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BACKGROUND: Approximately 60% of individuals with cystic fibrosis (CF) are affected by Aspergillus fumigatus infection. This condition is correlated with a decline in lung function and is identified as an independent risk factor contributing to hospital admissions among CF patients. This study investigates the dynamic interplay of A. fumigatus within the context of CF patients, tracing its evolution over time, with a specific emphasis on colonization dynamics. METHODS: An analysis was conducted on 83 sequential A. fumigatus isolates derived from sputum samples of six patients receiving care at a renowned CF hospital in Brazil. Employing microsatellite genotyping techniques, alongside an investigation into cyp51A gene mutations, this research sheds light on the genetic variations, colonization, and resistance of A. fumigatus within the CF respiratory environment. RESULTS: Our research findings indicate that CF patients can harbor A. fumigatus strains from the same clonal complexes for prolonged periods. Additionally, we identified that clinical isolates have the potential to spread among patients in the same healthcare facility, evidencing hospital contamination. Two patients who underwent long-term Itraconazole treatment did not show phenotypic resistance. However, one of these patients exhibited mutations in the cyp51A gene, indicating the need to monitor resistance to azoles in these patients colonized for long periods by A. fumigatus. We also observed co-colonization or co-infection involving multiple genotypes in all patients over time. CONCLUSION: This comprehensive examination offers valuable insights into the pathogenesis of A. fumigatus infections in CF patients, potentially shaping future therapeutic strategies and management approaches. This enhanced understanding contributes to our knowledge of A. fumigatus impact on disease progression in individuals with cystic fibrosis. Additionally, the study provides evidence of cross-contamination among patients undergoing treatment at the same hospital.

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Background: Breast cancer is the leading cause of cancer death among women worldwide. Studies about the genomic landscape of metastatic breast cancer (MBC) have predominantly originated from developed nations. There are still limited data on the molecular epidemiology of MBC in low- and middle-income countries. This study aims to evaluate the prevalence of mutations in the PI3K-AKT pathway and other actionable drivers in estrogen receptor (ER)+/HER2- MBC among Brazilian patients treated at a large institution representative of the nation's demographic diversity. Methods: We conducted a retrospective observational study using laboratory data (OC Precision Medicine). Our study included tumor samples from patients with ER+/HER2- MBC who underwent routine tumor testing from 2020 to 2023 and originated from several Brazilian centers within the Oncoclinicas network. Two distinct next-generation sequencing (NGS) assays were used: GS Focus (23 genes, covering PIK3CA, AKT1, ESR1, ERBB2, BRCA1, BRCA2, PALB2, TP53, but not PTEN) or GS 180 (180 genes, including PTEN, tumor mutation burden [TMB] and microsatellite instability [MSI]). Results: Evaluation of tumor samples from 328 patients was undertaken, mostly (75.6%) with GS Focus. Of these, 69% were primary tumors, while 31% were metastatic lesions. The prevalence of mutations in the PI3K-AKT pathway was 39.3% (95% confidence interval, 33% to 43%), distributed as 37.5% in PIK3CA and 1.8% in AKT1. Stratification by age revealed a higher incidence of mutations in this pathway among patients over 50 (44.5% vs 29.1%, p=0.01). Among the PIK3CA mutations, 78% were canonical (included in the alpelisib companion diagnostic non-NGS test), while the remaining 22% were characterized as non-canonical mutations (identifiable only by NGS test). ESR1 mutations were detected in 6.1%, exhibiting a higher frequency in metastatic samples (15.1% vs 1.3%, p=0.003). Additionally, mutations in BRCA1, BRCA2, or PALB2 were identified in 3.9% of cases, while mutations in ERBB2 were found in 2.1%. No PTEN mutations were detected, nor were TMB high or MSI cases. Conclusion: We describe the genomic landscape of Brazilian patients with ER+/HER2- MBC, in which the somatic mutation profile is comparable to what is described in the literature globally. These data are important for developing precision medicine strategies in this scenario, as well as for health systems management and research initiatives.

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BACKGROUND: Despite the high prevalence of sleep disturbances in idiopathic pulmonary fibrosis (IPF), the relationship between physical activity in daily life (PADL) and sleep in this population remains unclear. OBJECTIVES: Investigate the impact of sleep on different domains of PADL in IPF and characterize their PADL profile. METHODS: Sixty-seven participants (thirty-three with IPF and thirty-four healthy subjects [control group]) were included. The subjects underwent assessments of pulmonary function, exercise capacity, respiratory and peripheral muscle strength, PADL, sleep, dyspnea, and health-related quality of life. PADL and sleep measures were assessed using an activity monitor (Actigraph®, wGT3x-BT). Associations between sleep and PADL were done using correlation and regression models. RESULTS: In the IPF, sleep duration at night associated significantly with step counts, sedentary, light, and moderate-to-vigorous physical activity (MVPA) (-0.82 ≤ R ≤ 0.43; p < .05 for all). Lung function and sleep partially explained PADL variables (0.19 ≤ R2 ≤ 0.65, p < .05 for all). Compared to controls, the IPF subjects presented lower step counts, less time spent in MVPA, standing position, and more time spent in lying position (p < .05, for all). CONCLUSIONS: Sleep duration is associated with PADL in IPF. The PADL profile of patients is worse than in control subjects.

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Human bocaparvoviruses (HBoVs) belong to the Parvoviridae family, being currently classified into four species (HBoV1-4). These viruses have been found in association with respiratory and gastroenteric symptoms, as well as in asymptomatic individuals. This study aimed to investigate the occurrence of HBoVs in infants under 5 months old admitted to a Neonatal Intensive Care Unit (NICU) during the COVID-19 pandemic (between March 2021 and March 2022). Clinical samples (nasopharyngeal swab, serum, stool, and urine) were screened by qPCR TaqMan. The HBoV was detected in samples of 31.6% (12/38) of participants. The most frequent alteration among the HBoV-positive neonates was the chest X-ray with interstitial infiltrate, followed by tachycardia and vomiting. Viral DNA was detected in more than one type of clinical sample in three of the participants in association with respiratory symptoms. Two participants had positive stool samples with or without enteric symptoms. HBoV intermittent and continuous positivity patterns were observed. The present study stands out for the prospective evaluation of positivity for HBoV in different types of clinical samples from a population of hospitalized infants. Our data supports circulation of HBoV in nosocomial environment during the COVID-19 pandemic.

