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Joanna Ripoll Rozisky,1,2,4,* Yasmine Nonose,1,4,* Gabriela Laste,1,2,4 Vinicius Souza dos Santos,1,4 Isabel Cristina de Macedo,1,2,4 Ana Maria Oliveira Battastini,2,3 Wolnei Caumo,2,4 Iraci LS Torres1,2,41Laboratório de Farmacologia da Dor e Neuromodulação: Modelos Animais, Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, 2Programa de Pós-Graduação em Medicina, Ciências Médicas, 3Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil; 4Unidade de Experimentação Animal e Grupo de Pesquisa e Pós-Graduação, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil *Both authors contributed equally to this workAbstract: Morphine has been widely used in neonatal pain management. However, this treatment may produce adaptive changes in several physiologic systems. Our laboratory has demonstrated that morphine treatment in neonate rats alters nucleoside triphosphate diphosphohydrolase (NTPDase) activity and gene expression in central nervous system structures. Considering the relationship between the opioid and purinergic systems, our aim was to verify whether treatment with morphine from postnatal days 8 (P8) through 14 (P14) at a dose of 5 µg per day alters NTPDase and 5´-nucleotidase activities in rat serum over the short, medium, and long terms. After the in vivo assay, the morphine group showed increased hydrolysis of all nucleotides at P30, and a decrease in adenosine 5´-diphosphate hydrolysis at P60. Moreover, we found that nucleotidase activities change with age; adenosine 5´-triphosphate hydrolysis activity was lower at P16, and adenosine 5'-monophosphate hydrolysis activity was higher at P60. These changes are very important because these enzymes are the main regulators of blood nucleotide levels and, consequently, nucleotide signaling. Our findings showed that in vivo morphine treatment alters nucleotide hydrolysis in rat blood serum, suggesting that purine homeostasis can be influenced by opioid treatment during the neonatal period.Keywords: 5´-nucleotidase, morphine, neonate, NTPDase, rat blood serum

Brazil's extensive agricultural area makes it the world's leading soybeans and sugarcane producer. Therefore, the use of large amounts of pesticides directly impacts all environmental compartments, including rainwater. We analyzed 14 pesticides and 5 degradation products in rainwater from three cities in the State of São Paulo, southeastern Brazil, with distinct land uses. We also correlated pesticide concentrations with climate parameters and remote sensing images and estimated the wet deposition fluxes in all cities. A risk assessment was conducted to evaluate potential risks to aquatic life, as rainwater may contributes to pesticide contamination of freshwater. Pesticide concentrations ranged from 0.1 to 596 ng L -1 , including herbicides, fungicides, insecticides, and degradation products, with 100% detection frequency for atrazine and tebuconazole. The sum of wet deposition fluxes of pesticides in São Paulo (223 μg m -2 ) was about 3-fold lower than in the other cities with low population density and more agricultural activity (Brotas - 680 μg m -2 and Campinas - 701 μg m -2 ). Statistical analysis showed that the data from all cities differed from each other, with atrazine being the pesticide that contributed most to this difference, followed by carbendazim. Only two herbicides and one fungicide posed a risk to aquatic life. However, three insecticides and two insecticide degradation products had a risk quotient higher than 1, indicating that rainwater alone is a source of pesticide contamination. Thus, the use of rainwater for potable purposes must consider potential contamination, not only with pesticides, as shown here, but also with other toxic compounds., 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 © 2025. Published by Elsevier Ltd.)

Background: Evaluate the impact of Spondias mombin L. juice (SM), alone and in combination with Lactobacillus acidophilus, in an experimental model of intestinal mucositis., Methods: Swiss mice were orally administered with saline, SM, or SM combined with L. acidophilus NRRL B-4495 at 1 × 10 9 colony-forming unit (CFU/mL) for 15 days before the induction of intestinal mucositis by a single intraperitoneal injection of 5-fluorouracil (5-FU) at 450 mg/kg. On the 18th day, following euthanasia, tissue samples were collected for histopathological examination. Jejunum tissues were analyzed for MUC-2 immunoexpression, concentrations of interleukin-1-beta (IL-1β), interleukin 6 (IL-6) and tumor necrosis factor (TNF)-α, and invertase activity., Key Results: 5-FU induced intestinal damage in all intestinal segments, and this damage involved villus blunting, flattened and vacuolated cells, crypt necrosis, inflammatory cell infiltration, and mucosa and submucosal edema compared to the control group. In contrast, SM or SM with L. acidophilus prevented these morphological alterations in all intestinal segments (p < 0.05). Both treatments reduced the intestinal concentration of IL-1 beta (p < 0.05), IL-6 (p < 0.05), and TNF-alpha (p < 0.05). Notably, the combination of SM and L. acidophilus, but not SM alone, prevented the 5-FU-induced decrease in invertase activity and mucin expression (p < 0.05). Furthermore, SM combined with L. acidophilus resulted in an increased population of lactic acid bacteria in feces on the 7th and 18th days. Combining SM with L. acidophilus also decreased fecal excretion of γ-Ergostenol and γ-sitosterol., Conclusions and Inferences: SM, alone and combined with Lactobacillus acidophilus demonstrated significant protective effects against 5-FU-induced intestinal mucositis, reducing inflammatory markers., (© 2024 John Wiley & Sons Ltd.)

Ovariohysterectomy (OVH) is a common procedure in bitches, where ovarian suspensory ligament (OSL) rupture facilitates hemostasis but may also have adverse effects. Given the importance of minimizing the surgical stress response, this study aimed to evaluate the impact of OSL rupture in 20 healthy bitches undergoing elective open OVH; a celiotomy via the ventral midline was performed, and hemostasis achieved using bipolar coagulation, either with OSL rupture (OSL-R) or without (OSL-NR). Pain was assessed over 24 h post-surgery using the Visual Analogue Scale and the Short Form of the Glasgow Composite Measure Pain Scale. The physical parameters, complete blood count, glucose levels, erythrocyte sedimentation rate, and neutrophil oxidative and phagocytic functions were evaluated pre-surgery and at 6, 12, 24, and 48 h, as well as 10 days after. Oxidative metabolism was assessed through vitamin C and protein thiols, reduced glutathione, and thiobarbituric acid reactive substances. No differences in trans- and postoperative pain were observed between techniques, except for analgesic rescue rates. Differences were noted in the heart rate, total leukocyte count, segmented neutrophils, eosinophils, and monocytes. Both techniques resulted in low oxidative and phagocytic changes. Overall, OSL rupture appears to elicit a slightly more intense surgical stress response than the non-rupture technique.

