RESUMEN

BACKGROUND: The management of vestibular schwannomas (VS) encompasses a choice between conservative "wait-and-scan" (WAS) approach, stereotactic radiosurgery (SRS) or open microsurgical resection. Currently, there is no consensus on the optimal management approach for small to medium sized VS. This study aims to compared outcomes related to hearing in patients with small and medium sized VS who underwent initial treatment with WAS versus SRS. METHODS: A systematic review of the available literature was conducted using PubMed/MEDLINE, Embase, and Cochrane up December 08, 2023. Meta-analysis was performed using a random-effect model to calculate mean difference (MD) and relative risk (RR). A leave-one-out analysis was conducted. The risk of bias was assessed via the Risk of Bias in Non-randomized Studies-Interventions (ROBINS-I) and Cochrane Risk of Bias assessment tool (RoB-2). Ultimately, the certainty of evidence was evaluated using the GRADE assessment. The primary outcomes were serviceable hearing, and pure-tone average (PTA). The secondary outcome was the Penn Acoustic Neuroma Quality of Life Scale (PANQOL) total score. RESULTS: Nine studies were eligible for inclusion, comprising a total of 1,275 patients. Among these, 674 (52.86%) underwent WAS, while 601 patients (47.14%) received SRS. Follow-up duration ranged from two to eight years. The meta-analysis indicated that WAS had a better outcome for serviceable hearing (0.47; 95% CI: 0.32 - 0.68; p < 0.001), as well as for postoperative functional measures including PTA score (MD 13.48; 95% CI 3.83 - 23.13; p < 0.01), and PANQOL total score (MD 3.83; 95% CI 0.42 - 7.25; p = 0.03). The overall certainty of evidence ranged from "very low" to "moderate". CONCLUSIONS: Treating small to medium sized VS with WAS increases the likelihood of preserving serviceable hearing and optimized PANQOL overall postoperative score compared to SRS. Nevertheless, the limited availability of literature and the methodological weakness observed in existing studies outline the need for higher-quality studies.

Asunto(s)

RESUMEN

: We have synthesized twenty-three 1,4-dihydropyridine derivatives (1,4-DHPs) by using a microwave-assisted one-pot multicomponent Hantzsch reaction and evaluated their antibacterial activity against a representative panel of cariogenic bacteria and their in vitro antileishmanial activity against Leishmania (L.) amazonensis promastigotes and amastigotes. Thirteen compounds were moderately active against Streptococcus sanguinis, Streptococcus mitis, and Lactobacillus paracasei. Compound 22 (diethyl 4-(3-methoxy-4-hydroxyphenyl)-2,6-dimethyl-1,4-dihydropyridine-3,5-dicarboxylate) displayed moderate antibacterial activity against S. mitis and S. sanguinis, with a Minimum Inhibitory Concentration (MIC) of 500 µg/mL); compounds 8 (ethyl 2,7,7-trimethyl-4-(3-chlorophenyl)-5-oxo-1,4,5,6,7,8-hexahydroquinoline-3-carboxylate) and 10 (ethyl 2,7,7-trimethyl-4-(3-nitrophenyl)-5-oxo-1,4,5,6,7,8-hexahydroquinoline-3-carboxylate) were moderately active against S. sanguinis (MIC = 500 µg/mL) and very active against L. amazonensis promastigotes (IC50 = 43.08 and 34.28 µM, respectively). Among the eight 1,4-DHPs that were active (IC50 < 50 µM) against L. amazonensis promastigotes, compound 13 (ethyl 2,7,7-trimethyl-4-(3,4,5-trimethoxyphenyl)-5-oxo-1,4,5,6,7,8-hexahydroquinoline-3-carboxylate) was the most active (IC50 = 24.62 µM) and had a Selectivity Index (SI) higher than 4 compared to GM07492A cells. On the other hand, compound 9 (ethyl 2,7,7-trimethyl-4-(2-nitrophenyl)-5-oxo-1,4,5,6,7,8-hexahydroquinoline-3-carboxylate) was the most active against L. amazonensis amastigotes (IC50 = 16.27 µM and SI = 6.1) after 24 h of treatment. Based on our results, asymmetric 1,4-DHPs derived from dimedone exhibit antileishmanial potential.