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Abstract: Promoting socioemotional skills has been highlighted among the evidence to prevent suicidal behavior in childhood and adolescence. This review aimed to map and analyze national and international scientific papers on initiatives and programs for the prevention of suicidal behavior in adolescence based on the theoretical framework of socioemotional skills. It is a scoping review using the methodology proposed by the Joanna Briggs Institute. Eleven academic bibliographic databases were analyzed, and searches were conducted on institutional websites related to suicide prevention and Google. Papers in Portuguese, Spanish, French, and English from 2010 to July 2022 were included in the review, which consisted of 97 studies, analyzed through data matrix and thematic grouping. The results show that most are international and focused on suicide, not on self-harm alone. In general, they have an informational and instructional bias for professionals, institutions, and governments, proposed laws, programs and action plans, studies on the role of socioemotional skills and intervention research. Few strategies have been clearly tested and validated. The key elements are the ability to perceive, recognize, understand, express, and regulate one's own emotions, get motivated, and build empathy in relationships. Schools are key players in this process and the health system should act as a collaborative network. National and local prevention plans are required, emphasizing the role of schools, the health sector, and intersectoral coordination to promote health and quality of life.

Resumen: El fomento de las habilidades socioemocionales se viene destacando entre las evidencias de prevención de la conducta suicida en la infancia y la adolescencia. Este artículo tiene como objetivo identificar y analizar la producción científica nacional e internacional sobre iniciativas y programas de prevención de la conducta suicida en la adolescencia a partir del marco teórico de las habilidades socioemocionales. Se trata de una revisión de alcance que utiliza la metodología propuesta por el Instituto Joanna Briggs. Se realizaron búsquedas en 11 bases de datos académicas, en sitios web institucionales relacionados con la prevención del suicidio y en Google. Los textos incluidos estaban publicados en portugués, español, francés o inglés, en el período entre 2010 y julio de 2022. La muestra consistió en 97 publicaciones, y se utilizaron la matriz de datos y agrupación temática para analizarlas. Los resultados muestran que la mayoría de las iniciativas son internacionales y dirigidas al suicidio, sin privilegiar la autolesión. En general, tienen un sesgo informativo e instruccional dirigido a profesionales, instituciones y gobiernos, proyecto de ley, programas y planes de acción, estudios sobre el papel de las habilidades socioemocionales e investigación de intervención. Pocas estrategias habían sido probadas y validadas claramente. Los elementos clave fueron la capacidad de percibir, reconocer, comprender, expresarse y regular las propias emociones, motivarse y establecer relaciones de empatía. Las escuelas son las protagonistas, y el sector salud necesita actuar en una red de colaboración. Se necesitan planes de prevención nacionales y locales, que pongan énfasis en el papel de la escuela, del sector salud y de la articulación intersectorial para la promoción de la salud y la calidad de vida.

Resumo: Promover habilidades socioemocionais tem sido destacado, entre as evidências, como prevenção do comportamento suicida na infância e na adolescência. Este artigo visa mapear e analisar a produção científica nacional e internacional sobre iniciativas e programas de prevenção do comportamento suicida na adolescência baseados no referencial teórico das habilidades socioemocionais. Caracteriza-se por uma revisão de escopo utilizando a metodologia proposta pelo Instituto Joanna Briggs. Foram consultadas 11 bases bibliográficas acadêmicas, além de busca em sites institucionais relacionados à prevenção de suicídio e no Google. Foram incluídas publicações em português, espanhol, francês e inglês entre os anos de 2010 a julho de 2022. O acervo foi composto por 97 publicações, analisadas por meio da matriz de dados e agrupamento temático. Os resultados mostram que a maioria das iniciativas é internacional e voltada para o suicídio, sem privilegiar a autolesão. De forma geral, apresentam viés informativo e instrucional voltado para profissionais, instituições e governos, projetos de lei, programas e planos de ação, estudos sobre o papel das competências socioemocionais e pesquisas de intervenção. Poucas estratégias são claramente testadas e validadas. Os elementos-chave são a capacidade para perceber, reconhecer, compreender, expressar e regular as próprias emoções, motivar-se e estabelecer relações de empatia. As escolas são protagonistas e a saúde precisa atuar em rede colaborativa. São necessários planos nacionais e locais de prevenção, enfatizando o papel da escola, do setor saúde e da articulação intersetorial para a promoção de saúde e qualidade de vida.