OBJECTIVES: To (1) estimate the economic cost of disabling musculoskeletal pain in children and adolescents from a health care and societal perspective, (2) identify the characteristics of children and adolescents with higher costs, and (3) estimate the economic cost of children's pain to Brazil. DESIGN: Prospective cohort study. METHODS: We recruited children and adolescents with disabling musculoskeletal pain from public and private schools. The economic cost associated with disabling musculoskeletal pain was reported by parents each month for 1 year. The cost categories were health care, lost productivity, and patient/family costs. The sum of the categories resulted in the societal costs. Costs were reported using means, standard errors, medians, interquartile ranges, confidence intervals, and sum for each cost category. We compared participant characteristics between groups with low and high costs, and estimated the health and social cost of children's pain to the Brazilian federal budget. RESULTS: We included 237 children and adolescents with mean age of 11.8 years (standard deviation, 2.9). Total annual health care costs were $29.58 and $103.13 for health insurance/public health care and out-of-pocket, respectively, per child. Total annual societal costs were $177.62 per child. Individuals in low socioeconomic class E (with a monthly income of up to R$403.00) reported that heavy backpack weight, practice of fewer days of sports, and more negative psychosomatic symptoms were associated with higher health care costs. The annual costs to Brazil from the societal perspective was $1 001 329 553. CONCLUSION: Disabling musculoskeletal pain in children and adolescents in Brazil imposes a serious economic burden of up to $1 billion on the federal budget. J Orthop Sports Phys Ther 2024;54(12):1-10. Epub 4 November 2024. doi:10.2519/jospt.2024.12735 .

Objectives: To describe the trends in antibiotic prescribing by dental practitioners and to investigate the relationship between these trends and some factors of public oral health services in Minas Gerais (MG), Brazil., Methods: This was a time-series analysis of antibiotics prescribed by dental practitioners between January 2011 and December 2021. The outcome variables were number of defined daily doses (DDD) and DDD/1000 population/year in a sample of cities in MG. Covariates were public oral healthcare factors, such as coverage, estimates of dental procedures, and frequency of dental pain. Linear time-series regression models were used to examine trends and the influence of covariates on antibiotic prescribing., Results: Overall, the number of prescriptions increased by 334.69% between 2011 and 2021, with amoxicillin being the most commonly prescribed drug (78.53%). The number of DDD for all antibiotics increased from 17,147.13 to 77,346.67 and the average DDD/1000 inhabitants/year was 126.66 (SD: 130.28). The linear time-series regression model showed that for each one-year increase, the average log DDD/1000 inhabitants increased by 0.35 (standard error = 0.07, p < 0.001). No covariates were found to be associated with the outcome., Conclusions: In Minas Gerais, Brazil, a significant upward trend was observed in the number of prescriptions and the number of DDD of antibiotics prescribed by dental practitioners. No influence of factors related to public oral healthcare services on the outcome was observed, thereby emphasizing the need for further research on factors influencing medication use in dental practice., (© 2024 American Association of Public Health Dentistry.)

Objective: This case study aims to present the Foreign Accent Syndrome (FAS) in a patient with Cerebral Arteriovenous Malformation (cAVM), considering neuropsychological, radiological and microsurgical aspects., Methods: The patient underwent preoperative neuropsychological assessment and MRI and Tractography were performed to identify fibers close to the lesion site. In the surgical procedure, a craniotomy was performed for excision of the cAVM. After surgery and 6 months after the surgical procedure, the patient underwent further and neuropsychological evaluations., Results: The presence of AVM located in the posterior part of the medial surface of the left superior frontal gyrus was identified and the neuropsychological evaluation found cognitive deficits and symptoms characteristic of FAS, which disappeared after resection., Conclusion: This report presented a case of cAVM in which symptoms were found even without rupture, which was no longer observed after the surgical procedure, demonstrating the relationship of cAVM with the symptoms and neuroanatomical bases of FAS.

Background: Although tuberculosis (TB) poses a significant global health threat to children and adolescents, there is limited information on the factors associated with TB treatment outcomes in this group. This study investigated the social and health factors associated with unfavourable treatment outcomes in children and adolescents with TB in Brazil, a high TB burden country., Methods: We conducted a population-based national retrospective cohort study of children (0-9 years) and adolescents (10-17 years) with TB in Brazil notified to the national Sistema de Informação de Agravos de Notificação (Sinan) from Jan 1, 2001, to Dec 31, 2022. Unfavourable treatment outcomes were defined as loss to follow-up, treatment failure, and death. Logistic regression and multinomial models examined the association between social and health factors, unfavourable treatment outcomes overall, and loss to follow-up and death, respectively., Findings: A total of 88,270 children and adolescents with TB were included of whom 25,600 (30.6%) had healthcare worker-supervised directly observed therapy (DOT). Of these, 9303 (10.5%) individuals experienced unfavourable TB treatment outcomes. For children, HIV infection (adjusted Odds Ratio 2.4, 95% confidence interval 1.9-3.1) and did not receive DOT (2.3, 1.9-2.7) were associated with unfavourable treatment outcomes. For adolescents, alcohol use (1.6, 1.2-2.0), illicit drug use (4.2, 3.4-5.1), tobacco use (1.6, 1.3-2.1), HIV infection (2.7, 2.2-3.4), and not receiving DOT (2.6, 2.3-2.9) were associated with unfavourable TB treatment outcome. Receiving social protection through government cash transfers protected against death (0.5, 0.3-0.9)., Interpretation: In Brazil, TB treatment success rates were comparable to WHO End TB Strategy targets (90%). Substance use, HIV infection, and the absence of supervised treatment were the main factors associated with unfavourable treatment outcomes. Strategies to improve equity of TB treatment outcomes in this vulnerable group, including integrated HIV-TB services, DOT in healthcare facilities or communities, and holistic, person-centred healthcare and social protection, should be evaluated., Funding: Department of Health and Social Care (DHSC), the Foreign, Commonwealth & Development Office (FCDO), the Medical Research Council (MRC) and Wellcome, UK., Competing Interests: TW is funded by grants from the Wellcome Trust, UK (209075/Z/17/Z), the Department of Health and Social Care (DHSC), the Foreign, Commonwealth & Development Office (FCDO), the Medical Research Council (MRC) and Wellcome, UK (Joint Global Health Trials, MR/V004832/1), Medical Research Council (Public Health Intervention Development “PHIND” Award, MR/Y503216/1), and a Dorothy Temple Cross Tuberculosis International Collaboration Grant from the Medical Research Foundation (MRF-131-0006-RG-KHOS-C0942), UK. VSS, JRCH, RDSGN, ELNM, FDCJ, JNBSJ, WACCC, JRLS, JRSS and RQG have no conflict of interest to declare., (© 2024 The Authors.)

