Brazilian portuguese validation of the patient-reported outcome measure for urethral stricture surgery (USS-PROM) questionnaire.

INTRODUCTION: Urethral stricture is a common, albeit complex, condition that predominantly affects men. The aim of this study was to translate, culturally adapt, and validate the Patient-Reported Outcome Measure questionnaire for patients undergoing urethroplasty (USS-PROM) into Brazilian Portuguese using validated psychometric criteria. MATERIALS AND METHODS: The process involved translating and culturally adapting the original USS-PROM into Brazilian Portuguese (USS-PROMbr), synthesizing, back-translating, cross-culturally adapting, and analyzing the pre-final version with experts from our committee. This pre-version was administered to 10 patients who had undergone urethroplasty by the Reconstructive Urology team at the Hospital de Clínicas de Porto Alegre for face validation, linguistic, and semantic adjustments, resulting in the final USS-PROMbr version. Subsequently, well-established psychometric criteria, including content validity, internal consistency, and test-retest reproducibility, were assessed after administering the questionnaire to a total of 56 patients, with 50 of them responding to the test and retest. RESULTS: Evaluation of the pre-final version identified 15 questions as clear, and only one question was considered somewhat unclear necessitating modifications based on patient suggestions and subsequent reassessment by the research team. Psychometric criteria demonstrated good content validity, with a content validity index exceeding 0.80 for all questions; good internal consistency, Cronbach's alpha of 0.77, ranging from 0.70 to 0.78 with the exclusion of any item, and item-total correlations ranging from 0.33 to 0.67. The test-retest intraclass correlation coefficient was 0.74 for the lower urinary tract symptoms construct (Q1-Q6). CONCLUSION: The USS-PROMbr demonstrated acceptable cross-cultural adaptation and psychometric properties, making it a valid and useful tool for evaluating patients undergoing urethroplasty.

Skeletal Muscle Discomfort and Lifestyle of Brazilian Military Police Officers of Administrative and Tactical Force.

Our aim was to evaluate musculoskeletal discomfort and the lifestyle of military police officers of administrative and tactical force departments. Military police officers were distributed into two groups: administrative (Adm, n = 15) and tactical force (TF, n = 16) departments. Their lifestyle was assessed using the Fantastic Lifestyle questionnaire. Moreover, physical activity quantification was assessed using the International Physical Activity questionnaire, and musculoskeletal discomfort was quantified using the Corlett diagram. The mean total time of physical activity was 546 ± 276 min per week. No differences (p = 0.0832) were found between the Adm (454 ± 217 min) and TF (623 ± 301 min) groups. Concerning lifestyle, in general the sample presented very good (42%) and good (42%) style classification. For this parameter, no significant differences were found, but only a tendency was discovered (x2: 7.437; p = 0.0592); indeed, the TF presented a better classification (63%) of very good, compared to the Adm (53%) of good. No differences (p > 0.05) were found in musculoskeletal perception of discomfort between the right and left sides (p > 0.05) for all police officers and between the Adm and FT groups (p > 0.05). Military police officers showed high and moderate risk for waist circumference and waist-to-hip ratio, respectively; however, lifestyle and total time of physical activity were considered adequate without differences between military administrative and tactical force sectors.

Application of spatial environmental indicators in the assessment of degradation potential of water resources in water basins.

Changes in land use have been occurring in a continuous and disorderly way in recent decades due to rapid population growth and the growing demand for food. These constant changes result in a series of harmful effects to the environment, especially to water resources, significantly changing their availability and quality. This study aims to evaluate the degradation potential of watersheds through an evaluation of some environmental indicators using arithmetic means to construct an index called in this research "index of potential environmental degradation" (IPED). To form the IPED, the hydrographic sub-basins of the Sorocabuçu River, located in the central west of the State of São Paulo, Brazil, comprised the study area. The results showed that most hydrographic sub-basins, that is, eight units, present degradation values ranging from moderate to very high, resulting mainly from low conservation values of forests plus a use destined to the planting of temporary cultures depending on good physical conditions. On the other hand, only one sub-basin showed a low degradation value. The methodology used for the development of the IPED is easy to apply and an effective tool for environmental analyses. It may contribute to studies and forms of planning and land use management aiming the conservation of water resources and protected areas and reduction of degradation.

Influence of the Dose and Frequency of Administration of Tramadol on Analgesia, Hematological, Biochemical Parameters, and Oxidative Status of Cats Undergoing Ovariohysterectomy.

