Zinc Status and Autism Spectrum Disorder in Children and Adolescents: A Systematic Review.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder, the prevalence of which has increased in children and adolescents over the years. Studies point to deficiency of trace elements as one of the factors involved in the etiology of the disorder, with zinc being one of the main trace elements investigated in individuals with ASD. The aim of this review is to summarize scientific evidence about the relationship between zinc status and ASD in children and adolescents. This review has been registered in the International Prospective Register of Systematic Reviews (registration number CRD42020157907). The methodological guidelines adopted were in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were selected from an active investigation of the PubMed, Scopus, LILACS, and Google databases to search for observational studies. Fifty-two studies from twenty-two countries were included. The sample sizes ranged from 20 to 2635, and the participants ranged from 2 to 18 years old. Nine types of biological matrices were used, with hair, serum, and plasma being the most frequently used in the evaluation of zinc concentrations. Significant differences in zinc concentrations between the ASD and control groups were observed in 23 studies, of which 19 (36%) showed lower zinc concentrations in the ASD group. The classification of studies according to methodological quality resulted in high, moderate, and low quality in 10, 21, and 21 studies, respectively. In general, we did not observe a significant difference between zinc concentrations of children and adolescents with ASD compared to controls; however, studies point to an occurrence of lower concentrations of Zn in individuals with ASD. This review reveals that more prospective studies with greater methodological rigor should be conducted in order to further characterize this relation.

Effects of an individualized nutritional intervention on kidney function, body composition, and quality of life in kidney transplant recipients: Study protocol for a randomized clinical trial.

BACKGROUND: Proteinuria after kidney transplantation (KTx) has been a frequent problem due to several factors, high protein intake being one of them. Individualized nutritional intervention in the late post-KTx period can promote the improvement or the reduction of risks associated with the parameters of evaluation of kidney function, body composition, and quality of life in individuals submitted to KTx. METHODS: This is a single-center, randomized and stratified clinical trial. The study will be conducted in a university hospital in northeastern Brazil with 174 individuals aged ≥19 years submitted to KTx and followed up for 12 months. Assessments will take place at 3-month intervals (T0, T3, T6, T9, and T12). The patients will be allocated to intervention and control groups by random allocation. The intervention group will receive individualized nutritional interventions with normoproteic diets (1.0 g/kg) after 60 days of KTx whereas the controls will receive the standard nutritional guidance for the post-KTx period. The primary efficacy variable is the change from baseline in log proteinuria assessed with the urinary albumin/creatinine ratio. Secondary efficacy variables include body composition, anthropometry, quality of life assessment and physical activity, lipid profile and glycemic control. Ninety-two subjects per group will afford 70% power to detect a difference of 25% between groups in log proteinuria. Primary efficacy analysis will be on the modified intention-to-treat population with between-groups comparison of the change from baseline in log proteinuria by analysis of covariance. DISCUSSION: The study will assess the effects of an individualized nutritional intervention on proteinuria 12 months after KTx. TRIAL REGISTRATION: REBEC (RBR-8XBQK5).

BNT162b2 mRNA COVID-19 vaccine induces antibodies of broader cross-reactivity than natural infection but recognition of mutant viruses is up to 10-fold reduced

BackgroundSeveral new variants of SARS-CoV-2 have emerged since fall 2020 which have multiple mutations in the receptor binding domain (RBD) of the spike protein. ObjectiveWe aimed to assess how mutations in RBD affected recognition of immune sera by antibodies induced by natural infection versus immunization with BNT162b2, a mRNA-based vaccine against COVID-19. MethodsWe produced SARS-CoV-2 RBD mutants with single mutations in the receptor binding domain (RBD) region (E484K, K417N, N501Y) or with all 3 mutations combined, as occurring in the newly emerged variants B.1.351 (South Africa) and P.1 (Brazil). Using standard and avidity ELISAs, we determined the binding capacities to mutant RBDs of antibodies induced by infection versus vaccination. ResultsThese binding assays showed that vaccination induced antibodies recognize both wildtype and mutant RBDs with higher avidities than those raised by infection. Nevertheless, recognition of mutants RBDK417N and RBDN501Y was 2.5-3-fold reduced while RBDE484K and the triple mutant were 10-fold less well recognized, demonstrating that the mutation at position 484 was key for the observed loss in cross-reactivity. ConclusionOur binding data demonstrate improved recognition of mutant viruses by BNT162b2-induced antibodies compared to those induced by natural infection. Recognition may, however, be 10-fold reduced for the variants B.1.351/P.1, suggesting that the development of a new vaccine is warranted. The E484K mutation is an key hurdle for immune recognition, convalescent plasma and monoclonal antibody therapy as well as serological assays based on the wildtype sequence may therefore seriously impaired. Capsule summaryBNT162b2 mRNA COVID-19 vaccine-induced antibodies recognize mutant viruses with up to 10-fold lower efficiency

