Batch and Continuous Flow Total Synthesis of Cannabidiol.

Herein, we present a comprehensive total synthesis of cannabidiol integrating both batch and continuous flow conditions. Our approach is planned to streamline the synthesis of olivetolic acid derivatives and utilize an enantiomerically pure monoterpene moiety obtained from naturally occurring (R)-(+)-limonene by photocatalysis. Key reactions, including the synthesis of olivetolic ester and a Friedel-Crafts alkylation, are successfully adapted to continuous flow, resulting in improved yields and selectivities. This study not only offers a scalable and efficient route for cannabidiol synthesis but also contributes to the synthetic approaches to access cannabinoids (diversity synthesis), with potential applications in medicinal and industrial contexts.

First report of Colletotrichum chlorophyti causing soybean anthracnose in Brazil.

Soybean [Glycine max (L.) Merr.] is one of the world's five major food crops, and Brazil produces the highest share at around 42%. Anthracnose caused by Colletotrichum is an important limiting factor to soybean production. In November 2013, anthracnose symptoms, characterized by brown irregular-shaped lesions on petioles, stems, and pods were observed in soybean fields (1% of incidence) in Vera, Mato Grosso State, Brazil. From the five plants gathered in the field, three leaves along with their corresponding petioles were meticulously chosen for the removal of symptomatic tissues. Sampling of these tissues involved carefully cutting a 0.5 × 0.5 cm fragment in the lesion area. The fragments were disinfected with 70% ethanol for 1 min, followed by 1% sodium hypochlorite for 2 min. Then the fragments were rinsed three times in sterile distilled water, placed on water-agar, and incubated at 25 °C for four days, in a 12/12 h photoperiod. Hyphal tips were transferred to potato dextrose agar (PDA) plates and incubated as previously described for seven days. A Colletotrichum sp. single-spore isolate (LFN0461) was selected, grown, preserved in filter paper, and stored at -80 °C. In 2023, it was reactivated for molecular characterization. On PDA, colony showed a rough-like mycelial growth, violaceous-black (front/reverse), with curved-shaped conidia 14.7 - 28.2 × 2.1 - 8.96 µm (average 18.4 × 4.7 µm). The DNA was extracted from 10-day-old mycelium using the cetyltrimethylammonium bromide (CTAB) method. The rDNA internal transcribed spacer (ITS), glyceraldehyde-3-phosphate dehydrogenase (GAPDH), histone (HIS3), and ß-tubulin 2 (TUB2) regions were amplified by polymerase chain reaction (PCR), using the primer pairs ITS-1F + ITS-4 (Gardes and Bruns 1993; White et al. 1990), GDF1 + GDR1 (Guerber et al. 2003), CYLH3F + CYLH3R (Crous et al. 2006), and Bt2A + Bt2B (Glass and Donaldson 1995), respectively. The sequences were deposited in the GenBank database (accession numbers: PP209207 - ITS; PP213392 - GAPDH; PP213393 - HIS3; MN688797 - TUB2). The reconstruction of the multilocus phylogenetic tree revealed that the LFN0461 isolate clustered with C. cholorophyti reference strain (IMI 103806) with 99.9% of Bayesian probability. Given the seed-borne nature of soybean anthracnose (Boufleur et al. 2021; Yang et al. 2013), pathogenicity tests were carried out by soybean seeds inoculation. Fifty seeds of NS6220 IPRO (Nidera) cultivar were inoculated by water restriction method, with LFN0461 colonies grown on PDA amended with mannitol (Machado et al. 2004), while 50 seeds were placed on PDA amended with mannitol as negative control. Soybean seeds remained in contact with the inoculum for 48 hours. Subsequently, seeds were sown in 2 L pots (n = 10) containing sterilized substrate, which were placed in a greenhouse at 25 ± 5 ºC. After 10 days, inoculated soybean seedlings exhibited characteristic necrotic lesions on cotyledons and hypocotyls, while negative control plants remained asymptomatic. Colletotrichum chlorophyti was successfully reisolated from the symptomatic tissues. Currently, C. chlorophyti has been reported to cause soybean anthracnose and infect seeds in the United States (Yang et al. 2013, 2012). Although this pathogen has not been reported since our first observation in 2013 in Brazil, many Colletotrichum isolates are misidentified due to reliance on morphology (Boufleur et al. 2021). To our knowledge, this study is the first report of C. chlorophyti causing soybean anthracnose in Brazil, joining a new group of emergent Colletotrichum spp. associated with this disease.

Effects of a Multi-professional Intervention on Quality of Life of Women with Overweight or Obesity Post-Covid-19: A Pragmatic Trial

Obesity is a global Non-Communicable Chronic Disease (NCD) associated with various comorbidities and a high mortality rate. This scenario has increasingly affected the female population, leading to a rise in prevalence and related health issues. Therefore, the present study aimed to assess the health-related quality of life of women with overweight or obesity and symptoms of COVID-19 using a multi-professional intervention model. This research was conducted as a parallel group and repeated measures pragmatic trial, in which 28 participants aged between 25 and 65 were allocated into two groups: experimental (intervention group) and control (non-intervention participants). The Body Mass Index (BMI) was (30.5 ± 5.45 kg/m²) in the Experimental Group, and the Control Group was (31 ± 8.2 kg/m2). The 12-Item Health Survey (SF-12) questionnaire was applied to assess the quality of life in the physical and mental domains of COVID-19 survivors with different symptom severities (mild, moderate, severe) compared to the control group. At the end of the program, 28 participants finished the study (15 from the experimental group and 13 from the control group). The results indicated a significant improvement in the mental health domain only in the experimental group after the intervention period (p 0.05). Considering these findings, multi-professional actions emerge as a crucial component for enhancing the quality of life, particularly within mental health, during the 16-week intervention period.

