Leaf habit and plant architecture integrate whole-plant economics and contextualize trait-climate associations within ecologically diverse genus Rhododendron.

Plant resource strategies negotiate a trade-off between fast growth and stress resistance, characterized by specific leaf area (SLA). How SLA relates to leaf structure and function or plant climate associations remains open for debate, and leaf habit and plant architecture may alter the costs versus benefits of individual traits. We used phylogenetic canonical correspondence analysis and phylogenetic least squares to understand the relationship of anatomy and gas exchange to published data on root, wood, architectural and leaf economics traits and climate. Leaf anatomy was structured by leaf habit and carbon to nitrogen ratio was a better predictor of gas exchange than SLA. We found significant correspondence of leaf anatomy with branch architecture and wood traits, gas exchange corresponded with climate, while leaf economics corresponded with climate, architecture, wood and root traits. Species from the most seasonal climates had the highest trait-climate correspondence, and different aspects of economics and anatomy reflected leaf carbon uptake versus water use. Our study using phylogenetic comparative methods including plant architecture and leaf habit provides insight into the mechanism of whole-plant functional coordination and contextualizes individual traits in relation to climate, demonstrating the evolutionary and ecological relevance of trait-trait correlations within a genus with high biodiversity.

Connected language performance in neurotypical and persons with aphasia: Use of the Brazilian-Portuguese Story Retell Procedure (SRP-BP).

INTRODUCTION: It is important to analyze the micro- and macrostructure of connected language production across languages in neurotypical and impaired speakers such as people with aphasia (PWA). However, the validity, reliability, sensitivity, or specificity of the available Brazilian-Portuguese connected language production batteries remains untested. OBJECTIVE: The purpose of this study was to provide a preliminary assessment of the translated Brazilian-Portuguese Story Retell Procedure (SRP-BP) in PWA and neurotypical control participants (NCP) and investigate whether the SRP can serve as a measure of overall communication impairment in PWA. METHODS: This cross-sectional study was developed at the Federal University of São Paulo. Seven right-handed PWA and 14 NCP were recruited. PWA had a single left-hemisphere post-stroke lesion and were without severe aphasia or non-fluent aphasia that might interfere with performing the SRP. The connected language measures calculated from the SRP-BP were the numbers of words, information units, and propositions produced. The data were analyzed with the non-parametric Mann-Whitney test. RESULTS: The NCP produced significantly more information units and propositions in each of the 12 SRP-BP stories than the PWA group. The same group results were found for the number of words for 11 of the 12 stories, with no statistically significant difference between groups for the Água (Water) story. CONCLUSION: The SRP-BP distinguished the connected language production of PWA from that of NCP. These results motivate additional psychometric assessment and test development of the SRP-BP in neurotypical, PWA, and other language and cognitively impaired populations.

Translation and Adaptation of the English Story Retell Procedure to Portuguese: A Preliminary Study.

INTRODUCTION: The comprehension and production of connected language are essential for effective communication. However, few assessment and intervention programs requiring connected language have been made available in Brazilian Portuguese. One connected language sampling procedure, the Story Retell Procedure (SRP), has been widely studied in English and primarily for people with aphasia. The SRP employs 12 stories, whose individual plots are quite different and still equivalent in terms of verbal productivity measures. The first objective of this study was to present the translation and adaptation of the SRP stories into Portuguese and to determine whether the translations are similar to English stories. The second objective was to analyze a small group of healthy adults' responses to this assessment, thus observing whether the retellings of the SRP story forms in Portuguese would be similar to each other in the number of words, information units (IUs), and propositions - as demonstrated in English. METHODS: This preliminary study translated and adapted into Portuguese, the 12 original English SRP stories. Only small cultural adaptations were made, preserving the essential content of the stories. The stories were then presented to 14 healthy adults, and the participants' retellings from each story were compared to the other stories regarding the number of words, IUs, and propositions. RESULTS: Few differences were found in the retellings considering the variables analyzed. Particularly, the retells of Gasolina (Gas), Biblioteca (Library), Empréstimo (Loan), Sanduíche (Sandwich), Futebol (Baseball), and Multas (Ticket) were not significantly different in the three aspects investigated in this study (percentages of words, IUs, and propositions). CONCLUSION: The SRP stories adapted to Portuguese, despite having a quite close number of words, IUs, and propositions to those in the original stories, did not result in retellings with similar number of words, IUs, or propositions across stories. Nonetheless, the parameters analyzed were not significantly different among the majority of the stories, and some were nearly identical. This study identified the SRP stories that can be equivalently used in assessment, reassessment, and possibly in the rehabilitation of patients with communication disorders. Likewise, differences must be considered when the stories are used with pathological populations.

