Introduction: Altered states of consciousness (ASCs) cause changes in thinking, memory, perception of time and emotional expression; generate depersonalisation, transcendental mystical experiences, expansion of consciousness; perceptual distortions, including hallucinations, pseudo-hallucinations, sharpened perceptions, among others. ASCs are part of the human behavioural repertoire and can be classified into three groups: spontaneous, induced, and pathological. Considering the complexity of these phenomena, one of the biggest gaps in research in this field is the lack of a comprehensive characterisation that encompasses the different types of ASCs in a brain dynamic approach. In this way, a characterisation of these states using Brain Functional Networks (BFNs) will be able to access brain nuances that cannot be achieved with pre-established static methods. Methodology: To achieve the proposed objectives, we evaluated the brain activity by electroencephalography (EEG) of individuals in the different types of ASCs: Pathological - Schizophrenia (SCZ) and Major Depressive Disorder (MDD); Pharmacologically Induced - N, N-dimethyltryptamine (DMT) and Ketamine (KTM), and Psychologically Spontaneous - Meditation (MD) and mediumistic trance during Psychography (PSYC) in a mediumship group (MG). The public EEG datasets used were: EQZ and TDM groups (were compared with healthy controls (HC)); DMT and KTM (were paired with without DMT or KTM) and, from meditations (MD) (Himalayan Yoga Traditions (HY) and Isha Shoonya Yoga (ISHA) were paired with active thinking activity (AT)). Our own EEG datasets are the data from the Brahma Kumaris' Raja Yoga (RY) and Gurdjieff's (GD) meditations (both paired with relaxation (RL)), and the mediumship trance with PSYC and your control groups. The mediumship group (MG) were compared during writing in wakefulness (WW) and psychography (PSYC), and the CT group between WW and creative writing (CW). To the brain signature, we compared MG group during WW, PSYC and RL, and to the CT group, between WW, CW and RL. Both groups (MG and CT) were tested to psychologically using the Neupsilin, SCID-5, PANSS and Dissociative Experience Scale (DES) scales. Neuropsychological tests indicated that both groups, MG and CT, did not show mental disorders. After cleaning the EEG data artefacts, parameters were defined for constructing the BFNs, which were standardised due to the different characteristics of the data, and the networks were generated using time-varying graphs (TVGs) and the motif synchronisation method (MS). We then evaluated the indices of the networks considering time, both globally and locally: weighted degree (WD), probability of hub formation (PHF), path length (PL), E-I index (E-I), clustering coefficient (CC), coefficient of variation of edge (CVE), coefficient of variation of clustering (CVC) and full synchronisation time (FST). In addition, we propose a new index to analyse the interaction between brain regions (IBR) in ASC. To assess the brain pattern / brain signature, we investigated the distance between the weighted matrices. Results: In general, for SCZ compared to HC, we found differences for the WD, CVE, PHF and IBR indices. For MDD compared to HC, we found differences for WW, PHF, PL, FST, CVE, CVC and IBR. For the comparison between DMT and without DMT, we saw that WD, E-I, PHF, PL, CVE, CVC, FST and IBR showed significant differences. The evaluation of the networks during the use of the KTM showed differences for WD, E-I, PL, CC, FST and, CVC compared to without KTM. For the evaluation between the meditations and their control activities: RY, GD vs. RL and ISHA, HY vs. AT, only GD (vs. RL) showed differences for the follow indices WD, PHF and, CC; and ISHA vs. AT for E-I, CVE. When we compared the meditations each other (RY vs. GD vs. ISHA vs. HY), we observed differences for E-I, CVE, and IBR. For comparisons between MG vs. CT, we found no inter-group differences, only intra-group differences to MG between PSYC vs. WW. Neuropsychological tests indicated that both groups, MG and CT, did not show mental disorders. The MG scored for hallucinatory perceptions, but they did not have a schizophrenic disorder. The DES indicated two individuals from the MG with a tendency to dissociation, and none one of the CT. The results for the BFNs indices exhibited differences between PSYC vs. WW for CC, PL, CVE, CVC and IBR. The brain signature results revealed altered brain patterns for the MG, both in terms of intra-individual delta distance and between PSYC tasks compared to WW and RL. These results were the opposite for the CT group, which showed no changes in the intra-individual delta distance, nor for the comparisons between the tasks (WW, CW and RL). In order to relate all the results of the groups studied to the BFNs indices, we carried out principal component analysis (PCA) which revealed that the indices that most differentiated the groups were WD and PFH (PC1) and, CVE and CC for PC2. Conclusion: We were able to identify differences between the ASCs studied, considering their respective control states, less for the RY vs. RL and between HY vs. AT meditations. Through the BFNs, we saw that the ASCs promoted a different brain physiology from the usual state. Evaluation by PCA revealed that ASCs such as the trance experienced by MG, SCZ, DMT and KTM shared aspects of the BFNs in common. Despite the limitations found and the exploratory comparisons, we highlight the similarities between the cerebral characteristics of mediumistic trance, schizophrenia and DMT without, however, presenting associated pathological characteristics for MG. Mediumship trance promotes changes in the brain signature. This finding highlights the need for further research to understand the variations in individual brain patterns during different altered states of consciousness.

Introduction: Cystic Fibrosis is a chronic and progressive condition, in which advances in
diagnosis and treatment have contributed to longer patient survival, which leads to increased
use of health resources and care costs. Objective: To estimate the costs of diagnosing and
treating cystic fibrosis in individuals monitored at the Complexo Hospitalar Professor Edgar
Santos. Methods: Open ambispective cohort study, conducted between January 2005 and
April 2022, which included 66 individuals diagnosed with cystic fibrosis and regularly
followed up at the institution. Data were obtained by detailing each participant's care path,
considering only the average direct costs, what were identified, quantified and assigned
monetary values. Care costs were also compared between individuals diagnosed through
neonatal screening and those with late diagnosis. A bottom-up collection approach was used
for specific component costs. Costs were estimated from the perspective of the Unified Health
System and the provider institution. In the analyses performed for categorical variables,
absolute and percentage frequencies were obtained. For continuous variables with normal
distribution, mean and standard deviation (SD) were described, and non-normal ones, by
median and interquartile range. The non-parametric Mann-Whitney test was used to compare
costs between the two groups (screening and late diagnoses), and a Spearman correlation
analysis was performed between costs and follow-up time for each group. Results: During the
evaluated period, costs with the consumption of medicines predominated (R$ 6,497,011,60),
while the total cost with hospitalizations was R$ 126,781,41. In outpatient care, the
measurement of sweat chloride had a cost of R$ 9,150,00 for the health system. The average
cost of consultations per individual in the cohort was R$597,00 per year. Costs among
participants with late diagnosis were higher than costs among those diagnosed through
neonatal screening, being statistically significant (p<0.001). There was a weak correlation
between care costs and follow-up time both for those diagnosed through neonatal screening
and for those with late diagnosis. Conclusion: During the evaluated period, the costs of
Cystic Fibrosis care at the researched institution were high, mainly those related to the
medication consumption for the disease control. Individuals with a late diagnosis had higher
costs for the diagnosis and treatment of the disease, use more of health resources.

Introduction – Hepatitis B virus (HBV) infection is a global public health problem. In view
of this, the World Health Organization (WHO) recommends the use of orally administered
and licensed drugs for the treatment, such as tenofovir (TDF) or entecavir (ETV). These
drugs hinder the formation of new copies of the virus and are potent antivirals, as they have a
high genetic barrier. Therefore, they constitute an important preventive therapy, as a lower
viral load of the hepatitis B virus (HBV) can reduce the risk of developing liver cirrhosis
(HC) and hepatocellular carcinoma (HCC), the latter being one of the most serious
consequences of evolution of this infection. Considering such prevention, risk scores have
been developed and validated to predict the development of HCC. Among the various
evaluation tools available in the literature, the PAGE-B score seems to be the most
promising, as it presents a high level of agreement, using few variables available in any
medical records: platelets, age and gender. Despite this, this evaluator has not been validated
in multiethnic populations; only in Caucasians and Asians. Objective – Validation of the
PAGE-B risk score in the development of HCC in a multiethnic population of Brazilian
patients with HBV. Method – This is a cohort, historical, retrospective, descriptive and
analytical study. The study population consisted of patients with chronic HBV who were
being treated with antiviral drugs. The sample consisted of 659 individuals monitored at a
reference center in the states of Bahia and Rondônia, for a minimum period of three years,
undergoing antiviral treatment with nucleotides (DNA and RNA) analogues. The calculation
of the risk score of the PAGE-B score was used for the analysis of the described variables:
sex, age and platelet count. According to the score found for predicting HCC, the risk was
classified as low, moderate and high. Statistical analysis was performed using the Statistical
Package for the Social Sciences (SPSS) program. The cumulative probabilities of occurrence
of HCC in individuals were estimated by the Kaplan-Meier method, compared with the Logrank
test. The Cox regression proportional hazard model was used to estimate the effect of
several variables on the risk of occurrence of HCC. Results – The mean PAGE-B score was
12.77±5.631. According to the PAGE-B score, 206 (31.2%), 287 (43.5%) and 166 (25.3%)
patients were at low, moderate and high risk of developing HCC, respectively. During the
treatment and follow-up period, 31 (4.7%) patients developed HCC. These patients were
predominantly male, mean age 57.4 ± 12.6, and had lower platelet levels. In the stages of
fibrosis, the following data were obtained: (F0-F1) 355 (53.86%), (F2) 135 (20.48%), (F3) 59
(8.95%) and (F4) 110 ( 16.69%). Conclusion – The PAGE-B score offered 80% sensitivity,
55% specificity, 8% PPV, and 98% NPV for predicting HCC in the validation datasets. Based
on the aforementioned results, it was possible to validate the PAGE-B score in Brazil, which
can be a tool for predicting HCC.

Introduction: Oral anticoagulants are used as medicine that aims, among other effects, to prevent thromboembolic events in individuals with cardiovascular diseases. There is an increasing number of individuals who require dental treatment and use of anticoagulants; thus, it is essential to know, on the part of the dental surgeon, about the implications and appropriate therapeutic approaches in dental treatment for these individuals. Objective: To assess the level of knowledge of dental surgeons about dental treatment in users of oral anticoagulants, in order to identify their knowledge about appropriate dental and clinical surgical procedures in the care of these individuals. Material and Methods: Data-collecting for study was carried n out from the application of an online questionnaire that was sent through social media and email, and its public target was dental surgeons with active license from Federal Board of Dentistry/Regional Board of Dentistry. Study sample consisted of 173 participants. Data were analyzed using R software (4.1.2 version), which performed a descriptive analysis (absolute/relative frequency) in order to identify general and specific characteristics of the sample. Results: A total of 82.7% participants state that already carried out some kind of surgical procedure in their clinical routine and state that feel prepared to attend oral anticoagulants users, besides claiming that have confidence regarding anaesthetics to be administered and state that know which drugs must be prescribed, however state that frequency of attendance to individuals with this profile is rare. With regard to the definition of therapeutic conduct, majority of sample showed assertive answer but expressed limited knowledge about laboratory tests to be requested as well as about systemic conditions of patients that need oral anticoagulants. Regarding the occurrence of bleeding episode and adopted measures to control bleeding, 54,3% of participants stated that there were never cases of hemorrhage, for which they suggested gauze compress and local hemostatic agents as the main control measures; it is important to report that 1.2% mentioned the need to refer the individual to another level of care. Conclusion: From the results obtained in the study, it appears that more actions are needed to disseminate qualified and assertive information during the process of academic training and continuing education in relation to the approach in dental care for patients that are using anticoagulants in order to ensure integrity of care process, since dentists are indispensable agents in this process, which occurs in joint action with multidisciplinary teams at all levels of health care. 

COVID-19, a disease derived from the SARS-CoV-2 virus, began in 2019 in Wuhan, China, spread rapidly around the world and imposed social isolation on humanity. Initially proposed by the World Health Organization (WHO) in March 2020 to prevent the disease and reduce contamination by the coronavirus. Parallel to the COVID-19 pandemic, another was revealed: intra-family child and youth violence. The environment that should serve as protection, the home, has become the place for various types of violence and homicides. Objective – To analyze the occurrence of intra-family child and youth violence during the COVID-19 pandemic, from 2020 to 2021, in the municipality of Salvador, Bahia. Materials and methods – Secondary sources were used, containing data from January 2018 toDecember 2021, provided by the Police Statistical Documentation Coordination (CDEP), of records of violence committed against children and adolescents aged 0 to 17 years, in order sequentially, in the city of Salvador-BA. Initially, the prevalence of different types of violence characterization of the victims' sex and age group were observed through descriptive analysis of the variables. Results – 1560, 1959, 1504, and 1362 child and adolescent criminal incidents were recorded in the city of Salvador – BA, in the respective years 2018, 2019, 2020, and 2021. There was a significant association between the year of the crime, the nature of the violence perpetrated against children and adolescents, the age group of the victim, as well as color/ethnicity. Conclusion – Given the complex problem in which violence is structured, it is essential that the public authorities guarantee compliance with laws already established and advance public policies from basic care to curricular components in basic education, including universities so that professionals are qualified to deal with this phenomenon

ABSTRACT
Introduction: the healthy lifestyle combined with conscious consumption concerned with
environmental sustainability and respect for animal welfare, adopted by the vegan movement,
has had a direct impact on cosmetics consumption in Brazil and around the world. The vegan
public's consumption is based on ethical values and a particular way of life, representing an
expanding market niche. The vegan cosmetics market has expanded beyond beauty products to
include personal hygiene products such as dentifrices. Objective: to evaluate in vitro the effect
of dentifrices labeled as vegan on the mass and roughness of a nanoparticulate composite resin
subjected to simulated brushing and to carry out a critical analysis of the labeling of these
products. Methods: in vitro study carried out with 60 FILTEK Z350XT nanoparticulate
composite resin specimens, randomly divided into 6 groups (n=10): control group (CG -
Colgate® Total 12 Clean Mint) and test groups (GT1 - Colgate® Zero, GT2 - Creme Dental
Menta e Melaleuca Antisséptico, GT3 - Creme Dental Natural Tea Tree Limão e Menta, GT4
- Creme Dental Natural Dentes Saudáveis Cúrcuma e GT5 - Creme Dental Natural Proteção
Verde Camomila). The specimens were subjected to simulated brushing for 6 and 12 months,
and the mass and roughness were assessed before and after the brushing periods. The labeling
was analyzed to check the composition of the formulations, visual appeals and compliance with
ANVISA specifications. Results: in terms of mass, there was no significant difference between
the groups at the initial time and at each of the times evaluated. In the analysis of roughness in
relation to time, it can be seen that for the CG there was no significant difference (p>0.05) in
roughness after 6 and 12 months of brushing, while the test groups showed distinct behaviors.
After 12 months of brushing, the GT4 group showed greater roughness than GC, GT1 and GT2
(p<0.05) and the GT5 group showed greater roughness than GC and GT1 (p<0.05). The labeling
analysis identified the presence of visual appeals alluding to veganism on all the test toothpaste
packages, varying in the way the information was presented and the seals of the certifying
companies. Conclusion: the dentifrices labeled as vegan showed varied behaviors in relation
to the roughness of the nanoparticulate composite resin after 12 months of simulated brushing,
but the increase in roughness promoted by some of the dentifrices did not imply a significant
loss of mass. The labelling analysis showed the absence of seals issued by recognized certifying
companies.

A chronic infectious disease, leprosy has Mycobacterium leprae (M. leprae) as its etiological agent. It is transmitted through the upper airways of people infected with the multibacillary form, without treatment, which release droplets of the bacillus. M. leprae has a tropism for skin cells and peripheral nerves and can cause physical disabilities. Checking the degrees of physical disability (GIF), at the time of diagnosis and upon discharge due to cure, allows evaluating the quality of monitoring offered by health establishments and the disabling potential of the disease. Compulsory notification, its registration is mandatory in the National Information System for Notifiable Diseases (SINAN), although the incompleteness of the data and failures in notification create obstacles in the evaluation of services, in planning actions, and in controlling the disease. Studies show that the state of Bahia has the fifth worst performance in the country's GIF assessment. Due to the high prevalence in the state, it is necessary to individualize the evaluation of GIF in the southern region of Bahia. Objectives – Identify grade 1 and 2 physical disabilities and factors associated with their occurrence, in the population affected by leprosy, in the municipalities that make up the Ilhéus Health Operational Base of the Southern Regional Health Center of the State of Bahia, in the 2010 historical series to 2022. Material and methods – This is an ecological and cross-sectional study, which uses secondary data from SINAN. The sample consisted of 608 new cases of leprosy diagnosed between 2010 and 2022 in the Ilhéus Health Operational Base municipalities. The variables observed were: sex, age, race, education, zone, clinical form, degree of physical disability at diagnosis and discharge due to cure, operational classification, number of affected nerves and reaction. The relative frequency was calculated and the association was performed using Pearson's chi-square test of the variables with GIF 0 and GIF 1 and 2, at the time of diagnosis and discharge due to cure. Results – There was a predominance of men over the age of 15, blackbrown, from urban areas and with education above the 4th grade, with a dimorphic, multibacillary clinical form, with up to 1 compromised nerve and no reaction. It was observed that 19.73% of GIFs of new cases were not evaluated at diagnosis, 46.88% were not evaluated at discharge due to cure and only 46.71% were evaluated at both moments. An association was found between GIF 1 and 2 (being disabled) with the variables sex, affected nerves, operational classification and reaction at diagnosis and with the variables affected nerves, education, sex and reaction at discharge due to cure. A percentage of 2.79% worsened, 4.11% progressed and 39.80% remained stable in the analysis of the evolution of the pattern of GIFs at diagnosis and at discharge due to cure. Conclusion – The occurrence of grade 1 and 2 physical disabilities was found in the population affected by leprosy in the municipalities that make up the Ilhéus Health Operational Base, associated with males, with two or more compromised nerves, development of reaction and low education. Notification and monitoring of the evolution of GIFs 1 and 2 is low, signaling the precariousness of leprosy monitoring in Southern Bahia.

ABSTRACT
Introduction: Limitations in performing activities and social roles are the main difficulties faced by stroke survivors after discharge from hospital. Objective: To describe the profile of activity and social participation after hospital discharge of stroke survivors and associated factors. Material and methods: This is a longitudinal study of individuals in the subacute phase after stroke who were admitted to a state public neurology referral hospital located in Salvador (BA). The primary data assessed during hospitalization were stroke severity, postural control, functional disability, thoracic mobility, respiratory muscle strength and coughing ability. Secondary data were extracted from medical records and the outcomes activity and social participation were investigated six months after discharge. Linear regression analysis and Pearson's correlation were performed. The study was approved under protocol 4.982.188 and CAEE 15885919.2.0000.5028. Results: The sample consisted of 50 volunteers, mean age was 58±12 years, 27 (54%) were female, 30 (60%) had some work activity, mean NIHSS scale was 5±4, mean length of stay was 20±13 days, 42 (84%) with ischemic type stroke and 11 (22%) thrombolyzed. Some 21 (45%) had incomplete muscle strength (left hemiparesis) and 8 (16%) had heminegligence. The average PASS scale was 23±10 and 18 (60%) of the individuals had an average score of between 3-5 on the ERM scale, translating into moderate kinetic-functional impairment. With regard to respiratory function, the variation in umbilical cirtometry (2.4 ±5.0) was the most significant, MIP (53±31) and MEP (52±35) measurements were below the predicted values, mean TFP was 165 ± 92 and there was a moderate to good correlation between MEP and TFP (r=0.52 p= 0.005). The lowest mean score on the LIFE-H scale was attributed to the social participation domain (2.93±0.6) compared to activity (3.58±0.3). The explanatory variables showed no correlation with the outcomes investigated. Conclusion: The stroke survivors evaluated show low impairment in activity and social participation after hospital discharge, with the decline being more pronounced in social roles. They also showed a decline in thoracic mobility, respiratory muscle strength, coughing ability, postural control and functional capacity during hospitalization.

ABSTRACT
Introduction: Oral lichen planus (OLP) is a chronic inflammatory disease, considered a potentially malignant oral disorder, with its immunological mechanisms are associated with its development. It is believed that the pathogenesis of OLP is related to an intense subepithelial inflammatory infiltrate, that plays an important role in the damage suffered by the epithelial tissue. Chronic inflammation has also been strongly associated with the malignancy of this condition. Objective: To verify the association between the severity of the inflammatory infiltrate and epithelial characteristics observed in OLP lesions. Materials and methods: This is a retrospective cross-sectional study, with a sample comprising a total of 41 histological sections of OLP stained with Hematoxylin-Eosin, belonging to the Oral Pathology Laboratories of two higher education institutions in Bahia. Histological analyzes were performed using a light optical microscope with 10x and 40x objectives. The morphological aspects evaluated were: the presence and count of Civatte bodies, lymphocytic exocytosis, degeneration of the basal layer and the degree of tissue inflammation. Results: In the studied sample, there was a prevalence of severe tissue inflammation (85.4%). The prevalence of exocytosis, degeneration of the basal layer and civatte bodies were 72.5%, 82.9% and 76.3%, respectively. There was no significant association between the degree of tissue inflammation and the presence of exocytosis, degeneration of the basal layer and Civatte bodies (p>0.05). I did not observe a significant difference in the amount of Civatte bodies between the different degrees of concentration (p>0.05) and there was no significant association between the presence of exocytosis and the presence of degeneration of the basal layer and Civatte bodies (p>0 .05). The number of Civatte bodies did not differ significantly between samples with absence or presence of exocytosis (p>0.05). Conclusion: In this study, no significant associations were found between the severity of the subepithelial inflammatory infiltrate and the characteristics confirmed in the epithelial tissue of OLP cases. It is suggested that future research should be provided with larger and more balanced samples to better understand the pathogenesis of this disease.
Keywords: Lichen Planus, Oral. Morphological and Microscopic Findings. Epithelium. Connective Tissue. Inflammation.

This study evaluated the psychometric properties of the Acceptance and Action QuestionnaireII (AAQ-II) and the impact of stress on psychological well-being (BEP), considering psychological inflexibility (PI) as a mediator, among people who undergo or have undergone psychotherapy. or psychiatric treatment. Results showed N=1,128 between 18 and 65 years old, recruited from 40,000 emails sent to UFBA undergraduates. The sociodemographic questionnaire, AAQ-II, WHO-5 and the DASS-21 stress subscale were used. The AAQ-II showed high data factorability (KMO = 0.91), internal consistency (GLB = 0.92, Cronbach's alpha = 0.89) and Weighted Root Mean Square Residual (WRMR = 0.061). It showed unidimensional congruence values (I-UniCo > 0.95, I-ECV > 0.85) and a problematic residual index (IREAL) only for item 2. The factorial solution showed a satisfactory fit (X² = 267.21 , RMSEA = 0.077, NNFI = 0.97, CFI = 0.98, AGFI = 0.99), with all factor loadings greater than 0.30, with the exception of one item (0.28). The reliability of the other scales used was evaluated and the mediation model was tested for total and indirect effect. Next, data were analyzed by type of treatment received, using the t-test, MANOVA (p-value/Bonferroni) and confidence interval (Cohen's d). The results indicated that the AAQ-II has satisfactory psychometric properties in this sample and that PI mediates the relationship between stress and BEP. Therefore, a high level of stress is associated with lower BEP due to the presence of IP. Having undergone or undergoing psychotherapy or psychiatric treatment decreases PI. 

Introduction: Myelopathy associated to HTLV-1/tropical spastic paraparesis (HAM/TSP) is a progressive and disabling disease. Spasticity is one of the main symptoms, in which treatment focuses on antispastic drugs and rehabilitation programs. Botulinum toxin type A (BTA) is a consolidated intervention in the treatment of spasticity. However, there is a lack of studies on people with HAM/TSP. Objective: To evaluate the efficacy and safety of BTA in the treatment of people with HAM/TSP. Methods: Randomized, controlled, double-blind and placebo-controlled clinical trial, composed of individuals over 18 years old, diagnosed with HAM/TSP, who had not used BTA to treat spasticity. The primary outcomes were spasticity (modified Ashworth scale – MAS) and safety (adverse effects), and the secondary outcomes were pain (Michigan Body Map – MBM; and Visual Analogue Scale – VAS), functional motor independence (Motor Functional Independence Measure), spatial-temporal walk variables (10 meter walk test – 10mWT), functional mobility (Timed up and go test – TUG), performance in the sitting/standing (5-repetition sit/stand test – FTSST), functionality (World Health Organization Disability Assessment 2.0 – WHODAS 2.0) and quality of life (Short Form Health Survey 36 items – SF-36) were assessed before and 3 months after intervention. Participants were randomized into groups: BTA and placebo control (saline), stratified according to their ability to walk. The evaluator, neurologist and participants did not know which group they belonged to. Results: Two scientific articles were constructed. In total, 36 participants were analyzed, with a mean age of 59 (PD 14) years, and an average disease duration of 11 (PD 5) years. In the first study, in the BTA group, there was a difference in the physical aspects, pain, general health and mental health domains of the SF-36, and in the mobility domain of the WHODAS. In the placebo-control group, there was a difference in the mobility domain of the WHODAS, and in the pain domain of the SF-36. In the intergroup analysis, there was a difference in the general health status domain of the SF-36. There was no difference in the frequency of adverse effects. In the second study, there were no intra and intergroup differences in MAS, walk speed and cadence, step size, TUG and FTSST. Conclusion: BTA is safe for people with HAM/TSP. However, the first dose of BTA was not effective in treating people with HAM/TSP after 3 months of intervention. It is suggested that future studies identify profiles of people with HAM/TSP responding to BTA and determine more specific methods of therapeutic prescription of BTA for this population. 

