Universidade Estácio de Sá

Objectives To assess and synthesize the effect size and quality of the literature on the placebo and nocebo effects on motor performance and motor‐related perceptive responses. Design Umbrella review. Data sources Medline, Embase, Lilacs, Cochrane Database of Systematic Reviews for peer‐reviewed literature, PROSPERO for protocols, and the Open Access Theses and Dissertations for gray literature. Eligibility criteria for selecting studies Population—human participants with varied health conditions; intervention: placebo; control: no treatment or active intervention; outcome: motor performance (primary) and perceptual variables (secondary); study design—ystematic reviews with or without meta‐analysis. Results In total, 3432 records were gathered from searches, resulting in 13 eligible reviews after screening. These reviews encompassed 247 original studies, with 221 focusing on the placebo effect and 26 on the nocebo effect. Among all eligible systematic reviews, five conducted meta‐analysis with 5036 participants, and one provided a summary of effect sizes reported by the original studies with 1215 participants. The reviews reported small to large effects of placebo (SMD = 0.09–0.93) and nocebo (SMD = 0.37–1.20), and only two conducted the GRADE assessment. Conclusion We found varied placebo and nocebo effects on motor performance, likely due to the poor quality of the methodology used by most reviews, highlighting the need for well‐conducted systematic reviews on the placebo and nocebo phenomena.

Background Chronic subdural hematomas (cSDHs) are potentially life-threatening neurological conditions with an increasing incidence worldwide. However, comparative data on the different cSDH managements remain limited. Herein, we aimed to conduct a network meta-analysis comparing standalone embolization (EMB), surgery, EMB plus surgery (EMBSurgery), and observation, to provide further clarity. Method We systematically searched PubMed, Embase, Web of Science, and Cochrane Library for studies comparing at least two cSDH approaches between EMB, surgery, EMBSurgery, and observation. Primary endpoints included the need for reintervention, length of hospital stay, procedure-related complications, and mortality. Random-effects model was used to calculate mean difference (MD) and odds ratio (OR) under a 95% confidence interval (CI). Cost-effective analysis and subanalyses for the randomized studies were conducted. Results A total of 19 studies involving 23,996 patients were included. A significant reduction in reintervention was observed with EMBSurgery (OR 0.21, CI 0.04–0.79), while EMB showed a non-significant reduction (OR 0.41, CI 0.12–1.32), compared to surgery. EMBSurgery neither significantly increased hospital stay (MD 4.80, CI −0.435–11.4) nor yielded higher complications (OR 1.11, CI 0.49–2.36) compared to surgery. Indeed, lower mortality was observed in both groups (EMB: OR 0.61, CI 0.03–5.08; EMBSurgery: OR 0.41, CI 0.03–3.05) and procedural costs were not significantly higher for EMB and EMBSurgery compared to surgery (EMB: MD 32,000, CI –13,500–70,300; EMBSurgery: MD 16,200, CI –40,100–72,600). Subanalyses revealed significantly lower reintervention rates in the EMBSurgery group versus the surgery group (OR 0.34, CI 0.16–0.74; I2 0%). Conclusion EMB combined with surgery seems to reduce reinterventions in cSDH compared to surgery alone with non significant complications that need further analysis through randomized trials with longer follow-ups.

This work aimed to evaluate the potential of two cultivars of elephant grass (Pennisetum purpureum Schum), canara and capiaçu, as feedstocks for energy purposes through levoglucosan production by fast pyrolysis. Levoglucosan is an anhydrous pyrolytic sugar that has great potential as a fermentation substrate for the obtaining of biofuels. Then, pyrolysis experiments were carried out seeking to intensify the levoglucosan production through the evaluation of the thermochemical conversion at 400, 500, and 600 °C, with biomass acid pretreatment (5, 10, and 15% v/v acetic acid) for canara and capiaçu biomasses, and 50% canara/capiaçu mixtures for co-pyrolysis. Structural as well as physicochemical composition changes after biomass acid treatment were observed prior pyrolysis. Statistical analysis revealed that pyrolysis temperature and biomass type significantly affected levoglucosan production at p < 0.1. Then, optimization by using the Design-Expert software pointed out that canara cultivar had the greatest potential since produced around fivefold more levoglucosan than untreated biomass and almost twofold more than capiaçu at 500 °C. However, co-pyrolysis seems to be a good alternative when biomass mixtures from different cultivars/varieties are available. Thus, the results from this study can be interesting to support lignocellulosic feedstock diversification to attaining pyrolytic compounds with special focus in anhydrosugars for renewable fuel production, adding value to the elephant grass productive chain. Graphical Abstract

