Background: Tricuspid valve repair during mitral valve replacement surgery remains a controversial topic. The risk-benefit ratio in some populations remains uncertain, especially in rheumatic heart disease patients. Objective: To evaluate the impact of concomitant tricuspid repair on surgical mortality in patients undergoing cardiac surgery due to rheumatic mitral valve disease who have moderate to severe functional tricuspid regurgitation. Methods: This is a prospective cohort study from January 1, 2017, to December 30, 2022. All patients over 18 years of age who underwent cardiac surgery to correct rheumatic mitral valve disease with moderate to severe tricuspid regurgitation were included. The primary outcome was surgical death. In an exploratory analysis, clinical and echocardiographic data were obtained 2 years after the procedure. Results: 144 patients were included, 83 (57.6%) underwent tricuspid valve repair. The mean age was 46.2 (±12.3) years with 107 (74.3%) female individuals, the median left ventricular ejection fraction was 61.0% (55 - 67) and sPAP was 55.0 mmHg (46 - 74), with 45 (31.3%) individuals with right ventricular dysfunction. The total in-hospital mortality was 15 (10.4%) individuals, and there was no difference between the groups submitted or not to tricuspid repair: 10 (12.0%) versus 5 (7.5%); p = 0.46, respectively. There was an association with one variable independently: the sPAP value, RR 1.04 (1.01 – 1.07), p = 0.01. The estimated cut-off value of sPAP that indicates higher early mortality through the ROC curve (area 0.70, p=0.012) was 73.5mmHg. Conclusion: Performing tricuspid repair in individuals who underwent cardiac surgery to correct rheumatic mitral valve disease was not associated with increased surgical mortality. Our results suggest the safety of tricuspid repair even in this high-risk population, reinforcing the recommendations in current guidelines. 

Fecal incontinence is a complaint often reported by patients with Crohn's disease, with a great impact on their quality of life, associated with anorectal involvement of the disease, its surgical sequelae, functional disorders and systemic factors, such as inflammatory activity and altered stool consistence. Other factors unrelated to Crohn’s disease, such as age, sex and obstetric injuries, can also contribute to fecal incontinence. The aim of this study was to assess the clinical features and anorectal function of patients with Crohn’s disease to identify variables associated with fecal incontinence. Methods: This is a cross-sectional study of patients with Crohn’s disease, aged 18 years or older, under outpatient follow-up at the reference inflammatory bowel diseases unit at the Hospital Universitário Professor Edgard Santos, prospectively recruited, between August 2019 and May 2021. After consenting, patients responded to a specific questioner, had their medical records reviewed and underwent proctological examination and anorectal functional assessment with anorectal manometry. Patients with an ostomy or any condition that prevented anorectal manometry were excluded. Results: Of the 104 patients, 49% were incontinent. Fecal incontinence was associated with disease activity (p < 0.001), loose stools (p = 0.02), perianal disease (p = 0.006), history of anoperineal surgery (p = 0.048) and number of anoperineal surgeries (p = 0.048). = 0.036). Patients with incontinence had lower mean resting pressure (43.5 mmHg versus 53.1 mmHg; p = 0.038), lower mean squeeze pressure (62.1 mmHg versus 94.1 mmHg; p = 0.036) and lower maximum rectal capacity (140 ml versus 180 ml; p < 0.001). Conclusions: This is the largest study describing manometric findings in patients with Crohn's disease with and without fecal incontinence. Fecal incontinence was associated with disease activity, loose stools, anorectal disease, history of anoperineal surgery, number of anoperineal surgeries, lower resting and squeeze pressure, and lower maximal rectal capacity. The results of this study suggest that functional assessment with anorectal manometry can identify functional disorders associated with fecal incontinence and thus help in choosing the best approach.

Resistance and inspiratory muscle strength have been described for some decades as an important predictor of impaired lung function. However, several methods are applied in clinical practice, which makes it difficult to choose the ideal tool, still lacking studies that reproduce the reliability of the tests, in addition to a practical applicability that can precisely simulate the dynamic load imposed on the muscles during the strengthening work. , whether in athletes or mechanically ventilated patients. The prescription of the load during the training can be decisive for the therapeutic success, in critical patients there is a fine line between the muscle stimulated below its load tolerance capacity or the deleterious excessive training, for this prescription to be assertive it is necessary to choose the appropriate tool, in addition to the method to be used, as well as the reproducibility for the specific objective of the treatment. In view of the above, some pillars are crucial for the adequate prescription of training, among them, knowing if the chosen device has sufficient validity, if the test is reproducible, in addition to choosing it aiming at the specificity of the therapy to be applied, as well as the clinical goal to be achieved with the treatment.

Background and Aims: bone marrow transplantation (BMT) is the standard treatment for several hematologic pathologies. Post-BMT patients may develop hepatobiliary complications (C-HEPBILI) that impact morbidity and mortality. The differential diagnosis, among others, may include drug-induced liver injury (DILI), sepsis-associated liver injury (SALI), sinusoidal obstruction syndrome (SOS), graft-versus-host disease (GVHD), viral hepatitis, and ischemic and fulminant hepatitis. We aimed to evaluate the frequency, clinical characteristics and outcomes of patients with hepatobiliary alterations associated with BMT in a tertiary referral center. Methods: this is a cross-sectional study with data collected from the medical records of patients undergoing BMT between January/2017 and June/2022. We performed C-HEPBILI diagnosis based on criteria established in the current literature. Result: 377 patients were included, 55.7% had C-HEPBILI. Female gender, presence of pre-BMT hepatobiliary alteration, and haploidentical allogeneic transplantation were associated with increased risk of C-HEPBILI with OR 1.8 (p = 0.005), 1.72 (p = 0.0.13) and 3.25 (p = 0.003), respectively. Patients with C-HEPBILI had a longer hospital stay on average than those without complications (27.7 x 19.3 days, respectively, p < 0.001). Twenty-eight out of 210 patients with C-HEPBILI died compared to 5 of 167 without C-HEPBILI (OR 4.98; p = 0.001). Conclusion: C-HEPBILI is a frequent condition in patients undergoing BMT. There is a greater risk of its occurrence in women, people with pre-BMT liver alterations, and in haploidentical transplants. We showed that the occurrence of these complications increases the length of stay and is associated with a higher risk of death.

OBJECTIVES: To evaluate weight gain in people living with HIV (Human Immunodeficiency Virus) (PLHIV) who started antiretroviral therapy (ART) with a regimen based on Dolutegravir (DTG), comparing groups according to CD4+ count at baseline ( < 200 cells/mm³ versus ≥ 200 cells/mm³), in the period of 48 weeks. METHODS: This is a retrospective observational cohort study with PLHIV starting HAART (3TC/TDF+DTG) divided into 02 groups of equal numbers according to the baseline CD4+ value, attended at 02 reference outpatient clinics for monitoring PLHIV, located in Salvador -Bahia Brazil. Participants' data were collected in the period from January 2020 to March 2022, followed for at least 48 weeks, assessing weight/body mass index (BMI), CD4 count, HIV viral load, lipid levels and glycemic levels at baseline (D1), week 24 (W 24) and week 48 (W 48). RESULTS: 270 participants were evaluated, 135 in each arm. The average CD4 count in the low CD4 group (< 200 cells/mm³) was 78.3 ± 61.7 cells/mm³ and in the high CD4 group (≥ 200 cells/mm³) 536.7 ± 273 cells/mm³ ( p<0.001). The mean age was higher in the group with low CD4+ (< 200 cells/mm³): 39.4 years ± 11.6 (p < 0.001). There was greater weight gain in patients with low CD4 compared to high CD4, in this order, 11.2 ± 8.5 Kg vs. 2.2 Kg ± 4.2 Kg (p=0.004). In general, females showed a greater increase in weight when compared to males, in a proportion of 13.1 ± 7.9 Kg vs 1.4 ± 3.6 , respectively, p<0.001. The number of overweight/obese patients had a significant increase in the low CD4 group, while in the high CD4 group there was a tendency to stability. Viral suppression occurred at high rates in both groups. Summarily, overweight/obesity rates were similar to those observed for the Brazilian population. CONCLUSION: The existence of weight gain observed in this study suggests the occurrence of the “return to health” phenomenon, with women presenting a greater risk of excessive weight gain compared to men.

Sexually Transmitted Infections (STIs) are considered a public health problem, due to their magnitude and the lack of progress in the fight to reduce transmission and the difficulty of effective measures for adequate treatment. Objective: to evaluate the prevalence of sexually transmitted infections and associated factors in men who have sex with other men and transgender women attended at a reference clinic in Salvador/Bahia, Brazil. Methods: This is a cross-sectional descriptive study with a quantitative approach, integrated into the Proctology outpatient clinic in Salvador/Bahia, Brazil, 2021/2022. A total of 141 participants 117 (82.9%) MSM, 9 (6.4%) Bisexuals, 15 (10.6%) Trans Women, were tested through anal PCR exams for Chlamydia, Gonococcus and HPV and collection of blood for HIV and VDRL testing. A questionnaire including sociodemographic, epidemiological and clinical characteristics was used to capture information from participants. The data were organized in a spreadsheet using Excel® 2019 software and the analyzes were carried out using the Statistical Package for the Social Sciences (SPSS, IBM) software version 18.0). Results: In sociodemographic characteristics, 111 participants were over 30 years old (78.7%), 89 with over 12 years of schooling (63.1%), 130 single/divorced (92.2%), 100 currently employed (70.9%), 124 with family income of up to 5 minimum wages (87.9%), mostly MSM (117; 82.9%). The prevalence of HIV and anal STIs: among the participants in this study, 102 had a previous diagnosis of HIV (72.3%) and only 1 tested positive at the initial consultation. For anal infections: Chlamydia trachomatis (13; 9.2%), Neisseria gonorrhoeae (5; 3.5%), HPV (102; 72.3%), Syphilis (32; 22.7%) and at least 1 STI in 112 participants (79.4%). Conclusion: The studied population presents a high rate of cases of anal STIs. Number of sexual partners and drug use before sex were decisive for the results presented, which highlights the high vulnerability of this population to acquiring Sexually transmitted infections. 

The healthcare industry demands information technologies and computational methods to improve productivity and offer personalized assistance to patients. We developed softwares based on Workflow Based Approach (WBA) concept and computational methods using Python language to optimize the exam protocols. A framework to access new biomarkers and artificial intelligence (AI) signatures was developed and validated in COVID-19 CT patients, 18F-FDG-PET/CT cervical cancer and 18F-FDG-PET/CT Hodgkin lymphoma patients. This framework was feasible for robustness analysis: repetitivity (error < 5%), reproducibility (intraclass correlation coefficient, ICC > 90%) and clinical correlation (p < 0.05). The overall performance of predictive models was AUC=0.74 and AUC=0.96 for 18F-FDG-PET/CT cervical cancer and 18F-FDG-PET/CT Hodgkin lymphoma, respectively. A new AI software to support thorax CT COVID-19 diagnoses was implemented and validated within PACS/Viewer. Without the support of software, physicians performed with mean sensitivity and specificity of 83.4% and 64.3%, respectively. When they were assisted with AI software, mean sensitivity and specificity were 87.1% and 91.1%, respectively. In addition, AI software improved the inter-rater reliability from moderate to substantial agreement in a Cohen’s Kappa scale. 

Patients who survive critical illness frequently report symptoms of depression, anxiety and posttraumatic stress disorder. Distorted memories such as amnesia or delusional memories are risk factors for the development of those psychological sequelae. In this context, the ICU diary was created aiming to concretize what happened in the Intensive Care Unit (ICU), helping patients to interpret those experiences, improving mental health outcomes after ICU discharge. The thesis’s objective is to investigate the benefits of the ICU diary according to quantitative and qualitative studies, evaluating the construct of the diary as an intervention aiming the prevention of psychiatric symptoms and disorders after ICU discharge. Different methods were used in the elaboration of the thesis, with emphasis in: 1) summarizing with meta-analysis all studies that tested the impact of ICU diary in reducing psychological symptoms after ICU discharge; 2) synthesizing with thematic analysis the perceptions of all the participants in the creation and reading of the ICU diary; 3) reporting a comparative analysis of the quantitative and qualitative studies found during systematic review. All studies included adult patients that survived critical illness and their family members. The systematic review with meta-analysis shows that the use of ICU diary mitigates depression and improves quality of life in patients surviving critical illness, however there is no evidence of mental health benefits in family members at the moment. Qualitative synthesis and thematic analysis identified non-measurable benefits of the use of ICU diaries in patients and their relatives. The ICU diary promoted better comprehension of critical illness, improved communication with ICU staff and increased trust in healthcare professionals. It also promoted emotional connection between family members and ICU survivors. Apart from that, the qualitative analysis also suggests benefits of the ICU diary for health care providers since it promoted humanization of the patient and increased work satisfaction through emotional connection with patients and their relatives. Using comparative analysis, three components of the ICU diary were identified as important for its efficacy in improving metal health outcomes: the participation of ICU staff in the writing of the diary, the delivery of the diary after hospital discharge and the reading of the ICU diary with a health care professional. In conclusion, the ICU diary is an important tool in the care of the critically ill patient, improving comprehension of the critical illness, strengthening the love bond between family members and the patient, and allowing emotional connection between the ICU staff and patients and their relatives, improving nursing care.

Background: Newborn screening (NBS) is a public government program of preventive
action for the early diagnosis of various metabolic, hematological, infectious, or genetic
diseases that aims to implement the appropriate treatment and modify their evolution.
Cystic fibrosis (CF) is a chronic, progressive, autosomal recessive disease. In 2001,
Brazil began implementing the National Neonatal Screening Program and CF NBS
using a two-dose protocol of immunoreactive trypsinogen (IRT/IRT). Objective: To
evaluate the TNFC program of the State of Bahia using performance indicators and
accuracy indices in the first years after its implementation, analyze the use of new fixed
or floating cutoffs for the first and second doses of immunoreactive trypsinogen (IRT1
and IRT2) and describe the conditions that result in delayed CF diagnosis in children
undergoing NBS. Method: It is an observational study with two stages. The first is
population-based, descriptive, and individualized, with data collected retrospectively
between 2013 and 2017. The database used was that of the state of Bahia's NBS
service. The demographic data was obtained from DATASUS. The analysis of the CF
NBS used performance indicators. The screening's accuracy was assessed using
specific statistical tests that considered the CF NBS as a whole as well as each step
individually. The IRT's ideal cutting point value was determined using the ROC curve.
The Youden index was used to determine the best cutting point, taking into account
the previous year's cutting point values for the IRT1 and IRT2 percentiles of 99.4, 99.5,
99.6, and 99.7 (floating cutting point). The second stage consisted of a series of cases
of infants undergoing CF NBS but with a late diagnosis (> 2 months) of the disease
due to false-negative or procedural errors. Results: The total number of births was
1,017.576, with CF NBS coverage of 82.6% and a cumulative incidence of CF of
1:20.767 live births. The CF NBS predicted the presence of the disease in this
population with 99.9% accuracy, 79.6% sensitivity, 99.9% specificity, and a positive
predictive value of 6.1%. The median age at diagnosis was 3.5 months. Approximately
30% of IRT2 samples were collected after 30 days of life. There was a 23.6% tracking
loss between the first and second stages of CF NBS. Forty-nine infants were confirmed
to have CF, with 39 (79.6%) diagnosed through NBS and 10 (20.4%) due to falsenegative
results. When the test was analyzed with the IRT2 cutting point at 90 ng/mL
it showed a similar performance to the current cut point, with acceptable sensitivity and
specificity but a median reduction of 46.7% in the number of false-positive cases. The
case series included 14 infants, with 8 (57.1%) included because of false-negative
NBS and 6 (42.9%) due to NBS procedural errors. The median age at diagnosis was
5.3 months. The main symptom associated with CF at the initial assistance at the CF
center was severe nutritional impairment, which was present in 11 (78.6%) of these
infants. The mean Z-scores of Weight-for-Leight (W/L) and Leight-for-Age (L/A) were
−3.46 and −3.99, respectively. Twelve (85.7%) children were hospitalized at the time
of diagnosis, with a median hospital stay of 17.0 days. Early signs of Pseudo-Bartter
syndrome (50%) and respiratory changes (42.9%) were also observed. Conclusions:
The coverage of the CF NBS in Bahia was satisfactory, and the percentage of samples
collected within the first week of life has steadily increased. The IRT/IRT protocol in
this population had lower sensitivity and positive predictive value than recommended.
It was not possible to demonstrate the feasibility of establishing floating cutting points
for IRT1 or IRT2 using the methodology of the study. However, data analysis indicates
that changing the IRT2 cut point from 70 ng/mL to values between 90 ng/mL and 100
ng/mL reduces the occurrence of false negative results. Early symptoms associated
with CF in infants with delayed diagnosis included nutritional impairment, Pseudo-
Bartter syndrome, and respiratory symptoms. They all demonstrated the severity of the
disease and emphasize the importance of early diagnosis of these children and the
need for health professionals to be able to detect the most common clinical signs in
children with CF, even if the NBS test is negative. Despite its limitations, the current
protocol should be considered an important CF NBS strategy, while new approaches
will not be evaluated largely in terms of cost-benefit because of the low incidence of
CF and the few resources in the region of the population studied.

