Spinal Cord Stimulation in Refractory Postherpetic Neuralgia in Portugal: A Case Report.

Postherpetic neuralgia is one of the most severe complications after herpes zoster infection. Patients who experience persistent pain despite conservative treatment may benefit from interventional therapies, such as spinal cord stimulation. We present the case of a patient with severe refractory postherpetic neuralgia in the right T8 to L1 distribution who responded effectively to spinal cord stimulation. After its implantation, the patient had improvements in pain intensity, pain-related interference, quality of life, and satisfaction, with a simultaneous reduction of previous medications. This case report highlights the role of spinal cord stimulation in refractory neuropathic pain secondary to herpes zoster.

Activation of gelatinases in permanent human teeth after different experimental radiotherapy protocols.

The objective of this study was to compare the activation of gelatinases in dentin-enamel junction (DEJ) and underlying dentin of permanent teeth after experimental radiotherapy in conventional and hypofractionated modalities. Newly extracted third molars (n = 15) were divided into three experimental radiotherapy groups: control, conventional (CR), and hypofractionated (HR) (n = 5 per group). After in vitro exposure to ionizing radiation, following standardized protocols for each modality, a gelatinous substrate was incubated on the tooth slices (n = 10 per group). Activation of gelatinases was measured by in situ zymography, expressed in arbitrary fluorescence units (mm2) from three tooth regions: cervical, cuspal, and pit. Fluorescence intensity was compared among radiotherapy protocols and tooth regions in each protocol, considering a significance level of 5%. Considering all tooth regions, the fluorescence intensity of the CR group was higher than the HR and control groups, both in DEJ and underlying dentin (p <0.001). In addition, the fluorescence intensity was higher in underlying dentin when compared to DEJ in all groups (p <0.001). Considering each tooth region, a statistically significant difference between CR and HR was only observed in the pit region of underlying dentin (p <0.001). Significant and positive correlations between fluorescence intensities in DEJ and underlying dentin were also observed (p <0.001). Experimental radiotherapy influenced the activation of gelatinases, as well as exposure to the conventional protocol can trigger a higher activation of gelatinases when compared to hypofractionated, both in DEJ and underlying dentin.

Optimizing the Integration of Microwave Processing and Enzymatic Extraction to Produce Polyphenol-Rich Extracts from Olive Pomace.

The integration of green technologies such as microwave- and enzyme-assisted extraction (MEAE) has been shown to improve the extraction efficiency of bioactive compounds while reducing processing time and costs. MEAE using tannase alone (MEAE-Tan), or in combination with cellulase and pectinase (MEAE-Tan-Cel-Pec), was optimized to produce enriched phenolic and antioxidant extracts from olive pomace. The individual and integrated impact of enzyme concentration, temperature, and pomace/water ratio were determined using a central composite rotatable design. Optimal extraction conditions for MEAE-Tan (60 °C, 15 min, 2.34% of enzyme (w/w), and 1:15 pomace/water ratio) and MEAE-Tan-Cel-Pec (46 °C, 15 min, 2% of enzymes (w/w), in the proportion of 1:1:1, and 1:20 pomace/water ratio) resulted in extracts containing 7110.6 and 2938.25 mg GAE/kg, respectively. The antioxidant activity of the extracts was correlated with phenolic acid release, which was enzyme-dependent, as determined with HPLC-DAD analysis. Enzyme selection had a significant impact on the phenolic profile of extracts, with tannase releasing high concentrations of chlorogenic acid and the combined use of enzymes releasing high concentrations of hydroxytyrosol and chlorogenic and ferulic acids. The novelty of this study relies on the integration and optimization of two green technologies (microwave- and enzyme-assisted extraction) to improve the extraction efficiency of bioactive phenolics from olive pomace while reducing processing time and costs. While these techniques have been evaluated isolated, the benefits of using both processing strategies simultaneously remain largely unexplored. This study demonstrates the effectiveness of the integration and processing optimization of two environmentally friendly technologies as a promising alternative to treat agro-industrial byproducts.

Bioaccessibility Evaluation of Soymilk Isoflavones with Biotransformation Processing.

