Arcuate anterior jugular vein: a rare case report and its clinical relevance.

OBJECTIVE: The present study describes a rare anatomical variation of the anterior jugular vein (AJV) and discusses its clinical relevance. METHODS: A head and neck specimen fixed in 10% formaldehyde from a 42-year-old female cadaver was submitted to angio technique with pre-vulcanized latex and water-soluble ink. During a routine dissection for the discipline of topographic anatomy, the presence of an arcuate AJV was detected in the anterior triangle of the neck. RESULTS: An arcuate AJV was formed by the confluence of the submental and facial veins in the left submandibular region, which presented a complex network of anastomoses superficially to the left submandibular gland. After its origin, this vessel curved to the right at the level of the laryngeal prominence and followed the medial border of the right sternohyoid muscle to flow into the right AJV. In this topography, the arcuate AJV was located between the sternocleidomastoid muscle's anterior margin and the thyroid gland's right lobe. The presence of anastomoses between the two AJVs communicating the submandibular triangles was not detected. CONCLUSION: The arcuate AJV is a relevant anatomical variant in the superficial venous drainage of the neck that should be known by head and neck surgeons and radiologists to avoid surgical iatrogenic events.

Health-Related Physical Fitness and Biochemical Parameters in Overweight Older People during Social Isolation Imposed by the COVID-19 Pandemic: A Longitudinal and Observational Study.

With COVID-19, evidence indicates that the elderly will have worse biochemical markers related to health in social isolation. The objective was to analyze the impacts on physical fitness and biochemical parameters of older adults' health during COVID-19 social isolation. Quantitative, longitudinal, and observational study was conducted between 2020, 2021, and 2022. Thirty-three older adults of both sexes were evaluated. A sociodemographic questionnaire, biomarkers, and health-related physical fitness were used. Significant differences were observed for the sum of maximum isometric right and left handgrip strength, with a reduction in 2022 (p = 0.009); getting up and walking (p < 0.001), reduction in 2021 and 2022 (p < 0.05); elbow flexion and extension (p = 0.004), reduction in 2021 (p = 0.006); and sitting and standing (p = 0.002), reduction in 2022 (p = 0.003) and peak oxygen consumption (p < 0.001), reduction in 2021 and 2022 (p < 0.05). Differences were observed in fasting blood glucose (p < 0.001), with increase in 2021 and 2022 (p < 0.05), triglycerides (p < 0.001), with increase in 2021 and 2022 (p < 0.05), triglyceride-glucose index (p < 0.001), with increase in 2021 and 2022 (p < 0.05), triglyceride-glucose index with waist circumference (p < 0.001), with increase in 2021 (p < 0.001); and triglyceride-glucose index with body mass index (p < 0.001), with increase in 2021 (p < 0.001). However, no differences were observed between anthropometric and body composition (p > 0.05). Conclusions: Older people had changes in biochemical and physical fitness parameters related to health during the social isolation of the COVID-19 pandemic.

Effect of the Basilar Invagination (Type B) on Cervical Spine: A Case-control Study with MRI.

OBJECTIVE: To evaluate the effect of the basilar invagination (BI) type B on cervical spine. METHODS: The research protocol used head magnetic resonance imaging (MRI) exams from 41 participants with BI type B and 158 controls. The criterion for BI was the distance of the odontoid apex to Chamberlain's line (DOCL) equal to or greater than 7 mm. The clivus length (CLI), clivus canal angle (CCA), Welcker's basal angle (WBA), Boogaard's angle (BOA), upper cervical lordosis angle (UCL), and total cervical lordosis angle (CL) were evaluated. The descriptive analysis, group comparisons, and correlations between skull base and cervical spine parameters were performed at the 95% CI. RESULTS: Participants with BI type B showed shorter clivus length (CLI: 25.7 ± 7.3 mm); greater angulation of the skull base (WBA: 126.5 ± 10.4); greater inclination foramen magnum (BOA: 151.5 ± 14.5); decrease in the value of the CCA (131.6 ± 15); and greater angulations of UCL (17.9 ± 13.8) and CL (29.7 ± 19.9) in comparison to the control group (P < 0.05). Clivus length and CCA correlated inversely with UCL and CL, while BOA correlated directly with UCL and CL. The WBA did not correlate with CL (P < 0.05). CONCLUSIONS: The deformation of skull base in the BI of type B caused, on average, a hyperlordosis of almost 30° in the C2-C6 segment. This change was approximately 17° in the C2-C4, with the clivus hypoplasia being a risk factor for cervical hyperlordosis.