Diabetes mellitus (DM) is a global health problem and the 6th leading cause of death in the Americas. It is the second cause of disability in the region, with several associated comorbidities, such as retinopathy, nephropathy and cardiovascular diseases. Glycemic control is the main objective to be achieved to avoid these complications. For this, the glycated hemoglobin test has been widely used as a glycemic indicator, as it is a marker of chronic glycemia, which allows the assessment of glycemic levels in the last three months and does not require fasting for its performance. However, conventionally, this test is performed centrally, in a laboratory, and the result is only obtained a few days after it is performed, which is often a hindrance for patients, especially those who live in rural or remote areas. In order to facilitate obtaining the result of this examination, the point of care tests were developed. These tests allow the assessment of glycemic control to be performed close to the patient's care location and the result is obtained minutes after it is performed, which allows the diagnosis and monitoring to be performed at the same time as the consultation. In addition, studies have shown a good correlation between laboratory tests and point of care tests, which makes them a favorable technology for the management of diabetes mellitus, especially in rural and/or remote areas.

OBJECTIVE: To investigate the association between the presence of metabolic dysfunction associated with steatotic liver (MASLD), the current nomenclature of non-alcoholic fatty liver disease (NAFLD) and kidney disease, and the severity of MASLD in the pathogenesis of renal changes. METHODS: A systematic review was conducted to explore the relationship between the severity of MASLD and kidney disease (KD), an opinion article on MASLD as a risk factor for kidney disease, a cross-sectional study with the discussion that the majority of individuals with severe obesity has liver fibrosis even without Metabolic Syndrome, and a last cross-sectional study aimed to evaluate renal changes in individuals with severe obesity and MASLD. In this study, 97 patients were evaluated between December 2019 and June 2023 at the Ambulatório Magalhães Neto of the Professor Edgard Santos University Hospital Complex and NTCO (Obesity Surgical Treatment Center). Histological analysis was performed in all patients to define NASH and assess the presence of liver fibrosis. The presence of kidney disease in patients was assessed according to criteria recommended by KidneyDisease: Improving Global Outcomes (KIDIGO). Glomerular filtration rate was estimated by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). Clinical, demographic and oral health characteristics were described using frequencies, mean and standard deviation. Multivariate regression analysis was used to identify the influence of risk factors on renal function. RESULTS: The systematic review has provided significant data, suggesting a positive association between the presence and severity of MASLD and chronic kidney disease (CKD). Through a cross-sectional study with 560 individuals with obesity to evaluate the association of renal function and MASLD, we concluded that age was the only risk factor associated with changes in renal function. And, lastly, another cross-sectional study conducted using liver histological assessment of individuals undergoing bariatric surgery demonstrated that greater liver necroinflammatory activity was associated to a reduced glomerular filtration rate. CONCLUSIONS: Based on these studies, we conclude that there is an association between reduced glomerular filtration rate in individuals with metabolic dysfunction associated with steatotic liver, especially in those with greater necroinflammatory activity, even after adjustments for confounding variables.

Despite the known association between stroke and cancer, screening for Asymptomatic Carotid Disease in the preoperative period of oncologic surgeries is not yet formally recommended. Objectives: To determine the carotid ultrasound profile of patients undergoing major oncological surgeries and monitor them for the incidence of perioperative Stroke/TIA. Methods: A pilot, observational and prospective study was carried out in the ICU of Hospital Aristides Maltez, Salvador, Bahia, Brazil. Between 11/01/17 and 12/31/18, among the population of 480 patients in the immediate postoperative period admitted to the ICU, a consecutive sample was selected, consisting of individuals of both genders, aged between 19 and 75 years, asymptomatic from the cerebrovascular point of view. Patients who underwent head and neck surgery, patients with arrhythmias, neurological and carotid alterations were not included. Patients who presented with hemodynamic instability or other conditions that characterized imminent risk of death were excluded. The selected subjects underwent carotid and vertebral Doppler ultrasound until the second postoperative day, then classified according to the degree of stenosis established by the “2009 Joint recommendations for reporting carotid ultrasound investigations in the United Kingdom” and also regarding the morphological evaluation of the carotid plaque according to the classification of Geroulakos et al. The individuals were followed up until discharge from the ICU or death, cataloging data regarding the occurrence of Stroke/TIA and correlating them with the existence or not of asymptomatic carotid disease. Mortality and length of stay in the ICU were also measured. Collection instruments, determination of surgical size and protocol for vascular ultrasound were standardized. The study received approval from the institutional research ethics committee, CAEE 79356417.0.0000.0050. Results: fourteen patients were enrolled. The mean age was 61.14 years (± 9.51). There was one case of stroke. The average length of stay in the ICU was 3.57 (± 0.78) days. The mean intima-media thickness was 0.70 mm (± 0.06) 95% CI [0.66 - 0.73] for the left side and 0.85 mm (± 0.06) 95% CI [0.7287 - 0.9713] for the right side. Stenosis <50% (n = 5, 35.71%) and predominantly echogenic plaque morphology (Type 3) were the predominant changes. Conclusions: Our work emphasizes the importance of investigating the association between carotid disease, documented by Doppler Vascular Ultrasound, and the incidence of Stroke/TIA in the postoperative period of oncologic surgeries. The present investigative model is feasible, low cost and reproducible. 

Patient adherence is associated to successful pharmacotherapy; however, many patients do not take their medications as prescribed because of poor understanding of their purpose. To understand how to use the medication correctly, patients need to obtain clear guidelines and instructions, as their behavior and characteristics play a fundamental role in the effectiveness of a medication. Objective: The aim of this study was assessed older people’s knowledge of the purpose of drugs prescribed at medical appointments in primary care units and the aspects related to their level of knowledge of their medications. Methods: This was a cross-sectional study conducted in 22 basic health units in Brazil. Older adults who were waiting for medical consultations in the study facilities were interviewed after a consultation with a family practice physician. Data were collected from September 2016 to March 2019. Patients who were ≥ 60 years old who visited the primary care units were included in the study (n = 674). Knowledge of prescribed medications was assessed by comparing the responses to the questionnaire and the medication and prescription information. Multivariate analyses were conducted using a Poisson regression with robust variance. Results: The mean age of the sample was 70.1 (standard deviation ± 7.1) years. Among 674 patients, 272 (40.4%) did not know the indication of at least 1 of their prescribed drugs; among them 78 (11.6%) did not know the indication of any of their prescribed drugs. In the final multivariate analysis, polypharmacy, illiteracy, and cognitive impairment were found to be associated with misunderstanding the purpose of at least 1 prescribed drug. Moreover, illiteracy and cognitive impairment were associated with a greater misunderstanding of the purpose of all prescribed drugs. Conclusion: This study demonstrated that there is a considerable lack of knowledge about prescribed medications among older Brazilian adults after a medical appointment. For this reason, health services and professionals need to implement strategies to improve patient’s knowledge 

INTRODUCTION: The post-covid 19 consequences can arise in the short, medium and long term, leading to physical changes, reduced cardiorespiratory capacity, functional repercussions, limitations in activities of daily living and restrictions on social participation. OBJECTIVES: To summarize studies that seek to identify the impact on physical function, activities of daily living, and health-related quality of life in COVID19 survivors, and studies that purchased cardiorespiratory fitness as measured by cardiopulmonary exercise testing in COVID-19 survivors , as well as the influence of potential moderating factors. METHODS: These systematic reviews were conducted following the PRISMA protocol, we searched the following databases MEDLINE/PubMed, Scopus, SciELO and the Cochrane Library for studies that assessed the eligibility criteria for both articles observational studies and population of post-covid 19 survivors, for article 1 the eligibility criteria were considered (studies that assessed physical function, activities of daily living and health-related quality of life after COVID-19 from the first available date until July 2021), for the article 2 (studies that investigated cardiorespiratory fitness (peak oxygen consumption - VO2 peak) measured by cardiopulmonary exercise testing until May 2022). The Newcastle Ottawa Scale was used to assess methodological quality. RESULTS: In article 1, we included 35 studies, these studies demonstrated that COVID-19 survivors had reduced levels of physical function, activities of daily living and health-related quality of life. In addition, incomplete recovery of physical function and performance in activities of daily living were observed 1 to 6 months after infection. In article 2, 48 studies were included, the results show that cardiorespiratory fitness is consistently impaired in COVID-19 survivors, in addition, peak VO2 was reduced according to age, time of covid, disease severity, dyspnea, and reduced blood pressure. exercise capacity. CONCLUSION: Health-related functionality and quality of life is negatively impacted in COVID-19 survivors, as well as reduced cardiorespiratory fitness, secondary to determinants. 

Introduction: Good communication is essential for resolving to solve social conflicts, especially in a closed community, such as in prisons. However, we have observed that language and communication disorders are more frequent among individuals deprived of liberty than in the general population, reducing their problem-solving ability and increasing conflicts. Material and method: In this systematic review, articles were searched in the main databases of the last 38 years. After placing the descriptors, 1883 articles were found. After reading their titles and abstracts and applying the eligibility criteria, 25 articles were selected and included in the final review. Results: A sample of 2188 individuals was evaluated, two studies were conducted with a female population only, while twelve studied exclusively males, and 10 articles had a mixed population. All included studies evaluated language and communication disorders in general, with language impairment being more prevalent There are no English-language studies evaluating language and communication disorders in incarcerated individuals from African countries, Latin America or Asia. Discussion: The results of this systematic review suggest that individuals deprived of liberty have a high frequency of language and communication disorders, and thus end up being more vulnerable within the correctional system. Communication problems were found in different proportions among the groups; however, they affected all prison populations evaluated in this study. It is noticeable that even with the presence of speech and language pathology professionals in the correctional system, communication problems still occur, translating into the need for other strategies to improve reception and implementation. 

Objective: To evaluate the functional status of individuals with Osteogenesis Imperfecta (OI) followed up at a reference center in the state of Bahia. Materials and methods: This is an observational, cross-sectional, descriptive study, which evaluated individuals with OI, based on a non-probabilistic sampling. To assess motor function, the Motor Function Measure (MFM) score was used, in addition to the measurement of muscle strength using the Medical Research Council (MRC) score. Functional performance was measured using the Pediatric Assessment of Disability Inventory, Computerized Adaptive Testing (PEDI-CAT). To assess respiratory function, manovacuometry was performed with measurement of inspiratory and expiratory muscle strength, in addition to peak expiratory flow (PEF) and ventilometry to measure forced vital capacity (FVC). Results: Thirty-one individuals aged between two and 18 years old were evaluated. The overall score of MFM was 74.2%, the lowest score was found in participants with type III OI (56.3%). The median of the MRC index was 80. The mobility domain was the most affected in the PEDI-CAT evaluation, with a mean T score 23.9 (14.2 in type III). Assessment of respiratory function was performed in 23 individuals, with a mean age of 11.6 years. The mean inspiratory muscle strength was 64.4% of the predicted, and the expiratory 56.2% of the predicted. The mean PEF was 213.9 L/min, with 140.6 L/min in the type III group. Median FVC was 1.9 L, corresponding to 110% of the predicted. Conclusion: Among the evaluated individuals, functional alterations were identified, reduced global gross motor functionality and muscle strength, impacting the mobility domain, with the most relevant findings in individuals with type III OI. The respiratory function of those evaluated was altered, with values lower than expected in the entire sample for respiratory muscle strength, in addition peak expiratory flow reduced more expressively in the OI type III group.

Despite the burden of major depressive disorder (MDD), there is still a lack of biomarkers to aid in its diagnosis and pharmacological management. MicroRNAs (miRNAs), an epigenetic mechanism, seem promising candidates for biomarkers of MDD and clinical response to antidepressants. Our aim was to summarize the findings to date, providing more robust evidence for the selection and use of specific miRNAs as biomarkers for the diagnosis and treatment of MDD. Thus, a systematic review of the literature was performed in PubMed/MEDLINE, Cochrane, PsycINFO, Embase and LILACS databases from March to May 2022 using two sets of terms, one for microRNAs and one for antidepressants. Studies involving humans, animal models and cell cultures were included. Studies that evaluated herbal medicines, non-pharmacological therapies or epigenetic mechanisms other than miRNA were excluded. Differences were found in the expression of many miRNAs comparing assessment times - before and after antidepressant treatment - and the populations studied. However, due to the heterogeneity of the investigated miRNAs, limited sample sizes and wide variety of antidepressants used, few conclusions could be made. Thus, there is a promising potential for the use of miRNAs as biomarkers for the diagnosis and treatment of MDD; however, more homogeneous studies are needed 

Introduction: Psychotic depression (PD) is defined as a subtype of major depressive disorder (MDD), characterized by the presence of psychotic symptoms associated with depressive symptoms. Despite being a prevalent and serious disorder, there is no specific medication for its treatment. Ketamine has been used for the treatment of resistant depression with good response, but has been excluded in patients with psychotic symptoms due to its glutamatergic action. Currently, studies with ketamine in PD are limited to case reports and there are no randomized clinical trials evaluating the safety and efficacy of esketamine in patients with PD. Objectives: To assess the efficacy of esketamine in individuals with unipolar depression with treatment-resistant psychotic features. From the comparison between two populations of psychotic and non-psychotic resistant depression, to investigate whether there is a difference in the therapeutic response 24 hours after esketamine infusion. From the comparison between two populations of psychotic and non-psychotic resistant depression, to assess the safety of using esketamine in the presence of psychotic symptoms. Methods: An article related to the topic was prepared: a retrospective review of medical records of patients with PD followed by a matched case-control analysis in a ratio of 1:2 with individuals in non-psychotic depression (NPD). All patients were treated with a single subanesthetic dose of 0.5mg/kg of esketamine and evaluated for depressive symptoms 24 hours later. Results: We analyzed data from 45 subjects with treatment-resistant depression who received esketamine (15 with PD and 30 with NPD). We found a significant antidepressant effect in both groups. There was no statistical difference in therapeutic response when comparing groups. Treatment-induced dissociative symptoms were present in both groups but were self-limiting and no exacerbation of psychotic symptoms was reported. Conclusions: Esketamine appears to be an effective alternative in the treatment of PD and its response was comparable to that of patients with NPD. Furthermore, the use of esketamine was safe, with no evidence of worsening of psychotic symptoms. More clinical trials using ketamine in patients with PD are needed.

Background: The clinical practice guidelines show that many interventions are available for the treatment of patients with chronic low back pain, but the vast majority of these interventions has a modest effect in reducing pain and functional disability. A biomechanical approach which has been raised is that a likely weakness of the abductor muscles, extensors and rotators of the hip side (posterolateral complex-PLC) would lead to excessive contralateral pelvic drop during discharge activities such as walking, run, walk up or down stairs, generating overload in the lumbar region. Although the hip PLC strengtheningbeen very used in the treatment of patients with dysfunction of knee and hip, there is a lack of evidence for your use in patients with chronic low back pain.Objective: To determine whether the combination of conventional physiotherapy and hip PLC strengtheningis superior to conventional physiotherapy in improving pain, disability and muscle strength in patients with chronic low back pain. Study design: it was initially performed a systematic review with meta-analysis. Was also performed a randomized controlled trial. Study localization: the databases Medline, LILACS, SciELO, Cochrane Library databases and PEDro, were consulted to produce a systematic review; the randomized controlled trial was conducted in a rehabilitation clinic in Salvador, Brazil. Participants: the systematic review examined 14 clinical trials, including 413 patients who made stabilization exercises, 297 who performed general exercises and 185 patients who performed manual therapy. In the clinical trial, a total of 46 patients with chronic nonspecific low back pain were included.Patients were randomly divided into two groups: the hip PLC strengtheningassociated with the conventional physiotherapy (n = 22) or conventional physiotherapy (n = 24). Outcomes: The outcomes of pain, disability and muscle strength of the CPL were assessed. Intervention: In clinical trial, each group received 12 sessions of 45 minutes each over a period of 6 weeks. Results: A systematic review with meta-analysis showed that the stabilization exercises were superior to General exercises improves pain and disability and that the stabilization exercises had effects similar to those of manual therapy. In the clinical trial, 46 patients completed the Protocol. There was no statistical difference in pain (mean change: 3.2 vs. 2.1 p = 0.12) or disability (mean change: 3.6 vs. 3.8 p = 0.87) between groups. In both groups, hip extensors muscle strength improved significantly (mean change: 4.1 vs. 3.4 p = 0.6), but without a statistically significant difference. Conclusion:The addition of hip posterolateral complex strengthening to a conventional physical therapy program does not appear to result in improved clinicaloutcome for patients with chronic nonspecific LBP. 

