Universidade Nove de Julho

Resumo Introdução: Quelantes de fosfato (P) estão entre os medicamentos mais comumente prescritos para controlar níveis de P em pacientes com DRC em diálise. Ainda há escassez de dados sobre adesão aos quelantes de P, sem comparações entre modalidades dialíticas. Métodos: Acessamos fatores associados à adesão ao quelante de P entre pacientes em diálise em um hospital universitário. A adesão foi calculada como a razão entre número de comprimidos tomados por dia, conforme relatado, e número de comprimidos prescritos. Pacientes foram considerados não aderentes se a adesão fosse ao menos 20% menor ou 30% maior do que o prescrito. Resultados: Os pacientes (N = 137) eram jovens, predominantemente mulheres, em diálise por um período mediano de 53 meses. Sevelamer e carbonato de cálcio foram prescritos como quelantes de P para 70,8% e 10,2% dos pacientes, respectivamente, sem diferença entre modalidades dialíticas (p = 0,839). P correlacionou-se com número de comprimidos prescritos (r = 0,368; p = 0,001) e número de comprimidos tomados por dia (r = 0,275; p = 0,001). Encontramos hiperfosfatemia em 52 pacientes (36,4%). A adesão ao carbonato de Ca e sevelamer foi de 100% e 68,4%, respectivamente. Pacientes não aderentes eram mulheres, mais jovens, com albumina e ureia séricas mais elevadas e menor cálcio sérico. A regressão logística mostrou que sexo feminino (HR 3,30; IC 95%: 1,39–7,84; p = 0,007) e hemodiálise vs. diálise peritoneal (HR 4,55; IC 95%: 1,26–16,39; p = 0,021) permaneceram independentemente associados ao comportamento de não adesão. Conclusão: O presente estudo sugere que estratégias para aumentar a adesão devem ser implementadas. A relação entre adesão ao quelante de fosfato e melhores desfechos merece investigação mais aprofundada.

Introduction: Phosphate (P) binders are among the most common medications prescribed to control P levels in patients with chronic kidney disease on dialysis. There is still a paucity of data on adherence to P binders with no comparison between dialysis modalities. Methods: We accessed factors associated with P binder adherence among patients on dialysis in an academic hospital. Adherence was calculated as the ratio between the number of pills taken per day as reported and the prescribed number of pills. Patients were considered non-adherent if adherence was at least 20% less or 30% more than prescribed. Results: Patients (N = 137) were young, mostly women, and on dialysis for a median time of 53 months. Sevelamer and calcium carbonate were prescribed as P binders to 70.8% and 10.2% of patients, respectively, with no difference across dialysis modalities (p = 0.839). P correlated with the number of pills prescribed (r = 0.368, p = 0.001) and the number of pills taken per day (r = 0.275, p = 0.001). Hyperphosphatemia was found in 52 patients (36.4%). Adherence to Ca carbonate and sevelamer was 100% and 68.4%, respectively. Non-adherent patients were women, younger, with higher serum albumin and urea, and lower serum calcium. Logistic regression showed that female sex (HR 3.30, 95% CI: 1.39–7.84, p = 0.007) and hemodialysis vs. peritoneal dialysis (HR 4.55, 95%, CI: 1.26–16.39, p = 0.021) remained independently associated with a non-adherence behavior. Conclusions: The current study suggests that strategies to increase adherence should be implemented. Whether phosphate binder adherence is associated with better outcomes deserves further investigation.

PURPOSE Advancements in Machine Learning (ML) techniques have revolutionized diagnosing and monitoring epileptic seizures using Electroencephalogram (EEG) signals. This analysis aims to determine the effectiveness of ML techniques in recognizing patterns of epileptic seizures in the brain using EEG signals. METHODS We searched PubMed, Scopus, and Google Scholar for relevant RCTs, cohort studies, and case-control studies involving patients with prior epileptic seizures who underwent EEG analysis aided by ML techniques. Using the STATA software, we evaluated the accuracy of predicting epileptic seizures, measured using metrics such as Area under the curve (AUC), Sensitivity, and Specificity. RESULTS The random effects bivariate model of 4 studies with 214 patients revealed high diagnostic performance for ML techniques in detecting epileptic signals in EEGs. The estimated sensitivity was 0.97 (95% CI: 0.92-0.99), indicating its ability to accurately detect the condition in 97% of cases. Similarly, the estimated specificity was 0.99 (95% CI: 0.98-0.99), demonstrating its ability to correctly identify the absence of the condition in 99% of cases. There was also a high AUC (1.00, 95% CI: 0.99-1.00), indicating ML techniques can distinguish epileptic seizures from no seizures in EEG signals 100% of the time. These findings underscore the test's robust diagnostic utility in sensitivity and specificity. There was a significant between-study variability (heterogeneity) with a chi-square p-value <0.001 and an I2 value of 95%. A bivariate box plot further confirmed the heterogeneity. Deek's test for publication bias showed a non-significant p-value (p = 0.06) indicating the absence of publication bias. CONCLUSION ML techniques can potentially enhance diagnostic accuracy in epilepsy detection, offering valuable insights into developing advanced diagnostic tools for clinical practice.

