New candidate SNPs for genetic association with Alzheimer's disease: a linkage disequilibrium analysis for the FCGRIIB and PILRA genes

Background Two new SNPs have been recently associated to Alzheimer's disease in African American populations: FCGRIIB rs1050501 C/T, and PILRA rs1859788 A/G. The risk of Alzheimer's disease in FCGRIIB C and PILRA A allele carriers is three times higher than in non-carriers. However, the association between these and other single nucleotide polymorphisms (SNPs) has not been assessed. Methods Linkage disequilibrium analysis, with r= 0.8 as a threshold value, was used to impute new candidate SNPs, on genomic data from both genes in 26 populations worldwide (n= 2504) from the 1000Genomes database. Results Four SNPs (rs13376485, rs3767640, rs3767639 and rs3767641) were linked to rs1050501 and one (rs2405442) to rs1859788 in the whole sample. Conclusions Five novel SNPs could be associated with Alzheimer's disease susceptibility and play a causal role, even if none of them are exon variants since their potential roles in the regulation of gene expression.

Antecedentes Recientemente se han asociado dos nuevos polimorfismos de un solo nucleótido (SNP) a la enfermedad de Alzheimer en poblaciones afroamericanas: FCGRIIB rs1050501 C/T, y PILRA rs1859788 A/G. El riesgo de enfermedad de Alzheimer en los portadores de los alelos FCGRIIB C y PILRA A es tres veces mayor que en los no portadores. Sin embargo, no se ha evaluado la asociación entre estos y otros SNP. Métodos Se utilizó el análisis de desequilibrio de ligamiento, con r2= 0,8 como valor umbral, para imputar nuevos SNPs candidatos, sobre datos genómicos de ambos genes en 26 poblaciones de todo el mundo (n= 2504) de la base de datos 1000Genomes. Resultados Cuatro SNPs (rs13376485, rs3767640, rs3767639 y rs3767641) se vincularon al rs1050501 y uno (rs2405442) al rs1859788 en toda la muestra. Conclusiones Cinco nuevos SNP podrían estar asociados con la susceptibilidad a la enfermedad de Alzheimer y desempeñar un papel causal, aunque ninguno de ellos sea una variante de exón, dado su papel potencial en la regulación de la expresión génica.

Periodontitis and osteoporosis: a two-sample Mendelian randomization analysis

Abstract The incidences of periodontitis and osteoporosis are rising worldwide. Observational studies have shown that periodontitis is associated with increased risk of osteoporosis. We performed a Mendelian randomization (MR) study to genetically investigate the causality of periodontitis on osteoporosis. We explored the causal effect of periodontitis on osteoporosis by MR analysis. A total of 9 single nucleotide polymorphisms (SNP) were related to periodontitis. The primary approach in this MR analysis was the inverse variance-weighted (IVW) method. Simple median, weighted median, and penalized weighted median were used to analyze sensitivity. The fixed-effect IVW model and random-effect IVW model showed no significant causal effect of genetically predicted periodontitis on the risk of osteoporosis (OR=1.032; 95%CI: 0.923-1.153; P=0.574; OR=1.032; 95%CI: 0.920-1.158; P=0.588, respectively). Similar results were observed in simple mode (OR=1.031; 95%CI: 0.780-1.361, P=0.835), weighted mode (OR=1.120; 95%CI: 0.944-1.328, P=0.229), simple median (OR=1.003; 95%CI: 0.839-1.197, P=0.977), weighted median (OR=1.078; 95%CI: 0.921-1.262, P=0.346), penalized weight median (OR 1.078; 95%CI: 0.919-1.264, P=0.351), and MR-Egger method (OR=1.360; 95%CI: 0.998-1.853, P=0.092). There was no heterogeneity in the IVW and MR-Egger analyses (Q=7.454, P=0.489 and Q=3.901, P=0.791, respectively). MR-Egger regression revealed no evidence of a pleiotropic influence through genetic variants (intercept: -0.004; P=0.101). The leave-one-out sensitivity analysis indicated no driven influence of any individual SNP on the association between periodontitis and osteoporosis. The Mendelian randomization analysis did not show a significant detrimental effect of periodontitis on the risk of osteoporosis.

Macular dystrophies associated with Stargardt-like phenotypes / Distrofias maculares associadas a fenótipos Stargardt-like

ABSTRACT Purpose: Stargardt-like phenotype has been described as associated with pathogenic variants besides the ABCA4 gene. This study aimed to describe four cases with retinal appearance of Stargardt disease phenotypes and unexpected molecular findings. Methods: This report reviewed medical records of four patients with macular dystrophy and clinical features of Stargardt disease. Ophthalmic examination, fundus imaging, and next-generation sequencing were performed to evaluate pathogenic variants related to the phenotypes. Results: Patients presented macular atrophy and pigmentary changes suggesting Stargardt disease. The phenotypes of the two patients were associated with autosomal dominant inheritance pattern genes (RIMS1 and CRX) and in the other two patients were associated with recessive dominant inheritance pattern genes (CRB1 and RDH12) with variants predicted to be pathogenic. Conclusion: Macular dystrophies may have phenotypic similarities to Stargardt-like phenotype associated with other genes besides the classic ones.

