Performance Evaluation of Geometrically Different Pediatric Arterial Cannulae in a Pediatric Cardiopulmonary Bypass Model

ABSTRACT Objective: To define a reference chart comparing pressure drop vs. flow generated by a set of arterial cannulae currently utilized in cardiopulmonary bypass conditions in pediatric surgery. Methods: Cannulae from two manufacturers were selected considering their design and outer and inner diameters. Cannula performance was evaluated in terms of pressure drop vs. flow during simulated cardiopulmonary bypass conditions. The experimental circuits consisted of a Jostra HL-20 roller pump, a Quadrox-i pediatric oxygenator (Maquet Cardiopulmonary AG, Rastatt, Germany), and a custom pediatric tubing set. The circuit was primed with lactated Ringer's solution only (first condition) and with human packed red blood cells added (second condition) to achieve a hematocrit of 30%. Cannula sizes 8 to 16 Fr were inserted into the cardiopulmonary bypass circuit with a "Y" connector. The flow was adjusted in 100 ml/min increments within typical flow ranges for each cannula. Pre-cannula and post-cannula pressures were measured to calculate the pressure drop. Results: Utilizing a pressure drop limit of 100 mmHg, our results suggest a recommended flow limit of 500, 900, 1400, 2600, and 3100 mL/min for Braile arterial cannulae sizes 8, 10, 12, 14, and 16 Fr, respectively. For Medtronic DLP arterial cannulae sizes 8, 10, 12, 14, and 16 Fr, the recommended flow limit is 600, 1100, 1700, 2700, and 3300 mL/min, respectively. Conclusion: This study reinforces discrepancies in pressure drop between cannulae of the same diameter supplied by different manufacturers and the importance of independent translational research to evaluate components' performance.

Self-expandable metallic stent-induced esophagorespiratory fistulas in patients with advanced esophageal cancer

Background/Aims@#Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malignant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas (SEMS-ERFs). This study aimed to assess the risk factors related to the development of SEMS-ERF after SEMS placement in patients with esophageal cancer. @*Methods@#This retrospective study was performed at the Instituto do Cancer do Estado de São Paulo. All patients with malignant esophageal strictures who underwent esophageal SEMS placement between 2009 and 2019 were included in the study. @*Results@#Of the 335 patients, 37 (11.0%) developed SEMS-ERF, with a median time of 129 days after SEMS placement. Stent flare of 28 mm (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.15–5.51; p=0.02) and post-stent chemotherapy (HR, 2.0; 95% CI, 1.01–4.00; p=0.05) were associated with an increased risk of developing SEMS-ERF, while lower-third tumors were a protective factor (HR, 0.5; 95% CI, 0.26–0.85; p=0.01). No difference was observed in overall survival. @*Conclusions@#The incidence of SEMS-ERFs was 11%, with a median time of 129 days after SEMS placement. Post-stent chemotherapy and a 28 mm stent flare were associated with a higher risk of SEMS-ERF.

The psyllid fauna (Hemiptera: Psylloidea) of vegetable fields in Brazil

ABSTRACT Some psyllids transmit 'Candidatus Liberibacter solanacearum' (Lso), the causal agent of devastating plant diseases of cultivated Solanaceae and Apiaceae. The recent detection of Bactericera cockerelli and Lso in Ecuador seriously threatens these crops in South America. There, neither the role of native psyllids in the Lso epidemiology nor the psyllid fauna of vegetables are known. With the aim to identify potential vectors and risk scenarios for the spread of Lso in South America, a survey of the psyllid fauna of Solanaceae and Apiaceae crops and associated weeds was conducted in Brazil. Samples were taken at 29 localities in four states. A total of 2857 specimens were sampled, representing at least 37 species of 23 genera and seven families. The most frequent species on carrot, chilli pepper and potato were Russelliana solanicola, R. capsici and Isogonoceraia divergipennis, respectively. Immatures of R. capsici were found on chilli pepper and of R. solanicola on carrot and potato, confirming these plants as hosts. The two psyllid species have been suspected previously to transmit plant pathogens of unknown identity. Russelliana solanicola is one of the few polyphagous species. Here the species is reported for the first time from carrot. Recent collections in Rio Grande do Sul suggest that Solanum laxum represents the original host of R. capsici, which subsequently shifted to chilli pepper. Both, adaptation to agricultural crops and the possibility of ability to transmit pathogens, make the two Russelliana species dangerous potential vectors of Lso and other plant pathogens in South America.

