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Background: Surgical resection of locally advanced or borderline pancreatic ductal adenocarcinoma is a recognized procedure with curative intent performed in specialized oncology centers. Postoperative dysautonomia such as gastroparesis, mild hypotension, and diarrhea are common in elderly patients undergoing pancreaticoduodenectomy. A distinctive feature of our case, is the severing of an important sympathetic chain by the surgical procedure, leading to recurrent severe neurogenic shock. Locally advanced borderline tumor extension, aggressive maximal local tumor resection, and advanced age of the patient were the combined factors that explained the observed postoperative complication., Case Description: An 80-year-old woman underwent an elective R0 pancreaticoduodenectomy with total mesopancreas excision, distal gastrectomy and portal vein resection without relevant intraoperative and immediate postoperative complication. Pathology confirmed a 5.0 cm × 3.2 cm × 1.9 cm ductal adenocarcinoma in the head of the pancreas. After discharge, the patient returned to the emergency room complaining of nonspecific malaise, lipothymia, and cold sweating that was exacerbated by bowel movement attempts. During hospitalization, the patient experienced two additional severe hypotensive episodes with identical clinical presentation that required resuscitative measures in the intensive care unit (ICU). Because the third hypotensive episode developed without an obvious causal factor, apart from evacuation attempts, the hypothesis of neurogenic shock due to secondary splanchnic dysautonomia caused by extensive resection of the celiac plexus nerve structures after duodenopancreatectomy was considered., Conclusions: This discussion is important, as it enables the care team to recognize this differential diagnosis and provide the best care for the patient. The patient was treated with sympathomimetics, fludrocortisone, and mechanisms to increase venous return when clinical improvement promptly occurred, allowing discharge from the hospital. Despite the challenging prognosis of the disease, we were able to provide the patient with moments at home with their family., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-23-494/coif). The authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

The aim of the current ecological study is to assess the evolution of food deserts and food swamps in the metropolitan city of Belo Horizonte between 2008 and 2020. Food deserts were determined based on the density of healthy establishments per 10,000 inhabitants, whereas food swamps were set based on the density of ultra-processed food procurement establishments per 10,000 inhabitants. The rate of census tracts classified as food deserts has decreased between 2008 and 2020, whereas that of census tracts classified as food swamps has increased within this same period. Furthermore, despite the reduced number of food deserts, these areas have increased in census tracts living under lower socioeconomic vulnerability condition. Food swamps recorded sharp increase in census tracts living under higher vulnerability condition. The population living in the herein investigated city has been increasingly exposed to an unhealthy community food environment over 12 years. Monitoring changes in community food environment is key strategy to enable tracking the effectiveness and efficiency of actions taken in food environments to ensure the human right to adequate food.

Despite the increasing knowledge in the past years, only minimal attention has been directed to the neuropsychological aspects and the prevalence of cognitive impairment associated with reversible cerebral vasoconstriction syndrome (RCVS)., Objective: To describe the frequency and expand the understanding of cognitive dysfunction in RCVS., Methods: The neuropsychological evaluation was performed using a battery consisting of specific neuropsychological instruments that were administered to patients diagnosed with RCVS. A triage was conducted to exclude other potential causes of cognitive impairment. Performance on the tests was treated as a categorical variable, and a cutoff of -1.5 Z-score was adopted to indicate impaired performance., Results: Seven patients diagnosed with RCVS were evaluated, all of whom had a bachelor's degree and normal score in the Mini-Mental State Examination. The average time between diagnosis and neuropsychological evaluation was 1.8 years. Among the patients, 85.6% (n=6) exhibited performance below that of the normal population in at least two of the administered tests. Specifically, 71.4% (n=5) showed alterations in tests from the Psychological Battery for Attention Assessment, with impairment observed in concentrated (n=1), divided (n=3), or alternating (n=4) attention. Furthermore, 28.6% (n=2) demonstrated impairments in the Phonological Verbal Fluency Task, another 28.6% (n=2) exhibited difficulties copying elements of the Rey Complex Figure, and 14.3% (n=1) displayed lower performance in the Five-Digit test, all indicating executive dysfunction., Conclusion: This study provides evidence that cognitive impairment associated with RCVS is more prevalent than previously believed and has not received sufficient attention. Specifically, attention and executive functions are the cognitive domains most significantly impacted by RCVS., Competing Interests: Disclosure: The authors report no conflicts of interest.

Although the mechanisms of Pb-induced genotoxicity are well established, a wide individual's variation response is seen in biomarkers related to Pb toxicity, despite similar levels of metal exposure. This may be related to intrinsic variations, such as genetic polymorphisms; moreover, very little is known about the impact of genetic variations related to DNA repair system on DNA instability induced by Pb. In this context, the present study aimed to assess the impact of SNPs in enzymes related to DNA repair system on biomarkers related to acute toxicity and DNA damage induced by Pb exposure, in individuals occupationally exposed to the metal. A cross-sectional study was run with 154 adults (males, >18 years) from an automotive batteries' factory, in Brazil. Blood lead levels (BLL) were determined by ICP-MS; biomarkers related to acute toxicity and DNA instability were monitored by the buccal micronucleus cytome (BMNCyt) assay and genotyping of polymorphisms of MLH1 (rs1799977), OGG1 (rs1052133), PARP1 (rs1136410), XPA (rs1800975), XPC (rs2228000) and XRCC1 (rs25487) were performed by TaqMan assays. BLL ranged from 2.0 to 51 μg dL -1 (mean 20 ± 12 μg dL -1 ) and significant associations between BLL and BMNCyt biomarkers related to cellular proliferation and cytokinetic, cell death and DNA damage were observed. Furthermore, SNPs from the OGG1,XPA and XPC genes were able to modulate interactions in nuclear bud formation (NBUDs) and micronucleus (MNi) events. Taken together, our data provide further evidence that polymorphisms related to DNA repair pathways may modulate Pb-induced DNA damage; studies that investigate the association between injuries to genetic material and susceptibilities in the workplace can provide additional information on the etiology of diseases and the determination of environmentally responsive genes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

The effectiveness of endovascular thrombectomy in patients presenting low National Institutes of Health Stroke Scale (NIHSS) scores remains controversial, and the acquisition of additional evidence is required to refine the selection of candidates who may benefit the most from this therapeutic modality. In this study, we present the case of a 62-year-old individual, with left internal carotid occlusion stroke and low NIHSS, who had compensatory collateral flow from Willis polygon via the anterior communicating artery. The patient subsequently exhibited neurological deterioration and collateral flow failure from Willis polygon, indicating the need for urgent intervention. The study of collaterals in patients with large vessel occlusion stroke has garnered considerable attention, with research suggesting that individuals with low NIHSS scores and poor collateral profiles may be at a heightened risk of early neurological deterioration. We postulate that such patients may derive significant benefits from endovascular thrombectomy, and may posit that an intensive transcranial Doppler monitoring protocol could facilitate the identification of suitable candidates for such intervention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Santos Neto, de Sousa, Veras, Barros-Araújo, Ricarte and Pontes-Neto.)

