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The Fundao dam was designed to store iron mine tailings in the region of Mariana, MG, Brazil. When it ruptured, the tailings overflowed. These tailings affected the soil due to the formation of a thick crust as a result of drying (compaction) and hindered the natural revegetation process. In this context, the use of organic fertilizers, including vermicompost, is method of reducing the physical limitations on root growth caused by soil properties and changing soil-metal interactions. For this reason, vermicompost was added to iron mine tailings, and its morphological and physiological effects on maize, millet and sorghum plants were studied. The experiment was conducted in a greenhouse using 6 dm3 pots. The plants were subjected to three treatments: mine tailings, mine tailings + vermicompost, and a reference soil. From the V3 stage onwards, biweekly growth, leaf gas exchange and chlorophyll fluorescence evaluations were performed. At the end of the experiment, dry biomass and metal, macro- and micronutrient contents were quantified, and the root morphology was evaluated. The tailings created physical limitations on root growth and had low nutrient content as well as high concentrations of chromium, iron and manganese. The addition of vermicompost favored increases in shoot and root dry biomass, increases in root length, volume, surface area and diameter, and the absorption of macro- and micronutrients, which was reflected in the growth of the studied species. In addition, vermicompost led to greater investment in thick and very thick roots, and in general, the plants showed no symptoms of metal toxicity. Considering the characteristics of the studied tailings, it can be concluded that vermicompost favors the growth of plant species and may be a viable method for beginning the recovery process in areas containing iron mine tailings.

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate ≥25 mL/min/1.73 m2 and albuminuria (urinary albumin-to-creatinine ratio ≥30 to ≤5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level α = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049.

Resumen Este artículo expone la conceptualización, características, investigaciones nacionales e internacionales acerca de los ambientes de aprendizaje. Para esto, se realizó una revisión bibliográfica de aproximadamente cincuenta fuentes. A partir de estas, se elaboró la conceptualización y las características que según los autores consultados deberían tener los ambientes de aprendizaje para ser efectivos en los procesos de enseñanza-aprendizaje. Asimismo, se desarrolló un panorama internacional, estructurado por continentes, de investigaciones en las que se identificaron diversos elementos de estudio; y uno nacional, divido por regiones, en el que se evidencian definiciones, investigaciones y trabajos realizados, todo esto siguiendo un orden cronológico. Finalmente, se enfocó en cómo Colombia puede mejorar los ambientes de aprendizaje a través del rol del docente y su formación. Abstract This article presents the conceptualization, characteristics, national and international research on learning environments. For this purpose, a bibliographic review of approximately fifty sources was carried out. Based on these, the conceptualization and characteristics that learning environments should have in order to be effective in teaching-learning processes were elaborated according to the authors reviewed. Likewise, an international overview structured by continents was developed on research in which diverse elements of study were identified; and a national overview divided by regions, in which definitions, research and work carried out are evidenced, all following a chronological order. Finally, the paper focuses on how Colombia can improve learning environments through the role of teachers and their training. Resumo Este artigo expõe a conceituação, características, pesquisas nacionais e internacionais sobre ambientes de aprendizagem. Para isso, foi realizada uma revisão bibliográfica de aproximadamente cinquenta fontes. A partir delas, foram elaboradas a conceituação e as características que, segundo os autores consultados, deveriam ter os ambientes de aprendizagem eficazes para serem efectivos nos processos de ensino-aprendizagem. Da mesma forma, foi desenvolvido um panorama internacional de pesquisas, estruturado por continentes, pesquisas nas quais foi possível identificar vários elementos de estudo; e um outro panorama nacional, dividido por regiões, nas quais são evidenciadas definições, pesquisas e trabalhos desenvolvidos, todos seguindo uma ordem cronológica. Por fim, concentrou-se em como a Colômbia pode melhorar os ambientes de aprendizagem através do papel dos professores e de seu treinamento.

Background: Mitral valve repair in paediatric patients with chronic rheumatic heart disease is superior to valve replacement and has been used with good results. Objective: To identify predictors of unfavourable outcomes in children and adolescents submitted to surgical mitral valvuloplasty secondary to rheumatic heart disease. Methods: Retrospective study of 54 patients under the age of 16 operated at a tertiary paediatric hospital between March 2011 and January 2017. The predictors of risk for unfavourable outcomes were: age, ejection fraction, degree of mitral insufficiency, degree of pulmonary hypertension, presence of tricuspid insufficiency, left chamber dilation, preoperative functional classification, duration of cardiopulmonary bypass, duration of anoxia, presence of atrial fibrillation, and duration of vasoactive drug use. The outcomes evaluated were: death, congestive heart failure, reoperation, residual mitral regurgitation, residual mitral stenosis, stroke, bleeding and valve replacement. For all analyzes a value of p < 0.05 was established as significant. Results: Of the patients evaluated, 29 (53.7%) were female, with an average of 10.5 ± 3.2 years. The functional classification of 13 patients (25%) was 4. There was no death in the sample studied. The average duration of extracorporeal circulation was 62.7±17.8 min, and anoxia 50 ± 15.7 min. The duration of use of vasoactive drug in the immediate postoperative period has an average of 1 day (interquartile interval 1-2 days). The logistic regression model was used to evaluate the predictive variables for each unfavourable outcome. The duration of use of vasoactive drug was the only independent predictor for the outcomes studied (p = 0.007). Residual mitral insufficiency was associated with reoperation (p = 0.044), whereas tricuspid insufficiency (p = 0.012) and pulmonary hypertension (p = 0.012) were associated with the presence of unfavourable outcomes. Conclusion: The duration of vasoactive drug use is an independent predictor for unfavourable outcomes in the immediate and late postoperative period, while residual mitral regurgitation was associated with reoperation, and both tricuspid regurgitation and pulmonary hypertension were associated with unfavourable outcomes. Resumo Fundamento: A plastia da valva mitral, em pacientes pediátricos com cardiopatia reumática crônica, é superior à troca valvar e vem sendo utilizada com bons resultados. Objetivo: Identificar variáveis preditoras de desfecho desfavorável em crianças e adolescentes submetidos à valvoplastia mitral cirúrgica secundária à cardiopatia reumática. Métodos: Estudo retrospectivo em 54 pacientes menores de 16 anos, operados em um hospital pediátrico terciário entre março de 2011 e janeiro de 2017. As variáveis preditoras de risco para desfecho desfavorável foram: idade, fração de ejeção, grau de insuficiência mitral, grau de hipertensão pulmonar, presença de insuficiência tricúspide, dilatação de câmaras esquerdas, classe funcional no pré-operatório, tempo de circulação extracorpórea, tempo de anóxia, presença de fibrilação atrial e tempo de uso de droga vasoativa. Os desfechos avaliados foram: morte, insuficiência cardíaca congestiva, reoperação, insuficiência mitral residual, estenose mitral residual, acidente vascular cerebral, sangramento e troca valvar. Para todas as análises foi estabelecido valor de p < 0,05 como significante. Resultados: Dos pacientes avaliados, 29 (53,7%) eram do sexo feminino, com média de idade de 10,5 ± 3,2 anos. A classe funcional de 13 pacientes (25%) foi 4. Não houve morte na amostra estudada. O tempo médio de circulação extracorpórea foi de 62,7 ± 17,8 minutos e de anóxia 50 ± 15,7 minutos. O tempo de uso de droga vasoativa no pós-operatório imediato teve mediana de 1 dia (intervalo interquartil 1-2 dias). O modelo de regressão logística foi utilizado para avaliar as variáveis preditoras para o desfecho desfavorável. O tempo de uso de droga vasoativa foi o único preditor independente para os desfechos estudados (p = 0,007). A insuficiência mitral residual foi associada à reoperação (p = 0,044), enquanto a insuficiência tricúspide (p = 0,012) e a hipertensão pulmonar (p = 0,012) se associaram à presença de desfechos desfavoráveis. Conclusão: O tempo de uso de droga vasoativa é um preditor independente para desfechos desfavoráveis no pós-operatório imediato e tardio, enquanto insuficiência mitral residual se associou à reoperação e tanto a insuficiência tricúspide quanto a hipertensão pulmonar foram associadas a desfechos desfavoráveis.

