The “Hypertension Approaches in the Elderly: a Lifestyle study” multicenter, randomized trial (HAEL Study): rationale and methodological protocol

Background: Hypertension is a clinical condition highly prevalent in the elderly, imposing great risks to cardiovascular diseases and loss of quality of life. Current guidelines emphasize the importance of nonpharmacological strategies as a first-line approach to lower blood pressure. Exercise is an efficient lifestyle tool that can benefit a myriad of health-related outcomes, including blood pressure control, in older adults. We herein report the protocol of the HAEL Study, which aims to evaluate the efficacy of a pragmatic combined exercise training compared with a health education program on ambulatory blood pressure and other health-related outcomes in older individuals. Methods: Randomized, single-blinded, multicenter, two-arm, parallel, superiority trial. A total of 184 subjects (92/center), ≥60 years of age, with no recent history of cardiovascular events, will be randomized on a 1:1 ratio to 12-week interventions consisting either of a combined exercise (aerobic and strength) training, three times per week, or an active-control group receiving health education intervention, once a week. Ambulatory (primary outcome) and office blood pressures, cardiorespiratory fitness and endothelial function, together with quality of life, functional fitness and autonomic control will be measured in before and after intervention. Discussion: Our conceptual hypothesis is that combined training intervention will reduce ambulatory blood pressure in comparison with health education group. Using a superiority framework, analysis plan prespecifies an intention-to-treat approach, per protocol criteria, subgroups analysis, and handling of missing data. The trial is recruiting since September 2017. Finally, this study was designed to adhere to data sharing practices. Trial registration: NCT03264443. Registered on 29 August, 2017

Infecção oral pelo HPV e lesões epiteliais proliferativas associadas HPV oral infection and proliferative epithelial associated lesions

Os papilomavírus humanos (HPVs) pertencem à família Papillomaviridae e seu ciclo de vida é diretamente ligado à diferenciação das células epiteliais do hospedeiro. Possuem seis genes que se expressam precocemente e dois genes que se expressam tardiamente, sendo denominados respectivamente E (early) e L (late). O ácido desoxirribonucleico (DNA) viral dentro da célula do hospedeiro pode assumir duas formas: epissomal e integrada. O HPV tem como alvo as células basais de epitélios escamosos, em particular da área genital, onde está associado ao carcinoma da cérvice uterina. Na boca, o HPV está associado a papiloma escamoso oral, condiloma acuminado, verruga vulgar e hiperplasia epitelial focal. Entretanto, seu papel na carcinogênese oral é ainda controverso, sendo também identificado como agente etiológico de alguns carcinomas de células escamosas de cabeça e pescoço. A infecção pelo HPV pode agir sinergicamente com agentes carcinogênicos, como o tabaco e o álcool. Pelo menos 150 subtipos diferentes de HPV já foram identificados, sendo que 25 têm sido detectados em lesões orais. Considerando a relevância do tema para a melhor compreensão da infecção oral pelo HPV, o objetivo desta atualização é rever os aspectos relevantes da biologia do HPV, com ênfase na relação HPV-ceratinócitos, e a importância dos dados clínicos e histopatológicos na definição diagnóstica das lesões orais possivelmente associadas ao HPV.<br>Papillomaviruses belong to the family Papillomaviridae and their life cycle is directly linked to the differentiation of host epithelial cells. They have six genes that are expressed earlier and two genes that are expressed later in their life cycle, named respectively E (early) and L (late). Host cell viral DNA can take two forms: episomal and integrated. The human papillomavirus (HPV) targets the basal cells of squamous epithelia, particularly from the genital area, which is associated with uterine cervix carcinoma. In the oral area HPV is associated with oral squamous papilloma, condyloma acuminatum, verruca vulgaris, and focal epithelial hyperplasia. However, its role in oral carcinogenesis is still controversial. Moreover, it has identified as an etiological agent of some head and neck squamous cell carcinomas. HPV infection may act synergistically with carcinogens such as tobacco and alcohol. At least 150 different subtypes of HPV have been identified, of which 25 types have been detected in oral lesions. Considering the relevance of the topic for better understanding of HPV oral infection, the objective of this update is to review relevant aspects of HPV biology, with emphasis on HPV-keratinocytes relationship and the importance of clinical and histopathological aspects in the diagnosis of oral lesions possibly associated with HPV