Objective: A sharp increase in pediatric thyroid cancer incidence is observed during adolescence, driven mainly by girls. Differences in disease presentation across sexual maturity stages raise the question of whether sex steroids have a role in the heterogeneity. The aims of this study were to analyze the influence of puberty and sex on clinical presentation and prognosis and to evaluate the correlation between the expression of sex hormone receptors., Design and Methods: Clinical records and immunohistochemical of specimens from 79 patients were analyzed. Puberty was analyzed by two criteria: end of puberty and beginning, in which the age of 10 was the cutoff., Results: Postpubertal were more frequently classified as having low-risk disease and a lower frequency of persistent disease, especially when the completion of puberty was used as the criteria. Male sex was associated with a higher risk of persistent disease at the end of the observation period. Estrogen receptor α positivity was low in the entire sample, while progesterone receptor positivity was positive in 30% of the cases. Female hormone receptor expression was not associated with sex, American Thyroid Association risk score, persistent structural disease, or pubertal status., Conclusion: Our study showed that the completion of puberty correlated best with the clinical behaviour of pediatric thyroid cancer. It was also shown that postpubertal patients have a less aggressive initial presentation and better outcomes. However, this observation could not be explained by the expression of estrogen and progesterone receptors in the primary tumors.

Knowing the food environment to which the households benefiting from the Bolsa Familia Program (PBF) are exposed is necessary to identify exposure to environments that favor worse food choices. This work aimed to characterize the community food environment of the urban area of the municipality of Ouro Preto (MG), Brazil, and the surroundings of the homes of households that are beneficiaries of the PBF. This ecological study was conducted with data from the Single Registry and the State Treasury Department Systems, both from 2014, and from the 2010 Census. Spatial analyses were conducted to evaluate the clusters of beneficiary households and establishments. The peripheral and with lower per capita income census tracts (CTs) had little or no establishment for food sales, and greater agglomeration of PBF beneficiary households closer to unhealthy establishments (median: 65.73 meters). There was a higher concentration of - mainly unhealthy - food sales establishments in the central CTs and higher per capita income (59.2%). Given the above, it becomes important to dialogue with other nutrition-related public policies to reduce inequalities and improve physical access to healthy food sales establishments.

Evidence of changes caused by the COVID-19 pandemic in food security and nutrition conditions, as well as in different food environments, has called researchers' attention to substantial changes taking place in individuals' dietary habits. The aim of this study is to present and address changes that have already happened in food environments, during the first COVID-19 pandemic year, in a middle-income country. Multiple changes were observed and had direct impact on the population, among them, worsened health and nutrition indicators and advanced dietary inequalities, as well as on its food profile in different life cycles, if one takes into consideration aspects such as food availability, financial access and dietary quality.

Experimental and epidemiologic studies have shown that lead (Pb) is able to induce epigenetic modifications, such as changes in DNA methylation profiles, in chromatin remodeling, as well as the expression of non-coding RNAs (ncRNAs). However, very little is known about the interactions between microRNAs (miRNAs) expression and DNA methylation status in individuals exposed to the metal. The aim of the present study was to investigate the impact of hsa-miR-148a expression on DNA methylation status, in 85 workers exposed to Pb. Blood and plasma lead levels (BLL and PLL, respectively) were determined by ICP-MS; expression of the miRNA-148a was quantified by RT-qPCR (TaqMan assay) and assessment of the global DNA methylation profile (by measurement of 5-methylcytosine; % 5-mC) was performed by ELISA. An inverse association was seen between miR-148a and % 5-mC DNA, as a function of BLL and PLL (β = -3.7; p = 0.071 and β = -4.1; p = 0.049, respectively) adjusted for age, BMI, smoking, and alcohol consumption. Taken together, our study provides further evidence concerning the interactions between DNA methylation profile and miR-148a, in individuals exposed to Pb., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Araújo, Gomes, Devóz, Duarte, Ribeiro, Araújo, Batista, Antunes, Barbosa, Rodrigues, Rueff and Barcelos.)

This study optimizes the pyrodextrinization of yam (Dioscorea sp.) starch isolated from tubers grown in Brazil to produce a yellow pyrodextrin with the lowest enzymatically available starch (AS) content and color difference (ΔE) index. At 140 °C (fixed heating temperature), the effects of acid concentration (0.65 - 2.99 g of HCl/kg of starch) and incubation time (53 - 307 min) on the response variables were evaluated using a response surface methodology. Some physicochemical characteristics were also determined on pyrodextrins. Both factors negatively affected the AS content, although positively influenced the ΔE (P < 0.05). The yellow pyrodextrin produced with 1.82 g/kg and heating for 307 min, presented physicochemical properties similar to the commercial pyrodextrins from potato starch, with 46.6 % of AS, 24.5 of ΔE, high solubility and very low viscosity. The pyrodextrinization caused a decrease of 30 - 54 % in AS content (P < 0.05), making these yam pyrodextrins a promising material for water-soluble and very low viscous dietary fiber., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Cerebral amyloid angiopathy (CAA) is a cerebrovascular disorder caused by progressive deposition of β-amyloid peptides in the walls of small and medium-sized cortical and leptomeningeal vessels. Until today, the prevalence of CAA is unknown in our region., Objective: This study aims to analyze the prevalence of this entity in a specific elderly population in a tertiary hospital in Northeastern Brazil., Methods: A cross-sectional, retrospective study with the enrollment of patients aged 65 or older followed in the neurological outpatient service of the Universidade Federal do Piauí, Brazil, who underwent brain magnetic resonance imaging (MRI) from July 2016 to June 2018., Results: One hundred and seventy-four patients were enrolled, of whom 100 were women (57.4%) and 74, men (42.6%), aged from 65 to 91 years old (median age 73.27). Nine patients were excluded from the study due to unavailability of MRI sequences needed for an appropriate analysis. Out of the 165 remaining patients, 12 (7.2%) had established the diagnosis of CAA, according to the modified Boston criteria., Conclusion: The prevalence of CAA in our study was like those of medical literature, with a progressive age-related increase.

