Combination of 5% cysteamine and 4% nicotinamide in melasma: Efficacy, tolerability, and safety.

BACKGROUND: Melasma is a chronic dermatosis that impacts the patient's quality of life and can present considerable challenges in terms of effective treatment. OBJECTIVE: To evaluate the effectiveness, tolerability, and safety of 5% cysteamine combined with 4% nicotinamide in female subjects with melasma. METHODS: This single-center, single-arm, prospective, open-label study evaluated patients with melasma using a combination cream of 5% cysteamine and 4% nicotinamide in a progressive regimen (60 min in the first month, 120 min in the second month, and 180 min in the third month). RESULTS: Overall, 35 treated subjects exhibited reduced modified Melasma Area and Severity Index (mMASI) (p < 0.001) and decreased MelasQoL scores (p < 0.001), accompanied by improved brightness, luminosity, homogeneity, and spot intensity (p < 0.001). Photographic and colorimetric analysis revealed smaller spots and improved homogeneity. LIMITATIONS: Adherence to progressive daily treatment could not be evaluated long-term. CONCLUSION: A combination cream comprising 5% cysteamine and 4% nicotinamide was effective, tolerable, and safe for treating melasma.

ELMO CPAP: an innovative type of ventilatory support for COVID-19-related acute respiratory distress syndrome.

OBJECTIVE: To assess whether the use of ELMO, a helmet for noninvasive ventilation created in Brazil, had a positive impact on the prognosis of patients with hypoxemic respiratory failure caused by severe COVID-19. METHODS: This is a retrospective study of 50 critically ill COVID-19 patients. Epidemiological, clinical, and laboratory data were collected on ICU admission, as well as before, during, and after ELMO use. Patients were divided into two groups (success and failure) according to the outcome. RESULTS: ELMO use improved oxygenation parameters such as Pao2, Fio2, and the Pao2/Fio2 ratio, and this contributed to a gradual reduction in Fio2, without an increase in CO2, as determined by arterial blood gas analysis. Patients in the success group had significantly longer survival (p < 0.001), as determined by the Kaplan-Meier analysis, less need for intubation (p < 0.001), fewer days of hospitalization, and a lower incidence of acute kidney injury in comparison with those in the failure group. CONCLUSIONS: The significant improvement in oxygenation parameters, the longer survival, as reflected by the reduced need for intubation and by the mortality rate, and the absence of acute kidney injury suggest that the ELMO CPAP system is a promising tool for treating ARDS and similar clinical conditions.

Age-related variation in malignant cytology rates of thyroid nodules: insights from a retrospective observational study assessing the ACR TI-RADS.

OBJECTIVE: The influence of age on the malignant cytology rate of thyroid nodules remains uncertain. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is currently used to guide subsequent investigations of thyroid nodules, regardless of clinical variables. This study aimed to investigate the impact of age on the malignant cytology rates of thyroid nodules and the diagnostic performance of ACR TI-RADS across different age groups. DESIGN: A retrospective, single-center, observational study. METHODS: Patients aged ≥ 20 years with thyroid nodules, who underwent fine-needle aspiration biopsy between 2012 and 2019 were evaluated. Ultrasound images were used to obtain the TI-RADS data. Malignancy was determined based on suspicious for malignancy (Bethesda V) and malignant (Bethesda VI) cytology results or malignancy in cell block analysis. RESULTS: A total of 1023 nodules from 921 patients (88.2% female) were analyzed. The median age was 58.5 (interquartile range [IQR], 41.1-66.6) years, and the median nodule size was 2.4 (IQR, 1.7-3.6) cm. Stratification by age revealed a decreasing prevalence of malignant cytology across subgroups of 20-39, 40-59, and ≥60 years (10.7%, 8.5%, and 3.7%, respectively; P = .002). After adjusting for sex, multinodularity, nodule size, and ACR TI-RADS category, we observed that each year of age reduced the OR for malignant cytology by 3.0% (95% CI: 0.7%-5.3%; P = .011). When comparing the subgroups of 20-39 and ≥60 years, the malignant cytology rate decreased by half in TI-RADS 4 (from 21.4% to 10.4%) and two-thirds in TI-RADS 5 (from 64.7% to 22.6%). CONCLUSIONS: Our study demonstrated that as patient age increased, the rate of malignant cytology in thyroid nodules decreased. Moreover, age significantly influences the malignancy rates of thyroid nodules classified according to the ACR TI-RADS.

The Expanded Exercise Addiction Inventory (EAI-3): Towards Reliable and International Screening of Exercise-Related Dysfunction.

Exercise addiction (EA) refers to excessive exercise, lack of control, and health risks. The Exercise Addiction Inventory (EAI) is one of the most widely used tools in its assessment. However, the cross-cultural psychometric properties of the EAI could be improved because it misses three pathological patterns, including guilt, exercise despite injury, and experienced harm. Therefore, the present study tested the psychometric properties of the expanded EAI (EAI-3) in a large international sample. The EAI-3 was administered to 1931 physically active adult exercisers speaking five languages (Chinese, German, Italian, Japanese, and Turkish) and other measures for obsessive-compulsive behavior, eating disorders, and personality traits. The assessment structure and reliability of the EAI-3 were tested with factorial analyses and through measurement invariance across languages and sex. Finally, a cutoff point for dysfunction-proneness was calculated. The EAI-3 comprised two factors, reflecting the positive and pathological sides of exercise. The structure had excellent reliability and goodness-of-fit indices and configural and metric invariances of the scale were supported. However, three items caused violations in scalar invariance. The results of partial measurement invariance testing suggested an adequate fit for the data. Following sensitivity and specificity analysis, the EAI-3's cutoff score was 34 out of a maximum score of 48. This preliminary study suggests that the EAI-3 is a promising tool for screening EA in an international sample, with a robust and reliable structure comparable across languages and sex. In addition, the proposed cutoff could pave the way toward a consensus on a threshold to screen for EA.