Influência de exercícios ativos livres e de alto impacto no fortalecimento da musculatura pélvica

O objetivo do trabalho foi avaliar o efeito de exercícios livres na musculatura do assoalho pélvico, associados a exercícios de alto impacto como Jump e Step. O estudo foi realizado com 60 mulheres, de 20 a 65 anos, onde inicialmente foram submetidas a um teste de força da musculatura do assoalho pélvico, através do método bidigital, e após, foram realizadas aulas de Jump e Step associadas a exercícios livres na musculatura pélvica, durante 8 semanas, em 3 sessões de 60 minutos, em dias alternados. Ao final do treinamento, as mesmas foram submetidas novamente ao mesmo teste, sendo os resultados classificados de acordo com a Escala de Ortiz. Percebeu-se que após as 8 semanas de exercícios, 20% da amostra foi classificada com grau 0; 20% grau 2; e 60% grau 3. O fortalecimento da musculatura pélvica associada a exercícios de impacto foi eficiente em um programa de exercícios livres, considerando p≤0,05

INFLUÊNCIA DE EXERCÍCIOS ATIVOS LIVRES E DE ALTO IMPACTO NO FORTALECIMENTO DA MUSCULATURA PÉLVICADOI: http://dx.doi.org/10.5892/ruvrd.v14i1.2504

O objetivo do trabalho foi avaliar o efeito de exercícios livres na musculatura do assoalho pélvico, associados a exercícios de alto impacto como Jump e Step. O estudo foi realizado com 60 mulheres, de 20 a 65 anos, onde inicialmente foram submetidas a um teste de força da musculatura do assoalho pélvico, através do método bidigital, e após, foram realizadas aulas de Jump e Step associadas a exercícios livres na musculatura pélvica, durante 8 semanas, em 3 sessões de 60 minutos, em dias alternados. Ao final do treinamento, as mesmas foram submetidas novamente ao mesmo teste, sendo os resultados classificados de acordo com a Escala de Ortiz. Percebeu-se que após as 8 semanas de exercícios, 20% da amostra foi classificada com grau 0; 20% grau 2; e 60% grau 3. O fortalecimento da musculatura pélvica associada a exercícios de impacto foi eficiente em um programa de exercícios livres, considerando p≤0,05

Direito e Gênero: o Projeto Promotoras Legais Populares e sua Orientação à Emancipação Feminina / Law and gender: the Promotoras Legais Populares Project and its orientation to female emancipation

<p class="StandardCxSpFirst"><strong>Resumo</strong></p> <p class="StandardCxSpMiddle">O presente texto busca apresentar o projeto Promotoras Legais Populares com ênfase em sua realização no Distrito Federal como projeto de extensão vinculado à Universidade de Brasília. Evidencia os aportes teóricos e conceituais que sustentam o projeto, explicando sua lógica fundamentada na visão ampliada do Direito, na educação jurídica popular, nas reivindicações feministas e na ação afirmativa em gênero como esforços de libertação e emancipação.</p> <p class="StandardCxSpMiddle"><strong> </strong></p> <p class="StandardCxSpMiddle"><strong>Palavras-chave:</strong> Promotoras Legais Populares, Direito, feminismo.</p> <p class="StandardCxSpMiddle"> </p> <p class="StandardCxSpMiddle"> </p> <p class="StandardCxSpMiddle"><strong>Abstract</strong></p> <p class="StandardCxSpMiddle">This present text aims to introduce the Promotoras Legais Populares project, with emphasis on its performance in Distrito Federal as an extension project entailed to the University of Brasília. It highlights the theoretical and conceptual contributions underpinning the project, explaining its logic based on the enlarged view of the Law, the popular legal education, the feminist claims and the affirmative action on gender as liberation and emancipation efforts.</p> <p class="StandardCxSpMiddle"><strong> </strong></p> <p class="StandardCxSpLast"><strong>Keywords</strong><strong>:</strong> Promotoras Legais Populares, Law, feminism.</p><br /

Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients

Abstract Background Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. Methods This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). Results The median age of the model-derivation cohort was 59 (IQR 47–70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918–0.939) and validation (temporal AUROC 0.927, 95% CI 0.911–0.941; geographic AUROC 0.819, 95% CI 0.792–0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). Conclusions The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P <.01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P =.15). Secondary end points did not differ between groups after follow-up. Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death. © 2019 The Author

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora