ABSTRACT This study investigated the effectiveness of using the X-ray technique to assess the viability of papaya seeds. The X-ray images were performed in eight replicates of 25 seeds, placed on transparent acrylic plates on double-sided adhesive tape, previously identified, and then submitted to radiation in X-ray equipment "HP Faxitron". After exposure to X-ray radiation, the seeds were submitted to the germination test in rolls of germitest paper and kept in a germination chamber at 20-30 °C for 30 days. Seedlings were photographed and evaluated as normal seedlings, abnormal and non-germinated seeds. Afterward, the X-ray images and the seedlings from the same seeds were visually compared, and the X-ray images clearly showed seeds with and without internal filling. All abnormal seedlings were full seeds; therefore, X-ray images were not able to separate normal and abnormal. A 100% accuracy was verified by comparing the X-ray images and their respective seedlings, full seeds originated normal or abnormal seedlings, and empty seeds corresponded to non-germinated seeds. Therefore, using X-ray images is a promising technique to identify the viability of papaya seeds. The automated analysis of X-ray images is a simple, fast, and efficient technique to provide information on seed viability and generate parameters related to their germination capacity.

ABSTRACT Background: Colorectal cancer (CRC) has high mortality rates worldwide. In Brazil, it is the second most common cancer in both sexes. Delay in detecting premalignant lesions contributes to increased morbidity and mortality. In this scenario, the Piranhas project was created to track CRC in a low-income population in the hinterland of Alagoas. Objective: The study aimed to establish the main strategies and verify the feasibility of implementing a CRC tracking program and demonstrate the results obtained in the CRC Prevention Campaign in Piranhas/AL. Methods: The program took place in Piranhas, Alagoas, Brazil, through public-private partnerships. Individuals aged between 50 and 70 years of age were included for screening with a fecal occult blood test (FOBT) and colonoscopy in positive cases. Patient data were collected on standard forms. Results: A total of 2152 patients, aged between 50 and 70 years, were screened, 130 of which underwent colonoscopy. Several preneoplastic lesions were detected in 58 patients. The adenoma detection rate (ADR) was 33.85%. Conclusion: The study proved to be effective and viable since 44.6% of the program participants, who underwent screening with FOBT, followed by colonoscopy in positive cases, had some type of preneoplastic lesion. In addition, the program generated a significant social impact on the population of Piranhas due to the opportunity to diagnose and treat CRC precursor lesions.

RESUMO Contexto: O câncer colorretal (CCR) possui altas taxas de mortalidade em todo mundo. No Brasil é o segundo câncer mais comum em ambos os sexos. O atraso na detecção de lesões pré-malignas contribui com o aumento da morbimortalidade. Neste cenário, o projeto Piranhas foi criado para rastrear o CCR em uma população carente do sertão alagoano. Objetivo: O estudo teve como meta estabelecer as principais estratégias e verificar a viabilidade da implementação de um programa de rastreamento do CCR, assim como demonstrar os resultados obtidos na Campanha de prevenção de CCR no município de Piranhas/AL. Métodos: O programa aconteceu em Piranhas, Alagoas, Brasil, através de parcerias público-privadas. Foram incluídos indivíduos entre 50 e 70 anos para triagem com pesquisa de sangue oculto nas fezes (PSOF) e colonoscopia dos casos positivos. Os dados dos pacientes foram coletados em formulários padrão. Resultados: Foram rastreados um total de 2152 pacientes com idade entre 50 e 70 anos, sendo destes, 130 submetidos à colonoscopia. Várias lesões pré-neoplásicas foram detectadas em 58 pacientes. A taxa de detecção de adenoma foi de 33,85%. Conclusão: O estudo demonstrou-se eficaz e viável, uma vez que 44,6% dos participantes do programa que realizaram a triagem com PSOF seguido de colonoscopia nos casos positivos apresentava algum tipo de lesão pré-neoplásica. Além disso, o programa gerou grande impacto social na população de Piranhas, pela oportunidade de diagnóstico e tratamento de lesões precursoras do CCR.