O universo categorial do método em Marx: notas para o debate / The categorical universe of method in Marx: notes for the debate

Resumo: O artigo estabelece diálogo com leitores interessados na compreensão das categorias do método em Marx, como formulação autêntica da reprodução da realidade. As reflexões foram sistematizadas a partir da disciplina "O método em Marx", cursada no Programa de Pós-Graduação em Serviço Social da PUC-SP. Conclui-se que a compreensão das categorias contidas no pensamento de Marx é essencial para o desenvolvimento da concepção histórico-materialista no processo de investigação.

Abstract: The articlelays down dialogue with readers interested in understanding of the categories of the method in Marx, whilst formulation authentic reproduction of actuality. The reflections they were systematized from of discipline "The method in Marx", studied at Program of Post-graduates in Service Social from the PUC-SP. Conclude what a comprehension of the categories contained of thinking in Marx are essential on deployment of a historical-materialist conception in the research process.

Lumbar lordosis variation according the type of positioner used in lumbar arthrodesis / Variação da lordose lombar segundo os tipos de posicionadores utilizados em artrodese lombar / Variación de la lordosis lumbar según el tipo de posicionador utilizado en artrodesis lumbar

ABSTRACT Objective: Evaluate the influence of the most used surgical positioners for lumbar lordosis (LL) in asymptomatic individuals. Methods: Cross-sectional study based on demographic data and radiographic parameters of asymptomatic individuals. For this study, 16 volunteers, 15 males, and one female were selected, and the average age was 24.6 years. They were submitted to lateral radiographs of the lumbar spine in orthostasis in use of the following positioners: gel cushion, gel cushion with hip extension, four-point Relton-Hall and Wilson-type positioner. Results: The mean LL in the orthostatic position was 58.76º, whereas in the gel cushion positioner it was 52.51; on the gel cushion with hip extension of 58.23º, Relton-Hall/4points 37.63º and, finally, on the Wilson-type positioner of 40.87º. An average reduction of 5.42º of the LL was observed when positioning on the gel cushion in relation to the orthostasis. In the linear regression analysis, the data presented statistically significant results (p<0.05), demonstrating that the L4-S1 segment influences 60% in LL. Conclusion: The positioner with gel cushion and hip extension reproduces an LL similar to physiological values. Relton-Hall and Wilson-type positioners with hip flexion promote hypolordotic positioning compared to basal lordosis in orthostasis. Hip extension alone generated a 5.96º increase in the subject's lordosis. The L4-S1 segment has a 60% influence on the LL when the individuals are in the positioners. Level of evidence III; Controlled cross-sectional study.