RESUMO Objetivo: Fenótipos Stargardt-like já foram asso-ciados a variantes patogênicas no gene ABCA4. O propósito desse estudo é descrever quatro pacientes com achados retinianos semelhantes a doença de Stargardt com resultados moleculares diferentes do esperado. Métodos: Esse relato fez a revisão de prontuários médicos de quatro pacientes com distrofia macular e achados clínicos sugestivos de doença de Stargardt. Foram realizados avaliação oftalmológica, exames de imagens e testes usando next generation sequencing para avaliar variantes patogênicas associadas aos fenótipos dos pacientes. Resultados: Os pacientes apresentavam atrofia macular e alterações pigmentares sugerindo achados clínicos de doença de Stargardt. Dois pacientes foram associados a genes com herança autossômica dominante (RIMS1 e CRX) e dois pacientes foram associados a genes com herança autossômica recessiva (CRB1 e RDH12) com variantes preditoras de serem patogênicas. Conclusão: Distrofias maculares podem ter similaridades fenotípicas com fenótipo de Stargardt-like associados a outros genes além dos classicamente já descritos.

Incidence and impacts of pain in intensive care units: systematic review / Incidência e impactos da dor em unidades de terapia intensiva: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: In Intensive Care Units (ICU), patients are exposed to multiple procedures that can be painful, and health professionals are not always aware of the pain in these patients. Inadequate pain assessment and management, in turn, has been associated with several adverse outcomes, including an increased rate of infection, prolonged mechanical ventilation, hemodynamic disturbances, delirium, and compromised immunity. Thus, this study aimed to summarize the scientific evidence about the incidence and impacts of pain in critically ill patients. CONTENTS: A systematic review of observational studies (Pubmed and EMBASE databases) was performed with predetermined eligibility criteria. In the 32 studies included, it was identified that 10.1% to 61% of patients had pain at rest and 27.4% to 94% during procedures. In addition, there was evidence of improvement in patient outcomes after using validated instruments for pain measurement, including decreased length of ICU stay, duration of mechanical ventilation, mortality, delirium, adverse events, and disease severity. CONCLUSION: Through the present study, it was observed that pain is a common phenomenon in ICU and that its identification and management constitute a realistic goal and depend on the evaluation. Furthermore, pain appears to be associated with worse clinical outcomes. Therefore, efforts must be made to provide comprehensive care for critically ill patients, aiming not only at their survival, but also at alleviating their suffering.

RESUMO JUSTIFICATIVA E OBJETIVOS: Nas Unidades de Terapia Intensiva (UTI) os pacientes são expostos a múltiplos procedimentos que podem ser dolorosos, e nem sempre os profissionais de saúde estão alertas para a dor nesses pacientes. A avaliação e o manejo inadequado da dor, por sua vez, têm sido associados a uma série de resultados adversos, incluindo aumento da taxa de infecção, ventilação mecânica prolongada, distúrbios hemodinâmicos, delírio e imunidade comprometida. Dessa forma, este estudo teve como objetivo sumarizar as evidências científicas acerca da incidência e dos impactos da dor em pacientes críticos. CONTEÚDO: Foi realizada uma revisão sistemática de estudos observacionais (bases de dados Pubmed e EMBASE) com critérios de elegibilidade predeterminados. Nos 32 estudos incluídos, foi identificado que de 10,1% a 61% dos pacientes apresentaram dor em repouso, e de 27,4% a 94% apresentaram dor durante os procedimentos. Além disso, houve evidências de melhora nos resultados dos pacientes após o uso de instrumentos validados para a mensuração da dor, incluindo diminuição do tempo de permanência na UTI, duração da ventilação mecânica, mortalidade, delírio, eventos adversos e gravidade da doença. CONCLUSÃO: Através do presente estudo foi observado que a dor representa um fenômeno comum nas UTI e que a sua identificação e manejo constitui uma meta realista e dependente da avaliação. Além disso, a dor parece estar associada a piores desfechos clínicos. Sendo assim, deve-se voltar esforços para o cuidado integral ao paciente crítico, objetivando não só sua sobrevivência, mas também o alívio do seu sofrimento.

Epidemiological measures: application and interpretation in real-life scenarios according to epidemiological study designs

Frequency, association and impact measures are key concepts in clinical epidemiology; however, it has been found that a considerable proportion of health students and professionals have no knowledge of how to use or interpret them when reading a scientific paper or conducting research. This article aims to explain the main epidemiological measures, how they are used, derived and interpreted. They are approached from the perspective of each of the most frequently used types of primary quantitative research studies (randomized clinical trials, cohort studies, case-control estudies and cross-sectional studies) in order to provide the reader with the context in which they are used. Moreover, the process for calculating and interpreting each result in a real setting is explained using clinical examples for a better understanding of these concepts and in order to prevent their use from becoming just a mechanical or repetitive exercise.

Las medidas de frecuencia, asociación e impacto son conceptos fundamentales de la epidemiología clínica; sin embargo, se ha encontrado que una parte considerable de los estudiantes y de los profesionales en el área de la salud no sabe cómo usarlas ni cómo interpretarlas al leer un texto científico o al hacer una investigación. Este artículo busca explicar las principales medidas epidemiológicas, cuándo se usan, cómo se obtienen y cómo se interpretan. Se abordan desde cada tipo de estudios primarios más frecuentemente utilizados cuando se realizan investigaciones cuantitativas (ensayos clínicos aleatorizados, estudios de cohorte, casos y controles y estudios de corte transversal), con el fin de darle al lector el contexto en el cual se usan. Además, mediante ejemplos clínicos, se explica el proceso para calcular e interpretar cada resultado en un escenario real, con el fin de lograr una mayor comprensión de estos conceptos y de que su uso no sea un ejercicio mecánico o de repetición.