Isolamento social durante a pandemia de COVID-19 aumenta o indicativo de sarcopenia e o comportamento sedentário em idosos brasileiros / Social isolation during the Covid-19 pandemic increases the indicator of sarcopenia and sedentary behavior in brazilians older adults

Objetivo: comparar se o indicativo de sarcopenia e comportamento sedentário aumentou durante o isolamento social devido à pandemia de COVID-19 em idosos brasileiros. Métodos: Estudo transversal realizado com 98 idosos de ambos os sexos, sendo 64 homens e 34 mulheres das regiões Sul e Sudeste do Brasil, e que estavam em isolamento social total ou parcial devido à pandemia de COVID-19 (junho a julho de 2020). Foram utilizados o SARC-F e o Questionário Internacional de Atividade Física (IPAQ), versão curta. A coleta de dados quantitativos ocorreu através de um formulário on-line disponibilizado pela Survey Monkey. Os dados foram analisados por meio dos testes Kolmogorov-Smirnov, Levene, t independente e dependente, e coeficiente de Spearman. Adotou-se significância quando p < 0,05. Resultados: as mulheres (p = 0,047) e os idosos que não praticavam exercício físico (p = 0,001), apresentaram maior tempo sentado após o início da pandemia. Os idosos mais novos (p = 0,002) e que reportaram estar praticando exercício antes do isolamento social (p = 0,006) apresentam menores escores indicativos de sarcopenia durante a pandemia. Os idosos apresentaram aumento nos indicativos de sarcopenia (p = 0,050) e no comportamento sedentário (p = 0,001) durante o período de isolamento social. Conclusão: o período de isolamento social devido à pandemia da COVID-19 provocou aumento no indicativo de sarcopenia e no comportamento sedentário das pessoas idosas.

Objective: to compare whether the indicative of sarcopenia and sedentary behavior increased during social isolation due to the COVID-19 pandemic in elderly Brazilians. Methods: Cross-sectional study conducted with 98 elderly people of both sexes, 64 men and 34 women from southern and southeastern Brazil, and who were in total or partial social isolation due to the COVID-19 pandemic (June to July 2020). The SARC-F and the International Physical Activity Questionnaire (IPAQ), short version, were used. The collection of quantitative data took place through an online form provided by Survey Monkey. Data were analyzed using the Kolmogorov-Smirnov, Levene, independent and dependent t tests, and Spearman's coefficient. Significance was adopted when p < 0.05. Results: women (p = 0.047) and the elderly who did not exercise (p = 0.001) had more time sitting after the onset of the pandemic. Younger elderly (p = 0.002) and those who reported having been exercising before social isolation (p = 0.006) had lower scores indicative of sarcopenia during the pandemic. The elderly showed an increase in sarcopenia indicatives (p = 0.050) and in sedentary behavior (p = 0.001) during the period of social isolation. Conclusion: the period of social isolation due to the COVID-19 pandemic caused an increase in the indicative of sarcopenia and in the sedentary behavior of the elderly.

Dental and composite resin discoloration induced by different hydraulic calcium silicate-based cements: two-year in vitro assessment.

Few long-term studies assess the discoloration induced by hydraulic calcium silicate-based cement on dental structures. In addition, as far as we know, no long-term study has assessed the discoloration induced by these cement on composite resin. This in vitro study aimed to assess, during a period of two years, the discoloration potential of different hydraulic calcium silicate-based cements (hCSCs) on the enamel/dentin structure and composite resin restoration. A total of 40 enamel/dentin discs were obtained from bovine incisors, and 40 composite resin discs (10 mm in diameter × 2 mm thick) were fabricated. A 0.8 mm-deep cavity was made in the center of each disc and filled with the following hCSCs (n=10): Original MTA (Angelus); MTA Repair HP (Angelus); NeoMTA Plus (Avalon); and Biodentine (Septodont). An initial color measurement was performed (T0 - baseline). After 7, 15, 30, 45, 90, 300 days, and two years, new color measurements were performed to determine the color (ΔE00), lightness (ΔL'), chroma (ΔC'), hue differences (ΔH'), and whiteness index (WID). For enamel/dentin, the ΔE00 was significant among groups and periods (p<0.05). NeoMTA Plus had the greatest ΔE00. The NeoMTA Plus group had the greatest ΔE00 after two years for composite resin. Significant reduction in lightness was observed for all groups after two years (p<0.05). The most significant WID values were observed after 30 days for Biodentine (enamel/dentin) and MTA Repair HP groups (composite resin) (p<0.05). The hCSCs changed the colorimetric behavior of both substrates, leading to greater darkening over time. The Bi2O3 in the Original MTA seems relevant in the short periods of color change assessment.

A Novel Approach to Assess Balneotherapy Effects on Musculoskeletal Diseases-An Open Interventional Trial Combining Physiological Indicators, Biomarkers, and Patients' Health Perception.

The present study aimed to evaluate whether a 14-day period of balneotherapy influences the inflammatory status, health-related quality of life (QoL) and quality of sleep, underlying overall health state, and clinically relevant benefits of patients with musculoskeletal diseases (MD). The health-related QoL was evaluated using the following instruments: 5Q-5D-5L, EQ-VAS, EUROHIS-QOL, B-IPQ, and HAQ-DI. The quality of sleep was evaluated by a BaSIQS instrument. Circulating levels of IL-6 and C-reactive protein (CRP) were measured by ELISA and chemiluminescent microparticle immunoassay, respectively. The smartband, Xiaomi MI Band 4, was used for real-time sensing of physical activity and sleep quality. MD patients improved the health-related QoL measured by 5Q-5D-5L (p < 0.001), EQ-VAS (p < 0.001), EUROHIS-QOL (p = 0.017), B-IPQ (p < 0.001), and HAQ-DI (p = 0.019) after balneotherapy; the sleep quality was also improved (BaSIQS, p = 0.019). Serum concentrations of IL-6 were markedly decreased after the 14-day balneotherapy (p < 0.001). No statistically significant differences were observed regarding the physical activity and sleep quality data recorded by the smartband. Balneotherapy may be an effective alternative treatment in managing the health status of MD patients, with a decrease in inflammatory states, along with positive effects on pain reduction, patient's functionality, QoL, quality of sleep, and disability perception status.

Physical Activity Influences Health-Related Quality of Life in Adults with Juvenile Idiopathic Arthritis.

