Objectives: To summarize evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The literature on CBT interventions for adult OCD, including BT and exposure and response prevention, was systematically reviewed to develop updated clinical guidelines for clinicians, providing comprehensive details about the necessary procedures for the CBT protocol. We searched the literature from 2013-2020 in five databases (PubMed, Cochrane, Embase, PsycINFO, and Lilacs) regarding study design, primary outcome measures, publication type, and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association. Results: We examined 44 new studies used to update the 2013 American Psychiatric Association guidelines. High-quality evidence supports CBT with exposure and response prevention techniques as a first-line treatment for OCD. Protocols for Internet-delivered CBT have also proven efficacious for adults with OCD. Conclusion: High-quality scientific evidence supports the use of CBT with exposure and response prevention to treat adults with OCD.

RESUMO O objetivo do presente estudo foi comparar a diferença hormonal (cortisol) entre os sexos, especialidades do nado e desempenho dos nadadores adolescentes, verificar a existência das relações entre cortisol e aspectos cognitivos, entre 35 nadadores média de idade 15,41± 0,51 anos, avaliados durante o Campeonato Brasileiro Juvenil de Natação. Além disso, foram utilizados questionários, Ansiedade do Estado Competitivo (CSAI-2) e caracterização sociodemográfica. Também foram efetuadas coletas salivares. As nadadoras apresentaram maior ansiedade cognitiva (22,28± 5,16) vs masculino (16,84± 6,15, p= 0,012), ansiedade somática feminino (19,14± 5,43) vs masculino (15,15± 2,40, p= 0,008). Os velocistas apresentaram maior ansiedade somática (18,43± 4,80) do que nadadores de meia e longa distância vs meio fundo e fundo (15,35± 3,46, p= 0,042). Nadadores com baixo desempenho mostraram maior ansiedade cognitiva (21,80± 6,42) quando comparado a atletas de alto desempenho (17,55± 5,07, p= 0,049). Os velocistas exibiram maiores níveis de cortisol pré-competição (0,41± 0,12). Nadadores do sexo masculino apresentaram relações negativas entre ansiedade cognitiva e autoconfiança (r= −0,56; p= 0,001), ansiedade somática (r= −0,45; p= 0,001), bem como nadadores de média e longa distância (r= −0,52, p= 0,001) e nadadores de alto desempenho (r= −0,78, p= 0,001). Do mesmo modo, foi encontrado uma relação psicofisiológica nos atletas de baixo desempenho entre ansiedade somática e cortisol pré-competição (r= −0,50; p= 0,002). Portanto, treinadores e demais envolvidos na preparação destes atletas podem utilizar a medida biológica do cortisol salivar como marcador de ansiedade e desempenho esportivo em nadadores jovens.

ABSTRACT The objective of the present study was to compare the hormonal difference (cortisol) between the sexes, swimming specialities and performance of adolescent swimmers to verify the existence of the relationship between cortisol and cognitive aspects among 35 swimmers with an average age of 15.41± 0.51 years, evaluated during the Brazilian Youth Swimming Championship. In addition, questionnaires, Competitive State Anxiety (CSAI-2) and sociodemographic characterisation were used. Together, salivary collections were performed. Female swimmers had higher cognitive anxiety (22.28± 5.16) vs male (16.84± 6.15, p= 0.012). female (19.14± 5.43) vs male (15.15± 2.40, p= 0.008) somatic anxiety. Sprinters had higher somatic anxiety (18.43± 4.80) than middle and long-distance swimmers vs middle and long-distance swimmers (15.35± 3.46, p= 0.042). Low-performance swimmers had greater cognitive anxiety (21.80± 6.42) than high-performance swimmers (17.55± 5.07, p= 0.049). Sprinters exhibited higher pre-competition cortisol levels (0.41± 0.12). Male swimmers showed negative relationships between cognitive anxiety and self-confidence (r= −0.56; p= 0.001), somatic anxiety (r= −0.45; p= 0.001), as well as middle and long-distance swimmers (r= −0.52, p= 0.001) and high-performance swimmers (r= −0.78, p= 0.001). Likewise, a psychophysiological relationship was found in low-performance athletes between somatic anxiety and pre-competition cortisol. (r= −0.50; p= 0.002). Therefore, coaches and others involved in the preparation of these athletes can use the biological measurement of salivary cortisol as an anxiety marker and sports performance in young swimmers.

