Standardized Brazilian green propolis extract (EPP-AF®) in COVID-19 outcomes: a randomized double-blind placebo-controlled trial.

SARS-CoV-2 and its different variants caused a "wave and wave" pandemic pattern. During the first wave we demonstrated that standardized Brazilian green propolis extract (EPP-AF®) reduces length of hospital stay in adult patients with COVID-19. Afterwards, we decided to evaluate the impact of EPP-AF in hospitalized patients during the third wave of the pandemic. BeeCovid2 was a randomized, double-blind, placebo-controlled clinical trial in hospitalized COVID-19 adult patients. Patients were allocated to receive an oral dose of 900 mg/day of EPP-AF® or placebo for 10 days. The primary outcome was length of hospital stay. Secondary outcomes included safety, secondary infection rate, duration of oxygen therapy dependency, acute kidney injury and need for intensive care. Patients were followed up for 28 days after admission. We enrolled 188 patients; 98 were assigned to the propolis group and 90 to the placebo group. The post-intervention length of hospital stay was of 6.5 ± 6.0 days in the propolis group versus 7.7 ± 7.1 days in the control group (95% CI - 0.74 [- 1.94 to 0.42]; p = 0.22). Propolis did not have significant impact on the need for oxygen supplementation or frequency of AKI. There was a significant difference in the incidence of secondary infection between groups, with 6.1% in the propolis group versus 18.9% in the control group (95% CI - 0.28 [0.1-0.76], p = 0.01). The use of EPP-AF was considered safe and associated with a decrease in secondary infections. The drug was not associated with a significant reduction in length of hospital stay. ClinicalTrials.gov (NCT04800224).

Cirrhotic Liver Sustains In Situ Regeneration of Acellular Liver Scaffolds after Transplantation into G-CSF-Treated Animals.

Acellular liver scaffolds (ALS) produced by decellularization have been successfully explored for distinct regenerative purposes. To date, it is unknown whether transplanted ALSs are affected by cirrhotic livers, either becoming cirrhotic themselves or instead remaining as a robust template for healthy cell growth after transplantation into cirrhotic rats. Moreover, little is known about the clinical course of recipient cirrhotic livers after ALS transplantation. To address these questions, we transplanted ALSs into cirrhotic rats previously treated with the granulocyte colony-stimulating factor. Here, we report successful cellular engraftment within the transplanted ALSs at 7, 15, and 30 days after transplantation. Recellularization was orchestrated by liver tissue cell activation, resident hepatocytes and bile duct proliferation, and an immune response mediated by the granulocyte components. Furthermore, we showed that transplanted ALSs ensured a pro-regenerative and anti-inflammatory microenvironment, attracted vessels from the host cirrhotic tissue, and promoted progenitor cell recruitment. ALS transplantation induced cirrhotic liver regeneration and extracellular matrix remodeling. Moreover, the transplanted ALS sustained blood circulation and attenuated alterations in the ultrasonographic and biochemical parameters in cirrhotic rats. Taken together, our results confirm that transplanted ALSs are not affected by cirrhotic livers and remain a robust template for healthy cell growth and stimulated cirrhotic liver regeneration.

Photodynamic Inactivation of Microorganisms Using Semisynthetic Chlorophyll a Derivatives as Photosensitizers.

In this study, we describe the semisynthesis of cost-effective photosensitizers (PSs) derived from chlorophyll a containing different substituents and using previously described methods from the literature. We compared their structures when used in photodynamic inactivation (PDI) against Staphylococcus aureus, Escherichia coli, and Candida albicans under different conditions. The PSs containing carboxylic acids and butyl groups were highly effective against S. aureus and C. albicans following our PDI protocol. Overall, our results indicate that these nature-inspired PSs are a promising alternative to selectively inactivate microorganisms using PDI.

Liver scaffolds obtained by decellularization: A transplant perspective in liver bioengineering.

Liver transplantation is the only definitive treatment for many diseases that affect this organ, however, its quantity and viability are reduced. The study of liver scaffolds based on an extracellular matrix is a tissue bioengineering strategy with great application in regenerative medicine. Collectively, recent studies suggest that liver scaffold transplantation may assist in reestablishing hepatic function in preclinical diseased animals, which represents a great potential for application as a treatment for patients with liver disease in the future. This review focuses on useful strategies to promote liver scaffold transplantation and the main open questions about this context. We outline the current knowledge about ex vivo bioengineered liver transplantation, including the surgical techniques, recipient survival time, scaffold preparation before transplantation, and liver disease models. We also highlight the current limitations and future directions regarding in vivo bioengineering techniques.

Liver cirrhosis: An overview of experimental models in rodents.