La obesidad es una Enfermedad Crónica No Transmisible (ECNT) global asociada a diversas comorbilidades y una alta tasa de mortalidad. Este escenario ha afectado cada vez más a la población femenina, lo que ha llevado a un aumento en la prevalencia y problemas de salud relacionados. El presente estudio tiene como objetivo evaluar la calidad de vida relacionada con la salud de mujeres con sobrepeso u obesidad y síntomas de COVID-19 mediante un modelo de intervención multiprofesional. Esta investigación se llevó a cabo como un ensayo pragmático de grupos paralelos y medidas repetidas, en el que 48 participantes con edades comprendidas entre 25 y 65 años fueron alocadas en dos grupos: experimental (participantes de la intervención) y control (participantes de la no intervención). En el grupo experimental el Índice de Masa Corporal (IMC) fue de (30,5 ± 5,45 kg/m²). En el grupo control, el IMC fue (31 ± 8,2 kg/m²). Se utilizó el cuestionario de 12-Item Health Survey (SF-12) para evaluar la calidad de vida en los dominios físico y mental de las sobrevivientes de COVID-19 con diferentes grados de gravedad de síntomas (leves, moderados, graves) en comparación con el grupo de control (participantes que no recibieron intervenciones). Al final del programa, 28 participantes terminado el estudio (15 participantes de la intervención y 13 sin intervención). Los resultados indicaron una mejora significativa en el dominio de la salud mental solo en el grupo experimental después del período de intervención (p 0.05). A la luz de estos hallazgos, la rehabilitación multiprofesional emerge como un componente crucial para mejorar la calidad de vida, especialmente en el ámbito de la salud mental durante el período de intervención de 16 semanas.

A obesidade é uma Doença Crônica Não-Transmissível (DCNT) com alcance mundial, associada a diversas comorbidades e alta taxa de mortalidade. Esse quadro tem afetado cada vez mais o público feminino, com aumento da prevalência e doenças correlatas. O objetivo deste estudo foi avaliar a qualidade de vida relacionada à saúde de mulheres com sobrepeso ou obesidade com sintomas da COVID-19 utilizando um modelo de intervenção multiprofissional. Esta pesquisa foi conduzida como um ensaio pragmático de grupos paralelos e medidas repetidas, no qual 28 participantes de idade entre 25 a 65 anos foram distribuídas em dois grupos: experimental (participantes das intervenções) e controle (não participantes das intervenções). No grupo experimental o Índice de Massa Corporal (IMC) foi de (30,5 ± 5,45 kg/m²) e no grupo controle, IMC foi de (31 ± 8,2 kg/m²). Utilizou-se o questionário 12-Item Health Survey (SF-12) para analisar a qualidade de vida nos domínios físico e mental das sobreviventes da COVID-19 nas diferentes sintomatologias (COVID leve, moderada e grave) em comparação com o grupo controle (não participantes das intervenções). Ao final do programa, 28 participantes finalizaram o estudo (15 do grupo experimental e 13 do grupo controle). Os resultados indicaram uma melhoria significativa no domínio de saúde mental apenas no grupo experimental após o período de intervenção (p 0,05). Diante dos resultados a reabilitação multiprofissional emerge como componente importante para a melhoria da qualidade de vida, especialmente no âmbito da saúde mental durante as 16 semanas de intervenção.

Analysis of the bond of users from different basic health units with possible diagnosis of non-communicable chronic diseases during the covid-19 pandemic in a city in southern Brazil / Análisis del vínculo de Usuarios de distintas unidades básicas de salud con posible diagnóstico de Enfermedades Crónicas no transmisibles frente a la pandemia del Covid-19 en el en una ciudad del sur de Brasil / Análise do vínculo de usuários de diferentes unidades básicas de saúde com possível diagnóstico de doenças crônicas não transmissíveis frente à pandemia da covid-19 em uma cidade no sul do Brasil

Non-communicable chronic diseases (NCDs) are considered one of the leading causes of death worldwide. During the COVID-19 pandemic, these diseases have been neglected due to the Brazilian Unified National Health System (BHUS) overload. In this context, this study aimed to analyze the bond between patients with NCDs and primary care during the COVID-19 pandemic while also seeking to identify the population's level of knowledge about health parameters and their relationship with the healthcare system. A cross-sectional and observational study was conducted, in which an online questionnaire was administered to collect socioeconomic information from patients and their bond with BHUS in the metropolitan region of Maringa, Parana, Brazil, encompassing individuals over 18 years of age. The survey was promoted on social media, and interested participants responded to the questionnaire, which addressed topics such as identification, medication use, disease information, knowledge about NCDs, and general data related to COVID-19. The obtained and analyzed responses revealed a low bond level between this population and primary care and a lack of knowledge about NCDs and their health during the pandemic. There was a notable decrease in seeking healthcare services during this period, which may be explained by the fear of contracting the novel coronavirus. This study is essential to understand patients' responses to public health challenges during the pandemic. It can become a valuable ally in dealing with future pandemics and endemic crises, enabling improvements in care and raising awareness among the population about NCDs and the healthcare system.

