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The widespread adoption of metformin as a primary therapeutic agent for type 2 diabetes has prompted inquiries into its potential impact on vitamin B 12 (cobalamin) levels and subsequent deficiency. This study aimed to elucidate this complex relationship and enhance the care provided to patients undergoing metformin treatment. A comprehensive search of meta-analyses , systematic reviews, randomised controlled trials and guidelines published between January 2010 and September 2021 was conducted. MeSH terms 'metformin' and 'vitamin B 12 ,' along with corresponding DeCS terms, guided the search. Varied recommendations from different scientific associations underscore the need for regular monitoring of vitamin B 12 levels in patients undergoing long-term metformin therapy. Different durations of metformin exposure, spanning from 6 weeks to 48 months, were associated with decreased vitamin B 12 concentrations. Observed decreases in B 12 concentrations ranged from 7.7 to 65.8 pmol/L, with percentage reductions ranging from 6.3 % to over 35 %. The evidence highlights a dosage-dependent correlation between higher metformin doses and an increased prevalence of B 12 deficiency. The results obtained highlight the association between metformin and B 12 deficiency. The prevalence of B 12 deficiency under metformin is of a greater magnitude than the one declared on the Summary of Product Characteristics approved by the medicine regulatory agencies. Thus, clinicians should be aware of this possible side effect when prescribing metformin, in order to prevent, monitor and treat if present.

Background/Aim: Metformin has been associated with vitamin B 12 (cobalamin) deficiency, pushing scientific societies such as the American Diabetes Association and the European Association for the Study of Diabetes to emphasise the need for screening B 12 levels, without specific metformin doses or exposure durations triggering this screening. Robust data regarding the prevalence of B 12 deficiency in metformin-treated patients in Portugal are currently lacking. Aim of this study was to identify the prevalence of B 12 deficiency in a sample of diabetic patients taking metformin. Secondary objectives were determining the minimum dose and minimum and median time exposure time leading to this deficiency and identifying the average duration of metformin use in the patients with this deficiency. Methods: Descriptive and cross-sectional observational study was performed on a sample of 79 users from a population of 714 diabetic patients on metformin. Inclusion criteria comprised individuals aged 18 or older, receiving metformin for at least 1 month and voluntarily participating in the study. Exclusion criteria included a history of gastrectomy or B 12 supplementation. Results: A prevalence of 25.3 % of vitamin B 12 deficiency was identified in the study sample. Minimum doses of 500 mg of metformin per day and a minimum exposure period of 1 year were associated with B 12 deficiency. An average exposure time of 5.33 years was identified. Conclusion: These results align with the prevalence described in the few international studies and should alert physicians to potential clinical manifestations of this deficiency, such as anaemia and neurological symptoms like neuropathy.

Este trabajo presenta la caracterización geológica-geofísica de una probable ocurrencia de oro en Santa Catarina Gabro, en la región de São Sepé, estado de Rio Grande do Sul, sur de Brasil. Trabajos anteriores han indicado la presencia de oro en la región en las actuales campañas de prospección geoquímica de sedimentos y sugieren que el área de origen sería Santa Catarina Gabro. Para investigar sobre esta probable ocurrencia de oro, se realizaron estudios geológicos y estructurales, seguidos de la adquisición de información geofísica utilizando los métodos de resistividad DC e IP, con el arreglo dipolo-dipolo. Los datos geofísicos fueron procesados en inversión 2D y luego interpolados para permitir la visualización tridimensional de la posible mineralización. Interpretaciones basadas en la recopilación de datos geológicos y geofísicos, en asociación con el contexto estructural regional, sugieren que la probable mineralización se originó a partir de la intrusión del Granito São Sepé, cuyos fluidos hidrotermales se alojaron en fracturas durante los eventos tectónicos ocurridos en la región. Los resultados obtenidos en este trabajo permiten delinear una arquitectura de yacimiento factible con el contexto geológico de la región y ayudar a una futura estrategia de perforación dirigida a los objetivos probables identificados.

Conceptual models underpin river ecosystem research. However, current models focus on continuously flowing rivers and few explicitly address characteristics such as flow cessation and drying. The applicability of existing conceptual models to nonperennial rivers that cease to flow (intermittent rivers and ephemeral streams, IRES) has not been evaluated. We reviewed 18 models, finding that they collectively describe main drivers of biogeochemical and ecological patterns and processes longitudinally (upstream-downstream), laterally (channel-riparian-floodplain), vertically (surface water-groundwater), and temporally across local and landscape scales. However, perennial rivers are longitudinally continuous while IRES are longitudinally discontinuous. Whereas perennial rivers have bidirectional lateral connections between aquatic and terrestrial ecosystems, in IRES, this connection is unidirectional for much of the time, from terrestrial-to-aquatic only. Vertical connectivity between surface and subsurface water occurs bidirectionally and is temporally consistent in perennial rivers. However, in IRES, this exchange is temporally variable, and can become unidirectional during drying or rewetting phases. Finally, drying adds another dimension of flow variation to be considered across temporal and spatial scales in IRES, much as flooding is considered as a temporally and spatially dynamic process in perennial rivers. Here, we focus on ways in which existing models could be modified to accommodate drying as a fundamental process that can alter these patterns and processes across spatial and temporal dimensions in streams. This perspective is needed to support river science and management in our era of rapid global change, including increasing duration, frequency, and occurrence of drying.