RESUMEN

Callistemon viminalis has been widely known due to its therapeutic properties. Tuberculosis is a deadly infectious disease caused predominantly by Mycobacterium tuberculosis. Other respiratory diseases may also be caused by nontuberculous mycobacteria. Malassezia furfur causes dermal inflammation and tissue damage. This study aimed to evaluate in vitro inhibitory effects of essential oils (EOs) from C. viminalis leaves (EO-CL) and flowers (EO-CF) against M. tuberculosis, Mycobacterium kansasii, Mycobacterium avium and M. furfur strains. Their cytotoxic activity was evaluated by the brine shrimp assay. Resulting MIC values of all EOs under study were promising since they ranged from 50 to 100 µg/mL. Both EO-CL and EO-CF showed nontoxicity against Artemia salina by the brine shrimp assay (LC50 > 1000 µg/mL). GC-FID and GC-MS analyses showed that 1,8-cineole was the major component of both EOs. These results revealed the promising potential of EO-CL and EO-CF to develop new antibacterial and antifungal drugs.

RESUMEN

This study reports on the chemical composition and antileishmanial and anticandidal activities of volatile oils (VOs) of Schinus molle dried leaves (SM), Cinnamomum cassia branch bark (CC) and their blends. Major constituents of SM were spathulenol (26.93 %), ß-caryophyllene (19.90 %), and caryophyllene oxide (12.69 %), whereas (E)-cinnamaldehyde (60.11 %), cinnamyl acetate (20.90 %) and cis-2-methoxycinnamic acid (10.37 %) were predominant in CC. SM (IC50=21.45 µg/mL) and CC (IC50=23.27 µg/mL) displayed good activity against L. amazonensis promastigotes, besides having good or moderate activity against nine Candida strains, with Minimum Inhibitory Concentration (MIC) values ranging from 31.25 to 250 µg/mL. While the three SM and CC blends were not more active than the VOs tested individually, they exhibited remarkably high antileishmanial activity, with IC50 values ranging between 3.12 and 7.04 µg/mL, which is very similar to the IC50 of amphotericin B (positive control).

RESUMEN

It is an ecological study that analyzed the time trend of visceral leishmaniasis incidence rates in Brazil using segmented time regression by joinpoints. There was a decreasing incidence rate of this disease in the country with an average annual percent change (AAPC) of -5 (CI95%: -9.1; -0.6) and a reduction of 1.69 cases/100 thousand inhabitants in 2007, and 0.91/100 thousand inhabitants in 2020. The Central-West region showed the highest reduction percent (AAPC: -9.1; CI95%: -13.8; -4.3), followed by the Southeast region (AAPC: -8.7; -14.6; -2.5). The North and South regions showed the largest number of joinpoints in the time series. The highest incidences were recorded in the male population, however, stable (AAPC: 2.14; CI95%: -8.3; 0). In the age group analysis, the trend was decreasing for the groups from 0 to 4 years old (AAPC: -7.7; CI95%: -12.6; -2.4), 5 to 9 years old (AAPC: -7.3; CI95%: -13.6; -0,4) and 10 to 14 years old (AAPC: -5.5; CI95%: -10.3; -0.3). It was found that although Visceral Leishmaniasis is an endemic disease in Brazil, there was a decrease in its incidence rate from 2007 to 2020.

Asunto(s)

RESUMEN

Abstract It is an ecological study that analyzed the time trend of visceral leishmaniasis incidence rates in Brazil using segmented time regression by joinpoints. There was a decreasing incidence rate of this disease in the country with an average annual percent change (AAPC) of -5 (CI95%: -9.1; -0.6) and a reduction of 1.69 cases/100 thousand inhabitants in 2007, and 0.91/100 thousand inhabitants in 2020. The Central-West region showed the highest reduction percent (AAPC: -9.1; CI95%: -13.8; -4.3), followed by the Southeast region (AAPC: -8.7; -14.6; -2.5). The North and South regions showed the largest number of joinpoints in the time series. The highest incidences were recorded in the male population, however, stable (AAPC: 2.14; CI95%: -8.3; 0). In the age group analysis, the trend was decreasing for the groups from 0 to 4 years old (AAPC: -7.7; CI95%: -12.6; -2.4), 5 to 9 years old (AAPC: -7.3; CI95%: -13.6; -0,4) and 10 to 14 years old (AAPC: -5.5; CI95%: -10.3; -0.3). It was found that although Visceral Leishmaniasis is an endemic disease in Brazil, there was a decrease in its incidence rate from 2007 to 2020.