RESUMO: Objetivo: Avaliar a influência dos posicionadores cirúrgicos na lordose lombar (LL) em indivíduos assintomáticos. Métodos: Estudo transversal com dados demográficos e parâmetros radiográficos de indivíduos assintomáticos. Utilizamos 16 voluntários, sendo 15 do gênero masculino e uma do gênero feminino, com idade média de 24,6 anos. Foram submetidos a realização de radiografias em perfil da coluna lombar em ortostase nos seguintes posicionadores: coxim em gel, coxim em gel com extensão do quadril, Relton-Hall em quatro pontos e posicionador tipo Wilson. Resultados: A média de LL na posição ortostática foi de 58,76º, já no posicionador coxim em gel de 52,51; no coxim em gel com extensão dos quadris de 58,23º, Relton-Hall/4pontos 37,63º e, por último, no posicionador tipo Wilson, de 40,87º. Houve redução média de 5,42º da LL ao posicionar no coxim em gel em relação a ortostase, na análise de regressão linear os dados apresentaram resultados estaticamente significativos (p<0,05), demostrando que o seguimento L4-S1 apresenta uma influência de 60% na LL. Conclusão: O posicionador coxins em gel e extensão do quadril reproduz uma LL semelhante à fisiológica. Posicionadores do tipo Relton-Hall e Wilson com flexão do quadril promovem um posicionamento hipolordótico comparada a lordose basal em ortostase. A extensão do quadril por si só foi capaz de gerar um aumento de 5,96º na lordose do indivíduo. O seguimento L4-S1 apresenta uma influência de 60% na LL quando os indivíduos estão nos posicionadores. Nível de Evidência III; Estudo Transversal Controlado.

RESUMEN: Objetivo: Evaluar la influencia de los posicionadores quirúrgicos para la lordosis lumbar (LL) en individuos asintomáticos. Métodos: Estudio transversal con datos demográficos y parámetros radiográficos de individuos asintomáticos. Utilizamos 16 voluntarios, 15 hombres y una mujer, edad media de 24,6 años. Sometidos a radiografías laterales de la columna lumbar en ortostasis en los siguientes posicionadores: almohadilla de gel, almohadilla de gel con extensión de cadera, posicionador de cuatro puntos y posicionador tipo Wilson. Resultados: El promedio de LL en posición ortostática fue de 58,76º, en el posicionador de almohadilla de gel fue de 52,51º; en almohadilla de gel con extensión de cadera de 58,23º, 4 puntos 37,63º y, por último, en posicionador tipo Wilson de 40,87º. Se observó una reducción promedio de 5,42º de LL al posicionarse sobre la almohadilla de gel en relación a ortostasis. En el análisis de regresión lineal, los datos presentaron resultados estadísticamente significativos (p<0,05), demostrando que el segmento L4-S1 tiene una influencia de 60% en LL. Conclusión: El posicionador con almohadilla de gel y con extensión de cadera reproduce una LL similar a la fisiológica. Relton-Hall y Wilson con flexión de cadera promueven el posicionamiento hipolordótico en comparación con la lordosis basal. La extensión de la cadera por sí sola fue capaz de generar un aumento de 5,96º en la lordosis. El segmento L4-S1 tiene una influencia del 60% en la LL cuando los individuos están en los posicionadores. Nivel de evidencia III; Estudio Transversal Controlado.

Phoniatric evaluation: relationships between a set of tests and academic difficulties

Abstract Introduction: Learning disability has a significant relevance and can generate negative social impacts on the future of an individual if not corrected in time. Phoniatrics is an area of otorhinolaryngology responsible for evaluating, diagnosing, and referring these cases for therapy and/or complementing the multidisciplinary diagnosis. Objective: To evaluate in school-aged children the association between the application of a set of tests used in the phoniatric assessment and complaints of academic difficulties. To identify which tests would show the main association with academic performance when applied individually. Methods: Blind, cross-sectional study, subdivided into 4 stages. In the 1st stage, 66 children in the third year of elementary school were submitted to the set of tests of skills applied by the phoniatrician; in the 2nd stage, the physician asked the educators about complaints of academic difficulties regarding the students; in the 3rd stage the students' Portuguese language school grade was obtained and in the 4th stage an analysis was made between the data. Results: The educator identified complaints of academic difficulties in 27.2% of the 66 students. There was a statistically significant association between academic difficulties and the following tests of skills: dictation of words and pseudowords, dictation of words, dictation of pseudowords, rhyming, phonemic synthesis, and in the reading test; fluency, intonation and comprehension of the text and morals were analyzed in the reading test. In the multivariate logistic regression analysis, the tests selected to comprise the final model, showing greater association with the academic difficulty complaint were: dictation of words, intonation in reading and comprehension of the morals of the story. Conclusion: The tests identified as the most relevant in identifying academic difficulties were dictation of words, intonation in reading and comprehension of the morals of the story. However, the other tests that were part of the phoniatric consultation allowed the observation of the individual and their functioning abilities, leading to a better assessment of the case, regarding aspects not directly related to the pedagogical one.

