Resumen: La insulinoterapia es compleja en pacientes pediátricos porque presentan mayores variaciones de los requerimientos de insulina. Las insulinas tradicionales presentan limitaciones relacionadas al tiempo de inicio de acción y la duración del efecto, lo que ha llevado al desarrollo de nuevas insulinas, buscando disminuir las complicaciones crónicas, las hipoglicemias severas o nocturnas, y mejorando la adherencia a la terapia. En esta actualidad se revisa la información sobre nuevas insulinas, mecanismos de acción y beneficios que aportan en el tratamiento de la diabetes. Los análogos de insulina intentan imitar la secreción fisiológica de la hormona, incluyendo tiempo de acción y duración de su efecto. Los análogos prandiales más utilizados actualmente son las insulinas conocidas como ultra rápidas, entre las que se encuentra Faster Aspártica y las nuevas insulinas basales, glargina U300 y degludec, que presentan una acción prolongada mayor a 24 horas, por lo que requieren una dosis diaria. Nuevas tecnologías en desarrollo incluyen insulinas biosimilares como el biosimilar de glar- gina, ya disponible en clínica. Para el futuro se están desarrollando nuevas formulaciones, así como novedosas formas de dispersarlas, imitando la acción de las células pancreáticas, lo cual permitirá un manejo más fisiológico y personalizado de la enfermedad.

Abstract: Insulin therapy is complex in pediatric patients because they present greater variations in insulin requirements. Traditional insulins have limitations related to time of onset of action and duration of effect, which has led to the development of new insulins, seeking to reduce chronic complications, severe or nocturnal hypoglycemia, and to improve adherence to therapy. This review updates the information on new insulins, their mechanisms of action and the benefits they provide in the treatment of diabetes. Insulin analogues attempt to mimic the physiological secretion of the hormone, including time of action and duration of effect. The most used prandial analogs are the so-called rapid-acting insulins, including Faster Aspartic and the new basal insulins, glargine U300 and degludec, which have a prolonged action of more than 24 hours and therefore require a daily dose. New technologies under development include biosimilar insulins such as the glargine biosimilar, already available in the clinic. New formulations are being developed for the future, as well as novel ways of dispersing them, mimicking the action of pancreatic cells, which will allow a more physiological and personalized management of the disease.

SUMMARY OBJECTIVE: This study purposed to evaluate preoperative two tumor markers, namely, carcinoembryonic antigen and carbohydrate antigen (CA)19-9, in colorectal cancer for anatomotopographic location with disease stage and to assess their utility for diagnostic staging purposes. METHODS: The study retrospectively incorporated patients who had undergone surgery for colorectal cancer at our department in 2015–2018 and in whom carcinoembryonic antigen and CA19-9 tumor markers had been preoperatively analyzed. The obtained data were then statistically processed using R-project. RESULTS: A total of 155 patients had been incorporated, of whom 96 (62%) were men and 59 (38%) were women. Rectum was the most common location (74 patients, 48%), and the least represented stage was IV (18, 12%). The marker carcinoembryonic antigen was obtained in all 155 cases, while CA19-9 was in 105. The median carcinoembryonic antigen was 3 (0.34–1104.25), and the median CA19-9 was 12 (0.18–840.00). A significance was recognized between median carcinoembryonic antigen and disease stage (p-value=0.016), with stages I, II, and III (medians 2, 3, and 2) different from stage IV (median 13), while no significance for CA19-9 was recognized (p-value=0.343). No significance between either marker and location (carcinoembryonic antigen: p=0.276; CA19-9: p=0.505) was detected. The testing was performed at a significance level of alpha=0.05. CONCLUSION: This study revealed a significance between the marker carcinoembryonic antigen, but not CA19-9, and the disease stage, while no relationship of either of these markers with tumor location was found. Herewith, the study confirmed that higher carcinoembryonic antigen values may suggest the finding of more advanced forms of colorectal cancer and thus a worse prognosis of this malignant phenomenon.

RESUMO As manifestações neurológicas de COVID-19 não são bem compreendidas. Relatamos o caso de um homem febril de 44 anos que apresentou visão dupla e dor de cabeça dois dias após os sintomas iniciais de fadiga, fraqueza muscular generalizada e perda de apetite. O paciente foi posteriormente diagnosticado com COVID-19 e paresia transitória do nervo abducente, não apresentando sintomas respiratórios ou achados neurológicos específicos adicionais. Como o número de casos tem aumentado em todo o mundo, sugerimos que os médicos tenham um índice de suspeita maior para COVID-19 em pacientes com neuropatias cranianas, mesmo em casos leves sem sintomas respiratórios típicos.