Association of acanthosis nigricans with metabolic syndrome - An analytic cross-sectional study

Abstract Background: Globally, few studies have been undertaken to assess the association of acanthosis nigricans (AN) with metabolic syndrome (MS). Most of the available studies have either focused on a particular age group, gender, ethnicity or on a single component of MS. Objectives: To determine the association between AN and MS as a whole and with all individual components of MS in adult patients of either gender. Material and methods: This was a cross-sectional study with a comparative group. Eighty-one subjects were recruited in each group. Fasting plasma glucose (FPG) and lipid profile were done. MS was defined by using the international diabetic federation (IDF) criteria. Association of body mass index (BMI), waist circumference, blood pressure, FPG, high-density lipoprotein (HDL) and triglycerides (TG) with AN was assessed by Pearson's chi-square test followed by univariate and multivariate analysis. Results: The prevalence of MS was found to be significantly higher in the group with AN. On univariate analysis, a significant association of AN was found with BMI, waist circumference, high systolic and diastolic blood pressure, HDL, and TG. Multivariate analysis revealed a significant association between waist circumference, high systolic and diastolic blood pressure, and high TG levels with AN. The risk of MS was found to be eight times higher in cases of AN. Study limitations: The small sample size and single-center data are the limitations of the present study. Conclusion: AN is strongly associated with MS as a whole and with its individual components including increased waist circumference, hypertension, and dyslipidemia.

Dinámicas socioculturales y alternativas económicas de mujeres en un contexto de economía minera extractivista

Este artículo describe las dinámicas socioculturales presentes en Puerto Claver, El Bagre, Antioquia, a causa del contexto económico minero. El enfoque fenomenològico permitió un acercamiento a las realidades sociales a partir de la cotidianidad de las personas, de sus experiencias vitales y relatos. Un resultado es que la práctica extractiva de oro, arraigada en el corregimiento como la principal alternativa económica, genera desarraigo frente a otras formas de sobrevivencia, como la cosecha y siembra de alimentos y plantas medicinales, la pesca y la apicultura. Al transformarse las prácticas económicas y productivas, así como la relación con el medio ambiente, cambian también las relaciones sociales, las dinámicas socioculturales preexistentes y el tejido social y comunitario. En este contexto, las asociaciones de mujeres tienen un papel significativo en la resignificación y dinamización de procesos económicos alternativos a la práctica minera, a través de los cuales puedan transformar las relaciones sociales y comunitarias.

This article describes the socio-cultural dynamics present in the village of Puerto Claver, municipality of El Bagre, Antioquia, as a result of the mining economic context. The phenomenological approach allowed an approach to the social realities from the daily life of the people, their life experiences and stories. One result is that the practice of gold mining, rooted in the township as the main economic alternative, generates uprooting compared to other forms of survival, such as harvesting and planting food and medicinal plants, fishing and beekeeping. As economic and productive practices are transformed, as well as the relationship with the environment, social relations, pre-existing socio-cultural dynamics and the social and community fabric also change. In this context, women's associations have a significant role to play in re-signifying and energizing alternative economic processes to mining practices, through which they can transform social and community relations.

DO THE INDUSTRY AFFILIATION OF A COMPANY IMPACT ITS EFFECTIVE TAX RATE? - AN ANALYSIS OF INDIAN FIRMS

There are various determinants of the Effective Tax Rate of a company. This study attempts to ?nd out whether industry association impact Effective Tax Rates. Tax Rates and Tax Laws are speci?c to jurisdictions, and the results may vary from jurisdiction to jurisdiction. The study focuses on Indian conditions to examine the relationship between industry classi?cation and the Effective Tax Rate (ETR) of companies. The study covers the standalone ?nancials of the top 500 listed companies. Results show a signi?cant impact of the industry association on the Average Effective Tax Rate

Estudio preliminar de correlación fenotipo-genotipo en miocardiopatías de pacientes derivados a un centro de alta complejidad del conurbano bonaerense / A Preliminary Study of the Phenotype-Genotype Correlation in Cardiomyopathies in Patients Referred to a Tertiary Healthcare Center in the Suburbs of Buenos Aires

RESUMEN Introducción : Las miocardiopatías se definen como un trastorno del miocardio en el que el músculo cardíaco es estructural y funcionalmente anormal, en ausencia de enfermedad arterial coronaria, hipertensión arterial (HTA), enfermedad valvular y enfermedad cardíaca congénita. Estas enfermedades son relativamente frecuentes, y suponen una importante causa de morbimortalidad a nivel global. Aunque el estudio genético se recomienda para el cribado familiar, la falta de datos robustos sobre asociaciones genotipo-fenotipo específicas ha reducido su impacto en el manejo clínico. Objetivos : El objetivo de este estudio es analizar la frecuencia de mutaciones en una población de pacientes con miocardiopatía derivados a un centro de alta complejidad y el análisis de la correlación genotipo-fenotipo en las mutaciones identificadas. Material y métodos: Se estudiaron en forma prospectiva 102 pacientes con sospecha de miocardiopatía hipertrófica (MCH) familiar, de los cuales 70 constituían casos índices, de una cohorte ambispectiva de pacientes con miocardiopatías controladas en un hos pital público de alta complejidad de tercer nivel de atención de la provincia de Buenos Aires, desde enero 2012 al 30 agosto 2022. Resultados : De 102 pacientes 83 fueron considerados afectados. De eelos, 31 eran MCH y 52 fenocopias, sin diferencia en el pronóstico. Se realizó estudio genético en 77 pacientes, de los cuales 57 presentaron mutaciones reconocibles, en el 80% de los casos coincidentes con un Score de Mayo ≥3. Se detectaron 28 variantes de significado incierto. Conclusiones : Se comprobó que realizar estudio molecular guiado por el Score de Mayo permitió obtener un alto grado de probabilidad de detectar mutaciones. Se evidenció la importancia del estudio molecular debido a la existencia de solapamiento fenotípico y genotípico de las miocardiopatías. El conocimiento de la variante genética causal actualmente no afecta el manejo clínico de la mayoría de los pacientes con MCH, pero es de ayuda ante un pequeño grupo de genes que tienen opciones de tratamiento.