Brain-derived neurotrophic factor serum levels following ketamine and esketamine intervention for treatment-resistant depression: secondary analysis from a randomized trial

Abstract Objectives Evidence suggests that ketamine's influence on brain-derived neurotrophic factor (BDNF) might be involved in its mechanism of rapid antidepressant action. We aimed to evaluate the differential impact of ketamine and esketamine on serum BDNF levels and its association with response patterns in treatment-resistant depression (TRD). Methods Participants (n = 53) are from a randomized, double-blind clinical trial comparing the efficacy of single-dose ketamine (0.5mg/kg, n = 27) and esketamine (0.25mg/kg, n = 26) in TRD. Depression severity was assessed before and 24 hours, 72 hours, and 7 days after the intervention, using the Montgomery-Åsberg Depression Rating Scale (MADRS). Blood samples were collected before infusion, 24 hours, and 7 days afterwards. Results There were no significant changes in BDNF levels at post-infusion evaluation points, and no difference in BDNF levels comparing ketamine and esketamine. Both drugs exhibited similar therapeutic effect. There was no association between BDNF levels and response to treatment or severity of depressive symptoms. Conclusion There was no significant treatment impact on BDNF serum levels - neither with ketamine nor esketamine - despite therapeutic response. These results suggest that ketamine or esketamine intervention for TRD has no impact on BDNF levels measured at 24 hours and 7 days after the infusion. This clinical trial is registered on the Japan Primary Registries Network: UMIN000032355.

Factors associated with complications after percutaneous nephrolithotomy: an analysis of 1,066 cases

SUMMARY OBJECTIVE: The aim of this study was to identify predictive factors for complications after percutaneous nephrolithotomy. METHODS: We prospectively analyzed patients who underwent percutaneous nephrolithotomy from June 2011 to October 2018. The association of preoperative and intraoperative factors with the presence of complications was assessed using univariate and multivariate analyses. The significance level was set at p<0.05. RESULTS: A total of 1,066 surgeries were evaluated, and the overall complication rate was 14.9%. In all, 105 (9.8%) surgeries were performed in the prone position, and 961 (90.2%) were performed in the supine position. Univariate analysis demonstrated that surgical position, upper pole puncture, surgical time, number of tracts, and Guys Stone Score were associated with complications. In multivariate analyses, prone position (odds ratio [OR] 2.10; p=0.003), surgical time ≥90 min (OR 1.76; p=0.014), upper pole puncture (OR 2.48; p<0.001), and Guys Stone Score 3 or 4 (OR 1.90; p=0.033) were independent predictive factors for complications after percutaneous nephrolithotomy. CONCLUSION: Performing percutaneous nephrolithotomy in the supine position, in under 90 min, and avoiding upper pole punctures may reduce complications during the treatment of large kidney stones.

Unsuspected Subclinical Left Ventricular Dysfunction in Post-COVID Patients: A Real-world Observation

