Current Concepts in Early Mobilization of Critically Ill Patients Within the Context of Neurologic Pathology.

Neurocritical patients (NCPs) in the intensive care unit (ICU) rapidly progress to respiratory and peripheral muscle dysfunctions, which significantly impact morbidity and death. Early mobilization in NCPs to decrease the incidence of ICU-acquired weakness has been showing rapid growth, although pertinent literature is still scarce. With this review, we summarize and discuss current concepts in early mobilization of critically ill patients within the context of neurologic pathology in NCPs. A narrative synthesis of literature was undertaken trying to answer the following questions: How do the respiratory and musculoskeletal systems in NCPs behave? Which metabolic biomarkers influence physiological responses in NCPs? Which considerations should be taken when prescribing exercises in neurocritically ill patients? The present review detected safety, feasibility, and beneficial response for early mobilization in NCPs, given successes in other critically ill populations and many smaller intervention trials in neurocritical care. However, precautions should be taken to elect the patient for early care, as well as monitoring signs that indicate interruption for intervention, as worse outcomes were associated with very early mobilization in acute stroke trials.

Doenças crônicas não transmissíveis e motivação para estilo de vida saudável em mulheres adultas / Noncommunicable chronic diseases and motivation for a healthy lifestyle in adult women

Analisar a associação entre a presença de Doenças Crônicas Não Transmissíveis (DCNT) e a Motivação para o Estilo de Vida Saudável (MEVS) em mulheres adultas. Estudo transversal e analítico realizado em 12 Unidades de Atenção Primária à Saúde, com 691 mulheres adultas. Utilizaram-se um questionário para a caracterização sociodemográfica e clínica da amostra e Questionário sobre a Motivação para a Prática de Estilo de Vida Saudável (QMEVS). Maior porcentagem de hipertensão arterial dentre as DCNT estudadas (12,9%); não houve associação entre a motivação e presença de DCNT (p = 0,270); DCNT associaram-se significativamente à motivação extrínseca e intrínseca (p = 0,008; p = 0,020). Mulheres com DCNT têm mais chances de motivação extrínseca e menos chances de motivação intrínseca (1,98 e 0,5 vezes, respectivamente). Não houve associação entre amotivação e DCNT. Mulheres com DCNT têm mais chances de desenvolverem motivação extrínseca e menos chances de motivação intrínseca.

To analyze the association between the presence of Chronic Noncommunicable Diseases (CNCDs) and the motivation for a Healthy Lifestyle (HL) in adult women. Cross-sectional and analytical study carried out in 12 Primary Health Care Units, with 691 adult women. A Questionnaire for the sociodemographic and clinical characterization of the sample and a Questionnaire on the Motivation for the Practice of a Healthy Lifestyle (QMEVS) were used. There was a higher percentage of arterial hypertension among the CNCDs studied (12.9%); there was no association between a motivation and the presence of CNCDs (p = 0.270); CNCDs were significantly associated with extrinsic and intrinsic motivation (p = 0.008; p = 0.020). Women with CNCDs are more likely to have extrinsic motivation and less chance of intrinsic motivation (1.98 and 0.5 times, respectively). There was no association between a motivation and CNCDs. Women with CNCDs are more likely to develop extrinsic motivation and less chance of intrinsic motivation.

Contrasting leaf intercellular space development in sorghum and maize modulates different tolerance capacity to water limitation.

The objective of this study was to evaluate the relationship between intercellular spaces and leaf gas exchange and the effect of total intercellular space on the growth of maize and sorghum under water restriction. The experiments were conducted in a greenhouse in a 2 × 3 factorial arrangement (two plant types and three water conditions: field capacity (FC = 100%), 75%FC, and 50%FC) with 10 replicates. The lack of water was a limiting factor for maize because it showed reductions in leaf area, leaf thickness, biomass, and gas exchange parameters, while sorghum remained unchanged, maintaining its water-use efficiency. This maintenance was correlated with the growth of intercellular spaces in sorghum leaves because the increased internal volume led to better CO2 control and prevented excessive water loss under drought stress. In addition, sorghum had more stomata than maize. These characteristics contributed to the drought tolerance of sorghum, while maize could not make the same adjustments. Therefore, changes in intercellular spaces promoted adjustments to avoid water loss and may have improved CO2 diffusion, characteristics that are important for drought-tolerant plants.

Addition of respiratory exercises to conventional rehabilitation for children and adolescents with cerebral palsy: a systematic review and meta-analysis.

BACKGROUND: Respiratory dysfunctions are an important cause of morbidity and death in cerebral palsy (CP) populations. Respiratory exercises in addition to conventional rehabilitation have been suggested to improve respiratory status in CP patients. The objective of this systematic review and meta-analysis was to verify the effects of the addition of respiratory exercises to conventional rehabilitation on pulmonary function, functional capacity, respiratory muscle strength, gross motor function and quality of life in children and adolescents with CP. METHODS: We searched for randomized controlled clinical trials in PubMed/Medline, Lilacs, SciELO, EMBASE and Physiotheraphy Evidence (PEDro) from their inception until July 2022 without language restrictions. Studies that included respiratory exercises (breathing exercise program; feedback respiratory training; incentive spirometer exercise; inspiratory muscle training; and combination of respiratory exercises + incentive spirometer exercise) in combination with conventional rehabilitation for children and adolescents with CP were evaluated by two independent reviewers. The mean difference (MD) and 95% confidence interval (CI) were estimated by random effect models. RESULTS: Ten studies met the eligibility criteria, including 324 children aged from 6 to 16 years. The meta-analysis showed an improvement in inspiratory muscle strength of 22.96 cmH2O (18.63-27.27, n = 55) and pulmonary function of 0.60 (0.38-0.82, n = 98) for forced vital capacity (L); 0.22 (0.06-0.39, n = 98) for forced expiratory volume at 1 second (L); and 0.50 (0.05-0.04, n = 98) for peak expiratory flow (L/min). Functional skills in daily living activities improved in the intervention group. Caregivers' assistance of daily living activities, functional capacity, gross motor function and expiratory muscle strength showed a nonsignificant improvement. Social well-being and acceptance and functioning domains improved in only one study. CONCLUSIONS: Emerging data show significant enhancements in inspiratory muscle strength and pulmonary function in CP patients after respiratory training in addition to conventional rehabilitation. There is no consensus on the frequency, type or intensity of respiratory exercises for children with and adolescents with CP.