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Background: The success of endodontic treatment can be influenced by the type of endodontic sealer used, as certain sealers may be prone to apical microleakage, leading to treatment failure. The limitations of currently available sealers necessitate the development of new materials to improve the success rate of endodontic treatment. Therefore, the objective of this study was to assess the apical microleakage of newly developed hydroxyapatite-based endodontic sealers, including one derived from eggshells, and compare them with other commercially available sealers. Material and Methods: Eighty-five extracted human upper anterior teeth were selected for this study. The teeth were divided into 5 experimental groups and 2 control groups. The experimental groups were designated as follows: (1) HPSINT - obturated with gutta-percha cone and synthetic hydroxyapatite-based sealer, (2) BIOC - obturated with gutta-percha cone and Bio C-Sealer sealer, (3) AHPLUS-BC - obturated with gutta-percha cone and AHPLUS Bioceramic sealer, (4) AHP - obturated with gutta-percha cone and AHPLUS sealer, and (5) HPO - obturated with gutta-percha cone and sealer based on hydroxyapatite extracted from eggshells. Additionally, there were positive and negative control groups consisting of instrumented teeth filled with gutta-percha cones without any sealer and instrumented teeth without any filling, respectively. Methylene blue dye penetration was used to assess apical microleakage. Descriptive statistical analysis and Shapiro-Wilk normality test were applied to the observed results. As the samples followed a normal distribution, the ANOVA test was applied. Results: The control groups confirmed the validity of the experimental method, while the experimental groups showed varying degrees of dye penetration. The group obturated with Bio C-Sealer exhibited the highest mean apical microleakage, while AHPLUS Bioceramic sealer demonstrated lower mean than AHPLUS sealer and sealer based on hydroxyapatite extracted from eggshells (p<0.05). Finally, there was no difference between the synthetic hydroxyapatite-based sealer and AHPLUS Bioceramic sealer, AHPLUS sealer and sealer based on hydroxyapatite extracted from eggshells (p>0.05). No significant difference was observed between the hydroxyapatite-based sealers and the AHPLUS-BC sealer. Conclusions: The results of this study suggest that the newly developed hydroxyapatite-based endodontic sealers, including the one derived from eggshells, may have a lower risk of apical microleakage compared to other commercially available sealers. These findings highlight the potential of hydroxyapatite-based sealers to improve the success rate of endodontic treatment. Further research and clinical studies are warranted to validate these results and explore the long-term effects of these novel sealers. Key words:Endodontic treatment, apical microleakage, endodontic sealer, hydroxyapatite, eggshell-derived sealer.

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This study aims to understand how Brazilian online communities portray the topic of self-harm, discussing its particularities, the narratives produced, the interactions established, and the purpose of the digital space. It was based on qualitative research in the digital environment from the silent observation of Facebook online communities, which were selected considering the number of participants and their interaction. The observation followed a previous script and posts were recorded by screenshots. Publications were organized in the following categories: characterization and functioning of the community; self-directed violence (self-harm and suicide); motivations for the act; strategies to prevent the act; and loving experience. Results showed that the communities were positively guided and defended self-harm without any regulation, which guaranteed the free expression of their participants and detailed reports describing the methods and objects used, the level of efficiency, and how to hide the wounds. Although participants shared the fear of being discovered, they published images of their own scars and wounds, materializing discourses of suffering on the Internet and glamorizing the cuts, the feeling of pleasure, and the sense of belonging, since they are also identity marks. Our findings show that young people who harm themselves share their suffering experiences with other young people without the mediation of a professional, therefore, considering its possible effects on mental health is necessary.

Este estudo busca compreender como o tema da automutilação é retratado em comunidades online brasileiras, apresentando uma reflexão sobre suas particularidades, as narrativas produzidas, as interações estabelecidas e a finalidade desse espaço digital. Trata-se de pesquisa qualitativa feita em ambiente digital por meio da observação silenciosa de comunidades online do Facebook, selecionadas a partir do número de participantes e de interação. A observação foi orientada por um roteiro prévio e as postagens foram registradas por print screen. As publicações foram organizadas nas seguintes categorias temáticas: caracterização e funcionamento das comunidades; violência autoinfligida (automutilação e suicídio); motivações para o ato; estratégias para impedir o ato; e experiência amorosa. Os resultados revelaram que as comunidades se orientavam de maneira positiva, defendiam a prática da automutilação, com ausência de regulamentação, o que garantiu a livre expressão de seus participantes, havia relatos detalhados com descrição do método praticado, dos objetos utilizados e dos mais eficazes para tal e de como ocultar os ferimentos. Embora compartilhassem o medo da descoberta, publicavam imagens de suas próprias cicatrizes e ferimentos, materializando na rede discursos de sofrimento, bem como a glamourização dos cortes, o sentimento de prazer e o senso de pertença por ser também uma marca identitária. Nossos achados permitem inferir que jovens que se mutilam compartilham suas experiências com outros jovens em sofrimento, sem a mediação de um profissional, sendo premente considerar os possíveis impactos à saúde mental.

Este estudio pretendió comprender cómo las comunidades brasileñas en línea tratan el tema de la automutilación, poniendo en reflexión sus particularidades, las narrativas producidas, las interacciones establecidas y la finalidad de este espacio digital. Se realizó una investigación cualitativa en el entorno digital basada en la observación silenciosa de comunidades en línea en Facebook, seleccionadas en función del número de participantes y de interacción. La observación siguió un guion previo, y las publicaciones se registraban por "captura de pantalla". Las publicaciones se organizaron en las siguientes categorías temáticas: caracterización y funcionamiento de las comunidades; violencia autoinfligida (automutilación y suicidio); motivaciones del acto; estrategias para prevenir el acto; y experiencia amorosa. Los resultados revelaron que las comunidades se orientaban de manera positiva, defendían la práctica de la automutilación, con ausencia de normativa, lo que garantizaba la libre expresión de sus participantes, los relatos detallados con descripción del método, los objetos utilizados y los más efectivos y cómo disimular las heridas. Si bien compartían el miedo al descubrimiento, los participantes publicaron imágenes de sus propias cicatrices y heridas, materializando discursos de sufrimiento en la red, así como el glamur de los cortes, el sentimiento de placer y sentido de pertenencia por ser también una seña de identidad. Los hallazgos permiten inferir que los jóvenes que se autolesionan comparten sus experiencias con otros jóvenes que sufren y no tienen la mediación de un profesional, lo que es urgente considerar los posibles impactos en la salud mental.