This cross-sectional study aimed to evaluate the impact of physical activity and physical fitness on the health-related quality of life (HQoL) of adult patients with Juvenile Idiopathic Arthritis (JIA). Fifty-nine JIA patients and sixty healthy individuals participated in this study. All individuals had the following evaluations performed: body composition (electrical bioimpedance), physical fitness (6 min walk test (6MWT)), physical activity level (International Physical Activity Questionnaire (IPAQ)), and HQoL (Quality of Life Questionnaire in relation to Health-Short Form (SF36)). Thirty-nine (66%) JIA patients were considered sedentary compared with 15 (25%) in the control group (p < 0.01). JIA patients had a lower HQoL compared with the control group in all variables studied (p < 0.05). JIA patients who were very physically active had better HQoL conditions in the categories of functional capacity (p = 0.001), limitations by physical aspects (p = 0.003), and emotional aspects (p = 0.002) compared with sedentary patients. JIA patients had more cardiovascular abnormalities and walked shorter distances compared with healthy controls in the 6MWT. In conclusion, we observed that HQoL was reduced in adults with JIA. A high percentage of JIA patients were sedentary with lower physical fitness, but physically active patients had a better HQoL than sedentary patients. The duration of physical activity, rather than intensity, influenced the mental aspects of HQoL.

Papillary Thyroid Microcarcinoma: Insights from a Cohort of 257 Thyroidectomized Patients.

Papillary thyroid microcarcinoma management evolved, and less aggressive strategies are now considered. Questions, however, remain on these tumors' behavior, particularly on developing countries' real ground healthcare scenarios. Our aim is to gather insights on the natural history of papillary thyroid microcarcinoma on patients treated with thyroidectomy in Brazil. Consecutive patients diagnosed with papillary thyroid microcarcinoma had their clinical characteristics, interventions, and outcomes described. Patients were classified as incidental or nonincidental based on the diagnosis after or before surgery, respectively. A sum of 257 patients were included, 84.0% of which were women, and the mean age was of 48.3±13.5 years. The mean tumor size was of 0.68±0.26 cm, 30.4% were multifocal, 24.5% had cervical metastasis, and 0.4% distant metastasis. The nonincidental and incidental tumors differed in tumor size (0.72±0.24 and 0.60±0.28 cm, respectively, p=0.003) and in presence of cervical metastasis (31.3% and 11.9%, respectively, p<0.001). Male sex, nonincidental diagnosis, and younger age were independent predictors of cervical metastasis. After 5.5 years (P25-75 2.5-9.7) of follow-up, only 3.8% of patients had persistent structural disease (3.4% cervical). Predictors of persistent disease at multivariate analysis included cervical metastasis and multicentricity. In conclusion, incidental and nonincidental papillary thyroid microcarcinoma patients of the population studied displayed excellent outcomes. Cervical metastasis and multicentricity were frequent findings and prognostic factors for persistent disease.

Microstructural Changes in the Corpus Callosum in Systemic Lupus Erythematous.

Central nervous system (CNS) involvement in childhood-onset systemic lupus erythematosus (cSLE) occurs in more than 50% of patients. Structural magnetic resonance imaging (MRI) has identified global cerebral atrophy, as well as the involvement of the corpus callosum and hippocampus, which is associated with cognitive impairment. In this cross-sectional study we included 71 cSLE (mean age 24.7 years (SD 4.6) patients and a disease duration of 11.8 years (SD 4.8) and two control groups: (1) 49 adult-onset SLE (aSLE) patients (mean age of 33.2 (SD 3.7) with a similar disease duration and (2) 58 healthy control patients (mean age of 29.9 years (DP 4.1)) of a similar age. All of the individuals were evaluated on the day of the MRI scan (Phillips 3T scanner). We reviewed medical charts to obtain the clinical and immunological features and treatment history of the SLE patients. Segmentation of the corpus callosum was performed through an automated segmentation method. Patients with cSLE had a similar mid-sagittal area of the corpus callosum in comparison to the aSLE patients. When compared to the control groups, cSLE and aSLE had a significant reduction in the mid-sagittal area in the posterior region of the corpus callosum. We observed significantly lower FA values and significantly higher MD, RD, and AD values in the total area of the corpus callosum and in the parcels B, C, D, and E in cSLE patients when compared to the aSLE patients. Low complement, the presence of anticardiolipin antibodies, and cognitive impairment were associated with microstructural changes. In conclusion, we observed greater microstructural changes in the corpus callosum in adults with cSLE when compared to those with aSLE. Longitudinal studies are necessary to follow these changes, however they may explain the worse cognitive function and disability observed in adults with cSLE when compared to aSLE.

ELMO CPAP: an innovative type of ventilatory support for COVID-19-related acute respiratory distress syndrome / ELMO-CPAP: um suporte ventilatório inovador para síndrome do desconforto respiratório agudo por COVID-19

ABSTRACT Objective: To assess whether the use of ELMO, a helmet for noninvasive ventilation created in Brazil, had a positive impact on the prognosis of patients with hypoxemic respiratory failure caused by severe COVID-19. Methods: This is a retrospective study of 50 critically ill COVID-19 patients. Epidemiological, clinical, and laboratory data were collected on ICU admission, as well as before, during, and after ELMO use. Patients were divided into two groups (success and failure) according to the outcome. Results: ELMO use improved oxygenation parameters such as Pao2, Fio2, and the Pao2/Fio2 ratio, and this contributed to a gradual reduction in Fio2, without an increase in CO2, as determined by arterial blood gas analysis. Patients in the success group had significantly longer survival (p < 0.001), as determined by the Kaplan-Meier analysis, less need for intubation (p < 0.001), fewer days of hospitalization, and a lower incidence of acute kidney injury in comparison with those in the failure group. Conclusions: The significant improvement in oxygenation parameters, the longer survival, as reflected by the reduced need for intubation and by the mortality rate, and the absence of acute kidney injury suggest that the ELMO CPAP system is a promising tool for treating ARDS and similar clinical conditions.

