Screening and prevention of preterm birth: how is it done in clinical practice?

Objective: To ascertain how screening for preterm birth is performed among obstetricians working in public and private practice in a middle-income country. Methods: Cross-sectional study of 265 obstetrician-gynecologists employed at public and private facilities. An online questionnaire was administered, with items designed to collect data on prematurity screening and prevention practices. Results: The mean age of respondents was 44.5 years; 78.5% were female, and 97.7% had completed a medical residency program. Universal screening (i.e., by ultrasound measurement of cervical length) was carried out by only 11.3% of respondents in public practice; 43% request transvaginal ultrasound if the manual exam is abnormal, and 74.6% request it in pregnant women with risk factors for preterm birth. Conversely, 60.7% of respondents in private practice performed universal screening. This difference in screening practices between public and private practice was highly significant (p < 0.001). Nearly all respondents (90.6%) reported prescribing vaginal progesterone for short cervix. Conclusion: In the setting of this study, universal ultrasound screening to prevent preterm birth was used by just over half of doctors in private practice. In public facilities, screening was even less common. Use of vaginal progesterone in cervical shortening was highly prevalent. There is an unmet need for formal protocols for screening and prevention of preterm birth in middle-income settings.

Screening and prevention of preterm birth: how is it done in clinical practice?

Abstract Objective: To ascertain how screening for preterm birth is performed among obstetricians working in public and private practice in a middle-income country. Methods: Cross-sectional study of 265 obstetrician-gynecologists employed at public and private facilities. An online questionnaire was administered, with items designed to collect data on prematurity screening and prevention practices. Results: The mean age of respondents was 44.5 years; 78.5% were female, and 97.7% had completed a medical residency program. Universal screening (i.e., by ultrasound measurement of cervical length) was carried out by only 11.3% of respondents in public practice; 43% request transvaginal ultrasound if the manual exam is abnormal, and 74.6% request it in pregnant women with risk factors for preterm birth. Conversely, 60.7% of respondents in private practice performed universal screening. This difference in screening practices between public and private practice was highly significant (p < 0.001). Nearly all respondents (90.6%) reported prescribing vaginal progesterone for short cervix. Conclusion: In the setting of this study, universal ultrasound screening to prevent preterm birth was used by just over half of doctors in private practice. In public facilities, screening was even less common. Use of vaginal progesterone in cervical shortening was highly prevalent. There is an unmet need for formal protocols for screening and prevention of preterm birth in middle-income settings.

Incidence of thromboembolism and associated factors in multiple myeloma patients treated with immunomodulatory drugs: a retrospective analysis in Belo Horizonte, Brazil.

PURPOSE: The use of immunomodulators in the treatment of multiple myeloma (MM) patients has been associated with venous thromboembolism (VTE). Due to the increase in mortality of cancer patients, venous thromboembolism is an important concern for newly diagnosed multiple myeloma (NDMM) patients. The aim of this study was to determine the incidence of thromboembolic events and evaluate associated risk factors among Brazilian NDMM patients using immunomodulators. METHODS: Real-life retrospective cohort study in two Brazilian institutions with newly diagnosed multiple myeloma (NDMM) patients treated with immunomodulators from January 2009 to December 2019. Data was collected from patients' medical records for the period of 1 year, and Cox regression was performed to identify risk factors on the development of VTE. RESULTS: We included 131 patients of which there was a mean age of 61.5 years (SD 11.3), 51.9% female, and predominantly using thalidomide (97.7%) as immunomodulator. We found 9 VTE episodes among our patients, with a 12-month cumulative incidence of 6.97% (95% CI 3.41-12.24). Associated factors after multivariate analysis were recent sepsis, recent traumatic injury, previous VTE, and thromboprophylaxis. CONCLUSION: Our real-life retrospective cohort presented a low incidence of VTE among Brazilian NDMM patients treated with immunomodulators.

Occupational exposure to pesticides dysregulates systemic Th1/Th2/Th17 cytokines and correlates with poor clinical outcomes in breast cancer patients.