Las enfermedades crónicas no transmisibles (ENT) son consideradas una de las principales causas de muerte a nivel mundial. Durante la pandemia de COVID-19, estas enfermedades han sido desatendidas debido a la sobrecarga de las Unidades Básicas de Salud (UBS). En ese contexto, el objetivo de este estudio es analizar el vínculo entre los pacientes con enfermedades crónicas no transmisibles (ECNT) y la atención primaria durante la pandemia de COVID-19, buscando identificar el nivel de conocimiento de la población sobre los parámetros de salud y la relación con el sistema de salud. Se realizó un estudio transversal y observacional, en el que se aplicó un cuestionario en línea para recolectar información socioeconómica de los pacientes y su vínculo con las BHU en la región metropolitana de Maringá/PR, abarcando personas mayores de 18 años. La divulgación se realizó en las redes sociales y los interesados respondieron el cuestionario que abordó temas como identificación, uso de medicamentos, información sobre enfermedades, conocimientos sobre ECNT y datos generales relacionados con el COVID-19. Las respuestas obtenidas y analizadas revelaron un bajo nivel de vinculación de esta población con la atención primaria, así como un desconocimiento sobre las ECNT y su propia salud durante la pandemia. Hubo una notable reducción en la demanda de servicios de salud durante este período, lo que puede explicarse por el temor a la contaminación por el nuevo coronavirus. Este estudio se presenta como una herramienta importante para comprender la respuesta de los pacientes a los desafíos de salud pública durante la pandemia. Puede convertirse en un valioso aliado para enfrentar futuras pandemias y crisis endémicas, posibilitando mejoras en la atención y concientización de la población sobre las ECNT y el sistema de salud.

As doenças crônicas não transmissíveis (DCNTs) são consideradas uma das principais causas de morte em todo o mundo. Durante a pandemia da COVID-19, essas doenças têm sido negligenciadas devido à sobrecarga das Unidades Básicas de Saúde (BHU). Neste contexto, o objetivo deste estudo é analisar o vínculo dos pacientes com DCNTs com a atenção primária durante a pandemia da COVID-19, ao mesmo tempo em que busca identificar o nível de conhecimento da população sobre os parâmetros de saúde e o relacionamento com o sistema de saúde. Realizou-se um estudo transversal e observacional, no qual foi aplicado um questionário online para coletar informações socioeconômicas dos pacientes e seu vínculo com as BHUs na região metropolitana de Maringá/PR, abrangendo indivíduos maiores de 18 anos. A divulgação foi realizada em mídias sociais e os interessados responderam ao questionário que abordou tópicos como identificação, uso de medicações, informações sobre doenças, conhecimento acerca das DCNTs e dados gerais relacionados à COVID-19. As respostas obtidas e analisadas revelaram um baixo nível de vínculo dessa população com a atenção primária, assim como uma falta de conhecimento sobre as DCNTs e a própria saúde durante a pandemia. Observou-se uma notável redução na procura por serviços de saúde durante esse período, o que pode ser explicado pelo receio da contaminação pelo novo coronavírus. Este estudo se apresenta como uma ferramenta importante para compreender a resposta dos pacientes frente aos desafios da saúde pública durante a pandemia. Ele pode se tornar um aliado valioso para lidar com futuras pandemias e crises endêmicas, possibilitando melhorias nos cuidados e na conscientização da população sobre as DCNTs e o sistema de saúde.

Restructuring healthcare services, routines and procedures on reproductive medicine based on respect for differences.

Although the term homosexuality was removed from the International Classification of Diseases and trans identities from mental disorders, these classifications promote the pathologizing of homosexuality. The direct consequence is discrimination, which adds to the difficulty in carrying out accurate information related to the LGBT population and makes it very difficult to organize public policies suited to their needs. An important issue is related to the limited access of that population to assisted reproduction techniques, when compared to traditional families. The desire for same sex couples and transgender persons to have biological children is reportedly the same as for cisgender persons, but parenthood can be a much greater endeavor both medically and psychologically for them. The right to health includes freedom to control one's health and body, including sexual and reproductive issues. Despite these difficulties, we are living in a period of great social progress that increases access to assisted reproduction among novel patient populations. With legalization of gay marriage, individuals and couples who identify as lesbian, gay, bisexual and transgender, may seek to begin or expand their families with assisted reproduction technologies. Therefore, the aim of this review was to assist in the restructuring of healthcare services, routines and procedures, mainly related to reproductive medicine, in order to promote changes in values based on respect for differences. In conclusion, the healthcare personnel of fertility centers should undergo specific training and preparations to meet the specific demands of the LGBT patient population and to overcome communication barriers.