RESUMEN: Las proteínas S100 pertenecen al grupo de proteínas fijadoras de calcio y están presentes en actividades reguladoras fisiológicas intracelulares y extracelulares, como la diferenciación celular, y actúan en procesos patológicos inflamatorios y neoplásicos. Recientemente, sus expresiones en el sistema nervioso han sido ampliamente estudiadas, buscando dilucidar su acción a nivel del tálamo: una estructura del sistema nervioso central que forma parte de importantes circuitos, como el somatosensorial, conductual, de memoria y cognitivo, así como además de ser responsable de la transmisión y regulación de la información a la corteza cerebral. Este artículo es una revisión integradora de la literatura científica, que analizó 12 estudios presentes en Pubmed. El análisis mostró que la relación de las proteínas S100 y el tálamo ha sido descrita en procesos neoplásicos, trastornos mentales, hipoxia, trauma, estrés, infección, enfermedad de Parkinson y epilepsia. En resumen, es posible concluir que esta familia de proteínas es relevante como marcador en procesos de lesión talámica, requiriendo más estudios para comprender mejor su significado clínico, preclínico y su valor pronóstico.

SUMMARY: S100 proteins belong group of calcium-binding proteins and are present in physiological intracellular and extracellular regulatory activities, such as cell differentiation, and act in inflammatory and neoplastic pathological processes. Recently, its expressions in the nervous system have been extensively studied, seeking to elucidate its action at the level of the thalamus: A structure of the central nervous system that is part of important circuits, such as somatosensory, behavioral, memory and cognitive, as well as being responsible for the transmission and regulation of information to the cerebral cortex. This article is an integrative review of scientific literature, which analyzed 12 studies present in Pubmed. The analysis showed that the relationship of S100 proteins and the thalamus has been described in neoplastic processes, mental disorders, hypoxia, trauma, stress, infection, Parkinson's disease and epilepsy. In summary, it is possible to conclude that this protein family is relevant as a marker in processes of thalamic injury, requiring further studies to better understand its clinical, preclinical meanings and its prognostic value.

Objectives: To summarize evidence-based pharmacological treatments and provide guidance on clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The American Psychiatric Association (APA) guidelines for the treatment of OCD (2013) were updated with a systematic review assessing the efficacy of pharmacological treatments for adult OCD, comprising monotherapy with selective serotonin reuptake inhibitors (SSRIs), clomipramine, serotonin and norepinephrine reuptake inhibitors (SNRIs), and augmentation strategies with clomipramine, antipsychotics, and glutamate-modulating agents. We searched for the literature published from 2013-2020 in five databases, considering the design of the study, primary outcome measures, types of publication, and language. Selected articles had their quality assessed with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA). Results: We examined 57 new studies to update the 2013 APA guidelines. High-quality evidence supports SSRIs for first-line pharmacological treatment of OCD. Moreover, augmentation of SSRIs with antipsychotics (risperidone, aripiprazole) is the most evidence-based pharmacological intervention for SSRI-resistant OCD. Conclusion: SSRIs, in the highest recommended or tolerable doses for 8-12 weeks, remain the first-line treatment for adult OCD. Optimal augmentation strategies for SSRI-resistant OCD include low doses of risperidone or aripiprazole. Pharmacological treatments considered ineffective or potentially harmful, such as monotherapy with antipsychotics or augmentation with ketamine, lamotrigine, or N-acetylcysteine, have also been detailed.

Abstract Surgical correction is an effective treatment for adolescent idiopathic scoliosis (AIS) with deformities over 45°. In the Brazilian Unified Health System (SUS, Sistema Único de Saúde), if the surgical procedure is indicated, the patients are placed on a waiting list and wait until the treatment can be performed. An extended waiting period can be harmful due to worsening symptoms and increased treatment costs. Additionally, it has negative effects on the mental health and quality of life of these patients. This paper is a systematic review protocol to answer the following question: “What is the impact of the delayed surgical correction of AIS considering costs and quality of life?” Collecting health status information is the first step to improve high complex public health actions. Future publications from this protocol may serve as a subsidy to point out potential priority criteria to enhance the global health of AIS patients and the management of Brazilian public health financial resources.

