Fasting glucose: a cardiometabolic indicator for subclinical atherosclerosis on excess weight adolescents

Abstract Objective: To build a model based on cardiometabolic indicators that allow the identification of overweight adolescents at higher risk of subclinical atherosclerotic disease (SAD). Methods: Cross-sectional study involving 161 adolescents with a body mass index ≥ + 1 z-Score, aged 10 to 19 years. Carotid intima-media complex thickness (IMT) was evaluated using ultrasound to assess subclinical atherosclerotic disease. Cardiometabolic indicators evaluated included nutritional status, central adiposity, blood pressure, lipidic profile, glycemic profile, as well as age and sex. Data was presented using measures of central tendency and dispersion, as well as absolute and relative frequency. The relationship between IMT measurement (outcome variable) and other variables (independent variables) was assessed using Pearson or Spearman correlation, followed by multiple regression modeling with Gamma distribution to analyze predictors of IMT. Statistical analysis was performed using SPSS and R software, considering a significance level of 5 %. Results: It was observed that 23.7 % had Carotid thickening, and the prevalence of abnormal fasting glucose was the lowest. Age and fasting glucose were identified as predictors of IMT increase, with IMT decreasing with age by approximately 1 % per year and increasing with glucose by around 0.24 % per mg/dL. Conclusion: The adolescent at higher risk is younger with higher fasting glycemia levels.

The ecotin-like peptidase inhibitor of Trypanosoma cruzi prevents TMPRSS2-PAR2-TLR4 crosstalk downmodulating infection and inflammation.

Trypanosoma cruzi is the causative agent of Chagas disease, a chronic pathology that affects the heart and/or digestive system. This parasite invades and multiplies in virtually all nucleated cells, using a variety of host cell receptors for infection. T. cruzi has a gene that encodes an ecotin-like inhibitor of serine peptidases, ISP2. We generated ISP2-null mutants (Δisp2) in T. cruzi Dm28c using CRISPR/Cas9. Epimastigotes of Δisp2 grew normally in vitro but were more susceptible to lysis by human serum compared to parental and ISP2 add-back lines. Tissue culture trypomastigotes of Δisp2 were more infective to human muscle cells in vitro, which was reverted by the serine peptidase inhibitors aprotinin and camostat, suggesting that host cell epitheliasin/TMPRSS2 is the target of ISP2. Pretreatment of host cells with an antagonist to the protease-activated receptor 2 (PAR2) or an inhibitor of Toll-like receptor 4 (TLR4) selectively counteracted the increased cell invasion by Δisp2, but did not affect invasion by parental and add-back lines. The same was observed following targeted gene silencing of PAR2, TLR4 or TMPRSS2 in host cells by siRNA. Furthermore, Δisp2 caused increased tissue edema in a BALB/c mouse footpad infection model after 3 h differently to that observed following infection with parental and add-back lines. We propose that ISP2 contributes to protect T. cruzi from the anti-microbial effects of human serum and to prevent triggering of PAR2 and TLR4 in host cells, resulting in the modulation of host cell invasion and contributing to decrease inflammation during acute infection.

Fasting glucose: a cardiometabolic indicator for subclinical atherosclerosis on excess weight adolescents.

OBJECTIVE: To build a model based on cardiometabolic indicators that allow the identification of overweight adolescents at higher risk of subclinical atherosclerotic disease (SAD). METHODS: Cross-sectional study involving 161 adolescents with a body mass index ≥ +1 z-Score, aged 10 to 19 years. Carotid intima-media complex thickness (IMT) was evaluated using ultrasound to assess subclinical atherosclerotic disease. Cardiometabolic indicators evaluated included nutritional status, central adiposity, blood pressure, lipidic profile, glycemic profile, as well as age and sex. Data was presented using measures of central tendency and dispersion, as well as absolute and relative frequency. The relationship between IMT measurement (outcome variable) and other variables (independent variables) was assessed using Pearson or Spearman correlation, followed by multiple regression modeling with Gamma distribution to analyze predictors of IMT. Statistical analysis was performed using SPSS and R software, considering a significance level of 5 %. RESULTS: It was observed that 23.7 % had Carotid thickening, and the prevalence of abnormal fasting glucose was the lowest. Age and fasting glucose were identified as predictors of IMT increase, with IMT decreasing with age by approximately 1 % per year and increasing with glucose by around 0.24 % per mg/dL. CONCLUSION: The adolescent at higher risk is younger with higher fasting glycemia levels.