Introduction: In recent decades, biomaterials have been increasingly used in different experimental and clinical studies. Acellularized bovine pericardium (ABP) is a biomaterial that has a high amount of collagen and can be used in breast reconstruction, as it provides adequate three-dimensional support for tissue repair. Objective: To analyze the ABP’s biological behavior in the coverage of silicone implants in the back of rats. Material and Methods: 24 male Wistar rats, weighing between 250 and 350g, were distributed into two groups: experimental (EG) – biomaterial (ABP) superimposed on the mini breast prosthesis (MP); and control (CG) – MP without implantation of the biomaterial - with eight animals at each biological point at 1, 2, 4, 12 and 26 weeks post-operatively, in accordance with ISO 10993 - 6 (2010). Histomorphologically, the inflammatory response, formation of a fibrous capsule and the ABP’s biointegration with the host tissue, were evaluated. Results: In the macroscopic evaluation, no postoperative complications were observed across all biological points. Histological analysis showed a chronic inflammatory response in the EG and a chronic granulomatous response in the CG, moderate in both groups; formation of a thinner fibrous capsule in the EG when compared to the CG, at the biological endpoint; and biointegration of the ABP with host tissue at the implantation site. Conclusion: The ABP used did not reveal any complications during the three periods of analysis; remained intact and proved to be biocompatible with a regressive chronic inflammatory response over time; and biointegrated with the surrounding tissues at the implantation site.

Meditation is a mental action that brings countless health benefits. It is known that the practice of meditation induces different responses in brain activity, which seem to be linked to different factors such as the type of meditation and length of experience, for example. Among the different types of meditation, there are those accompanied by music, which are widely practiced. However, little is known about the role of music during meditation, particularly in electrical brain activity. Objective: To compare the power of delta, theta, alpha, beta and gamma frequencies, as well as the pattern of functional cortical connectivity in different types of meditation, with and without music, in experienced individuals in the practice of Raja Yoga - Brahma Kumaris meditation. Methods: 12 volunteers were evaluated, 5 women and 7 men, with a mean age (SD) of 50.45 (16.21) years, who were practitioners of Raja Yoga meditation, at the Brahma Kumaris institution, SalvadorBA-Brasil, for at least 6 years. The experiment was performed using an electroencephalograph with 22 electrodes and was divided into 4 stages: relaxation (RL), meditation (MD), meditation with specific music (MS) and meditation with nonspecific music (MN). Data were filtered and frequencies extracted for the power evaluation. Based on the power results, the frequencies that presented significant differences in the power were selected for the network construction and weighted degree (Kp) extraction, through the motifs method. Results: There was an increase in gamma power in the frontal region during MS and MI compared to MD, as well as an increase in beta power in the frontal region during MN compared to MD. For the beta frequency network, an increase in connectivity was observed in MN compared to MD, according to the paired assessment of all hemispheres, in addition to an increase in beta connectivity in the right hemisphere in MN compared to MS and MD in the task-hemisphere interaction. For the regions’ evaluation, there was an increase in beta connectivity, in the frontal region, during MN compared to MD and MS. And, for gamma network, there was an increase in connectivity in the frontal region during MN compared to MD.

aging is characterized by physiological changes that predispose to muscle wasting, which can be potentiated by poor nutritional status and a chronic, systemic, low-grade inflammatory state characteristic of aging named inflammaging. These are associated with dynapenia and sarcopenia in the elderly, especially those residents in long-term care facility. Objective: to investigate, during the COVID-19 pandemic, the association between nutritional and inflammatory status with dynapenia and sarcopenia in institutionalized elderly. Methods: this is a cross-sectional study carried out with elderly residents at a referral center for geriatrics and gerontology in the city of Salvador-BA. Sociodemographic and clinical data were collected. The diagnoses of dynapenia and sarcopenia were based on the European Consensus on Sarcopenia (EWGSOP2): dynapenia was assessed by hand dynamometer, muscle mass was assessed by calf circumference (CC) and physical performance was assessed by the Short Physical Performance Balance. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and inflammatory status by laboratory tests of C-reactive protein (CRP), neutrophil/lymphocyte (RNL) and platelet/lymphocyte (RPL) ratios, and by the immuneinflammation index (SII). Descriptive statistics were used to characterize the population. To assess associations between nominal variables, the Chi-Square or Fisher's Exact test was used, and to assess quantitative variables, the Student's t test or the nonparametric Mann-Whitney test was used. For associations between nominal variables, the chi-square test or Fisher's exact test was used. For quantitative variables, Student's t test or nonparametric Mann-Whitney test was used. Results: the population consisted of 46 elderly people with a mean age of 80.6 ± 7.5 years and a predominance of females (67.4%). The prevalence of dynapenia was 100% and sarcopenia was confirmed in 82.6%, being 97.4% severe sarcopenia, and 17.4% had isolated dynapenia. The prevalence of malnutrition or nutritional risk was significantly higher among sarcopenic patients (78.9%). There were no significant differences in inflammatory markers between the dynapenic and sarcopenic groups. Conclusion: there was a significant association between sarcopenia and worse nutritional status, but not with inflammatory status. Worse health outcomes were found in the sarcopenic elderly, indicating the potential combined impact of reduced strength, muscle mass and physical performance. The high prevalence of dynapenia, severe sarcopenia and malnutrition or nutritional risk point to the need for greater attention to institutionalized elderly people, especially in the context of the pandemic and its long-term effects.

 Binge Eating (BE) is defined by the consumption of large amounts of food in a short period of time and may be associated with metabolic syndrome (MS). Objective to verify whether there is an association between BE symptom and MS, as well as to estimate the prevalence of BE symptoms in the research participants; to evaluate whether there is a significant association between the MS cofactors (waist circumference-WC, Systemic Arterial Hypertension-SAH, Diabetes Mellitus-DM, High Density LipoproteinHDLc, triglycerides) and BE symptoms; to verify whether there is a significant association of BE and the factors associated with MS (homeostasis model assessment of insulin resistance-HOMA IR and Body Mass Index-BMI); and to analyze the sociodemographic profile of the research participants. Material and methods: cross-sectional, analytical study, with a sample composed of 52 volunteers, 50% with MS, adults and elderly, of both sexes. Data were collected non-presentially, due to restrictive measures required by the pandemic coronavirus disease 19 (COVID-19). A questionnaire, the Binge Eating Scale (BES), was applied, and secondary data were collected: sociodemographic, MS cofactor values, as well as their associated factors. We performed the Shapiro-Wilk test to assess normality of continuous variables and T-student test or Wilcoxon test in R software to compare groups, considering a 5% significance level significant. Results: The sample was composed mostly of women, adults, who studied up to high school, economically active, with an income of 1 to 2 minimum wages. The MS cofactors showed higher mean and median in the MS group, except for HDLc, as expected. The prevalence of BE, according to BES, was 15% in both groups, with and without MS. There was no significant association between BE and MS (p=1.00), cofactors (p>0.05) and factors associated with MS (p>0.05). The present study showed that the use of hypolipemiant is 2.21 times higher among those with BE. When comparing groups, even without significant association, the values of WC, glycemia, triglycerides, systolic blood pressure, BMI and HOMA IR showed higher means when compared to the group without BE, regardless of MS. Conclusion: It is concluded that, different from what was hypothesized, there was no significant association between BE and MS, as well as with the cofactors and factors associated with MS, possibly due to the sample size. 

A neuropsychiatric disorder is a prefrontal disorder with a cluster of symptoms accompanied by dysexecutive behavior related to dorsolateral prefrontal cortex dysfunction Negative symptoms and cognitive deficits in patients with schizophrenia are associated with impaired functional outcomes and quality of life pre-surgery in different spheres of their lives. Objective: This meta-analysis sought to review the data presented in the scientific literature regarding Transcranial Direct Current Stimulation (tDCS) in the treatment of weird and cognitive symptoms characteristic of schizophrenia. Methods: The search model was based on the PICOT strategy, being carried out in the databases MEDLINE/PubMed, Central Registry of Controlled Trials (Cochrane Library), EMBASE and SCOPUS until the data of September 6, 2021. The analysis was developed using o Revision Manager Version 5.4. The assessment of the effects of stimulation was assessed using the symptoms subscale of the positive and negative syndrome scale (PANSS) of each study. Results: 19 studies that addressed negative symptoms and 12 studies that addressed cognitive changes were included, totaling 834 subjects with schizophrenia or schizoaffective disorder. Conclusion: Although the results identify improvements in the frameworks, the heterogeneity between the study methods influenced the overall result of this met analysis. However, its therapeutic benefit for negative and cognitive symptoms requires a high stimulation frequency (at least times a day) with an intensity of 2 mA.

Introduction: Cystic fibrosis (CF) is an autosomal recessive, multisystemic and potentially lethal disease, which incidence is higher in Caucasian population. CF aetiology is characterized by the presence of pathogenic variants in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene, which encodes a homonymous protein. CF heterogeneity is high in frequency and complexity of its clinical manifestations and modifier genes are described as one of the factors that regulates the phenomenon. Objective: To establish the frequency of allelic variants in SERPINA1, SLC6A14 and SLC26A9 genes and to analyze their influence on the heterogeneity of clinical manifestations in individuals with CF. Materials and Methods: The study is cross-sectional. Genomic DNA samples from 56 individuals were subjected to realtime PCR (qPCR) technique in order to identify the genotypes of rs28929474 (SERPINA1), rs3788766 (SLC6A14) and rs7512462 (SLC26A9) variants. The Gene-Calc, dbSNP (NCBI), RegulomeDB 2.0.3 and HaploReg 4.1 platforms were consulted for determining the HardyWeinberg Equilibrium and obtaining genetic and functional data on the analyzed variants. The association between variants and CF-related clinical variables was determined by binomial logistic regression which was performed in RStudio 2022.07.0 software, in which four genetic models were considered: allelic, dominant, recessive and additive. Results: The minor alleles frequencies (MAF) for the rs3788766 and rs7512462 variants were A (0.41) and C (0.4), respectively. All of the alleles in rs28929474 variant were represented by nucleotide C. The rs3788766 variant was significantly associated with dornase alfa use in the recessive (OR = 0.23; p = 0.04) and additive (OR = 0.23; p = 0.04) models, occurrence of pulmonary exacerbations in dominant model (OR = 9.09; p = 0.04), nutritional risk of overweight in the allelic (OR = 4.48; p = 0.03), recessive (OR = 16.03; p = 0.02), and additive (OR = 19.73; p = 0.03) models, and nutritional risk of malnutrition in the allelic (OR = 0.22; p = 0.03), recessive (OR = 0.06; p = 0.02), and additive (OR = 0.05; p = 0.03) models. No significant associations were observed for the rs7512462 variant. Conclusions: The A and C alleles related to rs3788766 and rs7512462 variants, respectively, were frequent among the people in the study. The rs3788766 variant was associated with markers of lung disease (use of dornase alfa and episodes of lung exacerbations) and, especially, nutritional risk of overweight and malnutrition.

Introduction. Cognitive distortions are considered one of the main causes of stress and for this reason, it has been an area of research all over the world. The Cognitive Distortion Questionnaire (CD-Quest) is a questionnaire that identifies cognitive distortions and is used as an instrument in Cognitive-Processive Therapy (CPT). The objective of this study is to construct and analyze the psychometric properties of the CD-Quest S5, as well as to verify whether cognitive distortions mediate the impact of stress on well-being. Method The sample consisted of 1,124 undergraduate students. After evaluating the content validity and analyzing the data, the instrument was reduced to 5 items (out of the initial 15). The content and structure of the items were analyzed by a psychometrician. Finally, to investigate the relationship between the CD-Quest-S and stress-related distortions, the instrument was compared to the original version of the full scale and to two subscales (DASS-21 and WHO5), which measure the frequency of distortions. and the magnitude attributed to them. Result The results of exploratory factor analysis and concurrent validity indicated that CD-Quest-S items have good psychometric properties and reliably generate scores. Conclusion: The study shows that CD-Quest 5 presents favorable psychometric measures to assess cognitive distortions in a population of university students and that stress is directl related to well-being in this population.

ABSTRACT COVID-19 has become one of the most serious pandemics in world history. It is a disease that triggers an exacerbated inflammatory cascade, which demonstrates the relevance of specific micronutrients in attenuating clinical picture. Selenium has gained prominence due to its association with reduction in the incidence of infections, immune and antioxidant improvement, in addition to its contribution to the proper functioning of the thyroid. In Brazil, there are no studies that evaluated the relationship between selenium status in COVID-19 in hospitalized patients and its association with markers of clinical severity, inflammation and thyroid function. Based on this, the study aimed to evaluate inflammatory and clinical biomarkers as well as thyroid complications that are related to urinary selenium status in hospitalized patients with moderate and severe COVID-19. It is a cross-sectional study that is aligned with another cohort, descriptive, observational and prospective study. The sample consisted of 121 patients with COVID-19 that were admitted to the nursing units. Critical patients with a history of thyroid disease, pregnant women and those who used medications that interfere with thyroid metabolism or the ones that have been using iodinated contrast in the last 6 months were excluded from the study. All of the patients in the study had a confirmed diagnosis of SARS-CoV-2 through quantitative reverse transcriptase polymerase chain reaction of respiratory tract samples. Patients underwent measurement of hormonal and immunological biomarkers (thyroid thyroid-stimulating hormone, free triiodothyronine, free thyroxine, reverse triiodothyronine, thyroglobulin, Interleukin 6, D-dimer, C-reactive protein, lactic dehydrogenase). Urine samples were collected within the first 48 hours for selenium analysis. For clinical severity, NEWS2 and qSOFA scores were used, and body mass index was used for nutritional assessment. Patients were divided into tertiles. Mean total urinary selenium was 33.8 (SD=18.8 μg/L), median 31.0 μg/L. 94.2% of the patients had normal urinary selenium, considering the normal range for healthy individuals. Most patients who presented urinary selenium in the lowest tertile were elderly (N=22; 55%). Obese patients, on the other hand, had higher levels of selenium in tertile 3 (N=28; 78.6%). Regarding the NonThyroid Disease Syndrome, 5.7% of the patients presented alteration (p=0.008). Other comorbidities and severity scores were indifferent in the population and between groups. A negative correlation was observed between urinary selenium and all inflammation marker proteins interleukin 6, d-dimer and C-reactive protein (ρ <0; p>0.05), except with lactic dehydrogenase, though without statistical significance (ρ=0.085; p>0.05). Patients, in general, had urinary selenium excretion levels, considering the normal range for a healthy population. In obese population, the result was controversial, given the alterations in Se metabolism in situations of adiposopathy, hepatic and renal dysfunction. A high prevalence of elderly people with lower levels of Se was found, which reveals the vulnerability of this population. No statistically significant differences wereobserved between clinical severity scores, inflammatory biomarkers and urinary selenium, despite studies showing lower levels of selenium in other serious diseases. Non-Thyroid Disease Syndrome was the most significant thyroid complication in the study. 

Cardiovascular diseases (CVD) are the leading cause of death from chronic noncommunicable diseases (NCDs) worldwide. Functional performance assessment has been increasingly used in Intensive Care Units (ICU). Objetive: To verify the functional and ventilatory performance of individuals with heart disease admitted to the ICU and its correlation with the left ventricular ejection fraction (FEVE). Method: This is a cross-sectional study, carried out at the cardiovascular ICU of the Roberto Santos General Hospital, in which patients with heart disease, who underwent a transthoracic echocardiogram (ECOTT) at admission, were submitted to ventilatory function tests, through the assessment of the Maximum Inspiratory Pressure (MAXIP), Peak Expiratory Flow (PEF) and Functional Performance Assessment through the 6-Minute Walk Test (6MWT), Gait Speed Test (GST) and 1-Minute Sit and Stand Test (1min-TSO) , the LVEF value were recorded from the medical record. Results: 111 participants, mostly male (72%), with heart disease, most of them diagnosed with acute myocardial infarction (75%), had a mean maximum distance walked (6MWD) of 354.6±98, 2m, mean gait speed of 1.32±0.4m/s and at 1min-TSO 18±6.1 repetitions, a moderate correlation was identified in three functional tests (6MWT vs. TVM, r= 0.51, p <0.001; 6MWT vs. 1min-TSO, r=0.66, p=0.001 and TVM and 1min-TSO, r=0.51, p<0.001). Conclusion: There is a weak correlation between the LVEF value and the clinical tests, there is a moderate correlation between the functional tests, and it is important to deepen studies on the applicability of these tests in this population, in particular, the 1min-TSO that evaluates strength and resistance of lower muscles and demands less space and time for execution

Congenital malformations represent the second leading cause of mortality in children under one year of age. However, with the advancement of technology, life expectancy reaches 85% of cases after surgery. With increased survival, critically ill patients remain longer in the pediatric ICU, bringing motor, cognitive and pulmonary repercussions. There is a scarcity of studies evaluating the functional evolution of children undergoing cardiac surgery from hospital admission to discharge and its relationship with clinical outcomes. Objective: To verify the evolution of the functionality of children with congenital heart disease (CHD) undergoing cardiac surgery. Methodology: This is a prospective cohort study. We evaluated children with CHD in the preoperative period admitted to a public referral hospital for pediatric cardiology in Salvador. Children with CHD of both sexes, aged between 0 and 18 years old, at admission to the ward or at the PICU were included. The assessment of the functional outcome was evaluated at hospital admission (within 48 hours), at ICU discharge, at hospital discharge using the Functional Status Scale (FSS). Results: The sample consisted of 112 children, with a median age of 12 (6-57) months, 53.6% of whom were male. The most frequent type of heart disease was acyanogenic with 61.6%. Greater functional impairment was found at ICU discharge when compared to hospital admission and discharge. A moderate positive correlation was observed between time on MV and functionality at ICU discharge. Children with moderate to very severe dysfunction were younger, underweight, with longer CPB times, anoxia, MV time, and ICU time. Patients who were readmitted to the ICU had worse FSS scores at ICU discharge. Conclusion: Differences were observed between adequate function/mild dysfunction and moderate/very severe dysfunction in the three evaluation moments.

ABSTRACT

Pediatric Multisystemic Inflammatory Syndrome (SIM-P) is characterized by an exacerbated and delayed inflammatory response that occurs, on average, from two to four weeks after contact with SARS-CoV2 in the population aged 0 to 19 years. Its frequency is considered rare, but with the potential for death due to the severity of the clinical manifestations. The search for genetic variants that confer predisposition to SIM-P should involve the evaluation of the entire human genome or its coding regions (exome). The identification of genetic variants that are determinant for Y-PS-M is fundamental to better understand the genetic architecture of the disease and to define prevention strategies to detect individuals at high risk of developing the disease, as well as the treatment to partially restore the deficient immune response. Objective: Identify Copy Number Variants (CNVs) potentially involved in MIS-C. Methodology: The present study is descriptive in nature, with a convenience sample consisting of 21 children and adolescents (0-19 years of age). The data were organized in Excel 2013 and the statistical analysis was performed using the SPSS program, version 2.8.0 through descriptive and inferential analysis, with the data described by the medians and interquartile ranges. Clinical and laboratory information from individuals diagnosed with MIS-C after SARS-CoV-2 infection were used. The patients came from 03 (three) hospitals in the Northeast region of Brazil. Whole exome sequencing was performed using the Illumina platform (San Diego, CA, USA) with analysis of CNVs in 445 candidate genes. Results: We identified 43 pathogenic or likely pathogenic CNVs in 18 of the 21 patients. These CNVs are present in 30 genes associated with inborn immune errors or described related to SARS-CoV2 infection. Discussion: Most of these CNVs were considered secondary finds for being in heterozigose and associated with diseases with a standard of recessive inherited autosomal. However, eight of the patients showed signs of CNVs, that, according to the zygosity in evidence and the standard of inherited associated phenotypes, can be clinically relevant for SIM-P. These variants are present in the genes IFNGR1, CFHR3, CSF3R, CFHR4, DOCK8, ICOS, SRP72. Conclusion: The identification of these genetic markers enables a better understanding of susceptibility to MISC after COVID and can be applied for the development of targeted therapies.

Crohn's disease (CD) and Ulcerative Colitis (UC), which are chronic
inflammatory bowel diseases (IBD), can cause nutritional deficiencies and metabolic changes.
These alterations can lead to malnutrition, growth deficiency, excess adipose tissue and low
muscle mass. In addition, it can cause a reduction in muscle strength, characterized as
dynapenia. Objective: to evaluate the anthropometric status, prevalence of dynapenia and
associated clinical and nutritional factors in pediatric patients with Inflammatory Bowel
Disease in am outpatient care. Method: this is a cross-sectional study, carried out with
patients aged 2 to 18 years, of both sexes, treated at a reference clinic in the State of Bahia.
The following data were collected: clinical diagnosis, drug therapy, disease activity, serum
levels of vitamin D, erythrocyte sedimentation rate, measurement of weight, height, arm
circumference, arm muscle area, triceps and subscapular skinfolds, handgrip strength. The
sum of skinfolds, arm muscle area and anthropometric indices were calculated. The
anthropometric assessment was classified according to age and sex, according to standardized
criteria. Dynapenia was assessed by low relative handgrip strength. Data were analyzed by
measures of central tendency, Pearson's chi-square test or Fisher's exact test. Results: in
article 1, which described the anthropometric status, 82 patients were evaluated, with a mean
age of 11.2 (standard deviation = 4.448). For children under 5 years old, the weight/height
index identified a state of malnutrition in 30% of the participants and 

overweight in 

20%. In
those over 5 years old, the Body Mass Index/Age identified 11.3% with malnutrition and
14.1% with excess weight. The height/age indicator showed that 19.8% of the participants
were short. Body composition measurements showed adipose tissue depletion in 26.7% when
assessed by AC and in 4.1% by the sum of skinfolds. Low muscle reserve or risk for deficit
was found in 50.9% of participants. The second article, which investigated the presence of
dynapenia, evaluated 40 patients, with a mean age of 12.39 years (standard deviation = 3.28).
Dynapenia was present in 35% of the participants. There was no association between
dynapenia and the evaluated clinical variables. However, a higher frequency of dynapenia
was found among females (40%), children under 10 years old (37.5%), patients with Crohn's
disease (41.2%), those using corticosteroids (33.3% ), overweight (50%), low muscle reserve
(39.1%) and deficient vitamin D (38.5%). Conclusion: the results of the present study
allowed us to conclude that the nutritional assessment, based on the anthropometric indices
and indicators of body composition, identified that pediatric patients with IBD have some
degree of impairment of lean mass and adipose tissue, either in deficit or in excess , and tall.
In addition, an important frequency of dynapenia and vitamin D deficiency was identified.
Proper nutritional assessment, including identification of muscle strength, are of great
importance for the follow-up of pediatric patients with IBD and prevention of nutritional
disorders.

During the complex biological process of repair, numerous compounds have the ability to modulate its capacity, including chamomile (M. recutita). The effects of this plant are due to its biological properties, which can also be studied in the context of wound healing. Another biomodulatory agent widely investigated in the literature is laser photobiomodulation therapy (LPBMT), capable of accelerating the acute phase of inflammation, stimulating cell proliferation, increasing the contraction of skin wounds and accelerating re-epithelialization. Objective: To evaluate tissue repair in the oral mucosa of rats after topical use of chamomile alone and in association with LPBMT. Also, verify the normal tissue pattern, under topical action of this medicinal plant. Methods: Male Wistar rats were submitted to surgery on the dorsum of the tongue using a circular scalpel of 5 mm in diameter, as well as being evaluated for the application of chamomile in normal tissue (jaw mucosa). The animals were allocated into experimental groups, namely: Baseline, Control, Chamomile Extract fluid, Chamomile Infusion 1, Chamomile Infusion 2, Laser, Laser + Chamomile Infusion. Euthanasia was scheduled for days 3, 7 and 14 after the surgical procedure. Clinical, morphological and morphometric analyzes were performed on HE and Sírius Vermelho. Results: No clinical changes were observed in the normal cheek mucosa where chamomile was applied. The morphological and morphometric characteristics evaluated showed similarity between the experimental groups and the control/baseline group, with no statistical differences between them. In turn, when comparing the therapies chosen for the repair of ulcers on the dorsum of the tongue, it was noted that, in general, the Fluid Extract and Laser groups were able to modulate the exudative and proliferative phases of tissue repair, both clinically and histologically. The groups that used chamomile only under infusion or association with laser did not show significant differences in relation to the control group in most of the parameters evaluated. Conclusion: LPBMT and the topical use of M. recutita used in isolation and associated with laser were able to positively modulate different stages of tissue repair. However, better results were found when these therapeutic agents were used in isolation. Furthermore, the topical application of M. recutita under different formulations was not able to cause clinical or histological changes in the normal oral lining tissue.