Resumo A correção cirúrgica é uma opção efetiva de tratamento para casos de Escoliose Idiopática do Adolescente (EIA) com curvas acima de 45°. No âmbito do Sistema Único de Saúde (SUS), os pacientes avaliados nos centros de referência e com indicação cirúrgica são cadastrados em fila de espera até que o tratamento definitivo possa ser realizado. Um período de espera extenso pode ser prejudicial, do ponto de vista de piora dos sintomas e de aumento do custo de tratamento, além de gerar efeitos negativos na saúde mental e na qualidade de vida do paciente. O presente artigo trata-se do protocolo de uma revisão sistemática que buscará responder o questionamento: “Qual o impacto do tempo de espera para correção cirúrgica da EIA do ponto de vista de custo e qualidade de vida?.” O aperfeiçoamento das ações de saúde pública, na esfera da alta complexidade, inicia-se com o levantamento de informações sobre a situação de saúde de determinada condição. Diante disso, as futuras publicações provenientes deste protocolo poderão servir como subsídio para apontar possíveis critérios de prioridade, com o intuito de promover melhoria tanto no âmbito da saúde global de portadores de EIA, quanto na gestão financeira da saúde pública brasileira.

BACKGROUND The knowledge about eicosanoid metabolism and lipid droplet (LD) formation in the Leishmania is very limited and new approaches are needed to identify which bioactive molecules are produced of them. OBJECTIVES Herein, we compared LDs and eicosanoids biogenesis in distinct Leishmania species which are etiologic agents of different clinical forms of leishmaniasis. METHODS For this, promastigotes of Leishmania amazonensis, L. braziliensis and L. infantum were stimulated with polyunsaturated fatty acids (PUFA) and LD and eicosanoid production was evaluated. We also compared mutations in structural models of human-like cyclooxygenase-2 (GP63) and prostaglandin F synthase (PGFS) proteins, as well as the levels of these enzymes in parasite cell extracts. FINDINGS PUFAs modulate the LD formation in L. braziliensis and L. infantum. Leishmania spp with equivalent tissue tropism had same protein mutations in GP63 and PGFS. No differences in GP63 production were observed among Leishmania spp, however PGFS production increased during the parasite differentiation. Stimulation with arachidonic acid resulted in elevated production of hydroxyeicosatetraenoic acids compared to prostaglandins. MAIN CONCLUSIONS Our data suggest LD formation and eicosanoid production are distinctly modulated by PUFAS dependent of Leishmania species. In addition, eicosanoid-enzyme mutations are more similar between Leishmania species with same host tropism.

ABSTRACT Cystic fibrosis (CF) is a genetic disease that results in dysfunction of the CF transmembrane conductance regulator (CFTR) protein, which is a chloride and bicarbonate channel expressed in the apical portion of epithelial cells of various organs. Dysfunction of that protein results in diverse clinical manifestations, primarily involving the respiratory and gastrointestinal systems, impairing quality of life and reducing life expectancy. Although CF is still an incurable pathology, the therapeutic and prognostic perspectives are now totally different and much more favorable. The purpose of these guidelines is to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of the pulmonary symptoms of CF in Brazil. Questions in the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) format were employed to address aspects related to the use of modulators of this protein (ivacaftor, lumacaftor+ivacaftor, and tezacaftor+ivacaftor), use of dornase alfa, eradication therapy and chronic suppression of Pseudomonas aeruginosa, and eradication of methicillin-resistant Staphylococcus aureus and Burkholderia cepacia complex. To formulate the PICO questions, a group of Brazilian specialists was assembled and a systematic review was carried out on the themes, with meta-analysis when applicable. The results obtained were analyzed in terms of the strength of the evidence compiled, the recommendations being devised by employing the GRADE approach. We believe that these guidelines represent a major advance to be incorporated into the approach to patients with CF, mainly aiming to favor the management of the disease, and could become an auxiliary tool in the definition of public policies related to CF.