Rehabilitation Improves Persistent Symptoms of COVID-19: A Nonrandomized, Controlled, Open Study in Brazil.

OBJECTIVE: This study aimed to investigate the effects of an 8-wk face-to-face rehabilitation program on subjects with persistent symptoms of COVID-19 compared with a remote monitoring group. DESIGN: This is clinical, nonrandomized, controlled, and open study. The face-to-face supervised rehabilitation lasted eight consecutive weeks, twice a week. The remote monitoring group received health guidance. The allocation was carried out by preference because of the emergency period without vaccination during the pandemic. Fatigue, dyspnea (Pulmonary Functional Status and Dyspnea Questionnaire), and exercise capacity (Incremental Shuttle Walk Test) were the primary outcome measures. Lung function, functional status (Post-COVID-19 Functional Status), symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), attention (d2-R), memory (Rey's Auditory-Verbal Learning Test), handgrip strength, and knee extensor strength were secondary outcome measures. RESULTS: Thirty-seven subjects (24.3% hospitalized) completed the baseline and final assessment, rehabilitation ( n = 22, 40.8 [SD, 10.0] yrs, 54.5% female), or remote guidance ( n = 15, 45.4 [SD, 10.5] yrs, 40% female). Both groups showed improved fatigue and exercise capacity. Exercise rehabilitation improved dyspnea, anxiety, attention, and short-term memory. CONCLUSIONS: Rehabilitation is essential for dyspnea in subjects with persistent symptoms of COVID-19 while fatigue naturally reverses.

Association Between Body Mass Index, Obesity, and Clinical Outcomes Following Coronary Artery Bypass Grafting in Brazil: An Analysis of One Year of Follow-up of BYPASS Registry Patients

ABSTRACT Objective: To investigate the association between body mass index (BMI), obesity, clinical outcomes, and mortality following coronary artery bypass grafting (CABG) in Brazil using a large sample with one year of follow-up from the Brazilian Registry of Cardiovascular Surgeries in Adults (or BYPASS) Registry database. Methods: A multicenter cohort-study enrolled 2,589 patients submitted to isolated CABG and divided them into normal weight (BMI 20.0-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obesity (BMI > 30.0 kg/m2) groups. Inpatient postoperative outcomes included the most frequently described complications and events. Collected post-discharge outcomes included rehospitalization and mortality rates within 30 days, six months, and one year of follow-up. Results: Sternal wound infections (SWI) rate was higher in obese compared to normal-weight patients (relative risk [RR]=5.89, 95% confidence interval [CI]=2.37-17.82; P=0.001). Rehospitalization rates in six months after discharge were higher in obesity and overweight groups than in normal weight group (χ2=6.03, P=0.049); obese patients presented a 2.2-fold increase in the risk for rehospitalization within six months compared to normal-weight patients (RR=2.16, 95% CI=1.17-4.09; P=0.045). Postoperative complications and mortality rates did not differ among groups during time periods. Conclusion: Obesity increased the risk for SWI, leading to higher rehospitalization rates and need for surgical interventions within six months following CABG. Age, female sex, and diabetes were associated with a higher risk of mortality. The obesity paradox remains controversial since BMI may not be sufficient to assess postoperative risk in light of more complex and dynamic evaluations of body composition and physical fitness.

Patient Blood Management Program Implementation: Comprehensive Recommendations and Practical Strategies

ABSTRACT Introduction: Blood transfusion is one of the most common medical practices worldwide. However, current scientific literature has shown that the immunomodulatory effects of blood transfusion are associated with an increased likelihood of infection, prolonged hospitalization, and morbimortality. Also, it means high costs for healthcare systems. Methods: In this context, acknowledging that blood transfusions are essentially heterologous cell transplantations, the use of therapeutic options has gained strength and is collectively known as the patient blood management (PBM) program. PBM is an approach based on three main pillars: (1) treating anemias and coagulopathies in an optimized manner, especially in the preoperative period; (2) optimizing perioperative hemostasis and the use of blood recovery systems to avoid the loss of the patient's blood; (3) anemia tolerance, with improved oxygen delivery and reduced oxygen demand, particularly in the postoperative period. Results: Current scientific evidence supports the effectiveness of PBM by reducing the need for blood transfusions, decreasing associated complications, and promoting more efficient and safer blood management. Thus, PBM not only improves clinical outcomes for patients but also contributes to the economic sustainability of healthcare systems. Conclusion: The aim of this review was to summarize PBM strategies in a comprehensive, evidence-based approach through a systematic and structured model for PBM implementation in tertiary hospitals. The recommendations proposed herein are from researchers and experts of a high-complexity university hospital in the network of the Sistema Único de Saúde, presenting itself as a strategy that can be followed as a guideline for PBM implementation in other settings.

influência de aspectos socioeconômicos sobre os indicadores de guarda responsável em cães e gatos em Santana de Parnaíba - SP / influence of socio-economic aspects on responsible keeping indicators in dogs and cats in Santana de Parnaíba ­ SP / Influencia de los aspectos socioeconómicos en los indicadores de mantenimiento responsable en perros y gatos en Santana de Parnaíba