Background: Subclinical myocardial dysfunction may exist in post-COVID-19 patients and may carry significance in long term. Methodology: Subjects of long-COVID-19 with historically and radiologically significant pulmonary involvement (without documented cardiac involvement) were evaluated on outpatient follow-up echocardiographically when they had disproportionate shortness of breath (SOB), fatigue, or high pulse rate as perceived by the physicians. The common acute-phase symptoms were noted and scored retrospectively. The assessment included spirometry and measurement of chronic obstructive pulmonary disease (COPD) assessment test (CAT) score with measurement of the left ventricular (LV) and right ventricular (RV) free wall global longitudinal strain as an adjunct to routine two-dimensional and Doppler echocardiography and spirometry. The results were evaluated statistically with respect to the history of hospitalization. Results: The hospitalized (n = 15) and nonhospitalized (n = 10) patients were demographically similar. However, the nonhospitalized patients had higher total symptom score (p = 0.03), anosmia (p = 0.017), and ageusia (p = 0.0019). At follow-up (>3 months of acute illness), the nonhospitalized patients had a better CAT score (p = 0.04), higher change in max pulse rate (p = 0.03), and higher forced expiratory volume in 1 second (FEV1) (p = 0.002), tricuspid annular plane systolic excursion (TAPSE) (p = 0.02), and left ventricular global longitudinal strain (LVGLS) (–17.15 ± 1.19 vs –13.11 ± 1.91) (p = 0.0001). Overall, the two groups formed distinct clusters. The LVGLS and the maximum pulse rate difference in the two chair test (2CT) seem to contribute maximally to the variance between the two groups in multivariate analysis. Conclusion: The subclinical myocardial dysfunction persisting in post-COVID patients (without suspected cardiac affection and lower neuroinflammatory symptoms in the acute phase) with significant pulmonary affection needs further evaluation. They demonstrate a higher max pulse rate difference in the 2CT. This real-world observation demands further investigations

Sistemas algorítmicos, lucratividade do capital e implicações nas políticas sociais / Algorithmic systems, capital profitability and implications to social policies

Resumo: Os sistemas algorítmicos são instrumentos utilizados nas políticas sociais para acesso aos serviços. Essa ferramenta tecnológica invade as instituições públicas, controlando os processos de trabalho e o acesso de usuários. O pressuposto é o de que a utilização dos sistemas algorítmicos modifica não apenas a rotina institucional, como também é instrumento de poder pela quantidade gigantesca de dados armazenados, contribuindo à lucratividade do capital. O artigo reflete sobre essa dinâmica com base no estudo bibliográfico.

Abstract: Algorithmic systems are instruments used in social policies to access services. This technological tool invades public institutions controlling work processes and user access. The assumption is that algorithmic management not only modifies institutional routine but is also an instrument of power due to the gigantic amount of stored data which contributes to the profitability of capital. The article reflects on this dynamic by means of bibliographical study.

Recording cutaneous silent period parameters in hereditary and acquired neuropathies / Registro do período de silêncio cutâneo em neuropatias adquiridas e hereditárias

Abstract Background Cutaneous silent period (CSP) is the interruption in muscle activity after painful stimulation of a sensory nerve. Objective The aim of the present study is to assess CSP changes in patients with polyneuropathy (PNP). Methods The present study was carried out to assess CSP in individuals with diabetes (DM) and Charcot-Marie-Tooth (CMT) disease. The sample comprised 24 individuals with DM, 10 individuals with CMT1 disease, and 10 individuals with CMT2 disease. The control group (CG) consisted of 59 individuals. Results The mean latencies recorded for the upper limbs in the CG were 79.2 milliseconds (onset latency), 69.3 milliseconds (50% reduction latency), 112.2 milliseconds (end latency), and 33.1 milliseconds (CSP duration). On the other hand, the mean latencies recorded for the lower limbs were 99.0 milliseconds (onset latency), 85.0 milliseconds (50% reduction latency), 136.9 milliseconds (end latency), and 38.2 milliseconds (CSP duration). The mean latencies recorded for the CG were significantly lower than the ones recorded for other groups, both in the upper and lower limbs. Conclusions Cutaneous silent period values recorded for the CG in the present study were close to the ones reported in studies available in the literature. Abnormal CSP parameters were observed in the group of individuals with PNP. The end latency in the lower limbs helped differentiating the demyelinating subgroup from the axonal one.