This study aimed to evaluate the effects of the repeated administration of tramadol subcutaneously on postoperative analgesia, liver, kidneys, and oxidative status in the postoperative period of cats undergoing ovariohysterectomy. Thirty-seven cats were randomly assigned to 5 groups, according to the postoperative analgesic treatment: NaCl 0.9%, GC; tramadol at 2 mg/kg, T2B (q12h) and T2T (q8h); or 4 mg/kg, T4B (q12h) and T4T (q8h). Oxidative status was assessed at baseline, 12 hours and 24 hours after the final administration of tramadol by the activity of superoxide dismutase (SOD), catalase (CAT), myeloperoxidase (MPO), butyrylcholinesterase (BuChE), and lipoperoxidation (MDA). Total blood count, serum biochemistry and urinalysis were compared between baseline and 12 hours posttramadol. Postoperative pain was evaluated by applying the Glasgow Feline Composite Measure Pain Scale at baseline, 3 (T3), 6 (T6), 8 (T8), 12 (T12), 24 (T24) e 36 (T36) hours after extubation. No side effects were observed. Tramadol increased SOD activity while CAT varied among groups in all time points but not over time. MDA levels increased from baseline to 12 hours in all groups but T4T. MPO activity decreased from baseline to 24 hours in some groups, including GC. Creatinine and phosphatase alkaline decreased in T2T, T4B, and T4T at 12 hours. Higher pain scores were observed from T3 to T8, except for GC. Rescue analgesia was administered only at T3. No difference in pain scores was observed from T8 onwards. Based on the findings, it is suggested that tramadol at 2 mg/kg every 8 hours is recommended for postoperative analgesia of cats undergoing ovariohysterectomy.

Laparoscopic pyeloplasty proficiency during a residency program after adoption of a standardized simulation training program is maintained during the COVID pandemic despite reduced surgery volume.

PURPOSE: To evaluate the effect of the standardized laparoscopic simulation training program in pyeloplasty, following its implementation and during the COVID-19 pandemic. MATERIAL AND METHODS: A retrospective chart review was performed at Hospital de Clínicas de Porto Alegre, a tertiary referral center in south Brazil, in which 151 patients underwent laparoscopic pyeloplasty performed by residents between 2006-2021. They were divided into three groups: before and after adoption of a standardized laparoscopic simulation training program and during the COVID-19 pandemic. The main outcome was a combined negative outcome of conversion to open surgery, major postoperative complications (Clavien-Dindo III or higher) or unsuccessful procedure, defined as need for redo pyeloplasty. RESULTS: There was a significant reduction in the combined negative outcome (21.1% vs 6.3%), surgical time (mean 200.0 min vs 177.4 min) and length of stay (median 5 days vs 3 days) after the adoption of simulation training program. These results were maintained during the COVID-19 pandemic (combined negative outcome of 6.3%, mean surgical time of 160.1 min and median length of stay of 3 days) despite a reduction in 55.4% of the surgical volume. CONCLUSION: A structured laparoscopic simulation program can improve outcomes of laparoscopic pyeloplasty during the learning curve.

Simple lessons from complex learning: what a neural network model learns about cosmic structure formation.

We train a neural network model to predict the full phase space evolution of cosmological N-body simulations. Its success implies that the neural network model is accurately approximating the Green's function expansion that relates the initial conditions of the simulations to its outcome at later times in the deeply nonlinear regime. We test the accuracy of this approximation by assessing its performance on well-understood simple cases that have either known exact solutions or well-understood expansions. These scenarios include spherical configurations, isolated plane waves, and two interacting plane waves: initial conditions that are very different from the Gaussian random fields used for training. We find our model generalizes well to these well-understood scenarios, demonstrating that the networks have inferred general physical principles and learned the nonlinear mode couplings from the complex, random Gaussian training data. These tests also provide a useful diagnostic for finding the model's strengths and weaknesses, and identifying strategies for model improvement. We also test the model on initial conditions that contain only transverse modes, a family of modes that differ not only in their phases but also in their evolution from the longitudinal growing modes used in the training set. When the network encounters these initial conditions that are orthogonal to the training set, the model fails completely. In addition to these simple configurations, we evaluate the model's predictions for the density, displacement, and momentum power spectra with standard initial conditions for N-body simulations. We compare these summary statistics against N-body results and an approximate, fast simulation method called COLA (COmoving Lagrangian Acceleration). Our model achieves percent level accuracy at nonlinear scales of k ∼ 1 Mpc - 1 h , representing a significant improvement over COLA.