Juniperus virginiana sourced from colder climates maintain higher ratios of soluble sugars to starch during cold acclimation.

Non-structural carbohydrates (NSCs) are carbon compounds that serve a large variety of purposes, which makes it hard to disentangle how their concentrations change in response to environmental stress. Soluble sugars can accumulate in plants as metabolic demand decreases, e.g. in response to drought or as seasonal temperatures decrease. Alternatively, actively allocating to NSCs could be beneficial in cold acclimation or periods of increased aridity because soluble sugars serve non-metabolic functions as cryoprotectants and in osmoregulation. We used Juniperus virginiana, a woody plant currently expanding its range, to investigate whether plants sourced from colder and more arid locations maintained higher concentrations of NSCs. We sourced three populations of J. virginiana from across an environmental gradient, and we compared these with the closely related Juniperus scopulorum. We grew the plants in a common garden in northeast Ohio, part of J. virginiana's historic range. We exposed the plants to a drought treatment during the summer and then measured NSC concentrations and cold hardiness as the plants acclimated to colder temperatures and shorter days. We found that individuals originating from the warmer, more southern, range edge were initially not as cold hardy as plants from the other source populations and only reached similar hardiness after prolonged low temperatures. We did not find an effect of drought on NSCs, although this may be due to other traits conferring a high level of drought tolerance in J. virginiana. Across all plants, the NSCs concentration increased over the cold acclimation period, specifically as sugars. Although the highest concentrations of sugars were found in plants from southern populations, the plants from colder environments maintained higher ratios of sugars to starch. These results highlight the importance of NSCs in cold acclimation, and that plants sourced from different climates showed different physiological responses to shortening days and low temperatures.

Fatigue-life and stress distribution of a glass-ceramic under different loading conditions.

This study aimed to evaluate the effect of different loading conditions on the mechanical behavior and stress distribution of a leucite-reinforced glass-ceramic. Plate-shaped ceramic specimens were obtained from leucite-reinforced glass-ceramic (1.5 × 8.4 × 8.3 mm) and adhesively cemented to a dentin analog substrate. Monotonic and cyclic contact fatigue tests were performed to simulate sphere-to-flat contact, using a 6 mm diameter spherical piston; and flat-to-flat contact, using a 3 mm diameter flat piston. For the monotonic test (n=20), a gradual compressive load (0.5 mm/min) was applied to the specimen using a universal testing machine. Failure load data were analyzed with Weibull statistics. The cyclic contact fatigue test was performed using protocols (load and a number of cycles) defined by the boundary technique (n=30). Fatigue data were analyzed using an inverse power law relationship and Weibull-lifetime distribution. The stress distribution was investigated using Finite Element Analysis (FEA). The monotonic and the fatigue Weibull modulus were similar among the two contact conditions. In fatigue, the slow crack growth exponent was greater for sphere-to-flat contact, which indicates that the load level had a greater effect on the specimen's probability of failure. In conclusion, FEA showed different stress distribution for the tested loading conditions. The stress distribution and probability of fatigue failure of specimens tested in sphere-to-flat contact showed greater dependency to load level.

Seroprevalence of Toxoplasmosis in Puerperal Women Treated at a Tertiary Referral Hospital.

OBJECTIVE: To evaluate the seroprevalence of toxoplasmosis among puerperal women cared for at a tertiary university hospital and the level of understanding of these puerperal women about toxoplasmosis, vertical transmission, and its prophylaxis. METHODS: For this cross-sectional study, we evaluated 225 patients using presential interviews, prenatal documentation, and electronic medical records. Data were stored using Research Electronic Data Capture (REDCap) software. Prevalence rates were estimated by the presence of reactive IgG antibodies against Toxoplasma gondii. Data analysis was performed using the chi-square test and calculation of the odds ratio (OR). Seroreactivity to T. gondii and exposure variables (age, educational level, and parity) were analyzed using a confidence interval (95%CI) and a significance level of 5% (p < 0.05). RESULTS: The seropositivity rate for T. gondii was 40%. There was no association between seroprevalence and age. Primiparity was a protective factor against seropositivity and low education was a risk factor. CONCLUSION: Knowledge of T. gondii infection and its transmission forms was significantly limited, presenting a risk for acute maternal toxoplasmosis and vertical transmission of this protozoan. Increasing the education level regarding the risk of toxoplasmosis during pregnancy could reduce the rates of infection and vertical transmission of this parasite.