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Lignocellulosic biomass is a promising alternative for producing biofuels, despite its recalcitrant nature. There are microorganisms in nature capable of efficiently degrade biomass, such as the filamentous fungi. Among them, Aspergillus fumigatus var. niveus (AFUMN) has a wide variety of carbohydrate-active enzymes (CAZymes), especially hydrolases, but a low number of oxidative enzymes in its genome. To confirm the enzymatic profile of this fungus, this study analyzed the secretome of AFUMN cultured in sugarcane bagasse as the sole carbon source. As expected, the secretome showed a predominance of hydrolytic enzymes compared to oxidative activity. However, it is known that hydrolytic enzymes act in synergy with oxidative proteins to efficiently degrade cellulose polymer, such as the Lytic Polysaccharide Monooxygenases (LPMOs). Thus, three LPMOs from the fungus Thermothelomyces thermophilus (TtLPMO9D, TtLPMO9H, and TtLPMO9O) were selected, heterologous expressed in Aspergillus nidulans, purified, and used to supplement the AFUMN secretome to evaluate their effect on the saccharification of sugarcane bagasse. The saccharification assay was carried out using different concentrations of AFUMN secretome supplemented with recombinant T. thermophilus LPMOs, as well as ascorbic acid as reducing agent for oxidative enzymes. Through a statistic design created by Design-Expert software, we were able to analyze a possible cooperative effect between these components. The results indicated that, in general, the addition of TtLPMO9D and ascorbic acid did not favor the conversion process in this study, while TtLPMO9O had a highly significant cooperative effect in bagasse saccharification compared to the control using only AFUMN secretome.

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Este estudo busca compreender como o tema da automutilação é retratado em comunidades online brasileiras, apresentando uma reflexão sobre suas particularidades, as narrativas produzidas, as interações estabelecidas e a finalidade desse espaço digital. Trata-se de pesquisa qualitativa feita em ambiente digital por meio da observação silenciosa de comunidades online do Facebook, selecionadas a partir do número de participantes e de interação. A observação foi orientada por um roteiro prévio e as postagens foram registradas por print screen. As publicações foram organizadas nas seguintes categorias temáticas: caracterização e funcionamento das comunidades; violência autoinfligida (automutilação e suicídio); motivações para o ato; estratégias para impedir o ato; e experiência amorosa. Os resultados revelaram que as comunidades se orientavam de maneira positiva, defendiam a prática da automutilação, com ausência de regulamentação, o que garantiu a livre expressão de seus participantes, havia relatos detalhados com descrição do método praticado, dos objetos utilizados e dos mais eficazes para tal e de como ocultar os ferimentos. Embora compartilhassem o medo da descoberta, publicavam imagens de suas próprias cicatrizes e ferimentos, materializando na rede discursos de sofrimento, bem como a glamourização dos cortes, o sentimento de prazer e o senso de pertença por ser também uma marca identitária. Nossos achados permitem inferir que jovens que se mutilam compartilham suas experiências com outros jovens em sofrimento, sem a mediação de um profissional, sendo premente considerar os possíveis impactos à saúde mental.

This study aims to understand how Brazilian online communities portray the topic of self-harm, discussing its particularities, the narratives produced, the interactions established, and the purpose of the digital space. It was based on qualitative research in the digital environment from the silent observation of Facebook online communities, which were selected considering the number of participants and their interaction. The observation followed a previous script and posts were recorded by screenshots. Publications were organized in the following categories: characterization and functioning of the community; self-directed violence (self-harm and suicide); motivations for the act; strategies to prevent the act; and loving experience. Results showed that the communities were positively guided and defended self-harm without any regulation, which guaranteed the free expression of their participants and detailed reports describing the methods and objects used, the level of efficiency, and how to hide the wounds. Although participants shared the fear of being discovered, they published images of their own scars and wounds, materializing discourses of suffering on the Internet and glamorizing the cuts, the feeling of pleasure, and the sense of belonging, since they are also identity marks. Our findings show that young people who harm themselves share their suffering experiences with other young people without the mediation of a professional, therefore, considering its possible effects on mental health is necessary.

Este estudio pretendió comprender cómo las comunidades brasileñas en línea tratan el tema de la automutilación, poniendo en reflexión sus particularidades, las narrativas producidas, las interacciones establecidas y la finalidad de este espacio digital. Se realizó una investigación cualitativa en el entorno digital basada en la observación silenciosa de comunidades en línea en Facebook, seleccionadas en función del número de participantes y de interacción. La observación siguió un guion previo, y las publicaciones se registraban por "captura de pantalla". Las publicaciones se organizaron en las siguientes categorías temáticas: caracterización y funcionamiento de las comunidades; violencia autoinfligida (automutilación y suicidio); motivaciones del acto; estrategias para prevenir el acto; y experiencia amorosa. Los resultados revelaron que las comunidades se orientaban de manera positiva, defendían la práctica de la automutilación, con ausencia de normativa, lo que garantizaba la libre expresión de sus participantes, los relatos detallados con descripción del método, los objetos utilizados y los más efectivos y cómo disimular las heridas. Si bien compartían el miedo al descubrimiento, los participantes publicaron imágenes de sus propias cicatrices y heridas, materializando discursos de sufrimiento en la red, así como el glamur de los cortes, el sentimiento de placer y sentido de pertenencia por ser también una seña de identidad. Los hallazgos permiten inferir que los jóvenes que se autolesionan comparten sus experiencias con otros jóvenes que sufren y no tienen la mediación de un profesional, lo que es urgente considerar los posibles impactos en la salud mental.

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Os episódios envolvendo transtornos comportamentais como a ansiedade e a depressão têm aumentado ao longo dos últimos decênios. Ambos os transtornos atuam alterando o humor. Apesar da terapia convencional oferecer um volume considerável de medicamentos ansiolíticos e antidepressivos, ao mesmo tempo, que novos estão sempre sendo desenvolvidos e testados, a aromaterapia surge como prática integrativa que pode ser empregada de forma alternativa ou complementar à medicina convencional. Aquela tem se revelado potencial, contribuindo com a mitigação do quadro de sintomas referentes à ansiedade e depressão. Assim, o presente trabalho tem por objetivo explanar, por meio de uma revisão integrativa, de que forma os óleos essenciais atuam no tratamento dos transtornos de ansiedade e depressão. O estudo se trata de uma revisão integrativa, constituída a partir de artigos que correspondem a estudos e ensaios clínicos publicados em periódicos entre 2018 e 2022. A análise é elaborada a partir de um total de 8 trabalhos selecionados. São estudos sobre a utilização dos óleos essenciais que apontam a aromaterapia como um recurso promissor no tratamento de transtornos mentais e comportamentais, graças à sua ação ansiolítica e antidepressiva, além de promover alivio aos sintomas decorrentes da ansiedade e da depressão. A aromaterapia pode ser uma favorável alternativa complementar ao tratamento medicamentoso da ansiedade e depressão, em virtude da sua ação ansiolítica e antidepressiva, oferecendo uma melhor qualidade de vida e recuperação da saúde dos pacientes.