This study aimed to evaluate the effects of excessive and episodic consumption of ethanol (EtOH, a high-intensity drinking manner) on induced apical periodontitis in rats. Thirty-two animals were divided into the following four groups: control, EtOH, apical periodontitis, and EtOH + apical periodontitis. Ethanol exposure (3 g/kg 20 % w/v EtOH) was performed by orogastric gavage for 3 consecutive days, followed by 4 days of withdrawal for 4 weeks. Lesions were induced by exposing the dental pulp of the lower first molar and by the absence of any treatment/curative for 28 days. Finally, the animals were euthanized, and mandibles were collected. The mandible was divided medially, with one hemimandible being used for micro-computed tomography analysis of the volume of the periapical lesion and bone quality parameters, such as bone volume and trabecular bone assessments; the other hemimandible was used for histological analysis, with a descriptive histopathological analysis of the tissue and the pattern of bone loss presented, as well as an assessment of the collagen content present. The data were subjected to statistical analysis (one-way analysis of variance with Tukey's post-hoc test). Our results showed that the EtOH + apical periodontitis group had a larger volume of periapical lesions than animals that were not exposed to ethanol. Additionally, bone quality parameters showed a reduction in bone volume and thickening of the trabeculae, associated with increased tissue destruction and reduced collagen content in the remnant region of the alveolar bone. These results suggest that exposure to EtOH in a pattern of excessive alcohol consumption is an aggravating factor in apical periodontitis and, consequently, in its progression, the quality and quantity of the alveolar bone remaining in the region of the periapical lesion are the modulating aspects., Competing Interests: 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., (© 2024 The Authors.)

Sour rot, caused by Geotrichum citri-aurantii , is a significant post-harvest disease in citrus, resulting in economic losses due to the lack of effective fungicides. This study investigates the antifungal activity of citrus essential oils in controlling sour rot in Tahiti acid lime fruits. Essential oils were extracted via hydrodistillation with chemical composition analyzed by CG-MS and tested in vitro and in vivo. In vitro assays evaluated mycelial growth inhibition at 2 to 32 µL mL -1 concentrations. In vivo trials involved preventive and curative treatments on artificially inoculated fruits stored at 25 °C ± 2, and the results showed that Pera IAC sweet orange oil, at 32 µL mL -1 , reduced disease severity by 96% in curative treatments. In contrast, Late IAC 585 willowleaf mandarin oil demonstrated moderate inhibition (44%) at the highest concentration in vitro. The oils did not affect key fruit quality parameters such as juice yield and total soluble solids. These findings suggest that citrus essential oils could be natural alternatives to synthetic fungicides for post-harvest sour rot management, combining effectiveness with maintaining fruit quality.

This study evaluated the association between multimorbidity patterns and socioeconomic conditions with functional limitation in individuals aged 60 years or older from the State of Minas Gerais, Brazil. This was a cross-sectional study with data from the last National Health Survey. Dependent variables were functional limitations in basic (BADL) and instrumental activities of daily living (IADL). The independent variables were multimorbidity patterns and socioeconomic conditions. Multimorbidity patterns were defined using an exploratory factor analysis. The association between multimorbidity patterns and dependent variables was tested using logistic regression models adjusted for covariates. Multimorbidity patterns were associated with limitations in BADL and IADL, except for the metabolic profile for IADL. Individuals with higher income had lower chances of being limited in BADL. Older adults with a higher level of education and income had lower chances of limitation in IADL. Multimorbidity patterns and socioeconomic conditions were associated with limitations in BADL and IADL., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Fabiola Bof de Andrade reports financial support was provided by Minas Gerais State Foundation of Support to the Research. Karine Larissa Barbosa reports financial support was provided by Minas Gerais State Foundation of Support to the Research. Ana Carolina Borges reports financial support was provided by Minas Gerais State Foundation of Support to the Research. If there are other authors, they 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 © 2024 Elsevier Inc. All rights reserved.)

Introduction: Urinary incontinence (UI) is defined as any involuntary loss of urine that causes negative impacts on women's lives. Pelvic floor muscle training (PFMT) is considered to be "level A" of scientific evidence in the treatment of UI. Despite its efficacy, it is known that the effect of PFMT may depend on continuous adherence. Therefore, healthcare professionals are looking for alternatives to improve adherence in their patients. Healthcare has been innovating through mobile device apps., Objective: Thus, the objective of this study was to verify the effects of PFMT with the use of a mobile device app in incontinent women., Trial Design: This was a controlled, randomized clinical trial that occurred remotely., Methods: A total of 104 women with stress UI and/or mixed incontinence, over 18 years old, literate, with preserved cognitive capacity, with internet access and a mobile device with the Android system, participated in this study. They were randomly divided into two groups: The App group and the Booklet group, which underwent a PFMT protocol guided by a mobile app and a booklet, respectively. Both groups received daily reminders to perform the exercises. Before and after 12 weeks of intervention, it was evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the King's Health Questionnaire (KHQ)., Results: Both groups showed improvements in the final ICIQ-SF score. However, superior results were shown for the Booklet group (App: pre: 11.5 [±3.8], post: 9.8 [±4.5]; Booklet: pre: 12.6 [±4.5], post: 7.4 [±4.3]; p = 0.03)., Conclusion: It was concluded that PFMT, with the use of a mobile app, is capable of reducing UI and the impact of UI, but it is not superior to training with the use of booklet instructions., (© 2024 Wiley Periodicals LLC.)