SARS-CoV-2 variant with higher affinity to ACE2 shows reduced sera neutralization susceptibility

BackgroundSeveral new variants of SARS-CoV-2 have emerged since fall 2020 which have multiple mutations in the receptor binding domain (RBD) of the spike protein. ObjectiveWe aimed to assess how mutations in the SARS-CoV-2 RBD affect receptor affinity to angiotensin-converting enzyme 2 (ACE2) and neutralization by anti-RBD serum antibodies. MethodsWe produced a SARS-CoV-2 RBD mutant (RBDmut) with key mutations (E484K, K417N, N501Y) from the newly emerged Brazilian variant. Using Biolayer Interferometry, we analyzed the binding of this mutant to ACE2, and the susceptibility to neutralization by sera from vaccinated mice and COVID-19 convalescent patients. ResultsKinetic profiles showed increased RBDmut - ACE2 affinity compared to RBDwt, and binding of vaccine-elicited or convalescent sera was significantly reduced. Likewise, both sera types showed significantly reduced ability to block RBDmut - ACE2 binding indicating that antibodies induced by RBDwt have reduced capability to neutralize mutant virus. ConclusionOur physiochemical data show enhanced infectivity and reduced neutralization by polyclonal antibodies of the Brazilian variant of SARS-CoV-2. Capsule summarySARS-CoV-2 variant with Brazilian RBD mutations shows increased ACE2 affinity and reduced susceptibility to blockage by vaccine-elicited and convalescent sera.

Assessing antiretroviral therapy success in HIV/AIDS morbidity and mortality trends in Brazil, 1990-2017: an interrupted time series study.

To describe the trends of HIV/AIDS metrics related to the burden of disease for Brazil between 1990 and 2017 we conducted a timeseries analysis for HIV/AIDS indicators by extracting data from the Global Burden of Disease study. We calculated traditional prevalence, incidence and mortality rates, the number of years lost by HIV-related deaths (YLL) and disability (YLD), and disability-adjusted life years (DALY). We estimated time series models and assessed the impact of highly active antiretroviral therapy (HAART) on the same indicators. In the set of disability-adjusted life years (DALY), the highest weight of its magnitude was due to YLL. There was a decline, especially after 1996, of DALY, mortality and YLL for HIV/AIDS. However, YLD, incidence, and prevalence increased over the same period. Also, the analysis of interrupted time series showed that the introduction of HAART into health policy had a significant impact on indicators, especially for DALY and YLL. We need to assess the quality of life of people living with HIV, especially among older adults. In addition, we need to focus on primary prevention, emphasizing methods to avoid infection and public policies should reflect this.

Desenvolvimento vocacional e aconselhamento de carreira: contributos para a justiça social / Vocational Development and career counseling: contributions to social justice / Desarrollo vocacional y consejería de carrera: aportes a la justicia social

Neste artigo analisa-se o contributo das práticas de desenvolvimento vocacional e de aconselhamento de carreira para a inclusão e a justiça social. A abordagem é justificada pelo actual contexto de economia globalizada onde a rapidez da mudança tem levado à abertura de novas oportunidades, mas também tem colocado desafios à igualdade de oportunidades e à justiça social. Começa-se por situar historicamente o papel das práticas de desenvolvimento vocacional e de aconselhamento de carreira na promoção da justiça social. Depois, sublinha-se a necessidade destas práticas com populações desfavorecidas, equilibrando o foco no individuo com o foco nos fatores de discriminação e opressão. Por fim, apresenta-se um exemplo destas práticas onde a acção colaborativa é fundamental para facilitar a integração socioprofissional dessas populações.

This article addresses the contribution of career orientation and counseling to social inclusion and social justice. The approach is justified by the context of the current economic globalization, where rapid changes have led to new employment opportunities. However, they have also posed challenges related to equality and social justice. The role of professional orientation and counseling in the promotion of social justice is historically based. Thus, the need for practices, balancing both the focus on the individual and on discrimination, and oppression factors is highlighted for interventions in disadvantaged populations. Finally, we present several examples of these practices in which the collaboration between the target population, the family and different institutions of the community is central to the integration in the labor market.