O conhecimento de tutores acerca dos cuidados básicos veterinários como requisito para a guarda responsável de animais de companhia tem sido pouco explorado. Os perfis sócios demográficos estão relacionados ao grau de desenvolvimento de uma população, sendo fator preponderante na maneira como são criados os animais de companhia. O presente trabalho analisou a influência do perfil demográfico e de fatores socioeconômicos de tutores do município de Santana de Parnaíba na guarda responsável de cães e gatos. Foram incluídos 300 tutores (205 de cães e 95 de gatos), que levaram seus animais para mutirões de castração em Santana de Parnaíba entre dezembro de 2018 e janeiro de 2019. O instrumento utilizado foi composto de 38 questões sobre aspectos sócio demográficas, nutricionais, sanitários, comportamentais e de conforto. O escore de guarda responsável permitiu pontuação máxima de 15 pontos, sendo que os tutores de cães apresentam escore de guarda responsável 10% maior que tutores de gatos. A menor renda familiar e do tipo de pet de estimação influenciaram no escore. O presente trabalho mostrou que 79% dos cidadãos de Santana de Parnaíba apresentam escore de guarda responsável entre 10 e 14 pontos, com ótima informação e aplicação dos princípios que promovem a qualidade de vida.(AU)

Owners' knowledge of basic veterinary care as a requirement for the responsible ownership of companion animals has been little explored. Sociodemographic profiles are related to the level of development of a population, being a preponderant factor in the way companion animals are raised. The present work analyzed the influence of the demographic profile and socioeconomic factors of owners in the municipality of Santana de Parnaíba on the responsible ownership of dogs and cats. 300 owners were included (205 of dogs and 95 of cats), who took their animals to castration campaigns in Santana de Parnaíba between December 2018 and January 2019. The instrument used was composed of 38 questions on sociodemographic, nutritional, health aspects, behavioral and comfort. The responsible guardianship score allowed a maximum score of 15 points, with dog owners having a responsible guardianship score 10% higher than cat owners. Lower family income and type of pet influenced the score. The present work showed that 79% of the citizens of Santana de Parnaíba have a responsible custody score between 10 and 14 points, with excellent information and application of principles that promote quality of life.(AU)

Se ha explorado poco el conocimiento de los propietarios sobre los cuidados veterinarios básicos como requisito para la tenencia responsable de animales de compañía. Los perfiles sociodemográficos están relacionados con el nivel de desarrollo de una población, siendo un factor preponderante en la forma en que se crían los animales de compañía. El presente trabajo analizó la influencia del perfil demográfico y de los factores socioeconómicos de los propietarios del municipio de Santana de Parnaíba en la tenencia responsable de perros y gatos. Se incluyeron 300 propietarios (205 de perros y 95 de gatos), que llevaron a sus animales a campañas de castración en Santana de Parnaíba entre diciembre de 2018 y enero de 2019. El instrumento utilizado estuvo compuesto por 38 preguntas sobre aspectos sociodemográficos, nutricionales y de salud. comportamiento y comodidad. La puntuación de tutela responsable permitió una puntuación máxima de 15 puntos, y los dueños de perros obtuvieron una puntuación de tutela responsable un 10% más alta que los dueños de gatos. El menor ingreso familiar y el tipo de mascota influyeron en el puntaje. El presente trabajo mostró que el 79% de los ciudadanos de Santana de Parnaíba tienen un puntaje de custodia responsable entre 10 y 14 puntos, con excelente información y aplicación de principios que promueven la calidad de vida.(AU)

Efetividade de um programa multiprofissional de tratamento da obesidade durante a pandemia de COVID-19: aplicação do monitoramento remoto da enfermagem / Efectividad de un programa multidisciplinario de tratamiento de la obesidad durante la pandemia de COVID-19: aplicación de monitoreo remoto de enfermería / Effectiveness of a multidisciplinary obesity treatment program during the COVID-19 pandemic: application of remote nursing monitoring

Objetivo: Verificar a efetividade do monitoramento remoto da enfermagem associada a um programa multi-profissional de tratamento de obesidade na melhora dos biomarcadores cardiometabólicos e indicadores da aptidão física relacionada à saúde de adultos com obesidade acompanhados durante a pandemia da COVID-19. Métodos: Estudo caracterizado como um Ensaio Clínico Pragmático, realizado em um município do Sul do Brasil, com 22 mulheres, com idade entre 18 e 50 anos, portadores de telefone celular com acesso ao aplicativo WhatsApp® durante 16 semanas. Foram realizadas avaliações pré e pós intervenção por meio de exames labo-ratoriais, capazes de determinar os biomarcadores cardiometabólicos: HDL, triglicerídeos, LDL, colesterol total, glicemia, hemoglobina glicada, insulina, Homa-IR, Homa-β, PCR-us; e de testes capazes de avaliar os níveis da aptidão física relacionada à saúde: composição corporal, aptidão cardiorrespiratória, força muscular e flexibili-dade. Os dados obtidos foram analisados através do teste t para amostras pareadas e correlacionados a partir do valor de delta absoluto de cada variável por meio da correlação de Pearson. Os resultados foram considerados significantes quando o valor de p foi < 0,05. Este estudo possui parecer favorável do Comitê Nacional de Ética em Pesquisas. Resultados: Foram observadas melhoras significativas nos níveis de glicemia, insulina, Homa-IR e HDL, bem como nos indicadores de aptidão cardiorrespiratória e força muscular. Conclusão: O monitoramento remoto da enfermagem associado a um programa multiprofissional de tratamento de obesidade é uma inter-venção efetiva na melhoria dos biomarcadores cardiometabólicos e dos indicadores da AFRS.