The liver, a component of the gastrointestinal tract, is one of the most important organs in the human body. The liver performs over 500 functions to promote physiological homeostasis. In addition, the liver acts as a screen, by metabolizing substances carried by blood coming from the digestive tract before they enter the systemic circulation. This vital function exposes the hepatic tissue to hepatotoxic agents, which can lead to liver damage if the organ's repair and regenerative capacity is insufficient. Several conditions such as persistent exposure to hepatitis C and B viruses, alcohol, and drugs can provoke this disbalance, eventually leading to liver cirrhosis, which is an irreversible and life-threatening condition. This paradigm of irreversibility began to be reconsidered when several studies showed that hepatic fibrosis is potentially reversible after cessation of exposure to the hepatotoxic agent or eradication of the primary disease. In the context of basic research in liver fibrosis and cirrhosis, it is essential to keep in mind that the capacity of the organ to recover spontaneously might be a significant limitation to long-term studies that use experimental models of liver cirrhosis. Here, we review animal models where liver cirrhosis is experimentally induced. We focus on a surgery-based model, i.e., bile duct ligation (BDL), and hepatotoxic drugs such as carbon tetrachloride (CCl4), thioacetamide (TAA), and dimethylnitrosamine (DMN) administrated alone or in association with alcohol, the latter to potentialize the hepatotoxic effect of these agents. Also, we analyze the effects of these approaches, emphasizing the risks, spontaneous reversibility, and outcomes on animal health.

The use of standardized Brazilian green propolis extract (EPP-AF) as an adjunct treatment for hospitalized COVID-19 patients (BeeCovid2): a structured summary of a study protocol for a randomized controlled trial.

BACKGROUND: The 2019 coronavirus disease (COVID-19) pandemic continues to spread and affects large numbers of people with unprecedented impacts. Experimental evidence has already been obtained for use of the standardized extract of Brazilian green propolis (EPP-AF) against viral targets, and clinical rationality has been demonstrated for testing this extract as an adjunct to treatment in patients affected by COVID-19. The BeeCovid2 study aims to assess whether EPP-AF has an impact on the improvement of patients hospitalized with COVID-19 by reducing the length of hospital stay. METHODS: BeeCovid2 is a randomized, double-blinded, placebo-controlled clinical study being conducted in Brazil to provide further evidence on the effectiveness of standardized green propolis extract as an adjunctive treatment for adults hospitalized with COVID-19. Hospitalized patients over 18 years of age with a confirmed diagnosis of COVID-19 and up to 14 days of symptoms were included. Patients under mechanical ventilation at randomization, pregnant women, cancer patients, transplanted or using immunosuppression, HIV patients, patients who used propolis in the last 30 days, bacterial or fungal infection at randomization, impossibility of using medication orally or enterally, and advanced chronic diseases (e.g., advanced heart failure, severe liver disease, and end-stage chronic kidney disease). Enrolled patients are randomized at a 1:1 ratio to receive placebo or standardized propolis extract (900 mg/day) for 10 days. The study treatments are administered in a double-blinded manner, and patients are followed for 28 days. The primary outcome is the difference in length of hospital stay in days between groups. Secondary outcomes include the need for mechanical ventilation, the rate of secondary infection, rate of acute kidney injury, the need for renal replacement therapy, the requirement for vasoactive drugs, the use of an intra-aortic balloon pump (IABP), and the use of extracorporeal membrane oxygenation (ECMO). DISCUSSION: This trial is very useful and will provide more data on the effectiveness of using the standardized Brazilian green propolis extract as an adjunctive treatment in association with standard care in adults hospitalized with moderate to severe acute COVID-19. TRIAL REGISTRATION: ClinicalTrials.gov NCT04800224 . Registered on March 16, 2021.

SARS-CoV-2 variants show a gradual declining pathogenicity and pro-inflammatory cytokine stimulation and an increasing antigenic and anti-inflammatory cytokine induction

Hyper-transmissibility with decreased disease severity are typical characteristics of Omicron variant. To understand this phenomenon, we used various bioinformatics approaches to analyze randomly selected genome sequences (one each) of the Gamma, Delta, and Omicron variants submitted to NCBI from 15 to 31 December 2021. We show that: (i) Pathogenicity of SARS-CoV-2 variants decreases in the order: Wuhan > Gamma > Delta > Omicron; however, the antigenic property follows the order: Omicron > Gamma > Wuhan > Delta. (ii) Omicron Spike RBD has lower pathogenicity but higher antigenicity than other variants. (iii) Decreased disease severity by Omicron variant may be due to its decreased pro-inflammatory and IL-6 stimulation and increased IFN-{gamma} and IL-4 induction efficacy. (iv) Mutations in N protein are associated with decreased IL-6 induction and human DDX21-mediated increased IL-4 production in Omicron. (v) Due to mutations, the stability of S, M, N, and E proteins decreases in the order: Omicron > Gamma > Delta > Wuhan. (vi) Stronger Spike RBD-hACE2 binding in Omicron is associated with increased transmissibility. However, the lowest stability of the Omicron Spike protein makes Spike RBD-hACE2 interaction weak for systemic infection and for causing severe disease. Finally (vii), the highest instability of Omicron E protein may also be associated with decreased viral maturation and low viral load leading to less severe disease and faster recovery. Our method may be used for other similar viruses, and these findings will contribute to the understanding of the dynamics of SARS-CoV-2 variants and the management of emerging variants.

