Faculdade São Leopoldo Mandic

Parenteral nutrition is a critical therapeutic approach for patients undergoing hematopoietic stem cell transplantation. However, parenteral nutrition is associated with complications such as mineral disorders. This study evaluated the prevalence of hypophosphatemia, hypokalemia, and hypomagnesemia in adult transplant patients before and within the first 24 days of parenteral nutrition infusion. This retrospective cohort study included patients who underwent hematopoietic stem cell transplantation and required parenteral nutrition at a public quaternary hospital in Brazil between January 2012 and January 2022. Patients were categorized based on indications for parenteral nutrition and specific diagnoses. Laboratory monitoring of phosphorus, potassium, and magnesium levels was performed at predefined intervals during parenteral nutrition infusion, starting at 72 h and during subsequent 4-day intervals until engraftment. Hypophosphatemia, hypokalemia, and hypomagnesemia were defined as levels below established reference values. Descriptive analyses were applied, and the chi-square test, crude odds ratios, and Fisher's exact test were used to compare categorical variables between the periods. The study revealed varying prevalences of hypophosphatemia (21.1-40.3 %), hypokalemia (10.5-31.2 %), and hypomagnesemia (50.0-62.3 %) among the 77 patients included in the study. Severe mineral disorders were observed in only a small proportion of patients. Patients undergoing hematopoietic stem cell transplantation had a high prevalence of mineral depletion throughout the engraftment period.

Social vulnerability can trigger various disorders due to everyday factors that compromise quality of life and influence physical pain. This study aimed to evaluate the prevalence of symptoms of temporomandibular dysfunction (TMD), anxiety, and depression in homeless individuals. This is cross-sectional observational study, where sociodemographic questionnaires, the Diagnostic Criteria for Research (DC/TMD) symptom questionnaire, and the Hospital Anxiety Depression Scale (HAD) were applied to 40 homeless individuals in Brasília/DF. Student's t-test, Mann-Whitney U test, chi-square test, and Cohen's d'Or with Hedges correction were used to evaluate the study variables in SPSS, considering a significance level of 5% (p≤0.05). It was observed that 42.5% of participants reported having experienced pain in the jaw, temple, ear, or anterior region of the ear, while 57.5% denied this symptom It can be observed that the average number of positive responses was 4.88 (SD 2.32), indicating that, on average, participants presented approximately five positive responses on the instrument. Anxiety showed a mean of 11.25, with a low standard deviation (0.46), depression, on the other hand, showed a mean of 9.58, with a standard deviation of 1.11. The association between anxiety, depression, and chronic pain may increase the risk or worsening of temporomandibular disorders (TMD) in homeless individuals. In the present study, homeless individuals presented symptoms of TMD, with high levels of chronic pain in this group, in addition to concerning rates of anxiety and depression, especially in the female population.

Network geometry offers a principled lens for understanding the structure of biomedical knowledge. We apply exact Ollivier-Ricci curvature (ORC) -- a discrete analogue of Riemannian curvature computed via optimal transport -- to medical ontologies, disease comorbidity networks, biological interaction networks, and brain functional connectivity graphs. Three main results emerge. First, within a single database (the Human Phenotype Ontology), the formal IS-A taxonomy is hyperbolic (mean ORC = -0.112, tree-like), while the disease co-occurrence network is spherical (mean ORC = +0.430, clique-rich) -- a six-order-of-magnitude gap in the density parameter that the curvature phase transition framework predicts without free parameters. Second, age-stratified disease comorbidity networks from 8.9 million Austrian hospital patients reveal a geometric aging trajectory: mean ORC increases monotonically from +0.018 (age 20-30) to +0.119 (age 80+), driven by rising clustering and density that encode the accumulation of multimorbidity. Third, sedenion (R16) Mandelbrot orbit features -- exploiting the zero-divisor structure of the Cayley-Dickson tower -- discriminate ASD-like from ADHD-like brain network topology (AUROC = 0.990, sedenion-only), providing complementary geometric information to ORC. Canonical biological networks (C. elegans neural, E. coli gene regulatory, protein-protein interaction) are uniformly spherical, suggesting that evolved biological networks universally favour redundant, triangle-rich connectivity. All core mathematical claims are machine-verified in Lean 4 (0 sorry in 7 core modules). These results establish ORC as a quantitative geometric biomarker for biomedical network analysis and demonstrate that the same phase transition framework governing semantic networks extends to clinical and biological domains.