ABSTRACT Background : Cardiomyopathies are defined as a disorder of the myocardium in which the heart muscle is structurally and functionally abnormal, in the absence of coronary artery disease, hypertension (HT), valvular heart disease and congenital heart disease. These diseases are relatively common and a major cause of morbidity and mortality worldwide. Although genetic testing is recommended for family screening, lack of solid data on specific genotype-phenotype associations has reduced its impact on clinical management. Objectives : This study aims to analyze the frequency of mutations in a population of patients with cardiomyopathy referred to a tertiary healthcare center and to analyze the genotype-phenotype correlation of the identified mutations. Methods : We prospectively included 102 patients with suspected familial hypertrophic cardiomyopathy (HCM), 70 of which were index cases, from an ambispective cohort of patients with cardiomyopathies treated in a tertiary healthcare public hos pital in the province of Buenos Aires, from January 2012 to August 30, 2022. Results : Of 102 patients, 83 were considered affected. Of these, 31 were HCM and 52 were phenocopies, with no difference in prognosis. A genetic study was carried out in 77 patients, of whom 57 presented recognizable mutations, in 80% of the cases coinciding with a Mayo Score ≥3. Twenty-eight variants of uncertain significance were detected. Conclusions : It was confirmed that molecular testing guided by the Mayo Score provided high probability of detecting mutations. Molecular testing proved to be important due to the phenotypic and genotypic overlap in cardiomyopathies. Understanding the causative genetic variant, nowadays, does not affect the clinical management of most HCM patients, but is helpful in a small group of genes with treatment options.

Eventos de risco associados ao comportamento suicida / Risk events associated with suicide behavior

Objetivo: Analisar eventos de risco associados ao comportamento suicida em indivíduos atendidos em emergência geral. Métodos: Pesquisa exploratória, descritiva, abordagem qualitativa. Coleta de dados entre dezembro de 2017 e novembro de 2019, com pessoas que tentaram o suicídio, por meio de entrevista com questionário semiestruturado. Dados analisados com Análise de Conteúdo temático. Resultados: Entrevistados 113 participantes, 86 (76,1%) do sexo feminino, 57 (50,4%) na faixa etária entre 18 e 30 anos, 103 (91,2%) heterossexuais, 49 (43,4%) solteiros. Conforme a análise dos dados, o conteúdo foi agrupado em uma categoria com quatro unidades temáticas que deram ênfase às relações familiares traumáticas, presença de histórico de experiências traumáticas para além da família, condições socioeconômicas ecomportamento impulsivo e a percepção de inexistência de fatores de proteção. Sabe-se que no comportamento suicida há interferência das relações com familiares, com amigos e com outras pessoas com as quais haja relacionamento afetivo importante, de forma que o bom vínculo familiar assume papel de proteção ao comportamento suicida, enquanto vínculos familiares conflituosos são potenciais fatores de risco. Considerações finais: Resultados revelaram a experiência da multiplicidade de eventos que influenciaram a decisão pelo suicídio, ênfase para relações afetivas e familiares prejudicadas e experiências traumáticas (AU).

Objective: Analyze risk events associated with suicidal behavior in individuals seen in general emergency care. Methods: Exploratory, descriptive research, qualitative approach. Data were collected from December 2017 to November 2019 with people who attempted suicide through an interview with a semi-structured questionnaire. Data reviewed with thematic Content Analysis. Results: This survey interviewed 113 participants, 86 (76.1%) female, 57 (50.4%) aged between 18 and 30 years, 103 (91.2%) heterosexual, and 49 (43.4%) single. According to the data analysis, the content was grouped into one category with four thematic units that emphasized traumatic family relationships, the presence of a history of traumatic experiences beyond the family, socioeconomic conditions, impulsive behavior, and the perception of the nonexistence of protective factors. It is known that suicidal behavior is influenced by relationships with family members, friends, and other people with whom there is an important emotional relationship. Good family bonds, thus, take on a protective role against suicidal behavior, while conflicting family bonds are potential risk factors. Final remarks: Results disclosed the experience of the multiplicity of events that influenced the decision to commit suicide, emphasizing damaged affective and family relationships and traumatic experiences (AU).