Delirium is a common acute brain dysfunction in intensive care units (ICU) and is associated with negative short- and long-term clinical outcomes. There is no strong scientific evidence to support the use of pharmacological measures for its prevention and treatment. This thesis aims to evaluate the effect of combined non-pharmacological interventions in the prevention of delirium in critically ill patients, with an emphasis on: 1) systematically review the evidence on non-pharmacological measures used to reduce delirium in this population; 2) perform a synthesis by meta-analysis of the impact of these measures in reducing the occurrence of delirium and important clinical outcomes; 3) perform a pilot study to determine the overall incidence of delirium in the study ICUs and by motor subtype and to assess negative clinical outcomes associated with motor spectra; and 4) perform a randomized clinical trial (RCT) to assess the effectiveness of combination non-pharmacological interventions in preventing delirium and reducing negative clinical outcomes in critically ill patients. The systematic review and meta-analysis included 51 and 38 studies, respectively. The non-pharmacological measures investigated in these publications were classi]´lfied into fourteen categories. When pooling study results, non-pharmacological interventions were associated with lower risk of occurrence (relative risk, 0.64; Confidence Interval - 95% CI, 0.45 to 0.91) and duration of delirium (difference in means, -0.97 day; CI 95 %, -1.45 to -0.50), with no effect on ICU mortality. The pilot study was carried out with 95 patients admitted to three ICUs of a Brazilian philanthropic hospital and demonstrated an incidence of delirium of 43.1% (n=41), with a predominance of the mixed subtype (51.2%; n=21). The median duration of delirium was significantly longer in the mixed subtype than in the hypoactive subtype (3 days [Interquartile Range – IQR, 1.0-4.0] versus 1 day [IQR, 1.0-2.0]; p=0.03) and the severity was greater in the delirium hyperactive spectrum (median of 7 points) when compared to the others (p=0.04). The RCT was conducted in the same ICUs as the pilot study. Patients were randomly allocated to either the control group that received standard unit care or the experimental group that received standard unit care and a package of five nonpharmacologic interventions. 144 patients were analyzed, with 72 participants in each allocation group. The delirium incidence density was significantly lower in the intervention group ((1.34 x 10-2 versus 2.29 x 10-2 person-days), with a 60% lower risk of developing this disorder compared to the control group (Hazard Ratio, 0.40; CI 95%, 0.17-0.95; p=0.04), after adjustment for Simplified Acute Physiology Score III, surgical admission, and alcoholism. In conclusion, the systematic review and meta-analysis performed support the use of non-pharmacological interventions to prevent and reduce the duration of delirium in critically ill patients. In the pilot study, the duration and severity of delirium were greater in the mixed and hyperactive subtypes, respectively. The RCT showed that combined nonpharmacological interventions reduced delirium in patients admitted to intensive care units compared to standard care. 

Introduction: Hypertension is considered the main risk factor for cardiovascular diseases. Studies have shown that in addition to the absolute values of blood pressure, pressure variability is also associated with the development, progression and severity of lesions in target organs of arterial hypertension, high cardiovascular risk and fatal and non-fatal cardiovascular events. The prognostic value of blood pressure variability, assessed by ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), has been analyzed by several crosssectional and longitudinal studies, demonstrating an association with cardiovascular outcomes. On the other hand, blood pressure variability assessed in a single visit, through casual measurements, has been less studied, with some studies showing a positive association with stroke, cardiovascular risk and total mortality and others showing no association with total and cardiovascular mortality. Objective: To evaluate the association between blood pressure variability on a single visit and cardiovascular risk among participants in the ELSA-Brasil cohort. Results: A total of 14,357 individuals were included for analysis, of which 7,884 were female. Individuals in the last quartile of systolic blood pressure variability had significantly higher medians of age (p<0.001), serum levels of LDL cholesterol (p<0.001), blood glucose (p=0.001) and glycated hemoglobin (p<0.001) in compared to the first quartile. The prevalence of diabetes and reduced glomerular filtration rate was significantly higher among individuals in the last quartile (p=0.001 and p=0.004 respectively). The median pulse wave velocity was also significantly higher in this quartile (p.0.001), as was the prevalence of high risk of cardiovascular atherosclerotic disease (p<0.001). In general, men had a higher prevalence of high cardiovascular risk than women (p<0.001). As systolic blood pressure variability was greater in both sexes, the prevalence of high cardiovascular risk was also higher, with the greatest difference being observed in favor of men in the last quartile. Multivariate analysis was performed to assess the association between cardiovascular risk and systolic blood pressure variability according to sex. There was a significantly greater association between men in the third and last quartiles (OR=1.19; 95% CI: 1.01 – 1.39; OR=1.50; 95% CI: 1.27 – 1, 76, respectively) and, among women, in the last quartile of variability (OR=1.30; 95% CI: 1.06 – 1.61), after adjusting for abdominal obesity, per capita income, educational level, and average systolic pressure. Conclusion: Higher values of systolic blood pressure variability in a single visit found among the participants of the ELSA-Brasil who composed the baseline of the study, were related to markers and risk factors, and associated with a high cardiovascular risk, especially among men, regardless of the mean systolic pressure observed. 

OBJECTIVE: to investigate the associations between general health-related quality of life (HRQoL), oral health-related quality of life (HRQoL) and non-alcoholic fatty liver disease (NAFLD) before and during the period of the novel coronavirus pandemic. METHODS: A systematic review was performed on the association between NAFLD and periodontal disease (PD), a study to validate the RAND-36 quality of life questionnaire, and a prospective cohort study to assess oral health-related quality of life. during the period of the novel coronavirus pandemic in patients with NAFLD. In the validation study, 763 individuals participated in the study, 400 (52.4%) with chronic liver disease, and the confirmatory factor analysis of the RAND-36 was performed. In the cohort study, 58 patients were followed between December 2019 and December 2021 at the Magalhães Neto Ambulatory of the Complexo Hospitalar Universitário Professor Edgard Santos. Patients were evaluated using a specific collection instrument with clinical and demographic data, a Health-Related Quality of Life assessment questionnaire, RAND-36 and the oral health-related quality of life assessment questionnaire, OHIP-14 . The patients' oral health was evaluated according to criteria recommended by the World Health Organization and the European Association of Sanitary Dentistry. Clinical, demographic and oral health characteristics were described using frequencies, mean and standard deviation. Wilcoxon's non-parametric test was used to compare the scores of the OHIP-14 and RAND 36 questionnaires between the 2019 and 2021 assessments. RESULTS: The systematic review brought important data that confirm that patients with NAFLD have a higher prevalence of PD when compared to healthy controls. Through the validation study of the RAND-36 questionnaire, we concluded that it is effective in measuring the perception of health-related quality of life in individuals with and without chronic liver disease. And the prospective cohort study showed that the pandemic significantly impacted the HRQoL and HRQoL of NAFLD patients. CONCLUSIONS: There is a higher prevalence of periodontal disease in people with nonalcoholic fatty liver disease compared to individuals without the disease, the RAND-36 has good psychometric properties to measure HRQoL in people with chronic liver disease and population without comorbidities and HRQoL and HRQoL decreased significantly in NAFLD patients during the novel coronavirus pandemic period. 

Introduction: Obsessive-compulsive disorder (OCD) is the fourth most prevalent and disabling mental disorder, characterized by the occurrence of intrusive, invasive and uncomfortable thoughts (obsessions) and / or repetitive behavioral or mental rituals (compulsions), performed to reduce anxiety triggered by obsessions; sensory phenomena consisting of aversive or uncomfortable sensations or perceptions can also trigger compulsions. OCD is associated with anatomical and functional changes in the brain, in addition to dysfunctional cognitive distortions and nuclear beliefs (NB). Serotonin reuptake inhibitors, cognitive-behavioral therapy and exposure with response prevention (rituals) (ERP) are the treatments of choice. Cognitive Process Therapy is a recent and empirically validated psychotherapy whose focus is the restructuring of negative CNs. Objective: The objective of this study was to compare the effectiveness of Trial-Based Cognitive Therapy (TBCT) and Exposure with Response Prevention in the treatment of OCD. Method: A randomized, simple blind clinical trial was conducted, allocating 26 patients for individual treatment with the TCP (n = 12) or RPE (n = 14) groups. The groups were evaluated at baseline and at the end of the three-month treatment (12 sessions), and in the follow-up evaluations after three, six and twelve months. The primary measure was the change in the Yale-Brown Obsessive-Compulsive Symptom Scale (Y-BOCS) scores and the secondary measures included the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) scores. Results: There was a lack of evidence that TBCT and ERP were different from each other in reducing the scores of Y-BOCS, BDI and BAI. Both psychotherapies reduced the severity of symptoms, with high effect sizes. These results were maintained in the follow-up assessments. Conclusions: Despite the limitations resulting from the small number of treated patients, TBCT was similar to ERP, the gold standard in the treatment of OCD, in reducing the severity of symptoms, with a high effect size, indicating that TBCT is a clinically valid approach and can be promising in the treatment of this disorder.

Early mobilization can help reduce the risk of functional disability in critically ill patients and increase survival, but the appropriate dose has not yet been established. The objective of this thesis is to evaluate the feasibility, safety and preliminary effects of the addition of a protocol of progressive active mobilization with dose control and training load in critically ill patients (PROMOB). PROMOB was developed based on the results obtained from a systematic review (ARTICLE – 1 of TESE) of the description of active mobilization protocols in patients on invasive mechanical ventilation admitted to intensive care units (ICU). Through this review, it became clear that studies in the area do not adequately report the exercise dose according to the guidelines of the main international guidelines. Important aspects of exercise prescription such as intensity, volume and progression are not adequately described, which makes replication difficult both in research and in clinical practice. Thus, PROMOB was developed respecting reproducibility criteria and completeness of description of exercise variables. PROMOB was tested in a randomized, controlled, double-blind clinical trial. Previously independent individuals with the ability to perform activities in bed (age 18 years or older, < 72 hours of hospitalization) were included. The control group received usual care from the inpatient unit, while the intervention group, in addition to usual care, received the PROMOB protocol additionally. Statistical analysis was conducted following intention-to-treat principles. A confidence interval of 95% was adopted. From July 15, 2019 to December 2, 2020, we randomly assigned 67 eligible adult patients to receive standard care (33 [49.3%]; control group) or standard care plus the PROMOB protocol (34 [50.7%] ; intervention group). Most were women (62.7%), the general mean age was 48.8 (±15.5) years, 62.7% of whom were surgical patients. The main cause of hospitalization was cardiovascular (47.8%). There were no adverse events and the patients tolerated the exercises, even when asked to develop higher speeds of execution. 82% of the application of the protocol occurred with complete delivery of the exercises. There was no difference between the groups: Length of ICU stay (-0.6; 95%CI: -2.5 to 1.3); ΔMRC (0.1; 95%CI: -3.2 to 3.4); ΔHandgrip (0.1; 95%CI: -3.0 to 3.0); ΔFSS-ICU (1.1; 95%CI: -2.8 to 5.1). In the intra-group analysis, there was a difference between Handgrip (2.3; 95%CI: 1.1 to 5.9) and FSS-ICU (5.6; 95%CI: 2.5 to 8.7) in the intervention and FSS group. -ICU (4.6; 95%CI: 1.1 to 8.2) in the control group. PROMOB added to usual care is feasible, safe and well tolerated by patients, the current sample still has low analytical power for statements about efficacy.

Introduction: Ketamine has, in recent years, proven to be a fast-acting agent for the treatment of depressive symptoms. The molecular structure of ketamine has a chiral center, possessing the esketamine and arketamine isomers, each with distinctive properties. Arketamine has been tested on animal models, presenting rapid antidepressant effects with no adverse psychotomimetic events. However, no prior studies exist for the use of arketamine as an adjunctive treatment for bipolar depression. Objectives: To investigate the safety, feasibility, tolerability and antidepressant properties of intravenous arketamine as an adjunctive therapy in the treatment of bipolar depression and also to review the use of N-Methyl-D-Aspartate (NMDA) receptor antagonists for the management of bipolar disorder. Methods: Two articles related to the theme were prepared: (1) a pilot clinical trial of an escalating dose of arketamine infusion over 40 minutes, using a concentration of 0.5mg/kg, with follow-up after seven days using a concentration of 1mg/kg. The primary outcome was the change in total score on the Montgomery & Åsberg Depression Rating Scale (MADRS) after 24h of 1mg/kg infusion; (2) a literature review of several databases, selecting studies that evaluated the use of NMDA receptor antagonists in the adjunctive treatment of bipolar disorder in adults. Results: The mean total pre-infusion MADRS score was 36.66, which decreased to 27.83 24h after the first infusion of 0.5mg/kg of arketamine. This represents a reduction of 24.08% from the mean baseline MADRS score, or a mean difference of 8.83 points (95% CI: 0.29 - 17.37; p = 0.036). Only one subject met the response criteria (decrease ≥ 50% from baseline total MADRS score) 24h after infusion and none at day 7. Regarding the 1mg/kg dose, the mean total MADRS score before the second infusion was 32.0, which decreased to 17.66 24 hours later. This represents a 44.81% reduction from the mean baseline MADRS score or a mean difference of 14.34 points [95% CI 10.45-27.54, p<0.001]. Only two subjects met the response criteria 24h after the second infusion and only one individual presented response criteria seven days after the second infusion. Regarding the literature review, evidence points to glutamatergic abnormalities in the pathophysiology of bipolar disorder.The rapid antidepressant action of ketamine and its enantiomer, esketamine, has been reported in several clinical trials. Conclusion: Arketamine appears to have fast-acting antidepressant properties, as has been demonstrated in animal models of depression. All subjects tolerated both doses studied, showing no dissociative or manic symptoms. Arketamine proved to be a safe, tolerable and viable drug in the studied population. This pilot study is the first body of evidence to test intravenous arketamine for bipolar depression. Among the NMDA receptor antagonists, ketamine and its enantiomers appear to be the glutamatergic modulators with the greatest therapeutic potential.

Chronic joint pain in individuals with sickle cell disease (SCD) is associated with several musculoskeletal problems, including joint osteonecrosis, osteomyelitis, osteoarthritis, dactylitis and bone infarction. The poor correlation between structural joint damage and reported joint pain intensity suggests the involvement of maladaptive plasticity in the central nervous system (CNS). Therefore, a better understanding of the CNS mechanisms related to joint pain is very important to guide the evaluation and treatment of individuals with SCD. This doctoral thesis consists of two articles: A) a review of the literature that sought to highlight the maladaptive plasticity in the CNS potentially related to chronic joint pain in SCD and to present updated information to health professionals about musculoskeletal assessment with reliable methods of clinical musculoskeletal examination; and B) A cross-sectional study that sought to characterize brain activity through EEG in SCD individuals with movement-related pain during the resting state, as well as during motor imagery. The results of the first article highlight that many phenomena associated with maladaptive plasticity of the CNS related to joint pain may also be present and should be systematically evaluated in SCD. These phenomena mainly include impairment of pain control mechanisms, central sensitization, reorganization of the primary motor cortex, motor behavior deficits, and arthrogenic muscle inhibition. Assessment methods range from multidimensional questionnaires to quantitative or electrophysiological sensory assessment techniques. The second article involved 25 individuals with SCD and pain secondary to osteonecrosis of the hip matched for sex and age with 19 healthy controls. An EEG was recorded with 32 electrodes in both groups during resting conditions and motor imagery of the hip and hand. The study revealed that individuals with SCD exhibit dysfunctional brain activity on EEG, characterized by higher power spectral density at low EEG frequencies (delta and theta) compared to healthy controls, during resting-state conditions, and motor imagery. Furthermore, EEG dysfunctional brain activity involved cortical areas, such as the inferior parietal lobe, the somatosensory and primary motor cortices, and the precuneus, which are involved in pain, movement, emotion, and attention processing. The results of these two articles may help to solidify substrates for new hypotheses involving clinical studies of non-invasive brain neuromodulation, as these techniques can potentially help in the management of individuals with chronic pain and maladaptive dysfunctional plasticity.

