ABSTRACT The global reemergence of measles in 2018–2019 reinforces the relevance of high-coverage immunization to maintain the disease elimination. During an outbreak in the Sao Paulo State in 2019, several measles cases were reported in individuals who were adequately vaccinated according to the current immunization schedule recommends. This study aimed to assess measles IgG antibody seropositivity and titers in previously vaccinated adults. A cross-sectional study was conducted at CRIE-HC-FMUSP (Sao Paulo, Brazil) in 2019. It included healthy adults who had received two or more Measles-Mumps-Rubella vaccines (MMR) and excluded individuals with immunocompromising conditions. Measles IgG antibodies were measured and compared by ELISA (Euroimmun®) and chemiluminescence (LIASON®). The association of seropositivity and titers with variables of interest (age, sex, profession, previous measles, number of measles-containing vaccine doses, interval between MMR doses, and time elapsed since the last MMR dose) was analyzed. A total of 162 participants were evaluated, predominantly young (median age 30 years), women (69.8%) and healthcare professionals (61.7%). The median interval between MMR doses was 13.2 years, and the median time since the last dose was 10.4 years. The seropositivity rate was 32.7% by ELISA and 75.3% by CLIA, and a strong positive correlation was found between the tests. Multivariate analyses revealed that age and time since the last dose were independently associated with positivity. Despite being a single-center evaluation, our results suggest that measles seropositivity may be lower than expected in adequately immunized adults. Seropositivity was higher among older individuals and those with a shorter time since the last MMR vaccine dose.

ABSTRACT This article aims to evaluate social and health indicators of municipalities according to the rural-urban typology. This is an ecological study that used official publicly accessible data from the 853 municipalities in the state of Minas Gerais, Brazil. Descriptive and bivariate analysis were carried out using Poisson Regression and Kruskal-Wallis Test. 547 (64.12%) are rural municipalities. The highest average of the Municipal Human Development Index (MHDI) was observed among urban municipalities. The highest average coverage of the Family Health Strategy (FHS) was found among rural municipalities. In these municipalities, the best results were shown for the indicators of infant mortality, premature mortality and mortality from preventable causes, vaccine homogeneity and prevalence of malnutrition. The findings of this study show that greater FHS coverage is associated with the occurrence of better general living and health conditions in the populations served in rural municipalities. It is recommended that health managers encourage the consolidation of the FHS in communities with unfavorable socioeconomic and cultural contexts, such as remote rural locations and urban agglomerations, and the establishment of intersectoral actions with a positive impact on health.

RESUMO O presente artigo tem o objetivo de avaliar indicadores sociais e de saúde de municípios conforme a tipologia rural-urbano. Trata-se de estudo ecológico que utilizou dados oficiais de acesso público dos 853 municípios do estado de Minas Gerais, Brasil. Foram conduzidas análises descritivas e bivariadas através da Regressão de Poisson e Teste de Kruskal-Wallis. Do total de municípios, 547 (64,12%) são rurais. A maior média do Índice de Desenvolvimento Humano Municipal (IDH-M) foi observada entre os municípios urbanos. A maior média de cobertura da Estratégia Saúde da Família (ESF) foi verificada entre os municípios rurais, nos quais também foram demonstrados os melhores resultados para os indicadores de mortalidades infantil, prematura e por causas evitáveis, homogeneidade vacinal e prevalência de desnutrição. Os achados deste estudo evidenciam que uma maior cobertura da ESF está associada à ocorrência de melhores condições gerais de vida e de saúde das populações atendidas em municípios de tipologia rural. Recomenda-se aos gestores de saúde o fomento à consolidação da ESF em comunidades com contextos socioeconômicos e culturais desfavoráveis, como localidades rurais remotas e aglomerados urbanos, e o estabelecimento de ações intersetoriais com impacto positivo na saúde.

ABSTRACT Hypomagnesemia type I is a rare autosomal recessive disorder characterized by severe hypomagnesemia, often accompanied by hypocalcemia. This disease is caused by mutations in the TRPM6 gene (which encodes the respective channel), leading to reduced intestinal absorption of magnesium and increased renal excretion due to a defect in reabsorption in the distal convoluted tubule. It usually manifests itself in the first months of life, with symptoms of neuromuscular hyperexcitability and seizures, refractory to antiepileptic therapy. Treatment consists of administering high doses of magnesium throughout life. Here, we report a case of hypomagnesemia type I with a novel pathogenic variant of TRPM6 in a 5-month-old girl who developed refractory seizures due to hypomagnesemia.