Improving hemocompatibility of decellularized liver scaffold using Custodiol solution.

Organ decellularization is one of the most promising approaches of tissue engineering to overcome the shortage of organs available for transplantation. However, there are key hurdles that still hinder its clinical application, and the lack of hemocompatibility of decellularized materials is a central one. In this work, we demonstrate that Custodiol (HTK solution), a common solution used in organ transplantation, increased the hemocompatibility of acellular scaffolds obtained from rat livers. We showed that Custodiol inhibited ex vivo, in vitro, and in vivo blood coagulation to such extent that allowed successful transplantation of whole-liver scaffolds into recipient animals. Scaffolds previously perfused with Custodiol showed no signs of platelet aggregation and maintained in vitro and in vivo cellular compatibility. Proteomic analysis revealed that proteins related to platelet aggregation were reduced in Custodiol samples while control samples were enriched with thrombogenicity-related proteins. We also identified distinct components that could potentially be involved with this anti-thrombogenic effect and thus require further investigation. Therefore, Custodiol perfusion emerge as a promising strategy to reduce the thrombogenicity of decellularized biomaterials and could benefit several applications of whole-organ tissue engineering.

Comportamento suicida e ansiedade entre usuários de um centro de atenção psicossocial no nordeste brasileiro / Suicide behavior and anxiety among users of a psychosocial care center in northeast Brazil / Comportamiento suicida y ansiedad en usuarios de un centro de atención psicosocial en el nordeste de Brasil

O comportamento suicida tem sido conceitualizado como um contínuo de pensamentos e comportamentos desde a ideação até o suicídio em si. O objetivo deste trabalho é analisar a prevalência e os fatores associados ao comportamento suicida e o nível de ansiedade entre usuários de um Centro de Atenção Psicossocial (CAPS). Trata-se de um estudo observacional e transversal realizado entre julho e setembro de 2019 com 188 usuários adultos de um CAPS em Lagarto, Sergipe. Utilizou-se o Inventário de Ansiedade de Beck e a Escala de Avaliação do Risco de Suicídio de Columbia. Os resultados mostraram que, durante a vida, a prevalência de ideação suicida foi de 52,7% e de tentativas efetivas de suicídio, 31,8%, sendo maior entre pessoas com renda familiar menor que um salário mínimo (RP: 1,36, IC 95%: 1,07-1,56; RP: 1,97, IC 95%: 1,19-2,70, respectivamente). Com relação à ansiedade, 27,7% apresentaram ansiedade moderada e 21,8%, severa. A ansiedade severa e a tentativa efetiva de suicídio foram mais prevalentes no sexo feminino (RP: 2,70, IC 95%: 1,23-2,83; RP: 1,74, IC 95%: 1,23-1,84, respectivamente). A tentativa efetiva de suicídio se mostrou associada à ansiedade severa (RP: 2,99, IC 95%: 2,08-5,19). Foram encontradas prevalências elevadas e inter-relações da ideação suicida, tentativa efetiva de suicídio e ansiedade severa entre os usuários, com influência do sexo e renda familiar.

Suicidal behavior has been conceptualized as a continuum of thoughts and behaviors from ideation to suicide itself. This article aimed to analyze the prevalence and the factors associated with suicidal behavior and the level of anxiety among users of a Psychosocial Care Center (CAPS). This is an observational and cross-sectional study conducted between July and September 2019 with 188 adult users of a CAPS in Lagarto, Sergipe. The Beck Anxiety Inventory and the Columbia-Suicide Severity Rating Scale were used. The results showed that, during life, the prevalence of suicidal ideation was 52.7% and suicide rates, 31.8%, being higher among people who had a family income lower than a minimum wage (PR: 1.36, 95% CI: 1.07-1.56; PR: 1.97, 95% CI: 1.19-2.70, respectively). Regarding anxiety, 27.7% moderate anxiety and 21.8%, severe. Severe anxiety and effective suicide attempt were more prevalent in females (PR: 2.70, 95% CI: 1.23-2.83; PR: 1.74, 95% CI: 1.23-1.84, respectively). Effective suicide attempt is associated with severe anxiety (PR: 2.99, 95% CI: 2.08-5.19). High prevalence and interrelations of suicidal ideation, effective suicide attempt, and severe anxiety among users were found, with the influence of gender and family income.