RESUMO A fibrose cística (FC) é uma doença genética que resulta em disfunção da proteína reguladora de condutância transmembrana da FC (CFTR), que é um canal de cloro e bicarbonato expresso na porção apical de células epiteliais de diversos órgãos. A disfunção dessa proteína resulta em manifestações clínicas diversas, envolvendo primariamente os sistemas respiratório e gastrointestinal com redução da qualidade e expectativa de vida. A FC ainda é uma patologia incurável, porém o horizonte terapêutico e prognóstico é hoje totalmente distinto e muito mais favorável. O objetivo destas diretrizes foi definir recomendações brasileiras baseadas em evidências em relação ao emprego de agentes farmacológicos no tratamento pulmonar da FC. As perguntas PICO (acrônimo baseado em perguntas referentes aos Pacientes de interesse, Intervenção a ser estudada, Comparação da intervenção e Outcome [desfecho] de interesse) abordaram aspectos relativos ao uso de moduladores de CFTR (ivacaftor, lumacaftor + ivacaftor e tezacaftor + ivacaftor), uso de dornase alfa, terapia de erradicação e supressão crônica de Pseudomonas aeruginosa, e erradicação de Staphylococcus aureus resistente a meticilina e do complexo Burkholderia cepacia. Para a formulação das perguntas, um grupo de especialistas brasileiros foi reunido e realizou-se uma revisão sistemática sobre os temas, com meta-análise quando aplicável. Os resultados encontrados foram analisados quanto à força das evidências compiladas, sendo concebidas recomendações seguindo a metodologia GRADE. Os autores acreditam que o presente documento represente um importante avanço a ser incorporado na abordagem de pacientes com FC, objetivando principalmente favorecer seu manejo, podendo se tornar uma ferramenta auxiliar na definição de políticas públicas relacionadas à FC.

Abstract Introduction Despite the results of epidemiological and psychometric studies reporting comparable levels of tobacco dependence among males and females, some clinical studies have detected disparities. Some smoking cessation studies based on clinical setting programs reported poorer outcomes among women than men. Methods This retrospective cohort study aimed to compare treatment success and retention between men and women on a smoking cessation program (n = 1,014) delivered at a CAPS-AD unit in Brazil. The psychological intervention lasted 6 weeks for each group of 15 patients. Each patient had to participate in weekly group cognitive-behavioral therapy (CBT) sessions and individual medical appointments during this period. These appointments were focused on the possibility of prescribing pharmacological treatment (i.e., nicotine replacement therapy, bupropion, or nortriptyline) as adjuvants to group therapy. Results The women had lower smoking severity at baseline, more clinical symptoms, and lower prevalence of alcohol and drug use disorders and were older than the men. Females had significantly higher levels of success (36.6% vs. 29.7%) and retention (51.6% vs. 41.4%) than males. Sensitivity analysis showed that female gender was significantly associated with both retention and success, among those without drug use disorders only. Conclusion Depending on the smoking cessation setting (i.e., low and middle-income countries and mental health and addiction care units), females can achieve similar and even higher quit rates than males. Previous drug use disorder was an important confounding variable in the gender outcomes analyses. Future studies should try to replicate these positive smoking cessation effects of CBT-based group therapy plus pharmacotherapy in women.

Abstract The aim of this article is to analyze the Regional Climate Model Eta precipitation projections for the São Francisco (SF) and Paraíba do Sul (PS) River basins, Brazi. For that, the dynamic downscaling response was discussed in comparison with the CMIP5 models and, in particular, with the models HadGEM2-ES and MIROC5 to future climate horizon 2011 to 2040 in two scenarios of the fifth report from Intergovernmental Panel on Climate Change: RCP4.5 and RCP8.5. The results indicate that the Eta model nested in the global models adequately represented the precipitation simulations for the present climate. As for the evaluation of the representation of climate projections, the Eta projections disagreed on the sign of change with their forcing GCMs and other CMIP5 models in the analyzed basins, amplifying the drier signal. Precipitation reductions were pointed out for the two basins and with greater intensity in the RCP8.5 scenario, ranging up to -20% (SF) and 15% (PS) by the CMIP5 models and up to almost -40% for the Eta-HadGEM2-ES and Eta MIROC5 (SF and PS).