OBJETIVO: Avaliar a soroprevalência de toxoplasmose entre puérperas atendidas em um hospital universitário terciário e o nível de compreensão dessas puérperas sobre toxoplasmose, transmissão vertical e sua profilaxia. MéTODOS: Para esse estudo transversal, foram avaliadas 225 pacientes utilizando entrevistas presenciais, documentação de pré-natal e prontuário eletrônico. Os dados foram armazenados usando o software Research Electronic Data Capture (REDCap). As taxas de prevalência foram estimadas pela presença de anticorpos IgG reativos contra o Toxoplasma gondii. A análise dos dados foi realizada por meio do teste do qui-quadrado e cálculo do odds ratio (OR). A sororreatividade ao T. gondii e as variáveis de exposição (idade, escolaridade e paridade) foram analisadas, utilizando-se intervalo de confiança (IC95%) e nível de significância de 5% (p < 0,05). RESULTADOS: A taxa de soropositividade para T. gondii foi de 40%. Não houve associação entre soroprevalência e idade. A primiparidade foi fator de proteção contra a soropositividade e a baixa escolaridade foi fator de risco. CONCLUSãO: O conhecimento da infecção por T. gondii e suas formas de transmissão foi significativamente limitado, apresentando risco para toxoplasmose materna aguda e transmissão vertical desse protozoário. Aumentar o nível de escolaridade quanto ao risco de toxoplasmose durante a gravidez pode reduzir as taxas de infecção e transmissão vertical desse parasita.

Effects of post oak (Quercus stellata) and smooth brome (Bromus inermis) competition on water uptake and root partitioning of eastern redcedar (Juniperus virginiana).

Eastern redcedar Juniperus virginiana is encroaching into new habitats, which will affect native ecosystems as this species competes with other plants for available resources, including water. We designed a greenhouse experiment to investigate changes in soil moisture content and rooting depths of two-year-old J. virginiana saplings growing with or without competition. We had four competition treatments: 1) none, 2) with a native tree (Quercus stellata), 3) with an invasive grass (Bromus inermis), and 4) with both Q. stellata and B. inermis. We measured soil moisture content over two years as well as root length, total biomass, relative water content, midday water potential, and mortality at the end of the experiment. When J. virginiana and B. inermis grew together, water depletion occurred at both 30-40 cm and 10-20 cm. Combined with root length results, we can infer that J. virginiana most likely took up water from the deeper layers whereas B. inermis used water from the top layers. We found a similar pattern of water depletion and uptake when J. virginiana grew with Q. stellata, indicating that J. virginiana took up water from the deeper layers and Q. stellata used water mostly from the top soil layers. When the three species grew together, we found root overlap between J. virginiana and Q. stellata. Despite the root overlap, our relative water content and water potential indicate that J. virginiana was not water stressed in any of the plant combinations. Regardless, J. virginiana saplings had less total biomass in treatments with B. inermis and we recorded a significantly higher mortality when J. virginiana grew with both competitors. Root overlap and partitioning can affect how J. virginiana perform and adapt to new competitors and can allow their co-existence with grasses and other woody species, which can facilitate J. virginiana encroachment into grasslands and woodlands. Our data also show that competition with both Q. stellata and B. inermis could limit establishment, regardless of water availability.

Seroprevalence of Toxoplasmosis in Puerperal Women Treated at a Tertiary Referral Hospital / Soroprevalência de toxoplasmose em puérperas atendidas em um hospital terciário de referência

Abstract Objective To evaluate the seroprevalence of toxoplasmosis among puerperal women cared for at a tertiary university hospital and the level of understanding of these puerperal women about toxoplasmosis, vertical transmission, and its prophylaxis. Methods For this cross-sectional study, we evaluated 225 patients using presential interviews, prenatal documentation, and electronic medical records. Data were stored using Research Electronic Data Capture (REDCap) software. Prevalence rates were estimated by the presence of reactive IgG antibodies against Toxoplasma gondii. Data analysis was performed using the chi-square test and calculation of the odds ratio (OR). Seroreactivity to T. gondii and exposure variables (age, educational level, and parity) were analyzed using a confidence interval (95%CI) and a significance level of 5% (p < 0.05). Results The seropositivity rate for T. gondii was 40%. There was no association between seroprevalence and age. Primiparity was a protective factor against seropositivity and low education was a risk factor. Conclusion Knowledge of T. gondii infection and its transmission forms was significantly limited, presenting a risk for acute maternal toxoplasmosis and vertical transmission of this protozoan. Increasing the education level regarding the risk of toxoplasmosis during pregnancy could reduce the rates of infection and vertical transmission of this parasite.