Background: Plantar fasciitis is the most common cause of heel pain, and often responds to a wide range of therapies. A better understanding of the effects of different interventions will allow people with plantar fasciitis and their health professionals to define the intervention prescription more effectively. to the best of our knowledge, there is no published systematic review with meta-analysis on the effects of all different types of therapeutic interventions (conservative, physiotherapy interventions, pharmacological, non-pharmacological, and surgical interventions) in patients with plantar fasciitis. This systematic review expands on previous publications by conducting a comprehensive systematic review of the literature with meta-analysis of randomized clinical trials to investigate the effects of different therapeutic interventions on pain due to plantar fasciitis. Study Design: Systematic reviews and meta-analysis. Study Location: Medline, LILACS, SciELO, PEDro, and Cochrane Library database were reviewed. Participants: In the systematic review of article 1, 14 randomized clinical trials were identified and of these 11 were included, accounting for 601 patients. In the systematic review of article 2, 248 randomized clinical trials were identified and of these 202 were included, accounting for 13156 patients. Outcomes: Article 1 investigated the effects of low-level laser therapy on pain and disability in patients with plantar fasciitis. Article 2 investigated the effects of different types of therapeutic intervention on pain in patients with plantar fasciitis. Results: The systematic review with meta-analysis of article 1 showed that the application of low-level laser can improve pain in the short term in patients with plantar fasciitis, although this superiority has disappeared when compared with extra-corporeal shock wave therapy. The systematic review with meta-analysis of article 2 showed that comparing the different therapeutic interventions with the control group in the short term, the interventions: botulinum toxin (2.1 lower), micronized dehydrated human amnion/chorion membrane injection (3.3 lower), dry needling (2.3 lower), low-dye taping (3.6 lower), low-level laser therapy (2.1 lower), myofascial releases (1.8 lower), platelet-rich plasma (3.3 lower), radiofrequency (2.5 lower), and stretching (1.1 lower), resulted in effective treatments for pain. In the medium and long term, only extracorporeal shock wave therapy (1.0 and 2.5 lower) resulted in effective treatments for pain. In the short term, corticosteroid injection was effective in improving pain when compared to autologous blood injection, ozone therapy and orthoses. Soft Tissue Mobilization combined with Conventional Physical Therapy was effective in improving pain when compared to Conventional Physical Therapy alone. In the medium term, extracorporeal shockwave therapy was effective in improving pain when compared to corticosteroid injection. Stretching of the plantar fascia was effective in improving pain when compared to muscle stretching. Conclusion: Different therapeutic interventions seem to be a useful strategy for improving pain in patients with plantar fasciitis.

Background: Dissociation is a frequent phenomenon that, despite being one of the most studied topics in early psychiatry, has been academically neglected when compared to other behavioral phenomena. With the advent of the use of ketamine and esketamine in the treatment of treatment-resistant depression (TRD), the dissociative symptoms induced by them have become a potential focus of study, either because of the risks attributed to them or because of the possibility of being an experimental model for understanding dissociative phenomena themselves. Objectives: To investigate the relationship between trait dissociation and dissociation induced by ketamine or esketamine for TRD. To compare induced dissociation by ketamine and esketamine used as augmentation therapy in treatment-resistant depression (TRD). To review what the risk predictors are for dissociation induced by any method in adult clinical trials. Methods: We assessed whether trait dissociation measured by the Dissociative Experience Scale (DES) before medication was a predictor of risk for ketamine- or esketamine[1]induced dissociation measured by the Clinician-Administered Dissociative States Scale (CADSS) 40 minutes after infusion. In the literature review we will systematically search several databases for all studies that evaluated predictors for dissociation induced by pharmacological or non-pharmacological methods in clinical trials with adults. Results: We analyzed data from 61 adults with RDT (32 patients received esketamine and 29 received ketamine). We found a positive and exponential correlation between trait dissociation and induced dissociation by ketamine or esketamine use in TRD patients, even with sex control, depressive and anxiety symptoms, level of insomnia, and diagnoses of post-traumatic stress disorder, generalized anxiety disorder, panic disorder, and somatization disorder. Patients with high trait dissociation had a higher risk of induced dissociation state (relative risk [RR] 1.41, 95% CI 1.11–1.78) and very high induced dissociation (RR 3.05, 95% CI 1.14–8.15). There was no statistical difference in the levels of dissociation induced by ketamine or esketamine. We found that, although high levels of dissociation were induced by both drugs, it was not a serious adverse effect. Conclusions: We recommend screening for trait dissociation, and considering additional care for high trait dissociation patients, monitoring them from the start of infusion and until the resolution of the immediate adverse effects. The choice of ketamine or esketamine in patients with TRD may not be motivated by the potential for dissociation. Our results contribute to a greater understanding of the dissociative phenomena, revealing a potential for the use of ketamine or esketamine as experimental models of dissociation.

Introduction and objectives: Gastroschisis is a congenital malformation with increasing prevalence, characterized by the extrusion of abdominal viscera. Surgical treatment can be by the Silo technique (ST) or by the Exit-like technique (ELT). Our objective was to determine the prevalence of gastroschisis in Bahia, Brazil and to compare the results of two different surgical techniques for closing the gastroschisis.

Methods: This is a cross-sectional study carried out between January/2018 to January/2019, in two referral hospitals in Salvador, Bahia-Brazil. All Newborns (NB) diagnosed with gastroschisis, who were treated with ST or ELT were included in the analysis. All NB with congenital malformations incompatible with life or with poor prognosis were excluded from the comparative analysis between surgical techniques. The prevalence of gastroschisis was calculated, we described the main findings comparing ST with ELT using descriptive statistics and prevalence ratios, according to the Svetliza Reducibility Index (SRI), we also compared the outcome between surgical techniques.

Results: During the study period, 10,424 neonates were born in these two hospitals, 29 of them were diagnosed with gastroschisis, 19 submitted to ST and 10 submitted to ELT. The prevalence of gastroschisis was 1.42 per 10,000 NB in the state of Bahia. According to the SRI, there was no statistical significance, the SRI was 2.07 ± 0.77 in the ST group and 2.49 ± 0.98 in the ELT group (p=0.104). All NB treated with ELT shower a significant reduction in several parameters, such as: 20% less than multiple surgical interventions (p=0.021), 40% less in mechanical ventilation (p=0.009) and abdominal wall closure occurred in mean on the 5^th day in the ST and 0 day in the ELT group (p=0.000). The mortality in the ELT group was lower, but without statistics significance (52.6% in the ST group and 40% in the ELT group; p=0.7).

Conclusion: The results suggest a high prevalence of gastroschisis in the state of Bahia-Brazil. NB with gastroschisis treated with ELT had a better overall outcome when compared to those treated with ST, the mortality was massive in both groups, when compared to the literature.

Background: The decrease and imbalances in strength have a high relationship with biomechanical errors and muscle and joint injuries. The shoulder joint, being complex in movement and fundamental for human functionality, has high records of injury and absence from activities. A detailed strength assessment allows the creation of reference values for the musculature surrounding the joints, and serves as the basis for the physical therapy rehabilitation process. The isokinetic dynamometer is the gold standard instrument for quantifying muscle strength during movement. Objective: To analyze studies on reference values and protocols for measuring isokinetic muscle strength of upper and lower limbs in an untrained and uninjured healthy population. In addition, to determine predictive equations, reference values and compare peak torque at different angular velocities and between agonist / antagonist muscle groups for isokinetic shoulder muscle strength in an untrained and uninjured healthy Brazilian population. Study Design: Initially a Systematic Review was performed. A cross-sectional observational study was also carried out. Study Location: MEDLINE/PubMed, Scopus, Scielo, and Cumulative Index to Nursing and Allied Health (CINAHL) databases were consulted to produce the systematic review; and the observational cross-sectional study was carried out at the Federal University of Bahia. Participants: The systematic review analyzed 31 clinical trials, including 8109 patients who performed the isokinetic strength assessment. In the cross-sectional observational study, a total of 332 patients performed an isokinetic strength assessment for the shoulder joint. Results: In the systematic review, 31 studies met the inclusion criteria. Included studies were used to synthesize isokinetic muscle strength data according to age group and sex. We extracted 1821 normative data related to isokinetic strength. Of these, 1,157 items referred to lower limbs and 664 items referred to upper limbs. In the cross-sectional observational study we extracted xxx normative data related to isokinetic shoulder strength. The equations were as follows: Felxion = - 61.41 + 2.29 (age) - 0.03 (age2) +33.72 (gender), r2 of 49%. Extension = - 61.41 + 2.29 (age) - 0.03 (age 2) +33.72 (gender), r2 of 49%, Abuse = 63.27 - 0.55 (age) +17.96 (gender) +0.58 (weight), r2 of 34%, Adduction = = - 61.41 + 2.29 (age) - 0.03 (age 2) +33.72 (gender), r2 of 49% , internal rotation = - 61.41 + 2.29 (age) - 0.03 (age 2) +33.72 (gender), r2 of 49% , and External rotation = - 61.41 + 2.29 (age ) - 0.03 (age 2) +33.72 (gender), r2 of 49% Conclusion: This systematic review was able to raise the variables between studies such as angular velocities, positions, sets, repetitions for an assessment. In addition, it revealed normative isokinetic strength values for all body joints, which can be used as a clinical reference for normal strength values at different ages, for both sexes. The cross-section created prediction equations and normative values of isokinetic strength of the shoulder for all joints of the body and gathered important information for the construction of an isokinetic strength assessment protocol. 

Introduction: Sacarpenic obesity (OS) refers to the clinical and functional condition resulting from the coexistence of obesity and sarcopenia. In addition, the individual's lifestyle such as physical inactivity, moderate consumption of alcoholic beverages, lower education level, medium or low income may be associated with OS. Numerous methods and definitions for the diagnosis of sarcopenia are proposed and used in research, in addition to different cutoff points for the same indicator, making the diagnosis of this disease difficult. Objective: to estimate the prevalence of sarcopenic obesity in obese patients referred for bariatric surgery and characterize their lifestyle. Methodology: obese patients referred for bariatric surgery were received in an obesity treatment center, of both genders, treated between December / 2018 and February / 2020. Sociodemographic and anthropometric data (BMI and waist circumference) were collected and performed to assess strength , reserve and muscle functionality. Results: The prevalence of sarcopenia ranged from 0 to 2.1% depending on the method used, in addition men have higher alcohol consumption and smoking compared to women. Older people tend to have more breakfast, consume more fruits and vegetables , less soft drinks, in addition to controlling the consumption of foods rich in fat and sugars more when compared to younger people. Conclusion: the prevalence of sarcopenic obesity varied according to the method, but remained low in this sample. Special attention should be given to younger male members, as well as the eating behavior of obese women candidates for bariatric surgery, so that effective change occurs during surgical treatment for obesity, contributing to long-term weight reduction and maintenance . 

People with HTLV-1 Associated Myelopathy or Tropical Spastic Paraparesis (HAM/TSP) have sensorimotor losses and postural instability, resulting in frequent falls. These findings stimulate the use of exercise protocols associated with postural control. This study investigated the effectiveness of a balance training exercise protocol through a virtual game and which counterpart assessment methods that are best suited to patients with HTLV-1 associated myelopathy or tropical spastic paraparesis (HAM/TSP). This is a randomized crossover clinical trial performed in subjects with imbalance disorders (HAM/TSP). To evaluate postural oscillations by baropodometry (total area, anterior, posterior and lateral projection), the Footwork® system was used and by cinemetry (angle of the body, hip and ankle alignment in the lateral view), the CVMob system. And relate stabilometric and kinematic variables of postural oscillations with Berg’s balance scale (BBS) and Timed Up and Go (TUG) in subjects with HAM/TSP compared to clinical subjects. In addition, the Brief Pain Inventory and the WHOQoL Bref were used to measure pain intensity and quality of life. Comparison tests of the averages (intra and inter groups) and correlations were applied considering an alpha of 5% and power of 80%. The study was approved by the Ethics Committee of the Catholic University of Salvador and registered in the Clinical Trials database (NCT02877030). The final sample consisted of 39 individuals (26 group HAM / TSP; 13 comparative group), predominantly female subjects. An increase in the postural oscillations of the control subjects (p < 0.05), a reduction in the occurrence of falls (p = 0.039), and an improvement in the quality of life of the control-test group (p < 0.05) were observed. Moderate correlations were found between oscillation baropodometry and the angular variation of the ankle, as well as with the BBS in the three angles and the TUG for lateral oscillation (p = 0.406). Virtual game training did not improve the static balance, promoting an increase in postural oscillations. Immediately after the application of the protocol, there was a reduction in falls occurrence and improvement in the quality of life. The best resources available at no additional cost for outpatient use are the kinematic evaluation using a simple smartphone camera and free analysis software, and the TUG. 

Sarcopenia is a muscle disease with a high prevalence among older people, and adequate energy and nutrients intake has been pointed out as one of the main strategies for its prevention. However, there are still few studies in the literature investigating the relationship between sarcopenia and food intake, especially among older people living in the community. Objective: This doctoral thesis aimed to compare the food intake of older people with and without sarcopenia, as well as with the sarcopenia diagnostic measures. Methodology: A systematic review and meta-analysis included studies comparing the intake of calories and nutrients by sarcopenic and non-sarcopenic older people using MEDLINE/ PubMed, Scopus, LILACS, Cochrane and Scielo databases. Mean differences and 95% confidence intervals (95%CIs) were calculated, and heterogeneity was assessed using the I2 test. The original studies were cross-sectional, with data collection between 2016 and 2017, and included older women aged 60 and over, from the community, enrolled in three Open Universities of the Third Age in the city of Salvador, Brazil. Muscle mass was assessed by Skeletal Muscle Index and the Appendicular Muscle Mass. Handgrip strength and gait speed were used to investigate the strength and physical performance, respectively. Food intake was measured by a single-day 24-hour recall. Chi-square test was applied to compare the prevalence of sarcopenia between definitions of sarcopenia proposed by the EWGSOP and EWGSOP2 and the kappa coefficient was used to determine the degree of agreement between both consensus. Mann–Whitney U test was used to compare median differences among older people with normal and low appendicular skeletal muscle mass (ASMM), handgrip strength (HGS) and gait speed (GS) groups. Spearman`s correlation coefficient was performed to study the relationships between sarcopenia diagnostic measures and energy and nutrients intake. Multiple regression models using the stepwise procedure was used to assess the correlation between the diagnostic measures of sarcopenia and nutrients intake. Data were analyzed using the software Statistical Package for the Social Science, version 20.0 and in all analysis, p-values ≤ 0.05 was considered as statistically significant. Results: The results of this thesis are presented in the format of three scientific articles: a systematic review and meta-analysis, brief communication and an original article. 1) A total of 23 studies fulfilled the inclusion criteria for systematic review. The meta-analyses showed that the average calories ingested (19 studies, MD = -156.7 Kcal 95% CI: -194.8 to -118.7) were significantly lower in sarcopenic elderly compared to non-sarcopenic elderly. Compared to non-sarcopenic, sarcopenic elderly had lower consumption of proteins, carbohydrates, saturated fatty acids, vitamins A, B12, C and D, and minerals such as calcium, magnesium, sodium, and selenium. 2) In the brief communication, when we estimated the prevalence of sarcopenia and compared both definitions of sarcopenia, the EWGSOP and EWGSOP2, 171 women were included in our study, with a mean age of 70.0 ± 6.7 years. EWGSOP identified 20.5% of sarcopenia prevalence and EWGSOP2 4.7% (p=0.006). The overlap of sarcopenia and severe sarcopenia prevalence between both definition was 2.9% and 1.8%, respectively, and agreement for sarcopenia was mild and moderate for severe sarcopenia (p≤0.01). 3) In the original article, where we compare the intake of nutrients and energy by older women according to the diagnostic measures of sarcopenia and investigate its association, we included 168 older women, mean age 70 (± 6.7) years. Women with low muscle strength had a higher intake of proteins (p = 0.048), magnesium (p = 0.049) and phosphorus (p = 0.030), and those with impaired physical performance had a higher intake of vitamin D (p = 0.036). There was no significant difference in energy and nutrients intake between participants with adequate and low muscle mass. Vitamin E, protein and vitamin D were responsible for the variance of 20.9% of HGS, 46.3% of ASMM mass 24.9% of GS, respectively, after adjusting the final model for age, BMI and energy intake. Conclusions: The evidence so far available suggests a difference in caloric, macronutrient (proteins, carbohydrates, saturated fatty acids), and micronutrient (calcium, magnesium, sodium, selenium, and vitamins A, B12, C and D) intake among older people with and without sarcopenia. EWGSOP2 operational criteria affect the prevalence of sarcopenia among those individuals, which is lower compared to the EWGSOP criteria. Low agreement and limited overlap in sarcopenia diagnosis were observed among both operational definitions. There was a higher intake of nutrients by the elderly women with impaired muscle strength (proteins, magnesium and phosphorus) and physical performance (vitamin D).

