Resumen Introducción : El ataque cerebral (ACV) en adultos jó venes comprende aproximadamente el 10% de todos los eventos cerebrovasculares. La información disponible so bre la recurrencia de un nuevo evento en esta población y particularmente en Latinoamérica es limitada. Nuestro objetivo fue examinar la presencia de recurrencia de ACV luego de haber presentado un infarto cerebral. Métodos : Se realizó un estudio de cohorte retros pectivo, incluyendo pacientes con infartos cerebrales arteriales en edades comprendidas entre 18 y 55 años, entre enero de 2005 a mayo de 2020. El resultado principal fue la recurrencia de un ataque cerebro vascular. Resultados: Se incluyeron 138 pacientes durante una mediana de seguimiento de 24 meses. El 52.2% (n = 72) de sexo masculino y el 73,4% (n = 94) tuvo un NIHSS inicial menor a 4. El 38% (n = 52) tenía antecedentes de hipertensión arterial y 13,1% (n = 18) antecedentes de ACV / ataque isquémico transitorio (AIT) previo. El 13% (n = 18) presento recurrencia durante su seguimiento. Discusión : La recurrencia de los eventos neurovas culares ocurren predominantemente en pacientes con antecedentes de ACV/AIT previo, probablemente secun dario a enfermedades de difícil diagnóstico.

Abstract Introduction : Stroke (CVA) in young adults comprises approximately 10% of all cerebrovascular events. The information available on the recurrence of a new event in this population and particularly in Latin America is limited. Our objective was to examine the presence of stroke recurrence after having presented a stroke. Methods : A retrospective cohort study was carried out, including patients with arterial cerebral infarctions between the ages of 18 and 55, between January 2005 and May 2020. The main outcome was the recurrence of a cerebrovascular attack. Results : 138 patients were included during a median follow-up of 24 months. The 52.2% (n = 72) were male patients and 73.4% (n = 94) had an initial NIHSS score of less than 4. The 38% (n = 52) had a history of arterial hypertension and 13, 1% (n = 18) history of previous stroke / TIA. 13% (n = 18) presented recurrence during their follow-up. Discussion : The recurrence of neurovascular events occurs predominantly in patients with a history of previ ous stroke/TIA, probably secondary to diseases that are difficult to diagnose.

ABSTRACT OBJETIVE To estimate risk and protection factors associated with suicide in Campinas, Brazil, in 2019. METHODS This is a populational case-control study analyzing 83 cases of suicide that occurred in 2019 in Campinas, a Brazilian city with about 1.2 million inhabitants. Controls were composed of 716 inhabitants. An adjusted multiple logistic regression was used. Cases and controls were the dichotomous response variables. Sociodemographic and behavioral variables were the predictor variables. RESULTS The categories which presented higher risk of suicide were: males [OR = 5.26 (p < 0.001)]; people aged 10–29 years [OR = 5.88 (p = 0.002)]; individuals without paid work [OR = 3.06 (p = 0.013)]; individuals presenting problematic use of alcohol [OR = 33.12 (p < 0.001)] and cocaine [14.59 (p < 0.007)]; and people with disabilities [OR = 3.72 (p < 0.001)]. Moreover, the perception of fear was associated with reduced suicide risk [OR = 0.19 (p = 0.015)]. Higher district HDI levels also showed a 4% decrease in risk for each 0.01 increase in district HDI levels [OR = 0.02 (p = 0.008)]. CONCLUSIONS This study evidenced the association between sociodemographic and behavioral variables and suicide. It also emphasized the complexity in the dynamics between personal, social, and economic factors to this external cause of death.