Resumo Objetivo Avaliar a soroprevalência de toxoplasmose entre puérperas atendidas em um hospital universitário terciário e o nível de compreensão dessas puérperas sobre toxoplasmose, transmissão vertical e sua profilaxia. Métodos Para esse estudo transversal, foram avaliadas 225 pacientes utilizando entrevistas presenciais, documentação de pré-natal e prontuário eletrônico. Os dados foram armazenados usando o software Research Electronic Data Capture (REDCap). As taxas de prevalência foram estimadas pela presença de anticorpos IgG reativos contra o Toxoplasma gondii. A análise dos dados foi realizada por meio do teste do qui-quadrado e cálculo do odds ratio (OR). A sororreatividade ao T. gondii e as variáveis de exposição (idade, escolaridade e paridade) foram analisadas, utilizando-se intervalo de confiança (IC95%) e nível de significância de 5% (p < 0,05). Resultados A taxa de soropositividade para T. gondii foi de 40%. Não houve associação entre soroprevalência e idade. A primiparidade foi fator de proteção contra a soropositividade e a baixa escolaridade foi fator de risco. Conclusão O conhecimento da infecção por T. gondii e suas formas de transmissão foi significativamente limitado, apresentando risco para toxoplasmose materna aguda e transmissão vertical desse protozoário. Aumentar o nível de escolaridade quanto ao risco de toxoplasmose durante a gravidez pode reduzir as taxas de infecção e transmissão vertical desse parasita.

Fatigue-life and stress distribution of a glass-ceramic under different loading conditions

Abstract This study aimed to evaluate the effect of different loading conditions on the mechanical behavior and stress distribution of a leucite-reinforced glass-ceramic. Plate-shaped ceramic specimens were obtained from leucite-reinforced glass-ceramic (1.5 × 8.4 × 8.3 mm) and adhesively cemented to a dentin analog substrate. Monotonic and cyclic contact fatigue tests were performed to simulate sphere-to-flat contact, using a 6 mm diameter spherical piston; and flat-to-flat contact, using a 3 mm diameter flat piston. For the monotonic test (n=20), a gradual compressive load (0.5 mm/min) was applied to the specimen using a universal testing machine. Failure load data were analyzed with Weibull statistics. The cyclic contact fatigue test was performed using protocols (load and a number of cycles) defined by the boundary technique (n=30). Fatigue data were analyzed using an inverse power law relationship and Weibull-lifetime distribution. The stress distribution was investigated using Finite Element Analysis (FEA). The monotonic and the fatigue Weibull modulus were similar among the two contact conditions. In fatigue, the slow crack growth exponent was greater for sphere-to-flat contact, which indicates that the load level had a greater effect on the specimen's probability of failure. In conclusion, FEA showed different stress distribution for the tested loading conditions. The stress distribution and probability of fatigue failure of specimens tested in sphere-to-flat contact showed greater dependency to load level.

Resumo O objetivo deste estudo é avaliar o efeito de diferentes condições de carregamento no comportamento mecânico e na distribuição de tensões de uma vitrocerâmica reforçada com leucita. Amostras cerâmicas em forma de lâminas foram obtidas a partir de vitrocerâmica reforçada com leucita (1,5 × 8,4 × 8,3 mm) e cimentadas adesivamente a um substrato análogo de dentina. Ensaios de carga de compressão monotônica e fadiga foram realizados para simular o contato esfera-plano, usando um pistão esférico de 6 mm de diâmetro; e contato plano com plano, usando um pistão plano de 3 mm de diâmetro. Para o ensaio de carga de compressão monotônica (n=20), foi aplicada uma carga compressiva gradual (0,5 mm/min) ao corpo-de-prova usando uma máquina de ensaio universal. Os dados de carga de fratura foram analisados de acordo com a distribuição de Weibull. O teste de fadiga foi realizado com os protocolos (carga e número de ciclos) definidos pela técnica de boundary (n=30). Os dados de fadiga foram analisados usando uma relação de tempo de vida - tensão de lei da potência inversa (IPL- inverse power law). A distribuição de tensões foi investigada usando análise de elementos finitos (AEF). O módulo de Weibull para teste de compressão monotônico e de fadiga foram semelhantes entre as duas condições de contato. Em fadiga, o expoente de crescimento sub-crítico da trinca foi maior para o contato esfera-plano, o que indica que o nível de carga teve um efeito maior na probabilidade de falha do corpo-de-prova. Em conclusão, AEF apresentou distribuição de tensões diferente para as condições de carregamento testadas. A distribuição de tensões e a probabilidade de falha em fadiga dos corpos-de-prova testados utilizando o contato esfera-plano apresentaram maior dependência do nível de carga.

