A Case of Extensive Tuberculosis With Bacterial Infection Treated in a Peripheral Hospital.

Since 1997, the World Health Organization (WHO) publishes the Global Tuberculosis Report every year, which contains the most up-to-date and accurate statistical data on tuberculosis (TB) worldwide. TB is an infectious disease that is one of the leading causes of human morbidity. It ranks among the top 10 most common causes of death worldwide and is more likely than other pathogens, such as the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), to result in a fatal outcome. After the introduction of the TB vaccine, the situation improved significantly, but the disease was not defeated. In this context, we present the clinical case of a male patient who was admitted to the Emergency Department (ED) due to a productive cough, dyspnea, and weight loss. After a complementary study, he was diagnosed with extensive diffuse pulmonary TB with a bacterial infection.

Fatores de risco intrínsecos para quedas entre idosos institucionalizados / Intrinsic risk factors for falls among institutionalized older adults

Objetivo: Investigar os fatores de risco intrínsecos para queda entre idosos de duas Instituições de Longa Permanência (ILP) no interior de Minas Gerais/Brasil. Métodos: Foram avaliados 20 idosos com idade média de 79 anos (entre 60-100 anos). Foram aplicadas as escalas de Tinetti e Barthel para avaliação do equilíbrio corporal e independência funcional, respectivamente. A escala de Downton para análise do risco de quedas; a estesiometria, a dinamometria e o teste manual de força muscular para estimar respectivamente, a sensibilidade das mãos e pés, a força de preensão palmar e a força dos músculos de membros inferiores. A análise estatística utilizada foi o teste t-student, o teste de correlação de Pearson, a análise de variância (ANOVA-one way), considerando nível de significância de 5%. Resultados: A média geral do escore da escala de Dowton foi de 4,68 (p<0,05); a do equilíbrio corporal foi de 14,57 pontos (p<0,05), a escala de Barthel foi de 72,36 pontos (p<0,05); a força de preensão palmar foi de 2,73 kg/m² (±3,64) e a média de força em membros inferiores foi de 3,7 kg/m2 (p<0,05). Conclusão: Conclui-se que os idosos avaliados apresentam alto risco de quedas sendo os parâmetros mais comprometidos e responsáveis por este risco, a polifarmácia, desequilíbrio, fraqueza muscular, perda de sensibilidade e dependência funcional.

Objective: The objective of the study is to investigate the intrinsic risk factors for falls among elderly people from two Long Stay Institutions (ILP) in the countryside of Minas Gerais/Brazil. Methods: Twenty elderly people with a mean age of 79 years (between 60-100 years) were evaluated. Tinetti and Barthel scales were applied to assess body balance and functional independence, respectively. The Downton scale for the analysis of the risk of falls; esthesiometry, dynamometry and manual muscle strength test to estimate, respectively, the sensitivity of the hands and feet, the hand grip strength and the strength of the muscles of the lower limbs. The statistical analysis used was the t-student test, Pearson's correlation test, analysis of variance (ANOVA-one way), considering a significance level of 5%. Results: The general mean score on the Dowton scale was 4.68 (p<0.05); that of body balance was 14.57 points (p<0.05), the Barthel scale was 72.36 points (p<0.05); the handgrip strength was 2.73 kg/m² (±3.64) and the mean strength in the lower limbs was 3.7 kg/m2 (p<0.05). Conclusion: It is concluded that the evaluated elderly have a high risk of falls and the parameters most compromised and responsible for this risk are polypharmacy, imbalance, muscle weakness, loss of sensitivity and functional dependence.

Total marrow irradiation in hematopoietic stem cell transplantation for hematologic malignancies.

Total body irradiation (TBI) has been an essential component of the conditioning regimen in hematopoietic cell transplantation for many years. However, higher doses of TBI reduce disease relapse at the expense of more significant toxicities. Therefore, total marrow irradiation and total marrow and lymphoid irradiation have been developed to deliver organ-sparing targeted radiotherapy. Data from different studies show that TMI and TMLI can be safely administered in escalating doses in association with different chemotherapy conditioning regimen protocols, in situations with unmet needs, such as multiple myeloma, high-risk hematologic malignancies, relapsed or refractory leukemias, and elderly or frail patients, with low rates of transplant-related mortality. We reviewed the literature on applying TMI and TMLI techniques in autologous and allogeneic hematopoietic stem cell transplantation in different clinical situations.