Abstract Eosinophilic esophagitis is now one of the most common conditions diagnosed during the assessment of feeding problems in children and during the evaluation of dysphagia and food impaction in adults. We report a case of a 20-year-old male, with a history of asthma, who developed solid dysphagia and food impaction symptoms over a 10-year course. A late diagnosis led to incapacitating symptoms, advanced endoscopic findings, and riskier therapeutic options. Primary care providers are pivotal for timely and accurate detection of symptoms and proper referral to specialists.

Resumo A esofagite eosinofílica é atualmente um dos diagnósticos mais frequentes na avaliação de dificuldade alimentar em crianças e disfagia e impactação alimentar em adultos. O nosso caso clínico reporta um homem de 20 anos, com antecedentes de asma, que desenvolveu disfagia para sólidos e impactação alimentar ao longo de um período de 10 anos. O diagnóstico tardio levou ao desenvolvimento de sintomas incapacitantes, achados endoscópicos avançados e as opções terapêuticas com maiores riscos associados. Os médicos de família têm um papel essencial no diagnóstico correto e atempado destes sintomas e referenciação apropriada para a consulta da especialidade.

Abstract Background: There is controversy regarding the factors that determine a greater risk of severity and complications from COVID-19 in people living with HIV (PLHIV). Likewise, there are limited data on the impact of SARS-CoV-2 vaccination on hospitalization in this population. Aims: To describe clinical characteristics and outcome of COVID-19 in PLHIV; To assess risk factors for hospitalization; To evaluate the impact of vaccination on hospitalization. Methods: Multicenter, prospective, observational study (September 2020 to June 2022). Clinical and immunovirological variables, antiretroviral treatment (ART), SARS-CoV-2 vaccination, and hospitalization in PLHIV with COVID-19 were recorded. Univariate and multivariate analyzes were performed examining factors associated with hospitalization using two models: first model (without vaccination) and second model (vaccination, minimum one dose). Results: 1,201 PLHIV were included. The median age was 45 years. 65.3% were men; 38.7% presented comorbidities. 92.8% received ART and 83.1% presented undetectable viral load (VL). The median CD4+ T-cell count was 600/mm3. 95.7% presented symptoms. The rates of hospitalization, ICU admission, oxygen requirement, and death were 17.8 %, 2.8%, 10.7% and 1.39%, respectively. According to the multivariate analysis for the first model, age > 60 years and comorbidities were associated with a higher risk of hospitalization, while female sex and CD4+ > 500/mm3 had a protective effect. In the second model, only the comorbidities were associated with a higher risk of hospitalization, while vaccination and CD4+ > 500/mm3 reduced it. Conclusions: in PLHIV, comorbidities were associated with a higher hospitalization rate, while having elevated CD4+ T-cell counts and being vaccinated had a protective effect. ART and VL had no impact in any model, while age and sex only had an influence when vaccination was not considered.