Resumen Antecedentes: Agave potatorum es una especie endémica importante ecológica, cultural y económicamente. Poco se cultiva y sus poblaciones naturales están desapareciendo, por lo que una alternativa es la propagación por cultivo de tejidos vegetales. Preguntas: ¿Es posible regenerar nuevos individuos partiendo de estructuras somáticas? ¿Qué explante regenera más plántulas? ¿Qué combinación de reguladores del crecimiento vegetal estimula una mayor formación de brotes? Especie estudiada: Agave potatorum, semillas de Oaxaca, México. Lugar de estudio y fechas: Jardín Botánico, Instituto de Biología, UNAM, Ciudad de México, México. Desde 2020. Métodos: Semillas se desinfectaron y germinaron in vitro y ex vitro. Se cultivaron in vitro explantes de cotiledones, tallos y hojas en medio MS modificado, un mes con BAP (0-2 mg/L) combinado con 2,4-D (0-0.5 mg/L), posteriormente en MS sin reguladores del crecimiento vegetal. Las plantas obtenidas con tres o más raíces se sometieron a un proceso de aclimatización. Resultados: A dos meses de iniciados los cultivos las semillas germinaron in vitro (56.04 %) y ex vitro (31.87 %). Después de 10 meses del período de inducción, se obtuvieron 228 brotes y plántulas, 206 procedían de los tratamientos BAP 1.5-2 mg/L con 2,4-D 0.5 mg/L, con 8.1-12.5 brotes/explante de tallo y hoja. Más del 70 % de las plantas sobrevivieron en invernadero luego de dos meses. Conclusiones: Esta investigación puede contribuir a la conservación de la especie, enfrentar los efectos del cambio climático, la conservación de servicios ecosistémicos y potenciar la economía mediante un aprovechamiento sustentable de ésta y otras especies amenazadas.

Abstract Background: Agave potatorum is an endemic species of ecological, cultural and economic importance. Despite its importance and its overexploited status, it is barely cultivated and its natural populations have been disappearing, so an alternative is propagation by plant tissue culture. Questions: Is it possible to regenerate new individuals from somatic structures? From which explant do more plantlets regenerate? What combination of plant growth regulators stimulates more bud formation? Species studied: Agave potatorum, seeds from Oaxaca, Mexico Study site and dates: Botanical Garden, Institute of Biology, UNAM, Mexico City, Mexico. Since 2020 Methods: The explant culture of cotyledons, stems and leaves sections in modified MS medium was explored, one month with BAP (0-2 mg/L) combined with 2,4-D (0-0.5 mg/L). Subsequently in MS without plant growth regulators. The obtained plants with 3 or more roots underwent an acclimatization process. Results: The seeds' germination was achieved and at two months, the in vitro (56.04 %) and ex vitro (31.87 %) germination were obtained. At 10 months after the induction period, the total number of shoots and plantlets of all treatments was 228, most of them (206) were with BAP 1.5-2 mg/L with 2,4-D 0.5 mg/L promoted the regeneration of 8.1-12.5 shoots/explant of stem and leaf. More than 70 % of the plants survived in greenhouse after two months of culture. Conclusions: This investigation can contribute to the conservation of Agave potatorum, address climate change, conserve ecosystemic services, and strengthen the economy by using this and other endangered species sustainably.

Resumen Introducción: las clasificaciones de pie diabético (PD) son una herramienta que tienen el objetivo de mejorar la comunicación entre los profesionales, la referencia y contrarreferencia; proporcionar un pronóstico; ayudar en la valoración de las lesiones, y contribuir con fines estadísticos. Objetivos: describir las características de los pacientes que se presentaron al consultorio o a la guardia con un PD durante un período de 3 meses, determinar el riesgo según cinco clasificaciones (Texas, IDSA, San Elián, WIfI y SINBAD) y evaluar su evolución a 6 meses en relación con el grado de gravedad determinada por cada clasificación. Materiales y métodos: se analizaron 312 pacientes de 15 instituciones en Argentina. Para el análisis se utilizó la calculadora de clasificaciones de pie diabético/score de riesgo del Comité de Pie Diabético de la Sociedad Argentina de Diabetes. Resultados: el 43% de los pacientes (n=133) requirió internación al momento de la primera consulta y el 61% (n=189) había consultado previamente. El porcentaje de amputación mayor total fue de 8,33% (IC 95%; 5,5-11,9) (n=26) y el de amputación menor de 29,17% (IC 95%; 24,2-34,6) (n=91). A los 6 meses, el porcentaje de muerte fue de 4,49% (IC 95%; 2,5-7,4) (n=14), el 24,3% (IC 95%;19,6-29,5) presentaba la herida aún abierta (n=76), el 58,0% (IC 95%; 52,3-66,5) (n=181) cicatrizó y el 7,37% se perdió del seguimiento (n=23). Las clasificaciones de San Elián y WIfI se relacionaron con amputación mayor, cicatrización y muerte. En relación a la clasificación de Texas, el 49% de los pacientes presentó herida penetrante a hueso o articulación (Texas 3), con o sin infección. El 65,3% de las amputaciones mayores y el 78,6% de las muertes se produjeron en pacientes con isquemia. El punto de corte de San Elián para amputación mayor fue 20. Conclusiones: conocer los datos locales permite organizar los recursos para mejorar la atención de los pacientes.