Resumo O objetivo deste artigo é analisar as projeções de precipitação do modelo climático regional Eta para as bacias dos rios São Francisco (SF) e Paraíba do Sul (PS), Brasil. Para tanto, a resposta dinâmica da redução de escala foi discutida em comparação com os modelos CMIP5 e, em particular, com os modelos HadGEM2-ES e MIROC5 para o horizonte climático futuro de 2011 a 2040 em dois cenários do quinto relatório do Painel Intergovernamental sobre Mudanças Climáticas: RCP4.5 e RCP8.5. Os resultados indicam que o modelo Eta aninhado aos modelos globais representou adequadamente as simulações de precipitação para o clima presente. Quanto a avaliação da representação das projeções climáticas, as projeções Eta discordaram no sinal de mudança com seus forçantes GCMs e outros modelos CMIP5 nas bacias analisadas, amplificando o sinal mais seco. Reduções na precipitação foram apontadas para as duas bacias e com maior intensidade no cenário RCP8.5, variando em até -20% (SF) e 15% (PS) pelos modelos CMIP5 e em até quase -40% para os modelos Eta-HadGEM2-ES e Eta MIROC5 (SF e PS).

ABSTRACT Objective: To evaluate the early postoperative complications associated with the surgical approach of the cervical spine of patients with cervical spondylotic myelopathy (CSM), comparing the anterior surgical, the posterior surgical, and the combined approaches. Methods: This is a retrospective study based on a database with 169 patients. Demographic data, such as gender and age, and surgical data, such as surgical approach, number of segments with arthrodesis, surgical time, and complications, were evaluated. Complications were divided into major (deep surgical wound infection, intercurrence with the implant, early new compression, and heart failure) and minor (dysphagia, superficial infection, pain, urinary intercurrence, neuropraxia of the C5 root, acute confusional state, and surgical wound hematoma). Results: This included 169 patients, 57 women (33.7%) and 112 men (66.2%). Age ranged from 21 to 87 years, with a mean of 56.48 (± 11) years. Of these, 52 (30.8%) underwent the anterior approach; 111 (65.7%), the posterior approach; and 6 (3.5%), the combined approach. Conclusion: As in the literature, we evinced dysphagia, pain, and superficial infection of the surgical wound as the most frequent postoperative complications. However, it was impossible to establish a statistical relationship between the incidence of complications and surgical time, access route, and number of fixed segments. Level of Evidence III, Retrospective Comparative Study.

RESUMO Objetivo: Avaliar as complicações pós-operatórias precoces associadas à abordagem cirúrgica da coluna cervical de pacientes portadores de mielopatia cervical espondilótica (MCE), comparando a abordagem cirúrgica anterior, a abordagem cirúrgica posterior e a abordagem combinada. Métodos: Estudo retrospectivo baseado em um banco de dados com 169 pacientes. Foram avaliados dados demográficos, como gênero e idade, e dados cirúrgicos, como abordagem cirúrgica realizada, número de segmentos artrodesados, tempo cirúrgico e complicações. As complicações foram divididas em maiores (infecção profunda da ferida operatória, intercorrência com o implante, nova compressão precoce, insuficiência cardíaca) e menores (disfagia, infecção superficial, dor, intercorrência urinária, neuropraxia da raiz de C5, estado confusional agudo, hematoma de ferida operatória). Resultados: Foram incluídos 169 pacientes, sendo 57 do sexo feminino (33,7%) e 112 do masculino (66,2%). A idade variou de 21 a 87 anos, com média de 56,48 anos (± 11). Destes, 52 (30,8%) foram submetidos à abordagem anterior, 111 (65,7%) à abordagem posterior e 6 (3,5%) à abordagem combinada. Conclusão: Assim como na literatura, evidenciamos a disfagia, a dor e a infecção superficial da ferida operatória como as complicações pós-operatórias mais frequentes. No entanto, não foi possível estabelecer uma relação estatística da incidência de complicações com o tempo cirúrgico, a via de acesso e o número de segmentos fixados. Nível de Evidência III, Estudo Retrospectivo Comparativo.