Effect of maternal true combined endodontic-periodontal lesion on insulin and inflammatory pathway in adult offspring.

BACKGROUND: Maternal periodontal disease (PED) and apical periodontitis (AP) are associated insulin resistance (IR), increased tumor necrosis factor-α (TNF-α) levels, and alterations in insulin signaling (IS) in the gastrocnemius muscle (GM) of adult offspring. TNF-α stimulates I kappa B kinase (IKK) and c-Jun N-terminal protein kinase (JNK), resulting in IS attenuation. However, studies that investigated the maternal true endodontic-periodontal lesion (EPL) in offspring are scarce, and in this case, the impact could be even higher. This study aimed to evaluate the effects of EPL on the IR, IS, and inflammatory pathways on the offspring GM. METHODS: Female Wistar rats were distributed into control, AP, PED, and EPL groups. After 30 days of oral inflammation induction, rats from all groups were allowed to mate with healthy rats. The body weight of the offspring was assessed from birth to 75 days of age. After 75 days, the following measurements were performed: glycemia, insulinemia, IR, TNF-α content, and IKKα/ß, JNK, pp185 (Tyr), and IRS-1 (Ser) phosphorylation status in the GM. RESULTS: Maternal PED and EPL were associated with low birth weights. All maternal oral inflammations promoted IR and IS impairment in the GM and only maternal PED and EPL caused an increase in TNF-α content and IKKα/ß phosphorylation status in the GM of offspring. The offspring of the rats with EPL group showed worsening of metabolic changes when compared with offspring of rats with AP or PED. CONCLUSION: Association of maternal AP and PED promoted a more pronounced worsening in the health of the adult offspring.

Apical periodontitis promotes insulin resistance and alters adaptive immunity markers in rats.

OBJECTIVE: Apical periodontitis (AP) is a chronic or acute inflammatory disease usually developed from endodontic infections, predominantly due to gram-negative anaerobic bacteria invading the dental pulp. This study aimed to evaluate lymphocyte markers to assess the involvement of adaptive immunity in insulin resistance (IR) in a rat model of AP.Design.Forty-five male Wistar albino rats were divided into 3 groups (control, 1AP and 4AP). AP was induced in the upper right first molar (1AP), and in the first and second upper and lower right molars (4AP). The spleen was collected to evaluate the expression of transcription factors involved in lymphocyte polarization, including T-bet (Th1), GATA3 (Th2), and FOXP3 (Treg). Blood samples were assessed for serum cytokine levels transcribed by the respective lymphocyte polarizations, INF-γ (Th1), IL-4 (Th2) and TGF-ß (Treg). In addition, glucose and insulin levels were measured to evaluate IR by the HOMA-IR method. RESULTS: The results showed higher T-bet expression on AP groups, along with lower GATA3 and FOXP3 expression in the 1AP, in addition to increased GATA3 and decreased FOXP3 expression in the 4AP group compared to the CN group. There was no difference in the INF-γ levels, while IL-4 was decreased in the AP groups. Taken together, these results suggest that the adaptive immune system, with a predominance of the Th1 polarization, may be involved in the development of IR in rats with AP. CONCLUSIONS: AP promotes increase in the expression of T-bet (4AP) and decrease of FOXP3 expressions and IL-4 levels (1AP and 4AP). However, depending on the number of lesions (1 or 4 lesions), the expression of GATA3 appears differently. Thus, innate immunity and adaptive immunity may contribute to the IR observed in rats with AP.

Comparative Study on Lead and Copper Biosorption Using Three Bioproducts from Edible Mushrooms Residues.

Agricultural waste products can be used as biosorbents for bioremediation once they are low-cost and high-efficient in pollutants removal. Thus, waste products from mushroom farming such as cutting and substrate of Lentinula edodes (popularly known as shiitake) and Agaricus bisporus (also known as champignon) were evaluated as biosorbents for metallic contaminants copper (Cu) and lead (Pb). Shiitake and champignon stalks, and shiitake substrate (medium in which shiitake was cultivated) were dried, grounded, characterized and experimented to remove Cu and Pb from contaminated water. The Sips model was used to establish the adsorption isotherms. Regarding Cu, champignon stalks have the best removal efficiency (43%), followed by substrate and stalks of shiitake (37 and 30%, respectively). Pb removals were similar among three residues (from 72 to 83%), with the champignon stalks standing out. The maximum adsorption capacities (qmax) for Cu in shiitake and champignon stalks were 22.7 and 31.4 mg/g-1, respectively. For Pb, qmax for shiitake and champignon stalks, and shiitake substrate were 130.0, 87.0 and 84.0 mg/g-1, respectively. The surface morphology of the champignon stalks revealed an organized and continuous structure. After an interaction with metals, the stalk of champignon accumulated the metal ions into interstices. Mushroom residues showed a relevant adsorption efficiency, especially for Pb. Mushroom farming waste are a very low-cost and promising alternative for removing toxic heavy metals from aquatic environment.