Resumen Introducción: Existe controversia con respecto a los factores que determinan un mayor riesgo de gravedad y complicaciones por COVID-19 en personas que viven con VIH (PVVIH). Asimismo, hay datos limitados sobre el impacto de la vacunación contra SARS-CoV-2 en la hospitalización en esta población. Objetivos: Describir las características clínicas y evolutivas de COVID-19 en PVVIH; Evaluar factores de riesgo para hospitalización; Evaluar el impacto de la vacunación en la hospitalización. Pacientes y Métodos: Estudio observacional, prospectivo, multicéntrico (septiembre de 2020 a junio de 2022). Se registraron variables clínicas, inmunovirológicas, tratamiento antirretroviral (TARV), vacunación contra SARS-CoV-2 y hospitalización en PVVIH con COVID-19. Se realizaron análisis uni y multivariados examinando factores asociados a hospitalización utilizando dos modelos: primer modelo (sin vacunación) y segundo modelo (vacunación, mínimo una dosis). Resultados: Se incluyeron 1.201 PVVIH. La mediana de edad fue 45 años. El 65,3% fueron hombres; el 38,7% presentó comorbilidades. Recibía TARV el 92,8% y presentó carga viral (CV) indetectable el 83,1%. La mediana de linfocitos T CD4+ fue de 600 céls/mm3. El 95,7% presentó síntomas. Las tasas de hospitalización, ingreso a UCI, requerimiento de oxígeno y muerte fueron 17,8%, 2,8%, 10,7% y 1,39%, respectivamente. De acuerdo con el análisis multivariado para el primer modelo, la edad > 60 años y las comorbilidades se asociaron a mayor riesgo de hospitalización, mientras que el sexo femenino y un recuento de linfocitos T CD4+ > 500 céls/mm3 tuvieron un efecto protector. En el segundo modelo sólo las comorbilidades se relacionaron con un mayor riesgo de hospitalización mientras que la vacunación y células CD4+ > 500 céls/mm3 la redujeron. Conclusiones: En PVVIH las comorbilidades se asociaron con mayor tasa de hospitalización, mientras que tener linfocitos T CD4+ elevados y estar vacunado tuvieron un efecto protector. El TARV y la CV no tuvieron impacto en modelo alguno mientras que la edad y el sexo solo influyeron cuando no se consideró la vacunación.

Abstract The intrauterine device is the most used long-acting reversible contraceptive method, presenting a low incidence of complications. The authors present a case of an intrauterine device migration, with an uterine perforation by its lower extremity.

Resumo O dispositivo intrauterino é o método contracetivo reversível de longa duração mais utilizado, apresentando uma baixa incidência de complicações. Os autores apresentam um caso de migração de um dispositivo intrauterino, em que se verificou perfuração uterina a partir da sua extremidade inferior.

ABSTRACT: This article presents statistical analysis that verified the diversity of markets and marketing channels used by family farmers in the central region of Rio Grande do Sul/ Brazil, examining the occurrence of variables associated with the number of channels accessed. The non-probabilistic sample included 129 family farmers who produce fruits and vegetables in four municipalities in the Central Region of Rio Grande do Sul, Brazil, in the years 2019-2021. Nonparametric tests and bivariate statistical analysis were used, considering the significance level (≤) of 0.05. There was an average number of 2.4 channels in the Local and Conventional Markets, and 3.1 for the Local/Territorial and Public/Institutional Markets. However, a maximum of three channels is used in 75% of establishments. There was a low negative correlation between the mean age of the family farmers and the degree of diversification of the channels used to market the products and a positive correlation between infrastructure and diversificationof channels adopted and,family work and diversification. Finally, a dependency relationship was reported between the number of public policies accessed and the diversification of channels.

RESUMO: Este artigo apresenta análise estatística que visa verificar a diversidade de mercados e canais de comercialização utilizados pelos agricultores familiares na Região Central do Rio Grande do Sul, Brasil, examinando a ocorrência de variáveis associadas ao número de canais acessados. A amostra não probabilística incluiu 129 agricultores familiares que produzem frutas e hortaliças em quatro municípios da Região Central do Rio Grande do Sul nos anos 2019-2021. Foram utilizados testes não paramétricos e análise estatística bivariada, considerando o nível de significância (≤) de 0,05. Houve um número médio de 2,4 canais nos Mercados Local e Convencional, e 3,1 para os Mercados Local/Territorial e Público/Institucional. No entanto, um máximo de três canais é utilizado em 75% dos estabelecimentos. Houve baixa correlação negativa entre a idade média dos agricultores e o grau de diversificação dos canais utilizados para comercialização dos produtos e uma correlação positiva entre infraestrutura, e a diversificação dos canais adotados e mão-de-obra familiar e diversificação. Por fim, descobriu-se uma relação de dependência entre o número de políticas públicas acessadas e a diversificação de canais.