El comportamiento suicida se ha conceptualizado como un continuo de pensamientos y comportamientos desde la ideación hasta el suicidio mismo. El objetivo de este estudio fue analizar la prevalencia y los factores asociados a la conducta suicida y el nivel de ansiedad entre los usuarios de un Centro de Atención Psicosocial (CAPS). Se trata de un estudio observacional y transversal realizado entre julio y septiembre de 2019 con 188 usuarios adultos de un CAPS en Lagarto, Sergipe. Se utilizaron el Inventario de Ansiedad de Beck y la Escala de Evaluación del Riesgo de Suicidio de Columbia. Los resultados indujeron que, durante la vida, la prevalencia de ideación suicida fue del 52,7% y las tasas de suicidio del 31,8%, siendo mayor entre quienes tenían un ingreso familiar inferior al salario mínimo (RP: 1,36, IC 95%: 1,07-1,56; RP: 1,97, IC del 95%: 1,19-2,70, respectivamente). En cuanto a la ansiedad, el 27,7% presentó ansiedad moderada y el 21,8% severa. La ansiedad severa y el intento de suicidio efectivo fueron mayores en las mujeres (RP: 2,70; IC del 95%: 1,23-2,83; RP: 1,74; IC del 95%: 1,23-1,84, respectivamente). El intento de suicidio efectivo se asocia con la ansiedad severa (PR: 2,99; IC del 95%: 2,08 a 5,19). Se evidenció alta prevalencia e interrelaciones de ideación suicida, intento de suicidio efectivo y ansiedad severa entre los usuarios, con influencia del género y los ingresos familiares.

Antimicrobial resistance of bacterial strains in patients undergoing orthodontic treatment with and without fixed appliances.

OBJECTIVES: To identify microorganisms isolated from patients wearing fixed orthodontic appliances and to evaluate the resistance of isolated bacterial strains to different antimicrobials. MATERIALS AND METHODS: Seventeen healthy patients wearing a fixed orthodontic appliance (group 1) and six nonwearers (group 2, control group) were evaluated. The biofilm that formed around the orthodontic brackets was collected, and the samples were then plated in a chromogenic medium (chromIDT, bioMérieux). Colony-forming units (CFUs) were isolated and inoculated in blood-agar medium. Automated biochemical tests (VITEK 2, bioMérieux) were carried out to identify the genus and species of the microorganisms and the resistance provided by 43 drugs (37 antibacterial and 6 antifungal). RESULTS: The most prevalent microbial genera identified in group 1 were Streptococcus (24.0%), Staphylococcus (20.0%), Enterobacter (12.0%), Geobacillus (12.0%), and Candida (12.0%), and the most frequent species were Enterobacter cloacae complex (13.6%) and Staphylococcus hominis (13.6%). In group 2, the most prevalent genera were Streptococcus (57.1%), Staphylococcus (14.2%), Sphingomonas (14.2%), and Enterobacter (14.2%). With regard to antimicrobial resistance, 14 of 19 (74%) isolated bacterial strains were found to be resistant to at least 1 of the tested antimicrobials. CONCLUSIONS: The findings of the present study suggest that patients undergoing orthodontic treatment with fixed appliances have a more complex biofilm with a higher level of bacterial resistance.

Generation and functional characterization of a single-chain variable fragment (scFv) of the anti-FGF2 3F12E7 monoclonal antibody.

Single-chain variable fragments (scFvs) are small-sized artificial constructs composed of the immunoglobulin heavy and light chain variable regions connected by a peptide linker. We have previously described an anti-fibroblast growth factor 2 (FGF2) immunoglobulin G (IgG) monoclonal antibody (mAb), named 3F12E7, with notable antitumor potential revealed by preclinical assays. FGF2 is a known angiogenesis-associated molecule implicated in tumor progression. In this report, we describe a recombinant scFv format for the 3F12E7 mAb. The results demonstrate that the generated 3F12E7 scFv, although prone to aggregation, comprises an active anti-FGF2 product that contains monomers and small oligomers. Functionally, the 3F12E7 scFv preparations specifically recognize FGF2 and inhibit tumor growth similar to the corresponding full-length IgG counterpart in an experimental model. In silico molecular analysis provided insights into the aggregation propensity and the antigen-recognition by scFv units. Antigen-binding determinants were predicted outside the most aggregation-prone hotspots. Overall, our experimental and prediction dataset describes an scFv scaffold for the 3F12E7 mAb and also provides insights to further engineer non-aggregated anti-FGF2 scFv-based tools for therapeutic and research purposes.