Purpose: Diabetic retinopathy (DR) is a leading cause of preventable blindness, particularly in underserved regions where access to ophthalmic care is limited. This study presents a proof of concept for utilizing a portable handheld retinal camera with an embedded artificial intelligence (AI) platform, complemented by a synchronous remote confirmation by retina specialists, for DR screening in an underserved rural area., Design: Retrospective cohort study., Subjects: A total of 1115 individuals with diabetes., Methods: A retrospective analysis of a screening initiative conducted in 4 municipalities in Northeastern Brazil, targeting the diabetic population. A portable handheld retinal camera captured macula-centered and disc-centered images, which were analyzed by the AI system. Immediate push notifications were sent out to retina specialists upon the detection of significant abnormalities, enabling synchronous verification and confirmation, with on-site patient feedback within minutes. Referral criteria were established, and all referred patients underwent a complete ophthalmic work-up and subsequent treatment., Main Outcome Measures: Proof-of-concept implementation success., Results: Out of 2052 invited individuals, 1115 participated, with a mean age of 60.93 years and diabetes duration of 7.52 years; 66.03% were women. The screening covered 2222 eyes, revealing various retinal conditions. Referable eyes for DR were 11.84%, with an additional 13% for other conditions (diagnoses included various stages of DR, media opacity, nevus, drusen, enlarged cup-to-disc ratio, pigmentary changes, and other). Artificial intelligence performance for overall detection of referable cases (both DR and other conditions) was as follows: sensitivity 84.23% (95% confidence interval (CI), 82.63-85.84), specificity 80.79% (95% CI, 79.05-82.53). When we assessed whether AI matched any clinical diagnosis, be it referable or not, sensitivity was 85.67% (95% CI, 84.12-87.22), specificity was 98.86 (95% CI, 98.39-99.33), and area under the curve was 0.92 (95% CI, 0.91-0.94)., Conclusions: The integration of a portable device, AI analysis, and synchronous medical validation has the potential to play a crucial role in preventing blindness from DR, especially in socially unequal scenarios., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Lead poisoning is a global public health concern. Maternal exposure during intrauterine and lactational periods can present a higher susceptibility of harm to the offspring. Thus, pregnant female Wistar rats (Rattus norvegicus) were randomly divided in two experimental groups: control group and Lead group. The animals were exposed to 50 mg/kg of Lead Acetate daily for 42 days (21 days of gestational period + 21 days of lactational period). After the exposure period, the mandibles of the offspring were collected for lead quantification, Raman spectroscopy analysis, micro-CT, morphometric e histochemical analysis. Lead exposure altered the physical-chemical composition of alveolar bone and caused histological damage associated with a reduction in osteocyte density and collagen area fraction, increase in collagen maturity, as well as a reduction in bone volume fraction. An increase in trabecular spaces with anatomical compromise of the vertical dimensions of the bone was observed. Thus, the results suggest that developing alveolar bone is susceptible to toxic effects of lead when organisms are exposed during intrauterine and lactation periods., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Methicillin-resistant Staphylococci (MRS) cause infections at various sites and exhibit multidrug resistance. Despite their importance in veterinary medicine, only little is known about Staphylococcus spp. colonizing and infecting cats. Therefore, in this study, we aimed to isolate and identify Staphylococcus spp. colonizing hospitalized and non-hospitalized domestic cats and analyze their antimicrobial resistance profiles, genetic diversity, and risk factors associated with MRS colonization. A total of 218 oral and axillary swabs were obtained from 109 cats, including 77 non-hospitalized and 32 hospitalized cats. After plating on selective media, the isolates were identified via matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and rpoB and 16S rRNA gene sequencing. Subsequently, antimicrobial sensitivity of the strains was assessed, and they were screened for mecA gene. Methicillin-resistant S. haemolyticus (MRSH) isolates were subjected to multilocus sequence typing, whereas methicillin-resistant S. pseudintermedius (MRSP) and S. felis isolates were subjected to whole genome sequencing. S. felis was most commonly isolated from non-hospitalized cats (28.1%), whereas S. pseudintermedius and MRS were commonly isolated from hospitalized cats (25%). MRSH isolates from hospitalized animals were classified as ST3. The identified MRSP strains belonged to two well-known sequence types, ST551 and ST71. Moreover, antimicrobial use (p = 0.0001), hospitalization (p = 0.0141), and comorbidities (p = 0.002) were associated with increased MRS prevalence in cats., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Souza et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The use of bleaching agents to remove stains is one of the main dental procedures to improve the aesthetics of teeth. This review presents the main agents used for tooth whitening, existing clinical protocols, and the structural changes that may occur through their use. The main bleaching agents consist of hydrogen peroxide and carbamide peroxide, which are used in bleaching techniques for vital teeth. These techniques can be performed in the office by a professional or by the individual in a home en-vironment under professional guidance. Bleaching agents come in a variety of concentrations and there are over-the-counter products available on the market with lower concentrations of hydrogen peroxide. Due to the chemical characteristics of the agents, changes in the organic and inorganic content of the tooth structure can be observed. These changes are related to morphological changes characterized by in-creased permeability and surface roughness, such changes compromise the mechanical resistance of the tooth. Furthermore, bleaching agents can promote molecular changes after reaching the dental pulp, resulting in oxidative stress of pulp cells and the release of pro-inflammatory mediators. Despite the bleaching effectiveness, tooth sensitivity is considered the main side effect of use. Therefore, among the heterogeneity of protocols, those that used the bleaching agent for a prolonged time and in lower con-centrations presented more harmful effects on the tooth structure., (©The Author(s) 2024. Open Access. This article is licensed under a Creative Commons CC-BY International License.)

Background and Objectives: This study aimed to compare socio-cognitive skills and emotion comprehension between children with Autism Spectrum Disorder (ASD) and children with neurotypical development., Methods: This quantitative, cross-sectional, controlled study involved 19 children in each group, matched by age (6-12 years) and sex. The assessments examined cognitive aspects (Intelligence Quotient was assessed using the Vocabulary and Matrix Reasoning subtests; working memory using the digit span and letter-number sequencing subtests; attention using the Continuous Performance Test - Identical Pairs; and executive functions using the Trail Making Test), social functions (Children's Social Skills, Behavior Problems, and Academic Competence Inventory), and emotion comprehension (language was assessed using the Strange Stories Test; emotional facial expressions using the digital emotion comprehension test; emotional/affective prosody using the Profiling Elements of Prosody in Speech-Communication - Brazilian Portuguese adapted version)., Results: The group with ASD exhibited better performance in executive functions (p=0.02). However, they lagged the control group in social skills (p=0.04), behavior problems (p=0.03), and emotion comprehension (language, facial expressions, and prosody) (all p<0.05)., Conclusion: The findings indicate that children with ASD have diminished performance in social skills and emotion comprehension compared to children with neurotypical development. Therefore, the development of technologies and/or therapeutic interventions that address these deficits among children with ASD is recommended., Competing Interests: No conflicts of interest declared concerning the publication of this article.