Diazotrophic bacteria improve Hymenaea courbaril seedlings growth and survival in iron mine tailings.

One of the largest accidents with mine tailings happened in Brazil in 2015, with the rupture of the Fundão dam, and the physical characteristics of these tailings make it difficult to recover degraded areas. Hymenaea courbaril is a tree species native to Brazil that has low nutritional and water requirements, besides its capacity for survival in contaminated environments. In this study we hypothesized that inoculation with diazotrophs would improve the growth and physiology of H. courbaril in tailings, favoring the reforestation process aiming the recovery of the accident site. Every 20 days for 60 days, we investigated the morphophysiology of H. courbaril grown in iron mine tailings or soil, with the addition of nitrate (N-positive control), non-inoculation (negative control) or inoculation with native diazotrophic bacteria previously isolated from the tailings (UNIFENAS100-569; UNIFENAS100-654 and UNIFENAS100-638). We found that H. courbaril has survival capacity under mine tailings, with no growth alteration in the tailings, although there were signs of reduced ability for photoprotective responses. Inoculation with diazotrophic bacteria improved physiological aspects of H. courbaril and strain UNIFENAS100-638 was the most effective in favoring total growth of plants, net photosynthetic rate and root morphology under mine tailings. The survival capacity and growth of H. courbaril indicates the possibility of its use for reforestation in areas degraded by mine tailings. Further studies are necessary in field conditions and with a larger experimental period to more thoroughly understand H. courbaril tolerance.

Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in preterm infants supported by noninvasive ventilation. / Alternância de máscara nasal com pronga nasal reduz a incidência de lesão nasal moderada a grave em prematuros em uso de ventilação não invasiva.

OBJECTIVE: To investigate the association between noninvasive ventilation delivery devices and the incidence of nasal septum injury in preterm infants. METHODS: This retrospective singlecenter cohort study included preterm infants supported by noninvasive ventilation. The incidence of nasal injury was compared among three groups according to the noninvasive ventilation delivery device (G1 - nasal mask; G2 - binasal prongs; and G3, rotation of nasal mask with prongs). Nasal injury was classified according to the National Pressure Ulcer Advisory Panel as stages 1 - 4. Multivariate regression analyses were performed to estimate relative risks to identify possible predictors associated with medical device-related injuries. RESULTS: Among the 300 infants included in the study, the incidence of medical device-related injuries in the rotating group was significantly lower than that in the continuous mask or prong groups (n = 68; 40.48%; p value < 0.01).The basal prong group presented more stage 2 injuries (n = 15; 55.56%; p < 0.01). Staying ≥ 7 days in noninvasive ventilation was associated with a higher frequency of medical device-related injuries, regardless of device (63.81%; p < 0.01). Daily increments in noninvasive ventilation increased the risk for nasal injury by 4% (95%CI 1.02 - 1.06; p < 0.01). Higher birth weight indicated protection against medical device-related injuries. Each gained gram represented a decrease of 1% in the risk of developing nasal septum injury (RR: 0.99; 95%CI 0.99 - 0.99; p < 0.04). CONCLUSION: Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in comparison with single devices. The addition of days using noninvasive ventilation seems to contribute to medical device-related injuries, and higher birth weight is a protective factor.

OBJETIVO: Investigar a relação entre dispositivos de ventilação não invasiva e incidência de lesão do septo nasal em recém-nascidos pré-termo. MÉTODOS: Este estudo de coorte retrospectivo e unicêntrico incluiu prematuros em uso de ventilação não invasiva. A incidência de lesão nasal foi comparada entre três grupos, de acordo com o dispositivo de ventilação não invasiva (G1 para máscara nasal; G2 para prongas binasais e G3 para alternância entre máscaras e prongas nasais). As lesões nasais foram classificadas de acordo com o National Pressure Ulcer Advisory Panel como estágios 1 - 4. Foram realizadas análises de regressão multivariada para estimar os riscos relativos, a fim de identificar possíveis preditores associados a lesões relacionadas a dispositivos médicos. RESULTADOS: Entre os 300 lactentes incluídos no estudo, a incidência de lesões relacionadas a dispositivos médicos no grupo em uso alternado foi significativamente menor do que a nos grupos de máscara ou prongas de uso contínuo (n = 68; 40,48%; valor de p < 0,01).O grupo de prongas nasais apresentou mais lesões de estágio 2 (n = 15; 55,56%; p < 0,01). A permanência ≥ 7 dias em ventilação não invasiva foi associada a maior incidência de lesões relacionadas a dispositivos médicos, independentemente do dispositivo (63,81%; p < 0,01). Os incrementos diários na ventilação não invasiva aumentaram o risco de lesões nasais em 4% (IC95% 1,02 - 1,06; p < 0,01). Um maior peso ao nascer indicou proteção contra lesões relacionadas a dispositivos médicos. Cada grama extra representou diminuição de 1% no risco de desenvolver lesão do septo nasal (RR: 0,99; IC95% 0,99 - 0,99; p < 0,04). CONCLUSÃO: A alternância entre máscaras e prongas nasais reduz a incidência de lesão nasal moderada a grave em comparação com dispositivos únicos. O incremento de dias em uso de ventilação não invasiva parece contribuir para lesões relacionadas a dispositivos médicos, e um maior peso ao nascer é um fator de proteção.