ABSTRACT Neurological manifestations of novel coronavirus disease 3019 (COVID-19) remain unclear. We report the case of a 44-year-old febrile man who presented with double vision and headache 2 d after initial symptoms of fatigue, generalized muscle weakness, and loss of appetite. He was subsequently diagnosed with COVID-19 and transient abducens nerve paresis. He did not present with any respiratory symptoms or additional specific neurological findings. We recommend that with the rising number of cases across the world, physicians develop a greater index of suspicion for COVID-19 in patients with cranial neuropathies, even in those with mild disease without typical respiratory symptoms.

Abstract This study focused on the physiochemical characteristics of the oligosaccharide produced in preserved yuzu by NY 518 and its functions based on the intestinal health through antimicrobial activities. NY 518 was identified as Lactobacillus sakei. The oligosaccharide produced by L. sakei NY 518 was gluco-oligosaccharide. The oligosaccharide from preserved yuzu (OY) was found to have lower degree of polymerization than the oligosaccharide from sucrose (OS) owing to the presence of tri- to nona-saccharides. These oligosaccharides had lower pH and increased acidity, soluble solids, and viscosity than their substrates. OY had 67% α-glucosidase inhibition activity of OS and higher antibacterial effects on food-poisoning bacteria than OS. These results indicate that the oligosaccharide produced by L. sakei NY 518 in sugar-preserved foods exhibits beneficial functions (antidiabetic and antibacterial activities) and could be a good substitute for sugar.

Abstract Background: Functional bioengineered tooth regeneration using autologous or allogeneic alternative differentiated cells sources are thought to have a great potential in replacing conventional dentures. This study investigated the potential of dental pulp stem cells (DPSCs) conditioned medium for odontoblastic differentiation of Wharton’s jelly mesenchymal stem cells (WJMSCs). The DPSCs derived from healthy adult permanent first molars were cultured at high confluence prior to conditioned medium collection. The WJMSCs were cultured in six different treatments, with varying ratios of culture media to DPSCs-conditioned medium. MTT assay was used to measure the rate of proliferation of WJMSCs, while immunocytochemistry staining was utilised to detect the expression of dental matrix protein 1 (DMP-1). The deposited calcium was detected and analysed via Alizarin-Red Staining (ARS). Results: It was found that the proliferation of WJMSCs cultured under the mixture of complete medium and DPSCs conditioned medium showed significantly lower than the control; presumably the cells started to exit proliferative state prior differentiation. In 14 days of induction, the cells in all treatments showed osteoblastic-like morphology, calcium compound deposits were observed at day 7, 10 and 14 of differentiation suggested that DPSCs conditioned medium could lead to osteoblastic/odontoblastic differentiation. However, the DMP-1 protein can be seen only expressed minimally at day 14 of conditioned medium induction. Conclusions: In conclusion, DPSCs conditioned medium appeared as a potential odontoblastic induction approach for WJMSCs. To further investigate the stimulatory effects by DPSCs conditioned medium, specific signalling pathway need to be elucidated to enhance the differentiation efficiency.

Abstract The antimicrobial activities of certain spices and herbs are well-documented. Herbs and spices are often exposed to bacterial contamination, spore-forming bacteria in particular. The spores introduced during the production process result in a contamination that causes food alteration during storage. The aim of this study was to isolate spore-forming bacteria from commercially available spices and herbs, such as ginger, cinnamon, black pepper, curcumin, saffron, and clove. The API 50 CHB/E medium was used to identify different genera of spore-forming bacteria isolated from samples. We found that these belonged to the genus Bacillus, such as Bacillus cereus, which was isolated from cinnamon, and Bacillus subtilis, and isolated from curcumin and black pepper. The third species belonged to the genus Brevibacillus, Brevibacillus laterosporus, which was isolated from ginger. The D-values (decimal reduction) of each bacterium were determined at 80, 85, 90, 95, and 100 °C. The Z-value was determined for each bacterium. The whole-cell protein profiles of the identified bacteria were determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Since spore-forming bacterial contamination of herbs and spices can occur during their harvest, exsiccation, or through cross-contamination during packaging, we propose different methods for spore elimination.