Assistência farmacêutica no componente especializado: um estudo de análise lógica / Specialized component of pharmaceutical care: a logical analysis / Asistencia farmacéutica en el componente especializado: un estudio de análisis lógico

Este estudo objetivou realizar uma análise lógica das atividades de assistência farmacêutica em um serviço de referência, vinculado ao componente especializado em um município do semiárido baiano, com o intuito de mapear os processos e atividades implementados para assegurar a integralidade das práticas definidas pelo Ministério da Saúde. A pesquisa teve natureza qualitativa, avaliativa e descritiva e foi realizada em duas etapas: uma análise documental que derivou do modelo teórico; e uma aplicação de questionários aos farmacêuticos que atuaram ou atuam no serviço do componente especializado. Foi indicada uma imagem objetiva ideal; as atividades técnico-gerenciais estavam adequadas ao âmbito local. Contudo, foi descoberto que as atividades técnico-assistenciais estavam restritas à dispensação dos medicamentos conforme os protocolos clínicos. Constatou-se que as atividades técnico-gerenciais são realizadas como preconizadas e as técnico-assistenciais divergem daquilo recomendado pelas diretrizes políticas.

This study carries out a logical analysis of pharmaceutical care in a referral service, linked to specialized component, in a municipality in Bahia, Brazil, to map the procedures and activities implemented to ensure their comprehensiveness as defined by the Ministry of Health. The qualitative, evaluative and descriptive research was developed in two stages: a documentary analysis, derived from the theoretical model; and questionnaires applied to pharmacists who work or have worked in the specialized component service. Results showed an ideal objective image; the technical-managerial activities proved adequate at the local level. However, the technical care activities showed to be restricted to dispensing the drugs according to clinical protocols. In conclusion, the technical-managerial activities are carried out as recommended, while the technical care ones diverge from the policy guidelines.

Este estudio tuvo por objetivo realizar un análisis lógico de las actividades de la asistencia farmacéutica en un servicio de referencia vinculado al componente especializado en un municipio del semiárido baiano (Brasil), con el propósito de mapear los procesos y actividades implementados para asegurar la integralidad de las prácticas definidas por el Ministerio de Salud. El estudio fue de naturaleza cualitativa, evaluativa y descriptiva, realizado en dos etapas: un análisis documental que derivó el modelo teórico; y una aplicación de cuestionarios a los farmacéuticos que actuaron o actúan en el servicio del componente especializado. Los resultados indicaron una imagen objetivo ideal y que las actividades técnico-gerenciales eran adecuadas en el ámbito local. Sin embargo, las actividades técnico-asistenciales estaban restringidas a la dispensación de los medicamentos conforme a los protocolos clínicos. Se concluye que las actividades técnico-gerenciales son realizadas como preconizadas, y las técnico-asistenciales divergen de lo recomendado por las directrices políticas.

Maternal smoking during pregnancy and offspring body mass index and overweight: a systematic review and meta-analysis.

The present study aimed to conduct a systematic review and meta-analysis to evaluate the evidence on the association of maternal smoking during pregnancy with offspring body composition in childhood, adolescence and adulthood. MEDLINE, Web of Science and LILACS databases were searched. Reference lists were also screened. We included original studies, conducted in humans, that assessed the association of maternal smoking during pregnancy with offspring body mass index (BMI) and overweight in childhood, adolescence and adulthood, published through May 1st, 2018. A meta-analysis was used to estimate pooled effect sizes. The systematic review included 64 studies, of which 37 evaluated the association of maternal smoking during pregnancy with overweight, 13 with BMI, and 14 evaluated both outcomes. Of these 64 studies, 95 measures of effect were extracted and included in the meta-analysis. We verified that the quality of evidence across studies regarding maternal smoking in pregnancy and overweight and BMI of offspring to be moderate and low, respectively. Most studies (44 studies) were classified as moderate risk bias. Heterogeneity among studies included was high and, in the random-effects pooled analysis, maternal smoking during pregnancy increased the odds of offspring overweight (OR: 1.43, 95%CI: 1.35; 1.52) and mean difference of BMI (ß: 0.31, 95%CI: 0.23; 0.39). In conclusion, offspring of mothers who smoked during pregnancy have higher odds of overweight and mean difference of BMI, and these associations persisted into adulthood.

Conhecimento sobre ética médica e resolução de conflitos na graduação / Knowledge about medical ethics and conflict resolution during undergraduate courses / Conocimiento sobre ética médica y resolución de conflictos en la carrera de grado

Resumo Estudo quantitativo transversal descritivo que tem o objetivo de avaliar a percepção do graduando em medicina sobre a importância do ensino da ética médica e mensurar seu conhecimento sobre a temática em universidade pública do Nordeste brasileiro. Por meio de questionário aplicado a 230 estudantes foi possível avaliar deficiências provocadas pela ausência do ensino formal da ética médica e discutir a necessidade de abordagens diversificadas do tema durante a graduação. Resultados mostram maior taxa de acertos entre graduandos que cursaram ao menos uma disciplina sobre ética médica, mas índice insatisfatório em ambos os grupos. Um terço dos discentes que não tiveram contato com a temática revelaram não se sentir prejudicados por essa lacuna e 25,6% da amostra sequer valorizou a importância do tema em relação a outras disciplinas da graduação. Assim, torna-se necessário rever as estratégias do ensino médico para garantir melhores profissionais no futuro.