Alternância de máscara nasal com pronga nasal reduz a incidência de lesão nasal moderada a grave em prematuros em uso de ventilação não invasiva / Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in preterm infants supported by noninvasive ventilation

RESUMO Objetivo: Investigar a relação entre dispositivos de ventilação não invasiva e incidência de lesão do septo nasal em recém-nascidos pré-termo. Métodos: Este estudo de coorte retrospectivo e unicêntrico incluiu prematuros em uso de ventilação não invasiva. A incidência de lesão nasal foi comparada entre três grupos, de acordo com o dispositivo de ventilação não invasiva (G1 para máscara nasal; G2 para prongas binasais e G3 para alternância entre máscaras e prongas nasais). As lesões nasais foram classificadas de acordo com o National Pressure Ulcer Advisory Panel como estágios 1 - 4. Foram realizadas análises de regressão multivariada para estimar os riscos relativos, a fim de identificar possíveis preditores associados a lesões relacionadas a dispositivos médicos. Resultados: Entre os 300 lactentes incluídos no estudo, a incidência de lesões relacionadas a dispositivos médicos no grupo em uso alternado foi significativamente menor do que a nos grupos de máscara ou prongas de uso contínuo (n = 68; 40,48%; valor de p < 0,01). O grupo de prongas nasais apresentou mais lesões de estágio 2 (n = 15; 55,56%; p < 0,01). A permanência ≥ 7 dias em ventilação não invasiva foi associada a maior incidência de lesões relacionadas a dispositivos médicos, independentemente do dispositivo (63,81%; p < 0,01). Os incrementos diários na ventilação não invasiva aumentaram o risco de lesões nasais em 4% (IC95% 1,02 - 1,06; p < 0,01). Um maior peso ao nascer indicou proteção contra lesões relacionadas a dispositivos médicos. Cada grama extra representou diminuição de 1% no risco de desenvolver lesão do septo nasal (RR: 0,99; IC95% 0,99 - 0,99; p < 0,04). Conclusão: A alternância entre máscaras e prongas nasais reduz a incidência de lesão nasal moderada a grave em comparação com dispositivos únicos. O incremento de dias em uso de ventilação não invasiva parece contribuir para lesões relacionadas a dispositivos médicos, e um maior peso ao nascer é um fator de proteção.

ABSTRACT Objective: To investigate the association between noninvasive ventilation delivery devices and the incidence of nasal septum injury in preterm infants. Methods: This retrospective singlecenter cohort study included preterm infants supported by noninvasive ventilation. The incidence of nasal injury was compared among three groups according to the noninvasive ventilation delivery device (G1 - nasal mask; G2 - binasal prongs; and G3, rotation of nasal mask with prongs). Nasal injury was classified according to the National Pressure Ulcer Advisory Panel as stages 1 - 4. Multivariate regression analyses were performed to estimate relative risks to identify possible predictors associated with medical device-related injuries. Results: Among the 300 infants included in the study, the incidence of medical device-related injuries in the rotating group was significantly lower than that in the continuous mask or prong groups (n = 68; 40.48%; p value < 0.01). The basal prong group presented more stage 2 injuries (n = 15; 55.56%; p < 0.01). Staying ≥ 7 days in noninvasive ventilation was associated with a higher frequency of medical device-related injuries, regardless of device (63.81%; p < 0.01). Daily increments in noninvasive ventilation increased the risk for nasal injury by 4% (95%CI 1.02 - 1.06; p < 0.01). Higher birth weight indicated protection against medical device-related injuries. Each gained gram represented a decrease of 1% in the risk of developing nasal septum injury (RR: 0.99; 95%CI 0.99 - 0.99; p < 0.04). Conclusion: Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in comparison with single devices. The addition of days using noninvasive ventilation seems to contribute to medical device-related injuries, and higher birth weight is a protective factor.

Applications of chitosan to the roots and shoots change the accumulation pattern of cadmium in Talinum patens (Talinaceae) cuttings.

Chitosan induces tolerance to abiotic stress agents in plants. However, studies on the different application forms of this biopolymer are limited. This study evaluated the effect of two forms of chitosan application on the morphophysiology of and metal accumulation by Talinum patens cuttings subjected to Cd to develop new cadmium (Cd) decontamination technologies. Cuttings from 75-day-old plants were transferred to a hydroponic system. For 30 days, three Cd concentrations (0, 7, and 14 mg L-1) and three forms of chitosan application (without application, root, and foliar) were applied. The cuttings were tolerant to Cd because the metal did not influence biomass production or photosynthetic efficiency. Neither chitosan application nor Cd increased the modified chlorophyll content and fluorescence parameters. However, foliar chitosan reduced the transpiration rate. At the highest concentration of Cd, the application of chitosan in the root reduced the Mg content of the root system and shoots. The root application of chitosan increased the surface area and volume of thicker roots at the expense of finer ones. The foliar application resulted in greater total root length and surface area, mainly those finer. Furthermore, chitosan applied to the leaves activated catalase in the roots and leaves. In contrast to the root application, foliar application increased the accumulation of Cd in the roots. The action of catalase and the increase of fine roots may have favored a greater absorption of the nutrient solution and Cd in the chitosan foliar application treatment. It is concluded that chitosan foliar spraying can improve Cd rhizofiltration with T. patens.

Lung mechanics and respiratory morbidities in school-age children born moderate-to-late preterm.