Resumo Trata-se de um estudo ecológico que analisou a tendência temporal das taxas de incidência de leishmaniose visceral no Brasil mediante regressão temporal segmentada por pontos de inflexão. Observou-se tendência de decréscimo na taxa de incidência dessa patologia no país, com variação variação percentual média anual (average annual percent change - AAPC) de -5 (IC95%: -9,1; -0,6) e redução de 1,69 casos/100 mil habitantes em 2007, para 0,91/100 mil habitantes em 2020. A região Centro-Oeste apresentou a maior redução do AAPC (AAPC: -9,1; IC95%: -13,8; -4,3), seguida da região Sudeste (AAPC: -8,7; -14,6; -2,5). As regiões Norte e Sul apresentaram o maior número de pontos de inflexão (joinpoint) na série temporal. As maiores incidências foram registradas na população masculina, porém com tendência estacionária (AAPC: 2,14; IC95%: -8,3; 0). Na análise por faixa etária, a tendência foi decrescente nos grupos de 0 a 4 anos (AAPC: -7,7; IC95%: -12,6; -2,4), 5 a 9 anos (AAPC: -7,3; IC95%: -13,6; -0,4) e de 10 a 14 anos (AAPC: -5,5; IC95%: -10,3; -0,3). Verificou-se que, apesar de a leishmaniose visceral se tratar de uma doença endêmica no Brasil, houve declínio na sua taxa de incidência no período de 2007 a 2020.

RESUMEN

INTRODUCTION: Surgical intervention is the treatment of choice in patients with thoracic disc herniation with refractory symptoms and progressive myelopathy. Due to high occurrence of complications from open surgery, minimally invasive approaches are desirable. Nowadays, endoscopic techniques have become increasingly popular and full-endoscopic surgery can be performed in the thoracic spine with low complication rates. METHODS: Cochrane Central, PubMed, and Embase databases were systematically searched for studies that evaluated patients who underwent full-endoscopic spine thoracic surgery. The outcomes of interest were dural tear, myelopathy, epidural hematoma, recurrent disc herniation, and dysesthesia. In the absence of comparative studies, a single-arm meta-analysis was performed. RESULTS: We included 13 studies with a total of 285 patients. Follow-up ranged from 6 to 89 months, age from 17 to 82 years, with 56.5% male. The procedure was performed under local anesthesia with sedation in 222 patients (77.9%). A transforaminal approach was used in 88.1% of the cases. There were no cases of infection or death reported. The data showed a pooled incidence of outcomes as follows, with their respective 95% confidence intervals (CI)-dural tear (1.3%; 95% CI 0-2.6%); dysesthesia (4.7%; 95% CI 2.0-7.3%); recurrent disc herniation (2.9%; 95% CI 0.6-5.2%); myelopathy (2.1%; 95% CI 0.4-3.8%); epidural hematoma (1.1%; 95% CI 0.2-2.5%); and reoperation (1.7%; 95% CI 0.1-3.4%). CONCLUSION: Full-endoscopic discectomy has a low incidence of adverse outcomes in patients with thoracic disc herniations. Controlled studies, ideally randomized, are warranted to establish the comparative efficacy and safety of the endoscopic approach relative to open surgery.

Asunto(s)

RESUMEN

Measurement uncertainty is one of the widespread concepts applied in scientific works, particularly to estimate the accuracy of measurement results and to evaluate the conformity of products and processes. In this work, we propose a methodology to analyze the performance of measurement systems existing in the design phases, based on a probabilistic approach, by applying the Monte Carlo method (MCM). With this approach, it is feasible to identify the dominant contributing factors of imprecision in the evaluated system. In the design phase, this information can be used to identify where the most effective attention is required to improve the performance of equipment. This methodology was applied over a simulated electrocardiogram (ECG), for which a measurement uncertainty of the order of 3.54% of the measured value was estimated, with a confidence level of 95%. For this simulation, the ECG computational model was categorized into two modules: the preamplifier and the final stage. The outcomes of the analysis show that the preamplifier module had a greater influence on the measurement results over the final stage module, which indicates that interventions in the first module would promote more significant performance improvements in the system. Finally, it was identified that the main source of ECG measurement uncertainty is related to the measurand, focused towards the objective of better characterization of the metrological behavior of the measurements in the ECG.