Soy isoflavones are considered important sources of bioactive compounds, but they are poorly absorbable, due to their large hydrophilic structures. Some biotransformation strategies have been used to convert the glycosidic form into aglycones, making them available for absorption. This study evaluated the potential of enzymatic and/or microbial fermentation combined bioprocesses in a soymilk extract before and after gastrointestinal in vitro digestion. Commercial ß-glucosidase (ET) and a mix of commercial probiotics (F) containing Lactobacillus acidophilus, Lactobacillus casei, Lactococcus lactis, Bifidobacterium bifidum, and Bifidobacterium lactis were used to biotransform the soymilk phenolic extract. An isoflavone profile was identified using HPLC-DAD, total phenolic content was identified using the Folin-Ciocalteu test, and antioxidant capacity was identified using ORAC and FRAP. Soymilk enzymatically treated (ET) followed by microbial fermentation (ET + T) resulted in better conversion of glycosylated isoflavones (6-fold lower than control for daidzin and 2-fold for genistin) to aglycones (18-fold greater than control for dadzein and genistein). The total phenolic content was increased (3.48 mg/mL for control and 4.48 mg/mL for ET + T) and the antioxidant capacity was improved with treatments of ET + T (120 mg/mL for control and 151 mg/mL with ORAC) and with FRAP (285 µL/mL for control and 317 µL/mL). After the in vitro digestion, ET + T samples resulted in a higher content of genistein (two-fold higher than control); also, increases in the total phenolic content (2.81 mg/mL for control and 4.03 mg/mL for ET + T) and antioxidant capacity measured with ORAC were greater compared to undigested samples. In addition, the isolated microbial fermentation process also resulted in positive effects, but the combination of both treatments presented a synergistic effect on soy-based products.

Lessons learned from the COVID-19 pandemic for improved influenza control.

The World Health Organization noted that COVID-19 vaccination programmes could be leveraged to deliver influenza vaccination. In 2008, the International Federation of Pharmaceutical Manufacturers and Associations' (IFPMA) Influenza Vaccine Supply International Task Force (IVS) developed a survey method using the number of influenza vaccine doses distributed globally to estimate vaccination coverage rates. Seven hundred and ninety-seven million doses were distributed in 2021, representing a 205% increase over the 262 million doses distributed in 2004, exceeding the number of doses distributed during and after the 2009-2010 influenza pandemic. The most obvious explanation for the global increase is the enabling of critical elements of the vaccine ecosystem by decision-makers during the COVID-19 pandemic to reinforce implementation of influenza vaccination programs. Most of the improvements in performance of influenza programs during the COVID-19 pandemic can be classified in four categories: 1) promoting vaccination using tailored approaches for specific populations; 2) improving convenient access to influenza vaccines in COVID-safe settings; 3) improving reimbursement of seasonal influenza vaccination for priority groups; 4) maintaining the timing of vaccination to the autumn. In spite of the increase in rates of seasonal influenza vaccines distributed during the COVID-19 pandemic, globally, the rate of influenza dose distribution is sub-optimal, and a considerable proportion of the influenza infections remains preventable. To sustain the benefits from increased uptake of influenza vaccines, governments need to sustain the efforts made during the COVID-19 pandemic, and a number of global policy endeavours should be undertaken, including developing a clear global roadmap for achieving influenza control objectives, adopted by a WHA resolution, in line with the strategic objective 3 of the Global Influenza Strategy 2030, embedded in the Immunization Agenda 2030 (IA2030).

[Guidelines for the Diagnosis and Treatment of Spontaneous Intracranial Hypotension]. / Protocolo de Abordagem Diagnóstica e Terapêutica da Hipotensão Intracraniana Espontânea.

Spontaneous intracranial hypotension (SIH) is a syndrome characterized by disabling orthostatic headache, due to reduced cerebrospinal fluid (CSF) volume probably caused by a CSF fistula. It affects mostly women of working-age, although it is probably underdiagnosed. The aim of this article is to present a practical approach to the diagnosis and treatment of SIH. After a description of its symptoms and signs, we present a step-by-step approach to the confirmation of the diagnosis and treatment, considering different clinical scenarios. This is intended to guide clinical decision making, through a systematized and individualized management, aimed at the best interest of the patient.

A hipotensão intracraniana espontânea (HIE) é uma síndrome caracterizada por cefaleia ortostática incapacitante, fruto de uma redução do volume de líquido cefalorraquidiano (LCR) provavelmente causada por uma fístula de LCR. Afeta sobretudo mulheres em idade ativa, estando provavelmente subdiagnosticada. Este protocolo visa apresentar uma proposta de abordagem prática ao diagnóstico e tratamento da HIE. Após uma secção descritiva das manifestações clínicas da HIE, apresentamos um modelo de atuação passo-a-passo para a confirmação do seu diagnóstico e tratamento, considerando diferentes cenários clínicos. Pretende-se, assim, facilitar a decisão clínica através de uma conduta sistematizada e individualizada, visando o melhor interesse do doente.