En este artículo se analiza la contribución de las prácticas de desarrollo vocacional y de consejería profesional para la inclusión social y la justicia social. El enfoque está justificado por el contexto de la globalización económica actual, en el que la rapidez de los cambios ha conducido a nuevas posibilidades, pero también ha supuesto retos relacionados con la igualdad de oportunidades y la justicia social. Se comienza situando históricamente el papel de las prácticas de desarrollo vocacional y de consejería de carrera en la promoción de la justicia social. Luego, se destaca la necesidad de estas prácticas con poblaciones desfavorecidas, equilibrando el enfoque en el individuo y en los factores de discriminación y opresión. Por último, se presenta un ejemplo de estas prácticas en el cual la acción colaborativa es fundamental para facilitar la integración socio-profesional de estas poblaciones.

Smartphone serious games for vision and hearing assessment.

Falls are the second leading cause of accidental injury deaths worldwide. In this paper, it is intended to define methodologies that permit the evaluation of two potential factors which might have an impact on fall risk, these are: visual and hearing loss. The aim of the work developed is not to replace clinic visits, but to offer the user the means to continue the tracking of his vision and hearing at home, during the long time intervals between clinical tests. Tests conducted in a sample of our target users indicate a good ability to measure vision and hearing using an android smartphone and the proposed methodologies. While some tests require further validation, promising results were achieved in the most common tests for vision and hearing, presenting a good correlation between the system's results when compared to the traditional tests (for distance visual acuity) and the data gathered from the users (for hearing tests).

Resultados da artroplastia total do cotovelo Bi-Contact®: estudo multicêntrico / Results from Bi-Contact® total elbow arthroplasty: multicenter study

OBJETIVO: Descrever a experiência inicial de quatro serviços ortopédicos com a artroplastia total do cotovelo (ATC) Bi-Contact® relatando os resultados e complicações do procedimento. MÉTODOS: Estudo retrospectivo, através da análise de prontuários, de pacientes submetidos à ATC primária com modelo de prótese desenvolvido junto ao IOT-HCFMUSP. Foram avaliados 46 cotovelos (45 pacientes) operados de 2000 a 2009 em quatro serviços ortopédicos. RESULTADOS: A maioria dos pacientes era do sexo feminino (74 por cento) e a mediana da idade foi de 62,5 anos. Os diagnósticos encontrados foram sequela de trauma (47,83 por cento), artrite reumatóide (32,61 por cento), osteoartrose primária (8,7 por cento), fraturas agudas (6,52 por cento) e ossificação heterotópica (2,17 por cento). A mediana do tempo de acompanhamento foi de 2,08 anos (0,25-9). O procedimento melhorou significativamente a dor e o arco de movimento. Foi evidenciada a presença de pelo menos uma complicação em 69,57 por cento dos casos, sendo as principais infecção (28,26 por cento), necessidade de revisão (28,26 por cento), fratura intraoperatória (15,22 por cento) e soltura asséptica (15,22 por cento). CONCLUSÃO: A ATC do tipo Bi-Contact® propiciou uma melhora significativa na dor e no arco de movimento na presente série. O índice de complicação é alto, sendo as mais frequentes infecção, soltura asséptica e fratura intraoperatória.

OBJECTIVE: To describe the initial experience of four orthopedic clinics from using Bi-Contact® total elbow arthroplasty (TEA), reporting the results and complications of the procedure. METHODS: This was a retrospective study, through analysis on the medical records of patients who underwent primary TEA using a prosthesis model developed in conjunction with IOT-HCFMUSP. Forty-six elbows (45 patients) that were operated at four orthopedic clinics between 2000 and 2009 were evaluated. RESULTS: The majority of the patients were female (74 percent), and the median age was 62.5 years. The diagnoses encountered were trauma sequelae (47.83 percent), rheumatoid arthritis (32.61 percent), primary osteoarthrosis (8.7 percent), acute fractures (6.52 percent) and heterotopic ossification (2.17 percent). The median length of follow-up was 2.08 years (0.25-9). The procedure significantly alleviated pain and improved range of motion. It was observed that at least one complication was present in 69.57 percent of the cases, and the main ones were infection (28.26 percent), need for revision (28.26 percent), intraoperative fracture (15.22 percent) and aseptic loosening (15.22 percent). CONCLUSION: Bi-Contact® TEA provided significant alleviation of pain and improvement of range of motion in the present series. The complication rate was high, and the most frequently observed complications were infection, aseptic loosening and intraoperative fracture.