Self-regulated learning microanalysis feedback for developing clinical skills: A pilot study.

INTRODUCTION: The development of clinical skills requires the appropriate use of self-regulated learning (SRL). Students' use of key SRL processes as they perform a clinical skill can be identified by SRL microanalysis and used to provide feedback. SRL-microanalysis feedback only on students' key SRL processes has not been previously researched for developing clinical skills. The aim of this study was to investigate whether SRL-microanalysis feedback only on students' key SRL processes can improve both their use of SRL and their clinical skill performance. METHODS: Twenty-three final year medical students with no experience in the clinical skill required for mechanical ventilation participated in this study. Key SRL processes and clinical skill performance were measured before and after SRL microanalysis feedback. RESULTS: Overall, we found an improvement in the key SRL processes of planning and monitoring of performance, with a significant difference in monitoring. We also found an increase in students' clinical skill performance. DISCUSSION: This study, which is the first in clinical skills, demonstrated that SRL microanalysis feedback only on key SRL processes can improve both students' SRL and their clinical skill performance. studies are recommended with a great number of students and across a variety of clinical skills.

Establishing international optimal cut-offs of waist-to-height ratio for predicting cardiometabolic risk in children and adolescents aged 6-18 years.

BACKGROUND: Waist-to-height ratio (WHtR) has been proposed as a simple and effective screening tool for assessing central obesity and cardiometabolic risk in both adult and pediatric populations. However, evidence suggests that the use of a uniform WHtR cut-off of 0.50 may not be universally optimal for pediatric populations globally. We aimed to determine the optimal cut-offs of WHtR in children and adolescents with increased cardiometabolic risk across different countries worldwide. METHODS: We used ten population-based cross-sectional data on 24,605 children and adolescents aged 6-18 years from Brazil, China, Greece, Iran, Italy, Korea, South Africa, Spain, the UK, and the USA for establishing optimal WHtR cut-offs. We performed an external independent test (9,619 children and adolescents aged 6-18 years who came from other six countries) to validate the optimal WHtR cut-offs based on the predicting performance for at least two or three cardiometabolic risk factors. RESULTS: Based on receiver operator characteristic curve analyses of various WHtR cut-offs to discriminate those with ≥ 2 cardiometabolic risk factors, the relatively optimal percentile cut-offs of WHtR in the normal weight subsample population in each country did not always coincide with a single fixed percentile, but varied from the 75th to 95th percentiles across the ten countries. However, these relatively optimal percentile values tended to cluster irrespective of sex, metabolic syndrome (MetS) criteria used, and WC measurement position. In general, using ≥ 2 cardiometabolic risk factors as the predictive outcome, the relatively optimal WHtR cut-off was around 0.50 in European and the US youths but was lower, around 0.46, in Asian, African, and South American youths. Secondary analyses that directly tested WHtR values ranging from 0.42 to 0.56 at 0.01 increments largely confirmed the results of the main analyses. In addition, the proposed cut-offs of 0.50 and 0.46 for two specific pediatric populations, respectively, showed a good performance in predicting ≥ 2 or ≥ 3 cardiometabolic risk factors in external independent test populations from six countries (Brazil, China, Germany, Italy, Korea, and the USA). CONCLUSIONS: The proposed international WHtR cut-offs are easy and useful to identify central obesity and cardiometabolic risk in children and adolescents globally, thus allowing international comparison across populations.

Dental consensus on HSCT - Part II: dental Care during HSCT

ABSTRACT During the state of immune vulnerability in hematopoietic stem cell transplantation (HSCT), the patient has an increased risk of developing a vast number of complications, including severe problems in the oral cavity. These situations require professional oral care to act in the diagnosis and treatment of these conditions, as well as to develop prevention protocols to minimize patient's complications. Oral mucositis, opportunistic infections, bleeding, specific microbiota, taste, and salivary alterations are complications that can occur during HSCT and interfere with various aspects, such as pain control, oral intake, nutrition, bacteremia and sepsis, days of hospitalization and morbidity. Several guidelines have been published to address the role of professional oral care during the HSCT, we describe a consensus regarding these recommendations.