Purpose: The Pressure Cooker Technique (PCT) is an endovascular technique for brain arteriovenous malformations (bAVMs) that can minimize reflux and inadvertent embolization compared with conventional techniques, leading to a safer and more controlled embolization. This systematic review and meta-analysis aimed to assess the feasibility, safety, and efficacy of PCT for bAVMs. Methods: We searched PubMed, Embase, and Web of Science databases. Eligible studies included ≥ 4 patients employing PCT for bAVMs and reporting on clinical and angiographic outcomes. We used single-proportion analysis with 95% confidence intervals under a random-effects model to pool the data. Transvenous (TVE) and transarterial (TAE) approaches were analyzed separately. Results: Eight observational studies involving 168 patients, 106 treated by TVE and 62 by TAE, were included. The immediate complete obliteration rate was 97% (94%-100%) with TVE and 70% (38%-100%) with TAE. Procedure failure rate was 3% (0%-6%) and 0% (0%-3%) for TVE and TAE, respectively. Intracranial hemorrhagic complications were the most prevalent, with a 13% rate (3%-23%) in TVE. A good clinical outcome rate (Modified Rankin Scale ≤ 2) was 93% (82%-100%) in the TVE. Recurrence was 0% (0%-10%) in the TVE. The surgical retreatment rate was 11% (3%-19%) and 49% (36%-62%) in TVE and TAE, respectively. Conclusion: This systematic review and meta-analysis found that PCT is highly feasible, safe, and effective in treating bAVMs. Given the current evidence, PCT may be considered a valuable option for the treatment of high-grade bAVMs.

Continuous Positive Airway Pressure (CPAP) is the gold standard treatment for Obstructive Sleep Apnea (OSA). Its long-term effects on Resistant Hypertension (RHT) have not yet been fully established. We conducted a prospective intervention study to evaluate the impact of long-term CPAP therapy on office and ambulatory blood pressure (BP) in patients with RHT and moderate to severe OSA. Patients who used CPAP for a minimum of 12 months were included in the CPAP group and compared with those who declined to use CPAP despite clinical indications (control group). All participants underwent 24-h ambulatory blood pressure monitoring (ABPM) at baseline and at the end of the study. Intergroup comparisons of BP changes were performed using a general linear model, including two per-protocol analyses for patients with optimal CPAP adherence (at least 4 h/night) and those with refractory hypertension. A total of 124 individuals were included (65 in the CPAP group and 59 controls), with a mean age of 60.7 ± 7.8 years. The intention-to-treat analysis found no significant differences in overall BP changes between groups. The per-protocol analyses (50 CPAP users with optimal adherence and 28 with refractory hypertension) showed significant reductions in nighttime systolic BP (−8.1 mmHg (95% CI −14.7 to −1.5) and −25.6 mmHg (95% CI −40.1 – −10.5), respectively) and in nighttime diastolic BP (−5.3 mmHg (95% CI −9.6 to −1.1) and −13.9 mmHg (95% CI −22.5 – −5.3), respectively). These findings suggest that while CPAP benefits adherent patients and refractory hypertensives, its overall long-term effects on resistant hypertension require further investigation.

Trema micranthum (L.) Blume is a species from the Cannabaceae botanical family, present all over the tropics. A recent study conducted by our group identified the presence of cannabidiol (CBD), Δ⁹‐tetrahydrocannabinol, cannabidiolic acid, and tetrahydrocannabinolic acid‐A in T. micranthum extracts. Their presence in the plant's fruit, inflorescence, and leaf extracts was detected and quantified. T. micranthum has been identified as a potential new source of cannabinoids such as CBD. The present work focuses on a new Cannabinoid Profiling System (CPS) to present a wide view of cannabinoid chemical composition with several compassionate and modern mass spectrometry (MS) tools. Extracts from fruits, leaves, and inflorescences were obtained using a methanol/hexane (9:1, v/v) solvent mixture. Ultra high‐performance liquid chromatography coupled with high‐resolution tandem MS using targeted and untargeted approaches were used in these approaches. CPS allowed the identification of the 26 cannabinoids in T. micranthum described for the first time in this plant.