Objetivo: Evaluar la efectividad del monitoreo remoto de enfermería, en asociación con un programa multiprofesional de tratamiento de la obesidad, para mejorar los biomarcadores cardiometabólicos y los indicadores de aptitud física relacionados con la salud en adultos obesos durante la pandemia de COVID-19.Métodos: Se llevó a cabo un Ensayo Clínico Pragmático en un municipio del sur de Brasil, con la participación de 22 mujeres de edades comprendidas entre los 18 y 50 años, que contaban con teléfonos móviles con acceso a la aplicación WhatsApp® durante un período de 16 semanas. Se realizaron evaluaciones pre y postintervención mediante exámenes de laboratorio, que permitieron determinar los biomarcadores cardiometabólicos: HDL, triglicéridos, LDL, colesterol total, glucemia, hemoglobina glucosilada, insulinemia, Homa-IR, Homa-β, hs-CRP; y pruebas para evaluar los niveles de aptitud física relacionados con la salud: composición corporal, aptitud cardiorrespiratoria, fuerza muscular y flexibilidad. Los datos obtenidos se analizaron utilizando la prueba t para muestras pareadas y se correlacionaron mediante la correlación de Pearson, a partir del valor delta absoluto de cada variable. Se consideraron resultados significativos cuando el valor de p fue < 0,05. Este estudio recibió la aprobación del Comité Nacional de Ética en Investigación.Resultados: Se observaron mejoras significativas en los niveles de glucosa en sangre, insulina, Homa-IR y HDL, así como en los indicadores de aptitud cardiorrespiratoria y fuerza muscular.Conclusión: El monitoreo remoto de enfermería, en asociación con un programa multidisciplinario de tratamiento de la obesidad, resulta en una intervención eficaz para mejorar los biomarcadores cardiometabólicos y los indicadores de aptitud física relacionados con la salud.

Objective: To verify the effectiveness of remote nursing monitoring associated with a multi-professional obesity treatment program to improve cardiometabolic biomarkers and health-related physical fitness indicators in obese adults followed during the COVID-19 pandemic. Methods: The study was characterized as a Pragmatic Clinical Trial, carried out in a municipality in the south of Brazil. It involved 22 women aged between 18 and 50 years, who had cell phones with access to the WhatsApp® application for 16 weeks. Pre- and post-intervention evaluations were carried out through laboratory tests capable of determining cardiometabolic biomarkers: HDL, triglycerides, LDL, total cholesterol, glycemia, glycated hemoglobin, insulinemia, Homa-IR, Homa-β, hs-CRP. As well as tests capable of assessing the levels of physical fitness related to health: body composition, cardiorespiratory fitness, muscle strength and flexibility. The data obtained were analyzed using the t-test for paired samples and correlated from the absolute delta value of each variable using Pearson's correlation. Results were considered significant when the p value was <0.05. This study received a favorable opinion from the National Research Ethics Committee. Results: The study observed significant improvements in blood glucose, insulin, Homa-IR and HDL levels, as well as in indicators of cardiorespiratory fitness and muscle strength. Conclusion: Remote nursing monitoring associated with a multidisciplinary obesity treatment program is an effective intervention for improving cardiometabolic biomarkers and AFRS indicators.

Efeitos de um programa multiprofissional de tratamento da obesidade com treinamento aquático sobre parâmetros bioquímicos, composição corporal e aptidão física em adultos / Efectos de un programa de tratamiento multiprofesional de la obesidad con entrenamiento acuático sobre parámetros bioquímicos, composición corporal y condición física en adultos / Effects of a multiprofessional obesity treatment program with aquatic training on biochemical parameters, body composition and physical fitness in adults

Diante ao preocupante cenário mundial sobre a obesidade e a importância de intervenções multiprofissionais para mudança no estilo de vida da população com obesidade. O Objetivo foi analisar os efeitos de um programa multiprofissional para tratamento da obesidade com treinamento aquático, nos parâmetros bioquímicos, composição corporal e da aptidão física de adultos obesidade severa. O estudo foi conduzido por equipe multiprofissional com profissionais de Educação Física, Nutrição, Psicologia e Medicina, durante 24 semanas, com 16 indivíduos classificados com obesidade severa (IMC > 40 kg/m2). As Intervenções do programa proposto no estudo foram realizadas através treinamento aquático de exercícios aeróbicos associados com a orientação nutricional e psicológica. Foi analisada diminuição significativa no índice de Proteína C Reativa (mg/L) (p=0,0439); no percentual de gordura (%), ao final das 24 semanas do programa de tratamento (p=0,0136), também houve aumento significativo na força de pressão manual (kg) com 16 semanas (p=0,0006) e 24 semanas (p=0,0014). Este estudo apresentou resultados significativos na melhora dos parâmetros bioquímicos, composição corporal e da aptidão física em adultos com obesidade severa, justificando o quanto programas de tratamentos que visam a mudanças nos hábitos alimentares e estilo de vida são de grande importância para a saúde pública.