Microbial Lipid Based Biorefinery Concepts: A Review of Status and Prospects.

The use of lignocellulosic biomass as a raw material for the production of lipids has gained increasing attention, especially in recent years when the use of food in the production of biofuels has become a current technology. Thus, the competition for raw materials for both uses has brought the need to create technological alternatives to reduce this competition that could generate a reduction in the volume of food offered and a consequent commercial increase in the value of food. Furthermore, the use of microbial oils has been studied in many industrial branches, from the generation of renewable energy to the obtainment of several value-added products in the pharmaceutical and food industries. Thus, this review provides an overview of the feasibility and challenges observed in the production of microbial lipids through the use of lignocellulosic biomass in a biorefinery. Topics covered include biorefining technology, the microbial oil market, oily microorganisms, mechanisms involved in lipid-producing microbial metabolism, strain development, processes, lignocellulosic lipids, technical drawbacks, and lipid recovery.

Iodinated Contrast Enhancement of Breast Cancer on Prone Multidetector Computed Tomography-Preliminary Findings.

OBJECTIVES: Contrast-enhanced breast imaging has gained increasing importance in the diagnosis and management of breast cancer. The aim of this study was to assess breast cancer enhancement after contrast administration on prone multidetector computed tomography (MDCT). MATERIALS AND METHODS: This retrospective, unicentric, institutional review board-approved study included patients with newly diagnosed breast cancer who were submitted to contrast-enhanced MDCT in prone position, with image acquisition before and after nonionic iodinated contrast administration. RESULTS: Sixty breast cancer patients aged between 31 and 74 years (mean, 49 years) were included. Most patients (n = 50, 83.3%) had no special type invasive breast carcinoma and luminal subtype (n = 45, 75%). All index breast tumors were identified on prone MDCT. Forty-three cases (70.5%) presented as mass, 13 (21.3%) as nonmass enhancement and 4 (6.6%) as both mass and nonmass enhancement. Mean tumor density was 37.8 HU and 87.9 HU on precontrast and postcontrast images, respectively. Mean contrast enhancement was 50.2 HU (range, 20-109 HU). There were no statistically significant differences in tumor enhancement according to histological type, molecular subtype, nuclear grade, tumor size, or imaging presentation. CONCLUSIONS: Our results show that breast cancer usually can be identified and have significant contrast enhancement on prone MDCT images. This method could be used as an alternative when other contrast-enhanced breast imaging methods are not available.

Activation of gelatinases in permanent human teeth after different experimental radiotherapy protocols

Abstract The objective of this study was to compare the activation of gelatinases in dentin-enamel junction (DEJ) and underlying dentin of permanent teeth after experimental radiotherapy in conventional and hypofractionated modalities. Newly extracted third molars (n = 15) were divided into three experimental radiotherapy groups: control, conventional (CR), and hypofractionated (HR) (n = 5 per group). After in vitro exposure to ionizing radiation, following standardized protocols for each modality, a gelatinous substrate was incubated on the tooth slices (n = 10 per group). Activation of gelatinases was measured by in situ zymography, expressed in arbitrary fluorescence units (mm2) from three tooth regions: cervical, cuspal, and pit. Fluorescence intensity was compared among radiotherapy protocols and tooth regions in each protocol, considering a significance level of 5%. Considering all tooth regions, the fluorescence intensity of the CR group was higher than the HR and control groups, both in DEJ and underlying dentin (p <0.001). In addition, the fluorescence intensity was higher in underlying dentin when compared to DEJ in all groups (p <0.001). Considering each tooth region, a statistically significant difference between CR and HR was only observed in the pit region of underlying dentin (p <0.001). Significant and positive correlations between fluorescence intensities in DEJ and underlying dentin were also observed (p <0.001). Experimental radiotherapy influenced the activation of gelatinases, as well as exposure to the conventional protocol can trigger a higher activation of gelatinases when compared to hypofractionated, both in DEJ and underlying dentin.