Resumo Este artigo tem por objetivo estudar os valores da cidadania ecológica e os valores das comunidades caboclas no período pós-guerra do Contestado, analisando a compatibilidade entre eles. Por meio de abordagem indutiva, a pesquisa procura conceituar e localizar historicamente a cidadania ecológica, resgatando seus principais valores. Em seguida, descreve a cultura cabocla remanescente no oeste catarinense e seus valores inerentes. Estabelecidas essas bases, é demonstrada a compatibilidade entre esses valores por meio do resgate bibliográfico. pósguerra pós guerra Contestado eles indutiva seguida inerentes bases bibliográfico

Resumen Este artículo tiene como objetivo estudiar los valores de la ciudadanía ecológica y los valores de las comunidades caboclas en el período posterior a la Guerra del Contestado, analizando la compatibilidad entre ellos. A través de un enfoque inductivo, la investigación busca conceptualizar y ubicar históricamente la ciudadanía ecológica, rescatando sus principales valores. A continuación, describe la cultura cabocla remanente en el oeste de Santa Catarina y sus valores inherentes. Una vez establecidas esas bases, se demuestra la compatibilidad entre esos valores a través de búsqueda bibliográfica Contestado ellos inductivo continuación inherentes bases

Abstract his paper aims to study the values of ecological citizenship and the values of the cabocla communities in the post-Contestado War period, analyzing the compatibility between them. Through an inductive approach, the research seeks to conceptualize and historically locate ecological citizenship, rescuing its main values. Then, it describes the cabocla culture remaining in western Santa Catarina and its inherent values. Once these bases are established, the compatibility between these values is demonstrated through bibliographical survey postContestado post Contestado period them approach Then established

SUMMARY OBJECTIVE: This study aimed to evaluate the quality of life of patients with endometriosis before and after surgical treatment. METHODS: An observational, longitudinal, and prospective study was conducted with 102 women with pelvic pain and endometriosis that was unimproved by clinical treatment and indicated for surgical treatment. The patients’ quality of life was assessed using the 30-item Endometriosis Health Profile (EHP-30) questionnaire before and 3 and 6 months after surgery. The statistical tests were analyzed using the Statistical Package for Social Sciences version 17.0, and the Friedman test was used. RESULTS: There was a reduction in EHP-30 scores 3 and 6 months after surgery compared to before surgery, as well as 6 months after surgery compared to 3 months after surgery, in the central questionnaire (PART 1) and in Sections A, B, C, E, and F (p<0.0001). For Section D, there was a reduction in scores 6 months after surgery compared to before surgery (p<0.0001). CONCLUSION: Surgical treatment of endometriosis improves quality of life in several areas assessed by the EHP-30 questionnaire.

Abstract Oil-in-water photoprotective nanoemulsions (NEs) were developed using Babassu (BBS) lipophilic extract, nonionic surfactants, and low concentrations of organic sunscreens by ultrasonic processing. BBS extract was chosen due to its suitable physicochemical properties (acidity index, peroxide index, refraction index, and relative density) and predominance of saturated fatty acids, identified by gas chromatography-mass spectrometry (GC-MS), which promote biological activities and high oxidative stability. NEs were characterized by mean droplet size, morphology, polydispersity index (PdI), pH, and organoleptic properties, and the physical stability of the NEs was evaluated for 120 days at room temperature. The sun protection factor (SPF) was determined, and the photostability and in vitro cytotoxicity assays were performed for NEs. All NEs remained stable for 120 days, with a droplet size <150 nm and a monomodal distribution profile. The pH values were compatible with the skin’s pH. NE3 showed a spherical morphology, with a mean droplet size of 125.15 ± 0.16 nm and PdI of 0.145 ± 0.032. NE3 containing BBS extract and sunscreens presented an SPF of 35.5 ± 3.0, was photostable after 6 h of radiation and was non-cytotoxic to fibroblast cells. Thus, NE3 could be considered a promising formulation for developing synergic plant-extract sunscreen photoprotective products for the market.