Hypomagnesemia � An overlooked parameter in type 2 diabetes mellitus

Background: Diabetes Mellitus refers to a group of common metabolic disorders that share the phenotype of Hyperglycemia. It is the leading cause of morbidity and mortality throughout the world with an estimated worldwide prevalence of 439 million by 2030 and 19% of world抯 DM patients are Indians. Magnesium is an important co-factor for various enzymes involved in Insulin secretion and is involved in sodium-potassium ATPase pump. 25%-38% of Type 2 DM patients had Hypomagnesemia, which has also contributed in developing microvascular complications such as Diabetic Retinopathy (DR) and Diabetic Nephropathy (DN). Various studies have suggested that Magnesium supplementation in Type 2 DM patients with Hypomagnesemia have shown beneficial effects on insulin sensitivity and glucose metabolism. Aim and objectives: To study the prevalence of Hypomagnesemia in Type 2 DM patients and to study the association of Hypomagnesemia with microvascular complications such as DR and DN. Materials and methods: It is a hospital based Observational study carried out in 2022 for a period of 1 year including 60 patients fulfilling the ADA criteria for diagnosing T2DM and patients with Diabetic Retinopathy and Diabetic Nephropathy, and excluding patients with Malabsorption, Chronic diarrhoea, Renal Failure on diuretic therapy, Sepsis, Pancreatitis. Serum Magnesium levels of 1.6 mg/dl � 2.6 mg/dl is considered as normal range. Serum Magnesium were measured using Xylidyl blue colorimetric method. Results: The Mean age of the patients in our study was 55.89 years. Among 60 patients diagnosed with Diabetes Mellitus, 42 patients had Hypomagnesemia, 18 patients had Normomagnesemia (p- value: <0.0001). Patients with an HbA1c levels > 7% had Hypomagnesemia when to compared to patients with HbA1c <7% with a significant p value of 0.009. Hypomagnesemia was also associated with Diabetic Retinopathy and Diabetic Nephropathy with a significant p-value of 0.013 and 0.009 respectively. Conclusion: In our study, it has shown that patients with uncontrolled T2DM had Hypomagnesemia, which is also associated with micro-vascular complications of T2DM such as DR and DN.

Avaliação de letramento de risco em estudantes de medicina / Risk literacy assessment of medical students in Brazil / Evaluación de la alfabetización del riesgo en estudiantes de medicina en Brasil

Introdução: Para o processo de decisão compartilhada é essencial que profissionais da saúde interpretem dados estatísticos das melhores evidências disponíveis para que essas informações possam ser comunicadas para seus pacientes. Nesse contexto, o letramento de risco é a capacidade de avaliar riscos e benefícios de determinada ação. Apesar da importância dessa habilidade, estudos têm mostrado que muitos profissionais e estudantes possuem dificuldade na compreensão de conceitos estatísticos e de probabilidade e, dessa forma, baixo letramento de risco. Objetivo: Este estudo teve como objetivo avaliar o letramento de risco em estudantes de medicina e como isso impacta a capacidade de resolver um problema de cálculo de valor preditivo positivo de um exame de rastreamento. Métodos: Foram convidados estudantes do 4º, 5º e 6º anos da Faculdade de Medicina da Universidade de São Paulo para responder a um questionário composto pelo Berlin Numeracy Test (BNT), instrumento validado para a mensuração de numeracia, e um problema clínico sobre cálculo de valor preditivo positivo (VPP) em rastreamento de câncer de mama com mamografia. Avaliar qual o grau de letramento de risco em estudantes de medicina e verificar se existe associação entre o número de acertos no BNT e a capacidade de resolução do cenário clínico sobre VPP. Resultados: Obtivemos 97 respostas, em que 19 (19,52%) participantes acertaram 3 das 4 questões do BNT, e 61 (62,89%) acertaram todas as questões. Já na pergunta sobre VPP do rastreamento de câncer de mama houve 43 respostas corretas (44,33%). A média de pontuação no BNT da amostra de participantes foi de 3,41. Entre os estudantes que acertaram o cálculo do VPP, a média foi 3,67 e, entre os que erraram, foi de 3,21. Conclusões: Apesar da numeracia alta medida pelo BNT, os estudantes apresentam baixa taxa de acerto no caso clínico. Este estudo reforça os achados prévios de que o letramento de risco é uma habilidade difícil de ser aprendida, mesmo em pessoas com alta numeracia. Entretanto, o baixo número de respostas dificulta a interpretação mais precisa dos resultados.

Background: In order to accomplish the shared decision-making process, it is essential that health professionals are able to understand statistical data of the best available evidence, so that this information can be communicated to their patients. In this context, risk literacy is the ability to evaluate risks and benefits of a given action. Despite the relevance of this skill, research has demonstrated that many professionals and students have difficulty interpreting concepts of statistics and probability, therefore having low risk literacy. Objectives: This study aimed to evaluate risk literacy in medical students and how it impacts their ability to solve a problem concerning the positive predictive value (PPV) of a mass screening. Methods: Medical students from the 4th, 5th, and 6th years of the School of Medicine of Universidade de São Paulo were invited to answer a questionnaire comprised of the Berlin Numeracy Test (BNT), a validated instrument to measure numeracy, and a clinical problem regarding the PPV of a mammogram in the context of mass screening. To measure the level of risk literacy of medical students and to investigate whether there is an association between score in the BNT and the ability to correctly answer the clinical problem regarding PPV. Results: A total of 97 responses were collected, of which 19 (19.52%) participants answered 3 out of 4 questions of the BNT, and 61 (62.89%) correctly answered all the questions. In the clinical problem about PPV of cancer screening, there were 43 correct answers (44.33%). The mean BNT score of the participants was 3.41. Among the students who correctly answered the problem, the mean score was 3.76, and among the ones who answered incorrectly, it was 3.21. Conclusions: Despite the high numeracy measured by the BNT, students had a poor outcome in the clinical problem. This study reinforces previous findings that risk literacy is a difficult skill to be learned, even in individuals with high numeracy. However, the low response rate hinders a more precise interpretation of the results.