Episodes involving behavioral disorders such as anxiety and depression have increased over the last decades. Both disorders act by altering mood. Although conventional therapy offers a considerable volume of anxiolytic and antidepressant drugs, at the same time that new ones are always being developed and tested, aromatherapy emerges as an integrative practice that can be used as an alternative or complement to conventional medicine. Aromatherapy has revealed its potential to contribute to the mitigation of symptoms related to anxiety and depression. Thus, the present work aims to explain, by means of an integrative review, how essential oils act in the treatment of anxiety and depression disorders. The study is an integrative review, consisting of articles corresponding to studies and clinical trials published in journals between 2018 and 2022. The analysis is elaborated from a total of 8 selected papers. These are studies on theuse of essential oils that point to aromatherapy as a promising resource in the treatment of mental and behavioral disorders, thanks to its anxiolytic and antidepressant action, in addition to promoting relief to symptoms arising from anxiety and depression. Aromatherapy may be a favorable complementary alternative to drug treatment for anxiety and depression, due to its anxiolytic and antidepressant action, offering a better quality of life and health recovery for patients.

Los episodios relacionados con trastornos del comportamiento como la ansiedad y la depresión han aumentado en las últimas décadas. Ambos trastornos actúan alterando el estado de ánimo. Aunque la terapia convencional ofrece un volumen considerable de fármacos ansiolíticos y antidepresivos, al mismo tiempo que siempre se están desarrollando y probando otros nuevos, la aromaterapia surge como una práctica integradora que puede utilizarse como alternativa o complemento a la medicina convencional. La aromaterapia ha revelado su potencial para contribuir a la mitigación de los síntomas relacionados conla ansiedad y la depresión. Así, el presente trabajo pretende explicar, mediante una revisión integradora, cómo actúan los aceites esenciales en el tratamiento de los trastornos de ansiedad y depresión. El estudio es una revisión integradora, compuesta por artículos correspondientes a estudios y ensayos clínicos publicados en revistas entre 2018 y 2022. El análisis se elabora a partir de un total de 8 artículos seleccionados. Se trata de estudios sobre el uso de aceites esenciales que señalan a la aromaterapia como un recurso prometedor en el tratamiento de trastornos mentales y del comportamiento, gracias a su acción ansiolítica y antidepresiva, además de favorecer el alivio de los síntomas derivados de la ansiedad y la depresión. La aromaterapia puede seruna alternativa complementaria favorable al tratamiento farmacológico de la ansiedad y la depresión, debido a su acción ansiolítica y antidepresiva, ofreciendo una mejor calidad de vida y recuperación de la salud de los pacientes.

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Breast cancer is a heterogeneous disease, and the estrogen receptor (ER) remains the most important biomarker in breast oncology. Most guidelines set a positive expression threshold of 1% staining in immunohistochemistry (IHC) to define ER positivity. However, different expression levels may be associated with diverse degrees of sensitivity to endocrine therapy as ER expression may impact breast cancer molecular biology as a continuous variable. ER-lo tumors, defined as those with 1-10% ER expression, represent a relatively small subgroup of breast cancer patients, with an estimated prevalence of 2-7%. These tumors are similar to ERneg disease in their molecular landscape, clinicopathological characteristics, prognosis, and response to therapy. Nevertheless, a proportion may retain some degree of ER signaling dependency, and the possibility of responding to some degree to endocrine therapy cannot be completely ruled out. This review article discusses the most important considerations regarding the definition of ER positivity, pathology assessment, prognosis, and therapeutic implication of ERlo breast cancer from the medical oncology perspective.

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PURPOSE: A nationwide lockdown was enforced in Brazil starting in March 2020 because of the COVID-19 pandemic when cancer screening activities were reduced. In this study, we evaluated the impact of the COVID-19 pandemic on breast cancer (BC) diagnosis. METHODS: We extracted data from the medical records of patients age older than 18 years who were diagnosed with BC and started treatment or follow-up in private oncology institutions in Brazil between 2018 and 2021. The primary objective was to compare the stage distribution during the COVID-19 pandemic (2020-2021) with a historical prepandemic control cohort (2018-2019). Early BC was defined as stage I-II and advanced disease as stage IV. RESULTS: We collected data for 11,753 patients with an initial diagnosis of BC, with 6,493 patients in the pandemic (2020-2021) and 5,260 patients in the prepandemic period (2018-2019). We observed a lower prevalence of early-stage BC (63.6% v 68.4%) and a higher prevalence of advanced-stage BC (16.9 v 12.7%), after the onset of the pandemic (both P < .01). This pattern was similar for both estrogen receptor-positive/human epidermal growth factor receptor 2-negative and human epidermal growth factor receptor 2-positive tumors: significantly decreased in the early stage from 69% to 67% and 68% to 58%, respectively, and a considerable increase in advanced-stage disease from 13% to 15% and 13% to 20%, respectively. For triple-negative BC, there was a significantly higher percentage of patients with advanced-stage disease during the pandemic (17% v 11%). Overall, age 50 years or older and postmenopausal status were associated with a greater risk of advanced stage at diagnosis during the pandemic period. CONCLUSION: We observed a substantial increase in the number of cases of advanced-stage BC in Brazil during the COVID-19 pandemic.