The multifocality of actinic keratosis (AK), the unpredictability of lesion evolution with potential progression to squamous cell carcinoma (SCC), and the consequent risk of local extension and metastasis, alongside the recent development of new therapies, make the selection of a therapeutic regimen challenging. The increasing incidence of this condition is associated with economic costs and its impact on quality of life, which has fostered interest in studying protocols for treating this skin condition. The topical application of 16% methyl aminolevulinate (MAL) is well-established in the literature for its local therapeutic effects and ease of application. However, the high cost of medication, long incubation time, and adverse effects such as itching and burning in some patients limit the dissemination of this treatment. Studies are needed to test other protocols of this promising therapy to increase acceptance among patients and professionals. Therefore, the objective of this protocol is to compare the efficacy of the topical application of MAL at concentrations of 8% and 16%, mediated by red light, as well as to evaluate the impact of different incubation times (1 or 3 hours) in the treatment of actinic keratoses on the face, with a 6-month follow-up. This parallel-arm, 6-month follow-up randomized controlled, double-blind clinical protocol will consist of 4 groups: G1 - Control Group - MAL 16% irradiated with 643 nm and 75 J/cm² and 3-hour incubation time (n = 36), G2 - MAL 16% and 1-hour incubation (n = 36), G3 - MAL 8% - 3 hours (n = 36), and G4 - MAL 8% - 1 hour (n = 36). The primary outcome will be the complete remission of the lesion at six months. Secondary outcomes will include treatment success (75% reduction in the initial number of lesions), recurrence rate, emergence of SCC, incidence of adverse effects, and improvement in skin texture, wrinkles, and pigmentation using a validated scale. All outcomes will be assessed at 30 days, 3, and 6 months. At six months, quality of life will be assessed using the Actinic Keratosis Quality of Life questionnaire (AKQoL) and Face-Q. If data are normal, they will be subjected to 3-way ANOVA and presented as means ± standard deviation (SD). Otherwise, they will be presented as median and interquartile range and compared using the Kruskall-Wallis and Friedman tests. Categorical variables will be evaluated with the chi-square, Fisher’s exact, or likelihood ratio tests. A p-value < 0.05 will be considered significant.

Resumo Fundamento Vários Aplicativos (apps) foram desenvolvidos para auxiliar no manejo da hipertensão, mas pouco se sabe sobre a qualidade desses apps no cenário brasileiro, Objetivos Identificar e analisar a qualidade dos apps que visam o controle da pressão arterial (PA) disponíveis em português. Métodos Uma busca sistemática foi realizada nas lojas virtuais de apps do Brasil nos sistemas operacionais Android e iOS de novembro de 2021 a março de 2022, com uma atualização em março de 2024. A busca baseou-se nos padrões de revisão sistemática (PRISMA), utilizando palavras-chaves pré-definidas, incluindo apps em português, gratuitos e disponíveis para uso durante a busca. Três revisores independentes analisaram os apps usando a escala de cinco pontos MARS (Mobile App Rating Scale), e também quanto à presença de ferramentas e conteúdos sobre controle da hipertensão. Resultados Cinquenta e seis apps preencheram os critérios para extração dos dados. A ferramenta mais prevalente foi o registro dos valores da PA (98%). A ferramenta para adesão aos medicamentos e lembretes para seu uso esteve presente em somente 29% e 34% dos apps, respectivamente. A média do escore MARS foi 3,4 ± 0,74 e 3,1 ± 0,61 para os apps do sistema Android e do sistema iOS, respectivamente. O item mais bem avaliado foi “funcionalidade” tanto para os apps Android como iOS. Conclusão O presente estudo identificou vários apps de qualidade aceitável direcionados ao monitoramento da PA. Contudo, a maioria deles não incluíam fatores importantes relacionados ao controle da doença particularmente em relação à adesão ao tratamento, atividade física e presença de comorbidades.