18-month results of double-fanged 5-0 polypropylene suture transscleral bag fixation in subluxated cataracts / Resultados de 18 meses da técnica double fanged com sutura de 5-0 polipropileno para fixação transescleral de saco capsular em cataratas subluxadas

ABSTRACT Purpose: To evaluate the stability and efficacy of the double-flanged 5-0 polypropylene suture to fixate subluxated cataracts at 18 months and the possible complications of this new technique Methods: This technique uses a 5-0 polypropylene monofilament to create two flanges with a thermocautery, for fixation of a capsular tension segment to the sclera to fix the subluxated capsular bag. This technique was implemented in 17 eyes requiring intraocular lens implantation in a setting of zonular dialysis due to trauma, Marfan syndrome, microspherophakia, idiopathic disease, and post-phacoemulsification status. Results: Follow-up of the patients occurred at 18 months. Best-corrected visual acuity improved significantly from 0.85 to 0.39 (logMAR), whereas the spherical and cylindrical refractive errors and intraocular pressure remained stable from preoperation. No suture photodegradation or pseudophacodonesis were detected. Conclusion: The double-flanged 5-0 polypropylene suture transscleral bag fixation technique has shown favorable long-term outcomes in terms of bag intraocular lens/complex fixation and stability. In eyes with zonular weakness or dialysis, this technique appears to be a safe and knotless option for cataract surgery.

RESUMO Objetivo: Avaliar a estabilidade e eficácia da técnica double-flanged com sutura de 5-0 polipropileno para fixação de cataratas subluxadas aos 18 meses e as possíveis complicações desta nova técnica. Métodos: Esta técnica utiliza um monofilamento de polipropileno 5-0 para criar dois flanges com um termocautério para fixar um Segmento de Tensão Capsular na esclera a fim de estabilizar o saco capsular subluxado. Esta técnica foi implementada em 17 olhos que necessitavam do implante de lente intraocular em casos de diálise zonular devido a trauma, síndrome de Marfan, microesferofacia, subluxação idiopática ou pós-facoemulsificação que provocou subulxação do saco capsular intraoperatória. Resultados: O seguimento dos pacientes foi de 18 meses. A acuidade visual corrigida melhorou significativamente de 0,85 para 0,39 (logMAR), enquanto os erros de refração esféricos e cilíndricos e a pressão intraocular permaneceram estáveis. Nenhuma fotodegradação de sutura ou pseudofacodonese foi encontrada. Conclusão: A técnica double-flanged para fixação transescleral de saco capsular com sutura de 5-0 polipropileno mostrou resultados de estabilidade de longo prazo para o complexo lente/saco capsular. Então, aparenta ser uma opção segura para cirurgia de catarata, sem necessidade pontos, em olhos com fraqueza zonular ou diálise.

18-month results of double-fanged 5-0 polypropylene suture transscleral bag fixation in subluxated cataracts.

PURPOSE: To evaluate the stability and efficacy of the double-flanged 5-0 polypropylene suture to fixate subluxated cataracts at 18 months and the possible complications of this new technique. METHODS: This technique uses a 5-0 polypropylene monofilament to create two flanges with a thermocautery, for fixation of a capsular tension segment to the sclera to fix the subluxated capsular bag. This technique was implemented in 17 eyes requiring intraocular lens implantation in a setting of zonular dialysis due to trauma, Marfan syndrome, microspherophakia, idiopathic disease, and post-phacoemulsification status. RESULTS: Follow-up of the patients occurred at 18 months. Best-corrected visual acuity improved significantly from 0.85 to 0.39 (logMAR), whereas the spherical and cylindrical refractive errors and intraocular pressure remained stable from preoperation. No suture photodegradation or pseudophacodonesis were detected. CONCLUSION: The double-flanged 5-0 polypropylene suture transscleral bag fixation technique has shown favorable long-term outcomes in terms of bag intraocular lens/complex fixation and stability. In eyes with zonular weakness or dialysis, this technique appears to be a safe and knotless option for cataract surgery.

Bilateral Stroke: A Case Report.

We present the case of a 74-year-old woman, functionally independent in her daily activities, with a medical history notable for hypertension and dyslipidemia. She presented to the emergency room with an altered level of consciousness, opening her eyes only to pain, no verbal response, and flexion withdrawal from pain coupled with a Glasgow Coma Scale of 7. The intensive care unit was promptly summoned, and the patient was intubated and admitted to intensive care. Comprehensive laboratory assessments revealed no abnormalities and an initial cerebral CT scan showed no acute changes. A subsequent CT scan performed 24 hours post-event disclosed bilateral ischemia affecting the territories of the anterior and middle cerebral arteries. Regrettably, this catastrophic event precluded any potential for recovery. Consequently, the decision was made not to pursue further investigations to determine the underlying cause. The medical team opted for supportive treatment and comfort measures. Tragically, the patient died on the 37th day of hospital admission.