Pesticides are compounds known to cause immunetoxicity in exposed individuals, which have a potential to substantially modify the prognosis of pathologies dependent on an efficient immune response, such as breast cancer. In this context, we examined the circulating cytokine profile of Th1/Th2/Th17 patterns in women occupationally exposed to pesticides and their correlation with worse prognostic outcomes. Peripheral blood samples were collected from 187 rural working women with breast cancer, occupationally exposed or not to pesticides, to quantify the levels of cytokines IL-1ß, IL-12, IL-4, IL-17-A, and TNF -α. Data on the disease profile and clinical outcomes were collected through medical follow-up. IL-12 was reduced in exposed women with tumors larger than 2 cm and in those with lymph node metastases. Significantly reduced levels of IL-17A were observed in exposed patients with Luminal B subtype tumors, with high ki67 proliferation rates, high histological grade, and positive for the progesterone receptor. Reduced IL-4 was also seen in exposed women with lymph node invasion. Our data show that occupational exposure to pesticides induces significant changes in the levels of cytokines necessary for tumor control and correlates with poor prognosis clinical outcomes in breast cancer.

Factors associated with potentially inappropriate medications in elderly with multiple myeloma.

INTRODUCTION: Elderly with cancer often have multimorbidity, which determines a higher risk of polypharmacy. This is related to negative clinical results such as adverse drug reaction and emergence service visits. Furthermore, polypharmacy increases the risk of using potentially inappropriate medications. OBJECTIVE: To evaluate the use of potentially inappropriate medication in elderly with multiple myeloma and associated factors. METHODS: The study was conducted with older adults with multiple myeloma treated at outpatient oncology and hematology services in a southeastern Brazilian capital. Potentially inappropriate medications were classified using the American Geriatric Society/Beers 2019 Criteria. Variables were described using frequency and proportions, performing multiple logistic regression to identify factors associated with the use of potentially inappropriate medications. RESULTS: One hundred fifty-three older adults with multiple myeloma were included, with a median age of 70.9 years. The median number of medications was 8, and 63% of patients used polypharmacy. More than half (54%) of the patients used potentially inappropriate medications, and proton pump inhibitors (46%) and benzodiazepines (8%) were the most employed therapeutic classes. Older adults who used potentially inappropriate medications differed from those who did not use them in the following characteristics: income up to three minimum wages, higher schooling level, private service, multimorbidity, hypertension, cardiovascular disease, chronic kidney disease, depression, adverse event, and polypharmacy. Higher schooling levels and polypharmacy were independently associated with the use of potentially inappropriate medications in the multivariate analysis. CONCLUSION: Potentially inappropriate medication use was high in patients with multiple myeloma studied. The use of polypharmacy and higher schooling levels were independently and positively associated with the use of potentially inappropriate medications.

Chemotherapy-Induced Peripheral Neuropathy Impacts Quality Of Life And Activities Of Daily Living Of Brazilian Multiple Myeloma Patients.

BACKGROUND: Survival in multiple myeloma (MM) has improved in the past years with the introduction of immunomodulators and proteasome inhibitors. However, chemotherapy-induced peripheral neuropathy (CIPN) is associated with both drug classes affecting Health-Related Quality of Life (HRQoL) and activities of daily living (ADL). OBJECTIVE: We evaluated CIPN in MM patients to identify associated factors and impacts on HRQoL and ADL. METHODS: This is a cross-sectional study with Brazilian patients from public and private health services. Patients were interviewed using validated tools to measure CIPN and HRQoL, along with sociodemographic and clinical questions. Logistic regression was used to assess the association of CIPN with sociodemographic, clinical, and HRQoL variables. RESULTS: In total, 217 patients were eligible for the study. The median age was 67, 50.9% were women, 51.6% had low income, 47.5% had low education, and 55.3% attended private health services. The chemotherapy regimen most used was the combination of cyclophosphamide, thalidomide, and dexamethasone (17.5%) among the 24 types of regimens found. Most patients (90.3%) had at least one CIPN symptom: 62.7% were severe, and 51.62% were extremely bothered ADL. Numbness was the most common symptom (40.6%). CIPN was independently associated with education, hospitalization, chemotherapy, side effects, disease symptoms, and global health status in HRQoL. CONCLUSION: MM patients showed a high frequency of CIPN, which affected ADL and impaired HRQoL. Early and accurate detection of CIPN and dose management in patients with thalidomide and bortezomib-based regimens should be performed to provide better treatment outcomes and avoid permanent disabilities.