Introducción: Para el proceso de toma de decisión compartida, es esencial que los profesionales de la salud sean capaces de interpretar datos estadísticos a partir de las mejores evidencias científicas disponibles para que las informaciones puedan ser comunicadas a sus pacientes. En ese contexto, la alfabetización de riesgo es la capacidad de evaluar riesgos y beneficios de una determinada acción. No obstante la importancia de esa habilidad, estudios han demostrado que muchos profesionales y estudiantes tienen dificultades para comprender conceptos de estadística y de probabilidad y, por consecuencia, baja alfabetización de riesgo. Objetivos: Este estudio tiene como objetivo evaluar la alfabetización de riesgo en estudiantes de medicina y cómo eso impacta la capacidad de resolver un problema de cálculo del valor predictivo positivo (VPP) de un examen de tamizaje. Métodos: Estudiantes de 4º, 5º y 6º año de la Facultad de Medicina de la Universidad de São Paulo fueron invitados a responder un cuestionario compuesto por el Berlin Numeracy Test (BNT), un instrumento validado para medir la numeracia, y un problema clínico sobre el cálculo del VPP en el tamizaje de cáncer de mama con mamografía. Evaluar el grado de alfabetización de riesgo en estudiantes de medicina y verificar si existe asociación entre el número de aciertos en BNT y la capacidad de resolución del escenario clínico de VPP. Resultados: Se obtuvieron 97 respuestas, de las que 19 (19,52%) participantes respondieron correctamente 3 de las 4 preguntas del BNT y 61 (62,89%) respondieron correctamente todas las preguntas. En la pregunta sobre el VPP del tamizaje de cáncer de mama hubo 43 respuestas correctas (44,33%). La puntuación media de BNT de los participantes fue de 3,41. Entre los estudiantes que calcularon correctamente el VPP, el promedio fue de 3,67 y entre los que se equivocaron, fue de 3,21. Conclusiones: A pesar de la alta numeracia medida por el BNT, los estudiantes tienen una baja tasa de éxito en el caso clínico. Este estudio refuerzó los hallazgos previos de que la alfabetización de riesgo es una habilidad difícil de aprender, incluso en personas con un alto nivel de numeracia. Sin embargo, el bajo número de respuestas dificulta una interpretación más precisa de los resultados.

Temporal association between antibiotic use and resistance in Gram-negative bacteria / Associação temporal entre o uso de antibióticos e resistência em bactérias gram-negativas

Abstract The β-lactam/lactamase inhibitors (BLBLIs) combination drugs are considered an effective alternative to carbapenems. However, there is a growing concern that the increased use of BLBLIs may lead to increased resistance. This study determined the temporal association between the consumption of BLBLI and the antimicrobial resistance in Gram-negative bacteria. In this retrospective study, electronic data on the Gram-negative bacterial isolates, including A. baumannii, P. aeruginosa, E. coli, and K. pneumoniae from in-patients and susceptibility testing results were retrieved from the medical records of the clinical laboratory. A linear regression and cross-correlation analysis were performed on the acquired data. Increasing trends (p<0.05) in the consumption of BIBLI and carbapenem with a median use of 27.68 and 34.46 DDD/1000 PD per quarter were observed, respectively. A decreased trend (p=0.023) in the consumption of fluoroquinolones with a median use of 29.13 DDD/1000 PD per quarter was observed. The resistance rate of K. pneumoniae was synchronized with the BIBLI and carbapenem consumptions with a correlation coefficient of 0.893 (p=0.012) and 0.951 (p=0.016), respectively. The cross-correlation analysis against the consumption of BIBLI and meropenem resistant K. pneumoniae was peaked at 0-quarter lag (r=951, p=0.016). There was an increasing trend in the consumption of BLBLI and carbapenems. The increasing trend in the rates of resistance to piperacillin/tazobactam, in line with the increasing consumption of BLBLI, suggests that BLBLI has to be used with caution and cannot be directly considered as a long-term alternative to carbapenems.

Resumo Os medicamentos combinados de β-lactâmicos / inibidores da lactamase (BLBLIs) são considerados uma alternativa eficaz aos carbapenêmicos. No entanto, existe uma preocupação crescente de que o aumento do uso de BLBLIs pode levar ao aumento da resistência. Este estudo determinou a associação temporal entre o consumo de BLBLI e a resistência antimicrobiana em bactérias gram-negativas. Neste estudo retrospectivo, os dados eletrônicos sobre as bactérias gram-negativas isoladas, incluindo A. baumannii, P. aeruginosa, E. coli e K. pneumoniae de pacientes internados e os resultados dos testes de suscetibilidade foram recuperados dos registros médicos do laboratório clínico. Uma regressão linear e análise de correlação cruzada foram realizadas nos dados adquiridos. Foram observadas tendências crescentes (p < 0,05) no consumo de BIBLI e carbapenem com uma mediana de uso de 27,68 e 34,46 DDD/1000 PD por trimestre, respectivamente. Foi observada uma tendência de diminuição (p = 0,023) no consumo de fluoroquinolonas com uma mediana de uso de 29,13 DDD/1000 PD por trimestre. A taxa de resistência de K. pneumoniae foi sincronizada com os consumos de BIBLI e carbapenem com coeficiente de correlação de 0,893 (p = 0,012) e 0,951 (p = 0,016), respectivamente. A análise de correlação cruzada contra o consumo de BIBLI e K. pneumoniae resistente ao meropenem atingiu o pico no intervalo de 0 quarto (r = 951, p = 0,016). Houve uma tendência de aumento no consumo de BLBLI e carbapenêmicos. A tendência crescente nas taxas de resistência a piperacilina/tazobactam, em linha com o consumo crescente de BLBLI, sugere que BLBLI deve ser usado com cautela e não pode ser considerado diretamente como alternativa de longo prazo aos carbapenêmicos.