Despite significant advancements in antiretroviral therapy (ART) for HIV, adherence remains a challenge. While Brazil has validated scales for treatment adherence, few assess treatment adherence barriers. This underscores the necessity for validated questionnaires on adherence barriers to identify patient-specific challenges and enhance strategies for ART adherence. This study aimed to adapt and validate the Adherence Barriers Questionnaire for HIV Patients on Antiretroviral Therapy (ABQ-HIV), a 17-item questionnaire assessing the adherence barriers to ART, for the Brazilian context and to evaluate its psychometric properties in HIV patients. A methodological study on the psychometric properties and factorial structure of ABQ-HIV was conducted. The study followed seven steps: consent of the original authors, two translations, synthesis of the translations, expert committee, back-translation, pre-test, and reliability test. A high content validity index (0.93) was achieved with the expert committee. The study sample consisted of 230 adults with HIV, with 37.0 (29.3-45.0) years as the median age (IQR), and 52.2% were male. The exploratory factor analysis with a three subscales structure of 17 items showed good interpretability (Bartlett's sphericity (1167.2 [136]; p < 0.001) and Kaiser-Meyer-Olkin = 0.602) and internal consistency (α = 0.76; Ω = 0.76). The fit indicators were satisfactory (χ2 = 89.931; df = 88; p > 0.005; RMSEA = 0.010; RMSR = 0.07; CFI = 0.996; GFI = 0.940; AGFI = 0.907; NNFI = 0.995). The Brazilian version of ABQ-HIV is a potential instrument for identifying specific barriers to adherence to ART in adults living with HIV in Brazil.

This work provides insight into carbamazepine polymorphs (Forms I, II, III, IV, and V), with reports on the cytoprotective, exploratory, motor, CNS-depressant, and anticonvulsant properties of carbamazepine (CBZ), carbamazepine formulation (CBZ-F), topiramate (TOP), oxcarbazepine (OXC), and diazepam (DZP) in mice. Structural analysis highlighted the significant difference in molecular conformations, which directly influence the physicochemical properties; and density functional theory description provided indications about CBZ reactivity and stability. In addition to neuron viability assessment in vitro, animals were treated orally with vehicle 10 mL/kg, as well as CBZ, CBZ-F, TOP, OXC, and DZP at the dose of 5 mg/kg and exposed to open-field, rotarod, barbiturate sleep induction and pentylenetetrazol (PTZ 70 mg/kg)-induced seizure. The involvement of GABAergic mechanisms in the activity of these drugs was evaluated with the intraperitoneal pretreatment of flumazenil (2 mg/kg). The CBZ, CBZ-F, and TOP mildly preserved neuronal viability. The CBZ-F and the reference AEDs potentiated barbiturate sleep, altered motor activities, and attenuated PTZ-induced convulsion. However, flumazenil pretreatment blocked these effects. Additional preclinical assessments could further establish the promising utility of CBZ-F in clinical settings while expanding the scope of AED formulations and designs.

Introduction: Conservative treatments such as physical therapies are usually the most indicated for the management of musculoskeletal pain; therefore, a detailed description of interventions enables the reproducibility of interventions in clinical practice and future research. The objective of this study is to evaluate the description of physical interventions for musculoskeletal pain in children and adolescents., Methods: We considered randomized controlled trials that included children and adolescents between 4 and 19 years old with acute or chronic/persistent musculoskeletal pain. We included physical therapies related to all types of physical modalities aimed at reducing the intensity of pain or disability in children and adolescents with musculoskeletal pain. The description of interventions was assessed using the Template for Intervention Description and Replication (TIDieR) checklist. We performed electronic searches in the following databases: CENTRAL, MEDLINE, EMBASE, CINAHL, PsyINFO and PEDro up to April 2024. The description of physical interventions was presented using frequencies, percentages and 95% confidence intervals (CIs) of the TIDieR checklist items described in each study. We also calculated the total TIDieR score for each study and presented these data as mean and standard deviation., Results: We included 17 randomized controlled trials. The description measured through the TIDieR checklist scored an average of 11 (5.2) points out of 24. The item of the TIDieR that was most described was item 1 (brief name) and most absent was item 10 (modifications)., Conclusion: The descriptions of physical interventions for the treatment of musculoskeletal pain in children and adolescents are partially described, indicating the need for strategies to improve the quality of description to enable true clinical reproducibility., (© 2024. The Author(s).)

Pancreatic ductal adenocarcinoma (PDAC) represents one of the deadliest cancers among all solid tumors. First-line treatment relies on gemcitabine (Gem) and despite treatment improvements, refractoriness remains a universal challenge. Attempts to decipher how feedback-loops control signaling pathways towards drug resistance have gained attention in recent years, particularly focused on the role of phosphatases. In this study, a CRISPR/Cas9-based phenotypic screen was performed to identify members from the dual-specificity phosphatases (DUSP) family potentially acting on Gem response in PDAC cells. The approach revealed the atypical RNA phosphatase DUSP11 as a potential target, whose inhibition creates vulnerability of PDAC cells to Gem. DUSP11 genetic inhibition impaired cell survival and promoted apoptosis, synergistically enhancing Gem cytotoxicity. In silico transcriptome analysis of RNA-seq data from PDAC human samples identified NF-ĸB signaling pathway highly correlated with DUSP11 upregulation. Consistently, Gem-induced NF-ĸB phosphorylation was blocked upon DUSP11 inhibition in vitro. Mechanistically, we found that DUSP11 directly impacts nc886 expression and modulates PKR-NF-ĸB signaling cascade after Gem exposure in PDAC cells resulting in resistance to Gem-induced cell death. In conclusion, this study provides new insights on DUSP11 role in RNA biology and Gem response in PDAC cells., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Introduction: The EQ-5D-Y-3L is a generic measure of health-related quality of life in children and adolescents. Although the Brazilian-Portuguese EQ-5D-Y-3L version is available, there is no value set for it, hampering its use in economic evaluations. This study aimed to elicit a Brazilian EQ-5D-Y-3L value set based on preferences of the general adult population., Methods: Two independent samples of adults participated in an online discrete choice experiment (DCE) survey and a composite time trade-off (cTTO) face-to-face interview. The framing was "considering your views for a 10-year-old child". DCE data were analyzed using a mixed-logit model. The 243 DCE predicted values were mapped into the observed 28 cTTO values using linear and non-linear mapping approaches with and without intercept. Mapping approaches' performance was assessed to estimate the most valid method to rescale DCE predicted values using the model fit (R 2 ), Akaike Information Criteria (AIC), root mean squared error (RMSE), and mean absolute error (MAE)., Results: A representative sample of 1376 Brazilian adults participated (DCE, 1152; cTTO, 211). The linear mapping without intercept (R 2 = 96%; AIC, - 44; RMSE, 0.0803; MAE, - 0.0479) outperformed the non-linear without intercept (R 2 = 98%; AIC, - 63; RMSE, 0.1385; MAE, - 0.1320). Utilities ranged from 1 (full health) to - 0.0059 (the worst health state). Highest weights were assigned to having pain or discomfort (pain/discomfort), followed by walking about (mobility), looking after myself (self-care), doing usual activities (usual activities), and feeling worried, sad, or unhappy (anxiety/depression)., Conclusion: This study elicited the Brazilian EQ-5D-Y-3L value set using a mixed-logit DCE model with a power parameter based on a linear mapping without intercept, which can be used to estimate the quality-adjusted life-years for economic evaluations of health technologies targeting the Brazilian youth population., (© 2024. The Author(s).)