BACKGROUND: Pulmonary hypertension in response to exercise is a marker of the hemodynamic severity of mitral stenosis (MS). However, the factors related to elevated pulmonary pressure with exercise are not well defined. The aim of this study was to assess the parameters associated with the pulmonary pressure response to exercise in patients with pure rheumatic MS. An additional aim was to determine the impact of exercise-induced pulmonary hypertension on clinical outcome. METHODS: One hundred thirty patients with MS (94% women; mean age, 45 ± 11 years) underwent exercise echocardiography. A range of echocardiographic parameters were obtained at rest and at peak exercise. Symptom-limited graded ramp bicycle exercise was performed in the supine position. The primary end point was mitral valve intervention, either percutaneous or surgical. RESULTS: In the overall population, systolic pulmonary artery pressure (SPAP) increased from 38.3 ± 13.4 mm Hg at rest to 65.8 ± 20.7 mm Hg during exercise. Increases in mean mitral gradient, right ventricular function, left atrial volume, and net atrioventricular compliance were independently associated with SPAP at peak exercise, after adjusting for changes in heart rate. During the follow-up period (median, 17 months; range, 1–45 months), 46 adverse clinical events were observed. By multivariate Cox proportional-hazards analysis adjusted for age and sex, SPAP achieved at peak exercise was an important predictor of adverse outcome (adjusted hazard ratio, 1.025; 95% CI, 1.010–1.040; P = .001). New York Heart Association functional class (adjusted hazard ratio, 2.459; 95% CI, 1.509–4.006; P < .001) and the interaction between valve area and net atrioventricular compliance (P = .001) were also significant predictors of adverse events. Time-dependent areas under the receiver operating characteristic curve for the model with SPAP during exercise were better than for the model with SPAP at rest, with a significant improvement from 3 years onward. CONCLUSIONS: In patients with MS, the pulmonary artery pressure response to exercise is determined by a combination of factors, including transmitral mean gradient at exercise, net atrioventricular compliance, left atrial volume, and right ventricular function. Pulmonary artery pressure at peak exercise is a predictor of clinical outcomes and adds incremental prognostic value beyond that provided by standard resting measurements, including valve area. (J Am Soc Echocardiogr 2020;33:550–8.)

Improving the storage of minimally processed mangoes represents a substantial challenge for packaging. For this purpose, thermoplastic starch (TPS) and its composites with bacterial cellulose nanoribbons (TPS/BC) are used as wrapping materials to prolong the shelf life of minimally processed mangoes. Commercial polyvinyl chloride stretch (PVC) films and unwrapped mangoes are used as the controls. The samples were stored at 75% RH and 5 °C for five and ten days. The films are removed after storage and subjected to mechanical tests and physical evaluation. The weight loss, firmness, total soluble solids, and total titratable acidity in the mangoes are tested to monitor fruit ripening. ATR-FTIR is used as an alternative nondestructive technique to examine fruit quality through changes in the sugar and organic acid contents. The results showed that TPS films reduced mango weight loss until the fifth day (2.84%), whereas the reduction in weight loss seen in mangoes wrapped with TPS/BC is even lower (13.18%). Therefore, even though both TPS and TPS/BC films can be used to prolong the fruit shelf life for five days, the latter is more effective. The elongations at break of both film samples remained constant over time, which means that these films can be used under stress conditions. Fil: Montoya Rojo, Ursula Maria. Universidad Pontificia Bolivariana; Colombia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Tecnología en Polímeros y Nanotecnología. Universidad de Buenos Aires. Facultad de Ingeniería. Instituto de Tecnología en Polímeros y Nanotecnología; Argentina Fil: Zuluaga, Robin. Universidad Pontificia Bolivariana; Colombia Fil: Castro, Cristina. Universidad Pontificia Bolivariana; Colombia Fil: Velez, Lina. Universidad Pontificia Bolivariana; Colombia Fil: Gañán, Piedad. Universidad Pontificia Bolivariana; Colombia

Objectives To evaluate the effect of Care Quality Commission external inspections of acute trusts on adverse event rates in the English National Health Service. Methods Interrupted time-series analysis including all acute NHS trusts in England ( n = 155) using two control groups (new versus historical inspection regime and trusts not inspected). Multilevel random-coefficient modelling of (1) rates of falls with harm and (2) pressure ulcers, from April 2012 to June 2016, was undertaken using the new, resource-intensive regime of Care Quality Commission inspections as an intervention. Data used in the model included dates and type of inspection, patient safety indicators, demographic characteristics and financial risk of hospitals. Results In one year, Care Quality Commission inspected 66 acute trusts (42% of all English trusts) using their new regime and 46 (30%) using their previous one. Prior to inspections being announced, rates of falls with harm and pressure ulcers were improving in both intervention and control hospitals. The announcement of an inspection did not affect either indicator. After inspections, rates of falls with harm improved more slowly, and pressure ulcer rates no longer improved for trusts inspected using both regimes. Conclusions Neither form of external inspection was associated with positive, clinically significant effects on adverse event rates. Any improvement happening before the announced Care Quality Commission inspections slowed after the inspection.

Introduction Hypoparathyroidism is a rare disease. In low and medium-income countries there is limited data of clinical characteristics and patterns of clinical practice of patients with hypoparathyroidism. Methods Observational cross-sectional study in a tertiary care university hospital in Colombia. The clinical charts of adult patients with diagnosis of hypoparathyroidism were included. Inclusion criteria were a diagnosis of hypoparathyroidism with a PTH less than 20 pg/mL associated with hypocalcemia. Major results 108 patients fulfilled inclusion criteria. 91.7% (n=99) were women and 8.3% (n=9) were men. Mean age was 51.6 years (SD 15.5). 99.1% of patients were Hispanic and 0.9% were African American. Comorbidities were HTN in 42.6%, CAD in 3.7%, DM2 in 6.5%, dyslipidemia in 21.3%, PAD in 5.6%, Afib in 1.9%, stroke in 2.8%, valve heart disease in 0.9%, hypothyroidism in 88.9%, and thyroid cancer in 51.9% The etiology of hypoparathyroidism was postsurgical (93.5%), followed by idiopathic hypoparathyroidism (4.6%), post-radiation (0.9%), and unknown causes in (0.9%). Mental illness was found in 16.7% of cases, osteo-muscular compromise in 27.8%, carpo-pedal spam was referred by 15.7% of patients, and paresthesia in 35.2%. Seizures were reported by 9.3% of patients and basal ganglia calcification was found in 5.6% of cases. Trousseau sign was reported in 13% of cases and Chvostek in 6.5%. Initial calcium was 7.8 mg/dL (SD 1.8), the mean lowest calcium was 7.2 mg/dL SD 1.5, the last known urinary calcium was 237.4 mg/day (SD 48.08). However, it was only measured in 20 patients. The mean PTH level was 6.9 pg/ml (SD 0.54). Nephrocalcinosis was found in 2.8% of cases and nephrolithiasis in 3.7%. Patients required a mean of 0.7 emergency room consults, however, the range was wide from 0 to 21 consults. Median elemental calcium dose at last control was 960 mg/day (p25-p75 480-1440), median calcitriol dose was 0.5 ug/day (p25-p75 0.5-1.0). However, 13.8% of patients required more than 2000 mg/day of elemental calcium. PTH analogs were used in 1.9% of cases (n=2). Biochemical control of the disease was achieved in 50% of patients. Interpretation of the results and conclusions Our data suggest that patients with hypoparathyroidism from a medium income country share a similar clinical profile with patients from high-income countries. However, the biochemical control of the disease is low. Post-surgical hypoparathyroidism is the most common cause of hypoparathyroidism (93.6%) and its frequency is higher than other countries (75%), this suggests limitations in surgical performance or decreased detection of other rare etiologies. This study present for first time systematic data in Colombia and is one of the first studies in medium income countries.

Bioactive compounds (BC) present in muicle leaves were extracted using the best extraction conditions obtained with a Box–Behnken experimental design, extracting 95% of BC. Microencapsulation of muicle BC was carried out by spray drying using DE10 maltodextrin (MD) and soy protein isolate (SPI) as encapsulating agents. The best conditions for the ethanolic extraction of BC from muicle were 30 °C, 40% aqueous ethanol, and one extraction for 1 h. The best spray drying encapsulating conditions for BC and antioxidant capacity (AC) using MD as an encapsulating agent were: 160–80 °C and 10% MD in the feeding solution, and for SPI: 180–70 °C and 5% SPI in the feeding solution. Microcapsules were added to yogurt and a sensory evaluation and retention of BC during 15-day storage at 4 °C was performed. Sensory evaluation showed that yogurt with added MD microcapsules had better acceptance than that with SPI microcapsules. Based on this, a jelly with added muicle MD microcapsules was also prepared which obtained better acceptance by the judges. At the end of the storage period, yogurt with SPI microcapsules showed better retention of BC and AC than yogurts with MD microcapsules, however, products with MD microcapsules had better acceptance.

The aim of this study was developing formulations of H. undatus Haw. jam with pulp and peel, as well as evaluating nutritional compounds and texture properties through sensorial, instrumental, physical, biochemical and microbiological analyses of the final product. The fruit were selected, sanitized, pulped and grinded, and the formulations with different concentrations of pulp and peel (0 – 100%) were developed and evaluated. Microbiological evaluation showed that the formulations are in accordance with the current legislation. The increase in peel concentration in the jam formulations resulted in better consumer acceptance and higher concentration of phenolic compounds, antioxidants and B complex vitamins, such as B1, B5 and B6. In addition, it gave the jams acceptable and pleasant sensorial characteristics and texture. Adding peel to the formulations enabled us to make total use of the fruit, with no waste, besides making the coproduct richer in compounds that are beneficial to consumers’ health. El objetivo de este estudio fue desarrollar formulaciones de gelatina a partir de H. undatus Haw. con pulpa y piel, además de evaluar compuestos nutricionales y propiedades texturales mediante análisis sensorial, instrumental, físico, bioquímico y microbiológico del producto final. Los frutos fueron seleccionados, higienizados, despulpados y molidos, y se desarrollaron y evaluaron formulaciones con diferentes concentraciones de pulpa y piel (0 - 100%). La evaluación microbiológica mostró que las formulaciones están de acuerdo con la legislación vigente. El aumento de la concentración del peeling en las formulaciones de gelatina resultó en una mejor aceptación por parte del consumidor y una mayor concentración de compuestos fenólicos, antioxidantes y vitaminas B, como B1, B5 y B6. Además, estas formulaciones mostraron características sensoriales aceptables y agradables. La incorporación de las cáscaras a las formulaciones permitió aprovechar al máximo la fruta, sin desperdicio, además de enriquecer el coproducto en compuestos beneficiosos para la salud del consumidor. O objetivo deste estudo foi desenvolver formulações de geleia a partir de H. undatus Haw. com polpa e casca, além de avaliar compostos nutricionais e propriedades de textura por meio de análises sensoriais, instrumentais, físicas, bioquímicas e microbiológicas do produto final. Os frutos foram selecionados, sanitizados, despolpados e moídos, e as formulações com diferentes concentrações de polpa e casca (0 - 100%) foram desenvolvidas e avaliadas. A avaliação microbiológica mostrou que as formulações estão de acordo com a legislação vigente. O aumento da concentração da casca nas formulações de geleias resultou em melhor aceitação pelo consumidor e maior concentração de compostos fenólicos, antioxidantes e vitaminas do complexo B, como B1, B5 e B6. Além disso, estas formulações apresentaram características sensoriais aceitáveis e agradáveis. Adicionar as cascas às formulações possibilitou o aproveitamento total da fruta, sem desperdício, além de enriquecer o coproduto em compostos benéficos à saúde do consumidor.

Introdução: A Diabetes Mellitus (DM) estabelece um importante obstáculo para a saúde pública mantendo-se relacionado à qualificação das Unidades Básicas de Saúde (UBS). Por ser uma doença crônica, a DM pode acarretar danos sem possibilidades de serem revertidos e que refletem de maneira negativa na condição de vida dos indivíduos acometidos por esta patologia. Como decorrência do cuidado inadequado, podem surgir prejuízos nas extremidades do portador dessa patologia. É especialmente nas unidades básicas onde os funcionários da área da saúde precisam elaborar técnicas que viabilizem planos de cuidados que auxiliem na contribuição da assistência adequada e prevenção de agravos. Objetivo: Identificar através do estudo as dificuldades enfrentadas pelos profissionais e descrever quais as possíveis soluções para facilitar o cuidado para com a pessoa acometida por DM na atenção primária. Metodologia:Trata-se de um estudo de abordagem qualitativa, do tipo revisão integrativa no qual consta no procedimento de seis etapas que são a identificação do tema e seleção da hipótese, estabelecimento da estratégia de pesquisa, definição e coleta de dados, análise dos dados coletados, interpretação e apresentação dos resultados, onde será abordado o cuidado com o pé diabético na atenção básica. A estratégia de identificação e seleção dos artigos originou-se através da busca da Biblioteca Virtual de Saúde (BVS), com acesso as seguintes bases de dados eletrônicas como a Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE), Banco de Dados em Enfermagem (BDENF) e Scientific Electronic Library Online - Biblioteca Científica Eletrônica em Linha (SCIELO). Foram, também, realizadas buscas manuais nas listas de referências dos artigos selecionados no mês de março de 2021. Foram utilizados os seguintes descritores em ciências da saúde (DeCS): Diabetes mellitus; Pé diabético; Atenção primária e uso do boleador “and”. Foram adotados os seguintes critérios de inclusão para seleção dos artigos: materiais completos, em português e inglês, no formato de artigo e com recorte temporal de 2010 a 2020. Os critérios de exclusão foram os artigos duplicados, incompletos e que não atendiam a temática do estudo. Resultados: Após pesquisa minuciosa foram encontradas duas categorias: 1- A importância da prevenção das lesões no pé diabético para evitar danos irreversíveis à saúde e 2- O entendimento do público diabético quanto aos cuidados com os pés. Considerações Finais: Ao final da pesquisa foi possível concluir a importância da assistência fornecida pelo enfermeiro ao paciente diabético na Atenção Básica de Saúde. Sua função vai muito além de avaliar o estado geral do cliente, mas também há um papel de educador.

The Conyza sp. is an annual or short-lived perennial weed of the Asteraceae family. Fructans are linear fructose polymers used in the food industry as a prebiotic nutrient, fat, and sugar substitute and in the pharmaceutical industry as a drug delivery system. The objective of this study was to chemically characterize preliminarily fructans from Conyza sp. roots: fructooligosaccharides (FOS) and inulin-type and evaluated the prebiotic potential activity of these molecules in vitro. Chemical analyses (1H NMR, 13C NMR, GC-MS, FT-IR, and off-line ESI-HRMS) confirmed the presence of the fructans molecules in the aqueous crude extracts of Conyza sp. roots. The study of the prebiotic effect of Conyza sp. fructans in vitro showed an ability to stimulated lactobacilli strains with growth slightly similar (Conyza FOS) and smaller (Conyza inulin) than the commercial prebiotic inulin available (Orafti® GR). These data suggest that Conyza sp. a weed that causes problems agronomic can be used as a promising source to obtain fructans, compounds with potential in the food and technological industries.

Bacterial cellulose (BC), which is a hemicellulose- and lignin-free type of cellulose with unique properties, was produced by Komagataeibacter medellinensis, a new acid-resistant bacterial strain, using not suitable human consumption and sub-valorized food supply chain waste (FSCW) and agricultural by-products, namely, rotten banana, rotten mango and cheese whey. The BC was analyzed using Fourier transform infrared (ATR-FTIR) , tensile test, atomic absorption spectroscopy and thermogravimetric analysis. The properties of the BC obtained from each culture medium used were different, ranging from a material with high resistance and stiffness (280.6 MPa, 9.4 GPa) to a material with low resistance and less stiffness (17.7 MPa, 0.8 GPa). These properties provide considerable opportunities for obtaining different materials with multiple applications, such as composite reinforcements, wound dressings and edible films. The highest production of BC was achieved with rotten banana medium, and this BC also had the highest tensile properties. Meanwhile, the BC produced from cheese whey medium had the highest maximum rate of degradation temperature at 368 °C. This research demonstrated that FSCW and agrowaste by-products are advantageous alternative feedstocks in terms of economics and environmental concerns for producing BC with multiple properties and fields of application.

A técnica de CPR Grouting consiste no bombeamento de argamassa no interior da camada de solo mole sob elevadas pressões, com geodrenos colocados previamente entre as zonas a injectar. O tratamento resulta na diminuição do índice de vazios da camada compressível e no aumento da resistência, conduzindo a uma redução significativa dos recalques. O presente trabalho tem como objetivo comparar o comportamento de dois aterros experimentais, executados sobre solo mole, a partir de dados de instrumentação. Em um dos aterros, foi adotada a técnica CPR Grouting para o enrijecimento do solo. O segundo aterro foi executado apenas com geodrenos. Os aterros foram implementados em uma área no Recreio dos Bandeirantes, Rio de Janeiro, que apresenta espessuras de solo mole da ordem de 8,0 m. Os resultados permitiram avaliar a eficiência da técnica. Observou-se uma redução significativa dos recalques sobre o solo enrijecido, uma diminuição dos deslocamentos horizontais, e uma aceleração expressiva dos recalques.

This study isolated and identified the fungus that causes postharvest disease in dragon fruit (Hylocereus undatus Haw.). The in vitro and in vivo antifungal activity of some essential oils were evaluated against the fungus. Morphophysiological and molecular identification confirmed the fungus was Alternaria alternata. The essential oils of Cinnamomum zeylanicum, Cymbopogon flexuosus, Eucalyptus globulus, Eugenia caryophyllus, and Rosmarinus officinalis were evaluated by the microdilution broth technique, disc diffusion, scanning electron microscopy, and fluorescence microscopy. Evaluation of the composition of the essential oils by gas chromatography/mass spectrometry revealed substantial amounts of eugenol as a major constituent of E. caryophyllus and C. zeylanicum (90.50% and 80.70%, respectively). The other essential oils of R. officinalis contained α-pinene (24.5%) and camphor (22.0%) as major components. E. globulus contained 1,8-cineole (78.9%). C. flexuosus contained neral (35.1%) and geranial (42.6%). C. zeylanicum and E. caryophyllus were the most active against the isolated fungi at minimum inhibitory concentrations of 250 and 500 μg/ml, respectively, causing morphological changes in the hyphae. The in vivo assay indicated that the fruits that were treated with E. caryophyllus at concentrations of 500 and 1000 μg/ml exhibited a 31% reduction of mycelial growth compared with the control. These results suggest that the essential oils of C. zeylanicum and E. caryophyllus are active against A. alternata both in vitro and in vivo, which may be promising for control of the microorganism.

We investigated wound dressing composites comprising fibrils of bacterial cellulose (BC) grown by fermentation in the presence of polyvinyl alcohol (PVA) followed by physical crosslinking. The reference biointerface, neat BC, favoured adhesion of fibroblasts owing to size exclusion effects. Furthermore, it resisted migration across the biomaterial. Such effects were minimized in the case of PVA/BC membranes. Therefore, the latter are suggested in cases where cell adhesion is to be avoided, for instance, in the design of interactive wound dressings with facile exudate control. The bioactivity and other properties of the membranes were related to their morphology and structure and considered those of collagen fibres. Bioactive materials were produced by simple 3D templating of BC during growth and proposed for burn and skin ulcer treatment.

espanolEn este articulo, nos aproximamos a la construccion de la voz autoral en las tesis de doctorado en una disciplina humanistica: la filosofia. Nuestro proposito es mostrar, a partir de un estudio exploratorio centrado en la identificacion de marcas de primera persona y atribucion, la forma como los doctorandos construyen una identidad como escritores/investigadores de acuerdo con las exigencias del genero en esta area de formacion. Los resultados muestran que los tesistas tienen una marcada orientacion a construirse una imagen de especialistas que dominan el contenido disciplinar; sin embargo, son escasos los momentos en los que se asume un rol de autor-investigador que manifiesta un compromiso con la tarea indagatoria. Este hecho nos lleva a abrir la reflexion sobre el tema de la formacion de investigadores en el area de las humanidades, y la necesidad de proponer planes de intervencion en el marco de la alfabetizacion academica y cientifica que permitan a los egresados de estos programas convertirse en autores que eleven la visibilidad del area en el contexto academico local e internacional EnglishIn this article we approach the construction of authorial voice in doctorate theses of a humanistic discipline: philosophy. Our purpose is to illustrate, based on an exploratory study focused on the identification of marks of the first person and attribution, the way in which doctorate candidates construct an identity as writers/researchers according to the requirements of the discourse genre in this area. The results show that dissertation writers have a strong tendency to construct their identity as specialists who master the disciplinary content; however, the times, when they incorporate the role of authorresearchers, are rare. This fact leads us to open discussion as regards the training of researchers in the area of Humanities, and the need to propose intervention plans concerning academic and scientific literacy, which allow graduates of these programs to become writers who raise the visibility of the field in local and international academic contexts

The tomato crop plays an important environmental, economic and even social role, especially for creating employment and income. The present work aims to evaluate the effects of potassium (K) drip fertigation and of conventional K fertilization on the tomato crop quality. The experiment was conducted under field conditions, in the period between August 2011 and December 2011, in Fortaleza, CE, Brazil. The experimental design was in randomized blocks in a factorial arrangement and the treatments corresponded to doses (D1 = 200, D2 = 400 and D3 = 800 kg K2O ha-1) and K fertilizing methods (F1 - Fertigation and F2 - Conventional fertilization), plus an additional control (without K fertilization) for each fertilizing method, with four replicates. The following variables were analyzed: fruit firmness (FF), soluble solids content (SS), titratable acidity (TA), pH and SS/TA ratio. K fertilization through fertigation (400 kg K2O ha-1) increases SS and the SS/TA ratio of the tomato fruits. Thus, K fertigation is the most promising method, since it allows the use of a lower K dose. RESUMO A cultura do tomateiro desempenha papel relevante socioambiental e econômico, notadamente pela possibilidade de sua utilização como matéria prima na geração de emprego e renda. Objetivou-se, com o presente trabalho, a avaliação do efeito da adubação potássica aplicada via fertigação por gotejamento e de forma convencional na qualidade de frutos de tomate. O experimento foi conduzido em campo, no período entre agosto e dezembro de 2011, em Fortaleza, Ceará. O delineamento experimental foi em blocos ao acaso no esquema fatorial sendo estudados os fatores doses (D1 = 200; D2 = 400 e D3 = 800 kg ha-1 de K2O) e formas de aplicação (F1 - Fertirrigação e F2 - Adubação convencional) e uma testemunha adicional (controle-sem adubo potássico) para cada forma de aplicação com quatro repetições. Foram analisadas as seguintes variáveis: firmeza dos frutos (FF), teor de sólidos solúveis (SS), acidez titulável (AT), pH e a relação (SS/AT). A adubação potássica aplicada de forma fertigada (400 kg ha-1 de K2O) aumenta os SS e a relação SS/AT dos frutos de tomateiro. Desta forma, a fertigação potássica é mais promissora haja vista que este método permite maior fracionamento das doses a serem aplicadas.

Made available in DSpace on 2018-12-11T17:04:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-11-01 Diabetes has become a global epidemic. Its complications can have a significant impact on quality of life, longevity, and public health costs. The presence of diabetes might impair the prognosis of periodontal treatments due to its negative influence on wound healing. Antimicrobial photodynamic therapy (aPDT) is a local approach that can promote bacterial decontamination in periodontal pockets. The aim of this study was to investigate the local effect of adjunct aPDT to ultrasonic periodontal debridement (UPD) and compare it to UD only for the treatment of chronic periodontitis in type 2 diabetic patients. Twenty type 2 diabetic patients with moderate to severe generalized chronic periodontitis were selected. Two periodontal pockets with probing depth (PD) and clinical attachment level (CAL) ≥5 mm received UPD only (UPD group) or UPD plus adjunct aPDT (UPD + aPDT group). Periodontal clinical measures were collected and compared at baseline and 30, 90, and 180 days. After 180 days of follow-up, there were statistically significant reductions in PD from 5.75 ± 0.91 to 3.47 ± 0.97 mm in the UPD group and from 6.15 ± 1.27 to 3.71 ± 1.63 mm in the UPD + aPDT group. However, intergroup analysis did not reveal statistically significant differences in any of the evaluated clinical parameters (p > 0.05). The adjunct application of aPDT to UPD did not present additional benefits for the treatment of chronic periodontitis in type 2 diabetic patients. The ClinicalTrials.gov identifier of the present study is NCT02627534. Department of Diagnosis and Surgery - Division of Periodontics College of Dentistry – FOSJC UNESP – Sao Paulo State University, Av. Eng. Francisco José Longo, 777 Department of Biosciences and Oral Diagnosis College of Dentistry – FOSJC UNESP – Sao Paulo State University, Av. Eng. Francisco José Longo, 777 Department of Diagnosis and Surgery - Division of Periodontics College of Dentistry – FOSJC UNESP – Sao Paulo State University, Av. Eng. Francisco José Longo, 777 Department of Biosciences and Oral Diagnosis College of Dentistry – FOSJC UNESP – Sao Paulo State University, Av. Eng. Francisco José Longo, 777

The deconstruction of the hierarchical structure of cellulose results in the production of cellulose nanofibrils (CNFs). CNFs are commonly obtained by grinding and high-pressure homogenization processes and both treatments can be simultaneously used. Nevertheless, the influence of a two-stage high pressure homogenization of previously ground CNFs on the nanofibril diameter and the physical, thermal and mechanical properties of the resulting films has not been reported. The present study aims at understanding the changes exerted in cellulose after grinding and subsequent passing through the first and second stage of a high-pressure homogenizer. The films prepared from the resulting CNFs were analyzed by electron microscopy, infrared spectroscopy, X-ray diffraction, viscometry, thermal degradation and tensile tests. The data indicate that the initial grinding treatment prompted the most remarkable changes, resulting in enhanced mechanical properties of the films, while decreasing its thermal stability, intrinsic viscosity and crystallinity. Further fibrillation in a high-pressure homogenizer did not have a significant effect, except a decrease in thermal stability and intrinsic viscosity.

ResumenObjetivoValorar la aceptabilidad de la prueba del virus de la inmunodeficiencia humana (VIH) mediante búsqueda oportunista.DiseñoEstudio observacional, transversal.EmplazamientoCentros de atención primaria (CAP) del Sistema Nacional de Salud.ParticipantesPacientes de 18 a 65años a los que hubiese que realizar una analítica y que nunca antes se hubiesen realizado la prueba del VIH.Mediciones principalesEdad, sexo, pareja estable, nivel de instrucción, consumo de tabaco/alcohol, motivo de la analítica, aceptabilidad de la prueba del VIH, motivo por el que no acepta o por el que no se le ha realizado antes. Se realizó un análisis estadístico descriptivo, bivariante y multivariante (regresión logística).ResultadosDoscientos ocho médicos de 150 CAP captaron 3.314 pacientes. La aceptabilidad del test del VIH fue del 93,1% (IC95%: 92,2-93,9). De estos, el 56,9% no se la habían realizado antes por no considerarse en riesgo, y el 34,8% por no habérsela ofertado su médico. Del 6,9% que rechazaron la serología, el 73,9% alegaron no considerarse en riesgo. Mediante análisis de regresión logística las variables que mostraron relación con la aceptabilidad de la prueba positivamente fueron: la edad (grupo de 26 a 35años; OR=1,79; IC95%:1,10-2,91) y ser no fumador (OR=1,39; IC95%: 1,01-1,93). Los residentes en poblaciones entre 10.000 y 50.000 habitantes (OR=0,57; IC95%: 0,40-0,80) fueron los que en menor grado aceptaron la prueba. La prevalencia de VIH detectada fue del 0,24%.ConclusionesLa prueba serológica del VIH tiene una alta aceptación entre los usuarios que acuden para hacerse un análisis de sangre a los CAP. La búsqueda oportunista es coste-efectiva.AbstractObjectiveTo assess the acceptability of opportunistic search for human immunodeficiency virus (HIV).DesignCross-sectional, observational study.LocationPrimary Care Centres (PCC) of the Spanish National Health Care System.Participantspatients aged 18 to 65 years who had never been tested for HIV, and were having a blood test for other reasons.Recorded variablesage, gender, stable partner, educational level, tobacco/alcohol use, reason for blood testing, acceptability of taking the HIV test, reasons for refusing to take the HIV test, and reasons for not having taken an HIV test previously. A descriptive, bivariate, multivariate (logistic regression) statistical analysis was performed.ResultsA total of 208 general practitioners (GPs) from 150 health care centres recruited 3,314 patients. Most (93.1%) of patients agreed to take the HIV test (95%CI: 92.2-93.9). Of these patients, 56.9% reported never having had an HIV test before because they considered not to be at risk of infection, whereas 34.8% reported never having been tested for HIV because their doctor had never offered it to them. Of the 6.9% who refused to take the HIV test, 73.9% considered that they were not at risk. According to the logistic regression analysis, acceptability was positively associated to age (higher among between 26 and 35 year olds, OR=1.79; 95%CI: 1.10-2.91) and non-smokers (OR=1.39; 95%CI: 1.01-1.93). Those living in towns with between 10,000 and 50,000 inhabitants showed less acceptance to the test (OR=0.57; 95%CI: 0.40-0.80). The HIV prevalence detected was 0.24%ConclusionsAcceptability of HIV testing is very high among patients having a blood test in primary care settings in Spain. Opportunistic search is cost-effective.

With the advent of special education in Brazil boosted by the Salamanca Declaration (1994), some theoretical positions presented themselves, such as the full inclusion of persons with disabilities in ordinary schools and the inclusion from the look from the perspective of the development of higher psychological functions (VYGOTSKY, 1997). In addition, there are other theoretical positions and intermediate educational practices aimed at organic conditions of students with disabilities and to the possibilities of integration of those more committed in relation to disability in specialized education centers. From these considerations is that aims to understand the contributions of the authors of 12 articles of the Brazilian Journal of Special Education (RBEE) on special education in higher education, as well as the prospects for the students of special education target audience (PAEE) that enters the higher education. The qualitative approach, from the perspective of Cultural-historical. Psychology, has guided the analysis of these RBEE productions, in the period from 2010 to 2014. As a result it was found that the students who reach the PAEE higher education face difficulties through veiled prejudice, physical accessibility, inadequate curriculum, among others. It can be concluded that the inclusion of students PAEE lacks attention, since Kindergarten, with educational work guided in developing their higher psychological functions, so you can overcome the barriers located at all levels of schooling, so as to contribute to not only reach to higher education, but also (and especially) that come out with knowledge.

The aim of this work was to evaluate the physicochemical characteristics of murici (Byrsonima crassifolia (L.) Rich.) covered with starch-based coverings and stored at different temperatures. The fruits were harvested on EMBRAPA experimental farm, in the city of Pacajus-Ceara, where they were taken to the lab, washed, sanitized and naturally dried. Afterwards, they were treated with coverings made out of different concentrations of manioc starch solution and conditioned at 12 and 25°C. We carried out assessments on: pH, titratable acidity, soluble solids, ratio, ascorbic acid, average weight, color, humidity and water activity. The murici fruits were able to maintain their physical and chemical properties for ten days of storage at a temperature of 12°C. Out of the different concentrations of manioc starch-based coverings, the fruits treated with 4% solutions kept their good quality for commercialization. Key words: Murici fruits, temperatures, starch.

With the advent of special education in Brazil boosted by the Salamanca Declaration (1994), some theoretical positions presented themselves, such as the full inclusion of persons with disabilities in ordinary schools and the inclusion from the look from the perspective of the development of higher psychological functions (VYGOTSKY, 1997). In addition, there are other theoretical positions and intermediate educational practices aimed at organic conditions of students with disabilities and to the possibilities of integration of those more committed in relation to disability in specialized education centers. From these considerations is that aims to understand the contributions of the authors of 12 articles of the Brazilian Journal of Special Education (RBEE) on special education in higher education, as well as the prospects for the students of special education target audience (PAEE) that enters the higher education. The qualitative approach, from the perspective of Cultural-historical. Psychology, has guided the analysis of these RBEE productions, in the period from 2010 to 2014. As a result it was found that the students who reach the PAEE higher education face difficulties through veiled prejudice, physical accessibility, inadequate curriculum, among others. It can be concluded that the inclusion of students PAEE lacks attention, since Kindergarten, with educational work guided in developing their higher psychological functions, so you can overcome the barriers located at all levels of schooling, so as to contribute to not only reach to higher education, but also (and especially) that come out with knowledge.

This study aimed to evaluate the risk concerning child population's health because of the occurrence of AFM1 in UHT milk, powdered milk (PM) and infant formulae (IF). Determination of AFM1 was performed in 60 samples and evaluation of the mycotoxin exposure was carried out through the determination of the estimated daily intake (EDI), whereas risk characterization was evaluated with the calculation of the risk of Hepatocellular Carcinoma (HCC) and the Margin of Exposure (MOE). AFM1 ranged from 150 to 1020 ng/kg, and all the positive samples exceeded the limits stablished by European Community. The EDI for AFM1 ranged according to the age group of the population studied (0–5 years old) from 0.828 to 2.523, 0–2.113 and 0.029–0.833 ng/kg b. w./day in UHT, PM and IF, respectively. The number of HCC cases associated with AFM1 exposure (0.0015 a 0.0045) was higher than the limit of 0.001 case/100,000. MOE values for AFM1 were 728 to 239, considerably below the security margin of 10,000. These results point to a potential risk to the health of Brazilian child population exposed to AFM1 in dairy products.