Objective This case series aimed to describe the clinical and radiographic performance of a new two‐piece ceramic implant system in single‐tooth posterior sites, with at least 12‐month follow‐up. Materials and Methods Twenty‐two two‐piece zirconia implants placed in posterior sites of the upper and lower jaws of eighteen patients were included (6 males and 12 females; mean age 55.11 ± 14.14). Cone beam computed tomography (CBCT) was used in all cases for surgical planning, and periapical radiographs were used in the immediate postoperative period and implant follow‐up consultations. Implants were installed in healed sites or fresh sockets, with or without immediate provisionalisation. When necessary, a bone substitute was used to fill gaps in immediate implant sockets. Three months after surgery, the temporary prostheses were removed and seven lithium disilicate crowns were created by impression with addition silicone. All patients were surveyed on their satisfaction with the aesthetic results of the treatment using a Visual Analogue Scale (VAS). Results The patients were followed‐up for at least 12 months (mean 15.2 months [±0.429]), during which time clinical and radiographic success was observed in terms of osseointegration, stability at the marginal bone level (mean marginal bone loss 0.09 mm [±0.146]) and peri‐implant health in all cases. On the VAS, 17 patients reported being ‘very satisfied’ and one was ‘satisfied’. No mechanical or biological complications were observed during this period. Conclusion The two‐piece zirconia implant system used in this report is a safe and reliable potential alternative in oral rehabilitation involving posterior teeth, with success observed over 12 months of follow‐up.

BACKGROUND Bone regeneration is a central focus of regenerative medicine, with applications in orthopedics and dentistry, particularly for treating bone defects caused by trauma, infection, or congenital anomalies. Synthetic biomaterials, often combined with fibrin derivatives, offer promising solutions for bone healing and restoration. AIM To Explore the increasingly important role of the association of synthetic biomaterials with fibrin in bone regeneration. METHODS Search terms included: “synthetic biomaterials AND fibrin sealant”, “hydroxyapatite AND fibrin sealant”, “tricalcium phosphate AND fibrin sealant”, and “synthetic biomaterials AND platelet-rich fibrin (PRF)”, resulting in 67 articles. After rigorous screening, 21 articles met the inclusion criteria. RESULTS The reviewed studies assessed biomaterials like hydroxyapatite (HA), β-tricalcium phosphate (β-TCP), and fibrin-based products. Key findings highlighted the enhanced osteoconductivity and biocompatibility of HA and β-TCP, especially when combined with fibrin sealants. These composites show significant potential for improving cellular adhesion, promoting osteogenic differentiation, and accelerating bone regeneration. The antimicrobial properties and structural support for cell growth of certain biomaterials indicate a promising potential for clinical applications. CONCLUSION This systematic review emphasizes the growing role of fibrin-based biomaterials in bone regeneration and urges continued research to improve their clinical use for complex bone defects.

The present study investigated for the first time the influence of exposure time (24 or 48 h) of Biomphalaria glabrata (Gastropoda: Pulmonata) to Heterorhabditis bacteriophora (Rhabditida: Heterorhabditidae), strain HP88, on some physiological and reproductive parameters of the host mollusk. Throughout the experiment, intense glycogenolysis was observed in both exposed groups, which was more accentuated in the digestive gland. This change was accompanied by a significant increase in the free glucose content in the exposed snails, indicating that H. bacteriophora infection induces the breakdown of host glycemic homeostasis. In parallel, significant variations in lactate dehydrogenase activity in the hemolymph of B. glabrata exposed to entomopathogenic nematodes were observed, confirming the transition from aerobic to anaerobic metabolism in the hosts. This physiological scenario contributed to the establishment of the parasitic castration process in this interface, compromising the reproductive performance of host snails, suggesting the use of H. bacteriophora HP88 as a potential alternative for control of B. glabrata.

Objectives: To analyze the short-term (12-wk post-intervention) and long-term (6-month follow-up) effects of two exercise interventions (functional training or Mat Pilates) compared to a control group and a healthy reference group on non-motor symptoms in people with Parkinson's disease. Method: 35 individuals with Parkinson's disease were randomized into three groups: functional training, Mat Pilates, and control group, along with 11 age- and sex-matched healthy individuals for the healthy reference group. The exercise groups received twice-weekly 60-min sessions for 12 wk. The control group and healthy reference group maintained routine activities and also received educational lectures during the 12-wk period. Outcome measures included cognition (MoCA), depressive symptoms (BDI), anxiety (BAI), mood (BRUMS), and aging perspective (Sheppard Inventory). Results: Short-term effects were observed for the functional training group in the short term for depressive symptoms (p = 0.010) and cognition (p = 0.040), and in the short and long term for anxiety (p = 0.007) and happiness (aging perspective) (p = 0.002). For the Mat Pilates group, effects were observed in cognition (p = 0.048) and confusion (p = 0.049) in the short term, and in depressive symptoms (p < 0.001), anxiety (p = 0.033), happiness (p < 0.001), and loneliness (aging perspective) (p = 0.017) in the short and long term. The control group showed worsening in depressive symptoms (p = 0.030) and confusion (p = 0.033). Conclusion: Mat Pilates and functional training classes were effective in improving cognition, depressive symptoms, anxiety, and happiness. The control group and healthy reference group did not show significant effects in most studied variables. Both types of exercise can be recommended by professionals working with people with Parkinson's disease. Registration: ReBEC - RBR-6ckggn.