Introduction: To perform a head-to-head comparison of the uptake pattern of F-18 fluorodeoxyglucose in positron emission computed tomography (FDG PET/CT) in radioiodine refractory thyroid carcinomas (RAIR) in the same patient under elevated TSH levels ( e TSH) and suppressed TSH levels ( s TSH)., Methods: FDG PET/CT studies were performed under two conditions: levothyroxine intake ( s TSH) and 30 days after hormonal withdrawal ( e TSH). SUVmax values and the number of lesions detected (local recurrence and metastases in cervical and distant lymph nodes, lungs and bone) where blindly evaluated. Blood serum TSH and Tg levels were obtained prior to both studies. FDG PET/CT imaging, neck ultrasound, biopsy and follow-up were considered the reference standard., Results: Fifteen patients performed both e TSH and s TSH FDG PET/CT studies. Both were positive for metastases in 80% of the patients. e TSH FDG PET/CT studies did not reveal increased uptake (p = 0.0640) and did not demonstrate a higher number of lesions (p = 0.320) when compared to sTSH FDG PET/CT studies. There was no change in the clinical management of these patients., Conclusions: e TSH FDG PET/CT in patients with RAIR did not show more metastases in comparison to s TSH FDG PET/CT and there was no impact in clinical management of patients. Elevating TSH levels (whether by hormonal withdrawal or recombinant TSH) in patients being submitted to FDG PET/CT may not be necessary., (© 2020 Published by Elsevier Ltd.)

Objective: We analysed the impact of the national general truck drivers' strike on the availability, variety and price of foods sold by a food supply centre., Design: Descriptive study using secondary data to examine the percentage change in the mean price of fruits, vegetables and eggs before, during and after the strike. The strike in Brazil lasted 10 d from 21 to 30 May 2018. The drivers were on strike in order to make diesel oil tax-free and to obtain better working conditions., Setting: The food supply centre, named CEASA-Minas Grande BH, was located in the metropolitan area of a Brazilian city., Participants: We examined twenty types of foods., Results: After 10 d, there was a ~30 % reduction in the availability of all types of foods and prices increased. Foods with the highest price increases included cabbage (233·3 %), potatoes (220·0 %), papaya (160·0 %) and oranges (78·6 %). At the end of the strike, we observed reductions in the price of eggs, fruits, vegetables, roots and tubers; however, some foods remained more expensive than before the strike, including chayote (203·2 % higher), cucumber (66·7 % higher) and potatoes (60·0 % higher)., Conclusions: The general truck drivers' strike was correlated with a reduction in the availability of food and, consequently, increases in price and possibly restrictions on access. The strike demonstrated the dependence of metropolises on road transportation and the conventional market. We speculate that initiatives aiming to shorten the food supply chain and promote food sovereignty and resilience of the supply circuits could be important.

Background: The incidence of thyroid carcinoma has increased in most populations, including pediatric patients. The increase is almost exclusively due to an increase in the incidence of papillary thyroid carcinoma (PTC). Genetic alterations leading to mitogen-activated protein kinase (MAPK) pathway activation are highly prevalent in PTC, with BRAF V600E mutation being the most common event in adult PTC. Although a lower prevalence of BRAF V600E had been reported among pediatric patients, a higher prevalence of BRAF fusion has been identified in both radiation-exposed and sporadic pediatric PTC. However, little is known about the prognostic implications of BRAF fusions in pediatric PTC., Procedure: In this study, we investigated the prevalence of BRAF alterations (AGK-BRAF fusion and BRAF V600E mutation) in a large set of predominantly sporadic pediatric PTC cases and correlate with clinicopathological features. Somatic AGK-BRAF fusion was investigated by RT-PCR and confirmed by FISH break-apart. The BRAF V600E mutation was screened using Sanger sequencing., Results: AGK-BRAF fusion, found in 19% of pediatric PTC patients, was associated with distant metastasis and younger age. Conversely, the BRAF V600E, found in 15% of pediatric PTC patients, was correlated with older age and larger tumor size., Conclusion: Collectively, our results advance knowledge concerning genetic bases of pediatric thyroid carcinoma, with potential implications for diagnosis, prognosis, and therapeutic approaches., (© 2019 Wiley Periodicals, Inc.)

Background: We aim to identify the prevalence of food insecurity and to ascertain the association between food insecurity and food intake., Method: A cross-sectional survey., Setting: The study included users of a primary healthcare service in Belo Horizonte, Brazil, from 2013 to 2014. Socioeconomic, health, and food intake data were gathered using a questionnaire and the Brazilian Food Insecurity Scale., Subjects: Individuals 20 years old or older (n = 2817)., Results: The prevalence of food insecurity among families with individuals under 18 years was 41.0%, and 26.4% in other households. After adjusting for potential confounders, the households in food insecurity with members under 18 years old, the consumption of fruits and vegetables (RP = 0.70, 95%IC: 0.58-0.84), and fruits (RP = 0.74, 95%IC: 0.59-0.93) was lower; and consumption of beans was higher (RP = 1.49, 95%IC: 1.06-2.09) compared to those with food security. In households without members under 18 years old, the consumption of fruits and vegetables (RP = 0.68, 95%IC: 0.58-0.79), fruits (RP = 0.61, 95%IC: 0.50-0.74), and beans (RP = 0.78, 95%IC: 0.63-0.97) was lower; and the consumption of tubers (RP = 1.36, 95%IC: 1.03-1.79) was higher. However, the state of food insecurity did not affect the consumption of ultra-processed foods, independently of age, sex, marital status, educational level, and employed status., Conclusion: Food insecurity negatively affected the fruit and vegetable consumption in both types of families tested. The consumption of beans was higher in households with children and adolescents, and the consumption of tubers was higher in households without children and adolescents. However, food insecurity did not change the intake of ultraprocessed foods., (Copyright © 2018 Elsevier Inc. All rights reserved.)

In this study, goats were subjected to ovarian stimulation protocols to evaluate possible differences in ovarian follicular responses and oocyte production. Two experiments were conducted to assess the effects of hormonal protocol duration (seven or twelve days) and number of follicle stimulating hormone (FSH) applications (one or five doses). All animals received intravaginal sponges saturated with 60 mg medroxyprogesterone acetate and an application of 125 μg cloprostenol 72 h before the sponges were removed. For ovarian stimulation, 120 mg FSH was applied in a single dose 36 h before laparoscopic follicular aspiration (LOPU) or in five doses (30, 30, 20, 20, and 20 mg) at 12 h intervals, with the last dose applied 36 h before LOPU. In the first experimental phase, ultrasonography was performed to monitor follicular number and diameter, and in the second phase, the animals received LOPU to count the follicles and cumulus-oocyte complexes (COCs) and for morphological classification. There was no significant effect (P > 0.05) of any variable or combination of variables on follicle number on Day (D) 0 or D3/D8 (day of LOPU). However, evaluation at D6/D11 revealed an effect (P < 0.05) from the protocol duration with the highest number of small follicles resulting from the short protocol. There was also an effect (P < 0.05) of FSH dose number on the resulting number of medium and large follicles, with more medium follicles recovered after a single dose and more large follicles after multiple doses. There was no effect of any variable (P > 0.05) on the diameters of the large, medium, and small follicles, except for the D4/D9 evaluation, which showed a combination effect for large follicles (P < 0.05). In the second phase, no variable had an effect on the number of follicles visualized or aspirated, number of COCs recovered, recovery rate, morphological quality of COCs in grades 1, 2, 3, and 4, or rate of viable COCs. Thus, all four protocols efficiently stimulated the ovarian response and oocyte production of goats, although the short protocol (7 days) with a single dose of FSH was most efficacious based upon the greater number of medium-sized follicles available for aspiration, the shorter time, and greater practicality of execution., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: We evaluated the association between cognitive deficits and leukocyte telomere length (LTL) in HIV-1-infected individuals., Design: 73 HIV-1-infected patients undergoing neuropsychological evaluation and 91 healthy controls were included in this study. Fifteen HIV-1 positive patients did not have cognitive disorders whereas 26 had asymptomatic neurocognitive disorder (ANI), 13 presented mild to moderate neurocognitive disorder (MND), and 10 had HIV-associated dementia (HAD)., Methods: DNA from the peripheral blood of HIV-1-infected patients was used for measurement of telomere length by real-time PCR. HIV-1 viral load was determined in blood., Results: LTL decreased with age in healthy controls (p=0.0001). Regardless of the HIV status, age-matched LTL from HIV patients, including those with ANI and MND, were shortened in comparison to the healthy control group (p=0.0073); however, no association was found among the HIV-1-infected individuals with cognitive deficits (p=0.01). In addition, no gender-related association with LTL was observed (p=0.80), smoking, physical exercise, and plasma viral load were not correlated to telomere length (p=0.66)., Conclusions: We concluded that leukocyte telomere length may not be a marker of cellular senescence in individuals with HIV infection and neurocognitive disorders.

Purpose: Medullary thyroid carcinoma (MTC) is a malignant neoplasm of parafollicular cells. Because it is a neuroendocrine tumor, it has known somatostatin receptors (SSTRs). The actual frequencies of the SSTR subtypes and their potential influences (by binding with endogenous somatostatin) on MTC cell proliferation have not been fully elucidated to date. The present study evaluated the occurrence of SSTR subtypes 1, 2, 3 and 5 as well as the possible role that each subtype plays in the clinical evolution of patients with MTC., Methods: This retrospective, longitudinal study analyzed thyroid surgical material from 42 patients with MTC. Immunohistochemical staining was performed with monoclonal antibodies against subtypes 1, 2, 3 and 5 of SSTR. The histological material was classified as negative, focal positive or diffuse positive, in relation to each of the SSTR subtypes. The initial response to treatment, clinical course and patient mortality rate were assessed and related to the presence of SSTR subtypes., Results: The most prevalent SSTR subtype was SSTR 3, which was found in 81% of the patients, when considering any pattern of positivity. However, subtype 2 had the lowest number of positive patients, with 28.6% demonstrating any positive pattern. Subtypes 1 and 5 had an intermediate prevalence of positivity, with subtype 1 present in 45.2% of the patients and subtype 5 positive in 54.8% of the patients, when considering any pattern of positivity. The presence of STR 1, in the form of diffuse positivity, independently predicted a better response to the initial therapy, with a hazard ratio (HR) of 4.80 (p = 0.03)., Conclusion: This is the first study to show the correlation of the presence of SSTR1, detected by monoclonal immunohistochemical techniques, and better response to initial treatment and possibly better long-term clinical response in patients with MTC. In addition, these patients had low positivity rates for SSTR2, which might explain the low sensitivity of diagnostic and limited therapeutic response to octrotide based radioisotopes.

This study aimed to evaluate the efficacy and safety of continuing versus stopping aspirin [acetylsalicylic acid (ASA)] preoperatively in patients undergoing coronary artery bypass graft surgery. MEDLINE, EMBASE, CENTRAL/Cochrane Controlled Trials Register (CCTR), ClinicalTrials.gov, Scientific Electronic Library Online (SciELO), Literatura Latino Americana em Ciências da Saúde (LILACS), Google Scholar and reference lists of relevant articles were searched for randomized controlled trials that reported efficacy outcomes of myocardial infarction and mortality, and safety outcomes of blood loss, packed red blood cell transfusion and surgical re-exploration were compared between groups. Fourteen studies fulfilled our eligibility criteria and included a total of 4499 patients (2329 for 'continuing ASA' and 2170 for 'stopping ASA'). In the pooled analysis, continuing aspirin therapy did not reduce the risk of myocardial infarction [risk ratio 0.834, 95% confidence interval (CI) 0.688-1.010; P = 0.063] or operative mortality (risk ratio 1.384, 95% CI 0.727-2.636; P = 0.323). Preoperative ASA increased postoperative chest tube drainage (mean difference 143 ml, 95% CI 39-248 ml; P = 0.007) and packed red blood cell transfusion (mean difference 142 ml, 95% CI 55-228; P = 0.001) but did not increase the risk of surgical re-exploration (risk ratio 1.316, 95% CI 0.910-1.905; P = 0.145). This meta-analysis found no statistically significant difference regarding the risk of operative mortality and myocardial infarction between the 'continuing ASA' and 'stopping ASA' strategies. On the other hand, the mean volume of blood loss and packed red blood cell transfusion was higher in the 'continuing ASA' group, but this finding did not translate into higher risk of reoperation for bleeding., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Objective: To compare the safety and efficacy of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) using drug-eluting stents (DES) in patients with unprotected left main coronary artery (ULMCA) disease., Methods: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles were searched for clinical studies that reported outcomes at 1-year follow-up after PCI with DES and CABG for the treatment of ULMCA stenosis. Five studies fulfilled our eligibility criteria and they included a total of 4.595 patients (2.298 for CABG and 2.297 for PCI with DES)., Results: At 1-year follow-up, there was no significant difference between CABG and DES groups concerning the risk for death (risk ratio [RR] 0.973, P=0.830), myocardial infarction (RR 0.694, P=0.148), stroke (RR 1.224, P=0.598), and major adverse cerebrovascular and cardiovascular events (RR 0.948, P=0.680). The risk for target vessel revascularization (TVR) was significantly lower in the CABG group compared to the DES group (RR 0.583, P<0.001). It was observed no publication bias regarding the outcomes, but only the outcome TVR was free from substantial statistical heterogeneity of the effects. In the meta-regression, there was evidence that the factor "female gender" modulated the effect regarding myocardial infarction rates, favoring the CABG strategy., Conclusion: CABG surgery remains the best option of treatment for patients with ULMCA disease, with lower TVR rates.

Objective: To understand the perception of users of a Psychosocial Care Center about care in the context of drug use., Methods: Study based on the Phenomenology of Maurice Merleau-Ponty, developed in the Center for Psychosocial Care Alcohol and Other Drugs. The data has been submitted to the Analytical Technique of Ambiguity., Results: The drug use sometimes provides the consumer with pleasurable feelings, sometimes contributing to the occurrence of biopsychosocial harm and/or new possibilities for relationship with the drug., Conclusions: The drug use is an ambiguous process, which corresponds to the perception of different care profiles in the relationship between the consumer and the drug. It is up to the health professionals to recognize the diverse possibilities of care and to favor the construction of therapeutic projects based on listening and respecting the needs of drug users.