Resumo Antecedentes Período de silêncio cutâneo (PSC) é uma interrupção da atividade muscular após a estimulação dolorosa de um nervo sensitivo. Objetivo O presente estudo tem como objetivo avaliar alterações do PSC em indivíduos com polineuropatia. Métodos O presente estudo avaliou PSC em indivíduos com diabetes mellitus (DM) e com doença de Charcot-Marie-Tooth (CMT). A amostra compreendia 24 indivíduos com DM, 10 indivíduos com CMT tipo 1 e 10 indivíduos com CMT tipo 2. Um grupo controle continha 59 indivíduos. Resultados A média das latências do PSC registradas nos membros superiores no grupo controle foi 79,2 milissegundos (latência de início), 69,3 milissegundos (latência com redução de 50%), 112,2 milissegundos (latência final) e 33,1 milissegundos (duração do PSC). Por outro lado, a média das latências do PSC registradas nos membros inferiores foi 99,0 milissegundos (latência de início), 85,0 milissegundos (latência com redução de 50%), 136,9 milissegundos (latência final) e 38,2 milissegundos (duração do PSC). A média das latências registradas no grupo controle foi significativamente menor do que as registradas nos outros grupos (DM e CMT), tanto nos membros inferiores quanto nos superiores. Conclusões Os valores do PSC registrados no grupo controle no presente estudo estiveram próximos aos reportados na literatura. Parâmetros anormais foram observados no grupo de indivíduos com polineuropatia. A latência final do PSC obtida nos membros inferiores ajudou a diferenciar os subgrupos desmielinizantes e axonais.

Suicide attempt, impulsivity, and exposure to trauma in college students

Objectives: Past suicide attempt (SA) is one of the most important risk factors for suicide death. An ideation-to-action framework posits that impulsivity, potentially traumatic events, and mental disorders also play a role in increasing suicide risk. This study aimed to assess the association between trait impulsivity, lifetime exposure to trauma, and post-traumatic stress disorder (PTSD) with SA in a sample of Brazilian college students. Methods: A total of 2,137 participants filled self-reported questionnaires consisting of a sociodemographic and clinical questionnaire, Trauma History Questionnaire, Post-Traumatic Stress Disorder Checklist - Civilian version, and Barratt Impulsiveness Scale. Results: Our findings suggest that trait impulsivity may be interpreted as exerting a distal effect on SA, even in the presence of other variables - such as trauma history, psychological neglect, and PTSD - which also increase the odds of SA. High and medium levels of impulsivity, history of trauma, and PTSD increased the likelihood of SA. Conclusions: Intervention strategies to prevent SA may target trait impulsivity and exposure to traumatic experiences.

Mortality Indicators with Clinical Profile of Multisystem Inflammatory Syndrome in Children during SARS-CoV-2 Second Wave in India: A Tertiary Referral Center Experience

Background: Domestic work being unrecognized as a formal form of occupation in India, workers are often deprived of basic social security, including access to proper health care. Self‑negligence coupled with societal neglect makes them vulnerable to injury and a variety of illnesses. Objectives: We aimed to study the morbidity pattern of women domestic workers residing in a slum area of Kolkata, West Bengal, India. Materials and Methods: An observational descriptive cross‑sectional study was carried out by interviewing and clinically examining 106 randomly selected women domestic workers. Results: The majority (82.08%) had health complaints: heart burn being most common (40.57%). Musculoskeletal and dermatological issues were common. Anemia (31.25%) was a common prediagnosed morbidity. Pallor (33.96%) and dental caries (31.13%) were common; 50.94% reported workplace injury. Of those having complaints, 77.36% sought health care, 59.43% of whom relied on health facilities. Lack of time (54.05%), felt need (35.14%) and money (21.62%) affected adequate care seeking. Participants with cardiorespiratory complaints tended to visit health facilities significantly more (P < 0.05). Conclusion: Health vulnerabilities and neglectful behavior among domestic workers are evident, making the need to sensitize them about their health risks and ways to overcome such issues very vital. Awareness should also be generated about government health schemes to encourage timely health checkup and necessary intervention.