Background: The current literature supports the effectiveness of exercise, education, and self-management interventions for the long-term management of persistent low back pain. However, there is significant uncertainty about the implementation of interventions related to barriers, facilitators, and patient's preferences. This study will evaluate the Back to Living Well program implementation from a participant and organizational perspective. More specifically we address the following objectives: 1) identify program barriers and facilitators from participants' perspectives, 2) identify factors related to program, personal and contextual factors that contribute to negative and positive outcomes, and outcome trajectories, 3) identify factors influencing participants' selection of an in-person or e-health program, and 4) evaluate program specific barriers and facilitators from the organization and care delivery perspectives., Methods: This study will utilize a mixed-method convergent design including a longitudinal cohort strand and a longitudinal qualitative interview strand. The RE-AIM framework will be used to assess program implementation. Participants (n = 90, 1:1: in person or virtual) who choose to register in the program as well as staff (n = 10 to 15) involved in the delivery of the program will be invited to participate. Participants will participate in a 12-week physical activity, education, and self-management program. Implementation outcomes will be measured at 3-, 6-, 12-months, and six months after the end of the follow-ups. Interview scripts and directed content analysis will be constructed based on the Theoretical Domains Framework and the Neuromatrix Model of Pain, Theoretical Domains Framework. Staff interviews will be constructed and analyzed using the Consolidated Framework for Implementation Research. Participants will also complete pain, disability, quality of life and psychological questionnaires, wear an activity tracker at all time points, and complete weekly pain and activity limitation questions using a mobile application., Discussion: The study results will provide evidence to inform potential future implementation of the program. An effective, appropriately targeted, and well implemented exercise program for the long-term management (i.e., tertiary prevention) of LBP could minimize the burden of the condition on patients, the health care system and society., Trial Registration: ClinicalTrials.gov NCT05929846. This (Registration Date: July 3 2023) study has been approved by the Hamilton Integrated Research Ethics Board Project ID#15,354., (© 2024. The Author(s).)

Contaminants of emerging concern (CECs), including microplastics, have been the focus of many studies due to their environmental impact, affecting biota and human health. The diverse land uses and occupation of watersheds are important parameters driving the occurrence of these contaminants. CECs such as pesticides, drugs, hormones, and industrial-origin substances were analyzed in urban/industrial (Atibaia) and agricultural (Preto/Turvo) watersheds located in São Paulo state, Brazil. A total of 24 CECs were investigated, and, as a result, only 5 (caffeine, carbendazim, atrazine, ametrine and 2-hydroxytrazine) were responsible for 81.73 % of the statistical difference between watersheds contamination profile. The Atibaia watershed presented considerable concentrations of caffeine (ranging from 75 to 2025 ng L -1 ), while carbendazim (44 to 1144 ng L -1 ) and atrazine (3 to 266 ng L -1 ) presented highest levels in Preto/Turvo watershed. In all sampling points, the cumulative potential aquatic life risk assessed by the NORMAN database indicates some level of environmental concern associated to pesticides and caffeine (risk quotient >1). Microplastics had been analyzed in both watersheds, being the white/transparent fragments in size between 100 and 250 μm the most detected in this study. The estimated abundance in the Atibaia watershed ranged from 349 to 2898 items m -3 presenting some influence of pluviosity, while in Rio Preto/Turvo ranged from 169 to 6370 items m -3 , being more abundant in the dam area without a clear influence of pluviosity. In both basins, polyethylene and polypropylene were the most detected polymers, probably due to the intense use of single-use plastics in urban areas. Possibly, due to the distinct physic-chemical properties of microplastics and organic CECs, no correlations were observed between their occurrence, which makes us conclude that they have different transport mechanism, behavior, and fate in the environment., 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 © 2024 Elsevier B.V. All rights reserved.)

A heterogenized Mn(III) porphyrin-based catalyst was prepared for dye degradation. The new Mn(III) complex of 5,15-bis(4-aminophenyl)-10,20-diphenylporphyrin was immobilized, via covalent bond, in chloropropyl silica gel, generating the material (Sil-Cl@MnP) with a loading of 23 μmol manganese porphyrin (MnP) per gram of Sil-Cl. This material was used as a catalyst in degradation reactions of model dyes, a cationic dye [methylene blue (MB)] and an anionic dye (reactive red 120, RR120), using PhI(OAc) 2 and H 2 O 2 as oxidants. The oxidation reactions were carried out after the dye reached adsorption/desorption equilibrium with the catalytic material, with a much higher percentage of adsorption being observed for the cationic MB dye (20%) than for the anionic RR120 dye (3%), which may be associated with electrostatic attraction or repulsion effects, respectively, with the negatively charged surface of the silica (zeta potential measurement for Sil-Cl@MnP, ζ = -19.2 mV). In general, there was a higher degradation percentage for MB than for RR120, probably because the size and charge of RR120 would hinder its approach to the MnP active species on the silica surface. With respect to the oxidant, the PhI(OAc) 2 -based systems showed a higher degradation percentage than those of H 2 O 2 . It was observed that the increase in the oxidant concentration promoted a significant increase in the degradation of MB, with a degradation of approximately 65%. The efficiency of the catalyst was also evaluated after successive additions of the oxidant every 2 h, and it can be seen that the catalyst had no loss of efficiency, with a degradation percentage greater than 80% being observed after 8 h of reaction. The phytotoxicity of the products formed in the system was evaluated in a 1:23.5:188 molar ratio Sil-Cl@MnP: MB:PhI(OAc) 2 was used. In these studies, phytotoxicity was found for the germination of lettuce seeds when the original solution was used without dilution; however, when diluted (10% V/V), the results were close to the positive and negative controls. Thus, the material obtained proved to be a potential candidate for application in the degradation reactions of environmental pollutants., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

