (p=0.004). All cases in the prepectoral group underwent direct-to-implant reconstruction compared to 54 cases (34.2%) in the subpectoral group. Thirty-eight complications were recorded: 36 (22.8%) in the subpectoral group and 2 (9.1%) in the prepectoral group (p=0.24). Necrosis of the nipple-areola complex/skin flap occurred in 27 patients (17.1%) in the subpectoral group (prepectoral group: no cases; p=0.04). The groups were comparable regarding dehiscence, seroma, infection, and hematoma. Reconstruction failed in one case per group (p=0.230). In the multivariate analysis, IMF incision was associated with the prepectoral group (aOR: 34.72; 95%CI: 2.84-424.63). Conclusion The incidence of early complications was comparable between the two techniques and compatible with previous reports. The clinical and demographic characteristics differed between the techniques. Randomized clinical trials are required.

O Brasil é um país com grande biodiversidade. Em sua flora, é encontrada a espécie Jatropha gossypiifolia L., conhecida popularmente como “pinhão-roxo”, “pião-roxo”, “pião-preto”, “jalapão”, “erva purgante” e “mamoninha”. Essa planta é muito utilizada na medicina popular do Brasil e de outros países por apresentar vários efeitos terapêuticos em decorrência da composição química da planta, onde é possível encontrar ácidos orgânicos, alcaloides, esteroides, flavonoides, taninos, fenóis, saponinas, entre outros constituintes. Este estudo teve como objetivo analisar os usos terapêuticos, a atividade farmacológica e a toxicologia da Jatropha gossypiifolia L. com base na literatura. A metodologia consistiu em selecionar artigos das bases de dados Pubmed, Google Scholar, Scielo e BVS e realizar uma análise através dos critérios de inclusão e exclusão. Através desse estudo, foi observado que o “pinhão-roxo” apresenta efeitos terapêuticos como: antimicrobiano, cicatrizante, diurético, analgésico, anti-hipertensivo, anti-inflamatório, entre outros citados no estudo, incluindo alguns contraditórios, como o antidiarreico e purgante. Apesar dos efeitos citados, a toxicologia da planta é um fator importante, destacando-se principalmente o látex presente no caule que apresenta atividade tóxica, além de alguns estudos indicarem também citotoxicidade e genotoxicidade. A J. gossypiifolia é uma planta que apresenta diversas propriedades farmacológicas que podem ser benéficas ou prejudiciais à saúde, sendo necessária uma análise mais aprofundada dos seus efeitos.

Objective: This paper analyzes the initial impacts of IFRS 9 adoption on banks’ credit impairment level in an international perspective. Specifically, we analyze the impact on banks' financial position and performance, the bank- and country-specific determinants of the impairment magnitudes and the informational effects of the new standard. Method: The study is based on a sample of 149 listed banks from 12 countries from G20 and bivariate and multivariate analyses are applied. Results: Results indicate that credit impairment recognized under IFRS 9 is larger than under IAS 39, suggesting a more conservative accounting model and that the new standard affected banks’ performance and financial position. We show that IFRS 9 implementation was significantly different among countries, especially between high- and low-income countries and the information under IFRS 9 is more value-relevant than IAS39. Contributions: We add to the previous literature by documenting the initial impact of IFRS 9 implementation on financial statements and on value relevance, as well as the bank- and country-specific determinants of the level of this impact.

This paper explores the relationship between working capital management (WCM) strategies and business performance during the COVID-19 crisis. Data from 1,067 non-financial European firms from 33 countries distributed across 6 economic sectors in the period from 2015 to 2021, feed Ordinary Least Squares model (OLS), robust and quantile pooled regression. COVID-19 crisis seems to have negatively influenced only median-low-range performance firms in Europe, showing that crisis coming from productive capacity hibernation do not impact nor impose tough slow recovery, transversal to all firms, as occurred on other financial crises. As for WCM, only median-top-range performance firms had significant statistical evidence for negative impact, that become positive for median-range performance firms during COVID-19. For Eurozone firms, there was an additional positive influence of the WCM on performance during COVID-19. Median-range performance firms seems to benefit from conservative WCM strategies mitigating firms’ performance negative effect raised by COVID-19 crisis. Relation between COVID-19 and WCM seems to be sensitive to different levels of firms’ performance and to different business’ economic sector. Contrary to knowledge on WCM, performance and financial crises in Europe, for COVID-19 alike crises, performance benefits from higher cash conversion cycles and thus encourage conservative WCM strategies. Liquidity should not be pushed by adopting aggressive WCM strategies.

The cowpea weevil (Callosobruchus maculatus) is the main post-harvest pest of the cowpea crop because it causes damage when it feeds on the grains during storage and, consequently, inflicts economic loss. Among the promising alternatives to the chemical control of the beetle in stored grains is the use of biological control by means of the parasitoid Dinarmus basalis. This parasitic relationship has been reported in several Brazilian states. This study aims to record the occurrence of this parasitoid associated with C. maculatus in stored cowpea grains in the municipality of Barra, in the São-Franciscano Valley Mesoregion of the state of Bahia. The stored grains were obtained of cowpea cultivars yield trials, conducted at the School Farm, belonging to the Federal University of Western Bahia (UFOB), located at the geographical coordinates of 11°04'53''S latitude and 43°11'08''W longitude. The experiments were installed in February 2023 and the harvests were carried out in April. The harvested grains were packed in transparent plastic bags and stored in a warehouse under ambient conditions. The presence of the parasitoid together with C. maculatus was observed during an inspection of the grains carried out in October 2023, around six months after harvest.