BACKGROUND: Late and moderate prematurity may have an impact on pulmonary function during childhood. The present study aimed to investigate lung mechanics in school-age children born moderate-to-late preterm (MLPT). METHODS: Children aged 5-10 years were enrolled in this case-control study. Lung function and bronchodilator response were assessed by impulse oscillometry (IOS) at two hospital-based specialized clinics. A structured questionnaire was employed to assess respiratory morbidities. RESULTS: A total of 123 children was divided into two groups: case (MLPT) n = 52 and control (children born at term) n = 71. The results showed no difference between groups in mean baseline IOS variables: R5 0.80 ± 0.20 vs 0.82 ± 0.22 kPa/L/s, p = 0.594, R20 0.54 ± 0.13 vs 0.55 ± 0.13 kPa/L/s, p = 0.732, R5-R20 0.26 ± 0.12 vs 0.27 ± 0.15 kPa/L/s, p = 0.615, X5 -0.29 ± 0.01 vs -0.29 ± 0.1 kPa/L/s, p = 0.990, Fres 21.1 ± 3.3 vs 21.7 ± 3.1 L/s, p = 0.380, and AX 2.7 ± 3.36 vs 2.5 ± 1.31 kPa/L/s, p = 0.626. Bronchodilator response and the occurrence of respiratory morbidities after birth were also similar between groups. CONCLUSIONS: This study found lung mechanics parameters to be similar in school-age children born MLPT and those born at term, suggesting that pulmonary plasticity continues to occur in children up to school age. IMPACT: Late and moderate prematurity is associated with an increased risk of reduced pulmonary function during childhood. Follow-up reports in adolescents and adults born MLPT are scarce but have indicated pulmonary plasticity with normalization of airway function. Our results show that the lung function in school-age children born MLPT is similar to that of children born at term.

Stomatal cavity modulates the gas exchange of Sorghum bicolor (L.) Moench. grown under different water levels.

This work aimed to evaluate the effects of lower water levels on leaf intercellular spaces and to assess their relations with the gas exchange, anatomy, and growth of Sorghum bicolor. Experiments were conducted in a greenhouse, in which plants were subjected to three water conditions (ten replicates, n = 30): well-irrigated, decreased irrigation, and limited irrigation. Lower water levels had no significant effect on the growth of S. bicolor but increased the biomass of the roots. Moreover, the number of leaves, leaf area, and leaf size as well as the chlorophyll content were not affected by lower water levels, and no significant changes were detected for whole plant photosynthesis, transpiration, or stomatal conductance. The water content of the plants and the water potential remained unchanged. However, compared with other treatments, the decreased irrigation decreased water loss and increased the water retention. Lower water levels increased the intercellular CO2 percentage, mesophyll area, and proportion of stomatal cavities and promoted minor changes in leaf tissue and stomatal traits. The increased stomatal cavities provided higher CO2 uptake and prevented excessive water loss. Thus, modifications to the intercellular spaces promoted conditions to avoid excessive water loss while concurrently improving CO2 uptake, which are important traits for drought-tolerant plants.

Uso de argilas expansivas em camadas de impermeabilização de coberturas de aterros sanitários no Nordeste do Brasil / Use of expansive clays in waterproofing layers of landfill of the final cover in Northeastern Brazil

RESUMO Os aterros sanitários são obras construídas para o confinamento seguro dos resíduos sólidos e, entre seus elementos de projeto, destaca-se a camada de impermeabilização da cobertura final, frequentemente construída com solo argiloso, que deve, entre outras funções, minimizar ao máximo a infiltração de águas pluviais para o interior do aterro e o fluxo de gases com o meio ambiente. As características físicas, químicas e mineralógicas dos materiais dessa camada devem ser analisadas para a avaliar seu potencial de utilização. O presente trabalho teve como objetivo avaliar o desempenho de argilas expansivas, sujeitas à variação de umidade, como material impermeabilizante de cobertura de aterros sanitários, sendo caracterizadas duas amostras por meio de ensaios geotécnicos. As características foram compatíveis com os requisitos exigidos nas normas consultadas. A parte superior de uma camada de argila compactada foi reproduzida com uma das amostras em um modelo experimental, sujeita à secagem, com observação da formação de trincas e medições do teor de umidade ao longo do tempo e profundidade. A formação de trincas na superfície se iniciou para teores de umidade acima do limite de plasticidade. A aplicação de uma carga hidráulica na superfície após a etapa de secagem resultou em um fechamento das trincas em razão da expansão da argila, indicando eficiência na restrição de entrada de águas pluviais. No entanto, o uso de material expansivo para esse fim deve ser investigado quanto ao seu desempenho em campo, tanto na fase de construção, durante a compactação, quanto de operação, quando estará sujeito às variações climáticas.

ABSTRACT Solid waste landfills are works built to contain solid urban waste, being the most used final disposal method in Brazil. One of the most important components of the project is the final cover, the low hydraulic conductivity layer, with clayey materials, which has the function of minimizing the infiltration of rainwater into the landfill and the entry and exit of gases. The physical, chemical and mineralogical characteristics of clayey materials must be analyzed for potential use as a cover layer. The present work aimed to evaluate the use of clays, with expansive characteristics, subject to water content variations, as cover material in landfills, being characterized two clay samples through geotechnical tests. The characterization indicated samples with characteristics compatible with the requirements demanded by the consulted standards. One of them was used in a laboratory model and reproduced the upper part of a layer of compacted clay, subject to drying on the surface, with observation of the formation of cracks, and with measurements of the water content over time and depth. Cracks on the clay surface occurred during the drying process, starting for water contents above the limit of plasticity of the clay. The application of a hydraulic head on the surface, after the drying step, resulted in cracks closure, due to the expansion of the clay, indicating efficiency in the restriction of rainwater entry. However, the use of expansive material for this purpose should be investigated regarding its performance in the field, both in the construction phase, during compaction, and in operation, subject to climatic variations.