Abstract This descriptive cross-sectional study aimed to evaluate the medical student's perception of the importance of medical ethics being taught and to measure their knowledge about the subject in a public university in the Northeast of Brazil. Through a questionnaire, applied to 230 undergraduates, it was possible to evaluate deficits caused by the absence of formal medical ethics education and to discuss the need for diversified approaches to the subject during graduation. Results show a higher rate of correct answers among undergraduates who attended at least one discipline on medical ethics; whereas they indicated an unsatisfactory rate of success in both groups. One third of the undergraduates who did not have contact with the subject revealed that they did not feel put at a disadvantaged by this gap, and 25.6% of the sample did not value the importance of the subject in comparison to other undergraduate subjects. Therefore, it is necessary to review medical education strategies to ensure better professionals in the future.

Resumen Estudio cuantitativo transversal descriptivo que tiene el objetivo de evaluar la percepción del estudiante de medicina sobre la importancia de la enseñanza de la ética médica y mensurar su conocimiento sobre la temática en una universidad pública del Nordeste brasileño. A través de un cuestionario aplicado a 230 estudiantes fue posible evaluar las deficiencias provocadas por la ausencia de la enseñanza formal de la ética médica y discutir la necesidad de abordajes diversificados del tema durante el grado. Los resultados muestran una mayor tasa de aciertos entre los estudiantes que cursaron al menos una disciplina sobre ética médica, pero un índice insatisfactorio en ambos grupos. Un tercio de los estudiantes que no tuvieron contacto con la temática revelaron no sentirse perjudicados por esa laguna, y el 25.6% de la muestra ni siquiera valora la importancia del tema en relación con otras disciplinas de la carrera. Así, se hace necesario revisar las estrategias de la formación médica para garantizar mejores profesionales en el futuro.

Pharyngeal Airway Modifications in Skeletal Class III Patients Undergoing Bimaxillary Advancement Surgery.

PURPOSE: The purposes were to study the pharyngeal airway in patients with skeletal Class III malocclusion submitted to surgical orthodontic treatment and to correlate the alterations with bone movements. MATERIALS AND METHODS: The sample consisted of multislice computed tomography images from 13 patients obtained before and 6 months after maxillomandibular advancement surgery. The following measurements were obtained using Dolphin Imaging software (Dolphin Imaging, Chatsworth, CA): volume and area of the oropharynx, nasopharynx, and total airway, as well as the most constricted area, anteroposterior and lateral dimensions of the narrowest axial cross-sectional area, and airway length. The paired t test was applied at a significance level of 5%. RESULTS: Sagittal displacement of the maxilla and mandible was correlated with airway alterations using the Pearson correlation test. Alterations in airway measurements were observed in all patients after surgery. We noted a significant increase (P < .05) in total airway area, oropharyngeal area, and anteroposterior dimension of the most constricted area, as well as a significant reduction (P < .05) in airway length. A significant correlation (P < .05) was observed between nasopharyngeal area and maxillary movement and between airway length and mandibular movement (P < .05). CONCLUSIONS: The results of this study suggest significant alterations in pharyngeal airway measurements when preoperative and postoperative periods of bimaxillary advancement surgery were compared.

Retrospective study to assess the impact of ranibizumab 0. 5mg in the visual acuity of patients with macular diseases in a real life context / Estudo retrospectivo para avaliar o impacto de ranibizumab 0, 5mg na acuidade visual de pacientes com doenças maculares num contexto de vida real

Abstract Objective: The primary objective of the study is to evaluate, in a population in the state of Bahia, Brazil, the impact of ranibizumab in best-corrected visual acuity of patients with macular disease and macular edema. Methods: This study did a retrospective and observational assessment visual acuity of the group of patients followed at the Professor Edgard Santos University Hospital and Oftalmodiagnose Eye Hospital in 2011 and 2012 in a real life context. Results: The impact on sample patientes post-treatment demonstrated favorable outcome with an increase in visual acuity of 32%, which means improvement of more than one line in the snellem chart. Conclusion: Improvement in visual acuity of this group was observed from baseline to the end of follow up in a real-life context.

Resumo Objetivo: O objetivo principal do estudo é avaliar, em uma população no estado da Bahia, o impacto do ranibizumab na acuidade visual melhor corrigida de pacientes com doença macular e edema macular. Métodos: Para isso, fizemos uma avaliação retrospectiva e observacional da acuidade visual do grupo de pacientes seguidos no Hospital Universitário Professor Edgard Santos e Oftalmodiagnose Hospital de Olhos em 2011 e 2012 em um contexto de vida real. Resultados: O estudo demonstrou desfecho favorável com aumento da acuidade visual de 32%, o que significa melhora de mais de uma linha no quadro snellem. Conclusão: A melhora da acuidade visual desse grupo foi observada desde o início até o final do seguimento em um contexto da vida real.