ABSTRACT OBJETIVE To estimate risk and protection factors associated with suicide in Campinas, Brazil, in 2019. METHODS This is a populational case-control study analyzing 83 cases of suicide that occurred in 2019 in Campinas, a Brazilian city with about 1.2 million inhabitants. Controls were composed of 716 inhabitants. An adjusted multiple logistic regression was used. Cases and controls were the dichotomous response variables. Sociodemographic and behavioral variables were the predictor variables. RESULTS The categories which presented higher risk of suicide were: males [OR = 5.26 (p < 0.001)]; people aged 10–29 years [OR = 5.88 (p = 0.002)]; individuals without paid work [OR = 3.06 (p = 0.013)]; individuals presenting problematic use of alcohol [OR = 33.12 (p < 0.001)] and cocaine [14.59 (p < 0.007)]; and people with disabilities [OR = 3.72 (p < 0.001)]. Moreover, the perception of fear was associated with reduced suicide risk [OR = 0.19 (p = 0.015)]. Higher district HDI levels also showed a 4% decrease in risk for each 0.01 increase in district HDI levels [OR = 0.02 (p = 0.008)]. CONCLUSIONS This study evidenced the association between sociodemographic and behavioral variables and suicide. It also emphasized the complexity in the dynamics between personal, social, and economic factors to this external cause of death.

Abstract The genetic basis of oral epithelial (OED) is unknown, and there is no reliable method for evaluating the risk of malignant transformation. Somatic mutations are responsible for the transformation of dysplastic mucosa to invasive cancer. In addition, these genomic variations could represent objective markers of the potential for malignant transformation. We performed whole-exome sequencing of 10 OED samples from Brazilian and Chilean patients. Using public genetic repositories, we identified 41 deleterious variants that could produce high-impact changes in the amino acid structures of 38 genes. In addition, the variants were filtered according to normal skin and Native American genome profiles. Finally, 13 genes harboring 15 variants were found to be exclusively related to OED. High-grade epithelial dysplasia samples showed a tendency to accumulate highly deleterious variants. We observed that 62% of 13 OED genes identified in our study were also found in head and neck squamous cell carcinoma. Among the shared genes, eight were not identified in oral squamous cell carcinoma. To our knowledge, we have described for the first time 13 genes that are found in OED in a Latin American population, of which five genes have already been observed in oral squamous cell carcinoma. Through this study, we identified genes that may be related to basal biological functions in OED.

Abstract This study aimed to analyze the molecular characteristics of oral epithelial dysplasia (OED), highlighting the pathways and variants of genes that are frequently mutated in oral squamous cell carcinoma (OSCC) and other cancers. Ten archival OED cases were retrieved for retrospective clinicopathological analysis and exome sequencing. Comparative genomic analysis was performed between high-grade dysplasia (HGD) and low-grade dysplasia (LGD), focusing on 57 well-known cancer genes, of which 10 were previously described as the most mutated in OSCC. HGD cases had significantly more variants; however, a similar mutational landscape to OSCC was observed in both groups. CASP8+FAT1/HRAS, TP53, and miscellaneous molecular signatures were also present. FAT1 is the gene that is most affected by pathogenic variants. Hierarchical divisive clustering showed division between the two groups: “HGD-like cluster” with 4HGD and 2LGD and “LGD-like cluster” with 4 LGD. MLL4 pathogenic variants were exclusively in the “LGD-like cluster”. TP53 was affected in one case of HGD; however, its pathway was usually altered. We describe new insights into the genetic basis of epithelial malignant transformation by genomic analysis, highlighting those associated with FAT1 and TP53. Some LGDs presented a similar mutational landscape to HGD after cluster analysis. Perhaps molecular alterations have not yet been reflected in histomorphology. The relative risk of malignant transformation in this molecular subgroup should be addressed in future studies.

Abstract Behavioral characteristics may also take part in the etiology of dental caries. Sedentary behavior, especially watching television, is associated with increased intake of foods high in fat or free sugar, which could influence the occurrence of dental caries. The aim of this study was to assess the mediating effect of eating pattern on the relationship between television exposure time and the presence of dental caries in children. A cross-sectional study was conducted with a representative sample of 580 parent-child dyads with children aged 7 to 8 years in 20 public schools in Pelotas, Brazil. Parents or legal guardians were interviewed and provided information on demographic/socioeconomic data, children’s daily television exposure time, and answered the Biological Rhythms Interview for Assessment in Neuropsychiatry for Kids (BRIAN-K-eating pattern domain). Caries was evaluated through clinical examination. The mediating effect of eating pattern on the relationship between television exposure and presence of dental caries was estimated using the parametric g-formula. Prevalence of dental caries was 63%, and 22% of children watched TV 4 or more hours per day. Television exposure had no direct effect on the dental caries experience [odds ratio (OR): 1.05 (95% confidence interval (95%CI): 0.92–1.19)]. Nevertheless, difficulty maintaining regular eating pattern mediated the natural indirect effect of television exposure time (≥ 4 hours/day) on dental caries experience [OR: 1.07 (95%CI): 1.01–1.14)]. The results of this study confirm the indirect pathway between television viewing and dental caries and the role of disordered eating patterns in this association.