BACKGROUND In 2022, an outbreak of mpox that started in European countries spread worldwide through human-to-human transmission. Cases have been mostly mild, but severe clinical presentations have been reported. In these cases, tecovirimat has been the drug of choice to treat patients with aggravated disease. OBJECTIVES Here we investigated the tecovirimat susceptibility of 18 clinical isolates of monkeypox virus (MPXV) obtained from different regions of Brazil. METHODS Different concentrations of tecovirimat were added to cell monolayers infected with each MPXV isolate. After 72 hours, cells were fixed and stained for plaque visualization, counting, and measurement. The ortholog of F13L gene from each MPXV isolate was polymerase chain reaction (PCR)-amplified, sequenced, and the predicted protein sequences were analyzed. FINDINGS The eighteen MPXV isolates generated plaques of different sizes. Although all isolates were highly sensitive to the drug, two showed different response curves and IC50 values. However, the target protein of tecovirimat, F13 (VP37), was 100% conserved in all MPXV isolates and therefore does not explain the difference in sensitivity. MAIN CONCLUSIONS Our results support screening different MPXV isolates for tecovirimat susceptibility as an important tool to better use of the restricted number of tecovirimat doses available in low-income countries to treat patients with mpox.

ABSTRACT The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic demanded rapid diagnosis to isolate new COVID-19 cases and prevent disease transmission. Quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) rapidly became the gold standard for diagnosis. However, due to the high cost and delay of the results, other types of diagnosis were implemented, such as COVID-19 Ag Rapid Tests and Reverse Transcription Technique followed by Loop-Mediated isothermal Amplification (RT-LAMP). In this work, we validated the use of RT-LAMP in saliva samples rather than nasopharyngeal swabs, as the collection is more comfortable. First, we selected 5 primer sets based on the limit of detection for SARS-CoV-2 RNA, then validated their sensitivity and specificity in patient samples. A total of 117 samples were analyzed by fluorometric RT-LAMP and compared with qRT-PCR results. Our results show that the use of a high-sensitive primer ORF1-a, together with a low-sensitive primer set Gene E (time to threshold of 22.9 and 36.4 minutes, respectively, using 200 copies of viral RNA), achieved sensitivity in purified RNA from saliva samples of 95.2% (95% CI 76.1-99.8) with 90.5% specificity (95% CI 69.6-98.8) (n = 42).As RNA purification increases the turnaround time, we tested the outcome of RT-LAMP utilizing raw saliva samples without purification. The test achieved a sensitivity of 81.8% (95% CI 59.7-94.8) and a specificity of 90.9% (95% CI 70.8-98.8). As a result, the accuracy of 92.9% (95% CI 80.5-98.5) in purified RNA-saliva samples was lowered to an acceptable level of 86.4% (95% CI 72.6-94.8) in raw saliva. Although mass vaccination has been implemented, new strains and low vaccination progress helped to spread COVID-19. This study shows that it is feasible to track new COVID-19 cases in a large population with the use of raw saliva as sample in RT-LAMP assay which yields accurate results and offers a less invasive test.

Abstract Background: The COVID-19 pandemic may affect youth’s physical and mental well-being, partially because of the countries’ rules to contain the virus from spreading. However, there is still uncertainty about the impact of physical distancing on youth’s mental health. We aimed to estimate the prevalence of feeling agitated, anxious, down, sad, or low mood (FNF) due to physical distance measures and verify which factors are associated with young Portuguese and Brazilian people. Methods: We used cross-sectional data from the instrument “COVID-19 Barometer: Social Opinion” in Portugal (March 2020 and September 2021) and from “COVID-19 Social Thermometer” in Brazil (August 2020 to April 2021); these surveys included data regarding the health and socioeconomic impact on the population. The health and sociodemographic variables of the two countries were summarized as absolute and relative frequencies. A multivariable logistic regression model was fit by country to estimate the relation between FNF and selected variables of interest. Results: Approximately 36% of the sample studied reported anxiety, agitation, sadness, or low mood almost every day in Portugal and 52% in Brazil due to physical distancing. In Portugal, having more than two comorbidities represented a greater chance of experiencing FNF every day or almost every day (odds ratio [OR] = 1.51 [CI: 1.22-1.87]) than those without comorbidities. In contrast, having a university education level represented a protector factor (OR = 0.76 [CI: 0.67-0.88]). In Brazil, being unemployed increased the chance of FNF compared to students (OR = 11.2). Conclusions: Physical distancing measures have impacted the mental well-being of the young population in Portugal and Brazil. The countries must make a quick effort to attend to and protect young people’s well-being and mental health in the changing context of the current pandemic.