Pyruvate kinase M2 mediates IL-17 signaling in keratinocytes driving psoriatic skin inflammation.

Psoriasis is an inflammatory skin disease characterized by keratinocyte proliferation and inflammatory cell infiltration induced by IL-17. However, the molecular mechanism through which IL-17 signaling in keratinocytes triggers skin inflammation remains not fully understood. Pyruvate kinase M2 (PKM2), a glycolytic enzyme, has been shown to have non-metabolic functions. Here, we report that PKM2 mediates IL-17A signaling in keratinocytes triggering skin psoriatic inflammation. We find high expression of PKM2 in the epidermis of psoriatic patients and mice undergoing psoriasis models. Specific depletion of PKM2 in keratinocytes attenuates the development of experimental psoriasis by reducing the production of pro-inflammatory mediators. Mechanistically, PKM2 forms a complex with Act1 and TRAF6 regulating NF-κB transcriptional signaling downstream of the IL-17 receptor. As IL-17 also induces PKM2 expression in keratinocytes, our findings reveal a sustained signaling circuit critical for the psoriasis-driving effects of IL-17A, suggesting that PKM2 is a potential therapeutic target for psoriasis.

Percepções dos pais acerca da participação e comunicação de seus filhos com paralisia cerebral não oralizados / Parents' perceptions about the participation and communication of their children with non-speaking cerebral palsy / Percepciones de los padres sobre la participación y comunicación de sus hijos no oralizados con parálisis cerebral

Introdução: O conhecimento das percepções de familiares acerca da participação e comunicação de seus filhos com PC (Paralisia Cerebral) não oralizados contribui com processos educacionais e terapêuticos centrados na pessoa e na família. Objetivo: Conhecer aspectos da participação e comunicação de crianças e adolescentes com PC não oralizados, bem como fatores que favorecem ou dificultam o uso da CSA (Comunicação Suplementar e/ou Alternativa) no ambiente familiar e na escola. Método: Estudo descritivo e transversal de abordagem qualitativa, com amostra de cinco mães de alunos com PC não oralizados. Resultados: As mães relatam barreiras à participação de seus filhos e reconhecem a importância da comunicação nas interações e nas atividades familiares. Mencionam, também, não terem alcançado uso funcional da CSA, em casa, mas expressam satisfação com o nível de comunicação que têm com seus filhos. Por outro lado, abordam dificuldades de comunicação quando não identificam os desejos de seus filhos ou quando eles estão com outros interlocutores. Conclusão: Os achados evidenciam participação reduzida das crianças e do adolescente do estudo, e pouco, ou nenhum uso da CSA. Diante das dificuldades relatadas pelas participantes, os achados reforçam a necessidade de equipar os familiares, no sentido de promoverem a participação e a comunicação de seus filhos. Reforça-se a importância de profissionais de CSA e professores de educação especial trabalhar em parceria com os familiares, a fim de expandir as maneiras como interagem e se comunicam com seus filhos, e vice-versa, visando uma maior participação dos mesmos.

Introduction: Knowing family members' perceptions about the participation and communication of their children with non-speaking CP (Cerebral Palsy), contributes to educational and therapeutic processes centered on the person and family. Aim: Become acquainted with participation and communication aspects of children and adolescents with non-speaking CP, as well as factors that favor or hinder AAC (Augmentative Alternative Communication) use in the family environment and school. Method: Descriptive and cross-sectional study with a qualitative approach, with a sample of five mothers of students with non-speaking CP. Results: Mothers report barriers to their children's participation and recognize the importance of communication in family interactions and activities. They mention not having achieved functional use of AAC at home, but express satisfaction with the level of communication they have with their children. On the other hand, they address communication difficulties when they are unable to identify their children's wishes or when their children are with other interlocutors. Conclusion: The findings show reduced participation of the children and the adolescent in the study, as well as little or no AAC use. In view of the difficulties reported by the participants, the findings reinforce the need to equip family members, in order to promote these children's communication and participation. The importance of AAC professionals and special education teachers working in partnerships with families is reinforced. These professionals can help expand the ways in which mothers interact and communicate with their children, and vice versa, aiming at greater participation among them.