Abstract: Introduction: Knowledge and understanding of scientific research are skills that must be developed by all health professionals. Specifically in Medicine, these skills make up an important part of undergraduate and continuing medical education. Considering that medical training is closely related to the understanding of scientific evidence, it becomes relevant to analyze the involvement of medical students with scientific activities during the course. Objective: This study aimed to investigate the interest and involvement in scientific research among medical students, analyzing the academic profile and the extracurricular activities carried out, in addition to evaluating the scientific production and identifying the motivations and difficulties faced. Method: A cross-sectional study carried out with medical students from Salvador/Bahia, over 18 years of age. A virtual, structured, anonymous questionnaire was applied through Microsoft Forms, containing 21 questions about the academic profile and extracurricular activities carried out, in addition to data on scientific production and the motivations and difficulties faced by students. Result: Of the 460 participating students, there was a predominance of women (63.3%), aged 24.1+6.1 years, attending the basic (45.4%) and clinical (46.7%) cycles, who have no previous desire to work with research (54.8%). Among the participants, 54.6% were part of academic leagues, 31.1% were involved in research groups and 29.1% participated in monitoring. It was found that only 33.9% of students have abstracts published in congresses, 12.2% are co-authors of scientific articles and 7.4% are main authors. Interest in working with research increases during graduation (p = 0.010), with students motivated to produce scientifically (66.1%). Research experience (27.4%) and genuine interest in scientific discovery (20.9%) were the main motivating factors. However, 81.1% of students identify difficulties in producing scientific content, with inadequate guidance (16.0%) and lack of time (15.5%) being the main obstacles. No relationship was observed between motivation and difficulty to produce scientifically and the current academic cycle. Conclusion: Medical students show interest and participation in scientific research, however those who are actually involved in scientific activities represent the minority.

Resumo: Introdução: O conhecimento sobre pesquisa científica e a compreensão dela são habilidades que devem ser desenvolvidas por todos os profissionais de saúde. Especificamente na Medicina, essas habilidades compõem uma parcela importante da graduação e da educação médica continuada. Considerando que a formação médica possui estreita relação com a compreensão sobre evidências científicas, torna-se relevante analisar o envolvimento dos estudantes de Medicina com as atividades científicas durante o curso. Objetivo: Este estudo teve como objetivos verificar o interesse e o envolvimento em pesquisas científicas entre os estudantes de Medicina por meio da análise do perfil acadêmico e das atividades extracurriculares realizadas, avaliar a produção científica e identificar as motivações e dificuldades enfrentadas. Método: Trata-se de um estudo transversal, realizado com estudantes de Medicina de Salvador, na Bahia, maiores de 18 anos. Aplicou-se, por meio do Microsoft Forms, um questionário virtual, estruturado e anônimo contendo 21 perguntas acerca do perfil acadêmico e das atividades extracurriculares realizadas, além de dados sobre a produção científica e as motivações e dificuldades enfrentadas pelos estudantes. Resultado: Dos 460 estudantes participantes, houve predominância de mulheres (63,3%), com idade de 24,1+6,1 anos, cursando os ciclos básico (45,4%) e clínico (46,7%), que não possuem desejo prévio de trabalhar com pesquisa (54,8%). Dentre os participantes, 54,6% integraram ligas acadêmicas, 31,1% possuem envolvimento com grupos de pesquisa e 29,1% participaram de monitoria. Verificou-se que apenas 33,9% dos estudantes possuem resumos publicados em congressos, 12,2% são coautores de artigos científicos e 7,4% são autores principais. O interesse em trabalhar com pesquisa aumenta durante a graduação (p = 0,010), estando os estudantes motivados para produzir cientificamente (66,1%). A experiência em pesquisa (27,4%) e o interesse genuíno na descoberta científica (20,9%) foram os principais fatores motivadores. Entretanto, 81,1% dos discentes identificaram dificuldades para produzir conteúdo científico e apontaram como empecilhos a orientação inadequada (16,0%) e a falta de tempo (15,5%). Não foi observada relação entre a motivação e a dificuldade para produzir cientificamente e o ciclo acadêmico em curso. Conclusão: Os estudantes de Medicina demonstram interesse e participação em pesquisa científica, entretanto aqueles que, de fato, estão envolvidos com atividades científicas representam a minoria.