Ante el preocupante panorama mundial de la obesidad y la importancia de intervenciones multiprofesionales para el cambio en el estilo de vida de la población con obesidad, este estudio tiene como objetivo analizar los efectos de un programa multiprofesional para el tratamiento de la obesidad mediante entrenamiento acuático en parámetros bioquímicos, composición corporal y aptitud física en adultos con obesidad severa. El estudio fue llevado a cabo por un equipo multiprofesional compuesto por profesionales de Educación Física, Nutrición, Psicología y Medicina, durante un período de 24 semanas. Participaron 16 individuos clasificados con obesidad severa (IMC > 40 kg/m2). Las intervenciones del programa propuesto en el estudio incluyeron ejercicios aeróbicos acuáticos junto con orientación nutricional y psicológica. Se evidenció una disminución significativa en el índice de Proteína C Reactiva (mg/L) (p=0.0439); en el porcentaje de grasa (%), al final de las 24 semanas del programa de tratamiento (p=0,0136), también se evidencio un aumento estadísticamente significativo de la fuerza de presión manual (kg) con 16 semanas (p=0,0006) e 24 semanas (p=0,0014). Este estudio presentó resultados significativos en la mejora de los parámetros bioquímicos, composición corporal y aptitud física en adultos con obesidad severa, lo que justifica la importancia de los programas de tratamiento que se centran en los cambios en los hábitos alimentarios y el estilo de vida para la salud pública.

In the context of the concerning global prevalence of obesity and the critical need for multidisciplinary interventions to drive lifestyle changes among individuals with obesity, this study aims to investigate the effects of a comprehensive multidisciplinary program, including aquatic training, on biochemical parameters, body composition, and physical fitness in severely obese adults. Over a period of 24 weeks, a team of diverse professionals in Physical Education, Nutrition, Psychology, and Medicine collaborated on this research. The study enrolled sixteen participants with severe obesity (BMI > 40 kg/m2). The interventions encompassed aquatic aerobic exercises, accompanied by nutritional and psychological guidance. Significant improvements were observed in the C-Reactive Protein index (mg/L) (p=0.0439), with a notable reduction in body fat percentage (%) after the 24-week treatment program (p=0.0136). Additionally, manual pressure force (kg) displayed a statistically significant increase at 16 weeks (p=0.0006) and 24 weeks (p=0.0014). These compelling findings underscore the remarkable progress in biochemical parameters, body composition, and physical fitness among severely obese adults, underscoring the critical importance of treatment programs targeting dietary and lifestyle changes for public health improvement. By adopting a multidisciplinary approach, this study emphasizes the effectiveness of comprehensive interventions in addressing the complex challenges posed by severe obesity. In summary, this research reinforces the significance of implementing multidisciplinary programs to foster lifestyle modifications and provides valuable insights into tackling severe obesity in adult populations. By highlighting the pivotal role of holistic interventions, this study contributes to the ongoing global efforts to combat the escalating obesity epidemic.

Rosuvastatin enhances alterations caused by Toxoplasma gondii in the duodenum of mice.

Infection by Toxoplasma gondii may compromise the intestinal histoarchitecture through the tissue reaction triggered by the parasite. Thus, this study evaluated whether treatment with rosuvastatin modifies duodenal changes caused by the chronic infection induced by cysts of T. gondii. For this, female Swiss mice were distributed into infected and treated group (ITG), infected group (IG), group treated with 40 mg/kg rosuvastatin (TG) and control group (CG). After 72 days of infection, the animals were euthanized, the duodenum was collected and processed for histopathological analysis. We observed an increase in immune cell infiltration in the IG, TG and ITG groups, with injury to the Brunner glands. The infection led to a reduction in collagen fibers and mast cells. Infected and treated animals showed an increase in collagen fibers, acidic mucin-producing goblet cells, intraepithelial lymphocytes and mast cells, in addition to the reduction of muscle, neutral mucin-producing and Paneth cells. While treatment with rosuvastatin alone led to increased muscle layer, proportion of neutral mucin-producing goblet cells, Paneth cells, and reduction of collagen fibers. These findings indicate that the infection and treatment caused changes in the homeostasis of the intestinal wall and treatment with rosuvastatin potentiated most parameters indicative of inflammation.

Socioeconomic status and cancer survival in Brazil: Analysis of population data from the municipalities of Aracaju and Curitiba, 1996-2012.