Introducción: Conocer las percepciones de los familiares sobre la participación y comunicación de sus hijos con PC (Parálisis Cerebral) no hablantes, contribuye a procesos educativos y terapéuticos centrados en la persona y la familia. Objetivo: Conocer aspectos de la participación y comunicación de niños y adolescentes con PC no hablantes, así como factores que favorecen o dificultan el uso de la CAA (Comunicación Aumentativa y Alternativa) en el ámbito familiar y en la escuela. Método: Estudio descriptivo y transversal con enfoque cualitativo, con una muestra de cinco madres de alumnos con PC no hablantes. Resultados: Las madres relatan barreras para la participación de sus hijos y reconocen la importancia de la comunicación en las interacciones y en las actividades familiares. Mencionan no haber logrado uso funcional de la CAA en casa, pero expresan satisfacción por el nivel de comunicación que tienen con sus hijos. Por otro lado, abordan las dificultades de comunicación cuando no identifican los deseos de sus hijos o cuando ellos están con otros interlocutores. Conclusión: Los hallazgos muestran una participación reducida de los niños y adolescente en el estudio y poco o ningún uso de CAA. Los hallazgos refuerzan la necesidad de equipar a las familias para promover la participación y comunicación de sus hijos. Se refuerza la importancia de que profesionales de CAA y maestros de educación especial trabajen en colaboración con las familias para ampliar las formas en que interactúan y se comunican con sus hijos, y viceversa, buscando una mayor participación de estos.

Targeted Marrow Irradiation Intensification of Reduced-Intensity Fludarabine/Busulfan Conditioning for Allogeneic Hematopoietic Stem Cell Transplantation.

Reduced-intensity conditioning (RIC) regimens frequently provide insufficient disease control in patients with high-risk hematologic malignancies undergoing allogeneic hematopoietic stem cell transplantation (HSCT). We evaluated intensification of fludarabine/busulfan (Flu/Bu) RIC with targeted marrow irradiation (TMI) in a dose escalation with expansion phase I clinical trial. TMI doses were delivered at 1.5 Gy in twice daily fractions on days -10 through -7 (dose levels: 3 Gy, 4.5 Gy, and 6 Gy), Flu (30 mg/m2 for 5 days) and Bu (area under the curve, 4800 µM*minute for 2 days). Eligible patients were age ≥18 years with high-risk hematologic malignancy and compromised organ function ineligible for myeloablative transplantation (n = 26). The median patient age was 64 years (range, 25 to 76 years). Nineteen patients (73%) had active or measurable residual disease at transplantation. One-year disease-free survival and overall survival were 55% (95% confidence interval [CI], 34% to 76%) and 65% (95% CI, 46% to 85%), respectively. Day +100 and 1 year transplantation-related mortality were 4% (95% CI, 0.6% to 27%) and 8.5% (95% CI, 2% to 32%), respectively. The 1-year cumulative incidence of relapse was 43% (95% CI, 27% to 69%). Rates of grade II-IV and III-IV acute GVHD rates were 57% (95% CI, 39% to 84%) and 22% (95% CI, 9% to 53%), respectively. Whole blood immune profiling demonstrated enrichment of central/transitional memory-like T cells with higher TMI doses, which correlated with improved survival compared with control samples from patients undergoing allogeneic HSCT. Intensification of a Flu/Bu RIC regimen with TMI is feasible with a low incidence of transplantation-related mortality in medically frail patients with advanced malignancies. The recommended phase 2 TMI dose is 6 Gy.

Prevalence of Premenstrual Syndrome and Associated Factors Among Academics of a University in Midwest Brazil.

OBJECTIVE: To investigate the prevalence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) in university students, the factors associated with PMS, the most prevalent symptoms, and the interference of symptoms in academic, family, social, and work activities. METHODS: This cross-sectional study included 1,115 university students aged ≥ 18 years from the University of Rio Verde, Goiás. Premenstrual syndrome and PMDD were identified using the Premenstrual Symptoms Screening Tool. Associations with sociodemographic, behavioral, reproductive, nutritional, and health factors were investigated using the Poisson regression. RESULTS: The prevalence of PMS was 46.9% (95% confidence interval [CI] 44.0-49.8), and of PMDD, 11.1% (95% CI 9.3-13.0). The most prevalent symptoms were physical, such as breast tenderness, bloating, e weight gain (73%); followed by psychological ones such as overeating/food cravings, tearful/more sensitive to rejection (> 60%). More than 30% of the patients reported that the symptoms interfered in a moderate-to-severe way in their social and academic activities. After adjusted analysis, PMS was more prevalent in those who were attending the 1st/2nd semester of college (prevalence ratio [PR] 1.44; 95% CI 1.14-1.80), those who consumed alcohol in the last 30 days (PR 1.23; 95% CI 1.04-1.47), and those who had depression (PR 1.49; 95% CI 1.30-1.71). CONCLUSION: Almost half of the university students had PMS and ∼ 11%, PMDD. Physical symptoms were the most common and interfered in a moderate-to-severe way in various aspects of life. Attending the first semesters, consuming alcohol, and having depression were risk factors for PMS. The identification of risk factors for PMS is essential to prevent symptoms and reduce the impact of the syndrome.