RESUMEN

ABSTRACT Objectives: Exposing the clivus and upper cervical spine should, ideally, provide an adequate surgical field in which the surgeon can safely decompress and stabilize the craniovertebral junction (CVJ). We present a series of four cases with a narrative review of the literature in which Median Labiomandibular Glossotomy was used to treat CVJ disorders, in order to highlight the importance and indications of this access. Methods: We performed a retrospective analysis of patients who underwent MLMG for several pathologies. The group comprised four patients (two men and two women). Five approaches were performed (one revision surgery). Results: The approach was suitable for all cases, clivus was achieved when necessary. Distally, C4 was exposed to obtain satisfactory osteosynthesis. Laterally, we had a good view of the tumor borders and control of the vertebral artery. Complications encountered were a superficial wound infection that was easily healed, a later pharyngeal wound dehiscence and pseudoarthrosis, all in the same patient. There are 3 main anterior surgical techniques for managing lesions of the clivus, foramen magnum or upper cervical vertebrae. We chose Median Labiomadibular Glossotomy (MLMG) as a primary option, which provided a direct view of the clivus, C3 - C4 caudally and a wider surgical field. The main advantages of the MLMG technique include direct access to spinal pathology, an avascular plane through the median pharyngeal raphe, and a wider surgical field in both the transverse and sagittal dimensions. Conclusion: This approach provides excellent exposure of the craniocervical junction and upper cervical spine. Level of evidence IV; Series of cases analyzed retrospectively.

RESUMO Objetivos: A exposição do clivo e da coluna cervical alta deve, de modo ideal, proporcionar um campo cirúrgico adequado, no qual o cirurgião possa descomprimir e estabilizar a junção craniovertebral (JCV) com segurança. Apresentamos uma série de quatro casos, com revisão narrativa da literatura, nos quais a glossotomia labiomandibular mediana foi utilizada para tratamento de afecções da JCV, com o objetivo de destacar a importância e as indicações desse acesso. Métodos: Foi realizada uma análise retrospectiva dos pacientes submetidos a GLMM para diversas patologias. O grupo foi composto por quatro pacientes (dois homens e duas mulheres). Cinco abordagens/procedimentos<??> foram realizados (uma cirurgia de revisão). Resultados: O método/via de acesso/técnica foi adequado para todos os casos e o clivo foi alcançado quando necessário. Distalmente, C4 foi exposta para obter a osteossíntese satisfatória. Lateralmente, obteve-se boa visão das margens tumorais e controle da artéria vertebral. As complicações encontradas foram infecção superficial da ferida, com fácil cicatrização, deiscência tardia da parede posterior da faringe e pseudoartrose, todas no mesmo paciente. Existem três técnicas cirúrgicas principais com acesso anterior para o tratamento de lesões do clivo, forame magno ou vértebras cervicais superiores. Escolhemos a glossotomia labiomadibular mediana (GLMM) como opção primária, que proporcionou uma visão direta do clivo, de C3-C4 caudalmente e campo cirúrgico mais amplo. As principais vantagens da GLMM incluem acesso direto à patologia espinhal, plano avascular através da parte mediana da rafe da faringe e um campo cirúrgico ampliado nas dimensões transversa e sagital. Conclusões: Esta abordagem proporciona excelente exposição da junção craniocervical e da coluna cervical alta. Nível de evidência IV; Série de casos analisados retrospectivamente.