Resumo Introdução: A pandemia do COVID-19 pode afetar o bem-estar físico e mental dos jovens, em parte por causa das regras dos países para conter a propagação do vírus. No entanto, ainda há incerteza sobre o impacto do distanciamento físico na saúde mental dos jovens. Objetivou-se estimar a prevalência de sentir-se agitado, ansioso, deprimido ou triste (FNF) devido a medidas de distância física e verificar quais fatores estão associados a jovens portugueses e brasileiros. Métodos: Utilizamos dados transversais do instrumento “COVID-19 Barômetro: Social Opinião” em Portugal (março de 2020 até setembro de 2021) e do “COVID-19 Social termômetro” no Brasil (agosto de 2020 até abril de 2021); essas pesquisas incluíram dados sobre o impacto na saúde e socioeconômicos da população. As variáveis de saúde e sociodemográficas dos dois países foram resumidas em frequências absolutas e relativas. Um modelo de regressão logística multivariável foi ajustado por país para estimar a relação entre a frequência de sentimentos negativos (FNF) e variáveis selecionadas de interesse. Resultados: Aproximadamente 36% da amostra estudada relatou ansiedade, agitação, tristeza ou mau humor; quase todos os dias em Portugal e 52% no Brasil devido ao distanciamento físico. Em Portugal, ter mais de duas comorbidades representou maior chance de apresentar FNF todos os dias ou quase todos os dias (OR = 1,51 [IC 1,22 -1,87]) do que aqueles sem comorbidades. Em contrapartida, ter nível universitário representou fator protetor (OR = 0,76 [IC 0,67-0,88]). No Brasil, estar desempregado aumentou a chance de FNF em relação aos estudantes (OR = 11,2). Conclusões: As medidas de distanciamento físico têm impactado o bem-estar mental da população jovem em Portugal e no Brasil. Os países devem fazer um esforço rápido para atender e proteger o bem-estar e a saúde mental dos jovens no contexto de mudança da atual pandemia.

Resumo Introdução: A atual pandemia mundial por COVID-19 tem vindo a causar um impacto considerável não apenas na saúde, mas também na economia das sociedades, enfatizando a insegurança alimentar como um importante problema de saúde pública. Objetivo: Caracterizar o cenário de insegurança alimentar em Portugal durante a pandemia por COVID-19 e explorar as características sociodemográficas relacionadas. Metodologia: Trata-se de um estudo transversal, que utiliza dados de um inquérito online, realizado entre novembro de 2020 a fevereiro de 2021, incluindo 882 residentes em Portugal com idade igual ou superior a 18 anos. Recolheram-se dados sociodemográficos e de situação de segurança alimentar, sendo que esta última foi avaliada por meio da escala “United States Household Food Security Survey Module: Six-Item Short Form.” Foram calculados modelos de regressão logística brutos e ajustados (covariáveis: escolaridade, perceção de rendimento familiar e situação perante o trabalho durante a pandemia de COVID-19). Foram estimados Odds Ratio (OR) e respetivos intervalos de confiança a 95% (IC). Resultados: A maioria dos participantes era do sexo feminino (71,3%), com média de idade de 36,8 anos (DP 11,0). A prevalência de insegurança alimentar foi de 6,8%. Indivíduos com menor escolaridade (≤12 anos de estudo; OR 2,966; IC 95% 1,250-7,042), e aqueles que estavam e permaneceram desempregados desde o início da pandemia (OR 2,602; IC 95% 1,004-6,742) apresentaram maior odds de pertencer a um agregado familiar com insegurança alimentar, independentemente da escolaridade, situação perante o trabalho durante a pandemia por COVID-19 e perceção de rendimento familiar. Além disso e, independentemente da escolaridade e da situação perante o trabalho durante a pandemia por COVID-19, foi observado menor odds de pertencer a um agregado familiar com insegurança alimentar, aqueles que relataram perceção de rendimento familiar confortável (OR 0,007; IC 95% 0,001-0,062) comparativamente aqueles que perceberam o seu rendimento familiar como insuficiente. Conclusões: Estes resultados destacam os grupos populacionais que estão em maior risco de insegurança alimentar durante a atual pandemia por COVID-19. Estratégias eficazes de saúde pública devem ser desenvolvidas com o objetivo de endereçar a insegurança alimentar durante esta crise, especialmente entre os grupos de maior risco.