Both intestinal parasites and Sexually Transmitted Infections (STIs) are a public health problem in the world, whose relationship with conditions of social vulnerability is evident. In this context, co-infections between these agents are frequent, such as S. stercoralis infection in individuals infected with human T-lymphotropic virus type 1 (HTLV-1), which is around 2.4 times higher than in the population. general. Objective: To identify the presence of parasitic infections, emphasizing the co-infection of HTLV-1 and Strongyloides stercoralis in individuals treated at a referral center for HTLV in Salvador, Bahia, and parasitic and sexually transmitted infections in a rural community in Camamu-Bahia. Method: These are two epidemiological, descriptive and cross-sectional study, carried out from Jan./2014 to Dec./2019, with individuals with HTLV-1 treated by the Multidisciplinary Integrative Center of the Bahia School of Medicine and Public Health (CHTLV/EBMSP) Salvador-Bahia (n=178; group 1). and residents of a Rural Community (CR), Camamu-Bahia (n=223; group 2). Information on socioeconomic, sanitary and educational conditions was obtained through the epidemiological questionnaire. The parasitological diagnosis was performed through spontaneous sedimentation, Baermann-Moraes and culture on an agar plate. Serological diagnosis was performed for the detection of anti-S. stercoralis and STIs (HTLV-1/2, HIV-1/2, HBV, HCV e T. pallidum/Syphilis). Individuals from rural areas who needed treatment were referred for care by the Municipal Health Department of Camamu, Bahia. Health education activities were carried out, through workshops, for the prevention of parasites and STIs. Results: The HTLV-1 positive individuals treated at the CHTLV/EBMSP, despite having low socioeconomic conditions, are mostly residents of urban areas, whose sanitary conditions are relatively satisfactory and, consequently, had a lower frequency of infections by S. stercoralis (1.9%) and by other intestinal parasites, while among individuals from rural areas treated by this center the infection by S. stercoralis was about 9 times higher (17.6%). In CR, among STIs, there was a higher prevalence of syphilis (11.7%) followed by infection with HTLV-1 (8.1%). As for parasites, the infection rate in this community was 73.9% and the frequency of specific IgG4 anti-S. stercoralis (22.9%), about three times higher than the identification of larvae in feces (7.2%). The frequency of coinfection by S. stercoralis and HTLV-1 in the community was 1.3% (3/223)

was observed, considering only the parasitological diagnosis. When considering the positive cases in the parasitological and serological diagnosis (detection of IgG-4 anti-S. stercoralis) it was observed 6.7% and a prevalence of 16.7% among individuals with HTLV-1. The transmission by S. stercoralis within the family nuclei in the community showed that a total of 53.3% (119/223) of individuals with positive parasitological and/or serological tests were concentrated in 25 families. In families with five or more individuals, living in the same household, the prevalence of S. stercoralis was 2.45 times higher compared to individuals living in households with fewer than 5 people (p=0.028).  Of the 18 individuals infected by HTLV-1 in the RC, 17 belonged to the same family, probably the transmission occurred through the vertical route. Cytokines and total IgE measurements were performed in 12 individuals belonging to this family nucleus, of these cases, 10 were infected with HTLV-1 and three co-infected (S. stercoralis – hyperinfection and HTLV-1), demonstrating high levels of TNF-α (p=0.034) and IL-17 (p=0.011) and low levels of total IgE. In the process of territorial recognition and development of the research, the report of the experience of the researchers in the CR, emphasizes the situation of social vulnerability of the residents, the receptivity and trust towards the research team, the adherence to the treatment and the active participation in the workshops of prevention of parasitic infections and STIs. Conclusion: Parasitic infections and STIs have a high prevalence in the rural community studied. Coinfected individuals (HTLV-1 and S. stercoralis) living in precarious sanitary conditions are more predisposed to develop severe forms of infection. public policies Investments to prevent health problems can contribute to improving the quality of life of populations living in poverty.

Introduction: Muscle strength is one of the most important domains of the musculoskeletal system, it is already known that strong and healthy muscle is related to a more harmonious functioning of the systems of the human body, however is still limited in the literature the number of studies that investigate and validate the routine use of instruments for quantitative evaluation of peak torque isometric contraction for upper limbs (MMSS), which emerges as a versatile quantitative method, low cost, and easy applicability. In addition to the gap of having delimitation in the literature of reference values, as well as predictive equations of the maximum isometric force evaluated by the handheld dynamometer (DHH). This thesis proposes to further investigate the measurement properties of an established evaluation protocol. This study aimed to establish the reference values and predictive equation of isometric strength for MMSS muscles in healthy individuals aged 18 to 80 years. Method: This study had a quantitative, descriptive, cross-sectional approach and was developed using four procedural methodological strategies. At first (article 1), the protocol of evaluation of maximum isometric strength for 10 of  the main muscle groups of the upper limbs was described, in the second moment was studied the reliability and reproducibility between two methods of use of DHH for upper limb. Subsequently, the concurrent validation of the evaluation with DHH was investigated, compared to the "gold standard" instrument for strength assessment, the isokinetic dynamometer (DI), at the end of the investigation, The normative values of the peak torque for the isometric contraction of the main muscle groups of the MMSS were established, as well as the predictive equations for the limbs movements. Results: In article 1, a practical evaluation protocol was described from the standardization of the positions and measurement methods already reported in the literature, making it feasible and intuitive for evaluators with knowledge in biomechanics. In the second article, it was found that the method not fixed, where the examiner stabilizes the DHH with his own hand during the evaluation, presented excellent reliability and reproducibility, superior to the method fixed with inelastic tape compared. In the third study the evaluation of maximum isometric strength with DHH demonstrated concurrent validity of moderatestrong to excellent when compared to ID, its diagnostic ability has excellent accuracy, agreement compared to the gold standard method in the literature. The fourth article established the reference values for maximum isometric strength for 10 of the main muscle groups of the upper limbs, for dominant and non-dominant limbs. This study created the predictive equations of normality, using the variables weight, age, sex. Discussion: It was established a protocol of evaluation in supine position, aiming that it could be replicated in several environments and conditions. The standardization of the contraction time as well as the rest interval was convergent with methods previously described in the literature. Divergent from the studies described for lower limbs, in this thesis it was observed that the method not fixed presents excellent reliability and reproducibility when the protocol is well trained and dominated by the evaluators. The validation of the  proposed protocol is excellent, as well as previous studies, in some cases with methods similar to that adopted in this thesis. The thesis brings unpublished data of reference values and predictive equation for sample composed by Brazilian, enabling new studies with specific populations and risk groups for muscle weakness. Conclusion: The evaluation of the maximum isometric strength of the MMSS through the DHH is practical, valid, accurate and in agreement with the evaluation with the DI. This domain has established reference values and predictive equations, with easily accessible predictive variables, and the routine use of this method of evaluation and diagnosis in the investigation of muscle health should be encouraged

Objectives: to evaluate the soroconversion effectiveness after the administration of hepatitis B vaccine in children with type 1 diabetes mellitus (T1DM). Method: a systematic review of the literature where the articles were found in the period between 1982 and 2017, guided by the question: Is the seroconversion to hepatitis B with T1DM effective in children and adolescents? The literature was searched in the Medline, SciELO, Scopus and Science Direct database were consulted. Two evaluators independently searched, selected, extracted the data, and assessed the quality of the studies with coefficient of agreement of Kappa 0.7. The degree of agreement between both reviewers was excellent in all cases. Results: Studies with more than 100 participants were evaluated. The variables studied were the frequency/occurrence of immune responses to the hepatitis B vaccine, administered intradermally to fight the disease, as well as its influence on the prevention of hepatitis B in individuals living with diabetes. The sample size ranged from 41 to 4641 children and adolescents. Conclusions: This review is designed for conversion children, and with an enhanced response for an improved response, adolescents and with an enhanced version for an enhanced response, adolescents, with an enhanced version, for an improved immune response. vaccine against hepatitis B. 

Introduction: Dentifrices containing distinct agents like abrasives, peroxides, optical agents and activated charcoal for removing extrinsic stains have been used to promote tooth whitening. Activated charcoal has high porosity and large surface area, which gives this material adsorption capacity, so activated charcoal binds to the tooth surface deposits and retain them in the tooth pores, which are removed during brushing. Despite current activated charcoal-containing dentifrices popularity, their effectiveness in changing tooth color is still unproved, as well as their effectiveness on tooth structure during brushing, mostly when they are used in long term. Objective: Review the literature on the use of activated charcoal in Dentistry and evaluate in vitro the effect of simulated brushing with whitening dentifrices containing activated charcoal on bovine dental enamel. Materials and Methods: In vitro study performed with 70 test specimens divided into 7 groups (n=10): 1 control group (CGColgate® Total 12 Clean Mint) and 6 test groups (TG1- Colgate® Natural Extracts Activated charcoal and mint; TG2 - Colgate® Luminous White Activated charcoal; TG3- Oral-B ® 3D White Whitening Therapy Purification Charcoal; TG4- Oral-B ® Natural Essence Sodium bicarbonate & Charcoal; TG5- Suavetex ® Natural Activated charcoal; TG6- Curaprox® Black is White). Test specimens were submitted to simulated brushing for 6 and 12 months, of which mass, roughness and parameters of CIELAB system, color variation (∆E) and WID index were calculated before and after brushing. Data were analyzed through generalized linear models using R program and considering significance level of 5%. Results: In relation to mass, there was no significant difference among groups. Roughness analysis in relation to time showed no statistically significant difference among groups after 6 months of brushing, however TG1 and TG3 showed significantly less roughness in relation to the initial time (p<0.05) after 12 months of simulated brushing. Comparison among groups showed less roughness in TG2, TG3 and TG4 after 6 months of brushing, which differ statistically from control group, but in TG6 higher roughness was observed (p<0,05). After 12 months, TG1, TG2 and TG3 showed less roughness when compared to the CG (p<0.05). Color evaluation in relation to L*, a* e b* parameters and WID index showed no statistical differences between control group and test groups after 6 and 12 months of simulated brushing. After 12 months of brushing, ∆E was significantly higher for TG4 and significantly less for TG1. Conclusion: Activated charcoal-containing dentifrices did not prromote loss of mass nor roughness increase in bovine dental enamel surface after 6 and 12 months of simulated brushing. Whitening effect was similar to conventional dentifrices. 

Introduction: The tissue repair process is important in restoring the function of organs and
systems, so it is important to investigate alternatives that contribute to the positive modulation
of this process. In this context, Matricaria recutita (chamomile) is indicated for tissue repair,
due to its anti-inflammatory properties. In turn, antimicrobial Photodynamic Therapy (aPDT)
presents contradictory results in tissue repair. There are no documented reports on the
potentiated or non-potentiated effects resulting from the association between these two
therapies. Objective: Evaluate the effect of topical chamomile in the management of oral
mucositis (OM) in cancer patients and to evaluate this same agent in the repair of an
experimental ulcer made in the dorsum of the tongue in rats alone or associated with aPDT.
Material and methods: It was a systematic review, which sought articles of the randomized
clinical trial in the databases PubMed, Cochrane Library, and Bireme according to the
PRISMA parameters, registered in the PROSPERO. Furthermore, an experimental study was
carried out with 75 male Wistar rats were submitted to a 5 mm diameter surgical wound made
on the dorsum of the tongue. The animals were allocated in the experimental groups: control,
chamomile extract fluid (Ad-muc®), chamomile infusion, aPDT, aPDT + chamomile
infusion. Euthanasia was scheduled for the 3rd, 7th and 14th day after the surgical procedure.
Clinical, histomorphological and histomorphometric analyzes were performed on sections
stained with hematoxylin and eosin and red sirius. Results: A total of six articles were
included in the systematic review. The results showed that the application of topical chamomile
was effective in the prevention and (or) treatment of OM in four of the six studies, with a dose
ranging from 1% to 2.5% and duration that ranged from single to four times/day. Regarding
the experimental study, when comparing the therapies chosen for ulcers' repair on the dorsum
of the tongue, it was noted that the chamomile extract fluid (Ad-muc®) group showed
superior clinical (p<0.0001) and histological results, whether in descriptive or inferential
analysis (p<0.05). The groups that used chamomile under infusion did not show significant
differences in relation to the control group in most of the parameters evaluated, while the
groups that underwent aPDT did not modify tissue repair. Conclusion: The application of
topical chamomile in the different forms of presentation in the management of chemoinduced
OM seems to be well indicated. Additionally, the fluid extract of chamomile (Ad-muc®)
showed superiority in tissue repair in oral ulcers in rats. It is recommended that new clinical
trials be carried out in order to obtain results that reaffirm these findings and that favor the
establishment of effective protocols.

Introduction: Psychiatric disorders have been associated to decrease in bone mineral density. It occurs due to use of medication and lifestyle, in relation to psychopathology. Imaging techniques in Dentistry, such as computed tomography scan (CT scan), have been used as an indicator of bone mineral density. Objective: To evaluate bone quality in individuals diagnosed with psychiatric diseases, through radiomorphometric indices, obtained through CT Scan. Method: Face and mandible CTs were selected from patients diagnosed with psychiatric disorder undergoing treatment in an university hospital, during 2010-2022, and they composed the test group. Control group was constituted from face/mandible CTs of patients without psychiatric disorders that were matched by sex and age (+3 years). Analytics were made in DentalSlice® software, by which was obtained a standardized panoramic curve and mental foramen area. Total of 5 different tomography indicators were selected: computed tomography mental index (CTMI), computed tomography mandibular index superior (CTI(S)), computed tomography mandibular index inferior (CTI(I)) and index of mandibular alveolar bone resorption; they were measured bilaterally and averaged. Computed tomography cortical index (CTCI) was used for qualitative assessment of cortical mandibular. Analysis was made by a single trained examiner who performed measurements. Descriptive and exploratory analysis were made. Confirmation of pairing between test and control groups was performed by Student's t-test for age, Fisher's exact test for age range, and Chi-square test for gender and number of teeth. Comparisons between test and control groups for IMTC, ITC and IROAM were performed by generalized linear models. Analysis of association between CITC and group were performed by Fisher's exact test. Analysis were performed in R Core Team program (R Foundation for Statistical Computing, Vienna, Austria, 2022), with a significance level of 5%. Results: 67 CT’s were evaluated in test group and 56 in control group. Within the test  group, 76.1% used antipsychotics, 40.3% used antidepressants and 23.9% used lithium. Individuals with psychiatric disorders have lower IMTC and ITC (I) values than patients without psychiatric disorders (p<0.05). There was a lower percentage of individuals in C1 category of ICTC among patients in psychiatric disorder group (16,4%) than in control group (44,6%), p<0.05. Regarding the use of psychotropic medications, ITC (S) and ITC (I) were significantly higher among those using antipsychotics (p<0,05), while in individuals who used antidepressants, the ITC (S) and the ITC (I) were significantly lower (p<0.05). Regarding ICTC, there were only cases of category C1 among those using antipsychotics (p<0.05).Conclusions: It was observed that individuals with psychiatric disorders tended to have lower bone mineral density, and that most individuals with psychiatric disorders taking antidepressants or antipsychotics had thin and porous mandibular cortices.  

troduction – Staining on composite resins is still one of the most important causes of clinical failure in anterior and posterior teeth. Coloring substances as well as distinct lightcuring processes may influence color stability from these materials. Objective – To evaluate color change in two single-shade composite resins, Vittra UniqueÒ (FGM, Joinville – SC, Brazil) and Palfique OmnichromaÒ (Tokuyama, Yamaguchi, Japão), which were submitted to three light-curing processes and immersion in coffee for 30 days. Materials and methods – Methodological process was composed of the following articles: the first one evaluated color stability in two single-shade composite resins, Vittra Unique (FGM, Joinville – SC, Brazil) and Palfique Omnichroma (Tokuyama, Yamaguchi, Japan), which were submitted to three distinct light-curing processes. A light-curing process was performed using a LED unit that were positioned in the center of the specimen and also other two light-curing processes, in which the LED unit was positioned in the center of the two halves: upper and lower of the specimen, while the time of light application varied (20 seconds and 40 seconds, respectively); the second one evaluated specimens which were submitted to light-activation process, but using two LED units with distinct diameter lenses, Valo (9.75mm) and Valo Grand (12mm). For both articles, specimens measuring 2X8X10mm were made, which were submitted to the protocol of immersion in coffee for 30 days and color evaluation was carried out throughout the experiment (initial, 15 and 30 days) in CIEL*a*b* system standards, using a spectrophotometer (UV-2600, SHIMADZU) and a portable spectrophotometer (Easy Shade), in order to evaluate color alteration along the specimen. Results – For statistical analysis, the Analysis of Variance (ANOVA) and the Tukey test were used as a post hoc test, with a significance level of p ≤ 0.05. In Article 1, results of spectrophotometer showed higher ∆E for the 20s second group and lower ∆E for 40s first group. In Article 2, no statistically significant differences were observed for total color change (ΔE) between the two tested light-curing fixtures. In both articles, there was no significant difference in color stability between the two areas of the specimen in two tested resins. Conclusion – For both articles, the composite resins from groups that were immersed in coffee showed greater staining. In Article 1, two places light-curing process in association with long light exposure resulted in higher color stability for both tested composite resins. In Article 2, the diameter of the LED unit lens did not influence the color stability of the tested composite resins. 

Oral lichen planus (OLP) is considered a potentially malignant oral disorder with the possibility of varied clinical manifestations, characterized histologically by the presence of a strip of subepithelial inflammatory infiltrate and by degeneration of the basal layer of the epithelium. The presence of the keratin layer and Civatte bodies can also be identified. The diagnosis of OLP is clinical-pathological, which can generate subjectivity. The use of histomorphometry would generate more objective analyzes, which could assist in the diagnosis of these injuries. Objective: Check the association between the groups of white and red lesions and histomorphometric differences in OLP lesions. Methods: This was a retrospective cross-sectional study, in which 48 slides were analyzed, which belonged to the collection of two different laboratories of Higher Education Institutions, and which were subjected to evaluations from the point of view of morphological variables and morphometric measures. Histomorphometric analyzes comprised the measurement between the basal distance to the epithelial surface, the distance from the apex of the dermal papilla to the epithelial surface, interpapillary distance, dermal papilla width, thickness of the keratin layer, thickness of the subepithelial band of the inflammatory infiltrate, extension and depth ulcer and were performed at the Oral Biochemistry Laboratory of the Institute of Health Sciences of the Federal University of Bahia. Results: It was observed that 81.2% of the sample was female and 50.0% were under 50 years old. As for the injury site, it was observed that in 58.3% of cases it occurred in the jugal mucosa, with 83.3% of the sample showing a white lesion and 18.8% was a smoker. It was noted that 10.4%, 10.4% and 37.5% of the cases were classified as moderate / severe in relation to the variables keratosis, acanthosis and inflammatory infiltrate, respectively. It was also noted 52.1%, 54.2%, 12.5%, 39.6% and 68.8% of the cases exhibited, respectively, inflammatory infiltrate band, papillary projections, saw teeth, degeneration of the basal layer and Civatte bodies. There was no significant association between the type of injury and the variables sex, age, injury site and smoking habit (p> 0.05). There was no significant association between the type of lesion and histological variables (p> 0.05), as well as between types of lesion and morphometric variables (p> 0.05). There was also no significant difference between clinical-demographic variables and morphometric variables (p> 0.05). Conclusion: There seems to be no association between white and red lesions of OLP and their histomorphometric characteristics. However, it is suggested that further studies be carried out with the use of morphometry, in order to investigate whether there are histopathological differences between such lesions, which may define behavioral variations in them.

although respiratory function (RF) is diminished in the early stages of Parkinson's disease (PD), conventional and alternative physical therapy interventions don’t focus impaired respiratory function. OBJECTIVE: the aim of the study was to evaluate the effects of functional training, training on a stationary bicycle, and exercises performed on Exergame, on the respiratory function of elderly people with Parkinson’s disease in mild and moderate stages. METHODS: a total of 58 participants completed the intervention protocol, randomized into 3 groups, 18 in the functional training group (FG), 20 in the stationary bicycle training group (GB) and 18 in the Exergame group (GE). All interventions had a duration of 8 weeks and a frequency of 3 times a week. As a primary endpoint, forced expiratory volume in the first second (FEV1) was investigated. Secondary end points were forced vital capacity (FVC), peak expiratory flow (PEF), maximum inspiratory pressure (Pimax), and maximum expiratory pressure (Pemax). The evaluations were carried out before and after the interventions by a single blinded researcher. RESULTS: the performed interventions did not present significant results on FVC, FEV1 and PEF. However, GB showed a significant improvement in Pemax, median from 60cmH2o to 80cmH20 (p = 0.03) and the EG significantly improved Pimax, median from -58cmH2o to -70cmH2o (p = 0.01). There was no difference in the comparison between the groups. CONCLUSION: The interventions performed did not significantly change FVC, FEV1 and PEF however aerobic training on a stationary bicycle improved expiratory muscle strength and exergame exercises improved inspiratory muscle strength. These results suggest the need to evaluate and implement actions to prevent and treat respiratory function decline in elderly people with Parkinson’s disease at an early stage.

The clinical performance and physical properties of photopolymerized resinous materials are strongly influenced by their respective degrees of conversion from monomers to polymers. This conversion depends not only on the visible light emitted by the photopolymerizer and the photoinitiator system present in the resin, but also on the amount of light energy that reaches the material and which is dependent on how that light is made available to a resin. Objective: To verify the influence of the tip inclination of two light curing devices on the base and top microhardness of a composite resin, with two different degrees of opacity. Material and methods: One hundred and twenty cylindrical specimens (6mm in diameterX1.5mm height) were made and divided into twelve experimental groups (n = 10), according to the opacity of the composite resin (Vittra APS - FGM / color A1) : Enamel (E) and Dentin (D), with three angulations of the tip of the light curing device (0º, 20º and 45º) and with the two tested light curing devices (Valo - Ultradent and Radii-cal - SDI). The specimens were photoactivated according to the manufacturer's recommendation: Enamel (E) 20 seconds and Dentin (D) 40 seconds. On the top and bottom surfaces of the specimen, Knoop hardness values were recorded, from three indentations performed in the center of each surface, with a load of 245.2 mN (HV 0.025), applied for 15 seconds. The Knoop hardness value (KHN) was published by the average of the indentations of each surface of the specimen. The data were imposed by ANOVA (3 factors), Tukey test, for comparisons and multiple t-student tests, for paired data of the base and top microhardnesses, at the 5% significance level. Results: As the use of form was not verified among the three factors studied, the main factors were formed, for the two surfaces tested (top and bottom). Valo resulted in values higher than those used by Radii-cal, regardless of the opacity of the composite resin and the tested angulation. On the top surface, a dentin resin showing greater hardness compared to the enamel resin. Regarding the angulation, the highest hardness averages were adjusted to 0º and 20º, with no differences between them. Conclusion: The use of a photopolymerizer with a greater light spectrum was able to increase the microhardness of the resin composed of enamel and dentin. Increasing the angle of the photoactivator tip in relation to the resin material to 45o reduced the microhardness of the composite resin, regardless of its opacity.

epilepsy is characterized by changes in excitability and neuronal synchrony that lead to disorders in the brain network. Currently, about a third of patients have pharmacoresistance, so, neurostimulation has been used as an adjunctive treatment. In this context, the temporal structure of the stimulus has been shown to be essential for therapeutic efficacy. The electrical non-periodical stimulation (NPS), has shown significant anticonvulsant effects providing a basis for the development of studies in humans. The use of Acoustic nonperiodical stimulation (ANPS) following the NPS showed beneficial clinical results in patients with refractory epilepsy. Objectives: to evaluate the ANPS effects in functional cerebral synchrony networks in refractory epilepsy, from a dynamic perspective; to assess whether there were changes in dynamic functional connectivity after using ANPS treatment; to assess whether there was an increase in the Complete Synchronization Time (CST) after treatment. Methodology: from the electroencephalographic (EEG) records of patients with refractory epilepsy, in the interictal state, functional brain networks (RFC) were generated, represented by time-varying graphs (TVG) and aggregate static networks (ASN). We used the motifs synchronization association method and evaluated dynamic indices such as the degree of temporal connectivity and the CST. The effect of the ANPS was assessed for the acute phase (n = 11 patients) and up to the fifth day of stimulation (n = 8 patients). Results: the temporal connectivity decreased and increased significantly, on the first and fifth days, respectively. The distribution of edge weights showed a reduction (acute effect) and an increase on the fifth day, for the most frequent edges, with the maintenance of the highest weight edges, in all states. CST showed trends opposite to those of connectivity. While the most representative hubs showed variation in location, with no changes in connectivity or amount of synchronization. Discussion: Our results point to an acute effect of the EANP of a general reduction in the dynamic connectivity of the network, followed by an apparent habituation of the connectivity and amount of synchronization. In addition to a maintenance of the most important connections in the network, and a continuous change of the electrode’s hubs, in the network indicating a probable reorganization of the network. Conclusion: our results showed that the ANPS has a modulating effect on brain synchrony and that the temporal structure of the stimulus constituted a major factor for this, new assessments are necessary to verify the variability of topological connection patterns over time.