RESUMEN Objetivos: La exposición del clivus y de la columna cervical alta debe, de modo ideal, proporcionar un campo quirúrgico adecuado, en que el cirujano pueda descomprimir y estabilizar de manera segura la unión craneovertebral (UCV). Presentamos una serie de cuatro casos con revisión narrativa de la literatura, en los que se utilizó la glosotomía labiomandibular mediana para el tratamiento de afecciones de la UCV, con el objetivo de destacar la importancia y las indicaciones de ese acceso. Métodos: Se realizó un análisis retrospectivo de los pacientes sometidos a GLMM para diversas patologías. El grupo fue compuesto por cuatro pacientes (dos hombres y dos mujeres). Fueron realizados cinco abordajes/procedimientos (una cirugía de revisión). Resultados: El método/vía de acceso/técnica fue adecuado para todos los casos y el clivus fue alcanzado cuando fue necesario. Distalmente, C4 fue expuesta para obtener la osteosíntesis satisfactoria. Lateralmente, se obtuvo buena visión de los márgenes tumorales y control de la arteria vertebral. Las complicaciones encontradas fueron infección superficial de la herida, con fácil cicatrización, dehiscencia tardía de la pared posterior de la faringe y pseudoartrosis, todas en el mismo paciente. Existen tres técnicas quirúrgicas principales con acceso anterior para el tratamiento de lesiones del clivus, foramen magno o vértebras cervicales superiores. Elegimos la glosotomía labiomandibular mediana (GLMM) como opción primaria, que proporcionó una visión directa del clivus, C3-C4 caudalmente y campo quirúrgico más amplio. Las principales ventajas de la GLMM incluyen acceso directo a la patología espinal, plano avascular a través de la parte mediana del rafe de la faringe y un campo quirúrgico ampliado en las dimensiones transversa y sagital. Conclusiones: Este abordaje proporciona excelente exposición de la unión craneocervical y de la columna cervical alta. Nivel de evidencia IV; Serie de casos analizados retrospectivamente.

Asunto(s)

RESUMEN

OBJECTIVES: In order to evaluate host defense peptides (HDPs) HHC-10 and synoeca-MP activity in in vitro osteoclastogenesis process and in vivo induced apical periodontitis, testing the effect of molecules in the inflammatory response and in apical periodontitis size/volume after root canal treatment. MATERIALS AND METHODS: In vitro osteoclastogenesis was assessed on bone marrow cell cultures extracted from mice, while in vivo endodontic treatment involved rats treated with Ca(OH)2 or HDPs. In vitro osteoclasts were subjected to TRAP staining, and in vivo samples were evaluated by radiographic and tomographic exams, as well as histologic analysis. RESULTS: None of the substances downregulated the in vitro osteoclastogenesis. Nevertheless, all treatments affected the average of apical periodontitis size in rats, although only teeth treated with HDPs demonstrated lower levels of the inflammatory process. These results demonstrated the in vivo potential of HDPs. Radiographic analysis suggested that HHC-10 and synoeca-MP-treated animals presented a similar lesion size than Ca(OH)2-treated animals after 7-day of endodontic treatment. However, tomography analysis demonstrated smaller lesion volume in synoeca-MP-treated animals than HHC-10 and Ca(OH)2-treated animals, after 7 days. CONCLUSIONS: These molecules demonstrated an auxiliary effect in endodontic treatment that might be related to its immunomodulatory ability, broad-spectrum antimicrobial activity, and possible induction of tissue repair at low concentrations. These results can encourage further investigations on the specific mechanisms of action in animal models to clarify the commercial applicability of these biomolecules for endodontic treatment. CLINICAL SIGNIFICANCE: HDPs have the potential to be adjuvant substances in endodontic therapy due to its potential to reduce inflammation in apical periodontitis.

Asunto(s)

RESUMEN

The microbiota contributes to artisanal cheese bioprotection and biopreservation through inter and intraspecific competition. This work aimed to investigate the phylogenetic distribution of the repertoire of bacteriocin structural genes of model lactic acid bacteria (LAB) in order to investigate its respective role in the artisanal cheeses microenvironment. A phylogenetic analysis of the rRNA 16S gene from 445 model strains of LAB was conducted using bayesian inference and the repertoire of bacteriocin genes was predicted from these strains by BAGEL software. Bacterial strains were clustered in five monophyletic clades (A, B, C, D and E) with high posterior probability values (PP > 0.99). One bacteriocin structural gene was predicted for 88.5% of the analyzed strains. The majority of the species encoded different classes of bacteriocins. Greater diversity of bacteriocin genes was found for strains included in clade A, comprising Lactococcus lactis, Streptococcus agalactiae, Streptococcus thermophilus, Streptococcus macedonicus, Enterococcus faecalis and Enterococcus faecium. In addition, Lactococcus lactis presented higher diversity of bacteriocin classes, encoding glycocins, lanthipeptides, sactipeptides, cyclic and linear azole-containing peptides, included in bacteriocins class I, besides class II and III. The results suggest that the distribution of bacteriocin structural genes is related to the phylogenetic clades of LAB species, with a higher frequency in some specific clades. Information comprised in this study contributes to comprehend the bacterial competition mechanisms in the artisanal cheese microenvironment.