Objective  To identify the location of the Riché-Cannieu anastomosis (RCA) in relation to the Cardinal Kaplan Line (KCL) and the Y line. Methods  A total of 20 hands of 10 recently-deceased adult male cadavers aged between 27 and 66 years were dissected for the investigation of the relationship of the most distal point of the RCA with the KCL and with the Y line, drawn from the axis of the third metacarpal head, following the longitudinal axis of the hand. Results  In 20 limbs, the most distal point of the nerve communication was positioned distally in relation to the KCL. The Y line was positioned on the radial side in relation to the most distal point of the RCA in 14 limbs, and it was positioned on the ulnar side in relation to the Y line in 6 limbs. The crossing between the KCL and the Y line occurred proximal to the RCA in 18 limbs; in 1 hand, it was positioned distal to the intersection between these lines; and in another hand, the KCL was positioned exactly on the RCA. Conclusion  Knowledge of these anatomical relationships can prevent damage to nerve branches and thus also prevent paralysis of intrinsic muscles in surgical procedures in the palm of the hand., Competing Interests: Conflito de Interesses Os autores não têm conflitos de interesses a declarar., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ( https://creativecommons.org/licenses/by/4.0/ ).)

Aquatic humic substances (AHS) are defined as an important components of organic matter, being composed as small molecules in a supramolecular structure and can interact with metallic ions, thereby altering the bioavailability of these species. To better understand this behavior, AHS were extracted and characterized from Negro River, located near Manaus city and Carú River, that is situated in Itacoatiara city, an area experiencing increasing anthropogenic actions; both were characterized as blackwater rivers. The AHS were characterized by 13 C nuclear magnetic ressonance and thermochemolysis GC-MS to obtain structural characteristics. Interaction studies with Cu (II), Al (III), and Fe (III) were investigated using fluorescence spectroscopy applied to parallel factor analysis (PARAFAC) and two-dimensional correlation spectroscopy with Fourier transform infrared spectroscopy (2D-COS FTIR). The AHS from dry season had more aromatic fractions not derived from lignin and had higher content of alkyls moities from microbial sources and vegetal tissues of autochthonous origin, while AHS isolated in the rainy season showed more metals in its molecular architecture, lignin units, and polysacharide structures. The study showed that AHS composition from rainy season were able to interact with Al (III), Fe (III), and Cu (II). Two fluorescent components were identified as responsible for interaction: C1 (blue-shifted) and C2 (red-shifted). C1 showed higher complexation capacities but with lower complexation stability constants (K ML ranged from 0.3 to 7.9 × 10 5 ) than C2 (K ML ranged from 3.1 to 10.0 × 10 5 ). 2D-COS FTIR showed that the COO - and C-O in phenolic were the most important functional groups for interaction with studied metallic ions., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective: This study comprehensively analyzed the temporal and spatial dynamics of COVID-19 cases and deaths within the obstetric population in Brazil, comparing the periods before and during mass COVID-19 vaccination. We explored the trends and geographical patterns of COVID-19 cases and maternal deaths over time. We also examined their correlation with the SARS-CoV-2 variant circulating and the social determinants of health., Study Design: This is a nationwide population-based ecological study., Methods: We obtained data on COVID-19 cases, deaths, socioeconomic status, and vulnerability information for Brazil's 5570 municipalities for both the pre-COVID-19 vaccination and COVID-19 vaccination periods. A Bayesian model was used to mitigate indicator fluctuations. The spatial correlation of maternal cases and fatalities with socioeconomic and vulnerability indicators was assessed using bivariate Moran., Results: From March 2020 to June 2023, a total of 23,823 cases and 1991 maternal fatalities were recorded among pregnant and postpartum women. The temporal trends in maternal incidence and mortality rates fluctuated over the study period, largely influenced by widespread COVID-19 vaccination and the dominant SARS-CoV-2 variant. There was a significant reduction in maternal mortality due to COVID-19 following the introduction of vaccination. The geographical distribution of COVID-19 cases and maternal deaths exhibited marked heterogeneity in both periods, with distinct spatial clusters predominantly observed in the North, Northeast, and Central West regions. Municipalities with the highest Human Development Index reported the highest incidence rates, while those with the highest levels of social vulnerability exhibited elevated mortality and fatality rates., Conclusion: Despite the circulation of highly transmissible variants of concern, maternal mortality due to COVID-19 was significantly reduced following the mass vaccination. There was a heterogeneous distribution of cases and fatalities in both periods (before and during mass vaccination). Smaller municipalities and those grappling with social vulnerability issues experienced the highest rates of maternal mortality and fatalities., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

This systematic review aimed to verify whether there is evidence of an association between apical periodontitis and the presence of systemic biomarkers. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA. For this, the acronym PECO was used; population (P) of adult humans exposed (E) to the presence of apical periodontitis, compared (C) to adult humans without apical periodontitis, and the outcome (O) of the presence of biomarkers was observed. The articles were searched in PubMed, Scopus, Web of Science, LILACS, Cochrane Library, OpenGray, and Google Scholar grey databases. Subsequently, studies were excluded based on title, abstract, and full article reading, following the eligibility criteria. The methodological quality of the selected studies was evaluated using the Newcastle-Ottawa qualifier. After exclusion, 656 studies were identified, resulting in 17 final articles that were divided into case-control, cross-sectional, and cohort studies. Eight studies were considered to have a low risk of bias, one had a medium risk of bias, and eight had a high risk of bias. In addition, 12 articles evaluated biomarkers in blood plasma, four evaluated them in saliva, and only one evaluated them in gingival crevicular fluid. The results of these studies indicated an association between apical periodontitis and the systemic presence of biomarkers. These markers are mainly related to inflammation, such as interleukins IL-1, IL-2, and IL-6, oxidative markers, such as nitric oxide and superoxide anions, and immunoglobulins IgG and IgM., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier (CRD42023493959)., 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 © 2024 Matos-Sousa, Chemelo, Frazão, Bittencourt, Moura, Mesquita, Marañón-Vásquez, Fagundes, Paranhos, Maia, Monteiro and Lima.)