Whey Protein Supplementation in Older Adults With Type 2 Diabetes Undergoing a Resistance Training Program: A Double-Blind Randomized Controlled Trial.

BACKGROUND/OBJECTIVE: This study aims to analyze the effect of whey protein (WP) supplementation on glycemic control, muscle strength, quality of life, and body composition in older adults with non-insulin-dependent diabetes undergoing a resistance training program. METHODS: A double-blind, placebo-controlled, randomized study was carried out with older adults with Type 2 diabetes. Body composition, food intake, muscle strength, glycemic profile, markers of renal function, cardiopulmonary capacity, and quality of life were evaluated. Older adults were randomized into a supplementation group with 33 g of WP consumed twice a week on days of resistance training for 12 weeks supplemented group and a placebo group. RESULTS: In total, 39 older adults were randomized into two groups, 19 in the supplement group and 20 in the placebo group. Both groups showed improvement in muscle strength, with the WP group failing to exceed that of the control group. WP supplementation slightly increased blood urea compared with the placebo group (p = .05), but values remained within normal limits. The group that used WP showed a small improvement in mental health, according to the 12-Item Short-Form Health Survey questionnaire, but without clinically important improvements. CONCLUSION: Both groups showed improvements in muscle strength and mass, regardless of supplementation, showing that resistance exercises performed twice a week can contribute to the nonprogression of sarcopenia in older adults with Type 2 diabetes. More studies are needed to determine the safe and effective amount of supplementation to improve muscle strength without renal impairment in older adults with diabetes.

Low Thyroid Hormones Level Attenuates Mitochondrial Dysfunction and Right Ventricular Failure in Pulmonary Hypertensive Rats.

PURPOSE: This study is to investigate the repercussions of hypothyroidism in the pathophysiological progression of pulmonary arterial hypertension (PAH). METHODS: While the control (CTL, n = 5) male Wistar rats received vehicle, PAH was induced with monocrotaline (MCT group, n = 15). Hypothyroidism was induced in a subset of rats by methimazole 3 weeks prior to the MCT injection (MMZ + MCT group, n = 15). Plasma thyroid hormones were measured by radioimmunoassay. Electrocardiographic, echocardiographic, and hemodynamic analyses were performed to evaluate the progression of PAH. Gene expression of antioxidant enzymes and cardiac hypertrophy markers were assessed by qPCR. Mitochondrial respiration, ATP levels, and ROS production were measured in right ventricular (RV) samples. RESULTS: Plasma T3 and T4 decreased in both MCT and MMZ + MCT groups (p < 0.05). Right ventricular systolic pressure (RVSP) increased, and RV - dP/dt, + dP/dt, and contractility index decreased in the MCT versus the CTL group and remained within control levels in the MMZ + MCT group (p < 0.05). Relative RV weight, RV wall thickness, RV diastolic area, and relative lung weight were augmented in the MCT versus the CTL group, whereas all parameters were improved to the CTL levels in the MMZ + MCT group (p < 0.05). Only the MCT group exhibited an increased duration of QTc interval compared to the baseline period (p < 0.05). ADP-induced mitochondrial respiration and ATP levels were decreased, and ROS production was increased in MCT versus the CTL group (p < 0.05), while the MMZ + MCT group exhibited increased mitochondrial respiration versus the MCT group (p < 0.05). CONCLUSION: Hypothyroidism attenuated the RV mitochondrial dysfunction and the pathophysiological progression of MCT-induced PAH.

Evaluation of reduced graphene oxide from cotton waste as an efficient phenol adsorbent in aqueous media.