Introduction Children who suffer from severe caries in childhood may have negative impacts on the growth, development, nutritional problems and quality-of-life problems related to the oral health of the child and their family. There are no studies that have compared rehabilitative techniques of primary anterior teeth regarding patient-centred outcomes and even longevity of the restoration. Thus, this project aims to evaluate the effectiveness of restorative treatment of anterior primary teeth with monochromatic composite resin in single insertion through polyvinyl crowns, after selective removal of carious tissue compared with the effectiveness of conventional restoration. Methods and analysis This study proposes to conduct a randomised clinical trial, composed of a sample of 194 deciduous central and lateral incisors with active cavitated lesions, simplified International Caries Detection and Assessment System (ICDAS) C+ score (active and extensive stage caries: ICDAS 5 and 6), with involvement of more than two surfaces. This sample will be divided into two experimental groups, both with selective removal of carious tissue: a group in which conventional restoration will be performed using opaque resins, and another group with monochrome resin with chameleon effect and polyvinyl crowns. The explanatory variables—gender, age, toothbrushing, use of fluoridated toothpaste and dental floss, and socioeconomic status—will be collected through a questionnaire with open questions. The progression of caries lesions after 24 months of follow-up will be considered as the primary outcome. Secondary outcomes will include tooth survival, longevity of restoration, quality of life, perception and satisfaction of the participants’ parents/guardians. Ethics and dissemination This protocol has been approved by the Human Research Ethics Committee of Universidade Metropolitana de Santos (protocol number: 6.019.297. Approved 24 April 2023). Results will be submitted to international peer-reviewed journals and presented at international conferences. Trial registration number NCT05875064 .

Background The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) is a biaxial tool for TMD assessment. To implement a translated version in the Brazilian context, standardised adaptation and validation are necessary. Objective (s) To translate, adapt and verify the measurement properties of the DC/TMD Axis II instruments Pain Drawing (PD), Graded Chronic Pain Scale (GCPS), Jaw Functional Limitation Scale (JFLS) and Oral Behaviours Checklist (OBC). Methods The translation and cross‐cultural adaptation processes of orofacial‐related Axis II instruments followed the Guidelines for Establishing Cultural Equivalency. The validation research was carried out with 117 Brazilians with TMD, in two assessment days. Structural validity, internal consistency, test–retest reliability, measurement error, construct validity—hypothesis testing, and ceiling and floor effects were tested. Results PD showed substantial reliability (Kappa 0.63), and GCPS, JFLS and OBC showed excellent reliability over time (intraclass correlation coefficient > 0.85). The internal consistency was adequate for all instruments (Cronbach's alpha > 0.77) except for the functional activities domain of OBC (Cronbach's alpha = 0.48). Construct validity was good for all instruments (75% hypotheses confirmed), except for the OBC total score. Regarding parameters of structural validity, GCPS showed Goodness of Fit Index = 0.98 for the solution with two domains. JFLS and OBC presented Goodness of Fit Index < 0.90 for the solutions with three and two domains, respectively. Conclusion The Brazilian Portuguese version of DC/TMD Axis II can be used in Brazil, but more studies are necessary to find an adequate structure for JFLS and OBC in a Brazilian sample.

Introduction Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. Whether acute arm movement impacts arteriovenous fistula (AVF) blood flow is unknown. Methods In this cross-sectional analysis, we evaluated AVF blood flow using an ultrasound device at resting and after three muscle movements for proximal (elbow flexion, shoulder adduction and abduction) or distal AVF (fist extension and flexion, fingers squeeze), without and with a 2 kg load. Results We included 23 patients (14 men), 53 ± 13 years, 26.1% with diabetes, on dialysis for a median time of 5.2 months. At rest, blood flow in proximal and distal AVF were 4355 (2470, 7233) mL/min and 2286 (2063, 2442) mL/min, respectively. There was no significant difference between blood flow at resting and any movement before and after load in either proximal or distal AVF ( p > 0.05 for all comparisons). Conclusion Acute arm movement with or without load does not significantly alter the blood flow of mature AVF. These results demystify the general belief that patients should avoid AVF arm movement.