Abstract Introduction: the classifications of diabetic foot (DF) are a tool that aims to improve communication between professionals, referral and counter-referral, provide a prognosis, help in the assessment of lesions, and contribute to statistical purposes. Objectives: to describe the characteristics of patients who presented to the clinic or emergency department with DF over a period of 3 months, determine the risk according to 5 classifications (Texas, IDSA, SEWSS, WIfI, and SINBAD), and evaluate their evolution at 6 months in relation to the severity degree determined by each classification. Materials and methods: 312 patients from 15 institutions in Argentina were analyzed. The Diabetic Foot Classification Calculator/Risk Score from the Diabetic Foot Committee of the Argentina Argentina Diabetes Society was used for the analysis. Results: 43% of patients (n=133) required hospitalization at the time of the first consultation and 61% (n=189) had previously consulted. The total major amputation percentage was 8.33% (95%CI; 5.5-11.9) (n=26), and the minor amputation percentage was 29.17% (95% CI; 24.2-34.6) (n=91). At 6 months, the death rate was 4.49% (95% CI; 2.5-7.4) (n=14), 24.3% (95% CI; 19.629.5) had an open wound (n=76), 58.0% (95% CI; 52.3-66.5) (n=181) had healed, and 7.37% were lost to follow-up (n=23). The SEWSS and WIfI classifications were related to major amputation, healing, and death. Regarding the Texas classification, 49% of patients had a penetrating wound to bone or joint (Texas 3), with or without infection. 65.3% of major amputations and 78.6% of deaths occurred in patients with ischemia. The SEWSS cut-off point for major amputation was 20. Conclusions: knowing local data allows organizing resources to improve patient care.

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic Pelvic Pain (CPP) is characterized by persistent pain in the pelvic region for more than six months, affecting both men and women and causing significant impairment in quality of life (QoL). Two of the main non-invasive approaches are Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS). These techniques aim to modulate neural activity and promote pain relief. In this context, this research conducted an integrative literature review to summarize the results of relevant studies, aiming to identify the key parameters used in TMS and tDCS for CPP treatment. The objective was to assess the effect and efficacy of non-invasive neuromodulation as a therapeutic intervention for CPP. CONTENTS: For this integrative review, electronic searches were conducted in Pubmed, Scielo, PEDro, Medline, Cochrane, and Scopus databases, examining studies in Portuguese, English, or Spanish. The keywords “pelvic pain,” “transcranial direct current stimulation,” and “transcranial magnetic stimulation” and their derivatives were searched in the three languages in studies from 2013 to 2023. Seven studies were included for analysis. Both techniques showed positive effects in managing CPP, improving pain levels and quality of life to a relevant extent. However, there is still no consensus on the parameters applied in TMS and tDCS techniques for CPP. CONCLUSION: Non-invasive neuromodulation improves pain levels and quality of life in patients with CPP. Further studies are needed to establish more reliable parameter relationships, and the limited number of studies restricts definitive conclusions on the subject.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor pélvica crônica (DPC) é caracterizada pela persistência da dor na região pélvica por mais de seis meses, afetando tanto homens quanto mulheres e causando prejuízos significativos na qualidade de vida (QV). Duas das principais abordagens não invasivas são Estimulação Magnética Transcraniana (EMT) e a Estimulação Transcraniana por Corrente Contínua (ETCC). Nesse contexto, esta pesquisa realizou uma revisão integrativa da literatura com o intuito de resumir os resultados de estudos relevantes, buscando identificar os principais parâmetros utilizados no tratamento da DPC. O objetivo foi fornecer uma visão abrangente sobre essas técnicas de neuromodulação e suas aplicações específicas no controle da dor pélvica crônica. CONTEÚDO: Para esta revisão integrativa, as buscas eletrônicas ocorreram nas bases de dados Pubmed, Scielo, PEDro, Medline, Cochrane e Scopus, verificando estudos em português, inglês ou espanhol. “Dor pélvica”, “estimulação transcraniana por corrente contínua” e “estimulação magnética transcraniana” e suas derivações foram pesquisadas nos três idiomas em estudos entre 2013 e 2023. Sete estudos foram incluídos para análise. Ambas as técnicas apresentaram efeitos positivos no manejo da DPC, melhorando os níveis de dor e a QV em proporções relevantes. Entretanto, ainda não há um consenso sobre os parâmetros aplicados nas técnicas de EMT e ETCC para DPC. CONCLUSÃO: A neuromodulação não invasiva melhora os níveis de dor e a QV em pacientes com DPC. São necessários mais estudos para que relações mais confiáveis de parâmetros possam ser preestabelecidas e a ausência de um maior número de estudos limita conclusões acerca do assunto.