Health-related quality of life and use of medication with anticholinergic activity in patients with multiple myeloma.

PURPOSE: Verify the association between anticholinergic burden and health-related quality of life of patients with multiple myeloma. METHODS: Cross-sectional study with multiple myeloma outpatient from a state capital city in southeastern Brazil. Sociodemographic, clinical, and pharmacotherapeutic variables were collected by interview. Clinical data were complemented by medical records. Drugs with anticholinergic activity were identified with Brazilian Anticholinergic Activity Drug Scale. Health-related quality of life scores were obtained using QLQ-C30 and QLQ-MY20 instruments. Mann-Whitney was used to compare the median of the health-related quality of life scale scores and the independent variables. Multivariate linear regression was performed to verify the association between independent variables and health-related quality of life scores. RESULTS: Two hundred thirteen patients were included, 56.3% had multi-morbidities, and 71.8% used polypharmacy. In all health-related quality of life domains, there were differences between the medians of the polypharmacy variable. A significant difference was identified between the ACh burden and QLQ-C30 and QLQ-MY20 scores. Linear regression identified an association between the use of drugs with anticholinergic activity and the reduction of global status scores (QLQ-C30), functional scale (QLQ-C30), body image (QLQ-MY20), and future perspective (QLQ-MY20). Drugs with anticholinergic activity were associated with increased symptom scores (QLQ-C30 and QLQ-MY20). Polypharmacy was associated with reduction of functioning score and increase of symptom score (QLQ-C30). CONCLUSION: Anticholinergic burden in MM patients is associated with lower scores in quality of life domains: global health and symptoms (QLQ-C30) and functional (QLQ-C30 and QLQ-MY20). The presence of polypharmacy is also associated with lower scores for functional scales and symptom scales (QLQ-C30).

Comparison of three risk assessment models for thromboembolism in multiple myeloma patients receiving immunomodulators: a Brazilian historical cohort.

Venous thromboembolism (VTE) is among the complications of Multiple Myeloma (MM) and may occur in up to 10% of this patient population. However, medications used in MM therapy such as immunomodulators (IMID) may raise these rates. Thus, risk prediction models have been developed to quantify the risk of VTE in MM patients. The aim of this study is to compare the performance of three risk assessment models for VTE in newly diagnosed MM (NDMM) patients using immunomodulatory agents. A historical cohort study during a 10-year period in a Brazilian metropolis with NDMM treated with IMID. Data were collected from patient's medical charts for the period of one year to calculate the scores using IMPEDE VTE, SAVED, and International Myeloma Working Group (IMWG) guidelines. The area under the curve (AUC) of the Receiver Operating Characteristic curve analysis was calculated to assess the discriminative power of three risk assessment models. We included 131 patients (9 in the VTE group versus 122 in the non VTE group). According to IMPEDE, 19.1, 62.6, and 18.3% of patients were considered low, intermediate, and high risk, respectively. SAVED classified 32.1% as high risk and 64.9% had ≥2 risk factors based on IMWG guidelines. The AUC of the IMPEDE VTE score was 0.80 (95% CI 0.66-0.95, p = 0.002), of the SAVED score was 0.69 (95% CI 0.49-0.89, p = 0.057), and of the IMWG risk score was 0.68 (95% CI 0.48-0.88, p = 0.075). IMPEDE VTE was the most accurate in predicting the development of VTE in Brazilian patients on IMID therapy. The SAVED score and the IMWG guidelines did not show discriminative ability in predicting VTE based on the population involved in this study.

Effects of Chemical Fertilization and Microbial Inoculum on Bacillus subtilis Colonization in Soybean and Maize Plants.