RESULTS FROM BI-CONTACT(®) TOTAL ELBOW ARTHROPLASTY: MULTICENTER STUDY.

OBJECTIVE: To describe the initial experience of four orthopedic clinics from using Bi-Contact(®) total elbow arthroplasty (TEA), reporting the results and complications of the procedure. METHODS: This was a retrospective study, through analysis on the medical records of patients who underwent primary TEA using a prosthesis model developed in conjunction with IOT-HCFMUSP. Forty-six elbows (45 patients) that were operated at four orthopedic clinics between 2000 and 2009 were evaluated. RESULTS: The majority of the patients were female (74%), and the median age was 62.5 years. The diagnoses encountered were trauma sequelae (47.83%), rheumatoid arthritis (32.61%), primary osteoarthrosis (8.7%), acute fractures (6.52%) and heterotopic ossification (2.17%). The median length of follow-up was 2.08 years (0.25-9). The procedure significantly alleviated pain and improved range of motion. It was observed that at least one complication was present in 69.57% of the cases, and the main ones were infection (28.26%), need for revision (28.26%), intraoperative fracture (15.22%) and aseptic loosening (15.22%). CONCLUSION: Bi-Contact(®) TEA provided significant alleviation of pain and improvement of range of motion in the present series. The complication rate was high, and the most frequently observed complications were infection, aseptic loosening and intraoperative fracture.

RESULTS FROM FILLING "REMPLISSAGE" ARTHROSCOPIC TECHNIQUE FOR RECURRENT ANTERIOR SHOULDER DISLOCATION.

OBJECTIVE: To evaluate the clinical result from the filling ("remplissage") technique in association with Bankart lesion repair for treating recurrent anterior shoulder dislocation. METHODS: Nine patients (10 shoulders), with a mean follow-up of 13.7 months, presented traumatic recurrent anterior shoulder dislocation. All of them had a Bankart lesion, associated with a Hill-Sachs lesion showing the "engaging" sign. The Hill-Sachs lesion defect was measured and showed an average bone loss of 17.3% (7.7% to 26.7%) in relation to the diameter of the humeral head. All the cases underwent arthroscopic repair of the Bankart lesion, together with filling of the Hill-Sachs lesion by means of tenodesis of the infraspinatus. RESULTS: The Rowe score ranged from 22.5 (10 to 45) before the operation to 80.5 (5 to 100) after the operation (p > 0.001). The UCLA score ranged from 18.0 (8 to 29) to 31.1 (21 to 31) (p > 0.001). The measurements of external and internal rotation at abduction of 90° after the operation were 63.5° (45° to 90°) and 73° (50° to 92°) respectively. Two patients presented recurrence (one with dislocation and the other with subluxation). None of the patients presented pain in the region of the infraspinatus tendon after the operation. CONCLUSION: Over the short term, the filling ("remplissage") arthroscopic technique produced improvements in functional scores and a low complication rate when used for treating glenohumeral instability associated with Hill-Sachs lesions.

Resultados do procedimento artroscópico de "remplissage" na luxação anterior recidivante do ombro / Results from filling \"remplissage\" arthroscopic technique for recurrent anterior shoulder dislocation

OBJETIVO: Avaliar o resultado clínico da técnica de "remplissage" associada ao reparo da lesão de Bankart (BK) para o tratamento da luxação anterior recidivante do ombro. MÉTODOS: Nove pacientes (10 ombros), com seguimento médio de 13,7 meses, apresentaram luxação traumática anterior recidivante do ombro. Todos tinham lesão de BK associada à lesão de Hill e Sachs (HS), com sinal do "encaixe". O defeito das lesões de HS foi medido e apresentava em média 17,3 por cento (7,7 por cento a 26,7 por cento) de perda óssea em relação ao diâmetro da cabeça do úmero. Todos foram submetidos ao reparo artroscópico da lesão de BK associado ao preenchimento ("remplissage") da lesão de HS pela tenodese do infraespinal. RESULTADOS: O escore de Rowe variou de 22,5 (10 a 45) no período pré-operatório para 80,5 (5 a 100) no período pós operatório (p < 0,001). O escore da UCLA variou de 18,0 (8 a 29) para 31,1 (21 a 31) (p < 0,001). As medidas das rotações externa e interna, em 90º de abdução no período pós-operatório, foram 63,5º (45º a 90º) e 73º (50º a 92º), respectivamente. Dois pacientes apresentaram recidiva (um com luxação e outro com subluxações). Nenhum paciente apresentou dor na topografia do tendão infraespinal no período pós-operatório. CONCLUSÃO: A técnica de "remplissage" por artroscopia demonstrou, a curto prazo, melhora dos escores funcionais e baixo índice de complicações no tratamento da instabilidade glenoumeral associada às lesões de Hill-Sachs.