Determination of cyanide in whole seeds and brans of linseed (Linum usitatissimum Linn) by molecular spectrophotometry

Abstract The addition of linseed (Linum usitatissimum Linn) in the diet, as a functional food, has increased over the years. However, it possesses cyanogenic glycosides. This study aimed to quantify and compare cyanide concentration in whole seed and bran of brown and golden types to establish a safe limit of intake. Three commercial labels, from brown and golden whole seed types (Ab, Ag, Bb, Bg, Cb and Cg), and six commercial labels of brown and golden bran (1b, 2g, 3g, 4b, 5g, and 6b), were selected, totalizing twelve samples. Total cyanide concentration was quantified by a colorimetric method employing alkaline picrate, after acid hydrolysis. The whole seed cyanide values were between 348.4 and 473.20 µg/g and the bran cyanide values were between 459.53 and 639.35 µg/g. The analyzed bran presented increased cyanide concentrations than the whole seeds with no differences between brown and golden types. Food able to produce cyanide less than 90 µg/kg body weight, daily, is considered secure for consumption. Considering this limit and analyzed samples, it is safe to eat approximately two tablespoons of seeds or one tablespoon of bran. These results point out the importance of cyanide amount daily intake information to be in linseed packaging, to ensure secure consumption

Regional differences regarding the occurrence of falls and associated factors in two populations of Brazilian longevous people.

BACKGROUND: Few studies have explored regional asymmetries and their implications for health policies regarding episodes of falls among the population of ≥80 years old in continental and developing countries like Brazil with deep inequalities and sociocultural differences. OBJECTIVE: To evaluate the occurrence of falls and their association with functional capacity and nutritional status in the longest oldest-old living in two municipalities in the Northeast and Southeast of Brazil. METHODS: This is a cross-sectional study, with primary data collection in which were included in the research seniors aged 80 years or more, of both sexes, belonging to two Brazilian municipalities of discrepant socioeconomic aspects. The dependent variable was the occurrence of falls in the last year. The independent variables were grouped into demographic aspects, functional capacity and nutritional status. To identify variables that contribute to the occurrence of falls, the multiple logistic regression model, adopts a significance level of 5%. RESULTS: The sample was composed of 415 oldest-old adults. From the total, 32.3% reported having fallen in the last year, 24.7% in Brejo dos Santos and 37.8% in São Paulo. Among the former population, the mean value of walking speed for those who had falls was 0.27 m/s and for those who had no occurrence of falls was 0.33 m/s; and, among the seniors from São Paulo, the mean values were 0.51 m/s and 0.58 m/s, respectively. Significant correlations between walking speed and falls were verified for both populations, showing that the lower the walking speed, the higher the predisposition to falls. In the final regression model, the occurrence of falls was associated with moderate balance (OR = 5.28; CI: 1.11-25.18) among the longevous people Brejo dos Santos and with very poor functional performance (OR = 16.09; CI:1.46-177.06) among those from São Paulo. CONCLUSION: The results pointed out a lower prevalence of falls in longevous people from Brejo dos Santos than in those from São Paulo and differences regarding the associated factors, showing heterogeneity between the two populations; indicating the need for public policies and effective programmes aimed at preventing falls based on the maintenance or increase of functional capacity.

Efficient drug development of oseltamivir capsules based on process control, bioequivalence and PBPK modeling.

Oseltamivir phosphate is used to treat influenza. For registration of a generic product, bioequivalence studies are crucial, however, in vitro studies can sometimes replace the conventional human pharmacokinetic. To assess whether the dissolution profile is comparable with the in vivo release, physiologically based pharmacokinetic absorption models (PBPK) are being used. The aim of the study was to develop a generic capsule of oseltamivir phosphate 30 mg with process understanding and control, development of PBPK model and comparison of virtual bioequivalence study (VBE) to the real bioequivalence study that was also performed. For that, 30 mg capsules were prepared by wet granulation according to 22 full factorial design. The biobatch was prepared with the selected process and a batch was made with the API from the second manufacture. Both manufactures presented polymorph A and the second manufacture showed higher particle size. Product batches produced without adding water during granulation showed higher dissolution. The addition of water associated with higher conical mill speed, lowered the average weight of the capsules. The biobatch dissolution was similar to Tamiflu; also, they were bioequivalent. The crossover VBE between the biobatch and Tamiflu corroborated with the real bioequivalence study. The same result was found for the batch with higher particle size. PBPK model showed that computer simulations can help pharmaceutical companies to replace in vivo studies.