Dental consensus on HSCT - Part II: dental Care during HSCT.

During the state of immune vulnerability in hematopoietic stem cell transplantation (HSCT), the patient has an increased risk of developing a vast number of complications, including severe problems in the oral cavity. These situations require professional oral care to act in the diagnosis and treatment of these conditions, as well as to develop prevention protocols to minimize patient's complications. Oral mucositis, opportunistic infections, bleeding, specific microbiota, taste, and salivary alterations are complications that can occur during HSCT and interfere with various aspects, such as pain control, oral intake, nutrition, bacteremia and sepsis, days of hospitalization and morbidity. Several guidelines have been published to address the role of professional oral care during the HSCT, we describe a consensus regarding these recommendations.

Sudden and simultaneous population outbreak of Neoaulacoryssus speciosus in an urban area of 12 municipalities in the Caatinga biome.

The ground beetle, Neoaulacoryssus speciosus (Coleoptera: Carabidae) is of high relevance to field because it has been recorded as a pest of seeds and young plants of vegetables and other crops and a predator in agricultural crops, forest and weeds in Brazil. However, natural habitat changes are increasing agriculture and forest insect outbreaks in urban areas. A N. speciosus population outbreak occurred in October and November 2018 simultaneously in 12 neighboring municipalities at the beginning of the rainy season in the northern region of Minas Gerais State, Brazil. The objectives of this study were to report a sudden and simultaneous population outbreak of N. speciosus and to describe the factors of habitat change that could have contributed to this invasion in 12 municipalities in the northern region of Minas Gerais State in the Caatinga biome of Brazil. In addition, female and male genitals were described and illustrated, the scientific classification revised and common names of N. speciosus listed. Thousands of males and females of N. speciosus agglomerated in shady, humid places during the day and night for about 15 days. Neoaulacoryssus speciosus has been identified and illustrated, its scientific classification revised and four common names listed for this species.

Effects of exergaming on the microcirculation of adolescents with overweight or obesity-a clinical trial efficacy.

To assess the effect of exergaming on the microcirculation function of adolescents with overweight or obesity, this non-randomized clinical trial efficacy was conducted with 61 adolescents aged between 10 and 16 years. The intervention group (n = 31) performed exergaming three times per week for 8 weeks. Both groups received guidelines for a healthy diet and staying physically active. Microcirculation was assessed using a laser Doppler flowmetry (LDF) at baseline and after intervention. Primary outcomes derived from LDF assessment included resting flow, maximum flow, maximum/resting flow ratio, area under hyperemia, and post-occlusive reactive hyperemia (PORH). Secondary outcomes were body mass index and systemic blood pressure. Unpaired Student's t test compared intergroup analyses, and paired Student's t test compared intragroup analyses. The significance was set at 5%. Statistical analysis intergroup and intragroup was done by fitting a two-way mixed effects model. Microcirculation was similar between groups. Maximum flow (109.0 ± 38.3 versus 124.6 ± 43.0, P = 0.022), area under hyperemia (1614 ± 472 versus. 1755 ± 461, P = 0.023), and PORH (2.18 ± 0.49 versus 2.01 ± 0.52, P = 0.031) were statistically different after intervention. Body mass index decreased in intervention (24.5 ± 3.8-24.1 ± 4.0 kg/m2, P = 0.002) and control (25.2 ± 3.2-25.1 ± 3.3 kg/m2, P = 0.031) groups. Systolic blood pressure decreased significantly in the intervention group (110 ± 10-106 ± 9 mm Hg; P = 0.041) but not diastolic blood pressure (66.0 ± 7-68.8 ± 8 mm Hg; P = 0.089). Exergaming for 8 weeks led to improvements in the microcirculation function in adolescents with overweighed or obesity. Clinical trials: NTC03532659.

Pro-Apoptotic Antitumoral Effect of Novel Acridine-Core Naphthoquinone Compounds against Oral Squamous Cell Carcinoma.