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A pandemia da COVID -19 tornou-se um dos eventos de vida mais impactantes da experiência humana contemporânea. Este estudo examinou as propriedades psicométricas de uma versão da Impact of Event Scale, medida de sofrimento subjetivo relacionada aos eventos estressantes de vida, adaptada ad hoc ao contexto pandêmico. Participaram 318 moradores do Rio de Janeiro/RJ, que foram divididos aleatoriamente em duas amostras. Os escores do primeiro grupo foram submetidos à Análise Fatorial Exploratória, que extraiu uma solução de dois fatores: Pensamentos Intrusivos e Evitativos. No segundo, foi testado um modelo de dois fatores oblíquos, por meio de Análise Fatorial Confirmatória, que apresentou um bom ajuste aos dados. Os resultados também indicaram evidências de validade convergente, validade discriminativa e consistência interna as duas dimensões da escala. Uma Análise de Regressão indicou os Pensamentos Intrusivos da IES como principal preditor de Afetividade Negativa, evidência de validade de critério. Foram encontradas evidências suficientes de validade e fidedignidade para a IES adaptada ao contexto da COVID-19.(AU)

The COVID-19 pandemic has become one of the most impactful life events in recent human experience. This study examined the psychometric properties of a version of the Impact of Event Scale, a measure of subjective suffering related to stressful life events, adapted ad hoc to the pandemic context. A total of 318 residents of Rio de Janeiro / RJ took part in the study, and were randomly divided into two samples. The scores of the first group were submitted to Exploratory Factor Analysis, which extracted a solution of two factors: Intrusive Thoughts and Avoidant Thoughts. In the second, a model of two oblique factors was tested, through Confirmatory Factor Analysis, which presented a good fit to the data, evidence of convergent validity, discriminative validity and internal consistency for the two dimensions of the scale. Regression Analysis indicated the IES's Intrusive Thoughts as the main predictor of Negative Affectivity, providing evidence of criterion validity. Sufficient evidence of validity and reliability was found for the IES adapted to the context of COVID-19.(AU)

La pandemia de COVID-19 se ha convertido en uno de los eventos de vida más impactantes en la experiencia humana contemporánea. Este estudio examinó las propiedades psicométricas de una versión de la Impact of Event Scale, una medida del sufrimiento subjetivo relacionado con eventos vitales estresantes, adaptada ad hoc al contexto de la pandemia. Participaron 318 habitantes de la ciudad de Rio de Janeiro, que fueron divididos aleatoriamente en dos muestras. Las puntuaciones del primer grupo se sometieron al Análisis Factorial Exploratorio, que extrajo una solución de dos factores: Pensamientos Intrusivos y Evitativos. En el segundo, se probó un modelo bifactorial oblicuo, mediante Análisis Factorial Confirmatorio, que presentó un buen ajuste a los datos. Los resultados también indicaron evidencias de validez convergentes, validez discriminativa y consistencia interna en las dos dimensiones de la escala. Un Análisis de Regresión indicó que los Pensamientos Intrusivos son el principal predictor de Afectividad Negativa, evidencia de validez de criterio. Se encontró evidencias suficientes de validez y fiabilidad para la IES adaptada al contexto del COVID-19.(AU)

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OBJECTIVE: To determine whether abnormal continuous glucose monitoring (CGM) readings (hypoglycemia/hyperglycemia) can predict the onset of cystic fibrosis-related diabetes (CFRD) and/or clinical impairment (decline in BMI and/or FEV1) in pediatric patients with cystic fibrosis (CF). METHODS: This was a longitudinal prospective cohort study involving CF patients without diabetes at baseline. The mean follow-up period was 3.1 years. The patients underwent 3-day CGM, performed oral glucose tolerance test (OGTT), and had FEV1 and BMI determined at baseline. OGTT, FEV1, and BMI were reassessed at the end of the follow-up period. RESULTS: Thirty-nine CF patients (10-19 years of age) had valid CGM readings at baseline, and 34 completed the follow-up period (mean = 3.1 ± 0.5 years). None of the study variables predicted progression to CFRD or were associated with hypoglycemic events. CGM could detect glucose abnormalities not revealed by OGTT. Patients with glucose levels ≥ 140 mg/dL, as compared with those with lower levels, on CGM showed lower BMI values and z-scores at baseline-17.30 ± 3.91 kg/m2 vs. 19.42 ± 2.07 kg/m2; p = 0.043; and -1.55 ± 1.68 vs. -0.17 ± 0.88; p = 0.02, respectively-and at the end of follow-up-17.88 ± 3.63 kg/m2 vs. 19.95 ± 2.56 kg/m2; p = 0.039; and -1.65 ± 1.55 vs. -0.42 ± 1.08; p = 0.039. When comparing patients with and without CFRD, the former were found to have worse FEV1 (in % of predicted)-22.67 ± 5.03 vs. 59.58 ± 28.92; p = 0.041-and a greater decline in FEV1 (-36.00 ± 23.52 vs. -8.13 ± 17.18; p = 0.041) at the end of follow-up. CONCLUSIONS: CGM was able to identify glucose abnormalities not detected by OGTT that were related to early-stage decreases in BMI. CGM was ineffective in predicting the onset of diabetes in this CF population. Different diagnostic criteria for diabetes may be required for individuals with CF.

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In this retrospective and prospective study, histopathological and immunohistochemical analyses of 62 cases of lymphomas in cats were performed to classify the anatomic forms and subtypes, according to the WHO guidelines, and correlate it to FeLV proviral DNA detected using PCR. The most common anatomical form was gastrointestinal (40.3%, 25/62), followed by multicentric (29%, 18/62), mediastinal (17.7%, 11/62) and extranodal (12,9%, 8/62). Among the lymphoma subtypes, diffuse large B-cell lymphoma (DLBCL) (30.6%, 19/62) was the most commonly diagnosed followed by peripheral T-cell lymphoma (PTCL) (29%, 18/62) and enteropathy associated T-cell lymphoma type 2 (14.5%, 9/62). DNA extraction from paraffin-embedded neoplastic tissue was obtained in 28 cases and FeLV proviral DNA was detected by PCR, in 23 of these. Of the cases presenting with FeLV proviral DNA, nine (32%) were of the multicentric form, five (22%) of the mediastinal and extranodal forms and four (17%) of the gastrointestinal form. The most frequent subtypes with FeLV proviral DNA, independent of the anatomical form, were DLBCL (39.1%, 9/23) and PTCL (34.7%, 8/23). The presence of the FeLV proviral DNA in 23 cats of this study, probably had association with the multicentric form of lymphoma and higher occurrence in the DLBCL and PTCL subtypes.