Oral manifestations of HIV infection can be an early sign of the disease and may indicate progression to AIDS. Although antiretroviral therapies, especially highly active antiretroviral therapy (HAART), have reduced the prevalence of HIV-related oral lesions, ongoing updates in diagnosis and treatment are essential due to the extended life expectancy of individuals living with HIV. Periodontal disease is a significant concern in these patients, influenced by altered immune responses and microbial dynamics, though the mechanisms are not fully understood. This exploratory study aimed to investigate the oral microbiota and periodontal disease prevalence in HIV-positive individuals by analyzing subgingival plaque samples from 24 patients. We identified 12 bacterial species using Polymerase Chain Reaction (PCR) and amplicon sequencing. Seven species were detected, with Filifactor alocis, Tannerella forsythia, and Porphyromonas endodontalis being the most common. Porphyromonas gingivalis was present in only 13.6% of samples, while T. forsythia was found in 58.3%. Genetic diversity was also observed in P. endodontalis and Selenomonas sputigena amplicons, with specific single nucleotide polymorphisms (SNPs) identified in both species. These results highlight the complex microbial interactions in the oral environments of people living with HIV, emphasizing the need for personalized diagnostic and therapeutic strategies for managing oral health in this population.

Background Staphylococcus aureus clonal complex 30 (CC30) is a historically significant pathogen affecting both hospital and community settings. The notable pandemic clones, phage-type 80/81 (PT80/81) and the Southwest Pacific clone (SWP) have spread internationally, contributing to significant morbidity and mortality. Despite their importance, research on the evolution of sequence type (ST) 30 has been limited, often focusing on a small number of strains or specific regions. Methods In this study, we analyzed over 500 ST30 genomes from diverse sources, including Brazilian strains sequenced by our team, using genomic, pangenomic, phylogenetic, and time-calibrated phylogenetic analyses. Results We traced key evolutionary events, estimating that the specialization of PT80/81 and SWP occurred after a divergence around 1868, forming a group of PT80/81-related strains and another group formed by SWP-related strains. Our findings highlight major events involving gene acquisition and loss, as well as mobile genetic elements (MGE). Notably, PT80/81 lost most lpl genes during diversification, which may have restricted the circulation of related strains. Contemporary strains—defined as those that emerged in the 21st century—predominantly cluster within a group divided into three subgroups, including Brazilian strains that acquired a novel pathogenicity island. Also clustering within the contemporary group, most toxic shock syndrome toxin-1 (TSST-1)-producing strains are methicillin-susceptible S. aureus (MSSA) that have gained additional virulence traits, including sea, which enhance their adaptability and virulence. Conclusion Our study revises the evolutionary history of ST30 S. aureus uncovering critical pathoadaptive events that may explain its success. Additionally, our findings emphasize a neglected issue: the high prevalence of MSSA in hospital infections, particularly the silent circulation of TSST-1 producing strains, capable of causing severe infections. Robust surveillance studies to monitor these strains are crucial.

Objective Considering the little evidence about the action of the dentist in the management of patients diagnosed with malaria, this study aimed to analyze the main orofacial changes that affect these patients. Materials and Methods This is a cross‐sectional study where 38 patients diagnosed with malaria are included. An extraoral physical examination was carried out using the diagnostic criteria for temporomandibular disorders instrument. Signs of changes in the oral cavity were detected through intraoral physical examination. Results The xerostomia was measured according to the xerostomia inventory scale score (XISS). In this study participated 33 men (87%) and 5 women (13%), with a notable diagnosis of Plasmodium vivax ( n = 26). When assessed, the incidence of orofacial changes in the sample studied stands out as myalgia in the chewing muscles (92.1%) and arthralgia in the temporomandibular joint (65.7%). In this study, the results show that there is an association between types of malaria and dysgeusia ( p = 0.01). Conclusion Given the data obtained, it appears that the patients most affected by the infection are men, and the most commonly found changes are color changes in the oral mucosa, petechiae, xerostomia, arthralgia, myalgia in the chewing muscles, and dysgeusia, even without prior use of antimalarial medication.