RESUMO Objetivo: Avaliar se o uso do ELMO, um capacete para ventilação não invasiva criado no Brasil, teve impacto positivo no prognóstico de pacientes com insuficiência respiratória hipoxêmica por COVID-19 grave. Métodos: Estudo retrospectivo com 50 pacientes críticos com COVID-19. Dados epidemiológicos, clínicos e laboratoriais foram coletados na admissão na UTI e antes, durante e após o uso do ELMO. Os pacientes foram divididos em dois grupos (sucesso e falha) de acordo com o desfecho. Resultados: O uso do ELMO melhorou parâmetros de oxigenação como Pao2, Fio2 e relação Pao2/Fio2, e isso contribuiu para uma redução gradual da Fio2, sem aumento do CO2, conforme determinado pela gasometria arterial. Os pacientes do grupo sucesso apresentaram sobrevida significativamente maior (p < 0,001), conforme determinado pela análise de Kaplan-Meier, menor necessidade de intubação (p < 0,001), menos dias de hospitalização e menor incidência de lesão renal aguda em comparação com os do grupo falha. Conclusões: A significativa melhora nos parâmetros de oxigenação, a maior sobrevida, refletida pela menor necessidade de intubação e pela taxa de mortalidade, e a ausência de lesão renal aguda sugerem que o sistema ELMO CPAP é uma ferramenta promissora para o tratamento da SDRA e de condições clínicas semelhantes.

"a felicidade é uma coisa que os olhos transmitem". percepções sobre conexões sociais em pessoas idosas praticantes de exercícios físicos / "happines is a thing that the eyes transmit." perceptions about social connections in older people who practice physical exercises / "la felicida es una cosa que transmiten los ojos." percepciones sobre conexiones sociales en ancianos que practican ejercicios físicos

Resumo O objetivo deste estudo foi verificar as percepções das pessoas idosas sobre as características que contribuíram para as conexões sociais em um programa de exercícios físicos sistematizados. Para isso, utilizou-se da abordagem qualitativa e foram entrevistados 18 participantes após um programa de 16 semanas de treino. Foi realizada uma entrevista presencial, a partir de um roteiro com questões semiestruturadas. Os dados foram analisados pelo método de Análise Temática. Foram identificados quatro temas gerais: a) motivação extrínseca, b) características do grupo, c) características pessoais, e d)características profissionais. Além disso, foram identificados alguns atributos, como ter pessoas conhecidas nos programas, estar em grupo de participantes com idades próximas, estar aberto ao diálogo e ter profissionais com características socioafetivas como comunicação, empatia, entre outros, que podem influenciar na percepção de conexões sociais durante o exercício físico, potencializando seus benefícios e contribuindo para uma vida mais ativa.

Abstract The aim of this study was to verify the older people's perceptions about the characteristics that contributed to the social connections in a systematic physical exercises program. For this, a qualitative method was used, and 18 participants were interviewed after a 16-week training program. A face-to-face interview was carried out, based on a script with semi-structured questions. The data was analyzed using the Thematic Analysis method. Four general themes were identified: a) extrinsic motivation, b) group characteristics, c) personal characteristics, and d) professional characteristics. Furthermore, some attributes were identified, such as identify familiar people in the programs, belong in a group of participants with similar age, be open to dialogue and have professionals with socio-affective characteristics such as communication, empathy, among others, which can influence the perception of social connections during physical exercise, enhancing its benefits and contributing to a physically active life.

Resumen El objetivo de este estudio fue verificar las percepciones de las personas mayores sobre las características que contribuyen a las conexiones sociales en un programa sistematizado de ejercicio físico. Para eso, se utilizó un enfoque cualitativo y se entrevistó a 18 participantes después de un programa de entrenamiento físico de 16 semanas. Se realizó una entrevista cara a cara, basada en un guion con preguntas semiestructuradas. Los datos fueron analizados mediante el método de Análisis Temático. Se identificaron cuatro temas generales: a) motivación extrínseca, b) características grupales, c) características personales y d) características profesionales. Además, se identificaron algunos atributos como tener personas conocidas en los programas, estar en un grupo de participantes de edades cercanas, estar abiertos al diálogo y contar con profesionales con características socioafectivas como comunicación, empatía, entre otras, que pueden influyen en la percepción de las conexiones sociales durante el ejercicio físico, potenciando sus beneficios y contribuyendo a una vida más activa.

Realidade virtual nas capacidades cognitivas e psicológicas em pessoas idosas: Revisão sistemática com metanálise / Virtual reality in cognitive and psychological capacities in the elderly: a systematic review with meta-analysis / Realidad virtual en capacidades cognitivas y psicológicas en personas mayores: una revisión sistemática con metanálisis

Objetivo: Comparar os efeitos dos exercícios por realidade virtual (RV)com o exercício físico convencional para as capacidades cognitivas e psicológicas das pessoas idosas. Métodos: Incluídos artigos publicados entre 2012 e 2021, das bases de dados PubMed, Scielo, Cochrane Library e Web of Science. Critérios de inclusão: estratégia PICO (Participante, Intervenção, Comparação e Outcome/Desfecho; RoB 2- Cochrane para analisar o risco de viés para ensaios randomizados; GRADE Pro, avaliação da qualidade das evidências. Resultados e discussão: 403 artigos inicialmente identificados, 23 elegíveis para a revisão sistemática e 14 incluídos na metanálise. Instrumentos encontrados: Trail Making Test (TMT-B), Stroop Test, Montreal Cognitive Assessment (MoCA), Mini Exame do Estado Mental (MEEM) e Short Form Health Survey (SF-36). No TMT-B observamos heterogeneidade (Tau²=0,51, I²=82,97%, Q=17,51, p=0,001) e diferença estatisticamente significativa entre os grupos, favorecendo a intervenção por RV (p=0,028). No Stroop Test, não observamos heterogeneidade (Tau²=0, I²=0, Q=1,53, p=0,464) e não houve diferença entre os grupos (p=0,194). Nos testes MEEM e MoCA, tivemos heterogeneidade entre os grupos (Tau²=0,17, I²=63,47%, Q=18,055, p=0,012), favorecendo a RV de maneira estatisticamente significativa (p=0,008). O SF-36 não apresentou heterogeneidade entre os grupos (Tau²=0, I²=0, Q=1,53, p=0,464) e não houve diferença estatística significativa (0,657). Conclusão: Ainda não é possível afirmar que apenas a utilização da RV é eficiente, porém ressaltamos que as intervenções realizadas com as pessoas idosas, nas quais eles se sentem parte e são responsáveis pelo seu desempenho, mostram a interação e motivação para o exercício físico, ajudando a terem uma vida mais saudável e com mais qualidade.