Background: PRKAG2 syndrome is a rare, autosomal dominant disease caused by mutations in the gene which encodes AMPK, a protein involved in regulation of glycogen metabolism. Clinical manifestations include ventricular pre-excitation, ventricular hypertrophy, atrial arrhythmias, conduction disorders, and sudden death. Objective: This study describes the long-term clinical course, and incidence of cardiac complications in patients with PRKAG2 syndrome. Methods: Observational, single-family study involving a cohort of PRKAG2 mutation carriers. Clinical, electrocardiographic, echocardiographic, and electrophysiology study findings were analyzed. Results: From March 1996 to January 2020, data were obtained from 16 related carriers of an Arg302Gln mutation in the PRKAG2 gene (10 males, mean age 40 ± 11 years). Three individuals (18%) experienced sudden death. The prevalence of ventricular pre-excitation was 100%, right bundle branch block 69%, atrial flutter/atrial fibrillation 46%, and left ventricular hypertrophy 54%. Five patients (38%) received pacemakers (mean age 41 years). Electrophysiology study was performed in 6 patients and demonstrated fasciculoventricular accessory pathway; malignant arrhythmias could not be induced. The likelihood of sudden death or pacemaker implantation by age 40 was 44%. A significant association was observed between atrial flutter and need for pacemaker placement (P= 0.032). Conclusions: High prevalence of cardiac abnormalities was observed in a family with PRKAG2 syndrome secondary to Arg302Gln mutation. Affection by atrial flutter, third-degree atrioventricular block, and sudden death occurred at early ages, before 50 years. It is possible that the appearance of atrial flutter identifies patients most likely to have a pacemaker implant. However, this finding requires further evaluation in larger cohort studies.

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the cause of Coronavirus Disease 2019 (COVID-19). Although Real Time Reverse Transcription Polymerase Chain Reaction (qRT-PCR) of respiratory specimens is the reference standard test for detection of SARS-CoV-2 infection, collecting nasopharyngeal swabs (NPS) and/or oropharyngeal swabs (OPS) causes discomfort to patients and may represent a considerable risk for healthcare workers. The use of saliva as a diagnostic sample has several advantages. Objectives: The aim of this study is to validate the use of saliva as a biological sample for diagnosis of COVID-19 and to evaluate the test performance of the Xpert Xpress SARS-CoV-2 cartridge assay in comparison to a conventional qRT-PCR testing, using saliva as biological specimen. Method: This study was developed at Infectious Diseases Research Laboratory (LAPI), in Salvador, Brazil. Participants presenting with signs/symptoms suggesting SARS-CoV-2 infection, underwent a NPS and/or OPS, and self-saliva collection. Saliva samples were diluted, RNA isolation and qRT-PCR were performed. Results of conventional versus saliva samples testing were compared. Saliva samples were used to validate the Xpert Xpress SARS-CoV-2 platform. Statistical analyses were performed using Statistical Package for the Social Sciences software (SPSS) version 18.0. Descriptive statistics, Fisher and Mann-Whitney tests were performed; kappa coefficient, and coefficient of determination and correlation were calculated. Results: One hundred fifty-five participants were recruited, and samples pairs of NPS/OPS and saliva were collected. The sensitivity and specificity of RT-PCR using saliva samples were 94.4% (95% CI 86.4 – 97.8) and 97.6% (95% CI 91.7 – 99.3), respectively. The accuracy of the test using saliva was 96.1%. Forty saliva samples from symptomatic participants were collected. In the Xpert Xpress assay, the median cycle threshold value of the E gene was 29.7, and of the N2 gene was 31.6. In the conventional assay, the median cycle threshold value of the E gene was 34.9, and of the RdRp gene was 38.3. Conclusions – Use of self-collected saliva samples is an easy, convenient, and low-cost alternative to conventional NP swab-based molecular tests. These results can allow a broaden use of molecular tests for management of COVID19 pandemic, especially in resources-limited settings. 

OBJECTIVE: To investigate the associations between oral health quality and healthrelated life in individuals with asthma. METHODS: Two studies were carried out, a systematic review of the literature, and a cross-sectional study. We performed a systematic review based on research in the MEDLINE, Web of Sciences, SCOPUS, LILACS and Cochrane databases, using the "Periodontal diseases" AND ("adrenal cortex hormones" OR "adrenal cortex hormones" OR ("adrenal" AND " cortex "AND" hormones ") OR" adrenal cortex hormones "OR" corticosteroid "). We conducted a cross-sectional study from the asthma cohort of the Asthma Control Program in Bahia (ProAR) from February 2017 to November 2019. We included 125 patients; 40 with severe asthma, 35 with mild to moderate asthma, and 50 individuals without asthma. We conducted anamnesis and clinical examination and applied three structured questionnaires: the Oral Health Impact Profile (OHIP-14), the short 36-item questionnaire to assess health-related quality of life (SF36) version 2 and the Work Ability Index. RESULTS: In the systematic review after applying the inclusion criteria, eight studies were selected, two retrospective cohorts and six cross-sectional studies. In the cross-sectional study, the group of patients with severe asthma had a higher frequency of periodontitis (92.5%) and reduced salivary flow (80.0%) compared to those with mild to moderate asthma (54.3% and 74, 3%, respectively) and with the group without asthma (14.0% and 26.0%, respectively). Patients with severe asthma had systematically lower scores on the Work Ability Index, in the domains of health-related quality of life and in the domains of the Impact Profile on Oral Health (OHIP-14) when compared with patients with mild to asthma, moderate or with the group without asthma. CONCLUSIONS: The severity of asthma is associated with a worse oral health condition, including when associated with health-related quality of life and poor work ability. 

Background: Bipolar disorder (BD) is marked by a considerable degree of morbi-mortality, and it is frequently associated with expressive functional impairment (FI). Even in euthymia state and with adequate treatment, individuals usually maintain a gap between symptomatic and functional recovery, which underscores the significance of targeting this phenomenon through patient care. Objective: To perform a meta-analysis about the prevalence of FI in euthymic patients with BD, as assessed only by the Functioning Assessment Short Test (FAST). Then, reflect on the conceptual differences between residual and subsyndromal symptoms, which are frequently associated to functional outcome. Method: Meta-analyses were performed, searching for relevant papers published from 2007 to 2019 in Medline, Embase, Cochrane, PsycINFO databases and via hand-searching, without language restrictions. 1128 studies were initially identified, 13 of which were ultimately chosen based on the eligibility criteria. A two-step meta-analysis was performed using the mean difference with a 95% confidence interval for continuous variables and proportion estimation with a fixed-effects model for categorical variables. Subsequently, another article was made in the letter format to explore the conceptual differences between residual and subsyndromal symptoms. Results: all FAST domains showed worse FI in patients than in healthy controls. The prevalence of FI domains were as follows: global, 58.6%; occupational, 65.6%; cognitive, 49.2%; autonomy, 42.6%; interpersonal relationships, 42.1%; leisure, 29.2%; and financial issues, 28.8%. The presence of residual depressive symptoms was the most frequently cited variable associated with FI. Conclusions: This study highlights the relevance of functional assessment through patient care, as it constitutes one meaningful endpoint of response to treatment. It is also essential to standardize residual/subsyndromal terminologies in order to facilitate the comprehension of evolution of the disease and allow the warrant of finer-grained management strategies.

Strategies to enhance the effects of Transcranial Direct Current Stimulation (TDCS) are often developed based on the theory of metaplasticity. A theoretical-mathematical model estimated that the scaling cooling is able to increase the density of electrical current that reaches or cortex. It is possible that the use of cooling as a stimulus potentiates the polar effects of TDCS. The aim of this work is to investigate the effects of previous cooling of the scalp associated with TDCS on the cortical excitability of affected individuals. This work is a randomized, double-blind study of neurophysiological exploration. Cortical-motor and intracortical excitability of 102 filters,distributed in six experimental groups were evaluated, which included protocols of anodic, cathodic or simulated TDCS associated or not with cooling. Cortical excitability was measured using Transcranial Magnetic Stimulation (TMS) before, immediately after and 15 minutes afterperforming the experimental protocol. No relevant adverse effects were reported. An anodic TDCS on the primary motor cortex (M1) increased the excitability of the motor and intracortical axis, assessed by the amplitude of the motor evoked potential (MEP) and intracortical facilitation (ICF), respectively. On the other hand, it reduced intracortical inhibition (ICI). The cooling of the staggering reduced the ICI alone, but did not alter the cortical-motor excitability. Scalp cooling suppressed the excitatory effect of anodic TDCS on cortical-motor and intracortical excitability of the M1. It is possible that the rules of homeostatic metaplasticity and / or gating have mediated or blocked the cooling on the excitatory effect of anodic TDCS. Suggestions that the cooling favored the penetration of anodic current and an excessive density / dose of this current have reached M1 neurons. To prevent an excitation / inhibition imbalance in the neural network of blocked motor, motor circuits blocked the excitatory effect of anodic TDCS. It Concludes that the supreme stepped cooling decreasethe excitatory effect of the anodic TDCS, but the reduction in the magnitude of the cooling and / or the anodic TDCS could potentiate the excitatory effect according to the rules of homeostatic plasticity.

Introduction: The pharmacological treatment of depression is still largely based on a sequence of trials and errors, with a high rate of therapeutic failures, characterizing treatment-resistant depression (TRD). The development of markers that guide the choice of these interventions would be of great importance. The discovery of the ultra-fast antidepressant action of ketamine and esketamine opened a new area for the investigation of these biomarkers. Previous studies suggest that the influence of ketamine on brain-derived neurotrophic factor (BDNF) levels may be involved in its mechanism of action. Objectives: To review and evaluate the impact of ketamine and its enantiomers on peripheral levels of BDNF, as well as its possible association with the therapeutic response. Method: In the literature review, all the studies that evaluate the association between ketamine administration and its enantiomers with levels of peripheral BDNF in humans were searched in the databases. Four articles were prepared related to the theme of this dissertation: one comparatively evaluated the impact of ketamine and esketamine on BDNF levels in individuals with TRD; another is a double-blind, non-inferiority clinical trial and the protocol article for that trial. An open-label pilot study was also conducted, investigating the efficacy and safety of arketamine in for TRD patients. Results: The literature review has shown that the clinical data on the impact of ketamine on BDNF levels are inconsistent and come mostly from small, uncontrolled studies. In the main study, no association was found between the use of ketamine or esketamine and variation in serum BDNF levels, and no association was found between BDNF and patterns of treatment response. However, both drugs were effective in promoting improvement in depressive symptoms, with the other study finding that ketamine was non-inferior to ketamine in antidepressant efficacy 24h after infusion, with both equally safe. The pilot study found that arketamine produced rapid and sustained onset antidepressant effects with a low level of dissociation and hemodynamic changes. Conclusion: The findings described in this dissertation do not corroborate the use of serum BDNF measurements as a biomarker for treatment with ketamine or ketamine, but reinforce the role of ketamine and esketamine as effective and safe drugs in the treatment of ESRD. The demonstration of the antidepressant effect of arketamine is unprecedented in the literature and should be evaluated in the future with controlled studies. 

BACKGROUND: Although little known, neuropathic pain (NP) in rheumatoid arthritis (RA) is a phenomenon present in a portion of patients. Knowing the DN profile in a patient with RA is fundamental for its treatment. OBJECTIVES: To characterize NP in RA patients and to investigate the independent factors associated with NP in RA, considering sociodemographic, behavioral, lifestyle, and clinical aspects (degree of deformity and level of inflammation in functional hand joints in RA individuals), in a self-reported African descent ethnicity sample. METHOD: A literature review and two cross-sectional studies. RESULTS: a literature review chapter “Neuropathic Pain in RA” and two original articles - Article 1 “Inflammation and deformity and its relation to the type of pain in rheumatoid hands: cross sectional study” and article 2 “Neuropathic pain in rheumatoid arthritis and its association with Afro-Descendant ethinicity: a hierarchical analysis “. FINAL CONSIDERATIONS: The continuous flow of new knowledge about non-inflammatory pain in RA has expanded the limits of understanding pain in this disease. The articles published in this study showed that: 1) the wrist is the joint most affected by nociceptive pain, that small deformities are associated with NP, while high degrees of deformity are more frequent in nociceptive pain; 2) NP in a sample with RA was related to self-referenced Afrodescendant ethnicity and associated with functionality and a high level of anxiety

Introduction: Although much knowledge has been generated over the years about the human hair follicle and the cellular structures that comprise it, little has been described about the role of adhesion molecules and cytokeratins in their development. Objective: Identify the classes of the main adhesion and cell maturation molecules involved in the developmental stages of the developing human hair follicle. Materials and methods: Through case series study, by immunohistochemistry, we evaluated the expression of the molecules e-cadherin, p-cadherin, beta 1 Integrin, beta catenin, CD34 and cytokeratins (CK)1,10,13,14,16 and 20 in development of fetal human hair follicle at 149 skin samples from 35 embryos and fetuses of gestational ages ranging from 4 to 25 weeks. Results: CK14 was the first to be expressed in hair follicles from embryos at the 9th gestational week, followed by the expression of CK1, CK10, CK13 and CK16 at 12 gestational weeks. Subsequently, CK20 is expressed in fetuses at 14 weeks of gestation. Beta 1 integrin expressed in 100 %, e-cadherin expressed in 65,4 % and p- cadherin expressed in 76,9 % of the analyzed specimens. Beta catenin did not show immunoexpression in the cases analyzed at any concentration evaluated. It was positive at the control for tonsils and adult scalp. CD 34 immunostaining was present at 28.6% of the analyzed cases. Conclusions: About molecules studied, beta 1 integrin is the main adhesion molecule involved in the early stages of fetal follicular development. Cadherins pcadherin and e-cadherin are molecules necessary for the processes of orchestration and signaling of the initial steps of follicular formation. Of cadherins, p-cadherin is the most characteristic of the human fetal hair follicle. Beta catenin is downregulated during the fetal follicular development process and CD34 is low sensitive follicular stem cell marker. Cytokeratins are good markers of fetal follicular cell maturation.