Resumen La presencia de fósforo y nitrógeno en proporciones elevadas puede afectar negativamente la calidad de cualquier ecosistema. Hasta la fecha no ha sido pub1licado un estudio bibliométrico de fósforo y nitrógeno en ecosistemas acuáticos ecuatorianos. El objetivo de este estudio fue analizar y presentar marcadores bibliométricos de la producción científica de fósforo y nitrógeno en ecosistemas acuáticos ecuatorianos. Para la recolección de datos se utilizó la base de datos Scopus. Se hallaron un total de 823 documentos, de los cuales solo se validaron 49. Las publicaciones aumentaron considerablemente a partir del año 2013, y llegaron a un máximo de 16 en el año 2018. De estos los ríos fueron los ecosistemas más estudiados a lo largo del periodo, la mayor parte de las publicaciones fueron en el idioma inglés y la revista con más artículos fue Water. La mayor parte de los artículos se publicaron en revistas prestigiosas de biología, limnología, agua e hidrobiología. Las universidades líderes en esta temática son: la Universidad de Cuenca y la Escuela Superior Politécnica del Litoral

Abstract The high proportions of phosphorus and nitrogen can negatively affect the quality of any ecosystem. No bibliometric study of phosphorus and nitrogen in Ecuadorian aquatic ecosystems has been published yet. This study aimed to analyze and present bibliometric markers of the scientific production of phosphorus and nitrogen in Ecuadorian aquatic ecosystems. The Scopus database was used for data collection. An amount of 823 documents were found, out of which only 49 were validated. Publications increased considerably from 2013 onward, reaching a maximum of 16 in 2018. Of these, rivers were the most studied ecosystems throughout the period; most of the publications were in English, and the journal with the most articles was Water. Most of the reports were published in prestigious biology, limnology, water science, and hydrobiology journals. The leading universities in this field are the University of Cuenca and the Escuela Superior Politécnica del Litoral.

Resumen La alimentación durante los primeros 1000 días de vida (desde el vientre materno hasta los dos años) son fundamentales para la salud futura de una persona. Este artículo tiene por objetivo analizar los saberes y prácticas alimentarias materno-infantiles en localidades rurales del Estado de Hidalgo en México. Estudio de corte transversal, descriptivo, observacional desde una perspectiva fenomenológica combinando técnicas cuantitativas y cualitativas en 56 participantes y 7 informantes a quienes se entrevistó. El 48% de las mujeres entrevistadas ofrecieron leche materna exclusivamente durante 4 a 6 meses, el 57% destetó después del año. La familia fue la principal fuente de información de las mujeres (91%), por encima del personal de salud (80%), quien frecuentemente da opiniones contradictorias. El 71% prefirió el uso de conocimientos de herbolaria provenientes de parteras, hijas de parteras o adultas mayores. Los saberes, tradiciones y prácticas alimentarias de las madres de menores de dos años en el Carso Huasteco hidalguense, se basan en conocimientos tradicionales permeados por el discurso del personal de salud y los medios de comunicación, así como el acceso físico y económico a los alimentos procesados y frescos.

Abstract Nutrition during the first 1000 days of life (from the womb to two years of age) is fundamental for the future health of a person. The objective of this article is to analyze maternal and child feeding knowledge and practices in rural localities of the state of Hidalgo in Mexico. A cross-sectional, descriptive, observational study was carried out from a phenomenological perspective combining quantitative and qualitative techniques in 56 participants and 7 informants who were interviewed. 48% of the women interviewed offered breast milk exclusively for 4 to 6 months, 57% weaned after one year. The family was the main source of information for the women (91%), above the health personnel (80%), who frequently gave contradictory opinions. Seventy-one percent preferred the use of herbal knowledge from midwives, daughters of midwives, or older women. The knowledge, traditions, and food practices of mothers of children under two years of age in the Carso Huasteco hidalguense are based on traditional knowledge permeated by the discourse of health personnel and the media, as well as physical and economic access to processed and fresh foods.