Health-Related Quality of Life and Associated Factors: Regional Differences Among Oldest-Old in Brazil.

PURPOSE: The aim of this research was to investigate the extent to which socioeconomic and regional differences in Brazil may influence the quality of life. To this end, we examined factors associated with health-related quality of life in two populations of oldest-old people, aged 80 and over: one from the Northeast of Brazil and the other from the Southeast. METHODS: 417 participants aged 80 and over were interviewed face-to-face, 179 from Brejo dos Santos, one of the poorest regions in the Northeast; and 238 from São Paulo, one of the largest urban metropolises in Southeast Brazil. Data, which included socioeconomic and demographic factors, health status, and health-related quality of life, were collected using a structured questionnaire. The dependent variable was determined by the completion rate of the 12-item Short Form Survey and analyzed using multiple logistic regression. RESULTS: Although the population of São Paulo had four times as many long-lived women than men, had better literacy levels, used more medications, and presented a greater prevalence of symptoms suggestive of depression in comparison to the Northeast's population, no difference was observed in the proportion of good physical components among the two populations, 54.3% in Brejo dos Santos' oldest-old and 50.4% in São Paulo's (P = .6272). Quality and quantity of sleep were factors that most affected the health-related quality of life among the oldest-old of Northeast. CONCLUSION: Factors associated with health-related quality of life were different among the oldest-old people of the two locations, thereby corroborating the heterogeneous nature of the longevous population.

Psychosocial aspects and support networks associated with disability in two longevous populations in Brazil: a cross-sectional study.

BACKGROUND: Among the oldest old, aged 80 years and over, the prevalence of disability is higher than in other age groups and can be considered a predictor of mortality. OBJECTIVE: To evaluate how psychosocial aspects and support networks influence the disability of these oldest-old individuals, performing a comparison between two longevous populations, one living in one of the poorest regions of Brazil, in the backlands of Paraíba, and another living in one of the largest urban centres in Latin America. METHOD: A cross-sectional study in which 417 oldest-old persons aged 80 years and older were interviewed, with data collected through the "Health, Welfare and Ageing" survey conducted in two Brazilian cities. Disability was assessed by reporting the need for assistance in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Bivariate and multiple analyses were performed using R statistical software. RESULTS: Food insufficiency in the first years of life had negative repercussions on the disability of oldest old people living in the northeast. On the other hand, in this region, older people have a higher rate of support and live longer with their peers, which may contribute to reducing feelings of loneliness, depressive symptoms, and worse self-perception of health. In the Southeast, financial constraints, subjective poverty, and unmet needs may favour the development of functional limitations between long-lived people. CONCLUSION: Our findings indicate that regional differences in Brazil may influence the disability of older people aged 80 and older. In northeast Brazil, having no partner may contribute to disability for ADLs and IADLs; while, in the longevous population of São Paulo, having a worse self-rated health may contribute to disability for IADLs.

Pharmacokinetics of chloroquine and primaquine in healthy volunteers.

BACKGROUND: Vivax malaria is a neglected disease. There is an irrefutable need for better treatments with higher acceptability and efficacy. The treatment efficacy is influenced by many factors, including bioavailability. Hence, a straightforward strategy to improve vivax malaria treatment efficacy is the deployment of good quality formulations of primaquine and chloroquine. As these treatments were developed more than 70 years ago, many of the available data on blood levels of both drugs are based on obsolete analytical methodologies or pharmaceutical formulations, which are not available anymore. Herein, the results of three bioequivalence studies are presented, providing individual pharmacokinetic data on chloroquine and primaquine of more than a hundred healthy volunteers and using up-to-date analytical methods. METHODS: Three trials were designed as a single centre, randomized, single dose, open label, fasting, crossover bioequivalence studies comparing a new coated chloroquine tablet to the uncoated tablet, and 5 and 15 mg primaquine formulations to either an international reference product or the currently distributed tablets. Plasma concentrations of chloroquine and primaquine were measured using a validated HPLC-MS/MS method in accordance with current international regulatory requirements for bio-analytical methods. RESULTS: In total, a hundred eleven healthy volunteers of both genders were included in the three studies (n = 32; 30 and 56 respectively). No serious adverse events occurred. Drugs levels were measured in 5,520 blood samples. The estimated ratio of the geometric means of Cmax, AUC0-t and AUC0-inf of test and reference drugs and their 90% CI for chloroquine 150 mg, primaquine 15 mg and primaquine 5 mg were: 95.33% (89.18; 101.90), 86. 85% (82.61; 91.31), and 84.45% (76.95; 92.67); 93.28% (81.76; 106.41), 94.52% (86.13; 103.73) and 93.93% (85.83; 102.79); 97.44% (90.60; 104.78), 93.70% (87.04; 100.87) and 91.36% (85.27; 97.89), respectively. As Cmax and AUC0-t 90% CI were within the acceptance interval of 80-125% in all cases, the formulations tested were bioequivalent. CONCLUSIONS: In conclusion, the three studies provided detailed chloroquine and primaquine pharmacokinetic data in accordance with current regulatory standards. Together with other open data initiatives, this individual data may increase the accuracy of pharmacokinetic models guiding best dose, new combinations, regimens and formulations to optimize the current chloroquine and primaquine treatments for vivax malaria. The data presented here may support the deployment of high-quality drugs and evidence-based public health policies.