Tuberculosis (TB) remains the most important cause of death from a single infectious microorganism in the world, it is estimated that 10 million people developed the disease in 2018 worldwide, but it may still be neglected in many countries. This situation may be related to a limited evaluation of treatment results in countries with limited resources, as well as the presence of factors that affect the outcome of TB treatment. Objective: To identify determinants of cure and death in patients with tuberculosis. To determine the association between the volume of tuberculosis patients treated in the Health Service per year and the successful treatment of tuberculosis patients in Brazil. Determine the risk factors for death in patients with tuberculosis in Brazil. Determine risk factors for therapeutic failure among patients with resistance to rifampicin in Colombia. Methodology: An exhaustive literature review was carried out on the results of tuberculosis treatment and the health facilities that care for / assist patients with tuberculosis. A retrospective cohort study was conducted based on secondary data from cases diagnosed and reported as TB, who started treatment between January 2013 and December 2015 in Brazil and the cases of TB resistant to rifampicin in Colombia. The national TB control programs in Brazil and Colombia provided the data. The databases were cleaned and anonymized to be imported into the SPSS version 18. Statistical, descriptive and analytical analyzes were performed. Results: 144 studies were included in the review "Predictive factors for successful treatment of tuberculosis: a systematic review with meta-analysis". The success rate for the treatment of drug-sensitive TB in adults was 80.4% (95% CI: 78.6-82.1). America had the lowest treatment success rate, 75.9% (95% CI: 73.8-77.9), and Oceania had the highest, 83.9% (95% CI: 75.2- 91.0). In children, the success rate was 83.4% (95% CI: 71.0-92.9); in patients coinfected with HIV, it was 70.5% (95% CI: 62.8-77.6), and in patients with multidrugresistant tuberculosis (MDR-TB), it was 58.4% (95% CI: 51.4-64.6). Patients with negative sputum smears two months after treatment were almost three times more likely to be successfully treated (OR 2.7; 1.5 - 4.8), whereas patients younger than 65 years (OR 2.1; 1.8 - 2.5), nondrinkers (OR 2.0; 1.6 - 2.4) and HIV-negative patients (OR 1.9; 1.6-2.5 3) were two times more likely to be successfully treated. 22 articles met the inclusion criteria in the review "Performance of health facilities in the care of tuberculosis patients in Brazil: a literature review”. It was identified that in Brazil, the health services that act as a gateway for tuberculosis patients are emergency care and primary care, both of which have weaknesses to identify the cases, in addition, primary care has difficulty in retaining patients and hospitals have high rates of transfer and death. In the case of Brazil, 259 325 TB cases were registered at SINAN between 2013 and 2015, 13 339 were eliminated due to duplicates or lack of data, 245 986 eligible patients remained, of whom only 71 249 new confirmed TB cases were selected; 6 736 (65.6%) were seen in basic health units (UBS), 13 591 (19.1%) in TB reference clinics or centers, 8 631 (12.1%) in hospitals and 2 291 (3.2%) in other types of establishments such as emergency rooms and surveillance and management units. The median age was 37.5 years (IQ 27-51.6), the majority were men 49 477 (69.4), education was ≤8 years in 32 044 (45.0%) of the patients, the race / skin color 32 187 (45.2%) called themselves brown / mulatto, 5 644 (7.9%) were HIV positive and 5 415 (7.6%) had diabetes. In this cohort in general 55 195 (77.5%) of the patients were cured, 8 163 (11.5) abandoned the treatment, 3 853 (5.4) died, 2 959 (4.2) transfers, 197 (0.3%) bankruptcy and 882 (1.2) turned to MDR TB. The basic health units had the highest percentage of cure with 82.6%, with the lowest percentage of abandonment 10.9% and death 2.8%, however the hospitals had the lowest percentage of cure 47.9% with the highest percentage of abandonment 13% and death 21.5%. In the UBS: the female gender and the DOTs strategy in the UBS that provided the treatment were associated with the treatment's success; however, HIV positive and alcohol consumption were associated with death. In clinics: only the DOTs strategy in the clinic that provided the treatment was associated with successful treatment and HIV positive was associated with. In hospitals: HIV, alcohol consumption was associated with death. In other establishments: age between 15 and 65 years and the DOTs strategy in the establishment was associated with successful treatment. Conclusion: The UBS that treated less than 20 patients, the clinics that treated between three and nine patients, and the hospitals that treated less than 10 patients in the 3 years were more likely to successfully treat TB. In general, treating less than 50 patients over a 3-year period has been successfully associated with TB treatment in Brazil. In general, DOTS has been successfully associated with the treatment of TB in UBS and Clinics and HIV positive has been associated with death. In Colombia, 50.1% of patients with RR-TB who started treatment between January 2013 and December 2015 had unfavorable treatment results and 19.7% died during treatment. This high rate of unfavorable treatment outcomes was associated with affiliation with the subsidized health regime and age ≥ 60 years. 

This Thesis aimed to review and evaluate the use of N-Methyl-D-Aspartate (NMDA) antagonists in the treatment of depressive episodes, especially ketamine and its enantiomers: S (+): ketamine and R (-): arcetamine. As a result, 4 articles were published: a literature review that aimed to study the role of NMDA antagonists in the treatment of mood disorders, especially in bipolar depression; an original article with primary data that constitutes the main study of this Thesis - a double-blind, bicentric non-inferiority clinical trial in which participants with unipolar treatment-resistant depression (TRD) were randomized to the group of esketamine or ketamine in order to assess the clinical remission of depression 24h after infusion; a third methodological article referring to this study. For the evaluation of depressive symptoms, the Montgomery-Asberg Depression Rating Scale (MADRS) was used. The rates of remission and therapeutic response of ketamine and ketamine in the treatment of TRD were similar 24h after infusion. We did not observe any difference in tolerability between ketamine and ketamine. Finally, the fourth article from the Thesis was an open pilot study whose objective was to analyze the efficacy and safety of arketamine in TRD in humans. In conclusion, NMDA antagonists, such as ketamine and its enantiomers, have been considered promising discoveries in the treatment of TRD, with the antidepressant effect of these drugs being related to glutamatergic action. According to the main study of the Thesis, esketamine was non-inferior to ketamine 24h after the infusion and both were considered effective, safe and well tolerated. In addition, the pilot study originating from the Thesis demonstrated that arketamine has the potential to produce rapid and sustained onset antidepressant effects with a good safety and tolerability profile. In this context, the findings of the Thesis studies corroborate the evidence found in the literature, reinforcing the importance of understanding the role of the glutamatergic system in the pathophysiology of mood disorders, which may facilitate the development of more effective treatments in the treatment of unipolar and bipolar depression, more specifically in TRD.

Approximately 2% of the Bahian population is infected by the human T-cell lymphotropic virus type 1 (HTLV-1), with the highest concentration in Salvador, the state capital. This virus is associated with the appearance of various clinical and neurological conditions as a consequence of the chronic and progressive inflammatory process of the white and gray matter in the Central Nervous System. Infected individuals develop chronic neuropathic and/or nociceptive, often located in the lower back and lower limbs and that is difficult to resolve. Pain may be present even in the absence of neurological manifestations. Objective: To verify the characteristics and factors associated with chronic pain in individuals infected with HTLV-1, comparing them to a group of healthy seronegative individuals. Method: Cross-sectional study in patients from the multidisciplinary ambulatory of HTLV 1with positive ELISA test confirmed by Western blot, divided in tree groups stratified by the Expanded Disability Status Scale (EDSS) and Osame Motor Dysfunction Scale (OMDS) (HAM/TSP, Oligosymptomatic and Asymptomatic) and a comparison group of blood bank donors was paired by sex and age. All subjects had chronic pain (>6 months). Variables analysed included demographic data, as well as pain (visual analogue scale, McGill Inventory and DN4 questionnaire), symptoms of anxiety and depression (Hospital Anxiety and Depression Scale) and quality of life (SF-36). Results: Of the 142 individuals evaluated, 62.7% were female, 73.2% were between 20 and 64 years old, 61.3% were married, 54.2 %% had less than eight years of schooling and 79.6 and 79 , 6% had fixed income. Multivariate analysis, symptomatic individuals for HTLV-1 (PR = 1.21, 95% CI: 1.05 to 1.38), self-medication (PR = 1.29, 95% CI: 1.08-1.53), physical therapy (PR = 1.15, 95% CI: 1.02–1.28) and depression (PR = 1.14, 95% CI: 1.01–1.29) were associated with a greater likelihood of experience pain. On the other hand, physical activity (PR = 0.79, 95% CI: 0.67-0.93) and religious practice (PR = 0.83, 95% CI: 0.72-0.95) were associated with less likely to have pain. When a seronegative comparison group was added to the study, the analysis showed that Individuals with HTLV-1 refer to greater pain compared to controls, with more severe characteristics mainly in oligosymptomatic individuals and HAM / TSP. Neuropathic pain has also been found in the lower limbs of asymptomatic individuals. Oligosymptomatic individuals, on the other hand, have a higher profile of diffuse pain associated with depressive symptoms. Neuropathic pain in the lower limbs of individuals with HAM / TSP may be associated with a worse 6 perception of quality of life. Conclusion: The factors associated with worse pain in those infected with HTLV-1 were presenting symptoms for HAM/TSP and having depressive symptoms. Those who practice regular physical activity and spiritual activities report less pain intensity. Neuropathic pain has a greater impact on the perception of quality of life.

Objective: To describe the 2-year neurodevelopmental outcome in children with cerebral palsy (CP) associated with congenital Zika (CZ) and explore variables associated with a more severe presentation. Methods: Data on 69 children with CP associated with CZ, followed in a neurorehabilitation hospital, who consecutively attended the neurodevelopmental assessment at 2 years of age, were collected. Bayley III Scales of Infant and Toddler Development (BSDIII), Hammersmith Infant Neurological Examination (HINE) and Gross Motor Function Classification System (GMFCS) were used for the outcome evaluation. Descriptive and inferential statistical analysis were performed. Results: The median age at follow-up was of 24.0 (23-32) months. Only 3 (4.3%) children were not microcephalic. The majority presented with bilateral (94.2%) spastic (100.0%), GMFCS IV or V (92.8%) CP, epilepsy (73.1%), extremely low performances on cognitive (94.2%), language (95.7%) and motor (95.7%) BSDIII scores. The median HINE score was of 21.0 (range 9-75). There was a correlation between birth head circumference (HC) with the cognitive (r=0.3, p<0.01), language (r=0.3, p<0.01) and motor (r=0.3, p<0.01) BSDIII scores, as well as with the HINE score (r=0.3, p<0.01). An association was observed between an inferior median HINE score with congenital microcephaly (p=0.04), arthrogryposis (p=0.02) and epilepsy in the first year (p<0.01). Conclusion: Cerebral palsy related to CZ presents with a severe global impairment at a 2-year follow up. Birth HC, arthrogryposis and early epilepsy are associated with a worse outcome and may be considered as prognostic markers. These findings are important for the neurorehabilitation planning, parents guiding and future prognostic studies.

Numerous armed conflicts are currently occurring worldwide, and today more than 30 million people, including the child population, have been victims of death, displacement, and suffering on a large scale. In Colombia, the armed conflict has lasted more than six decades. In the last 10 years, the Colombian government entered a phase of the peace process through an intervention model that includes social, cultural, educational, and health assistance. Several studies have demonstrated in other regions the associative dynamics between psychosocial adjustment and the mental health of insurgents, war veterans, and civilian victims. However, in Colombia, these mental health interventions on ex-combatants of illegal armed groups are not clear. This thesis presents the first article at the national level in a non-clinical sample of excombatants, developed to describe the psychological results and quality of life in demobilized ex-combatants. We carried out a simple systematic sampling in hard-toreach people in a universe of 673 individuals who completed the training processes. Fifty-eight ex-combatants who met criterion A of the Diagnostic and Statistical Manual of Mental Disorders exposed to traumatic events participated in the study under the Colombian Agency for Reintegration and Normalization (ARN), following the guidelines for the preservation of identity. This study identified a higher prevalence of PTSD in women, with fewer years in the reintegration program, secondary education, deficient social status, and depression symptoms. Mean scores for signs of depression, resilience, and quality of life were consistently lower in ex-combatants with PTSD. The results suggest the need to continue the analysis with longitudinal studies to evaluate the interventions' impact over time. The second article presented in this thesis is a review of the scope of nursing interventions in children in armed conflict situations, who suffer intensely from the consequences of war. According to the United Nations Children's Fund (UNICEF), 31 million are displaced, 13 million are refugees, and 386 million live in extreme poverty. The results were summarized and categorized into three main topics related to nursing interventions for children living in situations of armed conflict, research trends, and key nursing care practices in armed conflict. The results showed the positive effect of interventions on children's mental health and the need to develop robust evidence to make nursing interventions in armed conflict situations more visible to promote quality of life through research methods and measures, with particular emphasis on attention to individual, family, community, social and cultural settings, risk factors and protective factors. 

The pursuit for sports performance enhancement is part of the nature of competitive sports. That is why there is a constant demand for options that may influence sports performance, including therapeutic ones. The aim of the present work was to assess if Spinal Manipulative Therapy (SMT) could influence soccer field athletes performance. For that, Sprint and Change of Direction (COD) tests were chosen, once they are commonly used in soccer as indicators of athletes acceleration, speed and change of direction ability. After an extensive systematic literature review about the effects of SMT on athletic performance, a randomized clinical trial was performed with 20 under-20 category athletes from one same professional soccer team. The aim was to assess their performance in these tests right before and after SMT or Placebo interventions. The systematic review included seven studies in which SMT effects were assessed in some physical sports performance aspect of different sports modalities athletes. From those, four studies revealed a better test performance after SMT interventions, and three showed no impact in a particular test. In this current clinical trial no changes were founded in Sprint or COD tests, in neither groups (SMT or Placebo). Additionally the proposed placebo intervention was internally validated. As a conclusion it was observed that SMT did not had any impact over filed soccer athletes` performance.

Congenital Zika syndrome (CZS) has been recently described, mainly in Northeastern Brazil. This study aimed: to describe the neurodevelopmental features at 12 months of age in children with cerebral palsy (CP) related to CZS, followed in a referral neurorehabilitation hospital; to evaluate the prevalence of confirmed cases, according to the currently accepted laboratory criteria; and to describe a case of CZS with normal neurodevelopment. Data on 82 children with CP and probable CZS, who consecutively attended the neurodevelopmental assessment, were collected. The primary outcomes were the developmental scores, evaluated with Bayley III Scales of Infant and Toddler Development. We also performed a retrospective survey of the medical records of the 538 suspected cases of microcephaly and / or CZS, to evaluate the prevalence of confirmed cases. The children were admitted into the rehabilitation program at a young age (4,8 months, SD 3,1) and followed beyond the first year of life (13,2 months, SD 2,1). The majority had severe congenital microcephaly (62,0%), spastic CP (96,2%), epilepsy (63,4%), absent expected postural reactions (93,2%), abnormal persistence of primitive reflexes (94,6%), and severe neuroimaging abnormalities, mainly calcifications (97,6%). Extremely low performances on cognitive (95,1%), language (97,6%) and motor (97,6%) developmental composite scores were observed. There was a correlation between birth head circumference (HC) (r=0,3, p=0,01) and follow up HC (r=0,4, p<0,01), with the cognitive score, as well as between the follow up HC and the motor score (r=0,2, p=0,03). The prevalence of confirmed cases was of 2,0%. We also described a case of a 20-month-old girl with CZS and normal Bayley III composite scores. As conclusions, CZS may be associated with a severe form of CP, mainly bilateral spastic, with global neurodevelopmental impairment and early signs of a poor prognosis for independent walking. Head circumference may be a prognostic marker among those children. These results may help establish goals for the rehabilitation program and identify priority health services. Also, the currently accepted criteria for laboratory confirmation of CZS are hardly filled in the vast majority of the suspected cases. Therefore, the scientific community should discuss standardized criteria for the diagnosis. Also, our case report indicates that detailed evaluation should be warranted even for typically developing children with possible CZS who receive medical attention later.

Background: Psychotic symptoms are present in most patients with bipolar disorder (BD) and are considered to be clinical specifiers of severity. Despite this, the presence of psychosis has been addressed by a limited number of studies, and findings regarding clinical and demographic correlates are often contradictory. Characterizing the differences between patients with BD with psychosis (BD-P) and non-psychotic bipolar patients (BD-NP) is extremely relevant for the understanding of this pathology and, consequently, for its treatment.

Objectives: To describe a series of cases of diagnostic conversion of TB to Schizoaffective Disorder (SD). To describe and compare clinical and sociodemographic characteristics among patients with BD-P and BD-NP, with emphasis on QoL.

Methods: Article 1 - Description of cases, preparation of tables, calculation of basic measures of biostatistics. Article 2 - A total of 452 euthymic outpatients with type I BD were evaluated in a multicenter cross-sectional study. Our study used a clinical and sociodemographic data questionnaire, mood scales for mania and depression, structured clinical interview for diagnosis of BD and comorbidities, and a quality of life scale. Patients with BD-P were compared with BD-NP. QoL was assessed by the World Health Organization quality of life instrument (WHOQOL-BREF). We categorize their variables in the 4 domains based on the median. Univariate, stratified analysis and multivariate COX model were used to investigate the differences between groups.

Results: In the case series: we identified three patients with a diagnosis of conversion to SD, confirmed by the application of SCID-I during follow-up. The mean time between the diagnosis of BD and the diagnostic conversion to SD was 9 years. The onset of the disease occurred during adulthood. None of the patients presented rapid cycling or attempted suicide.