Lead (Pb) is a toxic metal, frequently associated with occupational exposure, due to its widespread use in industry and several studies have shown high Pb levels in workers occupationally exposed to the metal. The aim of this study was to evaluate the influence of milk and dairy products (MDP) on Pb levels in blood (B-Pb), plasma (P-Pb), and urine (U-Pb), in workers from automotive battery industries in Brazil. The study included 237 male workers; information concerning diet and lifestyle were gathered through a questionnaire, and B-Pb, P-Pb, and U-Pb were determined by ICP-MS. Mean B-Pb, P-Pb, and U-Pb were 21 ± 12, 0.62 ± 0.73 μg/dL, and 39 ± 47 μg/g creatinine, respectively. Forty three percent of participants declared consuming ≤3 portions/week of MDP (classified as low-MDP intake), while 57% of individuals had >3portions/week of MDP (high-MDP intake). B-Pb and P-Pb were correlated with working time (r s  = 0.21; r s  = 0.20; p < 0.010). Multivariable linear regressions showed a significant influence of MDP intake on B-Pb (β = -0.10; p = 0.012) and P-Pb (β = -0.16; p < 0.010), while no significance was seen on U-Pb. Our results suggest that MDP consumption may modulate Pb levels in individuals highly exposed to the metal; these findings may be due to the Pb-Ca interactions, since the adverse effects of Pb are partially based on its interference with Ca metabolism and proper Ca supplementation may help to reduce the adverse health effects induced by Pb exposure.

Objective: To evaluate the occurrence of excessive gain in body mass index-for-age Z-score (BMI/AZ) and its associated factors in adolescent girls., Methodology: This is a cohort study conducted between 2007 and 2012 with 382 girls between 10 and 18 years of age attending public schools in Recife, Pernambuco, Brazil. Excessive gain in BMI/AZ (EGBMI/AZ) at follow-up was considered if the adolescent had a BMI/AZ >0.63 between follow-up and baseline., Results: In 2007, 33.5% of girls were overweight, and at the end of the study this prevalence was 26.2%, with no statistically significant differences. Of the 382 girls evaluated in the cohort, 33% showed EGBMI/AZ. In 2007, 95% of these girls were normal weight or underweight, and in 2012, 60% were classified as overweight. After adjusting for possible confounding factors, three variables remained independently associated with EGBMI/AZ: underweight, normal weight and maternal overweight., Conclusions: Both underweight and normal weight were associated with EGBMI/AZ, and this could be due to a physiological protection for the occurrence of menarche. In fact, maternal overweight has considerable influence on adolescents' nutritional status because of exposure to an obesogenic environment.

Quality and sensory attributes of meat from 32 mixed-breed Santa Inês lambs fed diets composed of four silages with old man saltbush (Atriplex nummularia Lind), buffelgrass (Cenchrus ciliaris), Gliricidia (Gliricidia sepium), and Pornunça (Manihot sp.) were evaluated. Meat from lambs fed diet containing old man saltbush silage (P<0.05) showed greater values for cooking loss. Of the sensory attributes evaluated in the Longissimus lumborum muscle of the lambs, color and juiciness did not differ (P>0.05). However, the silages led to differences (P<0.05) in aroma, tenderness, and flavor values. The meat from animals fed the pornunça and Gliricidia silages was tenderer. Flavor scores were higher in meat from lambs that consumed old man saltbush silage and lower in the meat from those fed buffelgrass silage. Diets formulated with buffelgrass silage for sheep reduce meat production. Based on the results for carcass weight and meat quality, old man saltbush and pornunça are better silages for finishing sheep., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: Deep sternal wound infection following coronary artery bypass grafting is a serious complication associated with significant morbidity and mortality. Despite the substantial impact of deep sternal wound infection, there is a lack of specific risk stratification tools to predict this complication after coronary artery bypass grafting. This study was undertaken to develop a specific prognostic scoring system for the development of deep sternal wound infection that could risk-stratify patients undergoing coronary artery bypass grafting and be applied right after the surgical procedure., Methods: Between March 2007 and August 2016, continuous, prospective surveillance data on deep sternal wound infection and a set of 27 variables of 1500 patients were collected. Using binary logistic regression analysis, we identified independent predictors of deep sternal wound infection. Initially we developed a predictive model in a subset of 500 patients. Dataset was expanded to other 1000 consecutive cases and a final model and risk score were derived. Calibration of the scores was performed using the Hosmer-Lemeshow test., Results: The model had area under Receiver Operating Characteristic (ROC) curve of 0.729 (0.821 for preliminary dataset). Baseline risk score incorporated independent predictors of deep sternal wound infection: obesity (P=0.046; OR 2.58; 95% CI 1.11-6.68), diabetes (P=0.046; OR 2.61; 95% CI 1.12-6.63), smoking (P=0.008; OR 2.10; 95% CI 1.12-4.67), pedicled internal thoracic artery (P=0.012; OR 5.11; 95% CI 1.42-18.40), and on-pump coronary artery bypass grafting (P=0.042; OR 2.20; 95% CI 1.13-5.81). A risk stratification system was, then, developed., Conclusion: This tool effectively predicts deep sternal wound infection risk at our center and may help with risk stratification in relation to public reporting and targeted prevention strategies in patients undergoing coronary artery bypass grafting.

Previous studies showed that lead (Pb) exposure may modulate gene expression by changes in the epigenetic status. However, little is known about the impact of Pb exposure and alterations on DNA methylation patterns in humans exposed to this metal. The aim of this study was to assess the consequences of exposure to Pb on DNA global methylation, in order to gain a better understanding of the interactions between Pb exposure and epigenetic effects. The study included 100 male workers employed in automotive battery factories from Paraná State, Brazil. Concentrations of Pb in blood (B-Pb) and plasma (P-Pb) were determined by ICP-MS, the percentage (%) of global DNA methylation was determined by quantification of 5-methylcytosine using indirect ELISA, and sociodemographic data collected by questionnaire by trained interviewers. The mean age was 37 ± 10 (18-67 years); 18% of participants were smokers, while 32% reported consumption of alcoholic beverages. The B-Pb and P-Pb levels were 20 ± 11 and 0.56 ± 0.64 µg/dl, respectively; % global DNA methylation was 2.8 ± 1.1% (ranging from 1.1 to 6.5%). B-Pb and P-Pb concentrations were significantly correlated. Furthermore, a marked association was noted between Pb biomarkers and DNA global methylation. Taken together, our data demonstrated that Pb exposure induced alterations on DNA global methylation in workers who were exposed to the metal and consequently may result in disturbances in the regulation of gene expression, leading to potentially several health adverse effect outcomes.