Introduction: Childhood overweight and obesity are a public health problem. The onset of the COVID-19 pandemic may have contributed to this pathology. The Body Mass Index z-score (BMI z-score) is an accepted indicator for the diagnosis and follow-up. Objectives: To evaluate whether the prevalence of overweight and obesity, and BMI z-score in children aged 2 to 5 years increased during the pandemic. Materials and methods: Retrospective cohort study. Patients assisted in public health facilities City of  Buenos Aires  (BA), aged 2 to 4 years, with weight and height records in two consultations, before and after the start of lockdown were included. Nutritional status (BMI z-score) and BMI z-score variation between both consultations were recorded. Results: 3866 subjects were evaluated, mean age 3.4±0.8 years; 48.1% female. The average interval between consultations was 14.3±2.5 months. The prevalence of overweight/obesity increased from 12.6% CI95% 11.6-13.6 to 20.9% CI95% 19.6-22.2; p<0.001, as did the BMI z-score (0.4±1.1 vs. 0.8±1.3; p<0.001). Conclusion: The prevalence of overweight and obesity, and BMI z-score in children aged 2 to 5 years increased significantly during the pandemic.

Introducción: El sobrepeso y la obesidad infantil constituyen un problema de salud pública. El inicio de la pandemia por COVID-19 pudo haber favorecido esta patología. El puntaje Z del Índice Masa Corporal (Z-IMC) es un indicador aceptado para su diagnóstico y seguimiento. Objetivos: Evaluar si la prevalencia de sobrepeso y obesidad, y el Z-IMC en niños de 2 a 5 años aumentó durante la pandemia. Material y métodos: Estudio de cohorte retrospectiva. Se incluyeron pacientes asistidos en efectores públicos de salud del Gobierno de la Ciudad Autónoma de Buenos Aires (GCABA), de 2 a 4 años de edad, con registro de peso y talla en dos consultas, antes y después de haber comenzado el aislamiento social preventivo y obligatorio (ASPO). Se registró estado nutricional (Z-IMC) y variación del Z-IMC entre ambas consultas. Resultados: Se evaluaron 3866 sujetos, edad promedio 3,4±0,8 años; 48,1% mujeres. El intervalo promedio entre consultas fue 14,3±2,5 meses. La prevalencia de sobrepeso/obesidad aumentó de 12,6% IC95% 11,6-13,6 a. 20,9% IC95% 19,6-22-2; p<0,001, al igual que el Z-IMC (0,4±1,1 vs. 0,8±1,3; p <0,001). Conclusión: La prevalencia de sobrepeso y obesidad, y Z-IMC en niños de 2 a 5 años aumentó significativamente durante la pandemia.

Introdução: O sobrepeso e a obesidade infantil são problemas de saúde pública. O início da pandemia de COVID-19 pode ter favorecido essa patologia. O escore Z do Índice de Massa Corporal (Z-IMC) é um indicador aceito para o diagnóstico e acompanhamento da obesidade. Objetivos: Avaliar se a prevalência de sobrepeso e obesidade, e o Z-IMC em crianças de 2 a 5 anos aumentaram durante a pandemia. Material e Métodos: Estudo de coorte retrospectivo. Foram incluídos pacientes assistidos em estabelecimentos públicos de saúde do Governo da Cidade Autônoma de Buenos Aires (GCABA), de 2 a 4 anos de idade, com registro de peso e altura em duas consultas, antes e depois do início do isolamento social preventivo e obrigatório (ASPO). Foi registrado o estado nutricional (Z-IMC) e a variação do Z-IMC entre as duas consultas. Resultados: Foram avaliados 3866 indivíduos, com idade média de 3,4 ± 0,8 anos; 48,1% mulheres. O intervalo médio entre as consultas foi de 14,3 ± 2,5 meses. A prevalência de sobrepeso/obesidade aumentou de 12,6% IC95% 11,6-13,6 para 20,9% IC95% 19,6-22-2; p<0,001, assim como o Z-IMC (0,4 ± 1,1 vs. 0,8 ± 1,3; p <0,001). Conclusão: A prevalência de sobrepeso e obesidade, e o Z-IMC em crianças de 2 a 5 anos aumentaram significativamente durante a pandemia.

Abstract Community forestry enterprises (CFEs) require regional business planning skills to establish and maintain business associations at large-scale. The aim of this study was to identify the perception of four CFEs on the limitations and opportunities for scaling up in CFEs in Central Mexico. We selected four contrasting CFEs of development and social organization level to assess barriers and opportunities for scaling up, applying interviews to different stakeholders. The analysis of obstacles and opportunities suggests that scaling strategies should foster technical and administrative training, develop infrastructure and strengthen internal governance that promote economic diversification and increased income from forest management.