Morbidity Pattern and Health-Care Seeking among Women Domestic Workers: Perspective from an Indian Metropolis

Background: Domestic work being unrecognized as a formal form of occupation in India, workers are often deprived of basic social security, including access to proper health care. Self‑negligence coupled with societal neglect makes them vulnerable to injury and a variety of illnesses. Objectives: We aimed to study the morbidity pattern of women domestic workers residing in a slum area of Kolkata, West Bengal, India. Materials and Methods: An observational descriptive cross‑sectional study was carried out by interviewing and clinically examining 106 randomly selected women domestic workers. Results: The majority (82.08%) had health complaints: heart burn being most common (40.57%). Musculoskeletal and dermatological issues were common. Anemia (31.25%) was a common prediagnosed morbidity. Pallor (33.96%) and dental caries (31.13%) were common; 50.94% reported workplace injury. Of those having complaints, 77.36% sought health care, 59.43% of whom relied on health facilities. Lack of time (54.05%), felt need (35.14%) and money (21.62%) affected adequate care seeking. Participants with cardiorespiratory complaints tended to visit health facilities significantly more (P < 0.05). Conclusion: Health vulnerabilities and neglectful behavior among domestic workers are evident, making the need to sensitize them about their health risks and ways to overcome such issues very vital. Awareness should also be generated about government health schemes to encourage timely health checkup and necessary intervention.

Analysis of the Anti-inflammatory and Antioxidant Potential of the Fractions Obtained From the Ethyl Acetate Partition of the Leaves of Diplopterys Pubipetala

Aims: The objective of this work was to analyze the anti-inflammatory, cytotoxic and antioxidant activity of the fractions of ethyl acetate from the leaves of D. pubipetala. Methodology: Liquid-liquid partitioning was performed, the ethyl acetate partition was eluted in classical liquid chromatography, followed by thin layer chromatography. Antioxidant activity was performed by the DPPH photochlorimetric method and the levels of interleukin (IL?6), tumor necrosis factor ? (TNF??), interleukin-10 (IL-10) and nitric oxide (NO) were identified in supernatants of cell cultures. Results: Fractions F4, F5 and F10 showed antioxidant activity. The F10 fraction indicated efficient anti-inflammatory activity by the production of IL-10 and nitric oxides. Fractions F4, F5 and F9 stimulated the production of IL-6 and TNF-?. Conclusion: These results indicate a possible synergistic action of the extract and the partition of ethyl acetate, since after fractionation the potential presented in previous studies was lower.

Art and science: impact of semioccluded vocal tract exercises and choral singing on quality of life in subjects with congenital GH deficiency

ABSTRACT Objectives: Currently, not much is known about the interactions between voice and growth hormone (GH). We have described large kindred with isolated GH deficiency (IGHD) due to a GHRH receptor mutation, resulting in severe short stature and high-pitched voice. These IGHD individuals have little interest in GH treatment, as they consider themselves "short long-lived people", rather than patients. Interestingly, they report normal general quality of life, but they rate their Voice-Related Quality of Life (V-RQOL) as low. Here, we assessed the social and auditory-perceptual impacts of artistic-intervention voice therapy with semioccluded vocal tract exercises (SOVTE) and choral singing, on their voices. Material and methods: Seventeen GH-naïve adult IGHD individuals were enrolled in a single-arm interventional pre-post study with 13 weekly sessions of choir singing over 90 days. Outcome measures were V-RQOL scores, self-assessment of voice, and auditory-perceptual analysis (GRBAS scale, G: grade of the severity of dysphonia; R: roughness; B: breathiness; A: asthenia; and S: strain). Results: Marked improvements in total (p = 0.0001), physical (p = 0.0002), and socioemotional (p = 0.0001) V-RQOL scores and in self-assessment of voice (p = 0.004) were found. The general grades of vocal deviation (p = 0.0001), roughness (p = 0.0001), breathiness (p = 0.0001) and strain (p = 0.0001) exhibited accentuated reductions. Conclusions: Voice therapy with semioccluded vocal tract exercises and choral training improved social impact and perceptual voice assessments in IGHD subjects and markedly improved their voice-related quality of life. This is particularly important in a setting where GH replacement therapy is not widely accepted.