The elimination of organic substances, such as phenol, in conventional and biological processes, has been considered a challenge for the petroleum industry. In this work, reduced graphene oxide (rGO), obtained from cellulosic biomass (CB-rGO), as cotton waste, was employed as a phenol adsorbent in an aqueous solution simulating refinery effluent. The CB-rGO was characterized using HRTEM, Raman, XRD, FTIR, BET, and zeta analysis. The behavior of variables such as pH, contact time, temperature, CB-rGO mass, and adsorbate concentration on the characteristics of the adsorption process were continuously investigated. These parameters of the adsorption process were evaluated across a range of adsorbent concentrations from 100 to 300 mg/L, pH in the range of 2-11, adsorbent mass 5-25 mg, contact time of 0-180 min, and temperature of 20-60 °C. The adsorption isotherm data were better described by the Freundlich equation compared to the Langmuir and Sips models, despite the small difference in R2 values. Mechanism diffusion was analyzed using the Boyd model and confirmed to be the rate-limiting step in the adsorption process. The endothermic nature of this CB-rGO adsorption process with phenol was confirmed by verifying the thermodynamic data. This successful removal of phenol from synthetic effluents highlights the promising potential of this adsorbent obtained from an industrial residue and being an ecologically more sustainable alternative compared to the synthesis of other materials identified to remove this contaminant.

Fatty Acid Amides Suppress Proliferation via Cannabinoid Receptors and Promote the Apoptosis of C6 Glioma Cells in Association with Akt Signaling Pathway Inhibition.

A glioma is a type of tumor that acts on the Central Nervous System (CNS) in a highly aggressive manner. Gliomas can occasionally be inaccurately diagnosed and treatments have low efficacy, meaning that patients exhibit a survival of less than one year after diagnosis. Due to factors such as intratumoral cell variability, inefficient chemotherapy drugs, adaptive resistance development to drugs and tumor recurrence after resection, the search continues for new drugs that can inhibit glioma cell growth. As such, analogues of endocannabinoids, such as fatty acid amides (FAAs), represent interesting alternatives for inhibiting tumor growth, since FAAs can modulate several metabolic pathways linked to cancer and, thus, may hold potential for managing glioblastoma. The aim of this study was to investigate the in vitro effects of two fatty ethanolamides (FAA1 and FAA2), synthetized via direct amidation from andiroba oil (Carapa guianensis Aublet), on C6 glioma cells. FAA1 and FAA2 reduced C6 cell viability, proliferation and migratory potential in a dose-dependent manner and were not toxic to normal retina glial cells. Both FAAs caused apoptotic cell death through the loss of mitochondrial integrity (ΔΨm), probably by activating cannabinoid receptors, and inhibiting the PI3K/Akt pathway. In conclusion, FAAs derived from natural products may have the potential to treat glioma-type brain cancer.

FeCo@hydrochar nanocomposites as efficient peroxymonosulfate activator for organic pollutant degradation.

Sulfate radical-based advanced oxidation processes (SR-AOPs) are renowned for their exceptional capacity to degrade refractory organic pollutants due to their wide applicability, cost-effectiveness, and swift mineralization and oxidation rates. The primary sources of radicals in AOPs are persulfate (PS) and peroxymonosulfate (PMS) ions, sparking significant interest in their mechanistic and catalytic aspects. To develop a novel nanocatalyst for SR-AOPs, particularly for PMS activation, we synthesized carbon-coated FeCo nanoparticles (NPs) using solvothermal methods based on the polyol approach. Various synthesis conditions were investigated, and the NPs were thoroughly characterized regarding their structure, morphology, magnetic properties, and catalytic efficiency. The FeCo phase was primarily obtained at [OH-] / [Metal] = 26 and [Fe] / [Co] = 2 ratios. Moreover, as the [Fe]/[Co] ratio increased, the degree of xylose carbonization to form a carbon coating (hydrochar) on the NPs also increased. The NPs exhibited a spherical morphology with agglomerates of varying sizes. Vibrating-sample magnetometer analysis (VSM) indicated that a higher proportion of iron resulted in NPs with higher saturation magnetization (up to 167.8 emu g-1), attributed to a larger proportion of FeCo bcc phase in the nanocomposite. The best catalytic conditions for degrading 100 ppm Rhodamine B (RhB) included 0.05 g L-1 of NPs, 2 mM PMS, pH 7.0, and a 20-min reaction at 25 °C. Notably, singlet oxygen was the predominant specie formed in the experiments in the SR-AOP, followed by sulfate and hydroxyl radicals. The catalyst could be reused for up to five cycles, retaining over 98% RhB degradation, albeit with increased metal leaching. Even in the first use, dissolved Fe and Co concentrations were 0.8 ± 0.3 and 4.0 ± 0.5 mg L-1, respectively. The FeCo catalyst proved to be effective in dye degradation and offers the potential for further refinement to minimize Co2+ leaching.