Resumen Las empresas forestales comunitarias (EFC) requieren habilidades de planificación comercial regional para establecer y mantener asociaciones comerciales a mayor escala. El objetivo de este estudio es identificar la percepción de cuatro EFC contrastantes sobre las limitaciones y oportunidades de escalamiento en el centro de México, con base en el nivel de desarrollo de aprovechamiento silvícola y organización social, aplicando entrevistas a diferentes actores. El análisis cualitativo de obstáculos y oportunidades sugiere que las estrategias de escalamiento deben fomentar capacitación técnica y administrativa, desarrollar infraestructura y gobernanza interna sólida, que favorezca la diversificación económica, y mayores ingresos derivados del manejo forestal.

Resumo Estudo ecológico com objetivo de determinar o consumo de naltrexona em baixa dose (LDN) nas 26 capitais brasileiras e Distrito Federal e acompanhar a tendência entre os anos de 2014 e 2020. A coleta de dados da dispensação de naltrexona manipulada, se deu por meio do Sistema Nacional de Gerenciamento de Produtos Controlados, publicizado em 2020, considerando-se baixa dose prescrições de até 5 mg. O cálculo dos coeficientes de dispensação utilizou as estimativas populacionais do Instituto Brasileiro de Pesquisa Geografia e Estatística. Utilizou-se análise estatística descritiva e de regressão generalizada de Prais-Winsten para a série temporal. As tendências observadas foram classificadas em crescentes, estáveis ou decrescentes, com intervalo de confiança de 95% e nível de significância de 5%. Os resultados demonstraram maiores coeficientes de consumo de LDN nas regiões Centro-Oeste, Sul e Sudeste e menores nas Norte e Nordeste. Observou-se dispensação de LDN crescente em 55,6% das capitais, estacionária em 44,4% e ausência de coeficientes decrescentes. Apesar das evidências limitadas quanto à farmacoterapia de LDN e da sua prescrição off-label, os dados demonstram que a prescrição, dispensação e consumo vem crescendo no Brasil, com ênfase nas regiões centro-sul do país.

Abstract The scope of this paper is an ecological study to determine the consumption of low-dose naltrexone (LDN) in the 26 Brazilian capitals and the Federal District and monitor the trend between the years 2014 to 2020. Data collection on the dispensation of manipulated naltrexone was done through the National Management System of Controlled Products, published in 2020, considering low-dose prescriptions of up to 5 mg. The calculation of the dispensation coefficients used the population estimates of the Brazilian Institute of Geography and Statistics. Descriptive statistical analysis and generalized Prais-Winsten regression analysis were used for the time series analysis. The trends observed were classified as increasing, stable, or decreasing, with a 95% confidence interval and 5% significance level. The results showed higher LDN consumption coefficients in the Mid-West, South and Southeast regions and lower coefficients in the North and Northeast. Increasing dispensation of LDN was observed in 55.6% of the capitals, being stationary in 44.4%, with no decreasing coefficients. Despite the limited evidence regarding LDN pharmacotherapy and its off-label prescription, the data show that prescription, dispensing, and consumption have been on the increase in Brazil, with emphasis on the central-south regions of the country.

Abstract The scope of this paper is an ecological study to determine the consumption of low-dose naltrexone (LDN) in the 26 Brazilian capitals and the Federal District and monitor the trend between the years 2014 to 2020. Data collection on the dispensation of manipulated naltrexone was done through the National Management System of Controlled Products, published in 2020, considering low-dose prescriptions of up to 5 mg. The calculation of the dispensation coefficients used the population estimates of the Brazilian Institute of Geography and Statistics. Descriptive statistical analysis and generalized Prais-Winsten regression analysis were used for the time series analysis. The trends observed were classified as increasing, stable, or decreasing, with a 95% confidence interval and 5% significance level. The results showed higher LDN consumption coefficients in the Mid-West, South and Southeast regions and lower coefficients in the North and Northeast. Increasing dispensation of LDN was observed in 55.6% of the capitals, being stationary in 44.4%, with no decreasing coefficients. Despite the limited evidence regarding LDN pharmacotherapy and its off-label prescription, the data show that prescription, dispensing, and consumption have been on the increase in Brazil, with emphasis on the central-south regions of the country.