Humpback whales (Megaptera novaeangliae) from the Southern Hemisphere carry information on persistent organic pollutants (POPs) from their feeding zones in Antarctica to their breeding grounds, making this species a sentinel of contaminants accumulation in the Southern Ocean. This study aimed to evaluate driving factors, namely feeding areas, trophic level, and sex, affecting POP concentrations in the blubber of humpback whales breeding off Mozambique and off Ecuador. Biopsies of free-ranging humpback whales including blubber and skin were collected in 2014 and 2015 from Ecuador (n = 59) and in 2017 from Mozambique (n = 89). In both populations, HCB was the major contaminant followed by DDTs > CHLs > PCBs > HCHs > PBDEs. POP concentrations were significantly higher in males compared to females. HCB, DDTs, HCHs and PBDEs were significantly different between whales from the Mozambique population and the Ecuador population. Sex and feeding habits were important driving factors accounting for POP concentrations in Ecuador whales. The whales from our study had some of the lowest POP concentrations measured for humpback whales in the world. These whales fed predominantly on krill as reflected from the low delta C-13 and delta N-15 values measured in the skin. However, the isotopic niches of whales from Mozambique and Ecuador did not overlap indicating that the two populations are feeding in different areas of the Southern Ocean. (c) 2020 Elsevier Ltd. All rights reserved.

Alicyclobacillus acidoterrestris is a bacteria capable of spoiling industrialized orange juice, making it a problem for the beverage industry. This study evaluated the effect of UV-C radiation in combination with nisin in the reduction of A. acidoterrestris spores using reconstituted orange juice. A. acidoterrestris spores were treated with nisin (7.81 and 15.62 μg/mL) in combination with different doses of UV-C (from 2.52 to 12.6 kJ/m2). The presence of vitamins in the juice after the treatments was investigated by UHPLC-HRMS using a ultra high performance liquid chromatography system. The combination of UV-C and nisin treatment showed counts below the detection limit of the method (

Biocatalysis represents an efficient and versatile tool for organic synthesis and green chemistry, since enzymes can perform many chemical transformations with advantages over their chemical counterparts. (4R)-(−)-carvone and its reduced derivatives are natural products with biological and industrial applications, specially (1R,2S,4R)-neodihydrocarveol, due to its pharmacological properties, as well as fragrances supplies. Dialkyl imidazolium-based ionic liquids (ILs) are known to be useful in biocatalytic processes due to their unique physico-chemical properties, low toxicity and ability to improve enzymatic activity. In the present study, we describe the bioreduction of (4R)-(−)-carvone using a filamentous fungus isolated from human skin, molecularly identified by MLSA as Epicoccum sorghinum, and ionic liquid (IL) 1-butyl-3-methyl-imidazolium tetrafluoroborate ([BMIM][BF4]), as co-solvent. The addition of 0.2% (v/v) of [BMIM][BF4] favoured the bioreduction of the substrate (4R)-(−)-carvone at a concentration of 0.198 mmol, affording 65% of the major compound (1R,2S,4R)-neodihydrocarveol, with diastereomeric excess greater than 99% after 18 h of biocatalytic reaction. Also, the isolated product was obtained with an appreciable yield of 59% after column chromatography.

Natural antimicrobial is an effective alternative for control Alicyclobacillus spp., known to cause spoilage in fruit juices. Because of this, in this study, evaluated the antibacterial activity of green tea fermented at 7 and 14 days with Kombucha (K07 and K14). The species used were Alicycobacillus acidoterrestris 0244T, Alicyclobacillus herbarius 0246T, Alicyclobacillus acidiphilus 0247T, Alicyclobacillus cycloheptanicus 0297T, Alicyclobacillus hesperidum 0298T. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) was performed against Alicyclobacillus. At 50% concentration of green tea, 1,563% K07 and 0.195% K14, there was a bacteriostatic effect (MIC) for all strains studied. While the minimum bactericidal concentration ranged from

International recommendations propose the presence of physiotherapists with specialized training in critical patients, available 24 hours a day and 7 days a week (24/7-PT) in the Intensive Care Unit (ICU), with a standardized physiotherapist/patient ratio of 1 per 5 beds in high complexity units. It is unknown if the organizational characteristics of the ICUs are related to the adherence with these recommendations. Objective: To determine the relationship between the organizational characteristics and the adherence of international recommendations of physiotherapy care, in adult ICUs at a national level. Methods: Secondary database analysis, with information from 86% of adult Chilean ICUs. The organizational characteristics (origin of the ICU, number of beds, level of complexity and technical-administrative dependency of the physiotherapist) were related to 24/7-PT availability, physiotherapist/patient ratio of 1 per 5 beds and presence of physiotherapy specialists. Results: Out of 64 adult ICUs, a 70% (n=45) have 24/7-PT availability. Physiotherapist/patient ratio was observed during weekdays in half of the private centers during day shifts. Presence of physiotherapy specialists was detected in 31% of the private sector. Significant differences were found between the number of beds and the probability to accomplish 24/7-PT availability and physiotherapist/patient ratio (p

The European Society of Intensive Care Medicine recommends the presence of a specialist physiotherapist, available every five beds, seven days a week in the high complexity Intensive Care Unit. However, in Chile the adherence of adult Intensive Care Units to this recommendation is unknown.To describe the organizational characteristics and the physiotherapist availability in adult Intensive Care Units in Chile, and according to the adherence to international recommendations, inform health decision-makers.Observational study based on a telephone survey. All adult Intensive Care Units institutions of high complexity, private hospitals and teaching health centers in Chile were eligible (n = 74). The primary outcome measures were the proportion of institutions with physiotherapist availability 24 hours a day and seven days a week (24/7 physiotherapist), a maximum caseload per physiotherapist of five patients and the presence of a specialist physiotherapist.Response rate was 86.5%, with 59% of responding units being public and 83% offering level III care. 70% of the adult Intensive Care Units in Chile have 24/7 physiotherapist (87% of the public and 46% of the private sector). 41% of the centers had a maximum caseload per physiotherapist of five patients during the day on weekdays. This number decreased on weekends and during night shifts. 23% of the Intensive Care Units had a specialist physiotherapist, being more common in the private sector (31%).In Chilean adult ICU, 24/7 physiotherapist availability is high, the prevalence of physiotherapists with specialist training is low. Future efforts should focus on promoting the uptake of specialist training.La Sociedad Europea de Medicina de Cuidados Intensivos recomienda la presencia de un Kinesiólogo con formación especializada, disponible cada cinco camas de alta complejidad, los 7 días de la semana en la Unidad de Cuidados Intensivos (UCI). En Chile se desconoce la adherencia de las UCI adulto a esta recomendación.Describir las características administrativas y de cobertura kinésica en las UCI adulto chilenas, y de acuerdo con la adherencia a las recomendaciones internacionales, informar a los tomadores de decisión en salud.Estudio observacional transversal, basado en encuesta telefónica. Se incluyeron las UCI adultos de establecimientos de mayor complejidad, clínicas privadas y centros asociados a universidades (n = 74). La proporción de instituciones con disponibilidad de kinesiólogos las 24 horas del día, los siete días de la semana (kinesiólogo 24/7), con un número máximo de cinco pacientes por kinesiólogo y presencia de un kinesiólogo especialista fueron reportados.La tasa de respuesta fue del 86,5% (n = 64), principalmente públicas (59%) y de nivel III (83%). El 70% (n = 45) de las UCI adulto chilenas cuentan con kinesiólogo 24/7; correspondiendo el 87% al sector público y el 46% al privado. El 41% de los centros posee un máximo de 5 pacientes por kinesiólogo en día hábil diurno, disminuyendo en fines de semana y horarios nocturnos. Un 23% de las UCIs cuenta con kinesiólogo especialista en intensivo, siendo mayor en el sector privado (31%).En UCI adulto chilenas, la disponibilidad de kinesiólogos 24/7 es alta, y la prevalencia de especialistas es baja. Estrategias de creación de programas de formación de especialidad podrían contribuir a disminuir la brecha de especialistas.