Nonlinear Models to Describe the Testicular Size Growth Curve of Mangalarga Marchador Stallions.

This study aimed to describe the testicular growth curve in Mangalarga Marchador stallions fitting nonlinear models to data of total scrotal width (TSW) and testicular volume (TV). A cross-sectional study was conducted with 120 stallions, aging from 1.75 to 21.93 years. The parameters of nonlinear models (Brody, Gompertz, Hill, Logistic I and II, Meloun I and II, Michaelis-Menten, Mitscherlich, and von-Bertalanffy) were estimated by Gauss-Newton iterative process. Goodness of fit was evaluated by the corrected Akaike (AICc) and Bayesian (BIC) information criteria, adjusted R2, error sum of square, mean absolute deviation and average prediction error. Based on the goodness of fit, the Logistic I model fitted better for TSW while Logistic II fitted better for TV growth curve. The inflection point (IP) of TSW growth was estimated in 5.23 cm at 0.76 years; the IP of TV growth was estimated in 139.36 cm3 at 2.57 years. The TV growth curve reached a plateau later than TSW growth curve, mainly because testicular height maintains growth for a longer period. In addition, there were moderate and positive correlations between whiter height and TSW and TV (r = 0.51 and r = 0.53, respectively). Findings suggest that TV is more associated with sexual maturity than sexual precocity. In addition, the moderate and positive correlations between whiter height and TSW and TV indicate that testicular traits can be included in selection programs of Mangalarga Marchador stallions with the same relevance as the morphometric traits.

Environmental noise in hospitals: a systematic review.

Environmental noise has been growing in recent years, causing numerous health problems. Highly sensitive environments such as hospitals deserve special attention, since noise can aggravate patients' health issues and impair the performance of healthcare professionals. This work consists of a systematic review of scientific articles describing environmental noise measurements taken in hospitals between the years 2015 and 2020. The researchers started with a consultation of three databases, namely, Scopus, Web of Science, and ScienceDirect. The results indicate that for the most part, these studies are published in journals in the fields of medicine, engineering, environmental sciences, acoustics, and nursing and that most of their authors work in the fields of architecture, engineering, medicine, and nursing. These studies, which are concentrated in Europe, the Americas, and Asia, use as reference values sound levels recommended by the World Health Organization. Leq measured in hospital environments showed daytime values ranging from 37 to 88.6 dB (A) and nighttime values of 38.7 to 68.8 dB (A). Leq values for outdoor noise were 74.3 and 56.6 dB (A) for daytime and nighttime, respectively. The measurements were taken mainly inside hospitals, prioritizing more sensitive departments such as intensive care units. There is a potential for growth in work carried out in this area, but research should also include discussions about guidelines for improvement measures aimed at reducing noise in hospitals.

Socioeconomic impact of high-cost drugs in Brazilian dermatology. Legal and financial aspects, and impact on clinical practice

Abstract The technological advancement of the pharmaceutical industry, resulting from the techniques of molecular biology and expansion of the knowledge of immunopathogenesis, has modified the therapeutic arsenal used in dermatology. Scientific research and regulatory standards cause drug costs to rise, thus making their use impossible in most public policies. In order to make high-cost drugs viable in the public health network, the Specialized Pharmaceutical Assistance Component was created. However, despite the frequent incorporation of medications, the constant requirement of drugs through lawsuits leads to exorbitant costs to the state budget. The present work analyzed through a descriptive observational study, the current situation of the Specialized Component and the involvement of medicines used in dermatology, through legal reviews, financial analyses, and medical articles, aiming at future incorporations for the specialty. When assessing the legal demands for dermatological drugs in the state of São Paulo, the specialty still has a low participation and psoriasis is the main disease involved in requiring drugs through the judicial system in the state. New methods of access to raw materials must be created to reduce legal issues. Cost-effectiveness and public planning studies are mandatory for incorporating new dermatological therapies.