Resumo Estudo ecológico com objetivo de determinar o consumo de naltrexona em baixa dose (LDN) nas 26 capitais brasileiras e Distrito Federal e acompanhar a tendência entre os anos de 2014 e 2020. A coleta de dados da dispensação de naltrexona manipulada, se deu por meio do Sistema Nacional de Gerenciamento de Produtos Controlados, publicizado em 2020, considerando-se baixa dose prescrições de até 5 mg. O cálculo dos coeficientes de dispensação utilizou as estimativas populacionais do Instituto Brasileiro de Pesquisa Geografia e Estatística. Utilizou-se análise estatística descritiva e de regressão generalizada de Prais-Winsten para a série temporal. As tendências observadas foram classificadas em crescentes, estáveis ou decrescentes, com intervalo de confiança de 95% e nível de significância de 5%. Os resultados demonstraram maiores coeficientes de consumo de LDN nas regiões Centro-Oeste, Sul e Sudeste e menores nas Norte e Nordeste. Observou-se dispensação de LDN crescente em 55,6% das capitais, estacionária em 44,4% e ausência de coeficientes decrescentes. Apesar das evidências limitadas quanto à farmacoterapia de LDN e da sua prescrição off-label, os dados demonstram que a prescrição, dispensação e consumo vem crescendo no Brasil, com ênfase nas regiões centro-sul do país.

ABSTRACT Background Reduced or null expression of E-cadherin protein is a frequent cause of diffuse gastric cancer (DGC). More than 50% of patients with DGC present somatic variants in CDH1 gene. Objectives The objectives of this study were to study E-cadherin expression and identify variants in the CDH1 gene in gastric tumors of patients with DGC. Methods We studied 18 Mexican DGC patients who attended a hospital of the Mexican Social Security Institute; E-cadherin expression was determined by immunohistochemistry, and variants were identified by Sanger sequencing in promoter and coding regions. Predictive analysis was performed using PolyPhen-2 and HOPE software. Results We found that 56% of DGC patients showed reduced expression of E-cadherin. All patients carried CDH1 variants; overall, 12 different CDH1 variants were identified. Predictive analysis revealed that the rs114265540 variant was probably damaging, with a value of 0.985, indicating a functional impact on the E-cadherin protein. Variants rs34939176 and rs33964119 were identified as risk factors for DGC (odds' ratios [OR] = 31.3, 95% CI 6.3-154.0, p < 0.001; OR = 6.1, 95% CI 2.0-19.0, p < 0.001, respectively) given their elevated frequency and by comparing it with those reported for MXL population in the 1000 Genomes Project database. Conclusions In this Mexican population, the percentage of diffuse gastric tumors with reduced expression of E-cadherin was similar to that reported in other populations. All gastric tumors of DGC patients studied had somatic CDH1 gene variants; however, the rs114265540, rs34939176, and rs33964119 variants were importantly related to DGC.

ABSTRACT BACKGROUND AND OBJECTIVES: Health professionals attitudes and beliefs about musculoskeletal pain have a negative influence on patient beliefs and outcomes. However, there is no gold standard for assessing knowledge and attitudes toward pain among these professionals. Thus, the objective of the present study was to translate, adapt and validate the Knowledge and Attitudes of Pain (KNAP) questionnaire into Brazilian Portuguese (KNAP-Br), apply the questionnaire and analyze the correlation of its results with the Neurophysiological Pain Questionnaire (NPQ). METHODS: After being translated, back-translated and adapted, the NKAP-Br was applied to 60 physical therapy and medicine students for validation. The correlation between the results obtained by multiplying the scores of the questions of the NKAP-Br instrument and the NPQ was evaluated. To assess reliability, another 200 students responded to the initial KNAP-Br (T1), performed the Pain Education Program (PEP) in one week and one week after T1, the participants received access to answer the KNAP-Br end (T2). RESULTS: Concurrent validity was assessed by the correlation between NPQ and the final KNAP-Br score. A significant correlation was found between the NPQ result (0.3 and p-value=0.0001) and the KNAP-Br score. Intragroups, 84% improved in the KNAP-Br score after studying PEP, 43.50% improved at or above the minimal detectable difference (MDD) and at or above the minimal important difference (MID). CONCLUSION: The questionnaire was translated and adapted respecting the Brazilian population cultural aspects and presented satisfactory reliability and construct validity, being considered valid for the assessment of knowledge and the interpretation of pain by health professionals.