Objective: To compare the effects of virtual reality (VR) exercises with conventional physical exercise on the cognitive and psychological capabilities of older people. Methods: Included articles published between 2012 and 2021, from the PubMed, Scielo, Cochrane Library and Web of Science databases. Inclusion criteria: PICO strategy (Participant, Intervention, Comparison and Outcome/Outcome and; RoB 2- Cochrane to analyze the risk of bias for randomized trials; GRADE Pro, assessment of the quality of evidence. Results and discussion: 403 articles initially identified, 23 eligible for the systematic review and 14 included in the meta-analysis. Instruments found: Trail Making Test (TMT-B), Stroop Test, Montreal Cognitive Assessment (MoCA), Mini Mental State Examination (MMSE) and Short Form Health Survey (SF-36). In TMT-B we observed heterogeneity (Tau²=0.51, I²=82.97%, Q=17.51, p=0.001) and a statistically significant difference between the groups, favoring the VR intervention (p=0.028). In the Stroop Test, we did not observe heterogeneity (Tau²=0, I²=0, Q=1.53, p=0.464) and there was no difference between the groups (p=0.194). In the MMSE and MoCA tests, we had heterogeneity between the groups (Tau²=0.17, I²=63.47%, Q=18.055, p=0.012), favoring VR in a statistically significant way (p=0.008). The SF-36 showed no heterogeneity between groups (Tau²=0, I²=0, Q=1.53, p=0.464) and there was no statistically significant difference (0.657). Conclusion: It is not yet possible to say that the use of VR alone is efficient, however we emphasize that interventions carried out with elderly people, in which they feel part of and are responsible for their performance, show interaction and motivation for physical exercise, helping them to have a healthier and more quality life.

Objetivo: Comparar los efectos de los ejercicios de realidad virtual (RV) con el ejercicio físico convencional sobre las capacidades cognitivas y psicológicas de las personas mayores. Métodos: Se incluyeron artículos publicados entre 2012 y 2021, de las bases de datos PubMed, Scielo, Cochrane Library y Web of Science. Criterios de inclusión: estrategia PICO (participante, intervención, comparación y resultado/resultado; RoB 2- Cochrane para analizar el riesgo de sesgo de ensayos aleatorios; GRADE Pro, evaluación de la calidad de la evidencia. Resultados y discusión: 403 artículos identificados inicialmente, 23 elegibles para la revisión sistemática y 14 incluidos en el metanálisis. Instrumentos encontrados: Trail Making Test (TMT-B), Stroop Test, Montreal Cognitive Assessment (MoCA), Mini Mental State Examination (MMSE) y Short Form Health Survey (SF-36). En TMT-B observamos heterogeneidad (Tau²=0,51, I²=82,97%, Q=17,51, p=0,001) y una diferencia estadísticamente significativa entre los grupos, favoreciendo la intervención de RV (p=0,028). En el Test de Stroop no observamos heterogeneidad (Tau²=0, I²=0, Q=1,53, p=0,464) y no hubo diferencia entre los grupos (p=0,194). En las pruebas MMSE y MoCA tuvimos heterogeneidad entre los grupos (Tau²=0,17, I²=63,47%, Q=18,055, p=0,012), favoreciendo la RV de forma estadísticamente significativa (p=0,008). El SF-36 no mostró heterogeneidad entre grupos (Tau²=0, I²=0, Q=1,53, p=0,464) y no hubo diferencia estadísticamente significativa (0,657). Conclusión: Aún no es posible afirmar que el uso de la RV por sí solo sea eficiente, sin embargo destacamos que las intervenciones realizadas con personas mayores, en las que se sienten parte y responsables de su desempeño, muestran interacción y motivación para el ejercicio físico. ayudándoles a tener una vida más sana y de calidad.

Dental and composite resin discoloration induced by different hydraulic calcium silicate-based cements: two-year in vitro assessment

Abstract Few long-term studies assess the discoloration induced by hydraulic calcium silicate-based cement on dental structures. In addition, as far as we know, no long-term study has assessed the discoloration induced by these cement on composite resin. Objective This in vitro study aimed to assess, during a period of two years, the discoloration potential of different hydraulic calcium silicate-based cements (hCSCs) on the enamel/dentin structure and composite resin restoration. Methodology A total of 40 enamel/dentin discs were obtained from bovine incisors, and 40 composite resin discs (10 mm in diameter × 2 mm thick) were fabricated. A 0.8 mm-deep cavity was made in the center of each disc and filled with the following hCSCs (n=10): Original MTA (Angelus); MTA Repair HP (Angelus); NeoMTA Plus (Avalon); and Biodentine (Septodont). An initial color measurement was performed (T0 - baseline). After 7, 15, 30, 45, 90, 300 days, and two years, new color measurements were performed to determine the color (ΔE00), lightness (ΔL'), chroma (ΔC'), hue differences (ΔH'), and whiteness index (WID). Results For enamel/dentin, the ΔE00 was significant among groups and periods (p<0.05). NeoMTA Plus had the greatest ΔE00. The NeoMTA Plus group had the greatest ΔE00 after two years for composite resin. Significant reduction in lightness was observed for all groups after two years (p<0.05). The most significant WID values were observed after 30 days for Biodentine (enamel/dentin) and MTA Repair HP groups (composite resin) (p<0.05). Conclusions The hCSCs changed the colorimetric behavior of both substrates, leading to greater darkening over time. The Bi2O3 in the Original MTA seems relevant in the short periods of color change assessment.

Cognitive Performance in Patients with Systemic Lupus Erythematosus Using the Ped-ANAM.