Resumo O objetivo deste estudo foi comparar a ativação de gelatinases na junção dentina-esmalte (DEJ) e na dentina subjacente de dentes permanentes após a radioterapia experimental nas modalidades convencional e hipofracionada. Os terceiros molares recém-extraídos (n = 15) foram divididos em três grupos de radioterapia experimental: controle, convencional (CR) e hipofracionada (HR) (n = 5 por grupo). Após a exposição in vitro à radiação ionizante, seguindo protocolos padronizados para cada modalidade, um substrato gelatinoso foi incubado nas fatias de dente (n = 10 por grupo). A ativação das gelatinases foi medida por zimografia in situ, expressa em unidades arbitrárias de fluorescência (mm2) de três regiões do dente: cervical, cúspide e fossa. A intensidade da fluorescência foi comparada entre os protocolos de radioterapia e as regiões do dente em cada protocolo, considerando um nível de significância de 5%. Considerando todas as regiões do dente, a intensidade de fluorescência do grupo CR foi maior do que a dos grupos HR e controle, tanto no DEJ quanto na dentina subjacente (p <0,001). Além disso, a intensidade da fluorescência foi maior na dentina subjacente quando comparada à DEJ em todos os grupos (p <0,001). Considerando cada região do dente, uma diferença estatisticamente significativa entre CR e HR foi observada apenas na região da fossa da dentina subjacente (p <0,001). Também foram observadas correlações significativas e positivas entre as intensidades de fluorescência no DEJ e na dentina subjacente (p <0,001). A radioterapia experimental influenciou a ativação das gelatinases, assim como a exposição ao protocolo convencional pode desencadear uma maior ativação das gelatinases quando comparada ao hipofracionamento, tanto no DEJ quanto na dentina subjacente.

Communication in radiology: evaluation of terminology and TNM descriptor use at a cancer center.

Objective: The purpose of our study was to evaluate the transmission of information from radiologists to physicians, focusing on the level of certainty and the use of imaging descriptors from the tumor-node-metastasis (TNM) staging system. Materials and Methods: Radiologists (n = 56) and referring physicians (n = 50) participated in this questionnaire-based, singlecenter study, conducted between March 20, 2020, and January 21, 2021. Participants were presented with terms commonly used by the radiologists at the institution and were asked to order them hierarchically in terms of the level of certainty they communicate regarding a diagnosis, using a scale ranging from 1 (most contrary to) to 10 (most favoring). They then assessed TNM system descriptors and their interpretation. Student's t-tests and the kappa statistic were used in order to compare the rankings of the terms of certainty. Items related to T and N staging were analyzed by Fisher's exact test. The confidence level was set to 97% (p < 0.03). Results: Although overall agreement among the radiologists and referring physicians on term ranking was poor (kappa = 0.10- 0.35), the mean and median values for the two groups were similar. Most of the radiologists and referring physicians (67% and 86%, respectively) approved of the proposal to establish a standard lexicon. Such a lexicon, based on the participant responses, was developed and graphically represented. Regarding the TNM system descriptors, there were significant differences between the two groups in the reporting of lymph node numbers, of features indicating capsular rupture, and of vessel wall irregularities, as well as in the preference for clear descriptions of vascular involvement. Conclusion: Our findings indicate that ineffective communication and differences in report interpretation between radiologists and referring physicians are still prevalent in the fields of radiology and oncology. Efforts to gain a better understanding of those impediments might improve the objectivity of reporting and the quality of care.

Objetivo: O propósito do nosso estudo foi analisar a transmissão das informações de radiologistas para médicos assistentes, com foco no nível de certeza e uso de descritores de imagem do sistema de estadiamento tumor­nódulo­metástase (TNM). Materiais e Métodos: Radiologistas (n = 56) e médicos assistentes (n = 50) participaram neste estudo unicêntrico, baseado em questionários respondidos entre 20 de março de 2020 e 21 de janeiro de 2021. Os participantes ordenaram hierarquicamente termos comumente usados por radiologistas da instituição para descrever o nível de certeza utilizando uma escala que variou de 1 (mais contrário) a 10 (mais favorável). Em seguida, foram avaliados os descritores relacionados ao sistema TNM e sua interpretação. O teste t de Student e o coeficiente de correlação kappa foram empregados para comparar a classificação dos termos. Os itens relacionados aos estadiamentos T e N foram analisados pelo teste exato de Fisher. O nível de confiança foi fixado em 97% (p < 0,03). Resultados: A concordância geral entre radiologistas e médicos assistentes na classificação hierárquica dos termos foi baixa (kappa = 0,10­0,35), porém, os valores médios e medianos dos dois grupos foram semelhantes. A maioria dos médicos (86%) e radiologistas (67%) foi receptiva à introdução de um léxico padronizado. Uma proposta de léxico foi elaborada com base nas respostas dos participantes e representada graficamente. Em relação aos descritores do sistema TNM, diferenças estatisticamente significativas foram observadas nos seguintes itens: forma de relatar o número de linfonodos; menção a características indicativas de ruptura capsular nodal; menção de irregularidades nas paredes vasculares; e preferência por descrições sucintas para comprometimento de estruturas vasculares. Conclusão: Falhas de comunicação e diferenças na interpretação de laudos entre radiologistas e médicos assistentes ainda são prevalentes em radiologia e oncologia. Esforços para melhor compreendê-los podem melhorar a objetividade do laudo radiológico e a qualidade do atendimento médico.