Objective To assess the test–retest reliability, internal consistency, and construct validity of the 9-item Tampa Scale for Kinesiophobia in patients with chronic low back pain. Design Questionnaire validation study. Setting Study was conducted in an online environment. Participants We included people aged 18 to 50 years with self-reported low back pain lasting > three months and assessed the Pain-Related Catastrophizing Thoughts Scale and the 9-item Tampa Scale for Kinesiophobia. Main measures We used intraclass correlation coefficient, standard error of measurement, minimum detectable change, and Cronbach's alpha to assess the reliability and internal consistency of the 9-item Tampa Scale for Kinesiophobia. We tested correlations between the domains of the 9-item Tampa Scale for Kinesiophobia and the other variables to assess construct validity. Results A total of 174 participants with chronic low back pain were included in the analysis. No ceiling or floor effect was found. In terms of construct validity, there was a positive correlation between the domains of the 9-item Tampa Scale for Kinesiophobia and the other variables. In the reliability analysis, there was adequate test–retest reliability of the two domains of the 9-item Tampa Scale for Kinesiophobia: intraclass correlation coefficient = 0.99, standard error of measurement = 3.4%, and minimum detectable change = 9.6% for the activity avoidance domain; and intraclass correlation coefficient = 0.99, standard error of measurement = 3.5%, and minimum detectable change = 9.9% for the somatic focus domain. There was acceptable internal consistency (Cronbach's alpha ≥ 0.68) for both domains. Conclusion The 9-item Tampa Scale for Kinesiophobia has adequate measurement properties in patients with chronic low back pain.

This study aims to assess the effects of aquatic training (AT) and its combination with photobiomodulation (PBM) on cytokine synthesis and plantar muscle morphology during compensatory hypertrophy (H) in Wistar rats. H was induced by bilateral ablation of synergistic muscles, and PBM using a laser (780 nm). AT involved 60 min sessions, 5 times/week, for 7 and 14 days. Muscle weight relative to body weight did not differ significantly between groups. TNF-α synthesis levels decreased in the H + AT + PBM group at 7 days compared to H Control. IL-6 and IL-1β levels showed no significant changes. Cross-sectional area (CSA) was higher in H + AT + PBM at 7 days and 14 days compared to H + AT and H Control. Fiber diameter increased in H + AT and H + AT + PBM compared to H at 14 days. AT with PBM decreased TNF-α expression, increased CSA and fiber diameter, whereas AT alone increased fiber diameter. In conclusion, the combination of photobiomodulation (PBM) therapy and aquatic training (AT) effectively reduced TNF-α levels while increasing muscle fiber diameter and cross-sectional area (CSA). Furthermore, AT alone demonstrated the capacity to maintain fiber diameter. Graphical abstract

Digital technology adoption in sustainable production practices is increasingly recognised as pivotal for advancing sustainability objectives. However, existing literature predominantly focuses on the technological aspects, leaving the nuanced experiences and insights of academic scholars underexplored. This study addresses this gap by surveying 314 scholars from diverse regions to evaluate the influence of various digital technologies on economic, operational, and environmental performance in sustainable production. Utilising multilevel ordinal logistic regression (M-OLR), the research identifies six critical digital technologies that significantly enhance sustainable production outcomes. The application of M-OLR effectively accounts for spatial heterogeneity, providing a more robust analysis compared to standard ordinal logistic regression (OLR) models. The findings underscore the essential role of digitalisation in facilitating sustainable transitions, offering novel insights into how digital technologies can drive improvements across economic, operational, and environmental dimensions. The implications extend to policy formulation and strategic planning of digital technologies to achieve comprehensive sustainability goals.

Background/Objectives: Infection poses a significant threat of mortality in patients with chronic kidney disease (CKD) undergoing hemodialysis. Staphylococcus aureus (S. aureus) is a common etiological agent, with prior nasal colonization identified as a risk factor for infection. The aim of the present cross-sectional study was to determine the prevalence of nasal S. aureus carriage among patients with CKD undergoing dialysis at a university hospital and identify potential factors associated with colonization. Methods: Nasal swabs were obtained, and bacterial isolates were identified using matrix-assisted laser desorption/ionization time-of-flight spectrometry and antibiogram testing with the Vitek 2 system. Demographic and clinical data were collected for the investigation of risk factors associated with colonization. Results: Among the 96 patients analyzed, 34 were carriers of S. aureus. Among these carriers, three (8.8%) harbored oxacillin-resistant strains. More than half of the S. aureus strains exhibited resistance to clindamycin but susceptibility to oxacillin. Colonization was associated with age and the use of corticosteroids/immunosuppressants. Conclusions: The prevalence of nasal S. aureus carriage was high among patients undergoing dialysis at the university hospital, exceeding that found in the general population. Nasal colonization by S. aureus was linked to corticosteroid use and age. Understanding factors associated with S. aureus nasal colonization in patients on dialysis can assist healthcare providers in preventing the spread of infection and cross-contamination, while reducing risk in this population.