Computerized batteries have been widely used to investigate cognitive impairment (CI) in patients with SLE. The aim of this study was to evaluate the cognitive performance of patients with SLE in relation to healthy controls using the Pediatric Automated Neuropsychological Assessment Metrics (Ped-ANAM) battery. In addition, we aimed to examine differences in Ped-ANAM scores according to age of disease onset, presence of disease activity, and disease damage. We included 201 consecutive adult-onset (aSLE) and childhood-onset SLE (cSLE) patients who were being followed at the hospital's rheumatology outpatient clinic and 177 healthy controls. We applied the percentage of correct answers on the Ped-ANAM subtests and the Performance Validity Index (PVI) metric and correlated them with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus Erythematosus Damage Index (SDI). Then, we established their relationships with neuropsychiatric systemic lupus erythematosus (NPSLE). We observed CI in a total of 38 (18.9%) SLE patients and 8 (4.5%) healthy controls (p < 0.001). CI was observed in eight (19.5%) cSLE patients and 32 (20%) aSLE patients (p = 0.8175). Individual analysis of the aSLE subtests showed a significant difference in all subtests compared to healthy controls; the greatest differences were in matching to sample (p < 0.001) and memory search ( p < 0.001). In the cSLE group, we observed a difference in the code substitution subtests (p = 0.0065) compared to the healthy controls. In the evaluation of clinical outcomes, disease activity was significantly correlated with CI in cSLE (r = 0.33; p = 0.042) and aSLE (r = 0.40; p = 0.001). We also observed an association between disease activity and neuropsychiatric manifestations (p = 0.0012) in aSLE. In conclusion, we determined that cognitive dysfunction, mainly in memory and attention, was more prevalent in patients with SLE. In both the cSLE and aSLE groups, disease activity was associated with worse cognitive function. This is the first study to use the Ped-ANAM in Brazil. Longitudinal studies are necessary to determine how the Ped-ANAM will perform over time.

Qualidade de vida em idosos não institucionalizados / Quality of life of non-institutionalized older people / Calidad de vida en ancianos no institucionalizados

Resumo Enquadramento: A perceção dos idosos acerca da sua qualidade de vida (QdV) é decorrente de uma multiplicidade de fatores, podendo ser avaliada através de escalas genéricas e/ou específicas. Objetivos: Avaliar a QdV de uma amostra de idosos não institucionalizados e analisar a sua relação com variáveis sociodemográficas e clínicas. Metodologia: Estudo descritivo-correlacional, transversal, de cariz quantitativo. Obteve-se uma amostra de 250 idosos. Aplicou-se um instrumento de recolha de dados que integrava duas escalas que avaliavam a QdV, uma genérica (EUROHIS-QOL-8) e outra específica para a população idosa (WHOQOL-OLD). Resultados: Ambas as escalas, numa classificação 0-100, revelaram, para o global, um índice médio de QdV acima do ponto médio (67,19 ±17,95 na EUROHIS-QOL-8 e 67,49±15,46 na WHOQOL-OLD). Revelaram ainda diferenças estatisticamente significativas da perceção da QdV com o sexo, escolaridade e estado civil. A WHOQOL-OLD não revelou a existência de diferenças estatisticamente significativas em função da variável "presença ou não de patologias", contrariamente à EUROHIS-QOL-8. Conclusão: A perceção da QdV dos idosos estava associada às variáveis: sexo, escolaridade e estado civil.

Abstract Background: Older people's perceived quality of life (QoL) is based on several factors and can be assessed through generic and/or specific scales. Objectives: To assess the QoL of a sample of non-institutionalized older people and analyze its association with sociodemographic and clinical variables. Methodology: A descriptive-correlational, cross-sectional, quantitative study was conducted with a sample of 250 older people. Data were collected using two scales for assessing QoL: one generic (EUROHIS-QOL-8) and another specific for older people (WHOQOL-OLD). Results: On a scale from 0 to 100, a mean QoL index above the midpoint was found for the total scales (67.19 +/- 17.95 in EUROHIS-QOL-8 and 67.49+/- 15.46 in WHOQOL-OLD). Statistically significant differences were found between perceived QoL and gender, education level, and marital status. Unlike the EUROHIS-QOL-8, no statistically significant differences were found in the WHOQOL-OLD for the variable "presence of a disease". Conclusion: Older people's perceived QoL was associated with the variables of gender, education level, and marital status.

Resumen Marco contextual: La percepción de los ancianos sobre su calidad de vida (QdV) es el resultado de una multiplicidad de factores y puede ser evaluada a través de escalas genéricas y/o específicas. Objetivos: Evaluar la QdV de una muestra de ancianos no institucionalizados y analizar su relación con variables sociodemográficas y clínicas. Metodología: Estudio descriptivo-correlacional, transversal y cuantitativo. Se obtuvo una muestra de 250 ancianos. Se aplicó un instrumento de recogida de datos que incluía dos escalas que evaluaban la calidad de vida, una genérica (EUROHIS-QOL-8) y otra específica para la población anciana (WHOQOL-OLD). Resultados: Ambas escalas, en una clasificación de 0 a 100, mostraron, para el total, un índice de QdV medio por encima del punto medio (67,19±17,95 en la EUROHIS-QOL-8 y 67,49±15,46 en la WHOQOL-OLD). También mostraron diferencias estadísticamente significativas en la percepción de la QdV según el sexo, la escolaridad y el estado civil. La WHOQOL-OLD no mostró la existencia de diferencias estadísticamente significativas en función de la variable "presencia o ausencia de patologías", al contrario que la EUROHIS-QOL-8. Conclusión: La percepción de la QdV de los ancianos se asoció con las siguientes variables: sexo, escolaridad y estado civil.

A política de ressocialização: Um estudo sobre os seus limites no sistema prisional de Minas Gerais / The resocialization policy: A study about its limits in the prison system of Minas Gerais / La política de resocialización: Un estudio sobre sus límites en el sistema penitenciario de Minas Gerais

Introdução: Na sociabilidade capitalista é necessário que o capital atenda a alguns interesses da classe trabalhadora, para que ela esteja em condições objetivas e subjetivas de ser explorada. As políticas públicas aparecem como uma forma de satisfazer alguns desses interesses, e são apresentados como direitos do cidadão. Objetivo: Este artigo empírico teve como objetivo refletir sobre os limites da política pública de ressocialização a partir do sistema prisional mineiro. Métodos: Os dados quantitativos e qualitativos foram coletados por pesquisa documental e observação participante com diário de campo construído in loco durante oito meses. Um levantamento bibliométrico foi realizado para averiguar o que a ciência expressa sobre o fenômeno em tela e o exame do desenvolvimento das categorias. Resultados: Apresentamos as limitações da política pública em cada um dos pilares para a ressocialização, e concluímos que as atividades no cárcere visam alterar as subjetividades das pessoas privadas de liberdade para que elas: i) se comportem como bons trabalhadores e estejam aptos à exploração direta ou indireta do Capital no cárcere; ii) sejam explorados pelo capital em condição de escravidão com a mediação do Estado. Conclusão: Por fim, reivindicamos a participação dos profissionais da área de Terapia Ocupacional que esteja radicalmente comprometido com o processo de ressocialização nesses espaços, pois sabemos que não é suficiente para superar as limitações da política pública, mas se torna uma forma de potencializar a quota parte do mais valor que está sendo devolvida à classe trabalhadora.