Plant growth-promoting endophytic microorganisms in agriculture have been expanding in Brazil and are an excellent strategy to face the challenges of current agriculture, such as reducing production costs with fewer environmental impacts, without detriment to productivity. However, little is known about the factors that can affect the colonization of endophytic such as inoculant concentration and mineral fertilization. The present study aimed to evaluate the influence of these factors on soybean and maize crops and found that for soybean crops, the highest Bacillus subtilis concentration of 1 × 104 and 1 × 1010 CFU ml-1 promoted the highest number of recovered bacteria, when there was no mineral fertilization. However, mineral fertilization limited the number of recovered bacteria, suggesting that mineral fertilization interferes with endophytic colonization. For maize crops, the highest number of recovered bacteria occurred from the concentration of 1 × 106 CFU ml-1, not differing from the highest concentrations. A mineral fertilization dose of 25% promoted the greatest B. subtilis recovery compared to the other treatments. Regarding plant development, the highest microbial inoculum concentrations did not necessarily promote greater positive growth promotion effects compared to the concentration of 1 × 104 CFU ml-1 for both crops. The results also suggest that the higher number of endophytic bacteria recovered in the plant does not necessarily affect plant growth in the same proportion. For soybean plants, there is a strong tendency that with the increase in the B. subtilis inoculant concentration, the need for mineral fertilization doses to achieve the same plant development is consequently increased, and inoculations with 1 × 105 and 1 × 106 CFU ml-1 with fertilization doses between 44% and 62% are the ideal combinations for greater plant development. In maize plants, the best growth promotion response (height) was obtained using inoculation concentration of 1 × 102 and 1 × 1010 CFU ml-1, increasing according to the increase in fertilization doses. The findings suggest, for soybean crop, that these high inoculum concentrations required more photosynthetic metabolites from the plants and more nutrients from the soil. Thus, the need for mineral fertilization for plant growth must be increased.

Inoculum Concentration and Mineral Fertilization: Effects on the Endophytic Microbiome of Soybean.

Soybean crops are of great economic importance worldwide and in Brazil. This crop is a commodity that provides large amounts of financial resources to the country. Soybean productivity is influenced by several biotic and abiotic factors, and most of these factors cannot be controlled by agricultural practices. Due to the soybean cultivars used and their required yields, the soybean crop, similar to other agriculturally important crops, requires large amounts of mineral fertilizers. There are several microorganisms that colonize soybean plant roots without causing symptoms or damage. These microorganisms that colonize plant tissues are called endophytes and can often promote plant growth and development. Little is known about the factors that influence endophyticism. The aim of the present study was to evaluate whether Bacillus subtilis inoculant concentrations and levels of mineral fertilization recommended for the crop have any influence on the endophytic microbiome of soybean plant roots. The results show that B. subtilis inoculations did not affect the endophytic community of the roots; however, the evaluation of the microbial community structure according to the alpha diversity metrics observed richness, Chao1 index, Shannon index and Simpson index showed that microbial diversity of endophytes was higher at fertilization levels of 50 and 100%, with a significant difference (p < 0.05) between 0 and 50% and 0 and 100% fertilization.

40 anos do Simpósio Nacional de Educação Física: revisitando um espaço de produção do conhecimento / 40 years of the National Symposium on Physical Education: revisiting a space to produce knowledge / 40 años del Simposio Nacional de Educación Física: revisitando un espacio de producción de conocimiento

O texto objetivou resgatar as memórias do Simpósio Nacional de Educação Física a partir dos trabalhos apresentados no evento. Realizou-se uma análise documental dos anais das edições de 1980 a 2021, a partir de: a) análise dos títulos, palavras-chave e resumos; b) análise do trabalho na íntegra, verificando a abordagem do conteúdo e categorização final a partir das áreas temáticas de conhecimento (ATC) estabelecidas. Cada resumo passou pela análise de dois pesquisadores adotando critérios de elegibilidade. O mapeamento das ATC foi baseado em temáticas delimitadas nos grupos temáticos do Colégio Brasileiro de Ciências do Esporte. Assim foram elencadas seis ATC: Atividade motora, Saúde e desempenho; Escola; Currículo e formação docente; Lazer e políticas públicas; Memória, esporte e cultura; Inclusão e deficiência. A ESEF-UFPel alcançou um patamar diferenciado, no ensino de graduação e Pós-Graduação e a pluralidade de formação dos docentes, contribuiu significativamente para ser uma referência no cenário nacional.

The text aimed to rescue the memories of the National Symposium of Physical Education from the works presented at the event. A documentary analysis of the annals of the editions from 1980 to 2021 was carried out, based on: a) analysis of titles, keywords, and abstracts; b) analysis of the work in its entirety, verifying the content approach and final categorization from the established thematic areas of knowledge (TAK). Each abstract was analyzed by two researchers adopting eligibility criteria. The mapping of the TAK was based on themes delimited in the thematic groups of the Brazilian College of Sports Sciences. Thus, six TAK were listed: Motor activity, Health, and performance; School; Curriculum and teacher training; Leisure and public policies; Memory, sport, and culture; Inclusion and Disability. The ESEF-UFPel has reached a differentiated level in undergraduate and graduate education and the plurality of teacher training has significantly contributed to being a reference on the national scene.