Combining Transcranial Direct Current Stimulation With Non-Invasive Interventions for Chronic Primary Pain: A Systematic Review and Meta-Analysis.

BACKGROUND: A growing number of studies has combined transcranial direct current stimulation (tDCS) with other non-invasive non-pharmacological therapies (NINPT) to enhance effects in pain reduction. However, the efficacy of these combined approaches in treating chronic primary pain (CPP) warrants thorough investigation. OBJECTIVE: This study aims to evaluate the efficacy of tDCS in conjunction with other NINPT in alleviating pain severity among CPP patients. METHODS: We conducted a systematic search for randomized controlled trials (RCTs) comparing the efficacy of tDCS combined with NINPT against control treatments in adult CPP patients. The search spanned multiple databases, including PubMed, EMBASE, LILACS, Scopus, Web of Science, and CENTRAL. RESULTS: Our systematic review included 11 RCTs with a total of 449 participants. In our meta-analysis, which comprised 228 participants receiving active-tDCS and 221 receiving sham-tDCS, we found a significant reduction in pain intensity (Standard Mean Difference = -0.73; 95% Confidence Interval (CI) = -1.18 to -0.27; P = .002) with the use of active-tDCS combined with NINPT. CONCLUSION: These findings substantiate the therapeutic potential of combining tDCS with other NINPT, highlighting it as an effective treatment modality for reducing pain intensity in CPP patients.

PERIOPERATIVE CARE IN DIGESTIVE SURGERY: THE ERAS AND ACERTO PROTOCOLS - BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER.

BACKGROUND: The concept introduced by protocols of enhanced recovery after surgery modifies perioperative traditional care in digestive surgery. The integration of these modern recommendations components during the perioperative period is of great importance to ensure fewer postoperative complications, reduced length of hospital stay, and decreased surgical costs. AIMS: To emphasize the most important points of a multimodal perioperative care protocol. METHODS: Careful analysis of each recommendation of both ERAS and ACERTO protocols, justifying their inclusion in the multimodal care recommended for digestive surgery patients. RESULTS: Enhanced recovery programs (ERPs) such as ERAS and ACERTO protocols are a cornerstone in modern perioperative care. Nutritional therapy is fundamental in digestive surgery, and thus, both preoperative and postoperative nutrition care are key to ensuring fewer postoperative complications and reducing the length of hospital stay. The concept of prehabilitation is another key element in ERPs. The handling of crystalloid fluids in a perfect balance is vital. Fluid overload can delay the recovery of patients and increase postoperative complications. Abbreviation of preoperative fasting for two hours before anesthesia is now accepted by various guidelines of both surgical and anesthesiology societies. Combined with early postoperative refeeding, these prescriptions are not only safe but can also enhance the recovery of patients undergoing digestive procedures. CONCLUSIONS: This position paper from the Brazilian College of Digestive Surgery strongly emphasizes that the implementation of ERPs in digestive surgery represents a paradigm shift in perioperative care, transcending traditional practices and embracing an intelligent approach to patient well-being.

Phenotypic Variability in Resistance to Anthracnose, White, Brown, and Blight Leaf Spot in Cassava Germplasm.