Oral squamous cell carcinoma (OSCC) is a global public health problem with high incidence and mortality. The chemotherapeutic agents used in the clinic, alone or in combination, usually lead to important side effects. Thus, the discovery and development of new antineoplastic drugs are essential to improve disease prognosis and reduce toxicity. In the present study, acridine-core naphthoquinone compounds were synthesized and evaluated for their antitumor activity in OSCC cells. The mechanism of action, pharmacokinetics, and toxicity parameters of the most promising compound was further analyzed using in silico, in vitro, and in vivo methods. Among the derivatives, compound 4e was highly cytotoxic (29.99 µM) and selective (SI 2.9) at levels comparable and generally superior to chemotherapeutic controls. Besides, compound 4e proved to be non-hemolytic, stable, and well tolerated in animals at all doses tested. Mechanistically, compound 4e promoted cell death by apoptosis in the OSCC cell, and molecular docking studies suggested this compound possibly targets enzymes important for tumor progression, such as RSK2, PKM2, and topoisomerase IIα. Importantly, compound 4e presented a pharmacological profile within desirable parameters for drug development, showing promise for future preclinical trials.

The Spatial and Temporal Variations in the Superparasitism of Diachasmimorpha longicaudata Population Lines on Different Hosts After Field Release.

Evaluating the behavior of the parasitoid Diachasmimorpha longicaudata (Ashmead) (Hymenoptera: Braconidae) in the field allows improving strategies for its release. Thus, the aim of this study was to evaluate spatial and temporal variations in the superparasitism of two populations of D. longicaudata on two fruit fly hosts after releasing them in a guava (Psidium guajava L.; cultivar 'Paluma') orchard. The two parasitoid populations used were CS and AS, which were reared on Ceratitis capitata (Wiedemann) and Anastrepha fraterculus (Wiedemann), respectively. Four releases were carried out without host choice. Host larvae were offered to the parasitoids in sentinel traps attached at varying heights on the plant, and in plants located at eight different directions and seven distances (7.0, 21.0, 35.0, 49.0, 59.4, 63.0, and 69.3 m) from the center of the parasitoid release point. The traps remained in the orchard for 24, 48, and 168 h after release. After removing the traps, they were taken to the laboratory for scar counting. The percentages of parasitism, superparasitism, mortality, and emergence of parasitoids were determined. Data were analyzed using the generalized linear mixed-effect model (GLMM). The AS females were more active, as they exerted higher parasitism and superparasitism at the first distance and 48 h after release, leaving a higher number of oviposition scars on the host A. fraterculus. Additionally, higher host mortality was observed in A. fraterculus at the closest points and the first 48 h. The highest percentage of parasitoid emergence was observed in C. capitata parasitized by AS females.

Oral lesions and saliva alterations of COVID-19 patients in an intensive care unit: A retrospective study.

AIM: To detect the type and frequency of oral lesions and clinical conditions suggestive of saliva alterations in COVID-19 patients in an intensive care unit (ICU), as well as to describe the patient´s management in each case METHODS: Information about oral conditions and mechanical ventilation was collected from oral medicine records of COVID-19 patients in an ICU (n = 519) RESULTS: From the total collected, 472 patients (90.9%) were examined by the oral medicine staff. In 242/472 patients (51.3%), alterations in the oral cavity were noted. The most frequent changes were mechanical trauma (18.1%, derived mainly from intubation), vascular/coagulation disturbances (24.1%, petechiae, bruises, varicoses, and oral bleeding), and saliva alterations (24.4%, dry mouth, and sialorrhea). Infectious lesions were mentioned in the oral medicine records (16.9%), most associated with a viral infection (15.7%), mainly herpesvirus. Improved oral change protocols included oral hygiene, use of specific medications, and laser therapy CONCLUSION: COVID-19 patients in the ICU often showed dryness in the oral and mucosa oral lesions related to vascular/coagulation disturbances, and mechanical trauma derived from orotracheal tube. An oral medicine staff must be aligned with the ICU multidisciplinary team to manage COVID-19 patients, as well as to establish diagnoses and oral cavity treatments.

Solutions, enablers and barriers to online learning in clinical medical education during the first year of the COVID-19 pandemic: A rapid review.