Easy Handling and Cost-Efficient Processing of a Tb3+-MOF: The Emissive Capacity of the Membrane-Immobilized Material, Water Vapour Adsorption and Proton Conductivity.

The development of convenient, non-complicated, and cost-efficient processing techniques for packing low-density MOF powders for industry implementation is essential nowadays. To increase MOFs' availability in industrial settings, we propose the synthesis of a novel 3D Tb-MOF (1) and a simple and non-expensive method for its immobilization in the form of pellets and membranes in polymethacrylate (PMMA) and polysulphone (PSF). The photoluminescent properties of the processed materials were investigated. To simulate industrial conditions, stability towards temperature and humidity have been explored in the pelletized material. Water-adsorption studies have been carried out in bulk and processed materials, and because of the considerable capacity to adsorb water, proton-conduction studies have been investigated for 1.

Adsorptive Capacity, Inhibitory Activity and Processing Techniques for a Copper-MOF Based on the 3,4-Dihydroxybenzoate Ligand.

Due to the fast, emerging development of antibiotic-resistant bacteria, the need for novel, efficient routes to battle these pathogens is crucial; in this scenario, metal-organic frameworks (MOFs) are promising materials for combating them effectively. Herein, a novel Cu-MOF-namely 1-that displays the formula [Cu3L2(DMF)2]n (DMF = N,N-dimethylformamide) is described, synthesized by the combination of copper(II) and 3,4-dihydroxybenzoic acid (H3L)-both having well-known antibacterial properties. The resulting three-dimensional structure motivated us to study the antibacterial activity, adsorptive capacity and processability of the MOF in the form of pellets and membranes as a proof-of-concept to evaluate its future application in devices.

Communication in radiology: evaluation of terminology and TNM descriptor use at a cancer center / Comunicação em radiologia: avaliação da terminologia e uso dos descritores TNM em um centro oncológico

Abstract Objective: The purpose of our study was to evaluate the transmission of information from radiologists to physicians, focusing on the level of certainty and the use of imaging descriptors from the tumor-node-metastasis (TNM) staging system. Materials and Methods Radiologists (n = 56) and referring physicians (n = 50) participated in this questionnaire-based, single-center study, conducted between March 20, 2020, and January 21, 2021. Participants were presented with terms commonly used by the radiologists at the institution and were asked to order them hierarchically in terms of the level of certainty they communicate regarding a diagnosis, using a scale ranging from 1 (most contrary to) to 10 (most favoring). They then assessed TNM system descriptors and their interpretation. Student's t-tests and the kappa statistic were used in order to compare the rankings of the terms of certainty. Items related to T and N staging were analyzed by Fisher's exact test. The confdence level was set to 97% (p < 0.03). Results: Although overall agreement among the radiologists and referring physicians on term ranking was poor (kappa = 0.10-0.35), the mean and median values for the two groups were similar. Most of the radiologists and referring physicians (67% and 86%, respectively) approved of the proposal to establish a standard lexicon. Such a lexicon, based on the participant responses, was developed and graphically represented. Regarding the TNM system descriptors, there were significant differences between the two groups in the reporting of lymph node numbers, of features indicating capsular rupture, and of vessel wall irregularities, as well as in the preference for clear descriptions of vascular involvement. Conclusion: Our findings indicate that ineffective communication and differences in report interpretation between radiologists and referring physicians are still prevalent in the fields of radiology and oncology. Efforts to gain a better understanding of those impediments might improve the objectivity of reporting and the quality of care.