INTRODUCTION: The association between socioeconomic status and cancer prognosis has been demonstrated in several countries. Despite the existence of indirect evidence of this phenomenon in Brazil, few studies in this regard are available. OBJECTIVES: The objective of the present study is to analyse socioeconomic related survival gaps for patients diagnosed with breast, cervical, lung, prostate, and colorectal cancer in the cities of Aracaju (SE) and Curitiba (PR). METHODS: Using population-based data, we estimated net survival by tumour site, year of diagnosis, socioeconomic status and local of residence. Net survival estimation was done with multilevel parametric model allowing flexible spline functions do estimate excess mortality hazards. RESULTS: 28,005 cases were included in survival analysis. Five-year net survival showed positive association with SES. Intermunicipal survival gaps favouring Aracaju where prominent for breast (reaching 16,1% in 5 years) OBJECTIVES: Study the impact of socioeconomic factors on cancer survival in two Brazilian capitals. METHODS: Survival analysis using population-based cancer data including patients diagnosed with breast, lung, prostate, cervical and colorectal cancer between 1996 and 2012 in Aracaju and Curitiba. Outcomes were excessive mortality hazard (EMH) and 5- and 8-years net survival (NS). The association of race/skin color and socioeconomic level (SES) with EMH and net survival were analyzed using a multilevel regression model with flexible splines. RESULTS: 28,005 cases were included, 6636 from Aracaju and 21,369 from Curitiba. NS for all diseases studied increased more prominently for Curitiba population. We observed NS gap between the populations of Aracaju and Curitiba that increased or remained stable during the study period, with emphasis on the growth of the difference in NS of lung and colon cancer (among men). Only for cervical cancer and prostate cancer there was a reduction in the intermunicipal gaps. 5-year NS for breast cancer in Aracaju ranged from 55.2% to 73.4% according to SES. In Curitiba this variation was from 66.5% to 83.8%. CONCLUSION: The results of the present study suggests widening of socioeconomic and regional inequalities in the survival of patients with colorectal, breast, cervical, lung and prostate cancers in Brazil during the 1990 s and 2000 s.

Exploring New Tools for Risk Classification among Adults with Several Degrees of Obesity.

The epidemic of obesity worldwide has been recognized as a very important challenge. Within its complexity, the identification of higher-risk patients is essential, as it is unsustainable to offer access to treatment to all people with obesity. Several new approaches have recently been presented as important tools for risk stratification. In this research, we applied several of these tools in a cross-sectional study involving adults with obesity classes I, II, III, and super-obesity. The participants had their cardiometabolic risk profiles assessed. The study included adults with obesity aged 18 to 50 years (n = 404), who were evaluated using anthropometric, body composition, hemodynamic, physical fitness, and biochemical assessments. These variables were used to identify the prevalence of risk factors for cardiometabolic diseases according to the classes of obesity by gender and age group. The results showed high prevalence of risk factors, especially among the upper classes of obesity (BMI > 35 kg/m2) using single parameters as the waist circumference, with almost 90% above the cut-off point. For smaller numbers such as Glycated Hemoglobin, however, the prevalence was around 30%. Indexes such as the atherogenic index of plasma (AIP) had the highest prevalence, with 100% of the male participants identified as being at increased risk for cardiovascular disease.

Ferenczi's variations on the death drive.

This theoretical paper discusses three variations on the death drive, developed by Sándor Ferenczi. We present a brief history of the use of the term death drive among the first psychoanalysts and argue that, as early as 1913, the notion is used by Ferenczi and serves as a conceptual background for his thinking. During the 1920s, Ferenczi revisits part of this concept, focusing on what he identifies as a primacy of self-destruction. The destructive drive gains an adaptive character responsible for the mortification of parts of the individual, in exchange for the survival of the whole. In this variation, the tendency to regress also arises as the self-destruction drive and the acceptance of unpleasure involves a psychic "reckoning-machine." In the final variation, left unfinished, the death drive at times receives new names, like drive for "conciliation," and at others, the very idea of the death drive is criticized.

Which anthropometric equation to predict body fat percentage is more strongly associated with maximum oxygen uptake in adolescents? A cross-sectional study.

BACKGROUND: Identifying the relationship between maximum consumption of oxygen and body fat percentage is important due to increased cardiovascular risk factors. OBJECTIVE: This study aimed to verify the association between body fat percentage determined by three predictive equations using anthropometric measures (Lohman, Boileau, and Slaughter) and maximum oxygen uptake (VO2max). We also aimed to estimate the capacity of these equations for explaining VO2max variations in adolescents according to sex. DESIGN AND SETTING: This was a cross-sectional study conducted in high schools in São José, Southern Brazil. METHODS: This study included 879 adolescents (14-19 years) from Southern Brazil. Aerobic fitness was assessed using the modified Canadian Aerobic Fitness Test. The independent variable was body fat percentage predicted by the Lohman, Boileau, and Slaughter equations. Analyses adjusted for sociodemographic variables, physical activity level, and sexual maturation were performed with P value < 0.05. RESULTS: All anthropometric prediction equations used to estimate body fat percentage explained VO2max variations in adolescents. In male adolescents, both regression models based on the Boileau et al.12 and Lohman10 equations revealed higher explanatory power for VO2max (20%) compared with that based on the Slaughter et al.13 equation (19%). In female adolescents, the model based on the anthropometric equation of Slaughter et al.13 showed the greatest explanatory power for VO2max (18%). CONCLUSION: The inverse relationship between VO2max and body fat intensifies the need for effective intervention programs that prioritize maintenance of appropriate body fat and aerobic fitness levels because inadequate levels of both factors result in negative health consequences.