El texto tuvo como objetivo rescatar las memorias del Simposio Nacional de Educación Física a partir de los trabajos presentados en el evento. Se realizó un análisis documental de los anales de las ediciones de 1980 a 2021, a partir de: a) análisis de títulos, palabras clave y resúmenes; b) análisis del trabajo en su totalidad, verificando el enfoque de contenido y categorización final a partir de las áreas temáticas de conocimiento (ATC) establecidas. Cada resumen fue analizado por dos investigadores que adoptaron criterios de elegibilidad. El mapeo de ATC se basó en temas definidos en los grupos temáticos de la Facultad Brasileña de Ciencias del Deporte. Así, se enumeraron seis ATC: Actividad motora, Salud y rendimiento; Colegio; Currículo y formación docente; Ocio y políticas públicas; Memoria, deporte y cultura; Inclusión y Discapacidad. La ESEF-UFPel ha alcanzado un nivel diferenciado en la formación de grado y posgrado y la pluralidad de la formación docente ha contribuido significativamente a ser una referencia en el escenario nacional.

Effect of Aspergillus and Bacillus Concentration on Cotton Growth Promotion.

There are no studies in literature on the effect of inoculant concentrations on plant growth promotion. Therefore, in the present study, two experiments were carried out, one under pot conditions and the other in the field with cotton crop, in order to verify the effect of Aspergillus and Bacillus concentrations on the biometric and nutritional parameters of plant and soil, in addition to yield. The pot experiment evaluated the effect of different concentrations, ranging from 1 × 104 to 1 × 1010 colony-forming units per milliliter (CFU mL-1) of microorganisms Bacillus velezensis (Bv188), Bacillus subtilis (Bs248), B. subtilis (Bs290), Aspergillus brasiliensis (F111), Aspergillus sydowii (F112), and Aspergillus sp. versicolor section (F113) on parameters plant growth promotion and physicochemical and microbiological of characteristics soil. Results indicated that the different parameters analyzed are influenced by the isolate and microbial concentrations in a different way and allowed the selection of four microorganisms (Bs248, Bv188, F112, and F113) and two concentrations (1 × 104 and 1 × 1010 CFU mL-1), which were evaluated in the field to determine their effect on yield. The results show that, regardless of isolate, inoculant concentrations promoted the same fiber and seed cotton yield. These results suggest that lower inoculant concentrations may be able to increase cotton yield, eliminating the need to use concentrated inoculants with high production cost.

Humic Substances in Combination With Plant Growth-Promoting Bacteria as an Alternative for Sustainable Agriculture.

Plant growth-promoting bacteria (PGPB) and humic substances (HSs) are promising options for reducing the use of pesticides and mineral fertilizers. Although many studies have shown the effects of PGPB and HSs separately, little information is available on plant responses to the combined application of these biostimulants despite the great potential for the simultaneous action of these biological inputs. Thus, the objective of this review is to present an overview of scientific studies that addressed the application of PGPB and HSs to different crops. First, we discuss the effect of these biostimulants on biological nitrogen fixation, the various effects of the inoculation of beneficial bacteria combined with the application of HSs on promoting the growth of nonleguminous plants and how this combination can increase bacterial colonization of plant hosts. We also address the effect of PGPB and HSs on plant responses to abiotic stresses, in addition to discussing the role of HSs in protecting plants against pathogens. There is a lack of studies that address the role of PGPB + HSs in biocontrol. Understanding the factors involved in the promotion of plant growth through the application of PGPB and HSs can assist in the development of efficient biostimulants for agricultural management. This approach has the potential to accelerate the transition from conventional cultivation to sustainable agrosystems.

Validity and reliability of the QLQ-MY20 module for assessing the health-related quality of life in Brazilians with multiple myeloma.