People with chronic kidney disease (CKD) have a high risk of developing changes in the oral cavity, thus, the dentists is one of the professionals of the multidisciplinary team who will contribute and care for these people, emphasizing the importance of knowledge for adequate clinical assistance. Objective: This study evaluated, through an electronic questionnaire, the degree of knowledge of dentists about the systemic condition of people with chronic kidney disease and its implications for oral health. Material and Methods: Dentists were invited, through virtual social networks and e-mail, to participate in the study. The study sample consisted of 264 participants. The data were analyzed using descriptive statistics of simple and relative frequencies, as well as measures of central tendency and dispersion. Results: The study showed that 88,25% considered it important to monitor the patient with the nephrologist; 76,13% agreed that blood pressure measurement should not be performed on the arm with the presence of a shunt; 52,65% did not know about the susceptibility of the occurrence of a brown tumor; 94,7% agreed with the appearance of opportunistic infections due to immunosuppression; 93,94% agreed to avoid nephrotoxic drugs; and 78,79% stated that antibiotic prophylaxis in the presence of shunt was necessary, among other results. In addition, most participants agreed to avoid nephrotoxic drugs, however they did not know or agreed with the prescription of non-steroidal anti-inflammatory drugs. The condition of the professional having one or more specialties contributed to the feeling safer for the patient attendance. Conclusion: The participants showed partial knowledge about the proposed theme. The clinical and pharmacological approaches were partially assertive and there are difficulties regarding the management of the person with CKD. The dentist's knowledge and performance in the care of people with systemic diseases is essential, aiming at comprehensive care for these patients.

: The practice of sports, especially recreational running, has increased considerably due to adherence to a healthier lifestyle. In running, musculoskeletal injuries of the lower limbs are frequent outcomes and the feet, being the first structure to receive and adapt to the forces of reaction to the ground, have been the subject of studies that seek to understand the mechanisms of injury and interventions focused on prevention. In this sense, a therapeutic approach is the use of insoles, however studies have shown controversial results and their action on biomechanical variables is not well understood. Objective: To verify the effect of using insoles on the strength of the lower limbs and the step pattern of recreational runners. Methods: 134 individuals were included, aged between 18 and 65 years, age group who tends to participate in street running, of both sexes, who have been running for at least 4 continuous months, with no history of injury in the last 3 months. Of this initially randomized sample, only 31 runners completed the study. The experiment group (GE) was then configured with 20 participants who received the test insoles made up of foot adjustment elements to replace the original insole of their usual tennis shoes and the control group (GC) in which 11 participants received a pair of type insoles sham that are flat and made of EVA with 5mm thickness and without any type of adjustment. Participants were interviewed and referred for the collection of the type of step using the 6-item Foot Posture Index (FPI-6) and isokinetic muscle strength using a Biodex System Pro 4. The variables of interest studied were: type of step, muscle strength of abductors and hip adductors, muscle strength of knee extensors and flexors and muscle strength of ankle inverters and eversors. The research was approved by the Research Ethics Committee of the Institute of Health Sciences of the Federal University of Bahia, under opinion No. 2,621,166. Results: There was no significant association related to the modification of the type of step after the insertion of the insoles. Significant differences were found in the movements of the hip joint, with increased muscle strength between the initial and final assessment for the right abduction and right adduction (EG and CG) and in the left abduction (only in the EG). Conclusion: The results suggest that although the use of insoles does not produce a significant change in the type of step, there is a tendency to neutralize the step. There was also no change in the muscular strength profile of the ankle and knee, but an increase in strength was found in the hip region, especially in the abductor group. These results should be interpreted with caution as this is a pilot study with a small sample.

Periodontitis is a multifactorial inflammatory disease that affects the supporting tissues of the tooth, which can lead to tooth loss. The interaction of specific bacterial complexes involved in periodontitis, risk factors that interfere with the immune response of the host, including, for example, the cellular regulation of fibroblasts, osteoblasts and osteoclasts, and genetic susceptibility and specific variants, may be associated with the disease and to the difficulty of treatment. The RANKL/RANK/OPG system is involved in osteoclast differentiation and activation, regulating cellular responses and bone resorption in periodontitis. Genetic variants can influence the expression of these genes, which have been associated with diseases, in different populations. Objectives: Describe the frequency and regulatory potential of RANK, RANKL and OPG system variants; assess their potential as ancestry informative genetic markers (AIM); to evaluate the association of genetic variants in RANK, RANKL and OPG with the presence of periodontitis. Methodology: Cross-sectional study with 506 adult individuals participating in a cohort, affected by asthma and periodontitis. The genomic DNA was extracted and genotyped using the Illumina Multi-Ethnic Global Array (MEGA, Illumina) platform. The NCBI, Regulome DB, Haploview 4.2 and rSNPBase platforms were consulted and used. For association analyses, they were classified as having the presence (n=117) or absence (n=389) of periodontitis; and statistical analysis was performed using the PLINK 1.9 software, using logistic regression adjusted for age, obesity, mouth breathing habit, flossing, asthma and main component of ancestry. Results: The most frequent variants in the population studied were: rs4941129 in RANK, lowest allele frequency (MAF) 50%; the rs9525641 in RANKL, MAF 46% and the rs3102724 in OPG, MAF 46%. The rs 17069898 (1f) in RANK, rs2200287 (1d) in RANKL and rs3134063 (1f) in OPG had greater functional impact. In OPG and RANK, nine polymorphisms were characterized as AIM, predominantly YRI (African) and CEU (European) populations. They were associated with periodontitis in the RANK 27 SNV gene (single nucleotide variant), 20 of which were positively (odds ratio >1) and 16 of them showed high correlation with each other, ranging from 81% to 100%; and 7 negatively (odds ratio<1) and 2 of them with high correlation (96%), while 2 in perfect balance (r2=1.0). In RANKL, 11 SNV were positively associated with periodontitis, with 6 being in perfect balance (r2=1.0) and 4 in high correlation, ranging from 96% to 100%. In OPG, 2 SNV were positively associated with periodontitis. These variants are in high linkage disequilibrium (r2=0.99). In the RANK gene 1f (rs4941125), 2b (rs55850220) and 3a (rs34432351, rs72931591 and in the RANKL 3a gene (rs115675044 and rs443188) there is a possibility of involvement in regulatory and functional regions. Conclusion: Variants of the RANK, RANKL and OPG genes were frequent in the population studied and had their most frequent alleles associated with diseases in ancestral populations; and 40 variants are positively and negatively associated with periodontitis.

The antinociceptive effect of ozone (O3) has been described in the literature and may be related to the increase in the endogenous antioxidant defense system, impacting cell metabolism and tissue oxygenation. However, the effect of this minimally invasive therapy in the treatment of myofascial pain remains controversial, especially in those pains related to temporomandibular disorders. Objective: To evaluate the effects of ozone therapy on nociception, inflammatory process, and tissue repair in the masseter muscle of rats in a carrageenan-induced inflammation model. Materials and Methods: The inflammatory process was induced through the administration of lambda carrageenan in a 2% solution of 100 µL, in the right masseter of the rats, and the nociceptive threshold evaluated using the digital analgesimeter for the von Frey test in times of 5 hours, 1, 3 and 7 days after its administration. The control group received saline under the same conditions. To assess the effect of ozone therapy (O3) on nociception caused by carrageenan, rats were treated with O3 at a dose of 0.0016 mg/Kg in a volume of 0.01ml right after administration of carrageenan or saline (O3+Car and O3+Salt). Ibuprofen at a dose of 14mg/Kg was used as a positive control (Ibup+Car and Ibup+Sal). One and eight days after administration of carrageenan or saline, the animals were euthanized and the masseters processed for semiquantitative histological analysis. Results: The antinociceptive study showed statistically significant differences between the Sal and Car groups in the periods of 5h, 1d, 3d, and 7d, between the Ca and Ibup+Car groups in 1d, 3d and 7d and between the Sal and O3-Sal groups in 5h and 7d. There was no difference in the nociceptive threshold variation when the Car and O3+Car groups were compared. One day after carrageenan, the histological evaluation of the Car group showed hemorrhage, edema and acute inflammatory infiltrate occupying areas of intense tissue destruction, which were slightly more severe in the O3+Car group. Within 8 days, the Car and O3+Car groups shared the same histological findings: chronic inflammatory infiltrate with some lymphocytes, many macrophages, and rare mast cells associated with severe tissue damage. Unlike the Sal and Ibup+Sal groups, the O3+Sal group showed a discrete chronic inflammatory infiltrate that filled small areas of tissue destruction. Some neutrophils were observed in the vicinity of regenerating muscle fibers in the groups undergoing ozone therapy. Conclusion: Intramuscular ozone therapy could not reduce nociception, muscle necrosis, and degeneration, inflammation, and edema induced by carrageenan infiltration in the masseter muscle, however, it was shown to stimulate the repair of tissue injuries of inflammatory origin through a pathway related to neutrophils.

Previous dental disorders and inadequate oral hygiene are risk factors for the emergence of oral complications during oncotherapy. It is important for the dentist and the medical team to work together to carry out prevention and dental therapies before and during oncotherapy. Objective: Evaluation of the epidemiological and imaging profile of individuals followed up in cancer treatment who underwent panoramic radiography before or during cancer therapy in a referenced diagnostic imaging clinic in Salvador-Bahia between August 2016 and March 2020. Material and methods: Sixty-five panoramic radiographs of these individuals were evaluated, which were divided into oncological pre-treatment and during. Data were tabulated: date of examination, sex, age, tumor location, presence and location of metastasis, stage and oncotherapeutic treatment, number of teeth with caries lesions, residual roots, affected by punctual bone loss except for furcation and with furcation involvement, root lesion, presence of dental calculus, generalized bone loss, CCM and ICM. Results: Were developed the variables NTO (analyzing the need for endodontic, periodontal, extraction and restoration treatment) and NDNTO (analyzing the number of teeth with such needs). 65 people were part of the analysis, 47.7% were in the pre-treatment and 52.3% during. In the pre-treatment, 51.6% were male and 48.4% female, while during the period it was 23.5% and 73.5%. The age group in the pre-treatment was 19.4% less than 45 and 80.6% 45 or more while in the during it was 8.8% and 91.2%. Regarding anti-resorptive and anti-angiogenic medication, there was only use during the period and this value was 41.2%. In the treatment modality, being together or alone in the pre-treatment 25.8% surgery, 35.5% radiotherapy, 80.6% chemotherapy, 22.6% hormone therapy, 6.5% target therapy, 29% immunotherapy, 6.5% BMT, 0% iodine therapy, 3.2% comfort measures and home palliative care; in the during was 47.1%, 35.3%, 91.2%, 38.2%, 20.6%, 2.9%, 2.9% 0% and 0% respectively. They presented dental calculus in the pre-treatment 67.7% and during the 85.3%. NTO 3% in the pre-treatment and 85.3% during. NDNTO a median was 4 (q=1 and q3=6) in the pretreatment and 4 (q1=2 and q3=7) during. Regarding generalized bone loss, in the pretreatment 45.2% of people were absent, 22.6% mildly, 9.7% mild to moderate, 12.9% moderate, 3.2% moderate to severe and 6. 5% severe and not during these values were 32.4%, 29.4%, 8.8%, 23.5%, 2.9% and 2.9%. n the CCM for pre-treatment were 22.6% continuous, 51.6% discontinuous and 25.8% indefinite, for during were 17.6%, 67.4% and 17.6% respectively. In the ICM for pre-treatment they were 6.5% in C1, 35.3% in C2 and 55.9% in C3 and for 8.8%, 35.3% and 55.9% respectively. Conclusion: There were a large number of people with unsatisfactory oral hygiene and some NTO. This number was high in the pretreatment period, but it was even higher in patients who were on anticancer therapy. BMD was lower during oncotherapy.

There are few studies assessing the speech and language development process of children born small for gestational age, although changes in these areas can entail psychosocial and school problems. Objective: Investigate aspects of oral language in schoolchildren born full-term and small for gestational age and to check whether these findings differ when compared to those found in schoolchildren born appropriate for gestational age. Material and Methods: This is a cross-sectional study, with a convenience sample, unpaired and nested in a cohort. Through an interview, information on perinatal and postnatal conditions was collected and participants underwent audiological and aspects of oral language using the ABFW test (2004). The results were assessed by descriptive and analytical analysis, using unpaired t test, Pearson’s chi-square test and Fisher’s exact test, with significance level p <0.05. Results: Article # 1, aimed to conduct a systematic review to verify findings in the literature that specify the association between the term birth of children considered small for gestational age and the outcomes in the development of oral language. The reviewed studies pointed out that being born small for gestational age can interfere with aspects related to language and reported greater chances of underperformance in small for gestational age children when compared to appropriate for gestational age children. In article # 2, the objective was to characterize the use of phonological productive processes in schoolchildren born full-term and small for gestational age. This is an observational, analytical, case-control and non-paired study, nested in a cohort with the outcome of phonological disorder. The small for gestational age group had a greater number of phonological productive processes, not expected for their age and those that change the syllable structure, when compared to the group of children appropriate for gestational age. It was noted that the phonological processes present in the small for gestational age population were: fricative plosivation, liquid simplification, palatal posteriorization and frontalization, plosive and fricative deafening, in addition to simplifying the consonant cluster and simplifying the final consonant, which were the most frequent in both groups. Although no association was found between phonological disorders and small for gestational age children, it was noted a greater use of productive phonological processes in this group. Article # 3, considered a cross-sectional study, typified as analytical, with convenience sampling, unpaired and nested to a cohort, objective to describe the expressive vocabulary performance of schoolchildren born full-term and small for gestational age. The studied population performed below the expected in expressive vocabulary tests, in most of the conceptual surveyed fields, with statistically significant differences in the average occurrences of designation by usual word in the semantic fields of transport facilities and forms and colors, non-designation of the field of foods, furniture and utensils and places and replacement process of the conceptual field of transport facilities. Conclusion: The findings of the articles suggest that children born full-term and small for gestational age are likely to perform poorly in tests that assess aspects of oral language, such as phonological and expressive vocabulary, when compared to appropriate for gestational age children.

The aesthetic restorative procedures include many dental materials, leading to the constant need for professional updating to obtain the best clinical result. The aim of this study was to evaluate the effect of different insertion techniques, with conventional and bulk fill composites, on the diffusion dynamics, the presence of voids and the marginal adaptation of the restorations, through stereoscopic and radiographic evaluations. For this, two studies were carried out: one with 60 specimens made with 6 different forms of restoration (n = 10) using conventional resin, conventional flow, regular bulk fill and bulk fill flow: BF (1 increment: 4mm of bulk fill regular), BFF + BF (2 increments: 2mm bulk fill flow + 2mm regular bulk fill), RC (2 increments: 2 mm of conventional resin each), RCF + RC (2 increments: 2mm of conventional flow + 2mm of conventional resin ), BFF + RCF (2 increments: 2mm bulk fill flow + 2mm conventional flow) and BFF + RC (2 increments: 3mm bulk fill flow + 1mm conventional flow resin). Water sorption, solubility and presence of voids in the restorations were evaluated. It was observed that the means of water sorption between the groups BF and RC did not show statistical difference, between the groups RCF + RC, BFf + RCf, BFf + RC, no statistical differences were identified in the means of water sorption nor in the averages of solubility. The RC group had a higher average number of voids with larger areas, when compared to the BF group. The BFF + RCF group, in relation to the average number of voids and the area, showed no statistical difference with the RC group, but, when compared with the BF group, it presented almost twice as many voids. It is concluded that regular bulk fill resin and conventional composite resin improve their diffusion dynamics properties when associated with other increments and flow resin. However, the quantity and area of the voids increase when these associations are made. In the second study, 60 molars were restored in 6 different ways, using the same types of composite resins as in the first study. The groups, after thermocycling, were evaluated for marginal adaptation, marginal infiltration through radiographic examination and stereoscopic examination by 3 examiners calibrated with the FDI criteria. No statistically significant differences were identified in the scores for marginal adaptation and marginal infiltration between groups. The exception was the BFF + RC group, which showed a statistically significant difference in relation to the other groups in the radiographic evaluation of marginal adaptation. Thus, it was possible to conclude that composite resin restorations have good marginal adaptation and low microleakage, regardless of the restorative technique, the type of composite resin and the use of fluid composite resins associated with each other. With the results of the two studies, it was possible to conclude that the type of composite resin used and the form of insertion of this material interfere in its diffusion dynamics, but not in the size of the voids, however, it was possible to achieve excellent results in the infiltration assessments and marginal adaptation of restorations.

Since its introduction two decades ago, the benefits of negative pressure therapy at wound management have been widely demonstrated at medical practice. However, the high cost and complexity have limited the use of treatment at places with limited health resources. To overcome the limitations, it has been proposed the use of less sophisticated and less expensive devices – simplified vacuum dressings –, although their usefulness is poorly studied. Objectives: To evaluate the efficacy, safety and operational and financial feasibility of a simplified vacuum dressing model. Material and Methods: Randomized clinical trial in which clinically contaminated wounds were treated with a simplified vacuum dressing device compared to a control dressing (silver hydrofiber). The study was developed in the form of two scientific articles. In the first one, these were considered as the efficacy outcomes: cleaning, presence of granulation tissue, clinical appearance and indication for surgical management of wounds. Efficacy indicators, the frequency of adverse effects and indicators of efficacy adjusted for adverse effects were calculated. In the second one, operational feasibility was analyzed through analysis of installation time and quantity of dressings performed, besides the financial feasibility through analysis of the direct economic costs of dressing changes. Results: Fifty wounds of moderate extension were treated (25 in each group), from which most of them are acute injuries located on lower limbs and almost all of them present biofilms. Arterial hypertension and diabetes mellitus were the most frequent comorbidities. Article 1: Simplified vacuum dressing were presented as more effective than the hydrofiber in all the evaluated outcomes. The recalcitrance of the wounds reduced the effectiveness of the device used to granulate and clean the lesions. There was a similar reduction of wounded areas in both treatment groups. In almost all of the wounds from the simplified vacuum dressing group was observed biofilm rupture. Bleeding, foam adherence to the bloody bed, pain, maceration, contact dermatitis, hematoma and necrosis were the complications found. Only with regard to bleeding and wound dressing adherence, it wasn’t found a favorable risk-benefit ratio in all the studied outcomes. There were no serious complications, treatment interruptions, worsening injuries or deaths. Article 2: The number of dressings per patient was lower, while the installation time was higher. The simplified vacuum dressing showed higher estimated costs, both for dressing and cost. The increase in costs associated with simplified vacuum dressing was related to the product average selling price and the number of dressing changes. Conclusion: Article 1: Simplified vacuum dressing was more effective for cleaning and covering the wounds with granulation as well as improving the clinical aspect and the indication for surgical closure of the lesions. Simplified vacuum dressing also had a favorable risk-benefit ratio for most of the complications found. Therefore, simplified vacuum dressing was considered to be an effective and acceptably safe form of vacuotherapy compared to silver hydrofiber. Article 2: Simplified vacuum dressing proved to be less viable both operationally (more complex installation) and financially (more expensive). Overall conclusion: The simplified dressing was considered a negative pressure therapy alternative, as it proved to be effective, safe and, compared to standard vacuotherapy, less costly. The lower viability was not considered a limiting factor, as it can be resolved with adequate training and minimizing dressing changes. 

COPD presents high prevalence and morbidity with high social cost. Environmental pollutants can contribute to exacerbation and hospitalizations for COPD, causing burdens to patients and the public health system. It is important to identify areas of higher concentration of hospitalizations and possible associated factors. Objectives: To describe the profiles of hospital admissions for COPD, concentrations of air pollutants and environmental parameters (study 1), and characterize the pattern of spatial distribution of hospital admissions, describing the socioeconomic and sociodemographic characteristics of the population and the presence of health establishments (study 2), from 2014 to 2015, in Salvador-BA. Methods: This is an exploratory descriptive epidemiological study, developed using two methodological strategies: In study 1, the admissions data were obtained through the SUS database and the values of the daily concentrations of atmospheric pollutants were generated by fixed air quality monitoring stations. In study 2, the georeferencing of the residences of the interns was performed, the Moran index was applied and the spatial density was calculated. The data of the internments were obtained through DATASUS, dispensing with appreciation by the Committee of Ethics and Research in Health. Socioeconomic and sociodemographic characteristics were evaluated, as well as the access to local health facilities were verified. Results: 641 admissions were identified in individuals from 0 to 98 years old, being predominant over 65 years old (60%) and in males (57%). Hospitalizations were more frequent during the same periods in which the highest concentrations of the pollutants SO2, NO2 and O3 were also verified. A moderate positive correlation was found between the number of hospitalizations and NO2. The concentrations of the air pollutants MP10 and SO2 exceeded, during the evaluated period, the limits established by the national legislation then in force and by the air quality guidelines established by WHO (study 1). The spatial distribution pattern of hospitalization cases was random. It was identified the existence of three regions of greater concentration of the inmates' homes, covering four neighborhoods. The highest number of hospitalizations occurred among male individuals and among residents of Pernambués and Bonfim. The highest and lowest population density were recorded in the neighborhoods of Pernambués and Bonfim, respectively. In comparison to Pernambués, the Caixa D`água neighborhood showed higher average income per household, lower population density and higher proportion of literate people (study 2). Conclusion: A moderate positive correlation was found between the number of hospitalizations and NO2. These findings suggest that exposure to air pollutants may be associated with the number of hospitalizations (study 1). There was no relationship of dependence between the hospitalizations and the localization of the residences of the interns. Less favorable socioeconomic conditions may be associated with COPD. Insufficient basic health care can lead to a worsening of COPD cases and, consequently, a higher number of hospitalizations (study 2).

Disorders of musculoskeletal system and their components are characterized as serious health problems and are included among main causes of pain and disability in work environments. Typology of work activity, socioenvironmental and economic context are likely related to the occurrence and severity of pain and disability in people, especially in artisanal fishermen. Objectives: To verify the prevalence of generalized musculoskeletal disorders by body region and musculoskeletal pain (paper 1); to determine factors associated with generalized musculoskeletal disorders and to describe fishermen from a traditional fishermen population of Todos-os-Santos Bay, Bahia, Brazil, with musculoskeletal disorders according to their occupation (paper 2). Material and Methods: A cross-sectional study was carried out based on a probabilistic sample that was stratified by occupation of 248 artisanal fishermen and shellfish gatherers resident at the district of Santiago do Iguape in the city of Cachoeira. Data collection took place between May and July 2017 in which were used instruments to characterize the fishermen and to determine physical factors related to work and work environment and organization. Finally, it was also used a validated instrument called Nordic Musculoskeletal Questionnaire in order to evaluate symptoms and self-reported musculoskeletal pain in the Brazilian population. Results: Findings on paper 1 described a number of 248 individuals, among which 170 were shellfish gatherers and 78 fishermen, and mean age of 36.7 years (SD = 10.5 years) for shellfish gatherers and 43.3 years (SD = 11.8 years) for fishermen. Average working hours per day 8.8 hours (SD = 1.9) for women and 9.1 hours (SD = 3.0) for men, and in both occupations work activity started approximately in 11 years old on average. Mean weekly income range was between R$ 57.00 (SD = 35.7) and R$ 94.6 (SD = 55.9). Prevalence of musculoskeletal disorders regardless occupation occurred in at least one body region in 93.5% of the sample, as well as the presence of musculoskeletal pain/discomfort in the last seven days in 95.2% of the fishery workers. Descriptively, the highest prevalence of MSD complaint affected shellfish gatherers in lumbar region (86.4%), wrist and hand (73.5%) and upper back (66.8%); and same regions were more affected in fishermen: lumbar (82.9%), wrist and hand (70.0%) and upper back (57.1%). Regarding the presence of pain last year, the frequency was higher among fishermen compared to shellfish gatherers in most of areas. On paper 2, according to multiple correspondence analysis, it was shown absence of association between musculoskeletal disorders and occupation, which concurred with Poisson modeling result that shown crude and adjusted PR values of 1.06 and 1.04, respectively, for occupation and musculoskeletal disorders. Regarding the factors associated with musculoskeletal disorders and fishery occupation, there was no difference either for shellfish gatherers or fishermen related to prevalence of generalized symptomatology, when evaluated together; women were associated with age lower than or equal to 37 years old, with children under 2 years old and incomplete high school education, which was quite the opposite for men who used medication for pain control. Regarding the physical factors related to fishing work, women had another concurrent work activity with fishing, besides squating and walking with load handling and pushing fishes during long working days. Men were associated with long working days and sitting posture. Conclusion: It was possible to notice the presence of severity of generalized musculoskeletal disorders in 93.5% of fishermen population, especially in lumbar region, wrist and hand, and upper back for both groups, and occurred in more than one body region at the same time. Musculoskeletal pain was strongly associated with the presence of the disorder in all body regions. Absence of association between generalized musculoskeletal disorder and occupation was also demonstrated due to the high prevalence of the disorder indiscriminately, as well as characterization of dissimilarity in these workers according to their occupation. It is essential to acknowledge the importance of seriousness of the matter and notification and promote an understanding about predictors in terms of health care and decent job for this important contingent of Brazilian workers.