Abstract Human campylobacteriosis can be transmitted from animals to human either directly or through contaminated food. So, food safety plays a critical role in preventing the prevalence of food-borne diseases. Probiotics microorganisms are considered one of the most promising new strategies in controlling gastrointestinal tract (GIT) infection. In this study, two probiotic strains Lactobacillus delbrueckii subsp. bulgaricus DSM 20080 and Bifidobacterium bifidum were investigated as anti-Campylobacter agent both in vitro and in vivo. Where they showed elevated antibacterial activity when used as mixed culture with a significant downregulation in the mice intestinal gene expression of IL-1β mRNA and TNF-α mRNA induced by Campylobacter jejuni. Besides, the histopathological investigation of mice intestinal tissue showed great morphological changes in the infected groups with C. jejuni compared with Probiotics treated group that showed healthy intestinal sections with well-defined and enhanced villi. Generally, our findings demonstrate that probiotics have a beneficial and significant effect in the reduction and treatment of destructive effect of C. jejuni on mice gut.

Abstract There is no biodistribution or imaging data on 99mtechnetium (Tc)-hexamethyl propylamine oxime (HMPAO)-labeled platelets in the literature. The current study aimed to present updated information about the clinical procedures for preparation and use of labeled platelets. Following two-step centrifugation at 1500 and 2500 rpm, the platelets were extracted from whole blood into platelet-rich plasma (PRP) above the buffy coat and then from PRP into a platelet pellet at the bottom of the tube. The 99mTc-HMPAO-labeled platelets were inspected for purity, viability, release of 99mTc from platelets, and sterility. Also, microscopic examination and thin layer chromatography (TLC) were performed. Biodistribution was assessed following necropsy in BALB/c mice and through imaging of New Zealand rabbits. The separation ratio was estimated at 98%, and radiochemical purity was measured to be 80%. The labeling efficiency was above 30% in more than half of the assays (range: 17-43%). The release of 99mTc from platelets was 9% per hour at 37ºC. After 24 hours, stability was estimated at 54% in the human serum. The target organs of mice included the spleen and liver. In rabbits, the imaging results indicated liver as the target organ. Thyroid uptake was negligible up to 90 minutes. Based on the findings, extraction of platelets and labeling them with 99mTc-HMPAO is a feasible and safe approach in routine practice.

Suffering is often experienced by those who obey God, while happiness is experienced by those who do not know God. This study aims to re-examine theodicy about disasters and calamities and tries to provide alternative thoughts regarding the relationship between God, accidents and humans, based on the story of Job. This research methodology is a qualitative approach through library research, by reading books and journals and investigating related books. Hermeneutic principles are also used to understand the meaning of the signs and symbols in the text. The results of this study indicate that the concept of anthropodicy stands as a complement to the idea of theodicy, which can help humans - especially believers - to understand the meaning of suffering and their vocation in a world full of uncertainty while still having faith in God, who is sovereign over all. CONTRIBUTION: This article contributes to providing an understanding of anthropodicy from Job's perspective, so that humans see suffering as God's sovereignty and as something that God allows in order to see God's omnipotence

Abstract Well-known as a food additive, glucomannan has excellent biocompatibility and biodegradability properties. However, glucomannan is easily gelled, which limited its use in high concentration. To reduce the gel formation ability of glucomannan, acetylation was conducted. This work aims to study the effect of acetylation on physicochemical properties of glucomannan. Acetylation was performed in heterogeneous system which glucomannan was immersed in ethanol (96%) with various concentrations of glucomannan (5-25%) and acetic acid (5-99%). This modified glucomannan was subsequently used as an encapsulation matrix for producing iron beads. The results showed that higher concentration of acetic acid in acetylation impacted on higher solubility and viscosity of glucomannan. The transmittance intensity of Infrared (IR) spectra and morphology of glucomannan were changed due to the acetylation and encapsulation process. The highest viscosity of the matrix (484.33 cP) led to the highest Encapsulation Yield (EY) (53.3%). Gompertz’s model fitted to describe the release profile of iron in all samples (R2>0.92) that showed the burst phenomena in the initial release. This work found that acetylated glucomannan had higher solubility and has a potency to protect the iron taste during oral consumption as it releases slower in neutral pH solution.

Resumo Conhecido como aditivo alimentar, o glucomanano possui excelentes propriedades de biocompatibilidade e biodegradabilidade. No entanto, o glucomanano é facilmente gelificado, o que limita seu uso em altas concentrações. Para reduzir a capacidade de formação de gel do glucomanano, procedeu-se à sua modificação, usando acetilação. Este trabalho tem como objetivo estudar o efeito da acetilação nas propriedades físico-químicas do glucomanano. A acetilação foi realizada em reação heterogênea, que foi conduzida em etanol (96%), com várias concentrações de glucomanano (5-25%) e ácido acético (5-99%). Este glucomanano modificado posteriormente foi usado como matriz de encapsulamento para a produção de grânulos de ferro. Os resultados mostram que uma maior concentração de ácido acético na acetilação impactou na maior solubilidade e viscosidade do glucomanano. A intensidade dos espectros de IR e a morfologia do glucomanano foram alteradas devido ao processo de acetilação e encapsulamento. A maior viscosidade da matriz (484,33 cP) levou ao maior rendimento de encapsulamento (53,3%). O modelo de Gompertz ajustou-se para descrever o perfil de liberação do ferro em todas as amostras (R2>0,92) que apresentaram os fenômenos de explosão na liberação inicial. Este trabalho verificou que o glucomanano acetilado apresentou maior solubilidade e poder de proteção do sabor do ferro durante o consumo oral, pois é liberado mais lentamente em solução de pH neutro.

RESUMO Objetivo: investigar a ofensividade de produtos controversos no Brasil, principalmente a influência da área de conhecimento. Design/metodologia/abordagem: um questionário com 11 produtos controversos foi convencionalmente respondido por uma amostra de 368 universitários das três áreas de conhecimento mais populares no Brasil (i.e., Ciências Humanas, Ciências Biológicas e da Saúde e Ciências Exatas e Tecnológicas). A ofensividade de cada produto controverso foi medida e comparada entre essas áreas de conhecimento por meio de testes t. Descobertas: Produtos controversos não ofenderam facilmente os participantes, sendo armas, remédios para emagrecer e roupas íntimas femininas os mais ofensivos. Em geral, os estudantes de Ciências Humanas são os mais facilmente ofendidos, e os de Ciências Exatas e Tecnológicas os menos ofendidos. Além disso, os resultados mostraram diferenças e semelhanças entre as pessoas de cada área de conhecimento. Originalidade/valor: Aprimoramento do nosso conhecimento sobre produtos controversos no Brasil, especialmente sobre a influência da área de conhecimento na ofensividade de produtos controversos.

ABSTRACT Purpose: investigate the offensiveness of controversial products in Brazil, especially the influence of the field of study. Design/methodology/approach: a questionnaire with 11 controversial products was conventionally answered by a sample of 368 college students from the three most popular fields of study in Brazil (i.e. Human Sciences, Biological and Health Sciences, and Exact and Technological Sciences). The offensiveness of each controversial product was measured and compared across those fields of study through t-tests. Findings: Controversial products did not easily offend respondents being guns, weight-loss medicine, and female underwear the most offensive ones. In general, students of Human Sciences are the most easily offended and those of Exact and Technological Sciences the least offended. In addition, results showed differences and similarities between people from each field of study. Originality/value: Improvement of our knowledge about controversial products in Brazil, especially about the influence of the field of study in the offensiveness of controversial products.

ABSTRACT Introduction and Objectives Percutaneous nephrolithotomy (PCNL) is the standard technique for managing large renal calculi. Second-look PCNL is typically performed under intravenous (IV) sedation or spinal / general anesthesia when removing remnant stones. This requires additional pre-anesthesia assessment and close monitoring. To simplify this procedure, we investigated the feasibility and safety of second-look PCNL without anesthesia and sheath after maturation of the nephrostomy tract. Material and Methods This study included 14 eligible patients with remnant stones >5mm in diameter, as determined by simple CT scan after supine PCNL through a single nephrostomy tract under general anesthesia. A 24Fr nephrostomy tube was inserted after surgery. Second-look PCNL was performed after seven days of maturation of the nephrostomy tract. Prior to second-look surgery, 25mg pethidine was injected intravenously. Second-look supine PCNL was performed using a rigid or flexible renoscope without anesthesia or sheath. Results The mean patient age was 57.4±8.5 years. The mean stone diameter was 5.4 × 3.3cm, while the mean number of stone branches was 4.1±1.4. The mean operation time during the first PCNL was 131.1±24.8 min, and the mean residual stone rate was 24.3%±10.2%. The mean operation time during second-look PCNL was 97.4±36.0 min; after the second procedure, the mean pain score on the numeric rating scale was 2.8±1.0. All patients were stone-free without complications. Conclusion Second-look PCNL without anesthesia and sheath after maturation of the nephrostomy tract may be an effective procedure for removing remnant stones in select patients without excessive levels of pain.