Burnout syndrome in pediatric urology: A perspective during the COVID-19 pandemic - Ibero-American survey.

INTRODUCTION: Burnout syndrome is a major cause of decreased life quality, mental health, and productivity for physicians. It is strongly related to work overload and has been a scarcely studied topic in pediatric urology. During the COVID-19 pandemic, authorities' recommendations have led to big changes in pediatric urology practice worldwide. This study aimed to evaluate the level of burnout in Ibero-American pediatric urologists (IPUs) during this pandemic. MATERIAL AND METHODS: A cross-sectional study was conducted by applying an electronic survey during the COVID-19 pandemic peak to members of the two major associations of pediatric urology in Ibero-America (the Ibero-American Society of Pediatric Urology [SIUP] and the Brazilian School of Pediatric Urology [BSPU]) to evaluate demographic, pre-pandemic, and pandemic data. Burnout levels were assessed using the Copenhagen Burnout Inventory (CBI) questionnaire. RESULTS: A response rate of 40% was obtained (182 out of 455 IPU respondents). Participants were from 14 different countries in Ibero-America and 75.4% were male. Data showed that during the pandemic there was a significant decrease in weekly workload, that is: > 40 h per week (h/w) (91.4%-44.6%, p < 0.001); and >6 h/w (94.9%-45.1%%, p < 0.001) in operating room time (ORT). Personal (Pe-BO), work-related (W-BO), and patient-related (Pa-BO) burnout levels among IPUs were 26.3%, 22.3%, and 7.4%, respectively (Summary table). An important difference by gender was seen, with women suffering more from the syndrome (odds ratio of 2.67 [95% confidence interval, 1.285.58; p = 0.013] for Pe-BO and OR of 3.26 [95% CI, 1.52-7.01; p = 0.004] for W-BO). CONCLUSION: A significant decrease in workload for IPU during the pandemic was observed, as well as a low level of burnout syndrome during this time. However, the predominance of burnout in women found in this study is notable.

Socioeconomic impact of high-cost drugs in Brazilian dermatology. Legal and financial aspects, and impact on clinical practice.

The technological advancement of the pharmaceutical industry, resulting from the techniques of molecular biology and expansion of the knowledge of immunopathogenesis, has modified the therapeutic arsenal used in dermatology. Scientific research and regulatory standards cause drug costs to rise, thus making their use impossible in most public policies. In order to make high-cost drugs viable in the public health network, the Specialized Pharmaceutical Assistance Component was created. However, despite the frequent incorporation of medications, the constant requirement of drugs through lawsuits leads to exorbitant costs to the state budget. The present work analyzed through a descriptive observational study, the current situation of the Specialized Component and the involvement of medicines used in dermatology, through legal reviews, financial analyses, and medical articles, aiming at future incorporations for the specialty. When assessing the legal demands for dermatological drugs in the state of São Paulo, the specialty still has a low participation and psoriasis is the main disease involved in requiring drugs through the judicial system in the state. New methods of access to raw materials must be created to reduce legal issues. Cost-effectiveness and public planning studies are mandatory for incorporating new dermatological therapies.

Terapia combinada de laser de CO2 e luz intensa pulsada no tratamento de lesões vasculares / Combined CO2 laser and intense pulsed light therapy in the treatment of vascular lesions

As lesões vasculares congênitas podem ser divididas em: tumores e malformações. Os hemangiomas são tumores vasculares benignos decorrentes da proliferação anormal de células endoteliais; já as manchas em vinho do Porto são malformações vasculares de provável herança autossômica dominante. Até o presente momento, não há estudos sobre a associação entre luz intensa pulsada e laser de CO2 como forma terapêutica destas patologias. A presente série de casos apresenta 10 casos de lesões vasculares tratadas com a combinação destas formas de irradiação. Conclui-se que esta terapia combinada pode ser efetiva na redução da espessura das lesões ou na atenuação da coloração

Congenital vascular lesions can be subdivided into tumors and malformations. Hemangiomas are benign vascular tumors resulting from the abnormal proliferation of endothelial cells, whereas port-wine stains are vascular malformations of a possible autosomal dominant inheritance. To date, there are no studies associating the use of intense pulsed light and CO2 laser as a therapeutic form for these pathologies. We present a series of 10 cases of vascular injuries treated with the combination of these forms of irradiation. This combined therapy can be effective in reducing the thickness of the lesions or in attenuating the color.