AIMS: The COVID-19 pandemic has seen a major disruption to undergraduate and postgraduate clinical medical education. The aim of this rapid review was to identify and synthesize published literature relating to the solutions, enablers and barriers to online learning implemented in clinical medical education during the first year of the COVID-19 pandemic. METHODS: All articles published before March 2021 in peer-reviewed journals, including MedEdPublish, that described authors' experience of online learning in response to the COVID-19 pandemic. A descriptive analysis of the solutions and a qualitative template analysis of enablers and barriers. RESULTS: 87 articles were identified for inclusion. Face to face teaching was maintained with interactive approaches between learners and/or learners and teachers. Several innovative solutions were identified. The enablers were a readiness and rapid response by institutions, with innovation by teachers. The barriers were the lack of planning and resources, usability problems and limited interactivity between teachers and students. CONCLUSIONS: Important and timely evidence was obtained that can inform future policy, practice and research. The findings highlighted the urgent need to use rapid design and implementation methods with greater explicit descriptions in published articles to ensure applicability to other contexts.

Severe oral ulcerative and lichenoid lesions associated with adrenal insufficiency in a patient treated with nivolumab: Report of a case and review of literature.

Nivolumab, an antibody against anti-programmed death type 1, has been used for treatment of advanced non-small cell lung cancer with improvement of overall survival. Usually, diarrhea, cutaneous rash, and pruritus are reported as the most common immune-related adverse effects of nivolumab therapy. Oral lesions and secondary adrenal insufficiency sometimes occur but usually are rare events. We report a case of a patient treated with nivolumab who then showed persistent oral ulcerative and lichenoid lesions, which were refractory to topical corticosteroids. The oral lesions were concomitant to nivolumab-induced adrenal insufficiency. These adverse events led to nivolumab discontinuation, which favored oral lesion healing and adrenal insufficiency remission. Through a brief review of the literature concerning nivolumab toxicity in the oral cavity, we discuss the clinical aspect and management of these lesions.

Intersectoriality of food and nutrition initiatives: relationship with the prevalence of obesity in the State of Paraíba / Intersetorialidade das ações de alimentação e nutrição: relação com a prevalência de obesidade no estado da Paraíba

ABSTRACT Objective: To identify the managerial profile and forms of intersectoral articulation in the framework of food and nutrition carried out in Primary Health Care and verify its association with the prevalence of obesity in the three health macro-regions of the State of Paraíba. Methods: Cross-sectional survey carried out in 151 municipalities in Paraíba, nested in a national population-based survey. Variables related to the manager, managerial profile, intersectoral forms of articulation, and obesity rates among adults were evaluated according to data from the Food and Nutrition Surveillance System. Results: All macro-regions presented a mean of adults obesity higher than the national reference for individual over 18 years of age described in the National Health Plan 2020-2023. The presence of the technician responsible for food and nutrition actions was associated with higher rates of obesity. The performance of food and nutrition education actions, and intersectoral practices related to the Food and Nutrition Security sector were associated with lower prevalence of obesity. Conclusion: The effectiveness of the actions cannot be guaranteed by the presence of a specific position for the actions. Food and Nutrition Education actions are recommended to reduce the prevalence of obesity.

RESUMO Objetivo: Identificar o perfil gerencial e as formas de articulação intersetorial relacionadas à área de alimentação e nutrição realizadas na Atenção Primária à Saúde e verificar sua associação com a prevalência de obesidade nas três macrorregiões de saúde do estado da Paraíba. Métodos: Pesquisa transversal realizada em 151 municípios paraibanos, aninhada em uma pesquisa nacional de base populacional. Foram avaliadas variáveis referentes ao gestor, perfil gerencial, formas de articulação intersetoriais, e índices de obesidade entre adultos de acordo com dados do Sistema de Vigilância Alimentar e Nutricional. Resultados: Todas as macrorregiões apresentaram média de obesidade em adultos superior à referência nacional para pessoas acima de 18 anos de idade descrita no Plano Nacional de Saúde 2020-2023. A presença do responsável técnico para ações de alimentação e nutrição esteve associada a maiores índices de obesidade. A realização de ações de educação alimentar e nutricional, e práticas intersetoriais relacionadas ao setor de Segurança Alimentar e Nutricional associaram-se a menores prevalências de obesidade. Conclusão: A eficácia das ações não pode ser garantida pela presença de cargo específico para as ações. Ações de Educação Alimentar e Nutricional são recomendadas para a redução da prevalência de obesidade.