In the cross-sectional study: Psychotic symptoms were present in 75.8% of the patients. QoL scores were very close between BD-P and BD-NP, and patients with worse QoL did not have significant differences in the prevalence of psychosis throughout life, even after multivariate analysis. Among the 4 domains, only the Physical had a Prevalence Ratio <1. The age of the first episode, disease duration, rapid cycling, and family history of psychosis were very similar between BD-P and BD-NP. The prevalence of psychotic symptoms was slightly higher in patients with a history of attempted suicide (PR=1,17), patients with comorbidities (PR=1,2) and patients with poorer overall functioning (PR=1,25).

Conclusions:

These results suggest that psychotic symptoms may become persistent, chronic and unrelated to the presence of mood episodes many years after the onset of BD. The history of psychosis does not appear to be related to QoL in our sample of patients with BD. In addition, there was a slight tendency to increase the prevalence of psychosis associated with suicide attempt, comorbidity and worse functioning.

Background: New antiretroviral drug classes and combined antiretroviral therapy (cART) increased survival and reduced the risk of AIDS-related illnesses. Nonetheless, virologic failure and resistance to antiretroviral therapy still occurs and can negatively impact mortality. The management of treatment for experienced patients remains a complex issue. In Brazil, Raltegravir (RAL) was the first integrase inhibitor in use, usually as a salvage therapy. Objective: we assessed long term survival, virologic success and adverse events in treatment experienced patients initiating either Raltegravir or other drugs for salvage regimens. Methods: we conducted a retrospective cohort study on adults with treatment failure (HIV-1 RNA viral load [PVL]>1000 copies/mL) initiating Raltegravir or other drugs (Darunavir/Ritonavir, Maraviroc or Etravirine). Mortality and virologic suppression (PVL<50 copies/mL) were ascertained using Kaplan-Meier method. Cox proportional hazard model and adjusted Hazard Ratios (HR_adj) were used to identify predictors for mortality or any event (death, virologic failure, toxicity, loss of follow-up and treatment interruption). Results: 168 patients (122 on Raltegravir; 45 on other drugs) were followed for 750 person-years (median of 4.5 years). Survival rates were similar for both regimens (1.2 vs 1.1 persons per 100-person-years; p=0.92). Virologic suppression was also similar (83.5% vs 92.3%, p=0.18). Patients receiving Raltegravir had similar virologic failure (2.4% vs 4.4%, p=0.81), toxicity (0.8% vs 2.2%, p=0.93) and loss of follow-up (4.1% vs 4.4%, p=0.88) than those under other drugs, but treatment interruption was mostly described on Raltegravir group (13.8% vs 2.2%, p=0.04). More than 3 previous treatment failures [HR_adj=2.1; 95%CI 1.1–4.2] and genotypic sensitivity score<3 [HR_adj=2.4; 95%CI=1.3–4.6] were found as independent predictors for any event, while more than 3 previous treatment failures [HR_adj=2.6; 95%CI=1.4–4.9] a predictor for mortality. Conclusion: Similar survival and virologic success rates were found for Raltegravir and other drugs for salvage regimens. Raltegravir was better tolerated but not reflecting on treatment interruption rates.

Introduction: In 2015, Brazil experienced an unprecedented Zika virus (ZIKV)
epidemic. A devastating consequence of this viral infection is Congenital Zika
Syndrome (SZC), which is transmitted from the pregnant woman to the newborn.
Most of the descriptions and publications report to SZC with a focus on the clinical
presentation of the newborns and in children with microcephaly and neurological
alterations. Scarce information is available regarding children with uterine exposure
to ZIKV and no clinical manifestations at birth. In the present study, hypothesized
that the spectrum of neurological changes related to ZIKV could be broader, with
other subtle lesions that would compromise neurodevelopment. Objective: Evaluate
the neurodevelopment profile of a selected sample of children uterine exposed to
ZIKV. Methods: This is a descriptive cross-sectional study including children who
had been admitted in Maternity Hospital with a serological and/or molecular
confirmation of ZIKV infection, non-microcephalics, evaluated at the Pediatric
Outpatient Clinic of the Medical School of Federal University of Bahia, trough the
Bayley Scales of Infant and Toddler Development Third Edition (BSID-III). Results:
Results: 29 children were evaluated (45% female), with mean age of 18 months.
Their mothers had a mean age of 25 years, 21% of which presented positive PCR for
Zika and 72% positive IgG. Language delay was identified in 9 (30.9%) children,
cognitive delay in 3 (10%) and motor delay in 1 (3.4%). Conclusion: In this study
was showed unfavorable outcomes on the development of children with intrauterine
exposure to ZIKV. Considering ZIKV neurotropism and deleterious results already
reported, it is observed that developmental surveillance is essential in early detection
of possible deviations in children with a history of congenital exposure, even though
there is no apparent alteration at birth.

Albinism describes a group of pigmentary disorders that leads to skin sensitivity and predisposition to skin malignances. The aim of the study was to analyze the clinic and epidemiological data and describe the frequency and possible risk factors for malignant skin lesions in albino patients. Besides, the secondary objective was to describe the dermoscopic pattern of the melanocytic lesions in albino patients.

There was a cross-sectional study evaluating epidemiological data, habits of sun exposition and sun protection and clinical examination of albino patients followed in a reference dermatology outpatient clinic in Brazil from March 2016 to June 2017. The primary outcome was the occurrence of malignant skin lesions in biopsied tissues.

Of 74 patients analyzed, 11 (15%) had suspicious lesions and were biopsied, of which 8 (72,7%) patients presented with basal cell carcinomas, 7 (63,3%) presented with squamous cell carcinoma and 1 (9%) presented with melanoma. Moreover, 32(43%) patients presented with actinic keratosis. History of sunburn, previous history of malignant lesions, sun exposure and utilization of umbrellas were associated with the presence of malignant lesions. Besides, the melanocytic lesions had 8 dermoscopic patterns that were described.

There was a high prevalence of malignant and pre-malignant lesions in this population. Some potentially modified risk factors were associated with the occurrence of malignant skin lesions. The study brings important information that can be used in public health policies to improve the quality of life of albino patients.

Introduction and Objective: Mullerian malformations are congenital anomalies which occur in the embrionary period. They are presented in various ways and cause a great negative impact in women who have serious consequences in their sexuality, reproduction and quality of life. Adequate treatments are surgery, for each specific case, and vaginal dilatation, while some types do not require any intervention. The aim of this study was to describe patients from diagnosis to treatment. Materials and Methods: Reports of 41 patients who had mullerian malformations and were assisted in the Hospital Universitário Professor Edgard Santos between 2010 and 2017 with data obtained from the review of their medical history. Results: The most frequent anomalies were Mayer-Rokitansky- Küster-Hauser syndrome (34.1%), transverse vaginal septum (24.4%) and Herlyn-Werner-Wunderlich syndrome (22%). Their main complaints were primary amenorrhea (63.4%) and/or pelvic pain (61%). Unilateral renal agenesis was identified in 39% of the cases. Twenty-six patients underwent surgery, twenty-one of them had satisfactory results and five others needed a new treatment, which was proven successful in two of them. Vaginal dilatation was recommended to fourteen patients, being post-surgical for six of them; however, just one showed a positive result. Two patients got pregnant after the surgical procedure. Patients with obstructive anomalies searched for assistance at an early age due to amenorrhea and sharp pain caused by menstrual flow retention. Those who did not feel any pain seeked medical help a little later. Conclusion: Despite being considered a rare disease, the frequency of mullerian malformations is greater than expected and most patients are only diagnosed after puberty. Many women who have reproductive problems end up having the diagnosis of mullerian malformation just during infertility investigation. Surgery of obstructive malformations has good results while uterine/vaginal agenesis demands more difficult follow-up; vaginal dilatation is strongly recommended as a first choice, nevertheless it is still not a consensus. The main complication of vaginoplasty is reobstruction. Psychological support is very important for all the patients who have genital anomalies.

Hypertension is a major risk factor for cardiovascular morbidity and mortality in post-menopausal women. Although menopausal hormone therapy(MHT) is a very effective treatment for vasomotor symptoms  in this period, the influence of this therapy on blood pressure is not yet clear.Objective: To evaluate the relationship between the use of MHT and hypertension in participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Study design: A cross-sectional study using the baseline ELSA-Brasil data on a cohort of 2,138 women who had experienced natural menopause. Hypertension, defined as arterial pressure ≥140/90 mmHg or previous antihypertensive use, and use of MHT, with participants being classified into never, past and current users. Associations were assessed using an adjusted logistic regression model. Results: Mean age was 58 ± 6.6 years. Overall, 1,492 women (69.8%) had never used MHT, 457 (21.4%) had used it in the past and 189 (8.8%) were current users. The use of MHT was more common in women who had body mass index <25 kg/m²and triglyceride levels <150 mg/dl, and who were physically less inactive, non-smokers, and non-diabetics. Current MHT users were less likely to have hypertension (OR=0.59; 95%CI: 0.41-0.85) compared to never users. In most cases, MHT was started at or before 59 years of age, within 10 years of becoming menopausal, and its use lasted for up to five years. The oral route was the most common route of administration among current users (80.3%).In the group of hypertensive women, combined estrogen/progestogen formulations (36.0%) and estrogen alone (32.0%) were the most common treatments used. Conclusion: In participants of the ELSA-Brasil cohort, current MHT use was inversely associated with hypertension, particularly in healthy women and in those under 60 years of age.

Introduction and Objective: Mullerian malformations are congenital anomalies which occur in the embrionary period. They are presented in various ways and cause a great negative impact in women who have serious consequences in their sexuality, reproduction and quality of life. Adequate treatments are surgery, for each specific case, and vaginal dilatation, while some types do not require any intervention. The aim of this study was to describe patients from diagnosis to treatment. Materials and Methods: Reports of 41 patients who had mullerian malformations and were assisted in the Hospital Universitário Professor Edgard Santos between 2010 and 2017 with data obtained from the review of their medical history. Results: The most frequent anomalies were Mayer-Rokitansky- Küster-Hauser syndrome (34.1%), transverse vaginal septum (24.4%) and Herlyn-Werner-Wunderlich syndrome (22%). Their main complaints were primary amenorrhea (63.4%) and/or pelvic pain (61%). Unilateral renal agenesis was identified in 39% of the cases. Twenty-six patients underwent surgery, twenty-one of them had satisfactory results and five others needed a new treatment, which was proven successful in two of them. Vaginal dilatation was recommended to fourteen patients, being post-surgical for six of them; however, just one showed a positive result. Two patients got pregnant after the surgical procedure. Patients with obstructive anomalies searched for assistance at an early age due to amenorrhea and sharp pain caused by menstrual flow retention. Those who did not feel any pain seeked medical help a little later. Conclusion: Despite being considered a rare disease, the frequency of mullerian malformations is greater than expected and most patients are only diagnosed after puberty. Many women who have reproductive problems end up having the diagnosis of mullerian malformation just during infertility investigation. Surgery of obstructive malformations has good results while uterine/vaginal agenesis demands more difficult follow-up; vaginal dilatation is strongly recommended as a first choice, nevertheless it is still not a consensus. The main complication of vaginoplasty is reobstruction. Psychological support is very important for all the patients who have genital anomalies.

Objective: To evaluate the clinical and sociodemographic characteristics of patients with type I bipolar disorder (BD-I), with comorbid personality disorder (PD). Methods: The original articles used a cross-section, 163 patients diagnosed with BD-I were evaluated in a state of euthymia, aged 18 years or older. For the evaluation, structured interviews were used for diagnoses of mental illness and PD, as well as a specific questionnaire for the collection of sociodemographic data and scales for assessing the intensity of mood, impulsivity and quality of life (QOL). Results: Comorbidity between BD and PD is associated with poor response to treatment, functional impairment, and increased suicidal behavior. The frequency of comorbid PD was 38.3% (n = 46 for a total n = 120 patients), the cluster C PD (n = 24; 20%) and Cluster B PD (n = 23; 19%) showed the highest frequency. Forty-one percent (n = 49) of the patients had at least one Suicide attempt (SA), which were associated with cluster B PDs, as well as high attentional impulsivity and lack of paid occupation. There was no association between self-declared (SD)-"race" and PD (total n = 163); however, SD-"black" had a lower score in the environmental QOL. Conclusions: PD are frequent comorbidities and have a negative impact on the evolution of patients with BD-I. The presence of cluster B PD should be treated as a marker of poor prognosis, since it is associated with important negative outcomes such as SA. In addition, other clinical and sociodemographic characteristics, such as attentional impulsivity and lack of paid occupation were also associated with suicidal behavior. On the other hand, SD-"race", a characteristic that has little been studied so far, was not associated with PD. This finding may indicate that SD-"race" is not among the possible factors related to the diagnosis of PD in patients with BD-I.

The present study aims to compare the cognitive effect of ketamine versus esketamine in treatment-resistant depression (TRD). In addition, it aims to evaluate the cognitive effect of ketamine and esketamine as a single group in patients with TRD and its association with depressive symptoms. This is a randomized, double-blind, bicentric clinical trial in which participants were randomly assigned to either ketamine or esketamine group. Participants' evaluations were done at baseline, 24 hours and 7 days after ketamine or esketamine infusion. The Montgomery-Asberg Depression Rating Scale (MADRS) was administered to measure depressive symptoms. For the neuropsychological evaluation, the following tests were administered: Five Digit Test (FDT), Corsi Block-tapping Task, WAIS III Digit Span and Rey's auditory-verbal learning test (RAVLT). In general, the cognitive effect of ketamine and esketamine is similar in patients with TRD. This treatment proved to be safe from a cognitive point of view and there were improvements in some cognitive functions such as processing speed, inhibitory control, cognitive flexibility and some aspects of auditory-verbal episodic memory. In conclusion, ketamine and esketamine are cognitively safe for the treatment of TRD.

Background: The Nintendo Wii (NW) presents weak evidence about its effectiveness combined with the Conventional Exercises (CE) used in physiotherapeutic practice, as well as studies emphasize the paucity of studies that analyze the isolated effects of NW in the rehabilitation of individuals with Parkinson’s Disease (PD). However, NW can be considered a promising therapeutic resource, presenting tools that encourage users to improve their performance through repetition and consequently improve motor function. Objective: To investigate if the effects of the combination of NW to CE are superior to isolated NW and to isolated CE when administered under the same therapeutic dose for the treatment of balance, gait, functional mobility and improvement in the quality of life of individuals with PD. Methods: Initially, a systematic review with meta-analysis was carried out aiming to compile the current knowledge about NW effects, isolated or associated with other physiotherapy modalities. The electronic research was conducted between December 2018 and January 2019 in the MEDLINE, PEDro, CENTRAL, LILACS and SciELO databases. The methodological quality was evaluated by the PEDro scale and the completeness of the description of the interventions by the TIDieR checklist. To reach the proposed objective, a Randomized Clinical Trial (RCT) was performed with 45 patients with PD allocated to groups that performed NW, EC or NW plus EC. The sessions occurred for 50 minutes, twice a week, in which evaluations were administered before and after the 2-month intervention. The primary outcome was the balance assessed through the Berg Balance Scale (BBS) and the secondary outcomes were gait measured by the Dynamic Gait Index (DGI), functional mobility analyzed by Timed Up & Go (TUG), and quality of life (QoL) assessed by the Parkinson's Disease Questionnaire (PDQ-39). Results: The review showed that the combination of NW with traditional physiotherapy was more effective than traditional physiotherapy alone in the rehabilitation of balance and QoL of PD patients, but the results demonstrated poor methodological quality and a low level of completeness of the intervention descriptions of the included studies. Regarding RCT, significant differences were found in the pre and post intervention analyzes of all the outcomes studied in the three groups, but there was no difference between the groups. However, the NWEC group presented a magnitude of therapeutic effect superior to the others in all the studied outcomes. Conclusion: The combination of NW and CE was statistically as effective as each intervention alone in improving the balance, gait, functional mobility and quality of life of PD patients, however, the group that used this combination had a magnitude of therapeutic effect superior to the others. Thus, it was evidenced that NW and CE were effective in the rehabilitation process of PD patients, however, it is possible that better results can be achieved by combination these techniques.