Introduction: In capitalist sociability it is necessary that the capital meets some interests of the working class, so that it is in objective and subjective conditions to be exploited. Public policies appear as a way to satisfy some of these interests and are presented as citizens' rights. Objective: This empirical article aimed to reflect on the limits of the public policy of resocialization from the prison system in Minas Gerais. Method: Quantitative and qualitative data were collected by documentary research and participant observation with a field diary built in loco during eight months. A bibliometric survey was conducted to ascertain what science expresses about the phenomenon in question and the examination of the development of the categories. Results: We present the limitations of public policy in each of the pillars for resocialization, and conclude that the activities in prison aim to alter the subjectivities of people deprived of freedom so that they: i) behave as good workers and are fit for direct or indirect exploitation of Capital in prison; ii) are exploited by Capital in a condition of slavery with the mediation of the State. Conclusion: Finally, we claim the participation of professionals in the field of Occupational Therapy who are radically committed to the process of resocialization in these spaces, because we know that it is not enough to overcome the limitations of public policy, but it becomes a way to potentiate the share of the most value that is being returned to the working class.

Introducción: En la sociabilidad capitalista es necesario que el capital responda a algunos intereses de la clase obrera, para que esté en condiciones objetivas y subjetivas de ser explotada. Las políticas públicas aparecen como una forma de satisfacer algunos de estos intereses, y se presentan como derechos de los ciudadanos. Objetivo: Este artículo empírico tiene como objetivo reflexionar sobre los límites de la política pública de resocialización desde el sistema penitenciario de Minas Gerais. Método: Los datos cuantitativos y cualitativos se recogieron mediante una investigación documental y una observación participante con un diario de campo construido in situ durante ocho meses. Se realizó una encuesta bibliométrica para conocer lo que la ciencia expresa sobre el fenómeno en pantalla y el examen del desarrollo de las categorías. Resultados: Presentamos las limitaciones de la política pública en cada uno de los pilares para la resocialización, y concluimos que las actividades en la cárcel tienen como objetivo alterar las subjetividades de las personas privadas de libertad para que: i) se comporten como buenos trabajadores y sean aptos para la explotación directa o indirecta del Capital en la cárcel; ii) sean explotados por el Capital en condición de esclavitud con la mediación del Estado. Conclusión: Por último, reivindicamos la participación de los profesionales del ámbito de la Terapia Ocupacional que están radicalmente comprometidos con el proceso de resocialización en estos espacios, porque sabemos que no basta con superar las limitaciones de las políticas públicas, sino que se convierte en una forma de potenciar la cuota de mayor valor que se está devolviendo a la clase trabajadora.

Cross-cultural adaptation and initial validation of the Brazilian-Portuguese version of the pediatric automated neuropsychological assessment metrics.

Automated neuropsychiatric batteries have been used in research and clinical practice, including for chronic diseases, such as Systemic Lupus Erythematosus. The Pediatric Automated Neuropsychological Assessment Metrics battery (Ped-ANAM), originally developed for use in American-English speaking individuals, allows tracking of cognitive functions. It can be applied to people over 9 years old. The aim of this study was to translate and present initial validation data from the Ped-ANAM into Brazilian-Portuguese. We translated the battery according to Beaton's guidelines. Psychometric properties were tested, internal consistency was analyzed by Cronbach's alpha coefficient, test-retest reliability by the intraclass correlation coefficient (ICC). Further, we measured the test execution speed at both times as a temporal stability. Principal component analysis (PCA) was used for structural validity. Evidence of construct validity was assessed through assessment of the relationships with the Wechsler Intelligence Scales. All participants prior to the start of study related activities signed an informed consent form approved by the local ethics committee. A sample of 230 individuals [mean (range) of age: 23 (9 to 60) years; 65% females] was included; a subset of 51 individuals [mean (range) of age: 18 (9 to 57) years, 59% female] completed the Ped-ANAM twice to assess test-retest reliability, and another subset of 54 individuals [mean (range) of age: 20.4 (7 to 62) years; 67% female] completed the Wechsler Intelligence Scales for Children and Adult for assessment of the Ped-ANAM's construct validity. Our results suggest that the internal consistency of the Ped-ANAM (Cronbach's α = 0.890) and its subtest test-retest reliability were excellent (ICC: 0.59 to 0.94). There was no clustering in the Principal Components Analysis, suggestive of non-grouping of the evaluated variables. Construct validity assessment to the Wechsler Scales showed expected ranges of low to strong correlations (Spearman correlations: ρ = 0.40 to ρ = 0.69). We concluded that, based on the results of this study, a cross-culturally validated Brazilian-Portuguese version of the Ped-ANAM has been developed and it is a reliable tool for the screening cognitive function.

Sedation, analgesia, and delirium management in Portugal: a survey and point prevalence study. / Abordagem da sedação, da analgesia e do delirium em Portugal: inquérito nacional e estudo de prevalência.