Relação das práticas parentais com sobrepeso e obesidade em adolescentes escolares: estudo de caso-controle / Relación de las prácticas parentales sobrepeso y obesidad en adolescentes escolares: estudio de casos y controles / Relation of parental practices overweight and obesity in school adolescents: case-control study

Objetivo: avaliar as práticas parentais educativas relativas à alimentação e sua relação com sobrepeso/obesidade em adolescentes escolares. Método: estudo de caso-controle com adolescentes de escolas públicas, mediante investigação das dimensões restritivas em relação ao consumo de doces e alimentos calóricos, pressão para comer, comer de acordo com a determinação e monitoramento-controle sobre consumo de doces e alimentos calóricos. Aplicou-se teste qui-quadrado com intervalo de confiança de 95%. Resultados: participaram 148 adolescentes (80 casos-sobrepeso/obesidade e 68 controles-eutróficos). Houve associação entre estado nutricional do cuidador e do adolescente (OR=5,688; p<0,01), maior percentual de sobrepeso/obesidade entre adolescentes submetidos a práticas restritivas de consumo de doces; em pressão para comer, proporção maior de adolescentes com sobrepeso/obesidade entre os cuidadores que discordaram; maior percentual de adolescentes com sobrepeso/obesidade entre as mães/cuidadores que relataram monitorar o consumo de alimentos calóricos na maior parte do tempo. Conclusão: as práticas parentais educativas relacionaram-se com o sobrepeso/obesidade em adolescentes escolares.

Objetivo: avaliar as práticas parentais educativas relativas à alimentação e sua relação com sobrepeso/obesidade em adolescentes escolares. Método: estudo de caso-controle com adolescentes de escolas públicas, mediante investigação das dimensões restritivas em relação ao consumo de doces e alimentos calóricos, pressão para comer, comer de acordo com a determinação e monitoramento-controle sobre consumo de doces e alimentos calóricos. Aplicou-se teste qui-quadrado com intervalo de confiança de 95%. Resultados: participaram 148 adolescentes (80 casos-sobrepeso/obesidade e 68 controles-eutróficos). Houve associação entre estado nutricional do cuidador e do adolescente (OR=5,688; p<0,01), maior percentual de sobrepeso/obesidade entre adolescentes submetidos a práticas restritivas de consumo de doces; em pressão para comer, proporção maior de adolescentes com sobrepeso/obesidade entre os cuidadores que discordaram; maior percentual de adolescentes com sobrepeso/obesidade entre as mães/cuidadores que relataram monitorar o consumo de alimentos calóricos na maior parte do tempo. Conclusão: as práticas parentais educativas relacionaram-se com o sobrepeso/obesidade em adolescentes escolares. Considerações finais: revelaram-se atendimentos influenciados por estereótipos de gênero e sexualidade, o que reduz o acesso a uma Atenção Primária à Saúde de qualidade, promotora do cuidado para com a saúde de mulheres lésbicas.

Objective: to evaluate the educational parental practices related to food and its relationship with overweight/obesity in school adolescents. Method: case-control study with adolescents from public schools, through investigation of the restrictive dimensions-in relation to the consumption of sweets and caloric foods, pressure to eat, eating according to determination and monitoring-control on consumption of sweets and caloric foods. Chi-square test was applied with a 95% confidence interval. Results: the participants were 148 adolescents (80 cases-overweight/obesity and 68 controls-eutrophic). There was an association between nutritional status of the caregiver and adolescents (OR=5.688; p<0.01), a higher percentage of overweight/obesity among adolescents submitted to restrictive practices of sweet consumption; pressure to eat, a higher proportion of overweight/obese adolescents among caregivers who disagreed; higher percentage of overweight/obese adolescents among mothers/caregivers who reported monitoring caloric food consumption most of the time. Conclusion: educational parenting practices were related to overweight/obesity in school adolescents.

TOP1 modulation during melanoma progression and in adaptative resistance to BRAF and MEK inhibitors.