Asunto(s)

RESUMEN

Introducción: Existe una gran diversidad de definiciones de estilo y numerosos cuestionarios para determinarlos; las clasificaciones son heterogéneas y el significado de los diferentes estilos no es coincidente. Sujetos y métodos: Con objeto de clarificar algunos puntos, este trabajo presenta una nueva herramienta, el cuestionario Escanero-Soria de estilos de aprendizaje (CESEA), y compara los resultados encontrados con los proporcionados por el cuestionario Honey-Alonso de estilos de aprendizaje (CHAEA), uno de los más utilizados en el ámbito hispanoparlante. Resultados: Los resultados muestran diferencias principalmente en lo que respecta al estilo activo, siendo más homogéneos y elevados en el nuevo cuestionario. Conclusiones: Dados los valores de fiabilidad encontrados y su mayor homogeneidad, se recomienda la utilización del CESEA para determinar los estilos de aprendizaje en los estudiantes de medicina con el objetivo de mejorar los menos desarrollados

Introduction: About the style term there are different definitions and a lot of questionnaires to determine them; moreover, rankings are heterogeneous and meaning of different styles is not coincident. Subjects and methods: In order to clarify some points, this paper presents a new tool (CESEA) and compares the results obtained with those provided by the CHAEA, one of the questionnaires most used in the Spanish-speaking world. Results: The results show differences mainly in regard with the active style. In general, the scores for the different styles are more homogenous and high in the new questionnaire. Conclusions: Given the reliability values found and the greater homogeneity of the same CESEA utilization is recommended to determine the learning styles of medical students in order to improve the less developed

Asunto(s)

RESUMEN

The objective of this study is to understand how a Learning Management System (LMS) plataform is used in a telehealth center to support two virtual learning enviroments focused on the education of the healthcare professionals and the students of a medical schoool. The study outcome is expected to provide indications towards choosing a better LSM for the telehelath center to support their educacional activities.

Asunto(s)

RESUMEN

Estudo descritivo sobre as representacoes sociais de professores do ensino fundamental da rede publica municipal da cidade de Sao Luis-MA acerca da hanseniase. A pesquisa foi desenvolvida em quatorze escolas municipais do Distrito Itaqui-Bacanga. Utilizou-se como metodologia a bordagem qualitativa e a entrevista semi-estruturada como tecnica de coleta de informacoes. O estudo utiliza o referencial teorico das representacoes sociais como base de sustentacao metodologica visando identificar conceitos, percepcoes e ideias sobre enfermidade. Vinte professores que atuam no ensino fundamental (quinta a oitava series), de diferentes disciplinas curriculares, participaram da investigacao. Nas entrevistas, foi observado que os professores interpretam e conceituam a doenca a partir de duas visoes: uma visao classificada como biomedica e a outra como sociocultural. A hanseniase foi percebida na visao biomedica como doenca de pele tendo como caracteristicas principais a manifestacao de manchas, feridas e perda de sensibilidade no corpo; a enfermidade e causada essencialmente pela falta de higiene; e o estar com hanseniase leva o individuo a perda de partes do corpo (mutilacoes). Na visao sociocultural a hanseniase foi a evidenciada como uma enfermidade antiga e ligada a aspectos religiosos; e estigmatizante e que ainda suscita preconceito. O autor, tendo em vista essed dados, sugere a possibilidade da inclusao do professor e da instituicao escolar como participes na divulgacao de informacoes sobre a hanseniase a partir de atividades de educacao em saude no contexto escolar, ampliando, dessa forma, as acoes para o controle da doenca. No entanto, ve a necessidade de uma parceria entre as secretarias de saude e educacao como uma forma de dividirem experiencias visto que o professor precisa conhecer determinados aspectos fundamentais da doenca para que possa divulgar informacoes e assim contribuir tanto na deconstrucao dos seculares conceitos estigmatizantes da hanseniase como na identificacao de possiveis casos em seu bairro ou comunidade que atua.

Asunto(s)