PURPOSE: Multiple myeloma (MM) is a rare but treatable hematological cancer, which makes the health-related quality of life (HRQoL) an important patient-report outcome measure in clinical studies. The Quality of Life Questionnaire Multiple Myeloma Module (QLQ-MY20) was developed by the European Organization for Research and Treatment of Cancer (EORTC) to measure HRQoL in people with MM. However, the Brazilian Portuguese version of QLQ-MY20 has not yet been validated for Brazil. This study aimed to evaluate the validity and reliability of the instrument for application in Brazilian patients with MM. METHODS: This is a cross-sectional methodological study with patients seen in health services in Belo Horizonte, Brazil. The variables were collected through face-to-face interviews with the QLQ-MY20 instrument and complemented with data from medical records. Content validity analyses (content validity coefficient [CVC]; correctness ratio), convergent and divergent validity (Spearman's correlation coefficient [CC]), internal consistency, and temporal reproducibility (test-retest; intraclass correlation coefficient [ICC]) were performed. RESULTS: 225 patients were included and 71.1% were older than 60. The analysis of the judging committee showed adequate content validity. We observed mainly a good internal consistency of the items and good discrimination power in the convergent and divergent validity. High ICC values were observed through the test-retest, and there was no difference in the scores between the two moments, which shows good temporal stability of the instrument. CONCLUSION: The study allowed us to conclude that the Brazilian version of the QLQ-MY20 module is valid and reliable, and thus suitable for application in Brazilians living with MM.

Validation of an Instrument for Measuring Adherence to Treatment With Immunomodulators in Patients With Multiple Myeloma.

Background: Validate the Treatment Adherence Measure (TAM) instrument in outpatients with MM concerning construct validity, reliability and the ceiling and floor effects. Methods: This cross-sectional study included patients diagnosed with MM previously treated with an immunomodulator for at least one month, aged 18 or over, and followed-up in the investigated outpatient clinics. Adherence to immunomodulators was measured by TAM. The TAM's reliability was assessed using Cronbach's alpha; The association between adherence and health-related quality of life was investigated to analyze the divergent and convergent construct, measured by the Quality of Life Questionnaire core (QLQ-C30) and the Quality of Life Questionnaire Multiple Myeloma module (QLQ-MY20). The presence of a ceiling or floor effect in the TAM was also analyzed. Results: Eighty-four patients were included in the study, achieving 97.6% adherence. Cronbach's alpha was 0.41, and the hypothesis of convergent construct validity was confirmed, with statistical significance, in contrast to the hypothesis of divergent construct validity. The presence of the ceiling effect in TAM suggested that this instrument does not allow changes to be detected in individuals concerning adherence to IMiDs. Conclusion: TAM instrument did not show satisfactory validity and reliability to measure MM's adherence. MM patients treated at oncohematological outpatient clinics in a metropolitan region of southeastern Brazil showed high adherence to IMiDs.

Effects of Mlx-8, a phospholipase A2 from Brazilian coralsnake Micrurus lemniscatus venom, on muscarinic acetylcholine receptors in rat hippocampus.

BACKGROUND: Here, we described the presence of a neurotoxin with phospholipase A2 activity isolated from Micrurus lemniscatus venom (Mlx-8) with affinity for muscarinic acetylcholine receptors (mAChRs). METHODS: The purification, molecular mass determination, partial amino acid sequencing, phospholipase A2 activity determination, inhibition of the binding of the selective muscarinic ligand [3H]QNB and inhibition of the total [3H]inositol phosphate accumulation in rat hippocampus of the Mlx-8 were determined. RESULTS: Thirty-one fractions were collected from HPLC chromatography, and the Mlx-8 toxin was used in this work. The molecular mass of Mlx-8 is 13.628 Da. Edman degradation yielded the following sequence: NLYQFKNMIQCTNTRSWL-DFADYG-CYCGRGGSGT. The Mlx-8 had phospholipase A2 enzymatic activity. The pKi values were determined for Mlx-8 toxin and the M1 selective muscarinic antagonist pirenzepine in hippocampus membranes via [3H]QNB competition binding assays. The pKi values obtained from the analysis of Mlx-8 and pirenzepine displacement curves were 7.32 ± 0.15, n = 4 and 5.84 ± 0.18, n = 4, respectively. These results indicate that Mlx-8 has affinity for mAChRs. There was no effect on the inhibition ability of the [3H]QNB binding in hippocampus membranes when 1 µM Mlx-8 was incubated with 200 µM DEDA, an inhibitor of phospholipase A2. This suggests that the inhibition of the phospholipase A2 activity of the venom did not alter its ability to bind to displace [3H]QNB binding. In addition, the Mlx-8 toxin caused a blockade of 43.31 ± 8.86%, n = 3 and 97.42 ± 2.02%, n = 3 for 0.1 and 1 µM Mlx-8, respectively, on the total [3H]inositol phosphate content induced by 10 µM carbachol. This suggests that Mlx-8 inhibits the intracellular signaling pathway linked to activation of mAChRs in hippocampus. CONCLUSION: The results of the present work show, for the first time, that muscarinic receptors are also affected by the Mlx-8 toxin, a muscarinic ligand with phospholipase A2 characteristics, obtained from the venom of the Elapidae snake Micrurus lemniscatus, since this toxin was able to compete with muscarinic ligand [3H]QNB in hippocampus of rats. In addition, Mlx-8 also blocked the accumulation of total [3H]inositol phosphate induced by muscarinic agonist carbachol. Thus, Mlx-8 may be a new pharmacological tool for examining muscarinic cholinergic function.