Despite fungal diseases affecting the aerial parts of cassava (Manihot esculenta Crantz) and causing significant yield losses, there is a lack of comprehensive studies assessing resistance in the species' germplasm. This study aimed to evaluate the phenotypic diversity for resistance to anthracnose disease (CAD), blight leaf spot (BliLS), brown leaf spot (BLS), and white leaf spot (WLS) in cassava germplasm and to identify genotypes suitable for breeding purposes. A total of 837 genotypes were evaluated under field conditions across two production cycles (2021 and 2022). Artificial inoculations were carried out in the field, and data on yield and disease severity were collected using a standardized rating scale. The top 25 cassava genotypes were selected based on a selection index for disease resistance and agronomic traits. High environmental variability resulted in low heritabilities (h2) for CAD, WLS, and BLS (h2 = 0.42, 0.34, 0.29, respectively) and moderate heritability for BliLS (h2 = 0.51). While the range of data for disease resistance was narrow, it was considerably wider for yield traits. Cluster analysis revealed that increased yield traits and disease severity were associated with higher scores of the first and second discriminant functions, respectively. Thus, most clusters comprised genotypes with hybrid characteristics for both traits. Overall, there was a strong correlation among aerial diseases, particularly between BLS and BliLS (r = 0.96), while the correlation between CAD and other diseases ranged from r = 0.53 to 0.58. Yield traits showed no significant correlations with disease resistance. Although the mean selection differential for disease resistance was modest (between -2.31% and -3.61%), selection based on yield traits showed promising results, particularly for fresh root yield (82%), dry root yield (39%), shoot yield (49%), and plant vigor (26%). This study contributes to enhancing genetic gains for resistance to major aerial part diseases and improving yield traits in cassava breeding programs.

Atividade física e comportamento sedentário de adolescentes da rede pública: uma análise de redes / Physical activity and sedentary behavior of adolescents in public schools: a network analysis

O Programa Saúde na Escola (PSE) e a Pesquisa Nacional de Saúde do Escolar (PeNSE) merecem destaque entre as ações de promoção e monitoramento da saúde de estudantes brasileiros. Nesse contexto, a promoção da atividade física em escolas integra as ações do PSE, além de ser monitorada pela PeNSE. O presente estudo verificou a associação entre características do indivíduo, socioeconômicas, de ações de promoção da atividade física e da saúde na escola, incluindo a adesão escolar ao PSE, com os comportamentos ativo e sedentário de estudantes brasileiros matriculados em escolas públicas, participantes da PeNSE ­ 2019. Trata-se de estudo com dados secundários. A amostra contou com 48.204 adolescentes, com idades entre 13 e 18 anos. As variáveis foram coletadas através de questionário. A adesão da escola ao PSE é uma das variáveis de maior centralidade da rede, com destaque para a sua medida de força (1,433); entretanto, apresentou-se pouco conectada aos indicadores de atividade física e ao comportamento sedentário dos jovens. A análise de redes mostrou que o gênero feminino participa menos das atividades físicas em aulas de Educação Física (-0,176) e em tempo livre (-0,283), assim como ter internet em casa foi a principal variável associada com o maior tempo de exposição aos comportamentos sedentários (0,225). Os resultados apontam para a importância da adesão escolar ao PSE e para a necessidade do desenvolvimento de ações efetivas de promoção da atividade física como estratégia de promoção da saúde no âmbito do PSE.

The School Health Program (SHP) and the National School Health Survey (PeNSE) deserve to be high-lighted among actions to promote and monitor the health of Brazilian students. In this context, the promo-tion of physical activity in schools represents part of the SHP actions, in addition to being monitored by the PeNSE. The present study verified the association between individual and socioeconomic characteristics, and actions to promote physical activity and health in school, including school adherence to the SHP, with the active and sedentary behaviors of Brazilian students enrolled in public schools, participants of the PeNSE ­ 2019. This is a study with secondary data, of 48,204 adolescents, aged between 13 and 18 years. The variables were collected using a questionnaire. The school 's adherence to the SHP is one of the variables with the highest centrality in the network, with emphasis on its measure of strength (1.433); however, it was poorly connected to indicators of physical activity and sedentary behavior in young people. Network analysis showed that females participate less in physical activities in Physical Education classes (-0.176) and in free time (-0.283). In addition, having internet at home was the main variable associated with longer exposure time to sedentary behaviors (0.225). The results point to the importance of school adherence to the SHP and the need to develop effective actions to promote physical activity as a health promotion strategy within the scope of the SHP.

A potent and selective activator of large-conductance Ca2+-activated K+ channels induces preservation of mitochondrial function after hypoxia and reoxygenation by handling of calcium and transmembrane potential.