OBJECTIVE: To establish current Portuguese critical care practices regarding analgesia, sedation, and delirium based on a comparison between the activities reported and daily clinical practice. METHODS: A national survey was conducted among physicians invited to report their practice toward analgesia, sedation, and delirium in intensive care units. A point prevalence study was performed to analyze daily practices. RESULTS: A total of 117 physicians answered the survey, and 192 patients were included in the point prevalence study. Survey and point prevalence studies reflect a high sedation assessment (92%; 88.5%), with the Richmond Agitated Sedation Scale being the most reported and used scale (41.7%; 58.2%) and propofol being the most reported and used medication (91.4%; 58.6%). Midazolam prescribing was reported by 68.4% of responders, but a point prevalence study revealed a use of 27.6%.Although 46.4% of responders reported oversedation, this was actually documented in 32% of the patients. The survey reports the daily assessment of pain (92%) using standardized scales (71%). The same was identified in the point prevalence study, with 91.1% of analgesia assessment mainly with the Behavioral Pain Scale. In the survey, opioids were reported as the first analgesic. In clinical practice, acetaminophen was the first option (34.6%), followed by opioids. Delirium assessment was reported by 70% of physicians but was performed in less than 10% of the patients. CONCLUSION: The results from the survey did not accurately reflect the common practices in Portuguese intensive care units, as reported in the point prevalence study. Efforts should be made specifically to avoid oversedation and to promote delirium assessment.

OBJETIVO: Determinar as práticas atuais de cuidados intensivos em Portugal quanto à analgesia, à sedação e ao delirium, com base em uma comparação entre as atividades relatadas e a prática clínica diária. MÉTODOS: Inquérito nacional em que os médicos foram convidados a relatar sua prática em relação à analgesia, à sedação e ao delirium em unidades de terapia intensiva. Para analisar a prática diária, realizou-se um estudo de prevalência pontual. RESULTADOS: Responderam ao inquérito 117 médicos, e 192 pacientes foram incluídos no estudo de prevalência pontual. O inquérito e o estudo de prevalência mostraram uma avaliação generalizada do nível de sedação (92%; 88,5%). A Escala de Agitação e Sedação de Richmond foi a mais reportada e utilizada (41,7%; 58,2%), e o propofol foi o medicamento mais reportado e utilizado (91,4%; 58,6%). A prescrição de midazolam foi relatada por 68,4% dos respondentes, mas o estudo de prevalência pontual revelou a sua utilização em 27,6%.Embora 46,4% dos respondentes tenham relatado excesso de sedação, na realidade foi documentado em 32% dos pacientes. O inquérito relatou avaliação diária de dor (92%) com uso de escalas padronizadas (71%). Identificou-se resultado semelhante no estudo de prevalência pontual, com 91,1% de avaliação da analgesia feita principalmente com a Escala Comportamental de Dor. No inquérito, os opioides foram relatados como analgésicos de primeira linha. Na prática clínica, o paracetamol foi a primeira opção (34,6%), seguido de opioides. A avaliação do delirium foi relatada por 70% dos médicos, embora tenha sido realizada em menos de 10% dos pacientes. CONCLUSÃO: Os resultados do inquérito não refletiram com precisão as práticas habituais nas unidades de terapia intensiva portuguesas, tal como relatado no estudo de prevalência pontual. Devem ser feitos esforços principalmente para evitar o excesso de sedação e promover a avaliação do delirium.

Abordagem da sedação, da analgesia e do delirium em Portugal: inquérito nacional e estudo de prevalência / Sedation, analgesia, and delirium management in Portugal: a survey and point prevalence study

RESUMO Objetivo: Determinar as práticas atuais de cuidados intensivos em Portugal quanto à analgesia, à sedação e ao delirium, com base em uma comparação entre as atividades relatadas e a prática clínica diária. Métodos: Inquérito nacional em que os médicos foram convidados a relatar sua prática em relação à analgesia, à sedação e ao delirium em unidades de terapia intensiva. Para analisar a prática diária, realizou-se um estudo de prevalência pontual. Resultados: Responderam ao inquérito 117 médicos, e 192 pacientes foram incluídos no estudo de prevalência pontual. O inquérito e o estudo de prevalência mostraram uma avaliação generalizada do nível de sedação (92%; 88,5%). A Escala de Agitação e Sedação de Richmond foi a mais reportada e utilizada (41,7%; 58,2%), e o propofol foi o medicamento mais reportado e utilizado (91,4%; 58,6%). A prescrição de midazolam foi relatada por 68,4% dos respondentes, mas o estudo de prevalência pontual revelou a sua utilização em 27,6%. Embora 46,4% dos respondentes tenham relatado excesso de sedação, na realidade foi documentado em 32% dos pacientes. O inquérito relatou avaliação diária de dor (92%) com uso de escalas padronizadas (71%). Identificou-se resultado semelhante no estudo de prevalência pontual, com 91,1% de avaliação da analgesia feita principalmente com a Escala Comportamental de Dor. No inquérito, os opioides foram relatados como analgésicos de primeira linha. Na prática clínica, o paracetamol foi a primeira opção (34,6%), seguido de opioides. A avaliação do delirium foi relatada por 70% dos médicos, embora tenha sido realizada em menos de 10% dos pacientes. Conclusão: Os resultados do inquérito não refletiram com precisão as práticas habituais nas unidades de terapia intensiva portuguesas, tal como relatado no estudo de prevalência pontual. Devem ser feitos esforços principalmente para evitar o excesso de sedação e promover a avaliação do delirium.

ABSTRACT Objective: To establish current Portuguese critical care practices regarding analgesia, sedation, and delirium based on a comparison between the activities reported and daily clinical practice. Methods: A national survey was conducted among physicians invited to report their practice toward analgesia, sedation, and delirium in intensive care units. A point prevalence study was performed to analyze daily practices. Results: A total of 117 physicians answered the survey, and 192 patients were included in the point prevalence study. Survey and point prevalence studies reflect a high sedation assessment (92%; 88.5%), with the Richmond Agitated Sedation Scale being the most reported and used scale (41.7%; 58.2%) and propofol being the most reported and used medication (91.4%; 58.6%). Midazolam prescribing was reported by 68.4% of responders, but a point prevalence study revealed a use of 27.6%. Although 46.4% of responders reported oversedation, this was actually documented in 32% of the patients. The survey reports the daily assessment of pain (92%) using standardized scales (71%). The same was identified in the point prevalence study, with 91.1% of analgesia assessment mainly with the Behavioral Pain Scale. In the survey, opioids were reported as the first analgesic. In clinical practice, acetaminophen was the first option (34.6%), followed by opioids. Delirium assessment was reported by 70% of physicians but was performed in less than 10% of the patients. Conclusion: The results from the survey did not accurately reflect the common practices in Portuguese intensive care units, as reported in the point prevalence study. Efforts should be made specifically to avoid oversedation and to promote delirium assessment.