OBJETIVO: Investigar a prevalência de síndrome pré-menstrual (SPM) e do transtorno disfórico pré-menstrual (TDPM) em alunas universitárias, os fatores associados à SPM, os sintomas mais prevalentes e a interferência dos sintomas nas atividades acadêmicas, familiares, sociais e de trabalho. MéTODOS: Este estudo transversal incluiu 1.115 estudantes universitárias ≥ 18 anos da Universidade de Rio Verde, Goiás. Síndrome pré-menstrual e TDPM foram identificados por meio do Premenstrual Symptoms Screening Tool. As associações com fatores sociodemográficos, comportamentais, reprodutivos, nutricionais e de saúde foram investigadas utilizando-se a regressão de Poisson. RESULTADOS: A prevalência de SPM foi de 46,9% (intervalo de confiança [IC] de 95% 44,0­49,8) e de TDPM, 11,1% (IC 95% 9,3­13,0). Os sintomas mais prevalentes foram físicos, como sensibilidade mamária, distensão abdominal e ganho de peso (73%); seguidos por psicológicos, como comer demais/desejos por comida, chorar/mais sensível à rejeição (> 60%). Mais de 30% relataram que os sintomas interferiam de forma moderada a grave em suas atividades sociais e acadêmicas. Após análise ajustada, a SPM foi mais prevalente naquelas que estava cursando o 1°/2° semestre da faculdade (razão de prevalência [RP] 1,44; IC 95% 1,14­1,80), as que haviam consumido álcool nos últimos 30 dias (RP 1,23; IC 95% 1,04­1,47), e as que tinha depressão (RP 1,49; IC 95% 1,30­1,71). CONCLUSãO: Quase metade das universitárias tinha SPM e cerca de 11%, TDPM. Os sintomas físicos foram os mais comuns e interferiram de forma moderada a grave em vários aspectos da vida. Frequentar os primeiros semestres, consumir álcool e ter depressão foram fatores de risco para SPM. A identificação dos fatores de risco para a SPM é essencial para prevenir os sintomas e reduzir o impacto da síndrome.

Auditory Brainstem Response with chirp stimuli in newborns: an integrative review / PEATE por estímulo chirp em recém-nascidos: uma revisão integrativa

ABSTRACT Purpose: to review the literature available on electrophysiological findings on ABR with chirp stimuli in newborns. Methods: articles were searched in PubMed, MEDLINE, Scopus, Web of Science, LILACS, and SciELO. Papers published in English and Portuguese between 2010 and 2020 were selected, including those that addressed ABR with air-conduction broadband chirp stimuli in newborns, that assessed ABR with a specific frequency, and that compared ABR results with chirp and click stimuli. Articles that assessed only bone-conduction results, duplicates, literature reviews, case reports, letters, and editorials were excluded. Literature review: the search strategy resulted in nine selected articles. Four studies (44.4%) analyzed ABR wave amplitude and latency with chirp stimuli, three studies (33.3%) compared the time of ABR procedures between chirp and click stimuli, two studies (22.2%) analyzed only amplitude, and two (22.2%), verified the specificity of ABR with chirp stimuli in neonatal hearing screening. Conclusion: chirp stimuli elicit responses with greater amplitudes, lower latencies, and shorter examination time than those with click stimuli in newborns.

RESUMO Objetivo: revisar a literatura disponível sobre os achados eletrofisiológicos do PEATE por estímulo chirp em recém-nascidos. Métodos: a busca dos artigos foi realizada nas bases de dados PubMed, Medline, Scopus, Web of Science, LILACS e Scielo. Foram selecionados artigos publicados em Inglês e Português, entre 2010 e 2020. Foram incluídos artigos que contemplavam o uso do PEATE por estímulo chirp banda larga por via aérea em recém-nascidos; que avaliavam o PEATE por frequência específica e que comparavam os resultados do PEATE por estímulo chirp e clique. Aqueles que avaliavam somente resultados por via óssea, artigos repetidos nas bases de dados, artigos de revisão de literatura, relato de casos, cartas e editoriais foram excluídos. Revisão da Literatura: a estratégia de busca resultou na seleção de nove artigos. Quatro estudos (44,4%) analisaram amplitude e latência das ondas do PEATE por estímulo chirp, três (33,3%) compararam o tempo de realização do PEATE por clique e chirp, dois estudos (22,2%) analisaram somente o parâmetro amplitude e dois (22,2%) verificaram a especificidade do PEATE por chirp na triagem auditiva neonatal. Conclusão: o estímulo chirp possibilita respostas com maiores amplitudes, maiores latências e menor tempo de realização do exame quando comparado ao estímulo clique em recém-nascidos.