Eating disorders are associated with adverse obstetric and perinatal outcomes: a systematic review

Objective: To systematically review the literature focusing on obstetric and perinatal outcomes in women with previous or current eating disorders (EDs) and on the consequences of maternal EDs for the offspring. Methods: The study was performed following the systematic review and meta-analysis (PRISMA) statement. PubMed, SciELO, and Cochrane databases were searched for non-interventional studies published in English or Portuguese from January 1980 to December 2020. Risk of bias was assessed using the Methods guide for effectiveness and comparative effectiveness reviews (American Agency for Healthcare Research and Quality). Results: The search yielded 441 records, and 30 articles were included. The psychiatric outcome associated with EDs in women was mainly perinatal depression. The most prevalent obstetric outcomes observed in women with EDs were vomiting, hyperemesis, bleeding, and anemia. Most studies found maternal anorexia nervosa and bulimia nervosa to be associated with low birth weight and slow fetal growth. Women with binge EDs delivered children with increased birth weight. Of the 30 studies included, methodological quality was good in seven, fair in eight, and poor in 15 studies. Conclusion: A considerable body of evidence was reviewed to assess obstetric and perinatal outcomes in EDs. Acute and lifetime EDs, especially if severe, correlated with poor perinatal, obstetric, and neonatal outcomes. Obstetricians and general practitioners should be vigilant and screen for EDs during pregnancy.

Is objective structured practical examination a cutting-edge assessment tool over traditional practical examination to prepare future “Indian Medical Graduate?” A study from Department of Pathology at a Government Medical College in West Bengal

Background: With the continuous evolution of medical education, an appropriate assessment method is the need of the hour. Most unavoidable drawback of traditional practical examination (TPE) is its subjectivity, which can be overcome by newer methods such as objective Structured Practical Examination (OSPE). Hence, many studies have been conducted to reevaluate the efficiency of TPE and nowadays assessment of undergraduate students who are going to be Indian Medical Graduate (IMG) always remains the topic of debate. Aim and Objectives: The aim of our study is to compare OSPE and TPE by obtaining the feedback of examiner and examinee and also by the marks obtained by students. Materials and Methods: It was an analytical study with longitudinal design. The study was conducted after receiving approval from the Institutional Ethics Committee. Total 140 students were included in the study. In 2nd professional MBBS at third semester, two internal examinations were held in 2019, first one was TPE and the second one was based on OSPE. After the completion of OSPE, students’ and teachers’ opinion were collected by given pre-validated questionnaire. Results: There were significant (P =< 0.05) difference between mean score in OSPE (17.1) and TPE (14.26) among students. According to students, OSPE reduces examiner’s bias (84.2%), was less stressful than TPE (78.5%) and also fair and objective as compared to TPE (85%). According to teacher’s opinion, OSPE requires more time, demands critical thinking of students (77.7%), more objective and eliminates bias (94.4%), ensures uniformity (64.4%), but they opined that depth of knowledge cannot be assessed by OSPE (83.3%). Most of the students (93.5%) and teachers (77.7%) said that OSPE should be included in Pathology practical examination. Conclusion: In our study, both teachers and students have given feedback in favor of OSPE as an assessment tool in practical examination of undergraduate medical students. In our opinion, OSPE should be included as an assessment tool in 2nd year undergraduate pathology practical examination to prepare future IMG.