The role of reactive oxygen species and nitric oxide in the formation of root cortical aerenchyma under cadmium contamination.

The present study aimed to evaluate root cortical aerenchyma formation in response to Cd-driven hydrogen peroxide (H2 O2 ) production and the role of nitric oxide (NO) in the alleviation of Cd oxidative stress in maize roots and its effects on aerenchyma development. Maize plants were subjected to continuous flooding for 30 days, and the following treatments were applied weekly: Cd(NO3 )2 at 0, 10, and 50 µM and Na2 [Fe(CN)5 NO]·2H2 O (an NO donor) at 0.5, 0.1, and 0.2 µM. The root biometrics; oxidative stress indicators H2 O2 and malondialdehyde (MDA); and activities of catalase (CAT), superoxide dismutase (SOD), and ascorbate peroxidase (APX) were analyzed. The root dry and fresh masses decreased at higher concentrations of NO and Cd. H2 O2 also decreased at higher NO concentrations; however, MDA increased only at higher Cd levels. SOD activity decreased at higher concentrations of NO, but CAT activity increased. Aerenchyma development decreased in response to NO. Consequently, NO acts as an antagonist to Cd, decreasing the concentration of H2 O2 by reducing SOD activity and increasing CAT activity. Although H2 O2 is directly linked to aerenchyma formation, increased H2 O2 concentrations are necessary for root cortical aerenchyma development.

Knee and ankle disorders during functional gait in mucopolysaccharidosis type VI / Distúrbios articulares de joelho e tornozelo durante a marcha funcional na mucopolissacaridose tipo VI / Trastornos de la rodilla y el tobillo durante la marcha funcional en mucopolisacaridosis tipo VI

ABSTRACT To evaluate knee and ankle disorders during functional gait assessment in individuals with Mucopolysaccharidosis type VI (MPS VI). 19 subjects were included in this cross-sectional study and allocated in three groups according to age: Children Group (n=11); Adolescent Group (n=4); and Adult Group (n=4). Subphases of one gait cycle were analyzed: Initial contact; Medium support, and Pre-Balance. All volunteers with MPS VI presented greater knee and ankle flexion angles, in all gait subphases, when compared to the normal values defined by literature (p<0.05). Initial contact subphase: knee flexion angle ranging from 8.5º to 15º; Ankle = Child Group −23.73º ± 8.53º; Adolescent Group = −25º ± 11.22º; Adult Group = −27.75º ± 3.3º. Medium support subphase: Knee = Child Group 19.64º ± 10.47º; Adolescent Group 16.75º ± 10.34º; Adult Group = 21.25º ± 12.84º. Ankle = Child Group −18.82º ± 8.91º ± 8.53º; Adolescent Group = −16.5º ± 9.33º; Adult Group = −22.25º ± 4.19º. Pre-Balance subphase: Knee = Child Group 22.72º ± 13.49º; Adolescent Group 21.25º ± 7.97º; Adult Group = 27º ± 16.27º. Ankle = Child Group -15º ± 9.76º; Adolescent Group = −15.75º ± 5.31º; Adult Group = −14.75º ± 3.86º. In this study, MPS VI individuals presented hyperflexion of knee and ankle as the main joint disorders during functional gait, regardless of age.

RESUMO O objetivo deste estudo foi avaliar distúrbios articulares de joelho e tornozelo durante a marcha funcional na Mucopolissacaridose tipo VI (MPS VI). 19 indivíduos foram incluídos neste estudo transversal e alocados em três grupos de acordo com a idade: Grupo Crianças (n=11); Grupo Adolescentes (n=4); e Grupo Adultos (n=4). Foram analisadas as subfases de um ciclo da marcha: contato inicial; apoio médio e pré-balanço. Todos os voluntários com a MPS VI apresentaram maiores ângulos de flexão do joelho e tornozelo, em todas as subfases da marcha, quando comparados aos valores normais definidos pela literatura (p<0,05). Subfase contato inicial: ângulo de flexão do joelho variando de 8,5º a 15º; Tornozelo = Grupo Criança -23,73º ± 8,53º; Grupo Adolescente = -25º ± 11,22º; Grupo Adulto = -27,75º ± 3,3º. Subfase apoio médio: Joelho = Grupo Criança 19,64º ± 10,47º; Grupo Adolescente 16,75º ± 10,34º; Grupo Adulto = 21,25º ± 12,84º. Tornozelo = Grupo Criança -18,82º ± 8,91º ± 8,53º; Grupo Adolescente = -16,5º ± 9,33º; Grupo Adulto = -22,25º ± 4,19º. Subfase pré-balanço: Joelho = Grupo Criança 22,72º ± 13,49º; Grupo Adolescente 21,25º ± 7,97º; Grupo Adulto = 27º ± 16,27º. Tornozelo = Grupo Criança = -15º ± 9,76º; Grupo Adolescente = -15,75º ± 5,31º; Grupo Adulto = -14,75º ± 3,86º. Neste estudo, os indivíduos com MPS VI apresentaram hiperflexão do joelho e tornozelo como principais distúrbios articulares durante a marcha funcional, independentemente da idade.