Abstract Introduction: The current worldwide COVID-19 pandemic has been having a considerable impact not only on health but also on the economy of societies, emphasizing food insecurity as a significant public health concern. Aim: The objective of this study was to characterize the scenario of food insecurity in Portugal during the COVID-19 pandemic and explore its related sociodemographic characteristics. Methodology: This is a cross-sectional study, using data from an online survey, performed from November 2020 until February 2021, including 882 residents aged 18 years or older in Portugal. Data on sociodemographics and food security status were collected, the latter was evaluated using the United States Household Food Security Survey Module: Six-Item Short Form. Crude and adjusted logistic regression models were performed (covariates: education, household income perception, and the working status during the COVID-19 pandemic). The odds ratio (OR) and respective 95% confidence intervals (CI) were estimated. Results: Most participants were women (71.3%), with a mean age of 36.8 years (SD 11.0). Food insecurity prevalence was 6.8%. Less-educated individuals (≤12 years of schooling; OR 2.966; 95% CI 1.250-7.042), and those who were and remained unemployed since the beginning of the pandemic (OR 2.602; 95% CI 1.004-6.742) had higher odds of belonging to a food-insecure household, regardless of education, working status during the COVID-19 pandemic, and household income perception. Moreover, lower odds of belonging to a food-insecure household were observed among those reporting a comfortable household income (OR 0.007; 95% CI 0.001-0.062) than those who perceived their household income as insufficient, independently of education and the working status during the COVID-19 pandemic. Conclusions: These findings highlight the population groups that are at a greater risk of food insecurity during the current COVID-19 pandemic. Effective public health strategies should be developed aiming to address food insecurity during this crisis, especially among the higher risk groups.

RESUMO Introdução: O oclacitinib é um inibidor seletivo da enzima cinase de Janus, que tem como alvo a interleucina-31, sendo utilizado no tratamento da dermatite atópica canina. Apesar de os tutores apresentarem um elevado grau de satisfação com este fármaco, o seu custo representa um foco de preocupação para 75%, sendo que 42,5% dos tutores referiram ter de limitar outras despesas para poderem pagar o tratamento do seu cão. Objetivos: Avaliar a possibilidade de adotar um protocolo alternativo com oclacitinib em dias alternados. Secundariamente, avaliar se existe vantagem em adicionar glucocorticoides orais no início deste protocolo. Métodos: Estudo prospetivo, aleatório, duplamente cego e controlado com placebo, incluindo 16 cães com diagnóstico de dermatite atópica, alocados nos grupos P (n=7; Placebo) e G (n=9; Glucocorticoides). Os animais foram avaliados quanto à gravidade lesional (CADESI-04) e grau de prurido (PVAS) no Dia -30, Dia 0 e end‑point (recidiva ou Dia 30). O estudo comportou duas fases distintas e sucessivas. Na primeira fase foi administrado oclacitinib (0,4-0,6 mg/kg, 14 dias, duas vezes por dia [BID], depois 16 dias, uma vez por dia [SID]) por via oral a ambos os grupos. No entanto, nos primeiros 7 dias, ao grupo G foi administrada prednisolona (1mg/kg SID) por via oral e ao grupo P um placebo no mesmo regime. Na segunda fase, todos os animais realizaram o mesmo tratamento, mantendo o oclacitinib, mas apenas em dias alternados, até à recidiva do seu quadro clínico. Resultados: Foi possível adotar o protocolo em dias alternados durante pelo menos 30 dias em 71,43% dos animais. As diferenças encontradas não foram estatisticamente significativas entre as médias de CADESI-04 e grau de prurido dos dois grupos no Dia 0 e no end-point. Também não foram encontradas diferenças entre os períodos de tempo médios sob o tratamento em dias alternados. Conclusões: Existe potencial neste protocolo em dias alternados que permite reduzir os custos mensais para metade, possibilitando um maior acesso a esta ferramenta terapêutica inovadora, segura e muito eficaz, mas também dispendiosa. Não parece existir benefício, em termos de redução da dose de oclacitinib, na introdução de prednisolona no início do tratamento.