OBJECTIVE: To evaluate the clinical result from the filling ("remplissage") technique in association with Bankart lesion repair for treating recurrent anterior shoulder dislocation. METHODS: Nine patients (10 shoulders), with a mean follow-up of 13.7 months, presented traumatic recurrent anterior shoulder dislocation. All of them had a Bankart lesion, associated with a Hill-Sachs lesion showing the "engaging" sign. The Hill-Sachs lesion defect was measured and showed an average bone loss of 17.3 percent (7.7 percent to 26.7 percent) in relation to the diameter of the humeral head. All the cases underwent arthroscopic repair of the Bankart lesion, together with filling of the Hill-Sachs lesion by means of tenodesis of the infraspinatus. RESULTS: The Rowe score ranged from 22.5 (10 to 45) before the operation to 80.5 (5 to 100) after the operation (p < 0.001). The UCLA score ranged from 18.0 (8 to 29) to 31.1 (21 to 31) (p < 0.001). The measurements of external and internal rotation at abduction of 90º after the operation were 63.5º (45º to 90º) and 73º (50º to 92º) respectively. Two patients presented recurrence (one with dislocation and the other with subluxation). None of the patients presented pain in the region of the infraspinatus tendon after the operation. CONCLUSION: Over the short term, the filling ("remplissage") arthroscopic technique produced improvements in functional scores and a low complication rate when used for treating glenohumeral instability associated with Hill-Sachs lesions.

Seqüestro pulmonar extralobar: análise anatomopatológica de dois casos em natimortos e revisão da literatura / Extralobar pulmonary sequestration: anatomical analysis of two cases in stillbirths and review of literature

O seqüestro pulmonar é definido como uma massa anormal de tecido pulmonar sem comunicação com a árvore brônquica. É anomalia rara, responsável por 0,15-6,45 por cento das malformações pulmonares congênitas. Quando possui revestimento pleural próprio, chama-se seqüestro pulmonar extralobar (SPE). Este trabalho descreve dois casos de SPE em natimortos (NM) com 32 (1) e 34 (2) semanas de gestação com diagnóstico clínico de hipoxia intra-uterina e adenomatose cística, respectivamente, e faz revisão da literatura. O diagnóstico envolveu análise ultra-sonográfica, sindrômica, macroscópica e microscópica dos NM. Foi observada massa supradiafragmática no hemitórax esquerdo ligada à aorta torácica (1) e ao diafragma (2). As MFs associadas foram agenesia tímica (2), hipoplasia pulmonar (2), pé torto congênito (1) e acondroplasia de membros (2). A microscopia evidenciou, nos dois casos, tecido pulmonar imaturo e pedículo vascularizado e inervado.

Pulmonary sequestration represents an abnormal pulmonary mass that does not communicate with the tracheobronchial tree. It is a rare malformation (MF), accountable for 0.15 percent-6.45 percent of pulmonary congenital MFs. When it has its own pleural covering, it is called extralobar (EBPS). This work describes two cases of EBPS in stillbirths (SB), at 32 (1) and 34 (2) weeks' gestation, with clinical diagnosis of intrauterine hypoxia and cystic adenomatosis, respectively. It also reviews the literature on the subject. The diagnosis involved ultrasonographic, syndromic, macroscopic and microscopic analysis. The macroscopy showed a supradiaphragmatic mass in the left hemithorax linked to thoracic aorta (1) and diaphragm (2). The associated MFs were: thymic agenesis (2), pulmonary hypoplasia (2), clubfoot (1) and achondroplasia (2). Microscopy demonstrated, in both cases, immature pulmonary tissue and vascularized and innervated pedicle.