Cavum septum pellucidum and vergae cyst: A symptomatic case with intracranial hypertension and multiple nerve involvement.

Background: Cavum septum pellucidum (CSP) and cavum vergae (CV) are normal anatomical variations present in some children, adolescents, and adults. When the cavity is larger than normal, it is called a cyst. Symptomatic cases of CSP and CV cyst are rare, and the clinical presentation is varied. A case with multiple nerve involvement is described. Case Description: A healthy 17-year-old female presented a sudden headache, right cervicobrachialgia, right ptosis, visual changes, and left facial paralysis over 10 days. Head magnetic resonance imaging revealed CSP and CV cyst. Inflammation, infection, and vascular disorders were ruled out. We decided to perform a right transfrontal endoscopic intraventricular septostomy and a right Monro foraminoplasty, which were successful. One month after surgery, the patient had no more signs or symptoms. She has remained asymptomatic for the past year. Conclusion: Multiple nerve involvement was directly related to CSP and CV cyst. The cyst bilaterally occluded the foramen of Monro causing intracranial hypertension. It was possible to obtain complete resolution of the clinical features through neuroendoscopic fenestration and foraminoplasty.

MANEJO DO HIPERTENSO COM FIBRILAÇÃO ATRIAL. O QUE MUDOU NA PRÁTICA MÉDICA? / HYPERTENSION AND ATRIAL FIBRILLATION: RECENT ADVANCES

A fibrilação atrial (FA) é a arritmia cardíaca sustentada mais comum na prática clínica. Estima se que 1 a 2% da população mundial seja acometida dessa arritmia e ainda se reconhece que este número está subestimado, dado que até um terço dos pacientes com FA são assintomáticos. Além dos fatores de risco clássicos como diabetes, doença valvar, infarto do miocárdio e insuficiência cardíaca, insuficiência renal crônica, obesidade e apneia obstrutiva do sono, a hipertensão tem um papel muito impactante no surgimento da FA pela sua alta prevalência, com isso sendo o fator de risco mais comum para o desenvolvimento de FA. O manejo adequado da HA é importante para prevenção da FA, controle do ritmo, insuficiência cardíaca e prevenção do acidente vascular cerebral (AVC). O tratamento deve ser integrado por equipe multidisciplinar, individualizando caso a caso, estando sujeito a mudanças ao longo do tempo, com o desenvolvimento de novos fatores de risco, sintomas, progressão da doença e com advento de novos tratamentos. Algumas drogas, tais como os BRAs e iECA parecem apresentar mecanismos específicos de atuação na redução do risco de arritmias. A ablação por cateter pode ser a estratégia mais eficaz para manutenção do ritmo sinusal, em paciente sintomáticos. O objetivo dessa revisão é resumir os dados atuais referente ao manejo do paciente hipertenso com fibrilação atrial.

Worldwide, AF is the most common sustained cardiac arrhythmia in adults. The currently estimated prevalence and incidence in the world are rising, owing to extended longevity and increased survival with chronic diseases. This multifactorial arrhythmia is intertwined with common concomitant cardiovascular diseases, which share classical cardiovascular risk factors, including hypertension, diabetes mellitus, heart failure (HF), coronary artery disease (CAD), chronic kidney disease (CKD), obesity, and obstructive sleep apnoea (OSA). The most common risk factor for AF in the general population is hypertension, and in these patients, left ventricular hypertrophy followed by left atrial enlargement creates the anatomical substrate for AF. Adequate management of hypertension is important for AF prevention, rhythm control, heart failure, and stroke prevention. Integrated management of AF patients requires a coordinated and agreed patient-individualized care pathway to deliver optimized treatment by an interdisciplinary team. The effect of some anti hypertensives, such as RAAS Inhibitors seems to be superior to other antihypertensive treatment to prevent AF recurrences in hypertensive patients with paroxysmal AF beyond the BP reduction. Guidelines suggest a more prominent role for radiofrequency ablation in the treatment of atrial fibrillation (AF), including its use as first-line therapy in recurrent symptomatic paroxysmal or persistent AF in whom a rhythm control strategy is chosen. The objective of this review is to summarize current data on the hypertension in relation to AF, their management, and ongoing research in the field.