Background/objectives: The objective of this study was to assess whether early menarche in normal-weight girls is associated with excess weight, abdominal obesity and metabolic changes at the end of sexual maturation., Subjects/methods: This is a cohort study of 255 normal-weight girls aged 10-18 years attending public schools in the city of Recife, Pernambuco, Northeast of Brazil. The following data were collected in 2007 and 2012: anthropometric; lifestyle, socioeconomic and demographic data; lipid profile; and self-assessed sexual maturation., Results: Eighty-four girls (32.9%) had early menarche. The socioeconomic level and time spent using a computer increased during this 5-year period, whereas the time spent watching television decreased. The prevalences of excess weight and abdominal obesity were 19.2% and 9.8%, respectively. The anthropometric and laboratory variables of girls with and without early menarche did not differ., Conclusions: These findings suggest that early menarche did not influence weight, abdominal obesity and serum lipids in the final stage of sexual maturation.

The reproductive biology of Urotrygon microphthalmum was studied based on specimens caught as by-catch in shrimp (Litopenaeus schmitti, Xiphopenaeus kroyeri, Farfantepenaeus subtilis and Farfantepenaeus brasiliensis) fishing operations between March 2010 and March 2012 on the coast of Pernambuco, Brazil. Females reached a larger total length (LT ) and total body mass (MT ) (298 mm and 148 g) than males (250 mm and 90 g). Length at maturity was estimated to be 188 and 199 mm LT for males and females. Uterine fecundity ranged from one to four embryos (mean ± s.d.: 1·85 ± 0·45). Size at birth was estimated to be 105 mm LT . Gestation lasted between 4 and 5 months. The reproductive cycle of U. microphthalmum is hypothesized to be asynchronous and biannual., (© 2016 The Fisheries Society of the British Isles.)

A new species of Potamotrygon is described from the Rio Negro drainage, Amazonas, Brazil. In spite of being cited or pictured several times in the scientific and aquarium fish literature since the 19th Century, it had been misidentified and still lacked a scientific name. Potamotrygon wallacei, n. sp., is diagnosed by the following characters: dorsal surface of disc light brown, with black irregularly-shaped vermiculate markings forming an amphora- or Ω-shaped figure on mid-disc, delimiting light brown reniform areas at disc center, and with subcircular light brown ocellate markings on disc margins; small body size (smallest known Potamotrygon species; largest examined specimen measured 310 mm DW); dorsal spines on tail usually rather low, without broad bases, in one to rarely three irregular rows, but extending posteriorly only to tail mid-length and not to caudal stings, with altogether relatively few spines; denticles on posterior mid-disc and tail base Y-shaped, with a central, anterior, bulbous cusp and usually two posterior pairs of smaller, rounded cusps; and single (anterior) angular cartilage. The new species is similar to P. orbignyi and other "reticulated" species in having a single (anterior) angular cartilage and in the color pattern of the tail, but is easily distinguished based on its size, dorsal tail spine arrangement, and specific details of color pattern.

Many surgeons are concerned about the flow capacity of a skeletonized internal thoracic artery (ITA) in comparison with a pedicled ITA used during coronary artery bypass graft (CABG). This work aims to summarize the evidence comparing the flow capacity of a skeletonized versus pedicled ITA during CABG. We performed systematic review and meta-analysis according to the PRISMA statement based on a search in MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, Google Scholar and reference lists of relevant articles. Studies included were original studies whose populations comprised patients undergoing CABG; compared outcomes between skeletonized versus pedicled ITA; the outcomes included data regarding intraoperative flow capacity of the grafts; the studies were prospective or retrospective or non-randomized or randomized controlled trials. In total, eight studies were identified and reviewed for eligibility and data were extracted. Forest plots and the summarized difference in means including 95% confidence intervals (CIs) were estimated and meta-regressions were performed. There was a statistically significant difference in favour of the skeletonized ITA compared with the pedicled ITA in terms of flow capacity (random-effect model: additional 20.8 ml/min, 95% CI 6.6-35.0, P = 0.004), being the summary measures under the influence of heterogeneity of the effects, but free from publication bias. We observed a difference with regard to the type of study, since non-randomized studies together demonstrated the superiority of a skeletonized ITA (random-effect model: additional 32.3 ml/min, 95% CI 21.0-43.6, P < 0.001), but the randomized studies together did not show it (random-effect model: additional 13.2 ml/min, 95% CI -1.1 to 27.6, P = 0.071). Meta-regression demonstrated some modulation influence by female gender, age and diabetes on the flow capacity of grafts. In summary, in terms of flow capacity, a skeletonized ITA appears to be superior in comparison with a pedicled ITA during CABG., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background: It is suggested that the internal thoracic artery (ITA) harvesting technique influences the incidence of sternal wound infection (SWI) after coronary artery bypass graft (CABG) surgery when both right and left ITAs are used. We conducted a meta-analysis to determine whether there is any difference between skeletonized versus pedicled bilateral ITA in terms of SWI after CABG., Methods: We performed a systematic-review using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles to search for studies that compared the incidence of SWI after CABG between skeletonized versus pedicled bilateral ITA until May 2014. The principal summary measures were odds ratio (OR) with 95% Confidence Interval (CI) and P values (statistically significant when <0.05). The ORs were combined across studies using weighted DerSimonian-Laird random effects model. Meta-analysis, sensitivity analysis and meta-regression were carried out by using the software Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, New Jersey)., Results: Eight studies involving 2633 patients (1698 skeletonized; 935 pedicled) met the eligibility criteria. There was no evidence for important heterogeneity of the effects among the studies. The overall OR (95% CI) of SWI showed statistical significant difference in favor to skeletonized ITA (random effect model: OR 0.327; 95% CI 0.217-0.492; P < 0.001). In sensitivity analysis, the difference in favor to skeletonized ITA was observed mainly in the presence of diabetes. In meta-regression, we observed no modulation of the effects., Conclusion: When both ITAs are used, the skeletonized technique appears to reduce the incidence of SWI after CABG in comparison to the pedicled technique., (Copyright © 2014 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.)

The clinical application of CCR5 antagonists involves first determining the coreceptor usage by the infecting viral strain. Bioinformatics programs that predict coreceptor usage could provide an alternative method to screen candidates for treatment with CCR5 antagonists, particularly in countries with limited financial resources. Thus, the present study aims to identify the best approach using bioinformatics tools for determining HIV-1 coreceptor usage in clinical practice. Proviral DNA sequences and Trofile results from 99 HIV-1-infected subjects under clinical monitoring were analyzed in this study. Based on the Trofile results, the viral variants present were 81.1% R5, 21.4% R5X4 and 1.8% X4. Determination of tropism using a Geno2pheno[coreceptor] analysis with a false positive rate of 10% gave the most suitable performance in this sampling: the R5 and X4 strains were found at frequencies of 78.5% and 28.4%, respectively, and there was 78.6% concordance between the phenotypic and genotypic results. Further studies are needed to clarify how genetic diversity amongst virus strains affects bioinformatics-driven approaches for determining tropism. Although this strategy could be useful for screening patients in developing countries, some limitations remain that restrict the wider application of coreceptor usage tests in clinical practice.