Resumen Aunque el consumo de marihuana es altamente prevalente entre universitarios de Argentina, poco se sabe respecto a los factores que permiten distinguir a los consumidores frecuentes de marihuana de quienes consumen esporádicamente. Por esta razón, en el presente trabajo se indagó sobre las posibles variaciones en los contextos de consumo, motivos de consumo, normas percibidas y estrategias conductuales de protección entre universitarios con consumo frecuente o esporádico de marihuana, y se analizó la utilidad de este conjunto de variables para distinguir entre estos los tipos de consumidores mencionados. Para ello, se contó con una muestra de 1083 estudiantes universitarios argentinos que completó una encuesta en línea sobre el consumo de sustancias. En particular, este trabajo se realizó con la submuestra que reportó consumir marihuana en los últimos 30 días (n = 158; 51.3 % mujeres). Dicha encuesta interrogaba sobre el consumo de marihuana y las consecuencias negativas asociadas, así como por motivos de consumo, normas sociales percibidas y estrategias conductuales de protección. Como resultado, los consumidores frecuentes presentaron mayor cantidad de consecuencias negativas (M = 4.92) que los consumidores esporádicos (M = 1.82; p < .05), y se halló un perfil distintivo en un conjunto de variables. A nivel multivariado, los motivos de animación (OR = 1.230; p < .05), las estrategias conductuales de protección (OR = .941; p < .05), el consumo en solitario (OR = 2.024; p < .05) y el consumo en fiestas universitarias (OR = 2.669; p < .05) discriminaron significativamente entre ambas clases de consumidores. En general, los hallazgos revelaron subpoblaciones heterogéneas de consumidores de marihuana que difieren no solo en el consumo y sus consecuencias, sino también en los contextos de consumo y en un conjunto de variables relevantes. Estas subpoblaciones distintivas requieren de intervenciones diferentes y específicas.

Abstract Although marijuana use is highly prevalent among university students in Argentina, little is known about the factors that distinguish frequent marijuana users from sporadic users. For this reason, the present study investigated the possible variations in the contexts of consumption, motives for consumption, perceived norms, and protective behavioral strategies among university students with frequent or sporadic marijuana use, and analyzed the usefulness of this set of variables to distinguish between these two types of users. For this purpose, a sample of 1083 Argentine university students completed an online survey on substance use. In particular, this work was conducted with the subsample that reported using marijuana in the last 30 days (n = 158; 51.3 % female). The survey asked about marijuana use and associated negative consequences, as well as motives for use, perceived social norms, and protective behavioral strategies. As a result, frequent users had a higher number of negative consequences (M = 4.92) than sporadic users (M = 1.82; p < .05), and a distinctive profile was found on a set of variables. At the multivariate level, cheerleading motives (OR = 1.230; p < .05), protective behavioral strategies (OR = .941; p < .05), solo use (OR = 2.024; p < .05), and college party use (OR = 2.669; p < .05) discriminated significantly between the two classes of users. Overall, the findings revealed heterogeneous subpopulations of marijuana users that differ not only in use and its consequences, but also in contexts of use and in a set of relevant variables. These distinct subpopulations require different and specific interventions.