Abstract Introduction The endoscopic access has reduced the morbidity associated with external approaches in diseases of themaxillary sinus. A reversible endoscopic medialmaxillectomy (REMM) is presented as an alternative for treatment of benign maxillary diseases. Objective To describe the REMM technique and report four cases of patients with benign maxillary sinus conditions treated through this approach. Methods The present study was divided into two parts: anatomical and case series. Two cadaveric dissections confirmed the feasibility of the REMMapproach. The same technique was performed on four consecutive patients with benign maxillary sinus disease. Results The cadaveric dissections confirmed wide exposure to the maxillary cavity, preserving the anatomy of the maxillary sinus. In the patient series, one patient presented with an antrochoanal polyp, one had a silent sinus syndrome, one had a chronic maxillary sinusitis secondary to a gunshot, and the last one had an inverted papilloma in the maxillary sinus. In all of the cases, the REMM approach provided excellent access and adequate resection, as well as preservation of the inferior turbinate, nasolacrimal duct, and lateral wall of the nose (including its osteomucosal component). Finally, all of the patients had an uneventful postoperative course. Conclusion The REMM technique is an excellent surgical approach to benign conditions of the maxillary sinus. It has few limitations and appears to be associated with less morbidity than conventional techniques.

Resumo: Introdução: Nos últimos anos, tem-se questionado sobre a qualidade de vida dos estudantes de Medicina dado o contexto em que estão inseridos. O estresse como resultado do somatório de carga horária extensa, dificuldade de conciliar a vida acadêmica com a pessoal e exposição a situações de dor e sofrimento tem-se mostrado como o principal fator para a queda da qualidade de vida desses acadêmicos. O objetivo deste estudo foi avaliar a qualidade de vida de acadêmicos de Medicina e seus fatores associados. Método: Trata-se de um estudo transversal realizado com 419 acadêmicos do curso de Medicina de uma fundação pública de Goiás. Foram incluídos alunos a partir de 18 anos e matriculados no curso do segundo ao oitavo período, de 2017 a 2018. Utilizaram-se os questionários sociodemográfico e de hábitos de vida e o World Health Organization Questionnaire for Quality of Life - Brief Form (WHOQOL-bref). Resultados: Os fatores relacionados com a baixa qualidade de vida foram: sexo feminino, utilizar estimulantes, pensar em desistir do curso e possuir comorbidade. Os relacionados com melhor qualidade de vida foram consumir frutas e hortaliças, praticar atividade física, mais tempo de sono e gestão do estresse. Conclusão: Este estudo encontrou um conjunto de fatores capazes de interferir na qualidade de vida desses estudantes, sugerindo a necessidade de intervenções direcionadas ao apoio pedagógico e psicológico.

Abstract: Introduction: In recent years, the quality of life of medical students has been questioned, given the context in which they are inserted. Stress as a result of the number of long hours, difficulty in reconciling academic and personal life, exposure to situations of pain and suffering, have been shown to be the main factors for the decrease in quality of life of these students. The aim of this study was to assess the quality of life of medical students and its associated factors. Method: Cross-sectional study with 419 medical students from a public institution in Goiás. The study was carried out with students over 18 years old and enrolled in the second to the eighth semester of medical school, between 2017 and 2018. Sociodemographic and lifestyle questionnaires and the World Health Organization Questionnaire for Quality of Life - Brief Form (WHOQOL-BREF) were used. Results: The factors related to low quality of life were: female gender, the use of stimulants, thinking about giving up medical school and having comorbidities. Those related to a better quality of life were consuming fruits and vegetables, practicing physical activity, more sleeping time and stress management. Conclusion: This study found a set of factors capable of interfering with the quality of life of these students, suggesting the need for interventions aimed at pedagogical and psychological support.