Cerebrovascular accident (CVA) is the leading cause of death and disability in Brazil, and its prognostic indicators of social reintegration are not well established yet. Mapping possible predictors of restrictions on social participation after stroke in the community can be an important tool to support the development of rehabilitation strategies even in a hospital environment. Objective: To identify deficiencies in structure and function and limitations in activity that predict restrictions on post-stroke social participation in the community (Article 1). Identify whether mobility, functional balance and the dependence on functionality at hospital discharge are capable of predicting restrictions on social participation one year after a stroke in the community (article 2). Method: This study aimed to investigate the theme through two methodological designs. Initially, a systematic review was carried out (article 1), selecting prospective and/or retrospective cohort studies that investigated deficits in structure and function and/or activity limitations, as predictors of social participation, in post-stroke individuals in the community. In this review, we excluded studies involving subarachnoid hemorrhage, as well as other neurological diseases, and participants in long-term care facilities. The Newcastle-Ottawa quality assessment scale was used to assess methodological quality, and the results were synthesized according to the exposures found, considering the statistical models used (article 1). Subsequently, a hospital-based dynamic concurrent cohort study was conducted (article 2). Individuals over 18 years of age with a diagnosis of acute stroke were included. Patients with dementia, previous functional limitations and cancer patients were not included. Mobility, balance and functional independence were the predictor variables at hospital discharge, and the outcome of interest was social participation assessed one year after stroke in the community (article 2). Results: Article 1, included 11 articles, total 2,412 subjects, 58.4% men, 83.7% Stroke I. Seven exposures were evaluated across studies. 10 studies assessed body structure and function exposures (stroke severity, cognitive, executive, emotional and motor function) and 8 studies assessed activity exposures (activity of daily living and ability to walk). Article 2, 48 patients included in the analysis after a one-year follow-up. The degree of functional independence at hospital discharge (b = 0.813; p <0.01) was an independent predictor of social participation, specifically locomotion (B = 0.452; p <0.001) and related social cognition (B = 0.462; p <0.001) to functional independence. Mobility (b = 0.040; p 0.777) and functional balance (b = 0.060; p 0.652) did not show an independent association. Cognitive functional independence was a predictor of daily activities (B = 0.786; p <0.001), social roles (B = 0.390; p = 0.014) and satisfaction (B = 0.564; p <0.001) of social participation. Conclusion: There is some evidence that stroke severity, mental and motor deficits, activities of daily life limitations and post-stroke walking ability can predict social participation in the community. Specifically, the degree of functional independence after stroke at hospital discharge was able to predict social participation in the community one year after the stroke.

Metabolic Syndrome (MS) is a complex disorder that includes abdominal obesity, associated with other cardiovascular and inflammatory risk factors such as CReactive Protein (CRP). Excess subcutaneous adipose tissue (which can be measured by middle upper arm circumference - MUAC) can increase inflammation and consequently cardiovascular risk in people with MS. In this sense, it is important to verify the association between MUAC and CRP (article 1); and whether genetic polymorphisms linked to anthropometric parameters can be used as a way to predict obesity in individuals with MS (article 2). Methods: This is a cross-sectional study with a quantitative approach with adults of both sexes with MS. Two studies were carried out. At first (article 1), MUAC, parameters for the diagnosis of MS (fasting glucose, HDL-c, triglycerides, blood pressure and waist circumference - WC), CRP, other indicators of cardiovascular risk were measured (conicity index and waist-to-height ratio) and body mass index (BMI) of patients, in order to verify the correlation between MUAC and the aforementioned parameters. Second (article 2), five polymorphisms (rs4081724, rs12446632, rs11847697, rs11583200 and rs17405819) were selected to identify the association between such polymorphisms and MUAC and the parameters for the diagnosis of MS. Genotyping of SNPs was performed by TaqMan assay technology. Data were analyzed by the SPSS ver 20.0 and the adequacy of genotypic frequencies of polymorphisms through the Arlequin ver 2000. Results: The study population was mostly female (84%); adult (60.5%); of black skin color (57.1%); and with high cardiovascular risk according to CRP (49.4%). An association was found between MUAC and serum CRP levels and crude multivariate logistic regression showed that each cm of MUAC increased by 10% the chance of presenting high cardiovascular risk according to CRP. According to the current classification of the MUAC, only 19% of the individuals studied were obese. No polymorphism evaluated was associated with MUAC and BMI, and among the polymorphisms studied, only rs17405819 was correlated with triglycerides and rs11847697 with diastolic blood pressure. Conclusion: MUAC was associated with serum CRP levels in individuals with MS, however, the genetic polymorphisms studied in this work were not able to show a correlation with anthropometric and clinical parameters.

To systematically review and evaluate by meta-analysis the effects of liver disease on the neuropsychomotor development of children and adolescents with their native livers (FN) and those who underwent liver transplantation (TxH) - article 1. Assess neuropsychomotor development (DNPM) and relate to the appropriate skills of children with chronic liver diseases from 0 to 6 years old (article 2). Describe the necessary skills of children and adolescents with liver disease (article 3). And to report the perception of mothers of children with liver disease about the DNPM, relating it to the results of the Denver II Screening Test - TTDII (article 4). Methods: Descriptive exploratory, sectional study, with a quantitative and qualitative approach, in which 73 children and adolescents from six months to seventeen years with chronic liver diseases attended at a Reference Center in the state of Bahia and their main caregivers from November 2018 to March 2020. In article 1, searches were carried out in the PubMed databases and Scopus journals from the first publications in the 1980s until June 2019, for observational studies. TTDII was evaluated in 32 children and after carrying out informing parents Inventory of Pediatric Disability Assessment (PEDI-CAT) in article 2. In article 3, the quick version of PEDI-CAT was applied to the expanded sample with 73 parents of children aged 0 to 17 years. The domains are daily activity, mobility, social cognitive and responsibility. In article 3, a narrative interview was conducted with the following triggering question: “What do you think of your child's development?” an interview was recorded and the data was transcribed. Results: In article 1, 25 studies were included with 909 children and adolescents with liver disease. Meta-analyzes increase total deficits IQ -0.41 (95% CI: -0.51 to -0.32; N: 9.973), verbal IQ - 0.38 (CI: 95%; - 0.57 to -0, 18; N: 10,284) and receptive language - 0.85 (CI: 95%; - 1.16 to - 0.53; N: 921) in TxH. In those with FN that were associated early, their Total and Verbal IQ scores (85 ± 8.8; 86.3 ± 10.6 respectively) were lower than those with late clinical manifestations (99.5 ± 13.8; 96.2 ± 9.2). In article 2, it was observed that in TTDII, 71.9% (23/32) of the sample showed suspicion / risk for DNPM. The relationship between the TTDII and PEDI-CAT instruments, it was found that among children with liver disease suspected / at risk for DNPM, the normative score / T-Score was 60.74 ± 9.18 for daily activities, 57.61± 11.84 for the mobility domain and 48.35 ± 6.29 for the social / cognitive domain. In article 2, the normative scores / T-Scores of activities of daily living with FN was 56.30 ± 10.67, mobility 49.09 ± 16.76 and the socio / cognitive score 44.46 ± 11, 02, responsibility 49.84 ± 11.87. Those who were transplanted obtained results from activities of daily living 51.20 ± 7.34, mobility 38.13 ± 19.99 followed by socio / cognitive scores 42.87 ± 10.59 and responsibility 49.83 ± 10.88. The mothers' perception of their children's development coincided with the results of the TTDII. Conclusion: Acute or chronic liver disease can cause declines in cognitive, motor and language functions. When assessed by the TTDII, children with liver disease dissipate the potential risk for delays in the DNPM, however, these skills have not dissipated by PEDI-CAT, even when the expanded sample has been expanded to older children and adolescents. The mothers of children with liver disease, in general, demonstrated a good perception about their children's DNPM, that is, these mothers can identify typical and atypical characteristics.

Recent studies have suggested the presence of neurodevelopmental impairments, especially for cognitive and language domains, in normocephalic children exposed to ZIKV during gestational period. The development of speech and language depends on the integrity of both peripheral and central auditory system. Undetected hearing disorders in childhood, either congenital or acquired, can significantly affect communication and cognition and also interfere with the child's neurodevelopment. Objective: To compare latency and amplitude of auditory cortical evoked potentials to neurodevelopment, gestational information and clinical and sociodemographic data for children supposedly exposed to zika virus. Methodology: Cross-sectional prospective exploratory study based on a representative simple random sample of the observational cohort study International observational prospective cohort study of zika in children and pregnant women (ZIP study), approved by the Research Ethics Committee CAEE No 56673616.3.1001.5269. The study population consisted of 237 hearing children supposedly exposed to ZIKV and not. The average age was 15 +/- 2,1 months. Previous hearing tests that presented otoacoustic emissions and short latency evoked potential confirmed inclusion criteria. To assess the cortical auditory potential, 150 tone burst stimuli presented monoaural, rate of 1.2 stimuli per second, which differed in frequency (standard stimulus: 1000 Hz; rare stimulus: 2000 Hz). To assess neurodevelopment, the Bayley Scales of Infant Development was applied. Results: The cortical potential were in all children and presented substantial difference of average latencies and level of statistical significance for P1 and N1 in children supposedly exposed to zika virus. The averages of P1-N1-P2-N2 latencies were higher in the group at risk for neurodevelopment in all assessed domains. The cognitive and expressive language domains were statistically significant for the mean latencies of all cortical potential structures. There was also an association between risk classification and sex for cognitive (p = 0.025) and language (p = 0.050) domains and a performance advantage for girls. The mean of the raw scores were also higher for females in all Bayley domains, with statistical significance for both receptive (p = 0.008) and expressive (p = 0.041) language. Conclusion: Children supposedly exposed to zika virus presented average latencies higher for P1-N1 cortical responses, which suggests a worse processing of the acoustic signal in relation to unexposed children. Supposed exposure to zika virus during pregnancy may be associated with higher latencies of P1-N1 complex and lower scores for neurodevelopmental domains, which suggests both cortical auditory and neurodevelopment impairments, especially for expressive language.

The general objective is the construction and validation of SADEE. Method: Exploratory research with virtual collection. Inclusion criteria: Brazilian, 18 years, full elementary school. Exclusion Criteria: SADEE incomplete. These items were analyzed: Construct validity through AFE and AFC; concurrent validity through correlations with the Liebowitz Social Anxiety Scale; internal consistency through Omega and test-retest; study of items through Item Response Theory. Results: sample with 407 sample-eligible participants. The coefficient of content validity (0.88) indicated good overall quality; nine items had content validity index below the recommended level. In the construct validity parallel analysis points to the retention of three dimensions; however, indicating sufficiency of retention only in the first factor. The validity of concurrent criteria with the social phobia scale of Liebowitz presented positive results. Of the 60 items, only 5 presented global adjustment with significant chi-square for the analysis by TRI. The set of items was maintained in order to understand if there are problems beyond the overall adjustment. The expectation functions of the item scores and the test presented adequate format, as well as the item characteristic curves. SADEE presented items with a satisfactory level of discrimination, as well as information functions that attest to the good sensitivity of the items to the latent trait. Conclusions: Adequate sample, with strong evidence of reliability and validity of concurrent criterion, but with content validity lower than expected. It was signaled adequacy of the items. 

ABSTRACT
Introduction - Bovine pericardium has been used for several decades in cardiac and vascular
surgeries, due to its resistance and ease of use. Decellularized bovine pericardium was first
used in this experimental study associated with a breast implant. The introduction of a foreign
body or non-autogenous implant may induce an inflammatory reaction that may lead to tissue
erosion, implant fistulization and extrusion. It is in this scenario that the use of extracellular
matrices and other dermal substitutes play an essential role. This biomaterial has lower elastin
content, which may be beneficial as it increases soft tissue coverage and prevents
irregularities during the process of breast expansion. Objective – To evaluate the use of
decellularized bovine pericardium to cover the breast implant on the back of rats.
Methodology – This is an intervention study and experimental research with 16 animals,
divided into two groups: control group and experimental group. The experimental group
received implantation on the back of the breast prosthesis and bovine pericardium and the
control group received implantation of the breast prosthesis only. Animals were sacrificed and
histomorphologically evaluated in biological points at 7 and 15 postoperative days. Results –
There was an increase in fibrous capsule thickness and initial biointegration of decellularized
bovine pericardium in the experimental group. There were no postoperative complications,
such as rejection or extrusion of the biomaterial and prosthesis, in the control and
experimental groups. Conclusions – Decellularized bovine pericardium biomaterial was
biocompatible, promoted an initial biointegration to the tissues and assisted in the healing of
the breast implant, thus preventing the emergence of postoperative complications.
Keywords: Biomaterials. Pericardium. Cicatrization. Breast implant. Rats.

Temporomandibular dysfunction (TMD) is a group of clinical conditions that affect the stomatognathic system, in particular the temporomandibular joint and masticatory muscles, has a high prevalence in the population and affects more young adult women. Postural balance is described as based on information from the visual, vestibular and proprioceptive muscle-articular sensory systems. In previous studies it was analyzed that postural balance is influenced by temporomandibular disorders. Objectives: To measure the degree of association between TMD and postural balance with regard to body oscillations and plantar load distribution. The secondary objectives are to verify whether there is an association between TMD severity levels and postural balance and to analyze the relationship between the visual sensor and postural balance when comparing individuals with and without TMD. Methods: Fifty women were analyzed through TMD screening and severity classification through the Fonseca Anamnesic Index. And the postural balance measured through Computerized Baropodometry, body oscillations and plantar support load distribution. The study was conducted under the conditions of open eyes (OA) and closed eyes (OF), open mouth, rest and maximal intercuspal position, hip-width support base and foot forward. The analyzes focused on verifying differences in postural balance between the groups of individuals with and without TMD according to the severity levels, as well as the influence of the visual system. Results: The results showed differences between the groups regarding the plantar load symmetry, greater asymmetry in the open mouth condition and support base in the hip width. In the foot forward condition and closed mouth greater area and front back oscillation speed. As for the association between OA and OF conditions with TMD severity levels, there was a relationship between areas and oscillation speed with moderate TMD. Conclusion: The results showed that TMD according to severity levels changed the postural balance regarding the plantar support load distribution and body oscillations.

Endoglin (ENG) is a coreceptor of the transforming growth factor-betafamily and participates in the regulation of cellular processes such as proliferation, differentiation, migration and apoptosis. ENG is most known for their expression in endothelial cells, playing an important role in angiogenesis and vasculogenesis. Furthermore, its differential expression has already been associated with pathogenic outcomes, some of them associated with mutations in the ENG gene. Objectives: Todescribe the frequency of genetic variants in the ENG gene in the population of Brazil, to compare the frequencies ofgenetic variants with ancestral populations that are involved in the admixture of the Brazilian population, to perform in silicoanalysiswith genetic variants found in the endoglin gene and to describe genetic variants that may be involved in pathogenic processes described in other populations. Methodology: We used the SCAALA and ProAR genomic database for the present descriptive study. The DNA was genotyped, and functional analysesin silico were performed using free programs and online platforms. Results: 85 genetic variants were analyzed, 52 variants presented minor allele frequency until 50% and 33 variants were monomorphic. The frequencies of genetic variants, in general, were intermediate between the frequencies of African and European populations. Functional analysesin silico indicate that from the 33missensevariants,10 had damaging score.After fine mapping strategy, we were able to find in literature genetic variantsin endoglin that have been previously associated with sporadic cerebral arteriovenous malformations,hereditary hemorrhagic telangiectasia type 1phenotype with pulmonary arteriovenous malformations, and preeclampsia.Conclusion: Some pathogenic phenotypes have been associated in other studies with the most frequent alleles in ENG. It is important to highlight the synonymous variant rs11545664 that was investigated in different outcomes.Further investigation regarding the functional mechanisms of this gene are necessary, since the endoglin participates in a range of important cellular processes and more efforts should be made for genetic studies in the Brazilian population, considering the admixture phenotype.

Chronic heart failure (CHF) is characterized by abnormality in the structure and/or function of the heart that leads to a decrease in the blood supply necessary to meet the body's metabolic demands. Patients with CHF have a decreased ability to walk with consequent changes in biomechanical gait parameters, and are related to hospitalization and mortality. Objectives: To characterize the gait biomechanics of hospitalized adult patients with chronic heart failure. Methodology: This was an observational cross-sectional study of patients admitted to a cardiac ward diagnosed with CHF, functional class II and III, between 18 and 60 years old and with medical clearance for ambulation prescribed in medical records. The space intended for the execution of the walking cycle was based on a distance of 10 meters. A descriptive analysis was performed to identify the general and specific characteristics of the sample studied. The Shapiro-Wilk test was used to verify the normality of data distribution, graphical analysis, symmetry and flattening of the distribution. To verify the relationship between the quantitative gait variables, Pearson's correlation was calculated for the parametric measures and Spearman's correlation for the nonparametric ones. Results: 30 patients participated in the study. Walking speed obtained a mean value of 0.86 m / s (SD = 0.14), with an average cadence of 45.8 strides / minute (SD = 6.9). Stride length averaged 1.14 m (SD = 0.12). The support phase had a median of 62.2 and the balance phase with 36.6. There was a high correlation between speed and cadence, moderate correlation between speed and stride length. Conclusion: A reduction in the evaluated parameters was observed, except in the stance phase which obtained a slight increase in its reference value. In an attempt to generate adequate speed, participants adapted their gait, increasing their cadence more often than their stride length. Patients with velocity above 1 m / s had better stride length indexes while those with velocity equal to or less than 0.8 m / s presented the worst cadence values.

Air pollution is seen as a public health problem, in Brazil and worldwide, whose effect is associated with the exacerbation of respiratory diseases. Objective: To describe the concentrations of particulate matter with an aerodynamic diameter of 10 µm (MP10), the meteorological parameters and the hospitalizations for pneumonia in the city of Salvador, State of Bahia, from 2014 to 2015. Methodology: Descriptive and observational study on air pollution and hospitalizations for pneumonia (ICD-10: J12-18.9), in the city of Salvador, Bahia. The data was obtained from the Center for the Treatment of Liquid Effluents and the Hospital Information System of the Unified Health System, provided by the Department of Information of the Unified Health System, respectively; tabulated and treated in Microsoft Excel® and R Statistical Software. Results: The minimum concentration recorded was 0.2 µg/m3 and the maximum was 969.4 µg/m3 for MP10 (Itaigara Station). The Av. Barros Reis Station showed the highest daily average concentrations. The number of hospitalizations for pneumonia added up to 9,362. Hospitalizations were prevalent in males (52.5%); and at the extremes of the age group, children from zero to 12 years of age (54.4%) and elderly, individuals aged 65 years or older (24.6%). On average, there were around 13 hospitalizations per day, with the month of June being the most frequent period. The most frequent diagnosis was bacterial pneumonia (J15.9). Conclusion: The average daily concentrations of PM10 are in accordance to the limits established by national guidelines. The amount of hospitalizations is decreasing, except for children, which remains high.

Congenital heart disease (CHD) is characterized by a set of structural and functional defects that arise during cardiac embryogenesis. It is the most common type of congenital defect, representing one third of all congenital anomalies. Several studies have been developed aiming to identify structural genes that are closely involved with physiological cardiac morphogenesis. Some copy number variations have been associated with the pathogenesis of CHD, as they include genes previously known to participate in heart development. Transcription factors participating in the Notch signaling pathway regulate interactions between physically adjacent cells, essential pathway for controlling spatial pattern, morphogenesis and homeostasis in embryonic and adult tissues. Notch gene expression reveals axial skeletal defects, disorders of the musculoskeletal systems, neurological disorders and degeneration, deafness, somatic mutation phenomena that lead to different cancers and congenital heart anomalies. This study evaluated 3 consanguineous families with individuals with previous genotyping showing alterations in chromosomes 9, 15 and 16. The results point to 23 patients with cardiovascular disorders and several cases of musculoskeletal disorders, as well as cases of craniofacial disorders, first trimester abortions and early neonatal deaths. An analysis suggested the possibility of participation of genes other than Notch in the cardiovascular and osteomioarticular pathogens evidenced in these families.

Bone loss may result  fromsome etiological factors such as trauma, pathological injuries or tissue atrophy after dental unitsloss. The pursuit for procedures that help or induce bone repair to reestablish the anatomical pattern has increased. The autologous platelet-rich fibrin (PRF) membrane has been used to help the bone neoformation process, showing good results, as well as low-level laser therapy (LLLT). Objective: Investigate the effect of LLLT (λ = 830 nm) along with the PRF membrane in bone neoformation. Methodology: 63 Wistar rats were used. These animals were divided into 04 groups: C (control), L (Laser), PRF (PRF) and PRFL (PRF and Laser).The PRF membranes ware obtained from intracardiac puncture of donor rats.A bone defect was created in the calvaria of 48 Wistar rats and the irradiated groups went through the first session of laser therapy shortly after the surgical procedure. Six animals from each group were euthanized after 30 and 60 days and histologicallyprocessed. Bone neoformation, bone thickness, osteoblast activity, inflammatory intensity and connective tissue formation / fibrosis were evaluated. Results: The highest average percentages of bone neoformation at 30 days (PRF -66.67% and PRFL - 60%) and 60 days (PRFL - 80%) were observed in defects using PRF. At 30 days, the PRF and PRFL groups presented similar results of vertical bone thickness and both showed statistical difference in relation to the other groups (p = 0.002). In particular, the percentage of vertical bone thickness at 60 days was significantly higher in the PRFL group than in the other groups (P = 0.025). At 30 and 60 days, osteoblast activity was higher in the PRF group (p = 0.000 and p = 0.020, respectively). At all times evaluated, inflammatory activity did not differ between groups. The presence of connective tissue / fibrosis after 30 days was higher in the PRFL group (p = 0.025), although the PRF group did not present this tissue in both experimental periods. However, after 60 days, the PRFL group presented an average of (80%) of the defects without the presence of connective tissue.

Autism Spectrum Disorder (ASD) is a group of conditions characterized by changes in social behavior, in communication and in language, and a restricted, stereotyped and repetitive repertoire. As it has become increasingly present in our world’s reality, discovering this disorder’s development causes is increasingly important. ASD has a multifactorial origin, with genetic factors associated with copy number variations (CNVs), one of the aspects that have been the study’s object in order to elucidate idiopathic cases. The general objective of this work was to study the CNVs found in patients with ASD, seeking to identify genes that explain their etiology. A convenience sampling, a nonprobability sampling was used. Eighty patients were analyzed from May 1 to October 15, 2019. The CNVs found were analyzed in the public CNVs banks, and the genes were evaluated in the STRING and SFARI databases. Twenty altered cases were observed, in which 7 CNVs were pathogenic and 13 CNVs were of uncertain significance (VOUS). The CNVs analysis, based on STRING and SFARI, allowed to identify genes associated with ASD and to reclassify CNVs VOUS regarding their relationship with ASD.