Pharmaceutical services in primary health care: dissatisfaction among users, managers and pharmacists

Abstract To assess the performance indicators for pharmaceutical services (PS) in primary health care (PHC), the level of satisfaction with pharmacy services among users and managers / pharmacists' impressions in relation to the findings were evaluated. The study used mixed methods, including a retrospective and descriptive study of the performance indicators for PS in PHC, an observational study on the level of satisfaction and a qualitative study of users' perception of pharmacy services at Health Units. Managers and pharmacists' impressions of the study results were also collected. Only 44.4% of pharmacies had a full-time pharmacist. From the establishments visited, 5.3% did not have an air-conditioned environment, and only 33.3% of the items essential to the Good Practices of Storage of Medicines and Supplies criteria were fulfilled. Although 77.9% of the prescribed medicines were dispensed, it did not reach the 80% standard. The satisfaction level of users was 3.2±0.6, indicating dissatisfaction with pharmacies' services. By means of an evaluation of each item within the questionnaire, it was possible to observe that variables related to pharmaceutical care presented low scores in relation to other domains, thus evidencing the fragility of the pharmaceutical- patient relationship in users' perception. Managers and pharmacists suggested that these results were related to the inadequate physical infrastructure of pharmacies, work overload, lack of recognition and undervaluation of pharmacists, lack of interaction within the PHC team, high turnover of pharmacists, and lack of PS prioritization by the administration. PS in PHC has structural and organizational weaknesses that require changes. In general, users are dissatisfied with pharmacies' services, especially with pharmaceutical care.

Pulp mill sludge-derived carbon activated with an alternative source of chemicals and its application in wastewater treatment - An approach for byproducts valorization.

The purpose of this study was to investigate pulp mill by-products valorization through activated carbon (AC) production and its application in wastewater treatment. Bio-sludge is a known promising precursor for AC production. The mill's chemical recovery stage generates an effluent (electrostatic precipitator ash leachate - EPAL) with high levels of potassium and sodium, which motivate studies regarding its viability as a chemical source for carbon activation. Bio-sludge and EPAL are problematic by-products and this research line would allow their return to the productive chain, as an adsorbent for the wastewater treatment. Two carbonization heating rates (3.5, 15 °C/min), three activation agents (NaOH, KOH, EPAL) and two activator:bio-sludge ratios (1:1, 2:1) were used for AC production. The best ACs in terms of surface area were those produced at 3.5 °C/min, with KOH or EPAL in 2:1 proportion. ACs produced under these conditions and commercial activated carbon (CAC) were used in adsorption tests with industrial wastewater. For color removal, KOH-activated carbon presented the greatest efficiency (80.45 %), followed by CAC (76.74 %) and EPAL-activated carbon (70.13 %). For COD removal, EPAL-activated carbon presented greater efficiency (53.49 %), followed by CAC (40.84 %) and KOH-activated carbon (36.86 %). Freundlich's model best described the experimental adsorption data. The KOH results were expected to be satisfactory, since KOH is proven to be effective for carbon activation. The EPAL-activated carbon results were remarkable, especially for COD removal, showing that EPAL can be used as an activator and that the by-products have potential for valorization according to the circular economy principles.

Active search strategies, clinicoimmunobiological determinants and training for implementation research confirm hidden endemic leprosy in inner São Paulo, Brazil.