Physical therapy after stroke enhances recovery promoting cortical reorganization and motor relearning. Among the techniques used for recovery are proprioceptive neuromuscular facilitation and virtual rehabilitation using video games. In this work, a review of the literature was carried out to know the effects of these two techniques, concluding through this review that both present an improvement in rehabilitation after stroke. A randomized clinical trial was conducted to investigate whether a hybrid strategy (PNF + RV) would have better results than the two techniques isolated in the sensorimotor function using the Fulg Meyer Scale. Sixteen 50-minute sessions were performed. 48 patients were randomized and divided equally into 3 groups: PNF, RV and PNF + RV. A statistically significant difference was found in the intragroup analysis in the three protocols, but there was no statistically significant difference in the intergroup analysis. A statistically significant difference was found in the intragroup analysis in the three protocols, but there was no statistically significant difference in the intergroup analysis. In analysis of FMA items separately, statistically significant improvements were found in upper and lower limb motor function in the RV group. There was also significant improvement in the passive movement and pain, upper limb motor function and balance in the PNF and RVPNF groups. Concluding that the use of a hybrid training program involving virtual rehabilitation and PNF presents after two months of treatment results similar to those obtained with the use of the isolated techniques. It is not possible to affirm with the present data the existence of superiority of one technique over the other.

BACKGROUND: Class I human leukocyte antigens, more specifically, the molecules encoded at the B locus (HLA-B) are associated with the risk progression HIV / AIDS. Different groups of HLA-B alleles have been reported with protective effect or increasing susceptibility to HIV infection, and those are expressed from the earliest stages of gestation. OBJECTIVE: The aim of this study is to evaluate which variants of HLA-B are associated with the risk of vertical transmission of HIV-1 in HIV-infected women and their children exposed during pregnancy, delivery or breastfeeding, in a referral HIV center in Salvador Bahia. METHODS. Cross-sectional study, were performed with HLA-B typing in 52 mothers (65 children), who were referred to the HIV / AIDS clinic of Professor Edgard Santos University Hospital in Salvador, Brazil. RESULTS. Mothers' prophylaxis shows a significant association with the prevention of vertical HIV-1 transmission (p = 0.03). Children corroborate the association, 95.1% HIV-1 negative children received prophylaxis (p = 0.001). Group allele frequencies of HLA-B * 14 (29.2%) and HLA-B * 18 (16.7%) was significantly higher in HIV-1 positive children (p = 0.002 and p = 0.04, respectively). The HLA-B * 14: 1 subgroup was also more frequently detected in HIV-1 positive children (p = 0.01). Not significant differences of HLA-B alleles were observed among mothers who transmitted the virus compared to those who did not. There was a positive significant association between risk of HIV transmission and absence of prophylaxis during the delivery, but the difference in allele frequency persisted even after statistical adjustment for this factor. CONCLUSIONS. The presence of the HLA-B * 14 allele is predictive of vertical transmission in children exposed to HIV-1. These findings help to understand the pathogenesis of HIV-1 vertical transmission and revealed the HLA-B * 14 allele as a crucial part of this process.

Erectile dysfunction (ED) is defined as the inability to have or keep a satisfactory penian erection. The HIV-infected men, usually, the low levels of testosterone promotes a decrease in sexual desire and ED. The aimed to determine the prevalence of ED in HIV-infected men, in Salvador, Brazil, as well as the associated factors. Study design was cross-sectional study in an AIDS referral center, in Salvador, Brazil, with male patients and equal or older than 18 years. In the data collection, 134 patients were interviewed, a questionnaires on clinical and socio-demographic characteristics and the International Index on Erectile Function. In the results, it was found most (55%) black and single (79%). The frequency of ED was 21.6% (29 patients), and was classified as severe in 86.2% of them. The most frequent detected comorbidity was arterial hypertension, which affected 13.4% patients. The main factors associated to ED in our study population were unemployment and low income. The detected prevalence is similar to that found in several studies, although some previous reports showed an association between older age and increased prevalence of ED, it was not detected in our study. No association was found between ED and sexual orientation, similar to some previous studies, in addition we did not detect any association between antiretroviral drugs in use by patients and ED. This is also the first study on ED n Northeastern region of Brazil, and provides information on risk factors and dimension of ED in our setting. Larger, prospective studies are necessary to define the magnitude of ED in HIV patients.

Renal failure (RF) is one of the most common comorbidities in hospitalized patients. It affects about 10% of patients and is the twelfth cause of worldwide mortality. The presence of this comorbidity favors the development of adverse drug events, as it causes important pharmacokinetic and pharmacodynamic changes that require special care in medication administration. Dose adjustment of medications during renal failure contributes to reduced treatment costs, mortality and length of hospital stay, as more than half of the adverse events produced by drugs are related to dose prescriptions that should have been adjusted. However, disagreements in the literature, the equations for estimating GFR, and the lack of a database containing all drugs that require changes in renal failure, have generated uncertainties about the best way to perform the adjustment. However, despite the risks, the need for dosage adjustment or not and the use of contraindicated drugs are underestimated in clinical practice. In view of the uncertainties and risks associated with failure to use drugs during renal failure, several studies have addressed the issue. However, even in view of the higher incidence of renal dysfunction and the lack of standards in dose adjustments during ICU admission, there are few data that have evaluated the appropriateness of equations and drug doses in the renal insufficiency of patients under intensive care.

Chronic viral infections and their complications in newborns are a public health problem. During pregnancy, these infections are not always diagnosed and treated in time, leading to maintenance of the transmission cycle and elevation of the risk of vertical transmission (TV). Objective: To estimate maternal and vertical transmission rate of Human Immunodeficiency Virus (HIV), human T-cell lymphotropic virus (HTLV-1/2), hepatitis virus (B / C), and Syphilis and to assess the associated factors. Methods: This is a cross-sectional study with 2,099 parturient attended in two public maternity hospital in Salvador, Brazil, between April 2016 and June 2017. Parturients and child were tested for these infections, and sociodemographic, obstetrical, clinical and prenatal, childbirth and puerperium data were collected. Results: HIV prevalence rates was 1.5%, seroprevalence rates for HTLV, HBV and HCV were 0.4%,0.4% and 0.1% respectively. And 4,7% for Syphilis. The evaluation of the exposed children of
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these viruses estimated a TV rate of 6.2% for HIV, 40% for HTLV, 0% for HBV and was not evaluated for HCV. We detected a high prevalence (3.7%) of probable cases of congenital syphilis. The sociodemographic, behavioral and obstetric factors of the mothers associated with the infections of the studied viruses evidenced a context of individual and social vulnerability. Conclusion. There are still high rates of TV in Salvador, Bahia suggesting the persistence of factors such as late diagnosis of infections during pregnancy and low adherence to recommendations by parturients in vulnerable conditions.

The present study aimed to investigate the relationship between impulsivity and Post-traumatic Stress Disorder (PTSD) with previous suicide attempts. 2137 college students in Brazilian northeast were enrolled in this study. Subjects filled a self-applied protocol consisting of a socio-demographic questionnaire, Trauma History Questionnaire (THQ), Post-traumatic stress disorder CheckList (PCL-C) and Barratt Impulsiveness Scale (BIS-11). History of neglect, use of substances and engagement in suicidal behaviors were assessed through "yes/no" questions. A hierarchical conceptual model was used to analyze the data. Our findings indicated that traumas, such as physical and sexual abuse before and after age 12, and psychological neglect, increased the chances of suicide attempts (SA). Impulsivity was indirectly associated with suicide attempts as it increased the risk of developing Post-traumatic Stress Disorder (the most proximal variable of SA). High impulsivity had a strong association with suicide attempts. Another finding revealed that attentional impulsivity might be an important predictor of developing PTSD. In sum, impulsivity is a relevant trait in both clinical and non-clinical populations, and may be related indirectly to SA. In another article produced in this thesis, a systematic review was carried out. Among the studies investigating the subfactors of impulsivity and its relation to suicide attempt, the most prevalent subdomain was motor impulsivity. Investigations on impulsivity and SA have been carried out with heterogeneous samples and still require studies with large groups of subjects, mainly prospective studies. Thus, early intervention strategies are needed in traits of impulsivity and adverse environmental conditions, in order to reduce the risk factors for suicide attempt.

Parkinson's disease (PD) is a chronic and degenerative disease that predominantly affects the elderly population and presents motor and non-motor manifestations. Among the non-motor manifestations, dysphagia is reported, and sialorrhea is a sign of swallowing. Another non-motor manifestation is the impairment of ventilatory mechanics. Both swallowing abnormalities and respiratory dysfunction, which can lead to respiratory infections secondary to aspiration, are important causes of morbidity and mortality in PD. Therefore, knowledge of swallowing changes and strategies for its treatment is an important and modifying measure of the disease in the parkinsonian patient. Thus, the present study sought to determine the impact of combined oral / vocal and respiratory expiratory exercises on swallowing changes in individuals with PD when compared with isolated oral / vocal or respiratory exercises. The first article showed that both oral and pharyngeal swallowing events, altered in PD, underwent modifications after the application of intervention protocols, either with isolated or combined exhaled oral / vocal and expiratory breathing exercises. It was observed a reduction of lingual festination, fractional swallowing, stasis and residue in buccal floor, residual in vallecula and piriform recess. The second article has brought a discussion about the use of ritigotine to reduce sialorrhea in this population

Background: In 2009, the World Health Organization (WHO) recommended establishing a four-drug regimen (rifampicin-R, isoniazid-H, pyrazinamide-Z and ethambutol-E) for treatment of tuberculosis (TB) to decrease the rates of drug resistance around the world. The Ministry of Health of Brazil included ethambutol in the intensive phase of sensible TB treatment in March 2010, due to the drug resistance and a desire to simplify anti-TB treatment (four drugs in one tablet). Objectives: To determine the impact of a regimen change from three drugs to four on cure and the frequency of adverse drug reactions in patients with tuberculosis. Methods: A retrospective cohort study was done with data from patients diagnosed with tuberculosis who received the anti TB regimen between January 2007 and December 2014 in Salvador, Brazil. Results: Patients under RHEZ-FDC regimen developed more frequently adverse drug reactions (ADR) than those using RHZ regimen (96 [23.6%] vs 63 [15.1%]; p <0.01). Patients under RHEZ-FDC regimen had 1.47 (95% CI 1.10-1.93) more risk to have ADR than RHZ after adjustment for age, alcohol and cigarette use. The overall number of ADRs episodes was also greater (170 [43.3%] vs. 107 [25.8%]; p = 0.01); being greater in patients older than 30 years (131 vs. 73; p=0.01). Conclusion: The use of four-drug regimen increased ADRs as compared with three-drug regimen, mostly in patients older than 30 years of age. Funding: This study was conducted using intramural funding from the Fundação José Silveira and Universidade Federal da Bahia.

Introduction: This paper consists of a narrative review of the literature on chronic pain in temporomandibular disorder (TMD) and a cross-sectional observational study. Objectives: The narrative review aims to characterize the pain of individuals with TMD, investigate the risk factors associated with TMD, and the aspects that favor the chronicity of this condition. For the original article, the objective is to characterize the electroencephalographic power density (PD) findings in the frequency bands (delta, theta, alpha and beta) of individuals with myofascial painful TMD and compare them to healthy controls. Methodology: The narrative review was carried out from March 2016 to January 2017. The original article was carried with eighteen women with chronic myofascial pain and TMD. The activity of quantitative electroencephalography (EEG) at rest was analyzed. PD in the delta (1.5-3.5 Hz), theta (4-7 Hz), alpha (8-12 Hz) and beta (13-30 Hz) bands were evaluated. Results: The narrative review consisted of 58 studies and revealed that pain in individuals with TMD is exacerbated. This condition suggests that pain may be associated with the presence of comorbidities such as depression, migraine and chronic fatigue syndrome. Risk factors and painful chronicity are also related to such comorbidities. The original article found that participants with myofascial painful TMD had higher levels of depression / anxiety symptoms (p <0.05), presence of heat allodynia in the masseter muscle region (p <0.01). There was no difference in the means of absolute PD when comparing the groups [F (1.34) = 0.664, P = 0.421]. However, subjects with myofascial painful TMD showed a decrease in the mean relative alpha PD compared to healthy subjects [F (1,31) = 5,317, P = 0.028] in the frontal, temporal and central regions. Conclusion: The original article concludes that the decrease in relative alpha DP in individuals with myofascial painful TMD may be an electroencephalographic characteristic of this population. A constant state of alertness to pain may be related to the observed alpha activity.

Being born small for gestational age implies an increase in morbimortality rates in childhood, as well as a possible change in growth pattern, body composition and fat deposition, which may be associated with the development of risk factors related to non- communicable chronic diseases. It is necessary to thoroughly and longitudinally evaluate the relationship between birth weight for gestational age, growth and subsequent anthropometric profile of these children. It is a prospective cohort performed in the first years of life that evaluated children born at term classified as small or adequate for gestational age (SGA/AGA) at pre-school age. Thirty-one children from public maternity hospitals in Salvador-Ba (19 small for gestational age, SGA and 12 adequate for gestational age, AGA) were enrolled. These children were attended monthly by a multidisciplinary team in the first year of life and in a single moment at school age. At birth SGA children were smaller and lighter than AGA and presented a weight for age deficit of 42.1%. The patients in this group presented an early growth indicators recovery, characterizing the occurrence of catch-up in the first 6 months of life. Despite the early and intense recovery presented by children born SGA, at preschool age they remained smaller and lighter than those born AGA, in addition, they had less body fat and muscle mass than these last group. For both groups, there was a predominance of adequacy of the anthropometric indicators of growth and body composition at preschool age. There was no register of overweight in the sample evaluated. The nutritional status at birth as well as the early growth recovery had no influence on the nutritional status of preschool-age children. These children did not present risk factors related to anthropometry for the development of future metabolic diseases.

The highly active antiretroviral therapy has contributed considerably toward increasing the survival rate of people living with HIV/AIDS (PLHA). However, due to poor treatment adherence, use of inappropriate antiretroviral regimens, incorrect administration of medications and other problems, there is a segment of patients who experience virologic failure, which contributes to the increase of morbidity and mortality of PLHA. In this retrospective cohort study (2013 to 2015), we sought to evaluate the factors associated with the mortality of PLHA diagnosed with virologic failure in 2013, who were attended at a center of reference for STD/HIV/AIDS. Included in the study were 165 individuals, over 18 years of age and in virologic failure. In the 2 years of follow-up after the study, 19 (11.5%) deaths were documented. The factors associated with the mortality were: report of illicit drug use (53%, p<0.01), being attended by a larger number of medical professionals (6.3 ± 3.2, p =0.02), use of first line NNRTIs (74%, p= 0.01), and history of abandoning HAART ≥ 3 months (90%), p=0.02). In the group of patients who died, a significantly larger viral load was detected than in the survivors (mean 49,192.4 ± 35,783.6 copies/mL, vs 26,389.2 ± 27,416 copies/mm³, p<0.01), lower mean CD4 cell counts (127.8 ± 145.6 copies/mm³ vs 303.3 ± 202.4 copies/mm³, p<0.01), and higher probability of previous virologic failures (89% vs 74.7%, p<0.01). Our results reinforce the importance of early detection of virologic failure as a factor associated with a decrease in mortality, as well as the need to devise strategies to decrease the occurrence of virologic failure. 

Aims:Left ventricular hypertrophy (LVH) is one of the consequences of resistant arterial hypertension (RAH) and an important marker for cardiovascular morbidity and mortality. This study aimed to evaluate LVH behavior using echocardiography in patients with RAH. Methods and Results: This was a transversal descriptive study that evaluated patients diagnosed with RAH, in a reference center for hypertension in Salvador, State of Bahia, Brazil.Sixty-two patients were studied, of which 51.6% presented with LVH and 49.4% had normal ventricular mass. LVH was more prevalent in females (56%). Most studied patients were of the black race (93.5%), although there were no significant differences in LVH prevalence between races. Ventricular geometry alterations were found in 77.4% of the patients. The most prevalent alteration was concentric LVH (41.7%), followed by concentric remodeling (33.3%) and eccentric hypertrophy (25%). Although they were undergoing hypertension treatment, 66.1% of the patients presented with high blood pressure levels. The mean atrial volume was 30.7 mL/m2 in patients with normal ventricular mass and 36.2 mL/m2 in patients with LVH. Abnormal diastolic function was predominant in the group with enlarged ventricular mass. Conclusion: We have observed a high LVH prevalence, particularly in the form of ventricular geometry alterations. Concentric LVH was the most frequent geometry, and it was associated with RAH and inadequate blood pressure control.