Resumo Objetivo: O propósito do nosso estudo foi analisar a transmissão das informações de radiologistas para médicos assistentes, com foco no nível de certeza e uso de descritores de imagem do sistema de estadiamento tumor-nódulo-metástase (TNM). Materiais e Métodos: Radiologistas (n = 56) e médicos assistentes (n = 50) participaram neste estudo unicêntrico, baseado em questionários respondidos entre 20 de março de 2020 e 21 de janeiro de 2021. Os participantes ordenaram hierarquicamente termos comumente usados por radiologistas da instituição para descrever o nível de certeza utilizando uma escala que variou de 1 (mais contrário) a 10 (mais favorável). Em seguida, foram avaliados os descritores relacionados ao sistema TNM e sua interpretação. O teste t de Student e o coeficiente de correlação kappa foram empregados para comparar a classificação dos termos. Os itens relacionados aos estadiamentos T e N foram analisados pelo teste exato de Fisher. O nível de confança foi fixado em 97% (p < 0,03). Resultados: A concordância geral entre radiologistas e médicos assistentes na classificação hierárquica dos termos foi baixa (kappa = 0,10-0,35), porém, os valores médios e medianos dos dois grupos foram semelhantes. A maioria dos médicos (86%) e radiologistas (67%) foi receptiva à introdução de um léxico padronizado. Uma proposta de léxico foi elaborada com base nas respostas dos participantes e representada graficamente. Em relação aos descritores do sistema TNM, diferenças estatisticamente significativas foram observadas nos seguintes itens: forma de relatar o número de linfonodos; menção a características indicativas de ruptura capsular nodal; menção de irregularidades nas paredes vasculares; e preferência por descrições sucintas para comprometimento de estruturas vasculares. Conclusão: Falhas de comunicação e diferenças na interpretação de laudos entre radiologistas e médicos assistentes ainda são prevalentes em radiologia e oncologia. Esforços para melhor compreendê-los podem melhorar a objetividade do laudo radiológico e a qualidade do atendimento médico.

Relationship between anxiety and internet searches before percutaneous ultrasound-guided diagnostic procedures: A prospective cohort study.

Invasive procedures guided by ultrasound (US) are part of routine medical diagnostic investigation. The lack of knowledge surrounding the technical aspects of such procedures can lead patients to seek complementary information on the Internet, which may in turn trigger anxiety. However, the intersection between the fields of Radiology and Psychology is poorly studied. Here, we identify the profile of an anxious patient before an US-guided intervention. We prospectively studied 133 patients undergoing image-guided procedures. The State-Trait Anxiety Inventory (STAI) was applied for psychometry. Significantly higher anxiety scores were observed in female patients (p = .001), those who believed they had received inadequate information from their referring physician (p = .006), and in patients who considered online information unreliable or difficult to access (p = .007 and p = .001, respectively). Participants who defined themselves as proactive online reported lower anxiety levels (p = .003).

Automated Notification of Relevant Expected or Incidental Findings in Imaging Exams in a Verticalized Healthcare System.

To describe the implementation of a standardized code system for notification of relevant expected or incidental findings in imaging exams and use of an automated textual mining tool of radiological report narratives, created to facilitate directing patients to specific lines of care, reducing the waiting time for interventions, consultations, and minimizing delays to treatment. We report our 12-month initial experience with the process. A standardized code was attached to every radiology report when a relevant finding was observed. On a daily basis, the notifications was sent to a dedicated medical team to review the notified abnormality and decide a proper action. Between October 1, 2020, and September 30, 2021, 40,296 sectional examinations (CT and MR scans) were evaluated in 35,944 patients. The main findings reported were calcified plaques on the trunk of the left coronary artery or trunk like, pulmonary nodule/mass and suspected liver disease. Data of follow-up was available in 10,019 patients. The age ranged from 24 to 101 years (mean of 71.3 years) and 6,626 were female (66.1%). In 2,548 patients a complementary study or procedure was indicated, and 3,300 patients were referred to a specialist. Customized database searches looking for critical or relevant findings may facilitate patient referral to specific care lines, reduce the waiting time for interventions or consultations, and minimize delays to treatment.