Treatment of mycobacteriosis in a patient with compatible symptoms after a cesarean delivery.

This study aims to report the diagnostic course and treatment of a fast-growing mycobacteria infection after cesarean delivery. We report the case of a 37-year-old woman admitted to the Infectious Diseases' Clinic of the Hospital das Clinicas da Universidade Federal de Pernambuco, Pernambuco State, Brazil, four months after a cesarean section, presenting with healing difficulties and located pain outside the surgical site. The first diagnosis was a probable rejection of the sutures that were not absorbed, but based on the clinical signs, reported history, complementary laboratory tests and no response to treatment with the conventional antibiotic therapy (cephalosporins/quinolones) prescribed, the ultimate diagnosis was a mycobacteriosis caused by Micobacterium fortuitum. Since fast-growing mycobacteria do not easily penetrate host tissues, they is mainly related to post-trauma or post-surgical procedures. It is extremely important to call attention to these occurrences in the gynecological-obsthetric field. Treatment for mycobacteriosis is often complicated because of the side effects of antibiotics, especially the ototoxicity of amikacin.

Socioeconomic Factors and Health Status Disparities Associated with Difficulty in ADLs and IADLs among Long-Lived Populations in Brazil: A Cross-Sectional Study.

OBJECTIVE: To evaluate the association between socioeconomic factors, health status, and Functional Capacity (FC) in the oldest senior citizens in a metropolis and a poor rural region of Brazil. METHOD: Cross-sectional study of 417 seniors aged ≥80 years, data collected through Brazil's Health, Well-being and Aging survey. FC assessed by self-reporting of difficulties in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Chi-square tests and multiple logistic regression analyses were performed using "R" statistical software. RESULTS: Socioeconomic and demographic inequalities in Brazil can influence FC in seniors aged 80 years and older. Comparatively, urban long-lived people had a higher prevalence of difficulties for ADLs and rural ones showed more difficulties for IADLs. Among urban oldest seniors, female gender and lower-income were correlated with difficulties for IADLs. Among rural oldest seniors, female gender, stroke, joint disease, and inadequate weight independently were correlated with difficulties for ADLs, while the number of chronic diseases was associated with difficulties for IADLs. CONCLUSION: Financial constraints may favor the development of functional limitations among older seniors in large urban centers. In poor rural areas, inadequate nutritional status and chronic diseases may increase their susceptibility to functional decline.

Influence of background color on color perception in dentistry.

OBJECTIVE: To evaluate the influence of neutral color backgrounds on the perception of color differences in dentistry. METHODS: A software was developed for this study that calculated the perceptibility (PT) and acceptability (AT) thresholds of color differences between a pair of computer-simulated incisor samples (n = 60 pairs) over three neutral color (white, gray and black) backgrounds. CIELAB and CIEDE2000 color difference formulas were used. Five groups of volunteer observers (N = 100) participated in the psychophysical experiment (n = 20): Dentists; Dental students; Dental auxiliaries; Dental technicians; and Laypersons. The psychophysical experiment was performed in a dark environment on a calibrated high-resolution screen. To determine PT and AT values, the 60 pairs of samples were randomly presented to each observer over the different backgrounds. The data were adjusted (TSK Fuzzy) and analyzed statistically using Student t-test and ANOVA (α = 0.05). RESULTS: Regardless of the metric and the background used, the PT values showed no difference among different observers (p > 0.05). Dentists showed the lowest PT values. Dental technicians showed the lowest AT (p ≤ 0.05) and similar values for the three backgrounds (p > 0.05), regardless of the metric used. The other groups of observers showed the lowest and the highest AT values when using black and white backgrounds, respectively (p ≤ 0.05). CONCLUSIONS: The lowest AT values using a black background indicates that the use of this background allows for the evaluation of slight color differences, and should be used for challenging color differences in esthetic dentistry. This study showed the influence of the observer experience on color evaluation in dentistry. CLINICAL SIGNIFICANCE: There was no influence of the background color on the perceptibility threshold. However, dentists and dental technicians showed greater ability to perceive slight color differences compared to other groups of observers.