Objective: To analyze the trend of hospitalizations for primary care-sensitive conditions in children in the state of Roraima, Brazil. Methods: Ecological time series study with secondary data collected from the Hospital Information System, on hospitalizations for primary care-sensitive conditions in children between 2010 and 2023. Results: The highest hospitalization rates were in 2021 (265.9/10,000 inhabitants/year) and the under 1 age group had the highest rates. There was a reduction in ambulatory care-sensitive conditions in group 1, in the first and second segments (MPC=-1.50; 95%CI -3.79-0.32 p=0.016 and MPC=-1.91; 95%CI -3.44--0.81 and p=0.007), group 2, with a constant drop throughout the series of 0.57% per month (95%CI -0.70--0.43 and p<0.001) and in group 16 (MPC=-0.38; 95%CI -0.55--0.21 and p<0.001). Bacterial pneumonia was the main cause of hospitalization in all age groups. Group 4 showed a uniform increase in rates of 1.56% per month (95%CI 0.27-2.80 and p=0.018). There was a drop in rates in the first segment at all ages: <1 year: -2.90% and p=0.019; 1 to 4 years: -1.75% (p=0.011) and 5 to 9 years: -0.79% (p=0.053), followed by an increase and then a drop again. In the last segment, all the age groups showed an increase in rates. Conclusions: The scenario in Roraima is worrisome and requires urgent interventions, as there is evidence of weaknesses in primary health care, probably aggravated by the migratory crisis. The strategies sought are still insufficient. Keywords: Primary health care; Child health; Hospitalization; Epidemiology

Objective: To analyze the trend of hospitalizations for primary care-sensitive conditions in children in the state of Roraima, Brazil. Methods: Ecological time series study with secondary data collected from the Hospital Information System, on hospitalizations for primary care-sensitive conditions in children between 2010 and 2023. Results: The highest hospitalization rates were in 2021 (265.9/10,000 inhabitants/year) and the under 1 age group had the highest rates. There was a reduction in ambulatory care-sensitive conditions in group 1, in the first and second segments (MPC=-1.50; 95%CI -3.79-0.32 p=0.016 and MPC=-1.91; 95%CI -3.44--0.81 and p=0.007), group 2, with a constant drop throughout the series of 0.57% per month (95%CI -0.70--0.43 and p<0.001) and in group 16 (MPC=-0.38; 95%CI -0.55--0.21 and p<0.001). Bacterial pneumonia was the main cause of hospitalization in all age groups. Group 4 showed a uniform increase in rates of 1.56% per month (95%CI 0.27-2.80 and p=0.018). There was a drop in rates in the first segment at all ages: <1 year: -2.90% and p=0.019; 1 to 4 years: -1.75% (p=0.011) and 5 to 9 years: -0.79% (p=0.053), followed by an increase and then a drop again. In the last segment, all the age groups showed an increase in rates. Conclusions: The scenario in Roraima is worrisome and requires urgent interventions, as there is evidence of weaknesses in primary health care, probably aggravated by the migratory crisis. The strategies sought are still insufficient. Keywords: Primary health care; Child health; Hospitalization; Epidemiology

This study investigated the potential of Kevlar aramid fiber reinforcement to enhance the mechanical properties and mitigate pathologies in concrete structures. The objectives were to analyze improvements in flexural and compressive strengths and to evaluate the effectiveness of Kevlar in reducing pathological manifestations under the specific conditions and methodologies of this experiment. Experimental testing was conducted on prismatic and cylindrical concrete specimens, prepared following standard mix ratios and testing protocols. Kevlar fiber was applied to the specimens using an epoxy resin, ensuring adhesion and uniform reinforcement. The results, obtained under these controlled conditions, showed a 6.90% increase in flexural tensile strength, from 0.29 MPa to 0.31 MPa, and a 14% enhancement in compressive strength, from 14 MPa to 16 MPa. Pathological manifestations, such as crack propagation, were significantly mitigated in the reinforced specimens, demonstrating improved structural preservation and reduced degradation under tensile and compressive stresses. These findings, specific to the experimental parameters and standards employed, confirm the dual benefits of Kevlar reinforcement. The study highlights its effectiveness in improving durability, reducing maintenance demands, and extending the service life of concrete structures, reinforcing its potential as a viable solution for advanced civil construction applications.