ObjectivesComputer-aided design/computer-aided manufacturing (CAD/CAM)-milled glass fiber posts offer notable advantages. However, their performance compared to that of prefabricated, composite-reinforced glass fiber posts is controversial. This study aimed to evaluate the fracture strength and fracture patterns of canine roots restored with relined glass fiber posts and CAD/CAM-milled glass fiber posts.Materials and methodsIn total, 20 decoronated canine roots underwent endodontic treatment (n = 10). In the relined group (control), prefabricated glass fiber posts (Reforpost Angelus #1, Angelus, Brazil) were relined with a resin composite (Z350, 3M ESPE, USA). In the milled group, the root canal was modeled using a post (Pinjet, Angelus) and red acrylic resin (Pattern Bright Kit, Kota Ind., Brazil). The acrylic resin patterns were scanned and milled from a glass fiber block (Fiber CAD Post & Core, Angelus). A dual-cure self-adhesive resin luting agent (RelyX™ U200, 3M ESPE) was used for post cementation in both groups. The specimens were subjected to compressive loading, applied at a 45° angle to the long axis of the tooth using a universal testing machine with 200 kgf of compressive force at a crosshead speed of 1 mm/min, until failure. The failure mode was classified as catastrophic (fracture extended to the middle and/or apical third) or repairable (glass fiber post and/or coronal core or limited to the cervical region). A statistical analysis was performed using an independent samples t-test (α = 0.05).ResultsA statistically significant difference was observed in the mean fracture strength, with higher values for the milled group (p = 0.004). Furthermore, the milled group had fewer catastrophic failures.ConclusionsThe CAD/CAM-milled glass fiber posts exhibited greater fracture strength and a reduced incidence of catastrophic fractures.

AI-based tutoring systems for medical education are typically evaluated at the interface layer (generation quality, user engagement) rather than the control layer (measurement rigor, governance transparency, safety instrumentation). This paper documents Darwin Education, a production-ready adaptive learning architecture that prioritizes psychometric grounding and safety governance over generative fluency. The system integrates four subsystems: (1) IRT-based psychometric inference from ENAMED (Brazilian Medical Education Assessment) microdata, (2) learning-gap detection via multidimensional difficulty modeling, (3) LLM-driven adaptive question generation with citation verification, and (4) multi-gate validation pipelines with mandatory human review for edge cases. We implement evidence-grounded documentation, requiring every numerical claim to be repository-anchored (source:line-range) or explicitly marked NOT YET COMPUTED. Runtime corpus enumeration reports 215 unique diseases and 602 unique medications (14.68% and 32.28% duplicate fractions, respectively) from Darwin-MFC submodule exports. Validation thresholds (auto-approve ≥ 0.85, pending review ≥ 0.70) and dangerous-pattern checks are codeinstrumented with audit trails. This implementation report makes no educational efficacy claim. All code, data, and reproducibility artifacts are openly available (GitHub, Zenodo DOI).

Sterility information on reciprocating endodontic instruments is often unclear on the packaging. This can make clinicians uncertain about the safe use of these instruments without prior sterilization. This study evaluated the sterility of different reciprocating file systems directly from their original packaging. Six instruments from five commercially available reciprocating systems (Reciproc® Blue, WaveOne® Gold, W File, X1 Blue MK Life, and AllPrime R Blue) were tested. Each file was aseptically removed from its packaging inside a laminar flow chamber and immediately placed into sterile glass vials containing 5 mL of Brain Heart Infusion (BHI) medium. A 0.25 mL aliquot from each vial was collected after 24, 48, and 72 hours of incubation and plated onto Petri dishes. Then, they were incubated for an additional 72 hours. To ensure methodological reliability, two instruments (one Reciproc® Blue and one AllPrime R Blue) were deliberately contaminated with Enterococcus faecalis and served as positive controls. The presence of colony-forming units (CFUs) was assessed at 24-hour intervals throughout the experimental period. No bacterial growth was detected in any of the test groups at any time point, while CFUs consistently appeared in the positive controls. Considering the limitations of this study, reciprocating endodontic files, in their original manufacturer-sealed packaging and without prior clinical use, seem free of microbial contamination and are safe for immediate clinical application.

Dental age assessment plays a crucial role in clinical and forensic contexts. For safer practices, however, the existing methods need to be tested. This study aimed to evaluate for the first time the applicability of Franco's, Willems', and Willems' II dental age assessment models in a Northeastern Brazilian sample. The sample consisted of 500 panoramic radiographs (250 males, 250 females) of Brazilian individuals between 6 and 15.9 years from the State of Ceará. Chronological (CA) and estimated (EA) ages compared using mean error (ME), mean absolute error (MAE), and root mean square error (RMSE). Statistical comparisons were performed through generalized estimating equations (GEE). The mean CA of the sample was 11.0 years. The mean EA was 11.3 years for Franco's model, 11.6 for Willems', and 11.5 for Willems II. Franco's model showed the smallest bias, with ME values being 0.25 and 0.21 years lower than Willems' and Willems II, respectively (p < 0.001). Differences between CA and EA were minimal across sexes and not clinically relevant. Age-group analysis revealed similar performance up to 11.9 years. Overall, Franco's model demonstrated better error metrics, but all the models showed comparable accuracy and consistency for dental age estimation in children and adolescents from Ceará, confirming their validity and suitability for both clinical and forensic applications in this population.