ABSTRACT Insects use biogenic volatile organic compounds (BVOCs) as chemical cues to find their host plants and colonize them. Studies of olfactory responses have reported that BVOCs released by host plants attract whiteflies. The citrus woolly whitefly, Aleurothrixus floccosus (Maskell) (Hemiptera: Aleyrodidae) is a serious foliar pest, infesting citrus orchards at the Pica Oasis, Tarapacá Region, Chile. We studied the attractant behavior of A. floccosus toward BVOCs emitted from lime (Citrus ×aurantiifolia (Christm.) Swingle), mandarin (Citrus reticulata Blanco), and tangelo (Citrus reticulata × Citrus ×paradisi Macfad.) shoots. We collected volatiles from living plants using dynamic headspace technique for 24 h. The BVOCs released by the Citrus species were collected on Porapak Q traps and analyzed by gas chromatography coupled to mass spectrometry (GC-MS). The chemical analysis revealed differences in abundances of monoterpenes, sesquiterpenes and aldehydes; thus, D-limonene (33.44%) was the most abundant compound in lime and significantly higher than mandarin and tangelo. On the other hand, sabinene (12.36%), nonanal (28.06%) and caryophyllene (22.97%) were more abundant in mandarin. Tangelo showed high abundance of β-phellandrene (17.01%), nonanal (17.87%) and caryophyllene (16.01%). In the two-choice bioassays, we found 13.5% and 17.1% more A. floccosus females in lime than in mandarin and tangelo, respectively. Our findings show that the volatile profile of ‘Limón de Pica’, C. aurantiifolia, elicits the strongest attractive behavior of A. floccosus females in the olfactometry experiments.

RESUMEN El objetivo del estudio fue evaluar los efectos de la levadura Saccharomyces cerevisiae como aditivo para la preparación de ensilado de avena y cebada en dos tiempos de fermentación (21 y 42 días). Se prepararon minisilos de avena y cebada y se evaluaron cuatro niveles de levadura (0, 15, 30 y 45 g/kg FV). Los minisilos fueron abiertos a los 21 y 42 días. Se prepararon tres repeticiones de ensilado para cada combinación de ensilado x nivel de levadura x tiempo de ensilado. Los valores de composición bromatológica del ensilado de avena en términos de proteína cruda (PC), materia mineral (MM), fibra detergente neutra (FDN), fibra detergente ácida (FDA), extracto etéreo (EE) y pH aumentaron cuando se agregó la levadura con relación al control, pero disminuyó la materia seca (MS). La calidad del ensilado de cebada en términos de MS, PC, FDN, FDA y EE mejoró al agregar 30 y 45 g/kg de levadura, en comparación al control; sin embargo, disminuyó para EE y pH. Los resultados demuestran que la inoculación de S. cerevisiae en los dos tiempos de fermentación incrementa el contenido de PC, EE, MM y pH del ensilado; sin embargo; el alto nivel de pH no permite conservar la calidad del ensilado. Se concluye que el mejor valor nutricional se obtuvo con la adición de S. cerevisiae de 45 g/ kg a los 42 días de fermentación en ambos ensilados, aunque disminuye algunos parámetros de importancia.

ABSTRACT The aim of this study was to evaluate the effects of the yeast Saccharomyces cerevisiae as an additive for the preparation of oat and barley silage in two fermentation times (21 and 42 days). Oat and barley minisilos were prepared using four levels of yeast (0, 15, 30 and 45 g/kg FV). The minisilos were opened at 21 and 42 days. Three silage replicates were prepared for each combination of silage x yeast level x silage time. The bromatological composition values of the oat silage in terms of crude protein (CP), mineral matter (MM), neutral detergent fibre (NDF), acid detergent fibre (FDA), ethereal extract (EE) and pH increased when the yeast was added in relation to the control, but the dry matter (DM) decreased. The quality of the barley silage in terms of DM, CP, NDF, FDAand EE improved when adding 30 and 45 g/kg of yeast, compared to the control; however, it decreased for EE and pH. The results show that the inoculation of S. cerevisiae in the two fermentation times increases the content of CP, EE, MM and pH of the silage; nevertheless; the high pH level does not allow proper conservation of the quality of the silage. It is concluded that the best nutritional values were obtained with the addition of S. cerevisiae of 45 g/kg at 42 days of fermentation in both silages, although it decreases some important parameters.