RESUMEN El objetivo de este estudio fue evaluar los trastornos de la articulación de la rodilla y el tobillo durante la marcha funcional en mucopolisacaridosis tipo VI (MPS VI). En este estudio transversal participaron 19 personas, las cuales se asignaron a tres grupos según la edad: Grupo Niños (n=11); Grupo Adolescente (n=4); y Grupo Adulto (n=4). Se analizaron las subfases de un ciclo de marcha: contacto inicial; soporte mediano y balance previo. Todos los voluntarios con MPS VI tuvieron mayores ángulos de flexión de rodilla y tobillo en todas las subfases de la marcha en comparación con los valores normales definidos por la literatura (p<0,05). En la subfase de contacto inicial: ángulo de flexión de la rodilla varia de 8,5º a 15º; Tobillo = Grupo Niños -23,73º ± 8,53º; Grupo Adolescente = -25º ± 11,22º; Grupo Adulto = -27,75º ± 3,3º. En la subfase de soporte mediano: Rodilla = Grupo Niños 19,64º ± 10,47º; Grupo Adolescente 16,75º ± 10,34º; Grupo Adulto = 21,25º ± 12,84º. Tobillo = Grupo Niños -18,82º ± 8,91º ± 8,53º; Grupo Adolescente = -16,5º ± 9,33º; Grupo Adulto = -22,25º ± 4,19º. En la subfase de balance previo: Rodilla = Grupo Niños 22,72º ± 13,49º; Grupo Adolescente 21,25º ± 7,97º; Grupo Adulto = 27º ± 16,27º. Tobillo = Grupo Niños = -15º ± 9,76º; Grupo Adolescente = -15,75º ± 5,31º; Grupo Adulto = -14,75º ± 3,86º. En este estudio, los individuos con MPS VI presentaron hiperflexión de rodilla y tobillo como los principales trastornos articulares durante la marcha funcional independiente de la edad.

Gas Exchange, Root Morphology and Nutrients in Maize Plants Inoculated with Azospirillum brasilense Cultivated Under Two Water Conditions

HIGHLIGHTS Azospirillum brasilense stimulates root growth in maize under water deficit. Maize inoculated with A. brasilense shows greater photosynthesis under drought conditions. Under water deficit, maize plants inoculated with A. brasilense showed greater water use efficiency (WUE).

Abstract The objective of this study was to evaluate the gas exchange, root morphology and nutrient concentration in maize plants inoculated with A. brasilense under two water conditions. The experiments were carried out in a greenhouse, one under irrigation and the other under water deficit. The treatments consisted of four A. brasilense inoculants (control (without inoculation), Az1 (CMS 7 + 26), Az2 (CMS 11 + 26) and Az3 (CMS 26 +42). At the V6 plant stage, water stress was imposed on maize plants for 15 days. The phytotechnical characteristics, gas exchange, root morphology, root dry matter and macronutrient analysis were evaluated after 15 days of water deficit imposition. The water deficit caused a reduction in the development of maize plants. The presence of A. brasilense Az1 under the same condition yielded higher photosynthesis, carboxylation efficiency, water use efficiency, and greater soil exploration with increased length, surface area and root volume of plants. Inoculation by A. brasilense increased root system volume by an average of 40 and 47% under irrigation and water deficit, respectively, when compared to non-inoculated plants. The inoculant Az1 attenuated the deleterious effects caused by drought and yielded the best growth of the root system, resulting in the tolerance of maize plants to water deficit.

Adesão ao tratamento anti-hipertensivo e ocorrência de Síndrome Metabólica / Adherencia al tratamiento antihipertensivo y la ocurrencia del Síndrome Metabólico / Adherence to antihypertensive treatment and occurrence of Metabolic Syndrome

RESUMO Objetivo Analisar a associação entre a adesão ao tratamento anti-hipertensivo e a ocorrência de Síndrome Metabólica em pacientes hipertensos de uma unidade de atenção primária à saúde. Método Estudo analítico com corte transversal realizado com 306 pacientes hipertensos de uma Unidade de Atenção Primária à Saúde localizada na cidade de Fortaleza-CE. Resultados Dos participantes do estudo 74,2% eram do sexo feminino, média 61,8 ± 11,9 anos e dentro da faixa etária de 54 a 69, 77,1% raça/cor parda, 60,8% com nível fundamental incompleto ou completo e 70,6% com renda familiar entre 1 e 2 salários mínimos. Dos hipertensos avaliados, 41,5% apresentaram Síndrome Metabólica e 76,5% apresentava aderência parcial ao tratamento anti-hipertensivo. Na avaliação estatística da associação entre as variáveis foi verificado não existir (p = 0,149 e p = 0,642). Os valores referentes à adesão ao tratamento anti-hipertensivo eram iguais, tanto nos pacientes com Síndrome Metabólica como dos que não apresentavam essa condição. Conclusão e implicações para a prática A adesão terapêutica anti-hipertensiva alta e parcial foi prevalente. A frequência de Síndrome Metabólica entre os hipertensos em estudo foi elevada. Portanto, medidas de prevenção para doenças cardiovasculares e alcance das metas terapêuticas devem ser implementas continuamente. Um desafio a ser superado pelos profissionais e serviços de saúde.

RESUMEN Objetivo Analizar la asociación entre la adherencia al tratamiento antihipertensivo y la aparición del síndrome metabólico en pacientes hipertensos en una unidad de atención primaria de salud. Método Estudio analítico con corte transversal realizado con 306 pacientes hipertensos de una Unidad de Atención Primaria de Salud ubicada en la ciudad de Fortaleza-CE. Resultados De los participantes en el estudio, el 74,2% eran mujeres, con una media de 61,8 ± 11,9 años y dentro del grupo de edad de 54 a 69, 77,1% raza / color marrón, 60,8% con nivel fundamental incompleto o completo y 70.6% con ingresos familiares entre 1 y 2 salarios mínimos. De los pacientes hipertensos evaluados, el 41.5% tenía síndrome metabólico y el 76.5% tenía adherencia parcial al tratamiento antihipertensivo. En la evaluación estadística de la asociación entre las variables, se encontró que no existía (p = 0,149 e p = 0,642). Los valores con respecto a la adherencia al tratamiento antihipertensivo fueron los mismos, tanto en pacientes con síndrome metabólico como en aquellos que no tenían esta condición. Conclusiones e implicaciones para la práctica La adherencia a la terapia antihipertensiva alta y parcial fue prevalente. La frecuencia del síndrome metabólico entre los pacientes hipertensos en estudio fue elevada. Por lo tanto, las medidas preventivas para las enfermedades cardiovasculares y el logro de objetivos terapéuticos deben implementarse continuamente. Un desafío a superar por los profesionales y servicios de salud.

ABSTRACT Objective To analyze the association between adherence to antihypertensive treatment and the occurrence of Metabolic Syndrome in hypertensive patients in a primary health care unit. Method Analytical cross-sectional study carried out with 306 hypertensive patients from a Primary Health Care Unit located in the city of Fortaleza-CE. Results Of the study participants, 74.2% were female, mean 61.8 ± 11.9 years old and within the age group of 54 to 69, 77.1% race / brown color, 60.8% with incomplete fundamental level or complete and 70.6% with family income between 1 and 2 minimum wages. Of the evaluated hypertensive patients, 41.5% had Metabolic Syndrome and 76.5% had partial adherence to antihypertensive treatment. In the statistical evaluation of the association between the variables, it was verified that it did not exist (p = 0,149 e p = 0,642). The values regarding adherence to antihypertensive treatment were the same, both in patients with Metabolic Syndrome and in those who did not have this condition. Conclusions and implications for practice High and partial antihypertensive therapy adherence was prevalent. The frequency of Metabolic Syndrome among hypertensive patients under study was high. Therefore, preventive measures for cardiovascular diseases and achievement of therapeutic goals must be implemented continuously. A challenge to be overcome by health professionals and services.

Do tailings from the Mariana, MG (Brazil), disaster affect the initial development of millet, maize, and sorghum?

The collapse of the Fundão dam in Mariana, MG, in 2015 resulted in the overflow of more than 50 million m3 of mud containing mine tailings, leaving a path of destruction and immeasurable social and environmental consequences. Tailings' chemical and physical assessments revealed the presence of some elements at levels higher than those allowed by Brazilian guidelines. The tailings also showed high density, which restricts vegetation recovery. Therefore, this study aimed to analyze the effects of mud containing mine tailings from the Fundão dam on the germination and initial growth and development of three plant species: millet, maize, and sorghum. These species were cultivated on substrates with five tailings proportions: 0 T (100% sand), 25 T (25% tailings + 75% sand); 50 T (50% tailings + 50% sand); 75 T (75% tailings + 25% sand); and 100 T (100% tailings). In experiment I, the germination and initial growth of seedlings (plants with 1 or none fully expanded leaf) in these substrates were evaluated. In experiment II, growth parameters, photosynthetic efficiency (gas exchange and chlorophyll a fluorescence), metal accumulation, and plant root morphology of the same species were evaluated at the three fully expanded leaves vegetative stage (V3). Overall, the germination of seedlings and the initial growth of the three species analyzed were not affected by the presence of tailings. However, in plants at the V3 stage, morphophysiology variations differed among species, given that their growth, biomass accumulation, and root dynamics were altered. Proportions of tailings in the substrate did not influence the absorption of iron or manganese by the studied plants. At the V3 stage, maize was the most tolerant, with a more robust root system, and showed fewer morphological changes and greater water use efficiency than the other studied species.

Vermicompost improves maize, millet and sorghum growth in iron mine tailings.

The Fundão dam was designed to store iron mine tailings in the region of Mariana, MG, Brazil. When it ruptured, the tailings overflowed. These tailings affected the soil due to the formation of a thick crust as a result of drying (compaction) and hindered the natural revegetation process. In this context, the use of organic fertilizers, including vermicompost, is method of reducing the physical limitations on root growth caused by soil properties and changing soil-metal interactions. For this reason, vermicompost was added to iron mine tailings, and its morphological and physiological effects on maize, millet and sorghum plants were studied. The experiment was conducted in a greenhouse using 6 dm3 pots. The plants were subjected to three treatments: mine tailings, mine tailings + vermicompost, and a reference soil. From the V3 stage onwards, biweekly growth, leaf gas exchange and chlorophyll fluorescence evaluations were performed. At the end of the experiment, dry biomass and metal, macro- and micronutrient contents were quantified, and the root morphology was evaluated. The tailings created physical limitations on root growth and had low nutrient content as well as high concentrations of chromium, iron and manganese. The addition of vermicompost favored increases in shoot and root dry biomass, increases in root length, volume, surface area and diameter, and the absorption of macro- and micronutrients, which was reflected in the growth of the studied species. In addition, vermicompost led to greater investment in thick and very thick roots, and in general, the plants showed no symptoms of metal toxicity. Considering the characteristics of the studied tailings, it can be concluded that vermicompost favors the growth of plant species and may be a viable method for beginning the recovery process in areas containing iron mine tailings.

The golden mussel proteome and its response to niclosamide: Uncovering rational targets for control or elimination.