ABSTRACT Introduction: Oclacitinib is a Janus kinase inhibitor with activity against IL-31 used for canine atopic dermatitis. Despite a high level of owner satisfaction with this treatment, the drug’s cost represents a concern for 75%, with 42.5% mentioning that they had to limit other expenses to afford the treatment of their dog. Objectives: To evaluate the possibility of adopting an alternative therapeutic protocol with oclacitinib on alternate days, and whether there is an advantage in administering oral glucocorticoids at the beginning. Methods: This prospective study was conducted as a randomised, placebo-controlled, double‑blinded clinical trial, and included 16 private-owned dogs diagnosed with atopic dermatitis, allocated in group P (n=7; Placebo) and G (n=9; Glucocorticoids). Dogs were evaluated for skin lesions (CADESI-04) and pruritus (PVAS) at Day -30, Day 0 and end-point (whether relapse or Day 30). This study comprised two distinct and successive phases. In the first phase, oclacitinib was given orally to both groups (0,4 mg/kg, twice a day [BID] for 14 days and once a day [SID] for 16 days). However, in the first 7 days, group G was given oral prednisolone (1 mg/kg SID) and group P was given a placebo following the same regimen. In the second phase, all animals underwent the same protocol with oclacitinib, only given every other day, until the disease’s relapse. Results: It was possible to adopt the alternate days’ protocol for at least 30 days in 71.43% of the animals. There were no significant differences between the mean values of CADESI-04 and pruritus at Day 0 and end-point. There were also no significant differences between the average alternate days’ treatment times of the two groups. Conclusions: The alternate days’ treatment protocol has the potential in allowing monthly costs to be reduced by half, giving greater access to this innovative, safe, and very effective, but also expensive, therapeutic tool. There seems to be no benefit, in matters of reducing the oclacitinib dose, in adding prednisolone at the beginning of the treatment.

RESUMO Fundamentos e objetivo: O Lokivetmab é o primeiro anticorpo monoclonal anti-interleucina-31 canina aprovado na União Europeia para o tratamento da dermatite atópica canina (DAC). Este estudo teve o objetivo de avaliar a eficácia e segurança do lokivetmab no tratamento de casos de DAC de um serviço de referência universitário, bem como a opinião geral dos tutores dos animais em relação ao tratamento. Métodos: Foram recrutados dezoito cães atópicos para realizarem duas injeções subcutâneas de lokivetmab, de acordo com o protocolo. De modo a determinar a eficácia e segurança do tratamento, foram avaliados ao longo de 56 dias as lesões cutâneas, o grau de prurido, o hemograma, os parâmetros hepáticos e os efeitos adversos. A satisfação geral dos tutores relativamente ao tratamento foi aferida no final do estudo, e foram contabilizados os animais que mantiveram o tratamento três meses após o término do estudo. Resultados: Observou-se uma redução significativa do grau de prurido ao longo das oito semanas, sendo que 76,5% dos cães alcançou uma melhoria clinicamente significativa. Em relação ao quadro lesional, 77,8% dos cães teve uma melhoria clinicamente significativa, com 61,1% dos animais a manifestá-la nas primeiras 4 semanas. Não foram registados efeitos adversos ou alterações nos parâmetros sanguíneos. A opinião dos tutores dos animais foi muito positiva no que se refere à melhoria da qualidade de vida do cão e da família e, três meses após o término do estudo, 77,8% dos cães mantinham o tratamento com lokivetmab. Conclusão: O lokivetmab revelou-se extremamente eficaz e seguro, além de ter a vantagem de não requerer administração em casa por parte do tutor, o que também contribui para o seu elevado grau de satisfação. A grande especificidade desta terapêutica biológica torna-a uma das mais potentes e promissoras na área da DAC.