In melanomas, therapy resistance can arise due to a combination of genetic, epigenetic and phenotypic mechanisms. Due to its crucial role in DNA supercoil relaxation, TOP1 is often considered an essential chemotherapeutic target in cancer. However, how TOP1 expression and activity might differ in therapy sensitive versus resistant cell types is unknown. Here we show that TOP1 expression is increased in metastatic melanoma and correlates with an invasive gene expression signature. More specifically, TOP1 expression is highest in cells with the lowest expression of MITF, a key regulator of melanoma biology. Notably, TOP1 and DNA Single-Strand Break Repair genes are downregulated in BRAFi- and BRAFi/MEKi-resistant cells and TOP1 inhibition decreases invasion markers only in BRAFi/MEKi-resistant cells. Thus, we show three different phenotypes related to TOP1 levels: i) non-malignant cells with low TOP1 levels; ii) metastatic cells with high TOP1 levels and high invasiveness; and iii) BRAFi- and BRAFi/MEKi-resistant cells with low TOP1 levels and high invasiveness. Together, these results highlight the potential role of TOP1 in melanoma progression and resistance.

Implementing healthcare professionals' training during COVID-19: a pre and post-test design for simulation training.

BACKGROUND: Coronavirus disease-19 (COVID-19) has imposed a new reality that presents several challenges for healthcare professionals. The main challenge has been the lack of proper training in relation to an unknown disease. OBJECTIVE: To investigate healthcare professionals' acquisition of knowledge of a new airway management protocol for COVID-19 through their participation in simulation training. DESIGN AND SETTING: Pre and post-test study with purpose sampling, carried out in a tertiary-level hospital in the city of Campinas, state of São Paulo, Brazil. METHODS: This was a cross-sectional pre and post-test intervention among healthcare professionals working in the intensive care unit and emergency department of a large hospital. The training was carried out using an in situ simulation scenario and the participants answered pre and post-tests consisting of a 20-item questionnaire about the new protocol. RESULTS: The paired-sample t test demonstrated that there was a significant increase in test score (t = -19.06; P < 0.001), from before the training (M = 8.62; standard deviation, SD = 3.53) to after the simulation training (M = 17.02; SD = 1.76). CONCLUSIONS: The simulated training had a positive impact on the healthcare professionals' acquisition of the COVID-19 protocol. We also demonstrated that in situ simulation training was an efficient tool for implementing new protocols, thus bringing benefits to healthcare systems, professionals and patients.

Implementing healthcare professionals' training during COVID-19: a pre and post-test design for simulation training

ABSTRACT BACKGROUND: Coronavirus disease-19 (COVID-19) has imposed a new reality that presents several challenges for healthcare professionals. The main challenge has been the lack of proper training in relation to an unknown disease. OBJECTIVE: To investigate healthcare professionals' acquisition of knowledge of a new airway management protocol for COVID-19 through their participation in simulation training. DESIGN AND SETTING: Pre and post-test study with purpose sampling, carried out in a tertiary-level hospital in the city of Campinas, state of São Paulo, Brazil. METHODS: This was a cross-sectional pre and post-test intervention among healthcare professionals working in the intensive care unit and emergency department of a large hospital. The training was carried out using an in situ simulation scenario and the participants answered pre and post-tests consisting of a 20-item questionnaire about the new protocol. RESULTS: The paired-sample t test demonstrated that there was a significant increase in test score (t = −19.06; P < 0.001), from before the training (M = 8.62; standard deviation, SD = 3.53) to after the simulation training (M = 17.02; SD = 1.76). CONCLUSIONS: The simulated training had a positive impact on the healthcare professionals' acquisition of the COVID-19 protocol. We also demonstrated that in situ simulation training was an efficient tool for implementing new protocols, thus bringing benefits to healthcare systems, professionals and patients.

Venous thromboembolism after ultrasound guided foam sclerotherapy.

OBJECTIVE: To analyze prevalence of venous thromboembolism (VTE) after ultrasound guided foam sclerotherapy. METHOD: Clinical retrospective study with patients treated from 2004 to 2014. Charts with incomplete data and follow-up less than 60 days were excluded. Polidocanol foam (Tessari method) was used. The primary outcome was the prevalence of VTE and the secondary were possible risk factors. Chi-square test and Marascuillo prodecure were applied at a significance level of 5%. RESULTS: 2,616 patients were included with 4,712 lower limbs treated. The mean age was 50.7±0.86, in majority female, 83.7%. VTE occurred in 0.49% (pulmonary embolism 0,3%) in a mean time of 44.0±42.2 days. Male gender, personal or family history of phlebitis or DVT and high caliber varicose veins were significantly associated to VTE. CONCLUSION: incidence of VTE is low, male gender, personal or family history of VTE and caliber of varicose veins greater than 7 mm increased the risk.