The Asian invasive species Limnoperna fortunei (Dunker, 1857), known as the golden mussel, causes great economic and environmental damage due to its fixative capacity and accelerated proliferation. Molecular studies for the control of larval and adult forms are of great economic, scientific and technological interest. Here, we first report on the compositional analysis of the L. fortunei proteome obtained through shotgun analysis using LC-MS/MS. Among those 2790 proteins identified, many of them related to secretory processes and membrane receptors. Our second approach consisted in exposing the mollusc to the molluscicide niclosamide to evaluate the induced proteomic alterations. Exposure to niclosamide at 0.25 mg/L for 24 h resulted in a pronounced differential abundance of proteins when compared to those obtained when exposure was reduced to 4 h at 2.3 mg/L. In total, 342 proteins were found differentially expressed in the responsive individuals as revealed by label-free quantitative proteomics. Regarding the affected cell processes were: cell division and differentiation, cytoskeletal organization and compartment acidification (upregulated), and energy metabolism (downregulated). Our findings constitute the first inventory of the expressed proteome of the golden mussel and have the potential to contribute with a more rational proposition of molecular targets for control and monitoring of this species. SIGNIFICANCE: With the recent availability of transcriptomic and genomic data applied to L. fortunei the timing is right to interrogate its putative gene repertoire using proteomic techniques. These have the potential to validate the existence of the predicted genes, infer their relative abundance and quantify their levels as a response to environmental stressors or various agents. Here we provided an inventory of the golden mussel proteome and evaluated its response to the molluscicide niclosamide. The obtained results open new avenues for intervention aimed at its control or elimination, particularly by targeting the various cellular processes that were uncovered.

Análise do Internato em Medicina da Família e Comunidade de uma Universidade Pública de Fortaleza-CE na Perspectiva do Discente / Analysis of a Family Practice Internship Program at a Public University in Fortaleza, Ceará, from the Student's Perspective

Resumo: Introdução: A atuação do médico de família e comunidade exige um domínio amplo de conhecimentos, habilidades e atitudes para enfrentar a complexidade dos pacientes, da família e da comunidade, com vistas a agir para além da dimensão curativa. Nesse contexto, o internato consiste em uma experiência fundamental para promover a articulação teórico-prática da formação médica. Objetivou-se analisar o internato em Medicina de Família e Comunidade (MFC) de uma universidade pública de Fortaleza-CE, na perspectiva do discente. Métodos: Realizou-se estudo transversal, descritivo, quanti-qualitativo, em agosto e setembro de 2018 com 30 acadêmicos do curso de Medicina do 12º semestre. A coleta de dados foi conduzida por meio de um questionário on-line que avaliou a percepção do acadêmico sobre a preceptoria, a aprendizagem, as aulas teóricas, a estrutura física das unidades, a satisfação geral com o internato e a relação com outros profissionais. Realizaram-se análise descritiva dos dados quantitativos e a análise de conteúdo do tipo temática. Resultados: A maioria dos acadêmicos era do sexo masculino (65,5%) e estava na faixa etária de 22 a 24 anos (55,1%). A satisfação geral com o internato foi considerada como boa (60%) e as aulas teóricas também (63,3%). O aprendizado foi avaliado como bom quanto à: relação médico-paciente e habilidades de comunicação (46,7%); habilidade de registro em prontuário (33,3%); habilidade para realizar atividades coletivas com usuários e equipe multiprofissional (43%). Um total de 73% considerou que o internato contribuiu para a futura atuação profissional na atenção básica. Os aspectos positivos do internato foram: preceptoria; aprendizado acerca da relação médico-paciente; autonomia do discente na condução dos casos; carga horária para estudos; aproximação com a realidade da comunidade; inserção na rotina da unidade; diversidade na aprendizagem; e formação teórico-prática. Por sua vez, destacaram-se como aspectos negativos: infraestrutura da unidade básica de saúde; aprendizagem acerca de ações coletivas e interdisciplinaridade; realização de atividades essenciais; prática baseada em evidências; e preceptoria. Conclusão: De forma geral, o internato em MFC foi bem avaliado pelos discentes, principalmente quanto à preceptoria, ao aprendizado em habilidades clínicas e à contribuição para sua formação médica em uma futura atuação na atenção primária. São necessárias novas pesquisas avaliativas que envolvam a percepção dos preceptores e dos demais profissionais da equipe de saúde, com inclusão da análise da dimensão formativa.

Abstract: Introduction: The work of a family medicine physician requires mastering a broad set of knowledge, skills and attitudes to deal with the complexity of patients, families and communities, with the aim of going beyond a healing perspective. In this context, the internship constitutes a fundamental experience to promote the theoretical and practical coordination of medical education. The objective of this study was to analyze a family practice internship program at a public university in the city of Fortaleza, state of Ceará, from the students' perspective. Methods: A cross-sectional, descriptive and quanti-qualitative study was developed in August and September of 2018 with 30 undergraduate medical students attending the 12th semester of the course. Data were collected by means of an online questionnaire that assessed the students' perception on preceptorship, learning, theoretical classes, unit infrastructure, overall satisfaction with the internship program and their relationship with other professionals. Quantitative data were submitted to descriptive and thematic content analysis. Most undergraduate students were males, (65.5%) aged between 22 and 24 years old (55.1%). Results: Overall satisfaction with the internship was considered good (60%), as well as with theoretical classes (63.3%). Learning was assessed as good regarding the physician-patient relationship and communication skills (46.7%); medical chart recording skills (33.3%); skills to perform collective activities with users and multiprofessional teams (43%). A total of 73% of students reported that the internship program contributed to their future professional performance in primary health care. The positive aspects of the internship program cited were: preceptorship; learning regarding the physician-patient relationship; students' autonomy in case conduction; course study load; getting closer to the reality of the communities; incorporation into the unit's routine; diversity in learning; and theoretical-practical training. The negative aspects were: infrastructure of the primary healthcare unit; learning of collective actions and interdisciplinarity; development of essential activities; evidence-based practice; and preceptorship. Conclusion: In general, the family practice internship program was well assessed by the students, mainly regarding preceptorship, learning clinical skills and the contribution to their medical education for future work in primary health care. Further assessment studies are needed, involving the perception of preceptors and other health professionals, and including an analysis of the educational dimension.