Maternal smoking during pregnancy and offspring body mass index and overweight: a systematic review and meta-analysis / Tabagismo materno durante a gravidez e índice de massa corporal e excesso de peso entre os filhos: uma revisão sistemática e metanálise / Tabaquismo materno durante el embarazo e índice de masa corporal y sobrepeso en los hijos: una revisión sistemática y metaanálisis

Abstract: The present study aimed to conduct a systematic review and meta-analysis to evaluate the evidence on the association of maternal smoking during pregnancy with offspring body composition in childhood, adolescence and adulthood. MEDLINE, Web of Science and LILACS databases were searched. Reference lists were also screened. We included original studies, conducted in humans, that assessed the association of maternal smoking during pregnancy with offspring body mass index (BMI) and overweight in childhood, adolescence and adulthood, published through May 1st, 2018. A meta-analysis was used to estimate pooled effect sizes. The systematic review included 64 studies, of which 37 evaluated the association of maternal smoking during pregnancy with overweight, 13 with BMI, and 14 evaluated both outcomes. Of these 64 studies, 95 measures of effect were extracted and included in the meta-analysis. We verified that the quality of evidence across studies regarding maternal smoking in pregnancy and overweight and BMI of offspring to be moderate and low, respectively. Most studies (44 studies) were classified as moderate risk bias. Heterogeneity among studies included was high and, in the random-effects pooled analysis, maternal smoking during pregnancy increased the odds of offspring overweight (OR: 1.43, 95%CI: 1.35; 1.52) and mean difference of BMI (β: 0.31, 95%CI: 0.23; 0.39). In conclusion, offspring of mothers who smoked during pregnancy have higher odds of overweight and mean difference of BMI, and these associations persisted into adulthood.

Resumo: Este estudo teve como objetivo realizar uma revisão sistemática e metanálise para avaliar as evidências sobre a associação entre tabagismo materno durante a gravidez e composição corporal dos filhos na infância, adolescência e vida adulta. Foram realizadas buscas nas bases de dados MEDLINE, Web of Science e LILACS, além de listas de referências. Incluímos estudos originais em seres humanos que avaliaram a associação entre tabagismo materno durante a gravidez e índice de massa corporal (IMC) e excesso de peso dos filhos na infância, adolescência e vida adulta, publicados até 1º de maio de 2018. A metanálise foi usada para estimar os tamanhos dos efeitos agregados. A revisão sistemática incluiu 64 estudos, dos quais 37 avaliaram a associação entre tabagismo materno durante a gravidez e excesso de peso, 13 com IMC e 14 com ambos os desfechos. Desses 64 estudos, foram extraídas 95 medidas de efeito, incluídas na metanálise. Verificamos que a qualidade das evidências nos estudos sobre o tabagismo materno e excesso de peso e IMC dos filhos era moderada e baixa, respectivamente. A maioria dos estudos (44) foi classificada como risco de viés moderado. A heterogeneidade entre os estudos era alta, e na análise de efeitos aleatórios agrupada, o tabagismo materno durante a gravidez aumentou a probabilidade de excesso de peso nos filhos (OR: 1,43; IC95%: 1,35; 1,52) e a diferença média do IMC (β: 0,31; IC95%: 0,23; 0,39). Conclui-se que filhos de mulheres que fumaram durante a gravidez têm maior probabilidade para excesso de peso e maior diferença média de IMC, e que essas associações persistem na vida adulta.

Resumen: El objetivo del presente estudio fue llevar a cabo una revisión sistemática y metaanálisis para evaluar la evidencia de asociación del tabaquismo materno durante el embarazo con el índice de masa corporal de los hijos durante la infancia, adolescencia y etapa adulta. Se buscó información en las siguientes bases de datos: MEDLINE, Web of Science y LILACS. También se analizaron listas de referencia. Se incluyeron estudios originales, realizados con humanos, que evaluaron la asociación del tabaquismo materno durante el embarazo con el índice de masa corporal (IMC) en los hijos, así como el sobrepeso en la infancia, adolescencia y etapa adulta, publicado el 1 de mayo de 2018. Se realizó un metaanálisis para estimar el tamaño de los efectos combinados. La revisión sistemática incluyó 64 estudios, donde 37 evaluaron la asociación del tabaquismo materno durante el embarazo con el sobrepeso, 13 con el IMC, y 14 evaluaron ambos resultados. De estos 64 estudios, se obtuvieron 95 medidas de efecto que se incluyeron en el metaanálisis. Verificamos que la calidad de las evidencias en los diferentes estudios, respecto tabaquismo materno durante el embarazo y el sobrepeso, así como el IMC en los hijos, era moderada y baja, respectivamente. La mayor parte de los estudios (44 estudios) estaba clasificada como de riesgo moderado de sesgo. La heterogeneidad entre los estudios incluidos fue alta y, en los análisis agrupados de efectos aleatorios, el tabaquismo materno durante el embarazo incrementó la probabilidad de descendencia con sobrepeso (OR: 1,43; IC95%: 1,35; 1,52) y la diferencia media del IMC (β: 0,31; IC95%: 0,23; 0,39). En conclusión, los hijos de las madres que fumaron durante el embarazo tienen una mayor probabilidad de sobrepeso, así como una diferencia media del IMC, y estas asociaciones persisten en la etapa adulta.