AIMS: Ischaemic heart disease remains a significant cause of mortality globally. A pharmacological agent that protects cardiac mitochondria against oxygen deprivation injuries is welcome in therapy against acute myocardial infarction. Here, we evaluate the effect of large-conductance Ca2+-activated K+ channels (BKCa) activator, Compound Z, in isolated mitochondria under hypoxia and reoxygenation. METHODS: Mitochondria from mice hearts were obtained by differential centrifugation. The isolated mitochondria were incubated with a BKCa channel activator, Compound Z, and subjected to normoxia or hypoxia/reoxygenation. Mitochondrial function was evaluated by measurement of O2 consumption in the complexes I, II, and IV in the respiratory states 1, 2, 3, and by maximal uncoupled O2 uptake, ATP production, ROS production, transmembrane potential, and calcium retention capacity. RESULTS: Incubation of isolated mitochondria with Compound Z under normoxia conditions reduced the mitochondrial functions and induced the production of a significant amount of ROS. However, under hypoxia/reoxygenation, the Compound Z prevented a profound reduction in mitochondrial functions, including reducing ROS production over the hypoxia/reoxygenation group. Furthermore, hypoxia/reoxygenation induced a large mitochondria depolarization, which Compound Z incubation prevented, but, even so, Compound Z created a small depolarization. The mitochondrial calcium uptake was prevented by the BKCa activator, extruding the mitochondrial calcium present before Compound Z incubation. CONCLUSION: The Compound Z acts as a mitochondrial BKCa channel activator and can protect mitochondria function against hypoxia/reoxygenation injury, by handling mitochondrial calcium and transmembrane potential.

RESIDUAL GASTRIC VOLUME IN MORBIDLY OBESE DIABETICS AFTER AN OVERNIGHT FASTING OR 3 HOURS OF A CARBOHYDRATE-ENRICHED SUPPLEMENT: A RANDOMIZED CROSSOVER PILOT STUDY.

BACKGROUND: To reduce the risk of regurgitation during anesthesia for elective procedures, residual gastric volumes (RGV) have traditionally been minimized by overnight fasting. Prolonged preoperative fasting presents some adverse consequences and has been abandoned for most surgical procedures, except for obese and/or diabetic patients. AIMS: The aim of this study was to assess the RGV in morbidly obese diabetic patients after traditional or abbreviated fasting. METHODS: This study was approved by the Ethics Committee for Research with Human Beings from the Federal University of Mato Grosso, under number 179.017/2012. This is a prospective, randomized, and crossover design study in eight morbidly obese type II diabetic patients. RGV was measured endoscopically after either traditional overnight fasting of at least 8 hours, or after abbreviated fasting of 6 hours for solids and 3 hours for a drink containing water plus 25 g (12.5%) of maltodextrin. Data were expressed as mean and range and differences were compared with paired t-tests at p<0.05. RESULTS: The study population had a mean age of 41.5 years (28-53), weight of 135 kg (113-196), body mass index of 48.2 kg/m2 (40-62.4), and type II diabetes for 4.5 years (1-10). The RGV after abbreviated fasting was 21.5 ml (5-40) vs 26.3 ml (7-65) after traditional fasting. This difference was not significant (p=0.82). CONCLUSIONS: Gastric emptying in morbidly obese diabetic patients is similar after either traditional or abbreviated fasting with a carbohydrate drink.

Green and fast prediction of crude protein contents in bee pollen based on digital images combined with Random Forest algorithm.

Bee pollen is considered an excellent dietary supplement with functional characteristics, and it has been employed in food and cosmetics formulations and in biomedical applications. Therefore, understanding its chemical composition, particularly crude protein contents, is essential to ensure its quality and industrial application. For the quantification of crude protein in bee pollen, this study explored the potential of combining digital image analysis and Random Forest algorithm for the development of a rapid, cost-effective, and environmentally friendly analytical methodology. Digital images of bee pollen samples (n = 244) were captured using a smartphone camera with controlled lighting. RGB channels intensities and color histograms were extracted using open source softwares. Crude protein contents were determined using the Kjeldahl method (reference) and in combination with RGB channels and color histograms data from digital images, they were used to generate a predictive model through the application of the Random Forest algorithm. The developed model exhibited good performance and predictive capability for crude protein analysis in bee pollen (R2 = 80.93 %; RMSE = 1.49 %; MAE = 1.26 %). Thus, the developed analytical methodology can be considered environmentally friendly according to the AGREE metric, making it an excellent alternative to conventional analysis methods. It avoids the use of toxic reagents and solvents, demonstrates energy efficiency, utilizes low-cost instrumentation, and it is robust and precise. These characteristics indicate its potential for easy implementation in routine analysis of crude protein in bee pollen samples in quality control laboratories.