RESUMO JUSTIFICATIVA E OBJETIVOS: As atitudes e as crenças dos profissionais de saúde sobre dor musculoesquelética têm influência negativa nas crenças e resultados dos pacientes. Entretanto, não existe um padrão ouro para avaliar o conhecimento e as atitudes relativas à dor entre esses profissionais. Dessa forma, o objetivo deste estudo foi traduzir, adaptar e validar o questionário Knowledge and Attitudes of Pain (KNAP) para a língua portuguesa brasileira (KNAP-Br), aplicar o questionário e analisar a correlação dos seus resultados com o Questionário Neurofisiológico de Dor (QND). MÉTODOS: Após ser traduzido, retrotraduzido e adaptado, o KNAP-Br foi aplicado em 60 estudantes de fisioterapia ou medicina para validação. Foi avaliada a correlação entre os resultados obtidos pela multiplicação dos escores das questões dos instrumentos KNAP-Br e QND. Para avaliação da confiabilidade, outros 200 estudantes responderam o KNAP-Br inicial (T1), realizaram em uma semana o Programa de Educação em Dor (PED) e uma semana após T1 os participantes receberam acesso para responder o KNAP-Br final (T2). RESULTADOS: A validade concorrente foi avaliada pela correlação entre QND e o escore final do KNAP-Br. Foi encontrada uma correlação significativa entre o resultado do QND (0,3 e valor de p=0,0001) e o escore do KNAP-Br. Intragrupos, 84% melhoraram no escore do KNAP-Br após estudar PED, 43,50% melhoraram igual ou acima da menor diferença detectável (MDD) e igual ou acima da diferença mínima importante (DMI). CONCLUSÃO: O questionário foi traduzido e adaptado, respeitando os aspectos culturais da população brasileira, e apresentou satisfatória confiabilidade e validade de constructo, sendo considerado válido para avaliação do conhecimento e para a interpretação da dor por profissionais de saúde.

RESUMO JUSTIFICATIVA E OBJETIVOS: As atitudes e as crenças dos profissionais de saúde sobre dor musculoesquelética têm influência negativa nas crenças e resultados dos pacientes. Entretanto, não existe um padrão ouro para avaliar o conhecimento e as atitudes relativas à dor entre esses profissionais. Dessa forma, o objetivo deste estudo foi traduzir, adaptar e validar o questionário Knowledge and Attitudes of Pain (KNAP) para a língua portuguesa brasileira (KNAP-Br), aplicar o questionário e analisar a correlação dos seus resultados com o Questionário Neurofisiológico de Dor (QND). MÉTODOS: Após ser traduzido, retrotraduzido e adaptado, o KNAP-Br foi aplicado em 60 estudantes de fisioterapia ou medicina para validação. Foi avaliada a correlação entre os resultados obtidos pela multiplicação dos escores das questões dos instrumentos KNAP-Br e QND. Para avaliação da confiabilidade, outros 200 estudantes responderam o KNAP-Br inicial (T1), realizaram em uma semana o Programa de Educação em Dor (PED) e uma semana após T1 os participantes receberam acesso para responder o KNAP-Br final (T2). RESULTADOS: A validade concorrente foi avaliada pela correlação entre QND e o escore final do KNAP-Br. Foi encontrada uma correlação significativa entre o resultado do QND (0,3 e valor de p=0,0001) e o escore do KNAP-Br. Intragrupos, 84% melhoraram no escore do KNAP-Br após estudar PED, 43,50% melhoraram igual ou acima da menor diferença detectável (MDD) e igual ou acima da diferença mínima importante (DMI). CONCLUSÃO: O questionário foi traduzido e adaptado, respeitando os aspectos culturais da população brasileira, e apresentou satisfatória confiabilidade e validade de constructo, sendo considerado válido para avaliação do conhecimento e para a interpretação da dor por profissionais de saúde.

ABSTRACT BACKGROUND AND OBJECTIVES: Health professionals attitudes and beliefs about musculoskeletal pain have a negative influence on patient beliefs and outcomes. However, there is no gold standard for assessing knowledge and attitudes toward pain among these professionals. Thus, the objective of the present study was to translate, adapt and validate the Knowledge and Attitudes of Pain (KNAP) questionnaire into Brazilian Portuguese (KNAP-Br), apply the questionnaire and analyze the correlation of its results with the Neurophysiological Pain Questionnaire (NPQ). METHODS: After being translated, back-translated and adapted, the NKAP-Br was applied to 60 physical therapy and medicine students for validation. The correlation between the results obtained by multiplying the scores of the questions of the NKAP-Br instrument and the NPQ was evaluated. To assess reliability, another 200 students responded to the initial KNAP-Br (T1), performed the Pain Education Program (PEP) in one week and one week after T1, the participants received access to answer the KNAP-Br end (T2). RESULTS: Concurrent validity was assessed by the correlation between NPQ and the final KNAP-Br score. A significant correlation was found between the NPQ result (0.3 and p-value=0.0001) and the KNAP-Br score. Intragroups, 84% improved in the KNAP-Br score after studying PEP, 43.50% improved at or above the minimal detectable difference (MDD) and at or above the minimal important difference (MID). CONCLUSION: The questionnaire was translated and adapted respecting the Brazilian population cultural aspects and presented satisfactory reliability and construct validity, being considered valid for the assessment of knowledge and the interpretation of pain by health professionals.