Colorectal cancer (CRC) is the type with the second highest morbidity. Recently, a great number of bioactive compounds and encapsulation techniques have been developed. Thus, this paper aims to review the drug delivery strategies for chemotherapy adjuvant treatments for CRC, including an initial scientific-technological analysis of the papers and patents related to cancer, CRC, and adjuvant treatments. For 2018, a total of 167,366 cancer-related papers and 306,240 patents were found. Adjuvant treatments represented 39.3% of the total CRC patents, indicating the importance of adjuvants in the prognosis of patients. Chemotherapy adjuvants can be divided into two groups, natural and synthetic (5-fluorouracil and derivatives). Both groups can be encapsulated using polymers. Polymer-based drug delivery systems can be classified according to polymer nature. From those, anionic polymers have garnered the most attention, because they are pH responsive. The use of polymers tailors the desorption profile, improving drug bioavailability and enhancing the local treatment of CRC via oral administration. Finally, it can be concluded that antioxidants are emerging compounds that can complement today’s chemotherapy treatments. In the long term, encapsulated antioxidants will replace synthetic drugs and will play an important role in curing CRC.

Background: Mitral valve repair in paediatric patients with chronic rheumatic heart disease is superior to valve replacement and has been used with good results. Objective: To identify predictors of unfavourable outcomes in children and adolescents submitted to surgical mitral valvuloplasty secondary to rheumatic heart disease. Methods: Retrospective study of 54 patients under the age of 16 operated at a tertiary paediatric hospital between March 2011 and January 2017. The predictors of risk for unfavourable outcomes were: age, ejection fraction, degree of mitral insufficiency, degree of pulmonary hypertension, presence of tricuspid insufficiency, left chamber dilation, preoperative functional classification, duration of cardiopulmonary bypass, duration of anoxia, presence of atrial fibrillation, and duration of vasoactive drug use. The outcomes evaluated were: death, congestive heart failure, reoperation, residual mitral regurgitation, residual mitral stenosis, stroke, bleeding and valve replacement. For all analyzes a value of p < 0.05 was established as significant. Results: Of the patients evaluated, 29 (53.7%) were female, with an average of 10.5 ± 3.2 years. The functional classification of 13 patients (25%) was 4. There was no death in the sample studied. The average duration of extracorporeal circulation was 62.7±17.8 min, and anoxia 50 ± 15.7 min. The duration of use of vasoactive drug in the immediate postoperative period has an average of 1 day (interquartile interval 1-2 days). The logistic regression model was used to evaluate the predictive variables for each unfavourable outcome. The duration of use of vasoactive drug was the only independent predictor for the outcomes studied (p = 0.007). Residual mitral insufficiency was associated with reoperation (p = 0.044), whereas tricuspid insufficiency (p = 0.012) and pulmonary hypertension (p = 0.012) were associated with the presence of unfavourable outcomes. Conclusion: The duration of vasoactive drug use is an independent predictor for unfavourable outcomes in the immediate and late postoperative period, while residual mitral regurgitation was associated with reoperation, and both tricuspid regurgitation and pulmonary hypertension were associated with unfavourable outcomes. Resumo Fundamento: A plastia da valva mitral, em pacientes pediátricos com cardiopatia reumática crônica, é superior à troca valvar e vem sendo utilizada com bons resultados. Objetivo: Identificar variáveis preditoras de desfecho desfavorável em crianças e adolescentes submetidos à valvoplastia mitral cirúrgica secundária à cardiopatia reumática. Métodos: Estudo retrospectivo em 54 pacientes menores de 16 anos, operados em um hospital pediátrico terciário entre março de 2011 e janeiro de 2017. As variáveis preditoras de risco para desfecho desfavorável foram: idade, fração de ejeção, grau de insuficiência mitral, grau de hipertensão pulmonar, presença de insuficiência tricúspide, dilatação de câmaras esquerdas, classe funcional no pré-operatório, tempo de circulação extracorpórea, tempo de anóxia, presença de fibrilação atrial e tempo de uso de droga vasoativa. Os desfechos avaliados foram: morte, insuficiência cardíaca congestiva, reoperação, insuficiência mitral residual, estenose mitral residual, acidente vascular cerebral, sangramento e troca valvar. Para todas as análises foi estabelecido valor de p < 0,05 como significante. Resultados: Dos pacientes avaliados, 29 (53,7%) eram do sexo feminino, com média de idade de 10,5 ± 3,2 anos. A classe funcional de 13 pacientes (25%) foi 4. Não houve morte na amostra estudada. O tempo médio de circulação extracorpórea foi de 62,7 ± 17,8 minutos e de anóxia 50 ± 15,7 minutos. O tempo de uso de droga vasoativa no pós-operatório imediato teve mediana de 1 dia (intervalo interquartil 1-2 dias). O modelo de regressão logística foi utilizado para avaliar as variáveis preditoras para o desfecho desfavorável. O tempo de uso de droga vasoativa foi o único preditor independente para os desfechos estudados (p = 0,007). A insuficiência mitral residual foi associada à reoperação (p = 0,044), enquanto a insuficiência tricúspide (p = 0,012) e a hipertensão pulmonar (p = 0,012) se associaram à presença de desfechos desfavoráveis. Conclusão: O tempo de uso de droga vasoativa é um preditor independente para desfechos desfavoráveis no pós-operatório imediato e tardio, enquanto insuficiência mitral residual se associou à reoperação e tanto a insuficiência tricúspide quanto a hipertensão pulmonar foram associadas a desfechos desfavoráveis.

Background Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes.Methods We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18-85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR) 25-75 mL/min per 1.73 m(2) of body surface area, and a urine albumin-to-creatinine ratio (UACR) of 300-5000 mg/g who had received maximum labelled or tolerated renin-angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0.75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders) were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0.75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for >= 30 days) or end-stage kidney disease (eGFR = 90 days, chronic dialysis for >= 90 days, kidney transplantation, or death from kidney failure) in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials. gov, number NCT01858532.Findings Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325) or placebo group (n=1323). Median follow-up was 2.2 years (IQR 1.4-2.9). 79 (6.0%) of 1325 patients in the atrasentan group and 105 (7.9%) of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR] 0.65 [95% CI 0.49-0.88]; p=0.0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3.5%) of 1325 patients in the atrasentan group and 34 (2.6%) of 1323 patients in the placebo group (HR 1.33 [95% CI 0.85-2.07]; p=0.208). 58 (4.4%) patients in the atrasentan group and 52 (3.9%) in the placebo group died (HR 1.09 [95% CI 0.75-1.59]; p=0.65).Interpretation Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Copyright (C) 2019 Elsevier Ltd. All rights reserved.