Optic neuritis and chorioretinitis as ocular manifestations of borreliosis in Brazil: three cases reported / Neurite óptica e coriorretinite como manifestações oculares da borreliose no Brasil: três casos relatados

Abstract Lyme disease is a systemic infection caused by a tick bite and transmission of the Borrelia burgdorferi spirochete. Species of tick vectors of the disease infest mainly wild or rural animals and rodents that may be asymptomatic reservoirs of the bacteria. Characteristic of the northern hemisphere, Lyme disease in Brazil takes on different characteristics, complicating diagnosis. This paper aims to describe three cases of Lyme-like disease in a city in the state of Bahia, Brazil, with ophthalmologic findings.

Resumo A doença de Lyme é uma infecção sistêmica causada pela picada do carrapato e transmissão da espiroqueta Borrelia burgdorferi. As espécies de carrapatos vetores da doença infestam, principalmente, animais silvestres, rurais e roedores que podem ser reservatórios assintomáticos da bactéria. Característica do hemisfério norte, a doença de Lyme no Brasil assume características distintas, dificultando seu diagnóstico. Esse trabalho tem por objetivo, descrever três casos da doença Lyme símile do Brasil, com achados oftalmológicos, em município do Estado da Bahia.

Reconstrução de couro cabeludo com retalho supragaleal: uma boa opção para grandes avulsões de escalpo / Scalp reconstruction with supragaleal flap: a great option for large scalp avulsion

O tratamento de grandes defeitos no couro cabeludo permanece um desafio, a despeito de muitas opções terapêuticas. De acordo com a localização, tamanho e profundidade da lesão, assim como características do paciente, o cirurgião plástico poderá optar dentre inúmeras técnicas com graus variados de complexidade, como enxertos de pele, expansores teciduais, retalhos locais ou livres, entre outras. A microcirurgia revolucionou a cirurgia plástica reparadora e se configura como padrão ouro de tratamento em casos complexos, no entanto, está disponível apenas nos grandes centros. Observando essa limitação, devemos nos ater ao preceito da escada reconstrutora, que prioriza uso da técnica mais simples possível e também deve ser aplicada em casos de ferimentos de escalpo. Nesse artigo demonstramos, em um caso de traumatismo numa menina de 4 anos de idade com perda de aproximadamente um terço do escalpo incluindo áreas de pericrânio, que é possível a reconstrução do couro cabeludo com a rotação de um retalho supragaleal seguida de enxertia de pele parcial sobre a gálea. Essa é uma técnica reprodutível e com curta curva de aprendizado, sendo uma opção bastante interessante para esses casos.

The treatment of large scalp defects remains a big challenge, even though several therapeutic options are available. According to localization, size and depth of injury, and patient's characteristics, the plastic surgeon may use techniques such as skin graft, tissue expanders, local or free flaps. Microsurgery has revolutionized reconstructive plastic surgery and is the gold standard for more complex cases. However, it is available only in large centers. Using the simplest technique is a broadly accepted concept that should be applied to scalp wounds as well. In this paper, we report a case of trauma of a 4 year-old child who lost approximate one third of the scalp including pericranium areas, that it is possible to reconstruct the scalp by rotating a supragaleal flap followed by a skin graft over the galea. This is an easily reproducible technique with a short learning curve, and therefore is an interesting option for large scalp injuries.

Effect of mechanical cycling on screw torque in external hexagon implants with and without platform switching.

This in vitro study evaluated the effect of mechanical cycling on the torque of retaining screw in external hexagon implants with platform switching (PS), regular platform (RP) and wide platform (WP). A total of 30 specimens were equally divided into 3 groups: PS, PR and WP. Each specimen was prepared with implants: 3.75 x 10 mm for RP group and 5.0x10 mm for PS and WP groups and its respective abutment with 32 Ncm torque. All groups were subjected to 106 cycles with 100 N (corresponding to about 40 months of chewing). The results were obtained with the reverse torque of each specimen and data were evaluated using ANOVA and Tukey test (p<0.05). The PS group showed statistically significant difference in screw removal torque (30.06±5.42) compared with RP (23.75±2.76) and WP (21.32±3.53) (p<0.05) groups; the RP and WP groups showed no statistically significant difference between them. It was concluded that the PS group showed higher reverse torque value, suggesting lower susceptibility of the abutment screw loosening.