Devices for osteoarthritis symptoms treatment: a patent review.

INTRODUCTION: Osteoarthritis is a musculoskeletal disease that can lead to the loss and inability of those affected to perform normal daily functions, which leads to a decrease in quality of life. The main symptoms of osteoarthritis are tenderness, joint pain, stiffness, crepitus, limited movement, and local inflammation. AREAS COVERED: The selected patents were deposited from 2010 to April 2022 involving 57 documents that were in line with the study objective in the final selection. The patents were classified in years, country, and applicants. Also, the therapeutic fields that presented the most documents were electrical stimulation, phototherapy, and ultrasound, followed by magnetic, electromagnetic, and thermotherapy. Therefore, the most current therapies used in the documents are already on the market. EXPERT OPINION: Although the OA is cureless, non-surgical treatments are classified as the primary management approach for this disease. The pharmacological and non-pharmacological therapies are employed to reduce its prevalence and ensure the effectiveness of treatments. A strategy for relieving OA symptoms is non-pharmacological treatment, which can be based on exercise and patient education, combined with other alternative therapies. These therapies are used as supplements to the main OA treatments, enhancing the effectiveness of treatment outcomes.

Influence of angiotensin receptor and converting enzyme blockers therapy in the respiratory outcome of COVID-19 hospitalized patients.

OBJECTIVES: COVID-19, caused by SARS-CoV-2, has spread around the world since 2019. In severe cases, COVID-19 can lead to hospitalization and death. Systemic arterial hypertension and other comorbidities are associated with serious COVID-19 infection. Literature is unclear whether antihypertensive therapy with angiotensin receptor blockers (ARBs) and angiotensin converting enzyme (ACE) inhibitors affect COVID-19 outcomes. We aim to assess whether ACEI/ARB therapy is a risk factor for worse respiratory outcomes related to COVID-19 in hospitalized patients. METHODS: Retrospective study enrolling admitted COVID-19-diagnosed patients by RT-PCR at the Hospital Geral de Fortaleza, Brazil, during 2021. Patient medical records, sociodemographic, and clinical data were analyzed. Chest CT images were analyzed using CAD4COVID-CT/Thirona™ software. RESULTS: A total of 294 patients took part in the study. A cut-off point of 66% of pulmonary involvement was found by ROC curve, with patients having higher risk of death and intubation and lower 60-day survival. Advanced age (RR 1.025, P=0.001) and intubation (RR 16.747, P<0.001) were significantly associated with a higher risk of death. Advanced age (RR 1.023, P=0.001) and the use of noninvasive ventilation (RR 1.548, P=0.037) were associated with a higher risk of intubation. Lung involvement (>66%) increased the risk of death by almost 2.5-fold (RR 2.439, P<0.001) and by more than 2.3-fold the risk of intubation (RR 2.317, P<0.001). CONCLUSIONS: Altogether, our findings suggest that ACEI or ARB therapy does not affect the risk of death and disease course during hospitalization.

Perioperative care in digestive surgery: the eras and acerto protocols - brazilian college of digestive surgery position paper / Cuidados perioperatórios em cirurgia digestiva: protocolos eras e acerto - posicionamento do colégio brasileiro de cirurgia digestiva