This study aimed to identify the prevalence of physical inactivity and associated factors in adolescents, using a cross-sectional design with a sample of 1,455 adolescents (741 females). Data were collected using a questionnaire consisting of socio-demographic, perceptual, and behavioral variables. Physical activity was estimated with the Physical Activity Questionnaire for Older Children and Adolescents. Prevalence of physical inactivity was 68% (95%CI: 65.6%-70.4%). The following variables remained associated with physical inactivity in the adjusted analysis (p < 0.05): living in an apartment, female gender, older adolescents, lower self-rated physical activity compared to peers, low perception of maternal physical activity, passive commuting to school, non-participation in physical education at school, non-enjoyment of physical education classes, and limited involvement in other types of physical exercise besides physical education at school. There were a high proportion of inactive adolescents. Strategies to prevent physical inactivity in adolescents should be elaborated with a central role for the school and family.

Objective: To understand the experience of primary caregivers of heart transplant recipients., Methods: A phenomenological approach was used to understand the caregivers' experience of caring for a heart transplant patient. In-depth interviews were conducted with 11 caregivers, in a Brazilian hospital, from December 2008 to March 2009., Results: Following the transplant, caregivers' lives change drastically; their priority becomes providing care for their relative. Despite successful transplant results, the uncertainty about future remains, generating permanent distress. Anxiety is exacerbated by familial or economic problems and, consequently, many participants turn to their local communities for support. Some caregivers learn from the experience and plan return to regular activities. Others feel helpless, unable to overcome personal losses and difficulties., Conclusions: Nurses are ideally placed to lead the way by providing family-centered support and education for caregivers of heart recipients. Listening to the concerns of family caregivers seems to be an essential aspect of effective interventions., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Introduction: Since the excess of body fat is associated with higher morbid-mortality rates (mainly in adults), precise, reliable, cost-effective, and broadly applicable methods are necessary for its assessment in population-based studies and in clinical practice., Objective: To evaluate the correlation between body fat estimated either by bioelectrical impedance or by the sum of skinfold thicknesses and anthropometric indicators of fat distribution., Methods: A cross-sectional study was conducted enrolled 348 undergraduate students (median 21 years), from the Federal University of Pernambuco, Northeast Brazil., Results: 262 of the subjects were women. Mean body fat assessed by bioelectrical impedance was 22.3 ± 6.2% in women and 15.2 ± 4.2% in men. Body fat obtained by the sum of skinfold thicknesses was similar to that assessed by bioelectrical impedance only in men. A strong correlation was observed between body fat assessed by bioelectrical impedance and that assessed by the sum of the skinfold thicknesses, waist circumference and waist-to-height ratio. Regarding the conicity index, there was a moderate correlation for men and a weak correlation for women., Conclusions: The sum of skinfold thicknesses surrogate of body fat percentage and can be used to assess body fat when BIA is not available in the field. Additional information about central fat distribution can be supply by measuring the waist circumference or waist-to-height ratio.

Human T-cell lymphotropic virus type 1 (HTLV-1) is an RNA virus responsible for diseases such as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukemia/lymphoma (ATL). Cell-to-cell contact and Tax-induced clonal expansion of infected cells are the main modes of virus replication, making virus detection during the viremic stage difficult. Consequently, the proviral load is the current virologic marker for disease monitoring, but the mechanisms of progression have not been established yet. Thus, this study investigated the presence of virus in plasma from asymptomatic HTLV-1 carriers and from HAM/TSP patients. Real-time PCR was performed on DNA from 150 plasma samples; 12 (8%) had detectable DNA amplification, including 6 (4%) asymptomatic HTLV-1 carriers and 14 (26%) HAM/TSP patients (p<0.005). Of the 33 samples submitted for nested PCR, six (18%, p=0.02) were positive for HTLV-1 RNA in the plasma. Additionally, 26 plasma samples were treated with DNAse enzyme to eliminate any DNA contamination before RNA extraction. Two of them (8%) showed amplification for HTLV-1 (p=0.5). Therefore, this study described for the first time the detection of free HTLV-1 RNA in plasma from HTLV-1-infected subjects, regardless of their clinical status. Thus, HTLV-1 viral replication does occur in plasma, and other transmission pathways for HTLV-1 should be investigated further., (Copyright © 2011 Elsevier B.V. All rights reserved.)

The aim of this study was to highlight the meaning of home dialysis as experienced by patients with chronic renal failure. The research design was influenced by Ricoeur's phenomenology. Nineteen patients from a Brazilian public hospital were interviewed, from May to September 2009. Interviews were guided by the question: "Tell me about your experiences lived undergoing PD". Findings unveiled the patients' perception of the drastic changes in their existence, consequent to disease and treatment; and the perception of themselves in that process. The feeling of anguish, physical pain and deprivations were part of living that condition. They foresee an uncertain future, depending on the expertise of health care providers and the demands on support of significant others. Findings suggest that individual aspects of patients' experiences must be considered if health care providers are to facilitate positive health outcomes.

Purpose: to evaluate psychosocial adaptation to pregnancy by translating and cross-culturally adapting a specific assessment instrument to be used with Brazilian women., Methods: this was a cross-sectional observational study. the translation and cross-cultural adaptation and of the Prenatal Self-evaluation Questionnaire (PSeQ) was performed following all the required methodological steps. another questionnaire was applied to characterize the sociodemographic and clinical status of the pregnant women (n=36). Statistical analysis consisted of the determination of the mean and standard deviation (SD) and of absolute and relative frequency. the statistical test used for the analysis of internal consistency was Cronbach's alpha coefficient, using SPSS version 17.0., Results: the volunteers were of low socioeconomic status, aged on average 25.1 years ( 5.5), and had an average gestational age of 25.9 weeks ( 8.1). 58.3% of these volunteers had not planned their current pregnancy. the pretest showed that 75% of the pregnant women found the questionnaire easy to understand. Regarding the PSeQ instrument, the identification with the maternal role was the subcategory which showed the highest average, 24.8 ( 5.6), while the relationship with the mother had the lowest average 15.4 ( 7.7). the internal consistency ranged from 0.52 to 0.89., Conclusion: the assessment of psychosocial adaptation to pregnancy in pregnant women is very important during the progress of pregnancy and permits intervention through obstetric-neonatal actions of promotion and prevention regarding the well-being of mother and child.

Background: Evidence has suggested that a significant proportion of children and adolescents has high levels of total cholesterol., Objective: To estimate the prevalence of hypercholesterolemia and associated factors in 07-12 year-old school children., Methods: School based cross sectional study of a random sample of 1,294 07-12 year-old school children from Caxias do Sul/RS, Brazil. The students answered an interview with information on socioeconomic status, food habits, and physical and leisure activities. Total cholesterol, cardiorespiratory fitness, body mass and height were measured to calculate body mass index. For the data treatment, univariate, bivariate, and multivariate analyzes were used., Results: The multivariate analysis identified that individuals from high socioeconomic level (OR: 1.70; CI: 1.05-2.75), of female gender (OR: 1.32; CI: 1.03-1.67), and overweight (OR: 1.40; IC: 1.10-1.77) had increased chances of having increased total cholesterol (> 3rd tercile)., Conclusion: High total cholesterol levels on 07-12 year-old school children are associated with high socioeconomic level, female gender, and overweight. Encouraging an active life style and appropriate dietary habits can help control cholesterol levels and reduce risk factors.