Objectives To investigate if photobiomodulation (PBM) can reduce dentin hypersensitivity (DH) through a randomized, controlled, double-blind clinical trial. Materials and methods One hundred and twelve patients experiencing DH after non-surgical scaling and root planing (SRP) were enrolled and divided into the Experimental Group - SRP + PBM (660 nm, 1.061 J/cm²) and the Control Group - SRP + PBM simulation. The primary outcome was the assessment of DH through tactile and thermal stimulation using the visual analog scale (VAS) after seven days. Additionally, paracetamol was prescribed and quantified as needed. Also, the impact of oral health on participants’ quality of life using the Oral Health Impact Profile (OHIP-14) questionnaire was applied. Outcome assessments occurred seven days and one-month post-application. Results In both 7 and 30 days, pain values were significantly lower in the experimental group compared to the control group (P = 0.001 and < 0.001, respectively). No differences were observed between the groups regarding analgesic usage. The experimental group also showed a significant improvement in the impact of oral health on participants’ quality of life (P < 0.001), with lower OHIP-14 scores at all time points (P = 0.008). Conclusions These results suggest that photobiomodulation significantly reduces pain at 7- and 30-days following scaling and root planing. Additionally, it is associated with improvements in the oral health-related quality of life in patients with dentin hypersensitivity. Clinical trial registration NCT05946265.

Background Anterior skull base meningiomas can cause significant symptoms such as mass effect and neuropsychological decline, necessitating surgical resection. The endoscopic extended transnasal approach has emerged as a minimally invasive alternative to craniotomy, offering a means to address these tumors despite challenges due to the proximity of critical neurovascular structures and the high risk of complications such as cerebrospinal fluid (CSF) leaks. This systematic review and meta-analysis evaluate the safety and efficacy of extended transsphenoidal techniques in anterior skull base meningiomas. Methods This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook. A search was performed in Medline, Embase, Cochrane, and Ovid. Eligible studies included those (1) in English, (2) with patients having anterior skull base meningiomas, and (3) who underwent endoscopic surgical management. Endpoints included CSF leak, length of stay, complications, and mortality. Results The analysis included data from 23 studies involving 573 patients with a median age of 54.77 (range 39.5–67.3) years. Approximately 71% of participants were female. The mean length of stay was 7.50 days (95% confidence interval [CI]: 6.64–8.47). The overall complication rate was 35% (95% CI: 0.22–0.49), with minor complications also occurring in 6% of cases (95% CI: 0.02–0.10). Major complications were reported in 20% of cases (95% CI: 0.10–0.30). The CSF leak rate was 7% (95% CI: 0.04–0.10). Conclusion In the setting of complex anatomical challenges and inherent risks, the technique showed a moderate complication rate and length of hospital stay. This method demonstrated lower CSF leak and complication rates compared to previously published studies from the past decade.

This brief report aimed to investigate the optical absorbance spectra of normal, dysplastic, and malignant epithelial cell lines under normal and nutritional stress conditions. HaCAT (keratinocyte), DOK (oral dysplastic), and oral squamous cell carcinoma (OSCC) cell lines (CA1, Luc4, SCC9) were evaluated regarding their optical absorbance after culture with 0–10% fetal bovine serum. Absorbance measurements indicated that HaCAT under serum starvation exhibited higher absorbance at blue (430 nm) and near-infrared (906 nm) wavelengths. DOK showed absorption at 440 nm and 945 nm. OSCC cells showed absorption peaks at blue (400–428 nm) and near-infrared. These findings highlight the importance of tailoring PBM parameters to individual needs to achieve optimal absorption and effectiveness. Moreover, the higher absorption peaks in the blue region support further studies to elucidate the potential use of blue light in oral dysplastic lesions and OSCC.

The Fourth Industrial Revolution has brought about profound changes in the professional environment, leading organisations to reassess their strategies in response to the appearance of emerging technologies and increasing globalisation. This chapter examines the evolution of the competencies necessary for project management professionals in this dynamic context, highlighting both current basic competencies and future essential competencies for professional and organisational success. The research based on a narrative review, using articles that previously dealt with the subject, identified an essential set of basic competencies, including effective communication, analytical thinking, leadership, technical skills, adaptability, and problem-solving. Additionally, it points to the growing importance of interpersonal competencies, such as emotional intelligence, negotiation, and conflict management, in an increasingly collaborative and diverse work environment. Regarding future competencies, the study revealed the need for project management professionals to develop competencies in areas such as data analysis, critical thinking, collaborative leadership, and adaptation to technological changes. The rapid evolution of the job market requires a continuous learning approach throughout one’s professional life, ensuring that professionals are always up-to-date and ready to face emerging challenges. By adapting to market demands and investing in the development of relevant competencies, professionals can ensure the success of their projects and drive innovation and sustainable growth within organisations in an ever-evolving work environment.