ABSTRACT BACKGROUND: The concept introduced by protocols of enhanced recovery after surgery modifies perioperative traditional care in digestive surgery. The integration of these modern recommendations components during the perioperative period is of great importance to ensure fewer postoperative complications, reduced length of hospital stay, and decreased surgical costs. AIMS: To emphasize the most important points of a multimodal perioperative care protocol. METHODS: Careful analysis of each recommendation of both ERAS and ACERTO protocols, justifying their inclusion in the multimodal care recommended for digestive surgery patients. RESULTS: Enhanced recovery programs (ERPs) such as ERAS and ACERTO protocols are a cornerstone in modern perioperative care. Nutritional therapy is fundamental in digestive surgery, and thus, both preoperative and postoperative nutrition care are key to ensuring fewer postoperative complications and reducing the length of hospital stay. The concept of prehabilitation is another key element in ERPs. The handling of crystalloid fluids in a perfect balance is vital. Fluid overload can delay the recovery of patients and increase postoperative complications. Abbreviation of preoperative fasting for two hours before anesthesia is now accepted by various guidelines of both surgical and anesthesiology societies. Combined with early postoperative refeeding, these prescriptions are not only safe but can also enhance the recovery of patients undergoing digestive procedures. CONCLUSIONS: This position paper from the Brazilian College of Digestive Surgery strongly emphasizes that the implementation of ERPs in digestive surgery represents a paradigm shift in perioperative care, transcending traditional practices and embracing an intelligent approach to patient well-being.

RESUMO RACIONAL: O conceito introduzido pelos protocolos de recuperação após a cirurgia modifica os cuidados perioperatórios tradicionais em cirurgia digestiva. A integração desses componentes modernos de recomendações, durante o período perioperatório, é de grande importância para garantir menos complicações pós-operatórias, redução do tempo de internação hospitalar e diminuição dos custos cirúrgicos. OBJETIVOS: Enfatizar os pontos mais importantes de um protocolo multimodal de cuidados perioperatórios. MÉTODOS: Análise criteriosa de cada recomendação dos protocolos ERAS e ACERTO, justificando sua inclusão no atendimento multimodal recomendado para pacientes de cirurgia digestiva. RESULTADOS: Os programas de recuperação avançada (PRAs), tais como os protocolos ERAS e ACERTO, são a base dos cuidados perioperatórios modernos. A terapia nutricional é de grande importância na cirurgia digestiva e, portanto, tanto os cuidados nutricionais pré-operatórios, quanto pós-operatórios são fundamentais para garantir menos complicações pós-operatórias e reduzir o tempo de internação hospitalar. O conceito de pré-habilitação é outro elemento-chave nos PRAs. O manuseio de fluidos cristalóides em perfeito equilíbrio é vital. A sobrecarga de fluidos pode atrasar a recuperação dos pacientes e aumentar as complicações pós-operatórias. A abreviação do jejum pré-operatório para duas horas antes da anestesia é agora aceita por diversas diretrizes das sociedades cirúrgicas e de anestesiologia. Combinadas com a realimentação pós-operatória precoce, essas prescrições não são apenas seguras, mas também podem melhorar a recuperação de pacientes submetidos a procedimentos digestivos. CONCLUSÕES: Este posicionamento do Colégio Brasileiro de Cirurgia Digestiva enfatiza fortemente que a implementação de PRAs em cirurgia digestive, representa uma mudança de paradigma no cuidado perioperatório, transcendendo as práticas tradicionais e adotando uma abordagem inteligente para o bem-estar do paciente.

Revisiting Genetic Influence on Mercury Exposure and Intoxication in Humans: A Scoping Review.

Human intoxication to mercury is a worldwide health problem. In addition to the type and length of exposure, the genetic background plays an important role in mercury poisoning. However, reviews on the genetic influence in mercury toxicity are scarce and not systematic. Therefore, this review aimed to systematically overview the most recent evidence on the genetic influence (using single nucleotide polymorphisms, SNPs) on human mercury poisoning. Three different databases (PubMed/Medline, Web of Science and Scopus) were searched, and 380 studies were found that were published from 2015 to 2022. After applying inclusion/exclusion criteria, 29 studies were selected and data on characteristics (year, country, profile of participants) and results (mercury biomarkers and quantitation, SNPs, main findings) were extracted and analyzed. The largest number of studies was performed in Brazil, mainly involving traditional populations of the Tapajós River basin. Most studies evaluated the influence of the SNPs related to genes of the glutathione system (GST, GPx, etc.), the ATP-binding cassette transporters and the metallothionein proteins. The recent findings regarding other SNPs, such as those of apolipoprotein E and brain-derived neurotrophic factor genes, are also highlighted. The importance of the exposure level is discussed considering the possible biphasic behavior of the genetic modulation phenomena that could explain some SNP associations. Overall, recommendations are provided for future studies based on the analysis obtained in this scoping review.