Scavenging as a pathway for plastic ingestion by marine animals.

Plastic pollution is prevalent worldwide and affects marine wildlife from urbanized beaches to pristine oceanic islands. However, the ecological basis and mechanisms that result in marine animal ingestion of plastic debris are still relatively unknown, despite recent advances. We investigated the relationship between scavenging behavior and plastic ingestion using green turtles, Chelonia mydas, as a model. Diet analysis of C. mydas showed that sea turtles engaging in scavenging behavior ingested significantly more plastic debris than individuals that did not engage in this foraging strategy. We argue that opportunistic scavenging behavior, an adaptive behavior in most marine ecosystems, may now pose a threat to a variety of marine animals due to the current widespread plastic pollution found in oceans.

Comunicação, comportamentos destrutivos e segurança do paciente / Communication, destructive behaviors and patient safety / Comunicación, comportamientos destructivos y seguridad del paciente

Objetivo: Refletir sobre o processo de comunicação e interação da equipe de saúde perioperatória no contexto da segurança do paciente. Método: Estudo teórico reflexivo, baseado em coluna publicada na revista da Association of periOperative Registered Nurses (AORN Journal), em março de 2014. Resultados: O processo de comunicação, no trabalho multiprofissional em saúde, interfere na segurança do paciente, tornando-se ferramenta essencial para evitar a ocorrência de eventos adversos durante a assistência à saúde. Considerações finais: Muitas barreiras e desafios precisam ser enfrentados no que diz respeito ao processo de comunicação eficaz e à inter-relação entre a equipe multiprofissional de saúde, com o objetivo de promover um cuidado seguro ao paciente em processo cirúrgico

Objective: To reflect on the communication and interaction processes of the perioperative health team in the context of patient safety. Method: Reflective theoretical study, based on a column published in the Association of perioperative Registered Nurses Journal (AORN Journal), in March 2014. Results: The communication process, in multiprofessional work in health, interferes in the patient's safety, becoming an essential tool to avoid the occurrence of adverse events during health care. Final considerations: Many barriers and challenges need to be addressed regarding the effective communication process and interrelation between the multiprofessional health team, with the objective of promoting safe care for the patient in the surgical process

Objetivo: Reflexionar sobre el proceso de comunicación e interacción del equipo de salud perioperatoria en el contexto de la seguridad del paciente. Método: Estudio teórico reflexivo, basado en una columna publicada en la revista de la Association of periOperative Registered Nurses (AORN Journal), en marzo de 2014. Resultados: El proceso de comunicación, em el trabajo multiprofesional en salud, interfiere en la seguridad del paciente, convirtiéndose en una herramienta esencial para evitar la ocurrencia de eventos adversos durante la asistencia a la salud. Consideraciones finales: Muchas barreras y desafíos necesitan ser enfrentados en lo que se refiere al proceso de comunicación eficaz y a la interrelación entre el equipo multiprofesional de salud, con el objetivo de promover un cuidado seguro al paciente en proceso quirúrgico

Combinación quirúrgica: una necesidad en odontopediatría / Combinação cirúrgica: uma necessidade em odontopediatria / Surgical combination: a necessity in Pediatric Dentistry