Resumen: Diferentes factores pueden influir en la calidad de vida de personas con discapacidad intelectual. Este estudio investigó los factores asociados con la calidad de vida relacionada con la salud oral en niños con discapacidades intelectuales desde la perspectiva de sus cuidadores. Se realizó un estudio transversal con niños brasileños institucionalizados, que fueron evaluados clínicamente y sus respectivos tutores, quienes respondieron cuestionarios. Los datos fueron recolectados a través de registros médicos, aplicación de instrumentos de evaluación y examen clínico oral (n=92). La mayoría de los niños presentaban una higiene oral deficiente (64,10%) y una experiencia de caries alta (59,8%). Si bien la percepción específicamente de las madres respecto del impacto de las condiciones de la salud oral en la calidad de vida fue baja, mostró una tendencia a aumentar en cuanto disminuía el nivel educacional, la frecuencia de cepillado y la historia de lactancia materna (p≤0.05). El hecho de que la percepción del impacto en la calidad de vida por parte de los tutores no se condiga con las precarias condiciones de salud oral exhibida por los niños con discapacidad intelectual, no sólo demuestra el desconocimiento respecto de la importancia de la salud oral en un contexto general, sino que también evidencia la necesidad de promover acciones que incentiven el cuidado y educación en relación con este aspecto, tanto en los tutores como en los niños afectados.

Abstract: Different factors can influence the perception of quality of life in individuals with intellectual disabilities. This study investigated the factors associated with quality of life related to oral health in children with intellectual disabilities from the perspective of their parents. A cross-sectional study was carried out with Brazilian children from specialized institutions and their respective guardians. Data were collected through medical records, application of instruments and oral clinical examination (n=92). Most children had poor oral hygiene (64.10%) and a high caries experience (59.8%). The mothers' perception of quality of life related to oral health was low, however there was an association of greater perception when they had low education, female child, less brushing frequency and history of breastfeeding (p≤0.05). Although the perception of quality of life was low, the oral condition found evidences the need to promote oral health education actions with children with intellectual disabilities and their respective guardians.

Abstract Scimitar syndrome is a rare congenital anomaly characterized by partial or complete anomalous pulmonary venous drainage of the right (rarely left) lung into the inferior vena cava. This anomalous vein resembles the curved Turkish sword “scimitar”[1]. Only few cases were reported with two scimitar veins[2]. “Myocardial bridge” constitutes a portion of the myocardial tissue that bridges a segment of the coronary artery, mostly the left anterior descending coronary artery . For the first time, a combination of double scimitar vein and a myocardial bridge was described in this study.

Background: Supplementation of vitamin B12 in older adults is a common practice to avoid vitamin B12 insufficiency. However, there is a paucity of information about the effects of cobalamin excess. Aim: To asses any potential effects of high levels vitamin B12 on mortality on adults aged ≥ 65 years admitted to an internal medicine service. Material and Methods: We Prospectively studied patients admitted to an internal medicine service of an academic hospital from September 2017 to September 2018, who were able to give their consent and answer questionnaires. We tabulated age, gender, medical history, comorbidity index (Charlson), frailty score (Fried scale), admission diagnosis and blood tests performed within 48 hours of admission. The primary outcome was death by any cause in less of 30 days or after one of year follow up, determined according to death certificates. Results: We included 93 patients aged 65 to 94 years (53% males). Fifteen patients died during the year of follow up (five within 30 days of admission). Those who died had higher cobalamin levels than survivors (1080.07 ± 788.09 and 656.68 ± 497.33 pg/mL respectively, p = 0.02). Patients who died had also a significantly lower corrected serum calcium, sodium (p = 0.04) and a medical history of chronic liver disease (p = 0.03). In the multivariable analysis, only vitamin B12 preserved the association with mortality (p = 0.009). Conclusions: There was a significant association between high levels of cobalamin and all-cause mortality in this group of patients aged ≥ 65 years-old.