This work’s objective was to evaluate the effect of different tooth whitening protocols and materials on the microhardness of irradiated and non-irradiated bovine enamels. Methodology: 64 bovine teeth were selected, their roots were sectioned at the cementoenamel junction and included individually in the vertical position in acrylic resin. The IR-irradiated group (n = 48) underwent the irradiation protocol with fractional doses of 2 Gy / day, adding, at the end, 50 Gy. The C-Control group (n = 48) was stored in distilled water, at 37ºC. The specimens of each group were randomized and divided into 4 subgroups, for whitening, for 21 days. 1- control group without intervention; 2- homemade whitening (Carbamide Peroxide at 16% - FGM); 3- in-office whitening (Hydrogen Peroxide at 35% - FGM); 4- home whitening associated with the in-office whitening (Carbamide Peroxide at 16% + Hydrogen Peroxide at 35%). The bleaching protocols duration was 21 days for all groups. The specimens were evaluated for Knoop microhardness (Mitutoyo-Shimatzu) from the arithmetic mean of three indentations (0.05 (490.3 mN)) performed on the dental enamel in a single time, after the irradiation and whitening protocol. Results: Exploratory analysis (Shapiro-Wilk; p> 0.05) and other variance parameters (ANOVA) were performed, in a factorial scheme (4x2). The multiple comparisons between the hardness averages (Tukey) revealed that irradiation did not reduce the microhardness of the control groups, the irradiation associated with bleaching reduced the microhardness of irradiated and non-irradiated bovine enamel, and the groups submitted to the in-office bleaching technique associated with the homemade showed a significant reduction in microhardness when compared to control groups.

Prematurity, low birth weight and multiple births are risk factors for structural changes in the brain, as well as deviations in motor, cognitive, social and language development. Objective: To characterize the pragmatic abilities of preterm infants; to describe the linguistic and neurological findings of twins born preterm. Method: For the analysis of pragmatic skills, 42 children born preterm, with low birth weight, of both sexes, aged two to four years, using the ABFW Pragmatic Protocol - Test of Children's Language. The study on the language performance of twins was performed by analyzing data from the charts of six pairs of preterm, low birth weight twins of both sexes at two years of age. Both studies were conducted at the State Center for the Prevention and Rehabilitation of People with Disabilities - CEPRED, in Salvador-Bahia-Brazil. Results: Regarding the communication initiative, during adult-child/ child-adult interaction, there was a better performance of moderate and late preterm infants. In relation to the communicative acts, the children did not reach the reference values proposed by the test. In the communicative environment, it was evidenced that the verbal means were the most used, however there was a high prevalence of the gestural means. The most observed communicative functions were: comment, narrative, game and object request. There was no association of language variables with age and sex. Extreme preterm infants presented inferior performance. In the second article, it was observed that the preterm twins presented atypical linguistic development and neurological alterations that could compromise the development of the language, causing delays or disturbances. Conclusion: Preterm children presented deviations in the development of pragmatic abilities in the age group investigated. Multiple births associated with prematurity and low birth weight pose risks to language development and may be influenced by neurological pathologies. Thus, this study alerts to the need for early intervention and to monitor the language development of preterm infants, including twins.

Stuttering is a very stigmatized fluency disorder in our society. Objective: The presented investigation in the first article had the objective to evaluate the efficacy of Cognitive Processual Therapy (TCP) and Fluency Promotion Program (GPF) models in comparison with the Therapeutic Fluency Group (GTF) in the treatment of persistent stuttering in adults. The second article had the objective of investigating whether there is a correlation between social anxiety disorder and anxiety and the degree of the impact on the stuttering of the participants. Methods: the first article is a randomized clinical trial with three parallel groups. Three different forms of treatment were offered, namely: group I Cognitive Therapy (PCT); Group II Promotion of Fluency (GPF) and Group III Therapeutic Group in Fluency (GTF), the latter was the control group. The different intervention groups were randomly disarranged, with 20 participants in each. We used the SSI-3 Stuttering Severity Instrument Ridley scale to measure stuttering severity index through a sample of spontaneous speech. Then the Brazilian version was applied to the Overall Assessment of the Speaker's Experience of Stuttering – Adults (OASES-A) both being applied prior and post intervention. The second article is an observational and cross- sectional study, where the following instruments were applied: Beck's self-applied questionnaire (BAI), the Dodge Scale and Social Discomfort Scale (SADS), Negative Fear Scale (FNE) and Liebowitz Social Anxiety Scale (LSEA) and we used the SSI-3 Stuttering Severity Instrument Ridley scale to measure stuttering severity index through a sample of spontaneous speech. Then the Brazilian version was applied to the Overall Assessment of the Speaker's Experience of Stuttering – Adults (OASES-A). Results: 59 individuals of both sexes participated in this study, with 44 men and 15 women. It is observed that in the pre-intervention there is similarity in the score representing qualitatively moderate-severe degree, and in the post intervention a reduced level in the OASES-A scale, going to the moderate degree in all three groups. On the other hand based on the analysis of variance model of linear mixed effect, it was verified that there was no interaction between time and group, and that only produced a significant difference (p <0.05) regardless of the group. In the second article for the analysis of the correlation coefficient, a division into two groups was carried out, the first was the participants with a high impact of OASES-A score greater than (> 3,00) and with low OASES-A participant score (= <3, 00). The data indicate that there was a weak positive correlation between OASES-A and BAI; there was a weak positive correlation between OASES-A and FNE, there was a moderate positive correlation between OASES-A and SADS; and there was also a positive correlation between OASES- A and LSAS-SR, and eventually there was a positive correlation between OASES-A and the SSI-3 index. Conclusion: All intervention groups showed a change in the OASES-A and SSI-3 scores, so there were beneficial changes that reduced the negative impact of stuttering on participants' lives. Although no treatment has been highlighted as more effective in comparing interventions. In the second article, the findings of two of the four instruments, demonstrate a moderate positive correlation between stuttering and social anxiety.

The upper limbs are highly specialized structures and under normal conditions give man the ability to perform directed and voluntary range, grasp of strength, precision and manipulation of objects. Parkinson's disease is a neurological condition, chronic and progressive, which among other signs presents hypokinetic disorders that can compromise the manual functions. Quantitatively measuring the kinematic parameters of the functional movement of the upper limbs through the CvMob can contribute as another auxiliary element in the diagnosis and follow-up of these patients. The aim of this study was to compare kinematic parameters exhibited by the upper limbs in individuals with and without Parkinson's disease (ARTICLE 1) and to compare the kinematic parameters of the upper limbs of individuals with Parkinson's disease according to the staging of the disease (ARTICLE 2). METHODS: Hybrid study, based on an outpatient basis, comprised a sample of 104 individuals, 52 participants with Parkinson's disease and 52 healthy participants. Evaluation instruments: evaluation sheet produced by the author, questionnaire of the MMSS produced by the author, Hoehn and Modified Yarh Scale, MEEM and MMSS cinematography by camera and later analysis by CvMob. For the statistical analyzes of (1) circular and linear statistics were used, from the application of the tests: Rayleigh, Watson, Equal Kappa, and Mann-Whitney, adopting the level of significance of 5% and non-parametric standardized difference. In order to evaluate the effect of staging, the η2 (eta squeared) and Bartlett tests were used to test homogeneity of the variances for analysis of linear variance, whereas for analysis the Rayleigh test was used for circular variance. The level of significance was 5%. All analyzes were performed in the statistical software R version 3.5. RESULTS: The mean angle in the left affected limb of Parkinson's group was (θ = 340.3 °) and (ρ = 0.2672), in the right affected limb Parkinson's group was (θ = 219.8 °) and (ρ = 0, 3720). The mean velocity, median (IIQ), for the left uninjured Parkinson's group was 27.1 (22.6) cm / s, right uninjured Parkinson's group was 29.6 (20) cm / s, Parkinson's limb 23.4 (28.7) cm / s, right ACL was 28.7 (31.5) cm / s, left GC 37.6 (24.1) cm / s, right GC 40, 5 (28.9) cm / s. The comparison of mean velocities ranged from (r = 0.01, p = 0.5750) to (r = 0.13, p = 0.9702). The comparison of mean standard deviations of mean velocities ranged from (r = 0, p = 0.5097) to (r = 0.14, p = 0.7369). The mean median (IIQ) shift for Parkinson's uninjured left limb was 10.5 (6.4) cm, Parkinson's limb not affected right was 15.8 (12.2) cm, Parkinson's left side was  14 , 6 (10.8) cm, right affected limb Parkinson's was 13.3 (9.8) cm, left GC was 13.5 (8) cm and right GC 12.9 (8.9) cm. The comparison of the mean displacements ranged from (r = 0 .01, p = 0.4420) to (r = 0.06, p = 0.8032). The comparison of mean standard deviations of  ean displacements ranged from (r = 0.02, p = 0.4129) to (r = 0.15, p = 0.0162) ARTI CLE 1). The mean angles at stages 1, 2, 2,5 and 3 were: (θ = 166.5 °), (θ = 231.5 °), (θ = 265.1 °), (θ = 206, (Ρ = 0.394), (ρ = 0.28347), (ρ = 0, 1) and (p = 0.0758), while the angular concentration in stages 1, 2, 2,5 and 3 were respectively: 40788), (ρ = 0.35641) and (p = 0.668). The mean velocity, on average (DP), in stage 1 was 28.1 (24.1) cm / s, in stage 2 30.4 (16) cm / s, in stage 2.5 29.4 (35, 19) cm / s and in stage 3 was 20.8 (21.1) cm / s, with the lowest mean velocity in stage 3 (η2 = 0.0195, p = 0.1, p = 0.81) . In the comparison of the standard deviations of the mean velocity (η2 = 0.0361, p = 0.37, p = 0.62). The mean (SD) mean displacement in stage 1 was 12.7 (5) cm, in stage 2 13.9 (7.8) cm, in stage 2.5 10.8 (9) cm and in stage 3 was 11.8 (6.5) cm (η2 = 0.0222, p = 0.28, p = 0.78). In the comparison of standard deviations of mean displacement (η2 = 0.012, p = 0.42, p = 0.9). (ARTICLE 2). CONCLUSION: There was no trend of directionality and no differences in the other kinematic parameters between individuals with and without Parkinson's or between the compromised limbs (ARTICLE 1). The different degrees of staging of the disease were not able to produce effects on the kinematic parameters evaluated (ARTICLE2). The results point to a similarity in functional capacity in the performance of kinemat ic parameters, performed by the upper limbs, among the populations studied. 

Selenium is an essential micronutrient for human health, since it constitutes the selenoproteins that play an antioxidant role and participate in the biosynthesis and activation of thyroid hormones. This study present as methodology a descriptive approach and cross-sectional design, developed from two distinct strategies. In article 1, a systematic review with metaanalysis was performed on the nutritional status of selenium in children in Brazil and worldwide. In article 2, data from 982 schoolchildren aged 6 to 14 years from public schools in Bahia, Brazil. In this study, urinary selenium and iodine were measured by the ICP-MS method, along with thyroid stimulating hormone (TSH) in filter paper blood samples. As results, article 1 revealed high prevalence of selenium deficiency (SD) in previously conducted studies in Brazil and worldwide (63% and 41%, 95% IC, respectively); however, high heterogeneity was found (I2= 100%). Article 2 showed adequacy in selenium and iodine nutrition. The median CSU and CIU were 38.7 and 210.0 (IQR: 26.8–52.9 and 129.3–334.1 μg/L, respectively). The prevalence of iodine deficiency and excessive CIU were observed in 17.1% and 30.9% of schoolchildren, respectively. There was a positive correlation between CSU and UIC (r = 0.60; p = 0.00). The mean TSH was 0.95 (IQR: 0.69–1.30 μUI/L). It is concluded that the article 1 verified the overall prevalence of SD among children, noting the complexity and methodological differences between studies. In article 2, an important correlation between urinary selenium and iodine concentration pointsto the fact that selenium nutrition may interact with other nutrients and/or dietary components. Thus, the inclusion of selenium measurement in micronutrient monitoring actions can contribute to a greater effectiveness of programs to prevent disorders in the child population.

Elderly people complain of difficulty to understand speech, which is not
always compatible with audiometric tests. Thus, one can think of changes in the auditory processing, suggesting that temporal ordering seems to be the most affected. Moreover, the central hearing abilities might be affected by clinical and sociodemographic factors. Objective: To research related factors and describe the performance in Frequency and duration patterns tests in elderly people. Method: anobservational, cross-sectional study conducted with elderly people aged 60 to 79 years. The participants were submitted to cognitive screening tests , interviews containing socio-demographic data and general health, audiologic evaluation and assessment tests of the temporal auditory processing (frequency and duration pattern tests) A descriptive analysis of the association between the performance in temporal processing and the variables (gender, age, level of education and audiometric alterations was conducted through multiple linear regression. Results: 86 elderly people took part in the test, most of them being female with ages between 60 and 69. The performance in both tests was better for males and elderly people with higher education level and similar for the different age ranges. In the pattern tests, elderly with auditory alteration had worse performance in relation to the ones with an average frequencies of 0.5 to 4 KHZ normal. Conclusion: The male gender and higher level of education are associated to better results in the temporal ordering tests, whereas auditory alteration is associated with worse performance only in the standard frequency test. 

The rapid spread of Zika virus in Brazil and subsequent confirmation of Congenital Zika Syndrome have garnered worldwide attention to the serious risks to childhood neurodevelopment arising from maternal Zika virus infection (ZIKV). Objective: The main objective of the present study was to systematically review the literature on knowledge so far produced about children exposed to maternal ZIKV infection (article 1) and to describe neurodevelopment of children without microcephaly born to mothers infected by ZIKV during pregnancy (article 2). Method: The present study employed two methodological strategies. After systematic research in the main electronic databases (Pubmed, Capes Journals, Web of Sciense, Scopus, Cochrane and Virtual Health Library) on the theme and application of eligibility criteria, 20 articles related to cognitive assessment of children exposed to intrauterine ZIKV, published in the last five years until November 2019, were included (article 1). The second stage of the study used an observational, descriptive, case series method with a convenience sample. Nine children, aged 20 to 46 months, born to mothers infected with ZIKV during pregnancy, with serological confirmation, were assessed by the Bayley-III Scales. Of these, one child presented positive serology for ZIKV and the others negative. Sociodemographic data, information on pregnancy, childbirth, child development, and other congenital infections were collected through semi-structured questionnaires and the health records of the child and pregnant woman. The children were evaluated by a child neurologist and the result of the brain magnetic resonance imaging (cMRI) when performed, it was described. Two children presented alterations in cMRI (article 2). This study was approved by the Human Research Ethics Committee of the Institute of Health Sciences of the Federal University of Bahia, protocol 2.015.503. Results: The systematic review of the literature allowed us to identify as main results, delayed cognition, motor skills, language and social domain, with worse performance in children with microcephaly or other severe brain injuries. Most normocephalic children exposed to ZIKV showed age-compatible performance; however, a smaller number of normocephalic children scored low on at least one assessed cognitive domain, characterizing specific developmental deficits (article 1). In the second stage of the study, of the evaluated children, six presented developmental alterations: language delay in the six children; four children with Autist ic Spectrum Disorder (ASD) and two children with delayed motor and language skills. Three children obtained satisfactory results on the Bayley –III Scales (article 2). It is assumed that the cognitive and neurological changes observed in five children may be related to exp osureto the effects of ZIKV infection on the intrauterine environment. Conclusion: In the case  series studied, language delay was observed in six children and changes in cMRI in two . ASD was diagnosed in four children exposed to ZIKV infection from mothers with no family history or perinatal complications. The systematic review highlights the high risk of intrauterine ZIKV exposure for child development and suggests investigating the cognitive development of all children exposed to maternal ZIKV infection. 

Objective – To evaluate, after in vivo implantation in critical bone defect in rat calvaria, the osteogenic behavior of a composite consisting of different concentrations of p-wollastonite and tricalcium β-phosphate for application in bone tissue bioengineering. Materials and methods – The sample consisted of 40 adult Male Wistar rats randomly distributed to compose four groups, with five animals in each group, evaluated at 15 and 45 days after composite implantation: Group 20/80 – critical bone defect filled with composite granules 20% pwollastonite and 80% tricalcium β-phosphate; Group 60/40 - critical bone defect filled with composite granules 60% p-wollastonite and 40% tricalcium β-phosphate; Group 80/20 - critical bone defect filled with composite granules 80% p-wollastonite and 20% tricalcium βphosphate; Control group - critical bone defect filled with clot. Results – Histological analysis showed bone neoformation restricted to the edges of the bone defect in all experimental groups at 15 days. Histomorphometry showed that groups 20/80, 60/40 and 80/20 and the control group formed similar percentages of bone neoformation at 15 days. At 45 days, the 60/40 group presented 65% bone neoformation. Fibrous septa was formation penetrating the biomaterial particles in all groups. In addition, the bone defect was filled in several layers of granules at both biological points. Conclusion – Composites consisting of different concentrations of p-wollastonite and tricalcium β-phosphate can be considered bioactive and biocompatible. Among the experimental groups group 60/40 presented higher percentages of bone neoformation and allowed to restore bone thickness and volume with dimensions similar to the edges of the calvaria of the animal.

In the search to provide favorable conditions for bone regeneration and to restore aesthetically and functionally critical bone lesions/defects, different biomaterials have been developed and evaluated, especially bioceramics. Among these, wollastonite (W) has stood out, in recent years, as a consequence of it bioactivity and ability to stabilize in wet environments. In addition to this bioceramics, tricalcium phosphate (TCP) has been widely used for decades as a result of presenting biocompatibility, osteoconductivity and osteoinductivity. However, the biodegradation of this bioceramic, asynchronous to the  bone neoformation mechanism, limits its application in extensive bone losses. In view of this, composite biomaterials have stood out, as they combine desirable properties of each i solated material. Thus, associating the favorable properties of W and TCP becomes auspicious for  bone repair. Objective: The purpose of this work was to investigate, through systematic review and meta-analysis, and to evaluate, through experimental study, the osteogenic potential of composite biomaterials containing W and TCP, after in vivo implantation. Methodology: A systematic review and meta-analysis of in vivo studies that  histomorphometrically evaluated the percentage of bone neoformation after implan tation of composite biomaterials of W/TCP. In parallel, a histomorphometric study of the repa ir of critical bone defect in rat calvaria was carried out by implanting composite frameworks  containing W and β-tricalcium phosphate (β-TCP), in different association percentages: 20W/80β-TCP (wt. %), 60W/40β-TCP (wt. %) and 80W/20β-TCP (wt. %), evaluated at the biological points of 15 and 45 days postoperatively. Results: Based on the investigation of the studies, the meta-analysis showed that the composite W/TCP biomaterials processed in the scaffold format, present a higher percentage of bone neoformation, in vivo, in relatio  n to the microsphere format. Throughout the experimental study, composite scaffold containing 20W/80β-TCP (wt. %) showed greater osteogenic potential (51%) and promising  characteristics for clinical applications. Conclusion: In conclusion, the scaffolds containing W/β-TCP composites, in their most varied percentages of association, presents promising osteogenic potential for bone regeneration in cases of extensive losses.  

One of the objectives of this study was to estimate the prevalence and factors associated with common mental disorder in adults registered in the Family Health Strategy (FHS) in Feira de Santana, Bahia. To this end, a cross-sectional study was carried out, with a random sample per cluster. Individuals aged 18 years or over, living in randomly selected households, were investigated. A questionnaire with sociodemographic variables, lifestyle and the Self-Report Questionnaire was used to identify common mental disorder. The prevalence ratio and the 95% confidence interval were used to measure the association and statistical significance between the variables studied. 791 adults were studied, 486 (61.5%) of whom were women. The average age was 44.21 ± 15.27, the predominant age group was 30-59 years 64%. Regarding the level of education, 239 (30.2%) studied until elementary school I, 47 (5.9%) were illiterate and 82 (10.4%) could only read and write their own name. The prevalence of common mental disorder was 223 (28.2%) and was associated with low education and low income. A systematic review was carried out to assess the prevalence and the factors associated with this disorder in adults in Primary Health Care. The research was carried out in the bibliographic databases: Medline / Pubmed; Lilacs; Web of Science; Scopus, without date restriction. 10 articles were selected, published between 2005 and 2018. The analyzed studies revealed a high prevalence of common mental disorder and had a greater association with females and individuals without a partner. The use of cutoff points different from the Self-Report Questionnaire to identify this disorder made it difficult to compare the included studies. New validations of the tool are needed, which take into account the different social, cultural and economic characteristics of the Brazilian regions, such as income, age group and education, for a better comparability of future research.

Parkinson's disease is a chronic and degenerative disease of central nervous system of unknown origin that causes movement disorders. Objective: To investigate the association between thoracic mobility, respiratory muscle strength and lung function in individuals with Parkinson's disease, its relation to the motor stage as well as to compare these respiratory measurements with people without the disease. Material and methods: This is an observational, cross-sectional study with a convenience sample of individuals with and without Parkinson's disease, adults of both sexes, in Salvador, Bahia. Both primary and secondary data was collected and the staging of the disease was classified according to the Hoehn and Yahr Modified Disability Stages Scale. Respiratory function was evaluated through tests of cirtometry, manovacuometry, spirometry and peak cough flow. Results: A total of 66 people were evaluated, 33 with PD and 33 without the disease, being the majority men (81.8%),with mean age of 62.1 ± 8.07 years. As for the motor stage in the Parkinson group, 39.4% were in stage 1.5. Measurements of thoracic mobility, respiratory muscle strength and lung function were reduced in people with Parkinson’s disease when compared to others without the disease. The umbilical variation presented a moderate correlation with forced expiratory volume in the first second (FEV1) (r = 0.50 p = 0.003), peak absolute and predicted expiratory flow (r = 0.63 p <0.001, r = 0.53 p = 0.003) and peak cough flow (r = 0.56 p = 0.001); (r = 0.42 p = 0.015) and forced vital capacity (r = 0.46 p = 0.007). The Pmax (r = -0, 41 p = 0.017), the PEmax (r = -0.42 p = 0.014), the predicted PEF (r = -0.38 p = 0.049), the PFT , P = 0.028) and the FEV1 / FVC ratio (r = -0.37 p = 0.036) showed a negative correlation, however weak with the Parkinson's disease motor stage. Conclusion: Individuals with Parkinson's disease show pulmonary function alterations, even in the early stages, when compared to others without the disease. The correlation between umbilical variation and inspiratory muscle strength; expiratory lung volumes and flows suggest a relationship between abdominal muscle impairment and respiratory changes associated with the disease, making respiratory evaluation and the early strengthening of the respiratory muscle, since its diagnosis relevant, in order to minimize future complications.

Treatment of the burned patient at the appropriate time prevents the occurrence of sequelae. The use of collagen-based skin substitutes can promote a sterile wound and serve as a framework for the healing process to occur. Objective - To evaluate tissue repair after the application of decellularized bovine pericardium biomaterial for the treatment of cutaneous burns. Methodology - This was an intervention study on experimental research with 48 rats, divided into two groups; with the experimental group being submitted to thermal burn on the back of the animals, by the brass plate method. After being burned, the experimental group received treatment with decellularized bovine pericardium biomaterial. The other group received treatment with rayon dressing soaked with petrolatum. The animals were sacrificed and evaluated histomorphologically at the biological time intervals of 7, 15, 28 and 60 postoperative days. Results - There was formation of granulation tissue with collagen fibers positioned in a more parallel manner and with less leukocyte fibrin exudate in the initial period of treatment in the experimental group. Maintenance of the biomaterial covering of the burned tissue was observed in up to 28 days. At the end of the 60 days, the control group presented a higher mean cicatricial contraction value when compared with that of the experimental group. Conclusion: The biomaterial was biocompatible, promoted the stability of the lesion and increased repair of the cutaneous lesion caused by the burn.

The diabetes mellitus type 1 is the most frequent endocrine disorder in infancy and adolescence and presents an increasing incidence with high morbidity and mortality. The risk for infections among them is greater. Thus, it is necessary to comply with the basic recommendation of vaccines and go beyond these, with a complementary vaccination. In this sense, this article aims to evaluate the vaccination status of children and adolescents with diabetes mellitus type 1, between 2 and 17 years of age which was observed in two public reference Hospitals. Methodology: Cross-sectional observational study performed at the Roberto Santos’ Hospital) and Professor Edgar Santos University Hospital Complex. The main characteristics of the study participants were measured through a structured questionnaire for this research and the evaluation of the vaccination condition was performed according to three criteria: verbal information provided by parents / guardians, result of questionnaire responses and assessment of the child's vaccination card. The analysis was performed using the statistical application Bioestat version 5.3. Results: 79 children and adolescents with diabetes mellitus type 1 were studied. There was predominance of the male gender and the brown and black ethnic groups. Eighty percent of children and adolescents had been vaccinated. Conclusion: The vaccination status of children and adolescents with type 1 diabetes mellitus accompanied by pediatric endocrinology services was satisfactory, reflected in the complete vaccination schedule.

Strongyloidiasis, an intestinal parasitic disease caused by nematodes of the genus Strongyloides, is among the major infections caused by geohelminths and affects between 30 and 100 million people worldwide, mainly in tropical and subtropical regions. Infections caused by Strongyloides stercoralis (S. stercoralis) are usually chronic and asymptomatic, and may persist for decades without diagnosis. However, in human immunocompromised patients co-infected with the human T-lymphotropic virus type 1 (HTLV-1) infection may progress to more severe forms (hyperinfection and / or dissemination) and low therapeutic response. Aim – To investigate the frequency of S. stercoralis infection and anti-S. stercoralis IgG seroprevalence in patients infected with HTLV-1, attended at the Integrative and Multidisciplinary Center for HTLV carrier care at the Bahiana School of Medicine and Public Health (CHTLV / EBMSP) in Salvador, Bahia. Methodology – This is an epidemiological, descriptive, cross-sectional study undertaken from January 2014 to December 2016. Patients were divided into two groups: Group 1 - patients living in the Salvador metropolitan region, and from cities in the interior of Bahia = 161) Group 2 - patients from only one family, living in Bahia de Camamu (n = 16). The diagnosis of S. stercoralis infection was performed by fecal larvae research and anti-S IgG screening of stercoralis by Enzyme Immunoadsorption Assay (ELISA). The diagnosis of the infection for HTLV-1 was performed through the ELISA and confirmed by Western Blotting (WB). The study was in accordance with the recommendations of Resolution CNS 466, of December 12, 2012. Results – In the present study, the frequency of S. stercoralis infection in subjects in Group 1 was 1.9% and in Group 2, 18.8%. The parasite load in infected individuals from Group 1 was low while three individuals from Group 2 were hyper-infected and had all parasitic forms on parasitological examination. The frequency of antibody IgG anti-S. stercoralis, in Group 1 individuals was 14.3% and in Group 2 it was 62.5%. The profile of the study population showed that both groups investigated lived on a monthly income up to one Brazilian minimum wage and had a low level of schooling. However, the health aspects in the individuals in Group 1 were relatively satisfactory, unlike those in Group 2 who were quite precarious. Discussion – Basic sanitation and health education are determining conditions for the acquisition of geohelminth infections. In addition to these factors, individuals infected with HTLV-1 are more susceptible to S. stercoralis infection. The low frequency of parasitosis in the individuals in Group 1, unlike that found in the Camamu family (Group 2), where most of the members were polyparasitized, may be explained by the exposure to various transmission factors. Moreover,the high parasite load in these individuals, possibly due to the lack of early diagnosis, led to a worsening of health status, unlike those who had continuous therapeutic follow-up in CHTLV / EBMSP. As for the differences in the frequency of results between the presence of the parasite and IgG anti-S. stercoralis detection, this is possibly due to low parasite load. Additionally, the frequency of antibodies may not reflect that an infection is present, but rather a previous exposure to the parasite as well as cross-reactions with other helminths. Conclusion – Seroprevalence of IgG anti-S. stercoralis cannot be conclusive of active infection. However, it may aid in the diagnosis of infection. In the groups studied here, the presence of antibodies IgG anti-S. stercoralis was seven and five times larger than the presence of fecal larvae in groups 1 and 2, respectively. Absence of basic sanitation in Group 2 individuals associated with HTLV-1 infection is probably determinant for hyperinfection and S. stercoralis infection in 18.8% of individuals.

Overweight and obesity are multifactorial diseases and major risk factors for chronic non-communicable diseases (NCDs). The motivation for change has been pointed out as one of the impact factors in treatment adherence. However, there is a lack of instruments that evaluate the motivational stages in the eating behavior of this population. Aim: This study aimed to adapt and evaluate the psychometric properties of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) in the context of overweight and obesity. Method: This is a cross-sectional, quantitative study. The psychometric properties of the instrument were investigated in a non-probabilistic sample of 177 individuals who were overweight or obese (IMC > 25 Kg/M2). Data was collected by means of an online platform and the invitation was made available on social networks (Facebook and Instagram) and Whatsapp. A Confirmatory Factor Analysis (CFA) was performed in order to provide data  based on the internal consistency of the SOCRATES-OO scale. In addition, the University of Rhode Island Change Assessment Scale (URICA) raw score was used to obtain data in terms of convergent validity, by its correlation with the domains of the best SOCRATES-OO solution. Results: According to CFA, the theoretical solution with two correlated facto rsprovided a better statistical fit: χ2 (151) = 283.835, p-value < 0.0001; RMSEA = 0.070 (confidence interval of 90% [CI] = 0.058 to 0.83); CFI = 0.976; TLI = 0.973, and W RMR = 0.9987. The reliability of AMREC and ACTION factors, evaluated by omega, was 0.92 4 and 0.943, respectively. Conclusion: The psychometric evaluation of the 19 items ofSOCRATES-OO presented a good fit to the two-factor model and satisfactory internal  consistency. However, future studies are needed in order to obtain additional evidence of instrument validity.

Blue covarine is a bleaching agent that produces optical changes on the surface of the teeth, associated with the abrasives of the dentifrice leading to tooth whitening. Objective: To determine the changes in colour, roughness and mass of the bovine enamel, after simulated brushing with dentifrices - containing blue covariate bleaching - for 6, 12 and 24 months.Materials and methods: 80 specimens were divided into 8 groups (n = 10): Control group (CG-water) and 7 test groups (TG1-Colgate Total 12, TG2-Oral-B 3D White Perfection, TG3 -Colgate Luminous Instant White, TG4-Close Up White Diamond Attraction, TG5-Close Up White Now-Glacier Fresh, TG6-Sorriso Xtreme White, TG7-Colgate Luminous White Advanced). The specimens were stained with coffee and subjected to simulated brushing for 6, 12 and 24 months. The colour, roughness and mass evaluations wereperformed after each brushing period. Results: No dentifrice test produced significant alterations in the roughness and mass of the specimens, however, when compared to CG, all of themproduced significant whitening. The comparison of the test groups did not show a significant difference in the colour variation between TG1, TG2, TG3, TG5, TG6 and TG7 in the study. The TG4 presented a variable behavior according to time, not statistically differing from TG3 at 6, 12 and 24 months, neither from TG6 at 6 and 12 months nor from TG7 at 12 months. Conclusion: The whitening effect of dentifrices containing blue covarine, after long periods of brushing, seems to be related mainly to association with mechanical bleaching agents, which, despite abrasives, did not damage the dental structure.

The Diabetes Mellitus type 2 (DM2) has assumed epidemic proportions, being responsible for several complications in target organs. Symptoms of anxiety and depression are very common among diabetics and are associated with a decrease in self-care and glycemic control. In this way, studies that relate psychiatric symptoms and diabetes are extremely relevant. Objective - Evaluate symptoms of anxiety and depression in patients with DM2. Methodology - This is a study of descriptive cross-sectional study in patients with DM2 seen at the endocrinology service of the University Hospital Professor Edgard Santos Complex in Salvador, Bahia. There were selected 30 individuals to compose a sample of convenience, after signing the Free and Informed Consent Form the sociodemographic and clinical data questionnaire and the Hospital Anxiety and Depression Scale (HADS). The data analysis was performed by the statistical program R 3.5.0. The variables were described using measures of central tendency (average) and dispersion (interquartile range) for continuous variables and absolute frequencies and for categorical variables. The associations between the categorical variables were performed using Pearson's Chi-square test and Fisher's exact test. It was calculated the Pearson's correlation coefficient between anxiety levels and depression. The level of significance was 5%. Results - A total of 30 patients were analyzed. A mean age of 61 years [SD±9.44] and a percentage of 73.3% of women. The scores obtained indicate that 53.3% presented significant symptoms of anxiety (HAD-A ≥ 8), 33.3% depression (HAD-D ≥ 8) and 26.7% depression and anxiety. No significant associations were found between depressive and anxious symptoms with the clinical and laboratory tests. Conclusions - The study shows that symptoms of anxiety and Depression are quite prevalent in patients with DM2

Strongyloides stercoralis infection is usually chronic and asymptomatic. However, when an impairement occurs in the host's immune system, this parasite disease may develop into severe conditions of hyperinfection and/or dissemination. Chronic alcoholism is one of the risk factors most associated with these clinical conditions. Aim. To evaluate the immunoblotting and ELISA for S. stercoralis infection diagnose in alcoholic patients using several antigenic preparations with different antibodies isotypes. Materials and methods. There were included in this study alcoholic patients admitted in the Centro de Acolhimento e Tratamento de Alcoolistas (CATA). Stool tests (spontaneous sedimentation, Baermann-Moraes and Agar Plate Culture) and ELISA for the detection of specific IgG, IgE and IgA1 were performed in all individuals. IgG1 and IgG4-ELISA were only made in patients diagnosed with S. stercoralis. Immunoblotting was performed using the soluble S. stercoralis (SsS) and S. venezuelensis (SvS) antigen, S. venezuelensis membrane antigen (SvM) and the combined NIE and SsIR recombinants antigens for IgG and IgA1 detection in 50 alcoholics sera, 20 being infected with S. stercoralis, 15 monoparasitized with otherhelminths and 15 negative for any enteroparasitosis. Only bands with sensitivity and specificity greater than 70% were considered for diagnosis. Results. The immunoblotting immunoreactivity varied according to the antibody isotype and antigens used. S. venezuelensis membrane antigen demonstrated sensitivity of 100% (20/20) in both IgG and IgA1 antibody tests and specificities of 90 (27/30) and 93.3% (28/30), respectively, demonstrating better diagnostic applicability. Homologous and heterologous soluble antigens demonstrated similar sensitivity and specificity when tested to IgG and IgA1, being lower than the heterologous membrane antigen for bothantibodies. The recombinant antigens demonstrated low specificities, with a high number of cross-reactions. SsIR was the recombinant with the greatest number of crossreactions, 86.7% (13/15) for both IgG and IgA1. IgG and IgA1 reactivity to the different antigenic preparations presented bands with a molecular weight ranging from 7 to 170kDa and 14 to 170 kDa, respectively. In SsS, the only band with more than 70% of both sensitivity and specificity to both IgG and IgA1 was at 26 kDa. In both SvS and SvM, a greater number of bands were observed for IgG and IgA1 compared to SsS. The 75 and 26 kDa bands of SvM presented the highest sensitivities and specificities for IgG and IgA1, with the 26 kDa band presenting 100% sensitivity for both antibodies, and specificity of 90 and 96.7% for IgG and IgA1, respectively. This band, for IgA1, demonstrated the highest sensitivity and specificity and the smallest difference between the two. At the end of the study, a total of 345 patients were evaluated. S. stercoralis infection frequency by parasitological methods was 21.4%. The ELISAs sensitivity and specificity varied according to the different classes and subclasses of antibodies tested, with the highest levels observed in IgG4 and IgE-ELISA, with 96 and 93% and 94 and 92%, respectively. However, the IgE immunoreactivity in alcoholic patients with fecal larvae elimination was only 70%, indicating that IgE-ELISA is a method with low sensitivity for strongyloidiasis diagnosis in these patients. IgA1 and IgG4-ELISA detected the highest antibodies frequency in alcoholic patients with faecal larvaeelimination, 80% and 85%, respectively. The mean optical density of specific IgG1 in the serum of alcoholic patients infected with S. stercoralis was significantly lower in relation to infected non-alcoholic individuals (p <0.05). In addition, only 57% of alcoholics with faecal larvae excretion were positive for IgG1-ELISA and a significant negative correlation (r = -0.273, p <0.05) was observed between anti-S. stercoralis IgG1levels and the parasite load. Approximately 92% of alcoholic patients with elimination of larvae in feces and negative ELISA for one or more classes or subclasses ofantibodies demonstrated immunoreactivity in immunoblotting for IgA1 using S. venezuelensis membrane antigen, confirming the presence of specific circulating antibodies. Conclusion. S. venezuelensis membrane antigen presented better applicability in the immunoblotting for S. stercoralis infection diagnosis and the IgA1 antibody screening has a specificity than IgG screening, showing that the bands at 17, 26, 75 and 90 kDa can be usede as molecular patterns in S. stercoralis diagnosis and italso are potential candidates for recombinant antigen production. IgG4 and IgE-ELISA demonstrated a high sensitivities and specificities, however a low reactivity in alcoholic patients. Moreover, it was observed a statistically significant increase in the parasite load of alcoholic patients infected with S. stercoralis and IgE and IgG1-ELISA negative. In alcoholic patients, IgG4 and IgA1-ELISA presented the best results among the evaluated ELISAs. Immunoblotting confirmed S. stercoralis infection in 92% of patients with elimination of fecal larvae but negative for one or more classes or sublasses of antibodies in the ELISA. This work sets a precedent for future studies in the use of different antibodies classes and subclasses for S. stercoralis diagnosis and immune response evaluation and raises the need for more studies in the development ofrecombinant antigens for strongyloidiasis diagnosis in risk groups of endemic areas.

ABSTRACT
Introduction: The complications of diabetes mellitus type 1 (1DM) can affect the auditory pathway.
Objectives: To investigate the auditory, peripheral and central pathways and the presence of
neuroauditic complaints in children and adolescents with 1DM. Methodology: 101 individuals
participated in this study, 50 with 1DM (GE) and 51 without (CG). All of them responded to an
audiological interview and performed threshold tone audiometry, immitance testing, amplitude
distortion product otoacoustic emissions (DPOAE), evaluation of the inhibitory effect of the efferent
pathway, tests the auditory brainstem response (ABR) and cognitive potential (PEALL). Results:
There was a significant statistical relationship between the groups regarding hearing complaints of:
dizziness (p=0,031), tinnitus (p= 0,020), difficulties in understanding speech in noise (p=<0,001),
difficulties in atention (p=0,025), memory problems (p= 0,002), distraction in noise (p= 0,007),
difficulties in understanding television (p=0,026) and telephone (p=0,042). The acoustic reflex
thresholds were altered in participants with diabetes at frequencies of 500 Hz (p = 0.005 / 0.003), 1
kHz left ear (p = 0.013) and 2 kHz (p = 0.036 / 0.008). In the DPOAE investigation, there was no
statistical significance. In the analysis of the inhibitory effect, a statistical difference was observed
in the left ear in the frequencies of 4 kHz (p = 0.001) and 8 kHz (p = 0.003). There was no association
between inhibitory effect, acoustic reflex, age of diagnosis, disease duration and metabolic control
in both ears. As for the association between ABR and metabolic variables, there was a positive
correlation between disease duration and metabolic control between the V wave and the us interpeak
intervals, I-III and I-V. Regarding the cognitive potential, there was no statistical significance
between the groups, and between diabetic participants and metabolic variables. Conclusion: The
reduction of the inhibitory effect, altered acoustic reflex and auditory evoked potentials in children
and adolescents with 1DM suggest that the peripheral and central auditory system could early be
compromised.

Feeding skills define a child's readiness for progression of its diet and the feeding behavior is essential for adequate intake of nutrients necessary for its development. Feeding difficulties in childhood have increasingly emerged as an object of multidisciplinary interest. Objectives – The research presented in the first article sought to determine whether preterm infants present oral motor disorder (OMD) after initial introduction of complementary feeding, as well as to identify the instruments that have been used to assess oral motor skills in this population. The second article aimed to investigate the association between OMD and feeding difficulty during the process of introducing complementary feeding in preterm infants. Methods – For the first research, a systematic review was conducted. The search for articles was conducted on LILACS, MEDLINE/PubMed, Scopus and Web of Science databases, comprising studies in Portuguese, Spanish and English without limitation of publication period. The second article presents a cross-sectional, observational and quantitative study. Dyads in follow-up at an outpatient clinic for high-risk newborns who had already begun complementary feeding and were up to 24 months corrected gestational age, were included in this study. Difficulties in the process of food introduction was verified through the mother's perception of the presence of defensive behaviors in their children during mealtime in the last month. The performance of oral motor skills was measured through the application of an adaptation of the “Clinical evaluation protocol of pediatric dysphagia” (PAD-PED). Results – As a result of the researches conducted, two original articles are presented. In the first, the analysis of 12 selected studies published between 2004 and 2016 is provided. The most studied age group was the first year of life. Two major groups of research strategies were identified: questionnaire and assessments of oral sensorimotor system and (or) functional assessment of swallowing and suction. Only five studies present a total frequency of oral motor disorders. In the research reported in the second article, the sample consisted of 62 dyads of children with a mean corrected gestational age (CGA) of 13.5 months. Complementary feeding was introduced at sixth month CGA by 55.7% of the mothers and 69.4% of them reported some sort of difficulty with this activity. Extremeprematurity had an association with defensive feeding behavior (p = 0.005), as well as the initial introduction of food with liquid consistency (p = 0.001), the extended period of timeusing enteral tube feeding (p = 0.044), the continuous positive airway pressure (CPAP) (p = 0.013) and parenteral nutrition (p = 0.039). Conclusions – From the data presented in the first article, it is possible to conclude that preterm infants have OMD after the beginning of complementary feeding and that there is neither homogeneity in the descriptions and frequencies of OMD, nor consensus about the most adequate instrument for their assessment. In the findings reported in the second article, the reports of mothers or their substitutes revealed that difficulties were encountered in the introduction of complementary feeding and there was no significant association between oral motor disorder and feeding difficulties. 

Introduction: Strontium (Sr) promotes the stimulation of the metabolic effects that occur during the formation of bone tissue, stimulates osteoblasts and produces an inhibitory effect on osteoclasts, as well as the ability to replace calcium in the crystal lattice of hydroxyapatite. It has been incorporated into the structure of novel bioactive materials as well as being used as a drug in the form of strontium ranelate to increase bone density in patients with osteoporosis, rheumatoid arthritis and bone metastatic diseases. Objective: The objective of this work was to quantify by the technique of spectrophotometry with atomic absorption with graphite furnace (GFAAS) and to evaluate histologically the effect of strontium deposition in liver and kidney of rats, after enteral administration of drugs containing strontium, for the bone regeneration. Materials and methods: Wistar rats were used between 350 and 480 grams in weight, divided into groups: Protos1 (GP1), Protos 2 (GP2), Drug (GF) and Control (GC) with their biological points of 15, 30 and 60 days. Results: The histological results were histologically altered in the liver and kidney. The deposited concentrations of Sr in mouse liver were also evidenced. Conclusion: It was concluded that the histological evaluation evidenced cellular alterations in the liver and kidney, being compatible with the increase of the concentration of Sr. The degree of Sr concentration was significant for 15 and 60 days, due to the high liver deposition attesting toxicity. 

Although the prevalence of hearing loss in congenital hypothyroidism has been significantly reduced in the last decades, there is still evidence of hearing abnormalities in this population that are independent of diagnosis and initiation of hormone replacement therapy in early stages. This evidence demonstrates the existence of subclinical impairment indicating that auditory dysfunctions continue to be a reality in thyroid hypofunction. Objective: To investigate subclinical auditory disorders in individuals with congenital hypothyroidism and its association with clinical, laboratory and symptomatic aspects. Material and Methods: A analytical, sectional exploratory study with a convenience sample composed of individuals with congenital
hypothyroidism, developed by using four methodological strategies. In the first moment (article 1), we have performed a study of narrative revision in order to make a bibliographical survey about the subject. In a second and third stage, we investigated otoneurological complaints (article 2) and self-reported participation restrictions in congenital hypothyroidism to detect symptoms related to probable subclinical impairment (article 3). In order to confirm the symptomatic findings of the previous articles, we have performed an auditory evaluation of the olivocochlear reflex (article 4). Results: In article 1, there were reports in the literature about endococcal,
retrocochlear and central abnormalities in congenital hypothyroidism. In articles 2 and
3, evidence indicates that these individuals present a higher prevalence ofotoneurological complaints, as well as mild/moderate degree of self-reported participation restrictions. Article 4 has shown that congenital hypothyroidism is susceptible to developing subclinical damage to the efferent system. All of these findings presented some factor of considerable association with clinical aspects and/or hormonal follow-up related to congenital hypothyroidism. Conclusion: The findings of the articles suggest that individuals with congenital hypothyroidism are susceptible to develop subclinical auditory abnormalities, verified through damage to the efferent system and the presence of vestibulocochlear symptoms and self-reported participation restrictions.

ABSTRACT
The objective of the present study is to analyze the signifiers surrounding the symptom of functional intestinal constipation in the speech of children, adolescents and their parents. This analysis was articulated to the following questions: how does constipation reveal the subjectivity of the child, the mother, the father and/or the crisis of the parental couple (ex-couple)? The present study is prospective-qualitative, with a non-probabilistic sample, including children and adolescents within an age range between 3 and 18 years old, diagnozed with functional intestinal constipation, referred to the analyst by the medical team of the Pediatric Hepatology and Gastroenterology Clinic at the HUPES-CPPHO complex of the UFBA. The research was divided into two branchs. The first branch dealt with the analysis of the signifiers that emerged in the speeches of the patients out of a questionnaire applied by the analist. Fourteen families were interviewed. The questionnaire approached three aspects of the symptom: the real of the body, the symbolic (ideas) and the imaginary (affects). The second part of the research addressed children’s and parent’s talk, surrounding the functional intestinal constipation symptom, during the preliminairy interviews. The Psychoanalytic techique used in the interviews was the analyst’s listenning in fluctuating attention and the patients’ free association. Listenning, in fluctuating attention, was the way through which the analyst followed the libido’s traces and its fixations revealed in the patients’ discourse. The signifiers were analysed in one hundred interviews carried out by the analyst. The responses collected showed, preliminarily, that the speech of the children and parents revealed unconscious conflicts underlying the symptom of functional intestinal constipation. A lack of success with medical treatment was reported by thirteen patients. The discourse of the mothers indicated self-demands, demands and difficulty with establishing limits. In the discourse of the fathers, a lack of time, disobediance of the child, mothers who hampered the performance of the paternal role and difficulties with authority were observed. Subsequentely, a sample of signifiers collected and associated with constipation: holding in, “I can’t speak”; muteness; not open up; to suspect; block; keep in, not give; give up; not know how to do it; having to do it. The signifiers’ analysis was deepened over the preliminary interviews. The following signifiers were repeated among the cases to make, stuck, poo, toilet, to glue, to hold versus to release, difficulty with sharing, shyness, pain, to spoil, dirty versus clean, anguish, aggressiveness, to suffer, father’s absence, fear, guilt, control,
baby, to be born, to kill, to play, to work, money, stubbornness, to hide, monster, limits, to eat versus not to eat, among others signifiers. The analysis of the patients’ discourse showed repressed unconcious matters regarding to the anal pulsion, the relationship of the child with the feces, the subjectivity of the child, the mother, the father and/or the crisis of the parental couple (ex-couple). All the ten patients that joined the treatment presented substantial enhancement, among those seven achieved the symptom’s cure. The results of the research, although parcial, were meaningful and demonstrated that Phychoanalysis heals through the signifiers since talking, during the treatment, goes through the body and produces cure effects.

Abstract
Introduction: The literature provides several approaches to reducing pain in individuals with
temporomandibular disorders. Isotonic exercises seem to enable the vascularization of regions
where they are performed, which eventually improves the mobility of the target muscles. In
addition to peripheral modifications, there are changes in the central nervous system
measurable through alpha power density in the regions of interest. This paper reports on a
parallel randomized controlled trial aimed to investigate the alpha power density and the
clinical aspects of individuals with temporomandibular disorder before and after performing
isotonic exercises and receiving selfcare counselling. Methods: The study was started upon
approval by the Research Ethics Committee (Approval No. 1,680,920). Inclusion criteria
were: age from 18 to 60 years, and diagnosis of muscular temporomandibular disorders
according to the Brazilian version of the research diagnostic criteria for temporomandibular
disorders, Axis I, diagnosis IA and IB of muscle pain, with or without restricted mouth
opening and scores ranging from 4 to 10 on the numerical scale for self-reported pain.
Exclusion criteria included: diagnosis of joint alterations such as disc displacement, arthralgia,
osteoarthrosis, and osteoarthritis; psychiatric and neurological disorders. Subjects were
randomized into two groups: the experimental group, which performed the exercises twice a
week for one month; and the control group, which was provided selfcare counselling only. In
a first moment, the individuals’ clinical conditions were investigated before and after
performing isotonic exercises and relaxation techniques (Paper 1). All exercises were drawn
upon the literature and aimed at joint lubrification and relaxation of cervical muscle and jawclosing
muscles. The instruments included: a questionnaire to collect demographic data, the
Brazilian version of the research diagnostic criteria for temporomandibular disorders,
numerical scale for pain, and myofunctional evaluation by AMIOFE scores. The statistical
approach was quantitative and inferential. In a second moment, electroencephalographic
recordings were collected for the same individuals before and after the exercises (Paper 2).
Electroencephalography was performed with a 32-channel device, with a sampling frequency
of 600 Hz, impedance of 5 kΩ. The electrodes were positioned according to the 10X20
system, with the electrode positioned in CZ used as reference. Data were exported to
programs MATLAB (The Mathworks, Inc., Natick, Massachusetts, USA). The individual
records were filtered offline by using bandpass between 0.5 and 50 Hz. Absolute power
density was measured using fast Fourier transform in epochs of 1,710 milliseconds. The
statistical approach was also inferential and quantitative. The same instruments of clinical
evaluation were used as in the first moment, alongside the analysis of electroencephalographic
records before and after 30 days of intervention with isotonic exercises. Results: Twentythree
individuals participated in the study, most female and multiracial Brazilians (pardos).
One individual from the experimental group and three from the control group dropped out for
personal reasons. Eleven and eight individuals were followed up in the experimental group
and in the control group, respectively. The degree of depression decreased in the experimental
group by the end of data collection. A change in the diagnosis of dysfunction was observed,
with disc displacement with reduction disappearing by the end of the study. The level of pain
reduced but was not ascribable to the intervention (Paper 1). No significant difference was
observed in alpha power density in the two moments (Article 2). Conclusion: Isotonic
exercises and relaxation techniques for pain reduction were not sufficient for clinical
11
improvement in individuals with temporomandibular dysfunction. A small increase was found
in the alpha power density in the left temporal, parietal and occipital regions.
Keywords: Temporomandibular Joint Dysfunction Syndrome, Electroencephalography,
Myofunctional Treatment

Hepatitis C is the principal cause of chronic hepatitis (20% to 25%) worldwide. One of the strategies adopted in attempting to reduce or eliminate this problem was the introduction of rapid screening tests. These help in the early diagnosis, which is critical to prevent the histological evolution to advanced fibrosis and thus, to avoid the consequences of its evolution if it is not treated. Objective: To determine the prevalence of Hepatitis C in a "baby boomer" population in an emergency service in the city of Catu-BA. Methodology: Descriptive sectional study in individuals of the "baby-boomer" population, out patients in an emergency service of the municipal hospital of Catu-BA, since july to october 2016, who underwent the rapid test for hepatitis C. Results: The study sample was of 285 patients. Among them, 28,1% were males and 71,9% were females. The mean age was 54,8 years. The rapid test was positive in 0,4% (n = 01), confirmed later by molecular biology test. 56,8% of the patients had some comorbidity. Among the risk factors to get hepatitis C, 10,2% received blood transfusions before 1993, 3,9% had tattoos or piercing, 63,5% said they had sexual intercourse without a condom, 65,6% had major surgeries, 78,6% (n = 224) underwent dental extraction using anesthesia and 41,1% reported using piercing-cutting objects. Conclusion: The prevalence found for anti-HCV antibody was lower than that reported in other studies. Perhaps because Catu is an oil city, where there are many companies that promote disease prevention actions, including AIDS, and this may have led to an indirect prevention of hepatitis C. The population studied presented little knowledge about the forms of transmission and prevention of hepatitis C, presented a certain "self-care", at least with regard to the sharing of needles and/or straws during the use of illicit drugs. However, she was unconcerned about safe sex. 

Parkinson's disease (PD) is a progressive neurodegenerative disorder that affects the central nervous system. The clinical situation is characterized by motor dysfunctions, but with the progression of the disease, respiratory dysfunctions become more evident and worrying. Currently, PD treatment based on the PNF and virtual rehabilitation (VR) methods are well established as to the repercussion in reducing the progression of motor dysfunctions, but little is known about the repercussion in the respiratory system. Objective: To compare the effects of treatment using FNP-­based kinesiotherapy and RV with Nintendo WII® on lung function of patients on PD treatment. Methodology: Controlled, randomized, longitudinal and prospective clinical trial. Twenty-­two patients were randomized, 10 for the VR group with Nintendo Wii (G0) and 11 for the PNF group (G1). Regarding respiratory muscle strength, the results were analyzed in relation to the predicted values of PImax and PEmax, and the physical performance was evaluated by the TUG test. Patients were submitted to 16 physiotherapy sessions in two weekly sessions. Results: When comparing the means of variables PImax, PEmax and FVC with the values predicted for the pulmonary function, no significant differences were found. When comparing lung function in the lighter stages with that of the moderate stages of PD, no differences were observed between the variables PImax, PEmax and FVC. In a paired analysis of the results obtained in groups G0 and G1, no difference was found between the values of PImax, PEmax and FVC and of the TUG test. There was no correlation between the TUG test values and the values for pulmonary function. Conclusion: Both the PNF method and the VR-­based method had no impact on lung function, since the predicted values of pulmonary function (PImax, PEmax and FVC) did not differ from those obtained in the study. There was no association between the physical performance assessed by the TUG test and the pulmonary function, as well as no correlation between the severity score of the PD and worsening of pulmonary function.

The discoloring of single teeth constitutes a great challenge for a restorative dentistry, since its results in localized disharmony which usually lead the tooth to be restored using esthetic materials, after great dental preparation. An alternative to minimize extensive preparation is the use of resinous pigments before the placement of restorative material, which may interact differently with the color of the tooth and the thickness of the cover resin. This study aimed to evaluate the colorimetric effect of darkened bases with a blending between flow dyes and two different thicknesses of a composite resin (dentin). A colorimetric evaluation of the effect of three dyes covered by two different thicknesses of a composite resin was performed on three dark substrates. 320 specimens were divided into 6 experimental groups (n=50), which were divided into 5 subgroups (n=10), depending on the interaction with the different pigments and thicknesses of the cover resin, and 2 control groups (n=10). The darkened bases were made with laboratory composite resin, in A4, B4 and C4 colors. For each base, three different pigments (white, ocher, opaque) were used, which in turn were covered with A2 composite resin, in two thicknesses (0,5 and 1,0mm). The color parameters were evaluated using a reflection spectrophotometer with D65 illuminat, by using the CIEL*a*b* system standards. The L*, a* and b* values were measured separately, and statistical analysis was performed with ANOVA, Tukey and Student t (5% significance). There was a significant difference between all the study factores tested, in all variables. For the L* axis, higher values were found for white and opaque pigments; while for a variable a*, the better results were achieved by the of the ocher pigment. The b* axis presented a distinct interaction for each hue and thickness. The opaque pigment had positive results in the interaction with shades A and C, while the B hue not interacted positively with any of the pigments tested. Based on this study, it could be concluded that the colorimetric interaction occurs differently for each variable studied (L*, a* and b*) in each hue and thickness tested; in general, the opaque pigment presented better results in L* and b* parameters; and, the ocher pigment produced better results in the a* parameter.

Movement is an essential aspect of life and allows the human being to interact with the environment, but the mechanism by which the neuromusculoskeletal system uses to promote improvement in the performance of motor tasks has not yet been well delineated. Objective : Quantitatively characterize the evolution pattern of the biomechanical strategies adopted in the process of sensorimotor adaptation in healthy individuals, exposed to a functional motor task demand. Methodology : This is a cross sectional, observational study, including 30 healthy subjects exposed to a motor task, consisting of a video game that uses the Nintendo Wii ® platform to identify the improvement of motor performance combined with the use of a software of kinematic analysi s of the movement, the CvMob, to characterize the evolution of motor strategies throughout the practice of the game. Results : 29 subjects, 1 exclusion, mean age of 26 years ± 3.05, of which 17 (58.63%) were female and 12 (41.37%) were male. The number of h its, which shows improvement in performance, presented an initial mean of 17.9 ± 6.05 and a final mean of 28.90 ± 1.87. The variability was measured by the percentage of the standard deviation in relation to the mean in the first evaluation, which was 33.3 8% for the score in the game and 28.9 0% for the Elements of Motion ( E OM ) and in the seventh the percentage of the standard deviation in the score game score was 6.49% and in EOM , 24.40%. It was possible to identify a trend to the inverse correlation betwee n the score and the amount of EOM with p = 0.00013 and r = 0.977. Conclusion : During the process of sensory motor adaptation there is a modification in the strategies used in the task, characterized by the reduction in the number of EOM , suggesting the de velopment of a more efficient final motor strategy.

Objective: To describe the frequency of internalizing and externalizing behavior problems in
adolescents aged between 11 and 17 years, coming from a public school in the city of
Salvador, Bahia, Brazil, from the parents/guardians perception. Methodology: The CBCL / 6-
18 was used to assess internalizing and externalizing behavioral problems in a sample of 347
parents or guardians of adolescent students, being an observational, cross-sectional study.
Results: The majority of the sample consisted of boys (52.4%), from which a higher
percentage was of 13 year-old adolescents (23.8%), self-identifying as black (45.5%). A total
of 20,4% of the adolescents (56 schoolchildren) presented behavioral problems in the total
range of problems above the expected age and sex, with scores equivalent to the CBCL / 6-18
clinical range. This prevalence is consistent with the literature. The score for internalizing
problems reached the clinical range for 16.4% of adolescents and in 15.3% for externalizing
problems. Analysis of gender differences revealed that parents/guardians of boys reported
more problems than parents/guardians of girls on the scale of internalizing problems, with a
higher percentage of boys achieving scores in the clinical range on this scale (20.5% x
11.7%), a statistically significant difference (p = 0.05). These data are in line, however
partially, with other important studies conducted with adolescents on the prevalence of
behavioral problems. Conclusion: This study collaborates with new data regarding the
research and evaluation of infantile-juvenile psychopathologies at the national level. Thus, it
can enable preventive actions and referrals directed at the young population. In addition,
sociodemographic variables may play a role in the manifestation of behavioral problems in
adolescence, needing to be investigated.

ABSTRACT
Contextualization: Chronic liver diseases are characterized by inflammatory and fibrotic
lesions of the liver, which may progress to liver cirrhosis. Such changes lead to systemic
complications that may interfere with respiratory muscle strength and the functional capacity
of developing children and adolescents. Objectives: To compare the values of MIP, MEP and
the distance covered during the 6MWT, in children and adolescents with chronic liver
diseases, with reference values for healthy individuals of the same age group. Methods: This
is an analytical, observational and cross-sectional study, carried out from June to December
2017. Children and adolescents aged 6 to 16 years, with chronic liver diseases, were recruited
at a reference outpatient clinic in Salvador, Bahia. Subjects with diagnoses of cardiopathies,
Pneumopathies, musculoskeletal and neuromuscular diseases or cognitive compromise were
excluded. The 6MWT and the evaluation of MIP and MEP were performed based on the
criteria established by the American Thoracic Society. Quantitative variables were expressed
as mean and standard deviation, and categorical variables were expressed in frequency and
percentage. The Wilcoxon test was used to verify the difference between the values of
distance traveled - evaluated and predicted. Pearson's correlation was applied between PImax
and PEmax and distance walked on the 6MWT. Results: The sample consisted of 40 children
and adolescents, 57.5% female, with a mean age of 11.68 ± 2.82 years, weight of 38.17 ±
11.92 kg, height 1.43 ± 0.13 m and BMI 18.12 ± 2.69 kg/m2. The mean MIP was -77.13 ±
23.31cmH2O and MEP 65.87 ± 18.18cmH2O. It was found difference between the predicted
and evaluated mean MIP of -17.71cmH2O (p<0.001), between predicted MEP and evaluated
MEP of 30.68cmH2O (p<0.001). There was no intercurrence during the 6MWT and no
volunteer required or requested to discontinue the test. The mean distance traveled was 346.46
± 49.21m, and the mean predicted for healthy individuals of the same age group was 532.43m
± 48.01m, with a difference of 185.54m (p<0.001). Conclusions: The children and
adolescents with chronic liver diseases evaluated presented reduced values of MIP, MEP and
distance walked on the 6MWT, in relation to the predicted values for the healthy population.
Such a finding may suggest the impairment of respiratory muscle strength and physical
capacity of individuals with the same profile as the sample studied.
Keywords: Hepatopathies. Chronic disease. Maximum respiratory pressures. Wal

Low levels of vitamin D are associated with poor prognostic factors in the intensive care unit. Vitamin D supplementation could improve the prognosis of critically ill patients. Methods: A systematic review of the literature was performed using the following electronic databases: PubMed, Cochrane, Medline and Scielo. The following keywords were used: “vitamin D”, “intensive care unit”, “critical care”, “sepsis”, “critical ill” and their respective translations to the Portuguese Medical Subject Headings Terms (Mesh terms). Results: In the end, a meta-analysis was performed using the R. Results statistical programm. It included seven studies that evaluated 752 patients, 472 of which (62.8%) were meales, with ages ranging from 54 to 68.9 years. As for the afore mentioned studies, six of them are prospective, randomized and double-blind; one is open. Among them all, five are unicentric and two are multicentric. The dose of vitamin D ranged from 150,000 IU to 540,000 IU. Its administration route as oral or via nasogastric tube in four studies, one of which used IV route and two studies used the intramuscular route. All studies showed an increase in vitamin D in comparison to baseline levels. Regarding adverse effects, it was evidenced that some mild side effects were present in only two studies. The meta-analysis revealed that vitamin D supplementation in critically ill patients can reduce mortality by 28-30 days. [RR 0.76 (95% CI: 0.57-1.00, p = 0.05)]. Regarding mortality, there was no significant difference between groups between 84 and 90 days [RR 1,09 (95% CI: 0.45-2.62, p = 0.85)], hospital mortality [RR = 0.84 (95% CI: 0.66-1.06, p = 0.14)], length of ICU stay [RR -1.44 (95% CI: -3.19-0.31, p = 0.11)], length of hospital stay [RR -6.46 (95% CI: -13.72-0.80, p = 0.08)] and length of mechanical ventilation [RR -0.91 (95% CI: -2.70-0.88, p = 0.32)]. Conclusion: The present metaanalysis showed that vitamin D supplementation in critically ill patients shows a reduction of 28-30 days in mortality. Thus, it is suggested that critical patients with at leas t 18 years of age should receive a dose > 150.000 UI of vitamin D to profit from this benefit. 

The nutritional and developmental alterations in patients with congenital heart disease are being recognized. However, the feeding practices that lead to adequate growth are still undefined in the case of children affected by such impairment. An understanding of the results of nutritional interventions can help to determine strategies so as to promote health as well as to guarantee the human right to a healthy and adequate diet for this specific population. OBJECTIVE: To describe the types of foods, feeding methods and weight evolution on hospitalized newborns and infants with congenital heart disease. METHODS: This is a observational longitudinal descriptive secondary study performed in a tertiary hospital with 65 newborns and infants with congenital heart disease diagnosed by echocardiography. The patients were grouped according to the number of days of hospitalization from 0 to 7; 8 to 14; 15 to 21; 22 to 28; 29 to 35 and more than 35 days. The following variables were analyzed at birth, on the seventh day of life and at hospital discharge: gender, gestational age, APGAR, type of heart disease, intrauterine growth, type of food, route of administration and prescribed intervals, weight gain, weight evolution, according to the score: Z weight and x age of the Intergrowth 21 curve. RESULTS: A total of 64 cases of newborns and infants with acyanotic heart disease and 1 with cyanotic heart disease were described. Several foods were prescribed, with breast milk being the most frequent at hospital discharge. There was no association between prescribed type of food and weight gain, although both the newborn and the infants who were exclusively breastfed presented the worst z scores for weight and age, regardless of the period of hospitalization and hospital discharge. The oral route was the most frequent at hospital discharge and in the groups with the shortest period of hospitalization. The most common dietary administration interval was free to demand at hospital discharge. Several medians of volumes were found, without the observation of relations with some analyzed parameter. The configuration of themost observed weight evolution curve was descendant, regardless of gender. CONCLUSION: Both the foods and the feeding methods prescribed resulted in the predominance of caloric rate and curve of weight evolution, which were smaller than those recommended.

The frequency of congenital infection by syphilis and cytomegalovirus (CMV) has increased in developing countries. Monitoring hearing is fundamental to detecting late onset changes. The aims of the present study were to investigate the influence of syphilis or CMV on the development of cochlear and neural functions, describe neuroelectrophysiological findings of the auditory pathway in infants with and without serology indicative of risk for syphilis and CMV and describe the characteristics of cochlear function in infants with and without serology indicative of risk for syphilis or CMV. A descriptive study (article 1) and a case study (article 2) were conducted. Data on newborns with a diagnosis of  syphilis or CMV detected at birth based on positive blood exams were collected from patient files at a public maternity. The guardians of the newborns were then contacted and asked to authorize the participation of the infants to evaluate their hearing. Transient evoked otoacoustic emissions, distortion product otoacoustic emissions, immittanciometry with a 1000-Hz probe and the study of nerve conduction of the brainstem auditory evoked potential (BAEP) were performed in infants at risk of congenital syphilis. The case study involved  a four-year-old child with congenital CMV and audiological findings throughout the four years. The final sample of the group at risk of congenital syphilis totaled 22 infants (20% adherence rate) and the same number of infants composed the non-exposed group. Statistically significant differences between groups were found for the amplitudes of the signal level at 4000 Hz in the right ear, at 3500 Hz in the left ear and the signal/noise ratio at 3500 Hz in the left ear (p < 0.05). No significant differences were found with regard to distortion product otoacoustic emissions or immittanciometry. For the BAEP, the Mann-Whitney exact test demonstrated significant differences between the exposed and nonexposed groups with regard to both the I-V interval and III-V interval in the left ear. The present results demonstrate that the follow up of infants affected by congenital syphilis or CMV is important to the monitoring of possible progressive changes.

The search for competent professionals in the field of Clinical Psychology necessarily derives from the quality of the supervised practice offered in training courses. However, often the approach and format of clinical supervision are a decision of the supervisor himself, conditioned to his academic and professional training, as well as previous experience as a student of supervision, without specific objective criteria or systematization of this process. The literature on supervisor training and its impact on the development of therapeutic competencies and treatment outcomes are still scarce and marked by methodological limitations, with little contribution to the implementation of effective practices of dissemination of Cognitive-Behavioral Therapy. Objectives: This study aimed at understanding the current panorama of supervised clinical practice in cognitive-behavioral therapy specialization courses in Brazil and evaluating the results obtained in therapeutic competence and in the perspective of supervisees regarding supervision after five training sessions of a group of clinical supervisors, in comparison to the control group. Method: Initially, all coordinators of accredited Cognitive-Behavioral Therapy specialization courses were invited to fill out an electronic questionnaire, with no respondent identification, on the supervised clinical practice offered in their specialization courses. Descriptive analyzes were performed with the objective of knowing the frequency of the studied variables. In the second stage of the research, 18 clinical supervisors of a private training center were randomly divided into 2 groups according to the moment of exposure to the intervention and again allocated to each subgroup of supervision previously drawn by the institution. The experiment group underwent five training sessions in core competencies in supervision. The evaluation of the development of therapeutic competences by 37 supervisees was performed using the Cognitive Therapy Scale by an evaluator blind to the participants' allocation, who evaluated sessions recorded before and after the intervention, and the performance of the clinical supervisor was evaluated immediately after each group supervision session, through thesupervisory feedback form, which is part of the Supervisor Competence Scale. Results: Mostcourses offer monthly, group supervision, and the minimum course load reserved for clinicalsupervision sessions was of at least 75 hours. The absence of a supervisory structure has been identified in more than half of the courses and the use of recorded sessions does not seem to be part of the clinical supervision sessions of the specialization courses in the country. The recruitment of clinical supervisors follows criteria related to their academic background and clinical experience, with little emphasis on the supervisor's training process and metasupervision sessions. In terms of the proposed intervention, there was an absence of evidence (p-value = 0.164) on the effectiveness of training in supervision skills, which can be explained by the educative nature of the experiment and by the recognized dilution effect of the training impact in pyramid training initiatives. In this study, supervisors who were trained in supervisory skills had more positive points (β = 0.701, p-value <0.001) and fewer negative points (β = -0.893, p = 0.043) identified in their performance by their supervisees. Therapists who experienced the first supervision term identified more negative aspects (β = 0.744, pvalue = 0.044) and points to improve (β = 0.811, p-value <0.001) in the performance of their supervisors than the therapists who were about to complete the specialization course. Among the supervisors of the experiment group, it was also observed that the risk of having a reflexive learning enhancing action identified was 4.64 times the risk of it occurring among the therapists in the control group (Risk ratio = 4,641, p-value <0.001). Conclusion: The data obtained confirmed the informal nature of supervised clinical practice and the training of clinical supervisors in specialization courses in Brazil. It is necessary that training initiatives are accompanied by the development of a new professional culture in which information about one's own performance is perceived as essential to the exercise of psychotherapy and any difficulties, as opportunities for learning.

Low birth weight was found to be associated with early morbidity and mortality in childhood, as well as late into adulthood due to its association with cardiovascular diseases related to obesity and metabolic syndrome. Term and LBW may be due to restricted intrauterine growth and result in a child who is small for gestational age (SGA). This would be the earliest form of human malnutrition. Whether the risk of late LBW-related illnesses is due to intrauterine nutritional impairment or subsequent growth pattern alone has not yet been defined and for this reason diet could play a key role. Evidence has been found that breastfeeding (BF) protects against obesity and diabetes mellitus in children born at term and with adequate weight for gestational age (AGA), with its effect lasting up to adulthood, but for the child born SGA this knowledge has not yet been established. The aims of this thesis were to conduct a review of the literature to investigate the metabolic outcomes and those related to adiposity in breastfed infants born term SGA; to evaluate a cohort of infants born full term and SGA and followed up to pre-school age, and to compare them with children born at term AGA. Methods: a systematic review was conducted in the MEDLINE, LILACS, SciELO, EMBASE databases without time or language restrictions using the PRISMA tool and the quality of the evidence was evaluated according to the criteria proposed by EPHPP (Effective Public Health Practice Project - Quality Assessment Toll for Quantitative Studies). The results of this review generated one article of the thesis. A second article was elaborated from the clinical-nutritional and laboratory data and cardiometabolic risk factors of infants born at term SGA and AGA and followed up until thepreschool age. Results: In the systematic review article, only seven studies were included, in which the breastfed SGA children were observed to have a better outcome related to adiposity and glycemic profile, in addition to hormones related to insulin resistance (IGF-1 and adiponectin), without impaired growth. Only one study, with a small number of patients, found a relationship of increased fat mass in infants who were breastfed and evaluated at six weeks of age. In the second article, originated from this thesis, 32 children born full term (20 SGAs and 12 AGAs) were followed-up. It was found that those with weight and height deficit at birth were found to have regained growth indicators in the first six months. There was a significant difference in the speed of weight gain between the groups in this evaluation period (peak catch up delta in the SGA group 1.43 versus AGA 0.55, p <0.001). However, even with this increased initial weight gain rate, there was no diagnosis of overweight or obesity in the evaluation at preschool age. In contrast, the SGA children had lower adiposity indicators. There was no statistically significant difference for the systolic (SBP) and diastolic (DBP) measurements between the groups. In the analysis of laboratory variables of cardiometabolic risk factors, performed from four to six years, no statistically significant difference between the groups was observed, although a significant difference was found between the groups in the measurements of triglycerides and HDL-cholesterol at 01 year of age. All the children in the study were breastfed in the first six months (exclusive BF rate of 65% in SGAs and 58% in AGAs for thefirst six months), with the mean time of 180 days of exclusive BF, with no difference betweengroups. Conclusion: only a few studies in the literature have evaluated the BF in children bornat term and SGA. Based on data from the studies published in the systematic review and on the cohort study performed as part of the thesis, we found a relationship between BF in the first six months of life and a better cardiometabolic and nutritional outcome, with repercussions up to the preschool age.

Heart diseases in childhood, whether congenital or acquired, are an important cause of morbidity and
mortality. Described as structural problems in the heart since birth, congenital heart diseases result
from failures in cardiac development of the fetus, soon after conception, and are related directly to
changes in pulmonary blood flow. When the appropriate treatment is not set out, the clinical
manifestations lead to the death of these children in the neonatal period. Rheumatic carditis is
considered the main cause of heart disease among children in underdeveloped and developing
countries. This study aimed to get to know the clinical and epidemiological profile of patients admitted
to the Cardio Pediatric Intensive Care Unit in a tertiary hospital in the city of Salvador, Bahia. This
cross-sectional exploratory study performed from January 2013 to December 2014, based on patient's
record, had a sample of 307 children and adolescents aged zero to 15 years, with congenital and
acquired heart disease from the countryside of Bahia and Salvador metropolitan region. The RACHS-1
score was used for the categorization of the various surgical procedures. The majority of the patients
(64.8%) came from the countryside. There was a predominance of male patients (52.4%), euthrophic
(35.1%) aged from 28 days up to one year (44%). Congenital heart diseases (91.9%) prevailed over
acquired heart diseases (8.1%). Hemodynamic complications were more frequent in this sample
(64.3). Most patients (88.9%) evolved to hospital discharge and 11.1% died of cardiogenic shock
(61.8%). As for the RACHS-1 score, the total correction surgery occurred in 75.8% and the partial
correction surgery in 24.2% of the patients. The risk 3 category had the highest rate (44.9%), whereas
the risk 4 category had higher prevalence of death (38.5%). The clinical and epidemiological criteria
for this study allowed the identification of the population profile. Patients aged between 28 days to one
year (p = 0.001), with cyanotic congenital heart disease (p = 0.004) undergoing cardiac surgery with
cardiopulmonary bypass time greater than 120 minutes (p = 0.018), have a higher risk of death.