BACKGROUND: This study evaluates implementation strategies for leprosy diagnosis based on responses to a Leprosy Suspicion Questionnaire (LSQ), and analyzes immunoepidemiological aspects and follow-up of individuals living in a presumptively nonendemic area in Brazil. METHODOLOGY/PRINCIPAL FINDINGS: Quasi-experimental study based on LSQ throughout Jardinópolis town by community health agents, theoretical-practical trainings for primary care teams, dermatoneurological examination, anti-PGL-I serology, RLEP-PCR, and spatial epidemiology. A Leprosy Group (LG, n = 64) and Non-Leprosy Group (NLG, n = 415) were established. Overall, 3,241 LSQs were distributed; 1,054 (32.5%) LSQ were positive for signs/symptoms (LSQ+). Among LSQ+ respondents, Q2-Tingling (pricking)? (11.8%); Q4-Spots on the skin? (11.7%); Q7-Pain in the nerves? (11.6%); Q1-Numbness in your hands and/or feet? (10.7%) and Q8-Swelling of hands and feet? (8.5%) were most frequently reported symptoms. We evaluated 479 (14.8%) individuals and diagnosed 64 new cases, a general new case detection rate (NCDR) of 13.4%; 60 were among 300 LSQ+ (NCDR-20%), while 4 were among 179 LSQ negative (NCDR-2.23%). In LG, Q7(65%), Q2(60%), Q1(45%), Q4(40%) and Q8(25%) were most frequent. All 2x2 crossings of these 5 questions showed a relative risk for leprosy ranging from 3 to 5.8 compared with NLG. All patients were multibacillary and presented hypochromatic macules with loss of sensation. LG anti-PGL-I titers were higher than NLG, while 8.9% were positive for RLEP-PCR. The leprosy cases and anti-PGL-I spatial mappings demonstrated the disease spread across the town. CONCLUSIONS/SIGNIFICANCE: Implementation actions, primarily LSQ administration focused on neurological symptoms, indicate hidden endemic leprosy in a nonendemic Brazilian state.

Does neoadjuvant therapy for pancreatic head adenocarcinoma increase postoperative morbidity? A systematic review of the literature with meta-analysis.

Neoadjuvant treatment (NT) for pancreatic head cancer may allow some patients to undergo curative resection, but its impact on postoperative complications remains unclear. A systematic review and meta-analysis were performed to compare overall postoperative morbidity, pancreatic fistula, and mortality between patients who underwent upfront surgery and those who underwent neoadjuvant therapy first. Forty-five studies with 3359 patients were included. No significant differences in morbidity and mortality rates associated with NT for pancreatic head cancer were detected in this study.

Pros and cons of radiotherapy omission in elderly breast cancer patients following breast conservative surgery.

Breast cancer is a highly prevalent disease worldwide, with adjuvant radiation therapy (RT) being considered standard of care after breast-conserving surgery (BCS). Older patient population can present multiple running comorbidities and less aggressive tumor behavior, and the absolute impact of adjuvant RT on local control can be low. This article aims to review the available literature about the impact of adjuvant RT, discussing characteristics to identify lower risk cases, and advantages and disadvantages of the omission of adjuvant radiotherapy in this group.

Use and implementation of the International Classification of Functioning, Disability and Health with Children and Youth within the context of Augmentative and Alternative Communication: an integrative literature review

ABSTRACT Purpose: to discuss the implementation and use of the International Classification of Functioning, Disability and Health (ICF) and International Classification of Functioning, Disability and Health, Children and Youth Version (ICF-CY) among children and adolescents, within the Augmentative and Alternative Communication (AAC) field. Methods: an integrative literature review. PubMed, Web of Science and VHL databases were searched for papers published between 2006 and 2017 that reported on the use of ICF and ICF-CY within the AAC context. Eighteen papers were reviewed and sorted into: Category i) papers which reported on the use of the ICF or ICF-CY with people who rely on AAC; and Category ii) theoretical papers or papers that used the ICF and ICF-CY to organize the results. Results: papers used the frameworks with different purposes, including the characterization of the children and their environment, goal setting and measurement of the results of therapeutic intervention. The papers drew on all elements, however, Activities and Participation were the components most used. Parents or caregivers were most commonly consulted in classifying the children's and young people's profiles of functioning, followed by the Educators and speech and language pathologists. Conclusion: classifications have shown advantages when used in the AAC field. Therefore, it is necessary to provide training in order for professionals to implement them in services.

Intensity-modulated ventricular irradiation for intracranial germ-cell tumors: Survival analysis and impact of salvage re-irradiation.