Genome-sequence, annotation and phylogenetic insights of the lactic acid bacterium Limosilactobacillus fermentum strain LAB1 obtained from the dairy beverage borhani

Limosilactobacillus fermentum is a promising probiotic with several documented health benefits. LAB1 is an antagonistic L. fermentum strain isolated from borhani, a traditional South Asian beverage prepared from dairy and plant ingredients. Here, I present the genome sequence of the L. fermentum LAB1 strain, its annotation, and phylogenetic features. The 2.01 Mb genome with a G+C content of 51.9% was assembled into 221 contigs and predicted to have 1,913 protein-coding genes, 98 pseudo genes, 7 rRNAs, 60 tRNAs, and 1 CRISPR array. As much as 91.1% of the coding sequences could be assigned to known functional genes. Determination of average nucleotide identity (ANI) of the genome sequence revealed 99.37% identity to that of the type strain ATCC 14931. Its 16S rRNA gene sequence extracted from the genome sequence showed close phylogenetic association with several L. fermentum strains. The genome sequence is expected to provide useful insights with regard to the phenotypic, metabolic and beneficial aspects of this lactic acid bacterium.(AU)

An interpretation of AAPOS uniform guidelines for instrument-based pediatric vision screen validation 2021 / 中华实验眼科杂志

In January 2022, after an eight-year hiatus, the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) published the latest version of AAPOS uniform guidelines for instrument-based pediatric vision screen validation.Based on recent studies, the new guidelines have been updated and supplemented in many aspects, such as screening population, key points, methods and diagnosis criteria, including clinically significant refractive errors and myopia, simplified age subgroups, and adopted meridional refractive power.The updated guidelines will improve pediatric eye care, early detection of amblyopia and refractive screening, reduce excessive referral and ultimately improve the effectiveness of vision screening.In this article, the background and specific content of the updated guidelines were interpreted to guide clinical practice.

Study on medication law of TCM compounds for treatment of blood stasis type vascular dementia / 国际中医中药杂志

Objective:To explore the medication law and core Traditional Chinese Medicine (TCM) compounds in the treatment of blood stasis vascular dementia (VD) based on data mining.Methods:The literature about TCM treatment for blood stasis VD was retrieved from the databases of CNKI, Wanfang, VIP, and CBM from January 2000 to November 2021. Microsoft Office Excel 2019, SPSS Modeler 18.0, SPSS Statistics 25.0, R X64 4.1.2, and Origin 2021 were used to perform medication frequency analysis, frequency analysis of four properties and five tastes of TCM, association rules, clustering analysis, factor analysis and data visualization.Results:A total of 196 articles were included, with 196 TCM prescriptions, involving 200 kinds of Chinese materia medica. High-frequency drugs were for Acori Tatarinowii Rhizoma, Chuanxiong Rhizoma, Salviae Miltiorrhizae Radix et Rhizoma, Polygalae Radix, Carthami Flos. The medicinal properties were mainly warm, mild and cold, the tastes were mainly sweet, bitter and pungent, and the meridians were mainly liver meridian, spleen meridian and heart meridian. A total of 19 association rules were obtained from the analysis of association rules for 2 kinds of Chinese materia medica, and the rules of the representative were Acori Tatarinowii Rhizoma- Polygalae Radix, Chuanxiong Rhizoma- Carthami Flos, Acori Tatarinowii Rhizoma- Curcumae Radix. A total of 4 categories were extracted through clustering analysis. Factor analysis extracted a total of 8 common factors. Conclusion:The core pathogenesis of blood stasis VD is blood stasis blocking brain collaterals, and there were also pathological factors such as qi deficiency, yin deficiency, phlegm turbidity and so on. The basic treatment is promoting blood circulation and removing stasis, and different methods of promoting blood circulation and drugs are selected. The methods of strengthening spleen and reducing phlegm, nourishing yin and blood, inducing resuscitation, tonifying the kidney and spleen, regulating qi, promoting collaterals and so on can also be used based on syndromes and symptoms of the patients.