Neste estudo retrospectivo e prospectivo, análises histopatológicas e imuno-histoquímicas de 62 casos de linfomas em gatos foram realizadas para classificar as formas anatômicas o e subtipos do linfoma, de acordo com as diretrizes da OMS. Além disso, foi realizada a extração de DNA dos tumores incluídos na parafina para obtenção de DNA pró-viral do FeLV por PCR, e relacionada com os exames anteriores. A forma anatômica mais comum foi a gastrointestinal (40.3%, 25/62), seguida pela multicêntrica (29%, 18/62), mediastinal (17,7%, 11/62) e extranodal (12,9%, 8/62). Entre os subtipos de linfoma, o linfoma difuso de grandes células B (DLBCL) (30.6%, 19/62) foi o mais comumente diagnosticado, seguido por linfoma de células T periférico (PTCL) (29%, 18/62) e o linfoma de células T associado a enteropatia tipo 2 (14.5%, 9/62). A extração de DNA de tecido neoplásico emblocado em parafina foi obtida em 28 casos e o DNA pró-viral de FeLV foi detectado por PCR, em 23 deles. Dos casos com DNA pró-viral do FeLV, nove (32%) eram da forma multicêntrica, cinco (22%) das formas mediastinal e extranodal e quatro (17%) da forma gastrointestinal. Os subtipos mais frequentes com DNA pró-viral do FeLV, independente da forma anatômica, foram DLBCL (39.1%, 9/23) e PTCL (34.7%, 8/23). A presença do DNA pró-viral do FeLV em 23 gatos deste estudo, provavelmente teve associação com a forma multicêntrica do linfoma e maior ocorrência nos subtipos DLBCL e PTCL.

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ABSTRACT Objective: To determine whether abnormal continuous glucose monitoring (CGM) readings (hypoglycemia/hyperglycemia) can predict the onset of cystic fibrosis-related diabetes (CFRD) and/or clinical impairment (decline in BMI and/or FEV1) in pediatric patients with cystic fibrosis (CF). Methods: This was a longitudinal prospective cohort study involving CF patients without diabetes at baseline. The mean follow-up period was 3.1 years. The patients underwent 3-day CGM, performed oral glucose tolerance test (OGTT), and had FEV1 and BMI determined at baseline. OGTT, FEV1, and BMI were reassessed at the end of the follow-up period. Results: Thirty-nine CF patients (10-19 years of age) had valid CGM readings at baseline, and 34 completed the follow-up period (mean = 3.1 ± 0.5 years). None of the study variables predicted progression to CFRD or were associated with hypoglycemic events. CGM could detect glucose abnormalities not revealed by OGTT. Patients with glucose levels ≥ 140 mg/dL, as compared with those with lower levels, on CGM showed lower BMI values and z-scores at baseline-17.30 ± 3.91 kg/m2 vs. 19.42 ± 2.07 kg/m2; p = 0.043; and −1.55 ± 1.68 vs. −0.17 ± 0.88; p = 0.02, respectively-and at the end of follow-up-17.88 ± 3.63 kg/m2 vs. 19.95 ± 2.56 kg/m2; p = 0.039; and −1.65 ± 1.55 vs. −0.42 ± 1.08; p = 0.039. When comparing patients with and without CFRD, the former were found to have worse FEV1 (in % of predicted)-22.67 ± 5.03 vs. 59.58 ± 28.92; p = 0.041-and a greater decline in FEV1 (−36.00 ± 23.52 vs. −8.13 ± 17.18; p = 0.041) at the end of follow-up. Conclusions: CGM was able to identify glucose abnormalities not detected by OGTT that were related to early-stage decreases in BMI. CGM was ineffective in predicting the onset of diabetes in this CF population. Different diagnostic criteria for diabetes may be required for individuals with CF.

RESUMO Objetivo: Verificar se leituras de continuous glucose monitoring (CGM, monitoramento contínuo da glicose) anormais (hipoglicemia/hiperglicemia) podem prever o aparecimento de diabetes relacionado à fibrose cística (DRFC) e/ou comprometimento clínico (declínio do IMC e/ou do VEF1) em pacientes pediátricos com fibrose cística (FC). Métodos: Estudo de coorte longitudinal prospectivo envolvendo pacientes com FC sem diabetes no início do estudo. O tempo médio de acompanhamento foi de 3,1 anos. Os pacientes foram submetidos a CGM de três dias, teste oral de tolerância à glicose (TOTG) e medida de VEF1 e IMC no início do estudo. TOTG, VEF1 e IMC foram reavaliados ao final do acompanhamento. Resultados: Trinta e nove pacientes com FC (10-19 anos de idade) apresentaram leituras de CGM válidas no início do estudo, e 34 completaram o acompanhamento (média = 3,1 ± 0,5 anos). Nenhuma das variáveis estudadas previu evolução para DRFC ou apresentou associação com eventos hipoglicêmicos. O CGM conseguiu detectar anormalidades glicêmicas não reveladas pelo TOTG. Pacientes com níveis de glicose ≥ 140 mg/dL no CGM, comparados àqueles com níveis menores, apresentaram valores de IMC e escores z de IMC menores no início do estudo - 17,30 ± 3,91 kg/m2 vs. 19,42 ± 2,07 kg/m2; p = 0,043; e −1,55 ± 1,68 vs. −0,17 ± 0,88; p = 0,02, respectivamente - e no final do acompanhamento - 17,88 ± 3,63 kg/m2 vs. 19,95 ± 2,56 kg/m2; p = 0,039; e −1,65 ± 1,55 vs. −0,42 ± 1,08; p = 0,039. Na comparação dos pacientes com e sem DRFC, os primeiros apresentaram pior VEF1 (em % do previsto) - 22,67 ± 5,03 vs. 59,58 ± 28,92; p = 0,041 - e maior declínio do VEF1 (−36,00 ± 23,52 vs. −8,13 ± 17,18; p = 0,041) no final do acompanhamento. Conclusões: O CGM foi capaz de identificar anormalidades glicêmicas não detectadas pelo TOTG que se relacionaram com reduções precoces do IMC. O CGM foi ineficaz na previsão do aparecimento de diabetes nesta população com FC. Diferentes critérios diagnósticos para diabetes podem ser necessários para indivíduos com FC.