BACKGROUND AND PURPOSE: The roles of surgery, chemotherapy, and parameters of radiation therapy for treating very rare central nervous system germ cell tumors (CNS-GCT) are still under discussion. We aimed to evaluate the survival and recurrence patterns of patients with CNS-GCT treated with chemotherapy followed by whole ventricle irradiation with intensity-modulated radiation therapy. MATERIALS AND METHODS: We reviewed the clinical outcomes of 20 consecutive patients with CNS-GCT treated with chemotherapy and intensity-modulated radiation therapy from 2004 to 2014 in two partner institutions. RESULTS: Twenty children with a median age of 12 years were included (16 males). Sixteen tumors were pure germinomas, and 4 were non-germinomatous germ cell tumors (NGGCT). All patients were treated with intensity-modulated radiation therapy guided by daily images, and 70% with volumetric intensity-modulated arc radiotherapy additionally. The median dose for the whole-ventricle was 25.2 Gy (range: 18-30.6 Gy) and 36 Gy (range: 30-54 Gy) for the tumor bed boost. The median post-radiation therapy follow-up was 57.5 months. There were 3 recurrences (2 NGGCT and 1 germinoma that recurred as a NGGCT), with 1 death from the disease and the other 2 cases each successfully rescued with chemotherapy and craniospinal irradiation. The overall survival at 5 years was 95% and disease-free survival was 85%. CONCLUSIONS: The results of this study suggest that the combined use of chemotherapy followed by whole ventricle irradiation with intensity-modulated radiation therapy is effective for CNS-GCTs, especially pure germinomas. Even being rescued with craniospinal irradiation, the NGGCT cases have markedly worse prognoses and should be more rigorously selected for localized treatment.

Avaliação de Crianças com Indicadores de Risco para Deficiência Auditiva Atendidas em um Serviço de Referência em Triagem Auditiva Neonatal / Evaluation of Children with Risk Indicators for Hearing Loss in a Newborn Hearing Screening Reference Service / Evaluación de Niños con Indicadores de Riesgo para Deficiencia auditiva Atendidas en un Servicio de Referencia en Triagem Auditiva Neonatal

Objetivo: Avaliar a audição de crianças com indicadores de risco para deficiência auditiva que realizaram triagem auditiva neonatal e retornaram para o acompanhamento após seis meses. Métodos: Estudo longitudinal realizado no Serviço de Referência em Triagem Auditiva Neonatal de um hospital universitário com crianças com indicadores de risco para deficiência auditiva. O estudo foi realizado em duas etapas: teste e reteste (quando necessário) e acompanhamento (aos seis meses de idade corrigida). Resultado: Na triagem foram avaliadas 179 crianças. Nesta etapa houve associação entre resultado "falha" em ambas as orelhas e suspeita de síndrome e resultado "falha" e citomegalovirose. Em todas as etapas 12 crianças apresentaram alterações condutivas confirmadas pela imitanciometria, e nenhuma apresentou alteração neurossensorial. Conclusão: A alteração auditiva condutiva foi a mais presente nesta população. Não foram detectadas alterações auditivas neurossensoriais em nenhuma criança avaliada no período do estudo, portanto o monitoramento auditivo dessas crianças deve ser realizado até idades mais avançadas para se detectar eventuais perdas auditivas progressivas ou de origem tardia.

Objective: To evaluate the hearing of children with risk indicators for hearing loss who underwent newborn hearing screening and returned to follow up after six months. Methods: Longitudinal study conducted at the Newborn Hearing Screening Service of a university hospital with children with risk indicators for hearing loss. The study was performed in two stages: test and retest (when necessary) and follow-up (at six months). Results: 179 children were evaluated in the screening. In this stage there was an association between "failed" result in both ears and suspected syndrome and "failed" result and cytomegalovirus. In all the stages, 12 children presented conductive alterations confirmed by the immittanciometry and none presented sensorineural alteration. Conclusion: Conductive hearing loss was more present in this population. No sensorineural hearing loss was detected in any child evaluated during the study period; therefore the auditory monitoring of these children should be performed until later ages to detect any progressive or late-onset hearing loss.

Objetivo:Evaluar la audición de niños con indicadores de riesgo para la deficiencia auditiva que realizaron la tamizaje auditivo neonatal y regresaron para el seguimiento después de seis meses. Métodos:Estudio longitudinal realizado en el Servicio de Referencia enTriage Auditiva Neonatal de un hospital universitario con niños con indicadores de riesgo para la deficiencia auditiva. El estudio fue realizado en dos etapas: prueba y reprueba (cuandonecesario) y seguimiento (a los seis meses de edad corregida). Resultado:En la selección se evaluaron 179 niños. En esta etapa hubo asociación entre resultado "falla" en ambas orejas y sospechosa de síndrome y resultado "falla" y citomegalovirosa. En todas las etapas, 12 niños presentaron alteraciones conductivas confirmadas por la imitanciometría y ninguna presentó alteración neurosensorial. Conclusión: La alteración auditiva conductiva fuela más presente en esta población. No se detectaron alteraciones auditivas neurosensorial en ningún niño evaluado en el período del estudio, por lo que el monitoreo auditivo de estos niños debe ser realizado hasta edades más avanzadas para detectar eventuales pérdidas auditivas progresivas o de origentardío.