Introducción: El Mesiodens es un diente supernumerario que se forma en la línea media entre los incisivos centrales superiores, más frecuentemente en la dentición permanente y en pacientes de sexo masculino. Su etiología es bastante desconocida, pero la hiperactividad de la lámina dentaria es la teoría más aceptada. Se presenta asociado a otras complicaciones, como el diastema interincisivo, que puede también estar asociado a la inserción anormal del frenillo labial superior, provocando alteraciones en la estética dentaria. El objetivo de este trabajo fue comunicar sobre un caso clínico de exodoncia de un mesiodens y de la resección del frenillo labial superior en un solo procedimiento quirúrgico, con seguimiento del cierre fisiológico del diastema luego de 1 año. Reporte de caso: El presente trabajo reporta el caso de un niño, de 11 años de edad, que ingresó a la clínica-escuela de Odontopediatría de la Facultad Independiente del Nordeste acompañado por su madre, con queja estética de separación dental. Después de la anamnesis, examen clínico y radiográfico se diagnosticó la presencia de mesiodens e inserción anormal del frenillo labial superior. Se seleccionó como tratamiento una técnica quirúrgica combinada de exodoncia del mesiodens y frenectomía en una misma sesión, con seguimiento de un año y observación del cierre progresivo del diastema entre los incisivos. Conclusión: El diagnóstico correcto de dientes supernumerarios y anormalidades del frenillo es fundamental, a través de un buen examen clínico y radiográfico para la realización del tratamiento individualizado, siendo exitoso en este caso la combinación quirúrgica.

Introdução: Mesiodens é um dente supranumerário que ocorre na linha média entre os incisivos centrais superiores, com maior frequência na dentição permanente e em pacientes do sexo masculino. Sua etiologia ainda não é completamente entendida, sendo a hiperatividade da lâmina dentária a teoria mais aceita. O mesiodens traz algumas complicações, sendo uma delas o diastema interincisal, podendo este também estar associado à inserção anormal do freio labial superior, causando alterações na estética dentária entre outros. O objetivo desse trabalho é relatar um caso clínico da remoção de mesiodens e freio labial superior em mesmo tempo cirúrgico, com avaliação do fechamento gradual fisiológico do diastema após 1 ano. Relato de caso: O presente trabalho relata um caso de uma criança, 11 anos de idade, sexo masculino, que compareceu à clínica-escola de Odontopediatria da Faculdade Independente do Nordeste (FAINOR) com sua mãe, com queixa estética de afastamento dentário; após anamnese, exame clínico e radiográfico foi diagnosticada a presença de mesiodens e inserção anormal do freio labial superior. Esse relato teve por escolha o tratamento de remoção cirúrgica do mesiodens associado à frenectomia labial superior em uma mesma sessão, com proservação de 1 ano e observação do fechamento gradual do diastema interincisal. Conclusão: O diagnóstico correto de dentes supranumerários e anomalias do freio é fundamental por meio de um bom exame clínico e radiográfico. A oportunidade individual da realização do tratamento é outro fator importante.

Introduction: Mesiodens is a supernumerary tooth that occurs on the midline between the maxillary central incisors, with a higher frequency on permanent teeth and on male patients. Its etiology is not completely understood yet, with dental lamina hyperactivity being the most accepted theory. Mesiodens may bring some complications, one of them being the interincisal diastema, which can also be associated with an abnormal superior labial frenum insertion, causing alterations in the dental aesthetics among others. The aim of this study is to report a clinical case of mesiodens removal and superior labial frenum on the same surgical time, with evaluation of the diastema's physiological gradual closure after one year. Case report: This study reports the case of a child, 11 years of age, male, who attended the Odontopediatrics teaching clinic of the Facultad Independente do Nordeste (FAINOR) with his mother, with an esthetic complaint of dental gap. After anamnesis, clinical and radiographic examination, the presence of mesiodens and abnormal insertion of the superior labial frenum were diagnosed. The treatment of choice was surgical removal of the mesiodens associated with superior labial frenectomy, with a one year follow-up and observation of the interincisal diastema's gradual closure. Conclusion: The correct diagnosis of supernumerary teeth and frenum abnormalities is fundamental, through a good clinical and radiographic examination. The individual opportunity for treatment is another important factor.