Current strategies to promptly, effectively, and equitably screen people with tuberculosis (TB) and link them to diagnosis and care are insufficient; new approaches are required to find the millions of people around the world with TB who are missed each year. Interventions also need to be designed considering how people interact with health care facilities and where appropriate should be suitable for use in the community. Here, the historical, new, and reemerging technologies that are being utilised for TB diagnosis globally are discussed, whilst highlighting that how we use and evaluate tests is just as important as the tests themselves., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: E. R. A. is the Chief Impact Officer for Global Access Diagnostics, Bedford England. The remaining authors declare that they have no competing interests., (© 2024. The Author(s).)

We aimed to investigate the effectiveness of physical training as a protective strategy to mitigate alveolar bone damage and blood antioxidant defense caused by ethanol (EtOH) consumption in a binge-drinking pattern. Male Wistar rats aged approximately 90 days were divided into four groups: control, training, EtOH, and training + EtOH. The physical training protocol was conducted on a treadmill for four consecutive weeks, while the animals in the EtOH group were administered EtOH via orogastric gavage for three consecutive days each week, following the binge drink pattern. After the training period, blood and mandibles were collected for plasma oxidative biochemistry analysis, and the alveolar bone was subjected to physicochemical composition analysis, tissue evaluation, and microtomography evaluation. Our results showed that EtOH induced oxidative stress and physical exercise promoted the recovery of antioxidant action. Physical training minimized the damage to the mineral/matrix composition of the alveolar bone due to EtOH consumption and increased the density of osteocytes in the trained group treated with EtOH than in those exposed only to EtOH. Furthermore, physical training reduced damage to the alveolar bone caused by EtOH consumption. Our findings suggest that physical training can serve as an effective strategy to reduce systemic enzymatic oxidative response damage and alleviate alveolar bone damage resulting from alcohol consumption. Further investigations are warranted to elucidate the underlying mechanisms and explore, in addition to physical training, the potential effects of other activities with varying intensities on managing alcohol-induced bone damage., 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 © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Introduction: The ESCPM group (Enterobacter species including Klebsiella aerogenes - formerly Enterobacter aerogenes, Serratia species, Citrobacter freundii complex, Providencia species and Morganella morganii) has not yet been incorporated into systematic surveillance programs., Methods: We conducted a multicentre retrospective observational study analysing all ESCPM strains isolated from blood cultures in 27 European hospitals over a 3-year period (2020-2022). Diagnostic approach, epidemiology, and antimicrobial susceptibility were investigated., Results: Our study comprised 6,774 ESCPM isolates. MALDI-TOF coupled to mass spectrometry was the predominant technique for bacterial identification. Susceptibility to new β-lactam/β-lactamase inhibitor combinations and confirmation of AmpC overproduction were routinely tested in 33.3% and 29.6% of the centres, respectively. The most prevalent species were E. cloacae complex (44.8%) and S. marcescens (22.7%). Overall, third-generation cephalosporins (3GC), combined third- and fourth-generation cephalosporins (3GC + 4GC) and carbapenems resistance phenotypes were observed in 15.7%, 4.6%, and 9.5% of the isolates, respectively. AmpC overproduction was the most prevalent resistance mechanism detected (15.8%). Among carbapenemase-producers, carbapenemase type was provided in 44.4% of the isolates, VIM- (22.9%) and OXA-48-enzyme (16%) being the most frequently detected. E. cloacae complex, K. aerogenes and Providencia species exhibited the most notable cumulative antimicrobial resistance profiles, with the former displaying 3GC, combined 3GC + 4GC and carbapenems resistance phenotypes in 15.2%, 7.4%, and 12.8% of the isolates, respectively. K. aerogenes showed the highest rate of both 3GC resistant phenotype (29.8%) and AmpC overproduction (32.1%), while Providencia species those of both carbapenems resistance phenotype (42.7%) and carbapenemase production (29.4%). ESCPM isolates exhibiting both 3GC and combined 3GC + 4GC resistance phenotypes displayed high susceptibility to ceftazidime/avibactam (98.2% and 95.7%, respectively) and colistin (90.3% and 90.7%, respectively). Colistin emerged as the most active drug against ESCPM species (except those intrinsically resistant) displaying both carbapenems resistance phenotype (85.8%) and carbapenemase production (97.8%)., Conclusions: This study presented a current analysis of ESCPM species epidemiology in Europe, providing insights to inform current antibiotic treatments and guide strategies for antimicrobial stewardship and diagnostics., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

This study comprehensively analyzed cases of scorpion envenomation in Brazil, exploring the temporal trends and geographic patterns of such incidents between January 1, 2012, and December 31, 2022. Simultaneously, we assessed the correlation between scorpion envenomation and social determinants of health and social vulnerability. We conducted a population-based ecological study, gathering information on the number of scorpion envenomation cases in Brazil, as well as socioeconomic data and social vulnerability indicators across the 5,570 Brazilian municipalities. The season-trend model, based on the classical additive decomposition method, informed estimations of scorpion envenomation variations over time. The spatial correlation of scorpion envenomation with socioeconomic and vulnerability indicators was assessed using the Bivariate Moran's I. A total of 1,343,224 cases of scorpion envenomation were recorded in Brazil from Jan 2012 to Dec 2022. A single increasing time trend was observed for the entire country for this period (APC 8.94, P < 0.001). The seasonal analysis was significant for Brazil as a whole and all regions (p < 0.001), with peaks evident between October and November. The spatial distribution of cases was heterogeneous, with spatial clusters concentrated in the high-risk Southeast and Northeast regions. There was a high incidence of scorpion envenomation in municipalities facing social vulnerability, and, paradoxically, in those with better sanitation and waste collection. Our study revealed a heterogeneous geographical distribution of scorpion accidents in Brazil. Municipalities with higher social vulnerability exhibited a high incidence of scorpion envenomation., 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 © 2024 Elsevier B.V. All rights reserved.)