Study on medication law of TCM compounds with national patents for treatment of vascular dementia / 国际中医中药杂志

Objective:To explore the prescription and medication law of Traditional Chinese Medicine (TCM) compounds in the treatment of vascular dementia (VD) based on patent database.Methods:TCM compounds with patents about VD were retrieved from Chinese patent announcement website of the State Intellectual Property Office and CNKI. The retrieval time was from the establishment to the databases to 31 st, March 2022. The frequency, clusteringand association analysis were carried out with the help of TCM inheritance auxiliary platform (V2.5). The medication law was analyzed. Results:154 TCM compound patents for the treatment of vascular dementia were screened, involving 227 kinds of Chinese materia medica. Among them, Acori Tatarinowii Rhizoma (44 times, 28.57%) was used more frequently, and the common medicinal pair was Salviea Miltiorrhizae Radix et Rhizoma- Acori Tatarinowii Rhizoma (17 times, 11.03%). The medicinal property was mainly warm, the taste was mainly sweet, and the meridian was mainly liver meridian. Those with high confidence based on association rules were " Corni Fructus -Acori Tatarinowii Rhizoma" (0.90), " Corni Fructus -Rehmannize Radix et Praeparata" (0.90). Based on the complex network, it was concluded that the core drugs were 14 groups such as " Rehmannize Radix et Praeparata- Cistanches Herba- Corni Fructus". The new prescriptions extracted by entropy cluster analysis included 7 groups such as " Rehmannize Radix et Praeparata, Cistanches Herba, Corni Fructus and Asparagi Radix". Conclusion:The treatment of VD by TCM compounds with national patents is mainly based on tonifying deficiency, promoting blood circulation and removing blood stasis, eliminating phlegm and dampness, expelling wind and dredging collaterals, opening orifices and resuscitation, which can provide reference for clinical practice and new drug research and development.

Study on the regular pattern of "disease-syndrome-medicine" of different diseases with the same treatment for blood stasis syndrome based on complex network similarity analysis / 国际中医中药杂志

Objective:To reveal the regular pattern characteristics of different diseases with the same treatment in the most common diseases with blood stasis syndrome; To provide reference for the clinical treatment of blood stasis syndrome and the development of new drugs.Methods:RCTs of blood stasis syndrome were retrieved from CNKI, Chongqing VIP, Wanfang Data, SinoMed, and China Medical Journal Full-text Database from the establishment of the databases to December 31, 2022. Diseases, accompanied symptoms, prescriptions and medicines were extracted. The diseases with the highest frequency among the three disease systems with the highest frequency were collected, and their medication characteristics and prescription rules were analyzed using frequency statistics and association rules Apriori algorithm. The core prescriptions of blood stasis syndrome of three kinds of diseases were excavated and their network similarity was analyzed.Results:A total of 2 052 articles were included. Stable coronary heart disease, ischemic stroke and DN were more common diseases with blood stasis syndrome. The common drugs for the three diseases were Chuanxiong Rhizoma, Carthami Flos, Persicae Semen, Angelicae Sinensis Radix. The core prescription of stable coronary heart disease was Persicae Semen- Carthami Flos- Chuanxiong Rhizoma- Angelicae Sinensis Radix- Paeoniae Radix Rubra; the core prescription of ischemic stroke is Buyang Huanwu Decoction; the core prescription of DN was Persicae Semen- Carthami Flos- Chuanxiong Rhizoma- Angelicae Sinensis Radix- Cornus Officinalis- Dioscoreae Rhizoma- Astragali Radix. The similarity between stable coronary heart disease and ischemic stroke core prescription network was 0.35, the similarity between ischemic stroke and DN core prescription network was 0.29, and the similarity between stable coronary heart disease and DN core prescription network was 0.26. Conclusions:The theory of "different diseases with the same treatment" can profoundly guide clinical practice. The core medicines of blood stasis syndrome are Persicae Semen, Carthami Flos, Angelicae Sinensis Radix, and Chuanxiong Rhizoma. On this basis, combined with different diseases and syndromes to make changes of adding and subtracting.

Acupoint selection rule of acupuncture therapy for relieving postoperative pain based on data mining / 国际中医中药杂志

Objective:To analyze the rule of acupoint selection for acupuncture in relieving postoperative pain based on data mining technology.Methods:Articles about acupuncture for postoperative pain were retrieved from CNKI, SinoMed, VIP, Wanfang, PubMed, Embase and Web of Science databases from establishment to June 6, 2022. Excel 2019 and SPSS Modeler 18.0 software were used to establish acupoints database and conduct the data analysis.Results:Totally 308 articles were obtained, involving 317 acupuncture prescriptions and 173 acupoints. Acupoints of bladder meridian, stomach meridian, large intestine meridian and spleen meridian were used frequently. Zusanli (ST 36), Hegu (LI 4) and Neiguan (PC 6) were high-frequency acupoints with a frequency of ≥50 times. Five-shu acupoint was often selected in specific acupoints. The common sites for acupuncture to relieve postoperative pain were abdomen, perianal, lumbar back and knee. Zusanli (ST 36), Neiguan (PC 6) and other acupoints were commonly used for abdominal postoperative pain, and the most commonly used combination was "Zusanli (ST 36)-Neiguan (PC 6)"; Chengshan (BL 57), Changqiang (GV 1) and other acupoints were often used for perianal postoperative pain, and "Chengshan (BL 57)-Changqiang (GV 1)" was highly correlated combination; Shenshu (BL 23) and Huantiao (GB 30) were commonly used for postoperative pain in the lumbar and back region, and acupoints with high correlation were "Ashi acupoint-Huantiao (GB 30)" and "Shenshu (BL 23)-Huantiao (GB 30)"; Xuehai (SP10) and Liangqiu (ST 34) were commonly used for postoperative pain of knee, and their compatibility had a high correlation.Conclusion:Acupuncture therapy for relieving postoperative pain often selects Yang meridians acupoints, and follows the principle of distal-proximal points combination and acupoint selection along meridians, and pays attention to the use of specific acupoints.