Introduction: To assess the effects of the habit of having evening dinner on the dietary macro- and micronutrient profile of chronic kidney failure patients on hemodialysis., Methods: Cross-sectional study carried out at a dialysis clinic at the city of Belo Horizonte, state of Minas Gerais. The study comprised 90 patients undergoing hemodialysis. Personal, clinical, and dietary (three-day food record) data were collected. The habit of having dinner was considered as having a complete evening meal, and the lack of that habit was considered as not having it or replacing it by a fast meal. The amounts of nutrient intake were estimated in the specific software Dietwin®., Results: The carbohydrate, thiamine, riboflavin, ascorbic acid, calcium, and selenium intake values showed no difference between the group having a complete evening meal and that not having it (p > 0.05). Both groups did not differ in the following: body mass index, and energy, protein, lipid, niacin, pantothenic acid, pyridoxine, folic acid, cobalamin, potassium, phosphorus, zinc, and magnesium intake values (p < 0.05). Regarding nutrient adequacy, the complete evening meal group performed better than the other group, except for carbohydrates, lipids, pantothenic acid, ascorbic acid, potassium, calcium, and zinc (p < 0.05). None of the patients showed the adequate pyridoxine, folic acid, and selenium intake values. Few patients in both groups showed adequate energy, pantothenic acid, and zinc intake values., Conclusion: The habit of having a complete evening meal influenced positively the micro and macronutrient intakes in chronic kidney failure patients on hemodialysis.

Objective: To purpose news body mass index (BMI) cut offs to 7 to 12 years old scholars., Subjects and Methods: 1.413 scholars of 7 to 12 years old selected of aleatory way. Were measured the BMI, total cholesterol (TC), and systolic (SBP) and diastolic blood pressure (DBP). To the date analyze were used the receiver operating characteristic curve (ROC curve) and the bivariate analyze., Results: The BMI cut offs proposed at this study show adequate capacity to identify true positive and negative to the cardiovascular diseases (CVD) risk factors presence. Besides, these cut offs show higher and more balanced sensibility and specificity values than other cut offs proposals., Conclusions: The BMI proposed at this study configure with as the more adequate alternative to the screening for the scholars with increased chances to carry DCV risk factors.

Stiff-person syndrome (SPS) is a rare neurological condition consisting of progressive and fluctuating rigidity of the axial muscles combined with painful spasms. The pathophysiology of SPS is not fully understood, but there seems to be an autoimmune component. The use of rituximab, a chimeric monoclonal antibody targeting CD20 protein in the surface of mature B cells, for the treatment of SPS is a recent therapeutical approach showing promising results. The authors present a case report of a 41-year-old female patient diagnosed with SPS who was treated with rituximab in a public hospital in Brasília, Brazil, showing a good and safe response to the treatment so far. Our data go along with some recent articles published in the literature.

This study aimed at describing patients' perception of their communication with nurses when performing home dialysis. Data were collected from interviews guided by the question: "What is communication like, between you and nurses, during home dialysis treatment?" Results show participants' perception of treatment during home peritoneal dialysis [Continuous ambulatory peritoneal dialysis (CAPD)]; relationship with nurses and family and the effects of treatment on one's existence. Patients can be self-caring and they learn to value the autonomy in their own care. However, some are unable to assume the responsibility for self-care. It was discovered that the connotation of "inspection" that some participants attributed to the nurse's visits, led to an alienation from the education process in the CAPD education. Findings suggest that effective communication and the development of the relationship of a working partnership with patients is crucial. Improvement in the nurses' communication, aiming at adapting it to the characteristics, limitations and specific needs of each patient, is significant for achieving better outcomes.

Successful heart transplantation in patients with Chagas disease depends on special care to be provided during all phases of the transplantation process, and requires specific and rigorous follow-up by the health care team. Recipients must be aware of the permanence of the trypanosome in their organisms as well as of the possibility of infection reactivation after transplantation. Therefore, the patient's knowledge regarding this condition and his active participation in his own treatment are of utmost importance. This study aimed at investigating heart transplantation as experienced by patients with Chagas disease, seeking to understand the meanings that they attribute to such an experience. The methodological procedures included: patient selection; interviews; data analysis, indication of the meaning units and individual analysis; search for discourse convergence; and hermeneutic analysis of convergences. From the data analysis, the following themes emerged: the time lived by recipients with Chagas Disease; the conception of heart transplantation presented by patients with Chagas Disease; and care in the course of heart transplantation.

Objective: To establish the prevalence of high blood pressure and associated factors among schoolchildren from Caxias do Sul, state of Rio Grande do Sul, Brazil., Methods: This school-based cross-sectional study assessed boys and girls aged 7 to 12 years from private and public schools. Three measurements of the children's blood pressure were taken during one visit to the schools. Weight, height, and waist circumference were measured. We also assessed the children's aerobic capacity (9-minute running test) and socioeconomic status. Statistical analysis was carried out using the chi-square test and logistic regression in order to control for confounding factors., Results: The sample included 1,413 children. Prevalence of schoolchildren with high blood pressure was 13.8% (systolic, diastolic, systolic/diastolic), and the proportion was higher (double) for obese and/or overweight children in comparison to normal-weight children. Children with increased waist circumference had 2.8 times greater chance of having high blood pressure levels than those with appropriate waist circumference (95% confidence interval 2.513-3.186 and p = 0.000). Individuals belonging to a high social class, defined according to the Brazilian National Economic Index, had 2.6 times greater chance of having high blood pressure., Conclusions: In the present study, schoolchildren aged 7 to 12 years from Caxias do Sul had high prevalence of high blood pressure levels; increased waist circumference, high socioeconomic status, and low physical capacity were associated with this condition. We suggest that measures be taken to promote the practice of physical activity and dietary control to improve blood pressure levels and thus reduce risk factors.

The aim of this study is to understand how nursing undergraduates perceive themselves while care delivery to terminal patients and expose the meaning of the experience they have. Fourteen students were interviewed, and answered the following question: What is the image you have about caring for a terminal patient? Students always consider this to be a painful experience, one that puts them face to face with their weaknesses and insecurities. They attribute their difficulties to their personal incapacity to accept death and to their lack of preparation and their inexperience. They report a lack of support from professionals with whom they share this care. In terms of professional development, for some, the experience was positive, despite the difficulties; others evaluate it as negative, resulting in a rejection of similar situations. Further studies on this subject are needed with a view to a deeper and broader reflection on nursing education in Brazil.