Abstract Background The continuous changes in the medical education to prepare medical doctors for the future requires updates in medical curriculum. However, the perspectives of the medical students are not frequently considered during the revision of the medical curriculum. In parallel with the process of defining and adjusting the medical curriculum, a large survey was performed to inquire the perspectives of the medical students at the Faculty of Medicine of the University of Porto (FMUP), Portugal, about the role of Histology and of Embryology. Methods Medical students at FMUP (Portugal) completed a structured and anonymous online questionnaire about the subjects Histology and Embryology. The questionnaire was prepared using questions of previous surveys performed in Europe, including another Portuguese medical school, and additional questions that were specifically prepared to this study. The questions referred to teaching methods, clinical relevance, use of virtual (digital) microscopes and association of Histology and Embryology with other subjects of the medical curriculum. Results Four hundred and sixty-two students participated in the study. The students in clinical years were more likely to recognise the clinical relevance of Histology (p = 0.016) and Embryology (p

Neuropathic pain is caused by a lesion or disease of the somatosensory system and is one of the most incapacitating pain types, representing a significant non-met medical need. Due to the increase in research in the field and since innovative therapeutic strategies are required, namely in intractable neuropathic pain, neurostimulation has been used. Within this approach, transcranial magnetic stimulation (TMS) that uses a transient magnetic field to produce electrical currents over the cortex emerges as a popular method in the literature. Since this is an area in expansion and due to the putative role of TMS, we performed a bibliometric analysis in Scopus with the primary objective of identifying the scientific production related to the use of TMS to manage neuropathic pain. The research had no restrictions, and the analysis focused on the characteristics of the literature retrieved, scientific collaboration and main research topics from inception to 6 July 2023. A total of 474 articles were collected. A biggest co-occurrence between the terms “neuropathic pain” and “transcranial magnetic stimulation” was obtained. The journal “Clinical Neurophysiology” leads the Top 5 most productive sources. The United States is the most productive country, with 50% of US documents being “review articles”, followed by France, with 56% of French documents being “original articles”. Lefaucheur, JP and Saitoh, Y are the two most influential authors. The most frequent type of document was “original article”. Most of the studies (34%) that identified the neuropathic pain type focused on traumatic neuropathic pain, although a large proportion (38%) did not report the neuropathic pain type. This study allows us to provide a general overview of the field of TMS application for neuropathic pain and is useful for establishing future directions of research in this field.

En la última pieza euripídea que llegó a representarse cuando el poeta se encontraba aún con vida, se presenta a un Edipo encerrado durante casi toda la acción trágica, presa de una angustia irracional que lo corroe que, finalmente, deberá ser expiada mediante el tradicional exilio. El presente escrito pretende dar una explicación del recurso del encierro en esta obra, Fenicias, con el fin de desentrañar su significado a la luz de los testimonios épicos y el drama ático bajo la premisa de que Eurípides conserva una deliberado y comprometido interés en el misterio de las pasiones y su naturaleza irracional.

Objectives: This study aims to summarize how child mortality—a Sustainable Development Goal stated by the United Nations—has been explicitly addressed in the context of innovations.Methods: A scoping review following the PRISMA-ScR Statement was performed analysing indexed and non-indexed literature.Results: Empirical and non-disruptive innovation in the context of process targeting under-five mortality rate was the main subset of literature included in this article. The increment of literature on innovation in the context of SDGs over the last years denotes its growing importance and even though innovation aiming to reduce child mortality is currently being done, a significant part of it is not published in indexed databases but as grey literature.Conclusion: Empirical, disruptive innovation under a structural approach and empirical, non-disruptive innovation under a project point of view are the main types of innovation addressed in the literature and would be of utmost potential to reduce child mortality rate. A systematic review of the methods used for the measures of evaluation of applied innovations, their quality and results would be of great importance in the future.

Las enfermedades constituyen una problemática limitante en el cultivo de trigo. Seleccionar variedades con resistencia genética es fundamental para aplicar un manejo adecuado. Ante la falta de información actualizada sobre el desempeño de los materiales de trigo frente a enfermedades en la región centro-sur de la provincia de Córdoba, el objetivo del trabajo fue evaluar el comportamiento de las mismas en dicha zona. Para ello, en la campaña 2017 se llevó a cabo un ensayo comparativo de rendimiento en un lote de producción comercial ubicado a 8 km de la localidad de Espinillos, departamento Río Cuarto, provincia de Córdoba . El ensayo se realizó según un diseño en bloques completamente aleatorizado, evaluando 27 variedades de trigo disponibles en el mercado. Cada variedad fue sembrada en una parcela de 7 surcos de 5,5 m de largo a 20 cm de distancia. Se determinó la incidencia y severidad para roya de la hoja (Puccinia triticina), roya estriada (Puccinia striiformis) y mancha amarilla (Drechslera tritici-repentis). Hubo cinco evaluaciones distanciadas cada quince días. También se cuantificó el área bajo la curva de progreso de la enfermedad (ABCPE). Los datos se analizaron mediante ANOVA y comparación de medias según el test DGC (5%). Finalmente, se realizó un estudio multivariado a partir del análisis de componentes principales (ACP) y con los resultados de este, un análisis de clusters (K-means). Los resultados mostraron elevada incidencia, severidad y ABCPE para roya estriada. Se identificaron materiales con buen comportamiento (test DGC p