Creatine improves anaerobic performance and promotes anthropometric changes in Brazilian college soccer players / La creatina mejora el rendimiento anaeróbico y promueve cambios antropométricos en futbolistas universitarios brasileños

Objective: This study aimed to evaluate the effects of creatine on the body composition and performance of college soccer players. Materials and method: Sixteen amateur soccer players were supplemented with creatine (n=8) or maltodextrin (placebo, n=8) for four weeks, using a loading protocol (20g/day in the first week, followed by 5g/day for the rest of the study period). Anthropometric measurements and three physical tests were performed before and after the intervention. Results: After the protocol, the Cr group showed increased body mass (pre 65.1 ± 8.2; post 66.4 ± 8.4; p=0.002), arm (pre 27.7 ± 4.3; post 28.3 ± 4.3; p=0.01), thigh (pre 49.9 ± 4.3; post 51.3 ± 4.6; p=0.012), and leg (pre 34.6 ± 2.3; post 34.8 ± 2.4; p=0.029) circumferences. For bangsbo repeat vertical jump test (BRVJ), there was an increase in maximum power (pre 2965.4 ± 691.8; post 3102.1 ± 818; p=0.034), maximum relative power (pre 44.5 ± 6.5; post 47.1 ± 6.5; p=0.045) and average power (pre 2757.6 ± 653.2; post 2937.7 ± 739.9; p=0.05) only in the Cr group. For running anaerobic sprint test (RAST), there was a significant improvement in average sprint and total times, and in the average power for both groups; however, only the Cr group showed significant improvement in maximum power (pre 517.93 ± 118.82; post 580.15 ± 119.06; p=0.01) and maximum relative power (pre 7.9 ± 1.2; post 8.5 ± 1.3; p<0.001). For wingate test (WIN), improvements were observed in maximum power (pre 456.4 ± 91.0; post 508 ± 79.7; p=0.003), maximum relative power (pre 7.0 ± 0.9; post 7.6 ± 0.6; p=0.012), average power (pre 354.8 ± 69.5; post 410 ± 71.5; p<0.001) and relative average power (pre 5.4 ± 0.6; post 6.1 ± 0.4; p=0.012) only in the Cr group.(AU)

Objetivo: Evaluar los efectos de la creatina en la composición corporal y el rendimiento anaeróbico en jugadores de fútbol universitario. Material y método: Dieciséis jugadores fueron suplementados con creatina (Cr) (n=8) o maltodextrina (placebo, n=8) durante cuatro semanas, utilizando un protocolo de carga (20g/día la primera semana, seguidos de 5g/día durante el resto del período de estudio), realizándose mediciones antropométricas y tres pruebas físicas anaeróbicas antes y después de la intervención. Resultados: El grupo Cr mostró un aumento en las circunferencias del brazo (antes 27,7 ± 4,3; después 28,3 ± 4,3; p=0,01), muslo (antes 49,9 ± 4,3; después 51,3 ± 4,6; p=0,012) y pierna (antes 34,6 ± 2,3; después 34,8 ± 2,4; p=0,029) y aumento en la masa corporal (antes 65,1 ± 8,2; después 66,4 ± 8,4; p=0,002). No se registraron cambios significativos en el grupo placebo. En la prueba de saltos verticales repetidos (Test de Bangsbo) hubo un aumento en la potencia máxima (antes 2965,4 ± 691,8; después 3102,1 ± 818; p=0,034), relativa máxima (antes 44,5 ± 6,5; después 47,1 ± 6,5; p=0,045) y media (antes 2757,6 ± 653,2; después 2937,7 ± 739,9; p=0.05) solo en el grupo Cr. En la prueba de carrera (RAST), hubo una mejora significativa en los tiempos de sprint total y promedio, y en la potencia promedio para ambos grupos; sin embargo, únicamente el grupo Cr mostró una mejora significativa en la potencia máxima (antes 517,93 ± 118,82; después 580,15 ± 119,06; p=0,01) y máxima relativa (antes 7,9 ± 1,2; después 8,5 ± 1,3; p<0,001). Para la prueba de Wingate en miembros superiores, se observaron mejoras en potencia máxima (antes 456,4 ± 91,0; después 508 ± 79,7; p=0,003), relativa máxima (antes 7,0 ± 0,9; después 7,6 ± 0,6; p=0,012), media (antes 354,8 ± 69,5; después 410 ± 71,5; p<0,001) y potencia relativa media (antes 5,4 ± 0,6; después 6,1 ± 0,4; p=0,012) solo en el grupo Cr.(AU)