ABSTRACT Background and objective: Lokivetmab is the first anti-canine interleukin-31 monoclonal antibody approved in the European Union for Canine Atopic Dermatitis (CAD) management. This study aimed to assess the lokivetmab’s efficacy and safety in treating CAD cases from a university reference service, as well as the dog’s owner’s overall opinion regarding therapy. Methods: Eighteen atopic dogs were enrolled to perform two subcutaneous injections of lokivetmab, according to the protocol. In order to determine the efficacy and safety of the treatment, skin lesions, pruritus score, blood count, liver parameters and adverse side effects were evaluated over 56 days. The overall pet owner’s satisfaction about the therapy was assessed at the end of the study, and the number of animals that maintained the treatment three months after the end of the study was considered. Results: There was a significant reduction in pruritus score over the eight weeks, with 76.5% of the dogs showing a significant clinical improvement. Regarding the lesion score, 77.8% of the dogs achieved significant clinical improvement, with 61.1% reaching it in the first 4 weeks. There were no reported adverse side effects or changes in blood tests. Pet owner’s opinion regarding the improvement of both the dog and its family’s quality of life was very positive, and three months after the end of the study, 77.8% of the dogs continued their therapy with lokivetmab. Conclusion: Lokivetmab proved to be extremely effective and safe, in addition to sparing pet owners from at home drug administrations, which also contributes to their high satisfaction degree. The great specificity of this biological therapy makes it one of the most potente and promising in the CAD field.

ABSTRACT INTRODUCTION: Population growth and climate change have prompted reflection on which dietary patterns will be responsible for ensuring healthier and more environmentally sustainable foods. Greater inclusion of plant-based foods such as legumes can be part of this transition. OBJECTIVES: This study aimed to monitor and characterize the consumption of legumes in the Portuguese adult population, and to compare the predisposition to include these foods as protein substitutes for meat or fish in 2014 and in 2020. METHODOLOGY: Two semi-structured questionnaires were developed with some identical questions, one in 2014 and the other in 2020, published online through social networks. There were 1741 valid participants in 2014 and 908 in 2020. The categorical variables were obtained through n and % and compared using the chi-square test. Age was described using median and interquartile range and compared using the Mann-Whitney U test. The analysis was conducted using the SPSS 24.0 software. RESULTS: In 2014, 19.9% of respondents reported using legumes as a substitute for meat and fish and in 2020, this percentage increased to 31.7% (p< 0.001). The percentage of the respondents that claimed not to be willing to make such a replacement decreased from 15.0% (2014) to 11.5% (2020) (p = 0.017). The main drivers and barriers for legume consumption were identified and 77.5% of the respondents were not familiar with the recommended daily intake. CONCLUSIONS: Despite the Portuguese population is increasingly available to modify their dietary habits. However, it is necessary to develop strategies to increase knowledge about dietary recommendations for a healthy and sustainable diet.

RESUMO INTRODUÇÃO: O crescimento populacional e as alterações climáticas têm motivado a procura de padrões alimentares mais saudáveis e ambientalmente mais sustentáveis. Uma maior inclusão de alimentos de origem vegetal, como as leguminosas, pode fazer parte deste caminho. OBJETIVOS: O objetivo deste estudo foi avaliar o consumo de leguminosas em duas amostras da população adulta portuguesa, e comparar a predisposição para a inclusão destes alimentos como substitutos proteicos da carne ou do pescado, em 2014 e 2020. METODOLOGIA: Foram elaborados dois questionários semiestruturados com algumas perguntas iguais, um em 2014 e outro em 2020, disseminados online, através das redes sociais. Foram participantes válidos 1741 indivíduos em 2014 e 908 em 2020. As variáveis categóricas foram descritas através de n e % e comparadas através do teste de qui-quadrado. A idade foi descrita através de mediana e intervalo interquartil e comparadas através do teste de Mann-Whitney U. A análise foi conduzida através do software SPSS 24.0. RESULTADOS: Em 2014, 19,9% dos entrevistados referiu que utilizava leguminosas como substituto da carne e do pescado e, em 2020, esta percentagem subiu para 31,7% (p< 0,001). A percentagem de inquiridos que afirmaram não colocar tal hipótese diminuiu de 15,0% (2014) para 11,5% (2020) (p = 0,017). As principais motivações e barreiras para o consumo de leguminosas foram identificadas e 77,5% da amostra mostrou não ter conhecimento sobre a sua porção diária recomendada. CONCLUSÕES: Apesar de os portugueses estarem dispostos a alterar os seus hábitos alimentares, é necessário desenvolver estratégias para aumentar o conhecimento acerca das leguminosas, nomeadamente das recomendações alimentares para uma dieta saudável e sustentável.