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OBJECTIVE: To investigate the reliability, internal consistency and validity of the Brazilian Portuguese version of the University of California San Diego Shortness of Breath Questionnaire (UCSD SOBQ) in patients with interstitial lung disease (ILD). METHODS: Patients with ILD completed the questionnaire at three different time points, one week apart, with the assistance of two independent assessors. Intra- and inter-rater reliability were analysed via the intraclass correlation coefficient (ICC). Internal consistency was assessed with the Cronbach's alpha coefficient. For the validity analysis, associations between variables were assessed with Spearman's or Pearson's correlation coefficient. RESULTS: Thirty patients with ILD (idiopathic pulmonary fibrosis, connective tissue disease-associated pulmonary fibrosis, sarcoidosis, asbestosis or non-specific interstitial pneumonia) were included (15 men; mean age, 59 ± 10 years; DLCO: 46 [33-64] % predicted). UCSD SOBQ scores showed excellent agreement and internal consistency in the intra-rater analysis (ICC: 0.93 [0.85-0.97]; Cronbach alpha: 0.95) and in the inter-rater analysis (ICC: 0.95 [0.89-0.97]; Cronbach alpha: 0.95), as well as correlating significantly with dyspnoea (as assessed by the Medical Research Council scale; r = 0.56); Medical Outcomes Study 36-item Short-Form Health Survey domains bodily pain, general health, vitality and physical functioning (-0.40 ≤ r ≤ -0.74); six-minute walk distance (r = -0.38); and quadriceps muscle strength (r = -0.41). CONCLUSIONS: The Brazilian Portuguese version of the UCSD SOBQ is valid, is reliable and has internal consistency in patients with ILD in Brazil.

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BACKGROUND: There is limited information regarding impairment in functional performance tests and their measurement properties in ILD. The present study aimed to verify the impairment and measurement properties of functional performance tests in ILD. METHODS: ILD and healthy individuals underwent assessments of pulmonary function, peripheral muscle strength (handgrip force and maximum isometric contraction of quadriceps femoris - MIVCq) and exercise capacity (6-min walk test - 6MWT). Functional performance was assessed by timed-up-and-go with usual (TUGu) and fast (TUGf) gait speeds, 4-m gait speed (4MGS), sit-to-stand in 30 s (30sec-STS), 1 min (1min-STS) and with 5 repetition (5rep-STS) and Short Physical Performance Battery (SPPB). Functional performance was compared between groups, validity (correlation with 6MWT and MIVCq) and reliability of tests were checked in subjects with ILD (intra- and inter-rater agreement analysis). RESULTS: Seventy-six participants (40 ILD [25 women, 61 ± 11 years, FVC 75 ± 17 %pred] and 36 healthy [22 women, 61 ± 9 years, FVC 97 ± 11 %pred]) were included. Functional performance in ILD was worse than in healthy individuals in all tests, except for the 30sec-STS (p = 0.13). Pre-specified validity criteria were reached for TUGu, TUGf, 4MGS and 5rep-STS (-0.69 < r < 0.55; p < 0.05 for all). Except for 4MGS and SPPB, all tests showed good to excellent inter-rater (0.85 < ICC<0.93; p < 0.05 for all) and all tests showed good to excellent intra-rater (0.83 < ICC< 0.94; p < 0.05 for all) reliability. CONCLUSIONS: Subjects with ILD present worse functional performance than healthy individuals. According to reliability and validity results, TUGu, TUGf and 5rep-STS seem to be the most appropriate tests to evaluate functional performance in ILD.

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BACKGROUND: Worldwide, colorectal cancer (CRC) and gastric cancer (GC) are the third and the fifth most prevalent, respectively. Diarrhea is a common symptom in patients on chemotherapy or radiotherapy treatment and can reduce treatment tolerance. Surgical resections and chemotherapy change the intestinal microbiota that can lead to lactose intolerance, small intestinal bacterial overgrowth (SIBO). OBJECTIVE: The aim of the study was to evaluate the frequency of diarrhea in patients with CRC and GC on chemotherapy with SIBO or intolerance of lactose. METHODS: This is a descriptive and observational study with patients of both sexes, over 18 years old, in treatment in the Gastro-Oncology outpatient clinic of the Federal University of São Paulo. Patients with a confirmed diagnosis of CRC or GC during chemotherapy treatment were included. To detect bacterial overgrowth and lactose intolerance, breath hydrogen test with lactulose and lactose was done. Number and aspects of the evacuations and toxicity degree were collected. For the nutritional assessment, weight and height were performed to calculate the BMI. and the Patient Generated Subjective Global Assessment (PG-SGA). RESULTS: A total of 33 patients were included, 29 with CRC and 3 with GC. Most of them were male (57.57%), mean age of 60.03±10.01 years and in chemotherapy with fluoropyrimidine and oxaliplatin (54.5%). Diarrhea was present in 57.6% and 30.3% had toxicity grade 2. According to the BMI, 78.9% were eutrophics, obese or overweight, but according to PG-SGA, 84.9% had moderate or severe nutritional risk grade. Between patients, 45% had lactose intolerance and 9% SIBO. Diarrhea grade 2-3 was observed in 66.6% of patients with SIBO and 66.7% of that with lactose intolerance. No statistical difference was observed between patients with SIBO or lactose intolerance and grade of diarrhea. CONCLUSION: Diarrhea was a frequent symptom in chemotherapy patients with gastric or colorectal cancer independent of the presence of SIBO or lactose intolerance. Surgery and chemotherapy treatment impacted in the intestinal habit of patients. Diagnosis of other causes of diarrhea may contribute to a better tolerance to treatment and quality of life.

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