Search

Abstract Heart failure is a highly prevalent disease, which courses with frequent readmissions, mainly by Acute Heart Failure (AHF). Reduced renal function is associated with increased mortality in patients with HF. Therefore, an accurate and precise evaluation of renal function in patients with HF is crucial. The error of estimated GFR (eGFR) is wide and common, showing a ± 30% variability compared to measured GFR (mGFR). However, there is no evidence on the error of formulas in reflecting real renal function and particularly the consequences of this error in patients with AHF. This is a prospective study comparing the impact of mGFR versus eGFR in the onset of cardiovascular (CV) outcomes in patients with AHF. This was tested with cox survival analysis. Measured GFR was determined by the plasma clearance of iohexol-dbs and eGFR by Cockroft-Gould, MDRD, CKD-EPI creatinine, CKD-EPI cystatin-C and CKD-EPI creatinine + cystatin-C equations formulas. Also the agreement between mGFR and eGFR was analyzed. A total of 90 patients were included. Average age was 66 (± 12 years) and 52 (58%) were male. Of them 53 patients (59%) had a cardiovascular event during follow-up, 22 fatal (41%). The agreement between mGFR and eGFR indicated moderate precision and accuracy (concordance correlation coefficient of 0.77; CI = 0.73–0.82). In multiple cox survival analysis, mGFR was significantly associated with cardiovascular events together with NTproBNP, BMI, LVEF and previous coronary artery disease (p = 0.037; HR = 0.98, 95% CI = 0.95–0.99). Estimated GFR by formulas was not significant. In patients with AHF the error of formulas is large, frequent and random, also, mGFR and not eGFR predicted future CV events. The error of eGFR may have clinical consequences in specific subpopulations.

Objective: To compare the phase angle (PhA) through bioelectrical impedance (BIA) of children with intestinal failure (IF) using prolonged parenteral nutrition (PN) followed by an Intestinal Rehabilitation Program, with a control group. Methods: Children under 10 years of age with IF using prolonged PN for >60 days (study group) were included. The control group consisted of healthy children without chronic pathologies, matched by sex and age. Anthropometric parameters evaluated were: weight, height, weight/age z-score (W/A), height/age z-score (H/A), BMI, BMI/A z-score, arm circumference, triceps skinfold, subscapular skinfold, mid-arm muscle circumference. BIA parameters were resistance (R), reactance (Xc), and phase angle (PhA). Results: Twenty-eight children were included in the study group, median (IQR) age was 11 (8–27) months, 53.6 % were male. In the control group, 28 children were included, median (IQR) age was 12.5 (8–24.7) months, 50 % were male. Children from the study group had W/A z-scores and H/A z-scores significantly lower than controls. There was no significant difference between PhA in the study group and controls, [median (IQR) 4.3° (3.8;4.6) vs 4.0° (3.8;5.4) respectively, p = 0.980]. Prematurity was significantly higher in the study group than in the controls, but there was no significant correlation between gestational age at birth and PhA of the children from the study group. Conclusion: Children with IF using prolonged PN showed lower W/A and H/A compared to the control group, but without significant difference between the PhA of children with IF compared to controls.

PURPOSEBreast cancer (BC) is the most common female cancer worldwide, and the burden is increasing across sub-Saharan Africa. For women with hormone receptor–positive (HR+) cancers, endocrine therapy (ET) taken for 5-10 years can reduce the risk of recurrence by half. We explored experiences with ET and barriers to utilization among survivors in Botswana.METHODSWe recruited women with nonmetastatic disease from a survivorship cohort who had undergone mastectomy within 1-5 years for semi-structured interviews to explore experiences with treatment. This thematic content analysis focused on ET, so the sample included women with HR+ cancer who should have received ET and HR− women who reported taking ET.RESULTSWe analyzed interviews with 19 women (mean age 54 years, 42% stage I/II, 58% stage III). Three key themes were identified: (1) limited provider counseling, (2) challenges refilling prescriptions at public pharmacies, and (3) high medication and transportation costs associated with private pharmacies. Subthemes included immunohistochemistry result communication, lack of knowledge, frequent public pharmacy stockouts, inconvenient prescription refill policies, and medication switching and discontinuation, especially among participants with low socioeconomic positions (SEPs). Women's persistence, SEP, and financial support facilitated refills. Although some experienced side effects, they were not a common reason for discontinuation.CONCLUSIONBC survivors in Botswana face multilevel barriers to accessing and adhering to ET. Provider and health system improvements are needed to effectively communicate ET importance and increase access to consistently available and affordable medication.

Objetivo: analizar la secuencia de eventos que condujo al asesinato de mamʉ Adolfo Torres en 1928 en la Sierra Nevada de Santa Marta, poniendo de relieve las tensiones entre un proyecto misional respaldado por el Estado colombiano y la comunidad arhuaca. Metodología: la investigación se sustenta en el análisis detallado de varios fondos de archivos inéditos, en particular los del Corregimiento de San Sebastián de Rábago y de los capuchinos en Valencia. Estos archivos permitieron reconstruir los conflictos surgidos a partir de la llegada de la misión capuchina en 1917, la persecución de niños arhuacos que escaparon de la misión y los eventos que culminaron en el asesinato de mamʉ Adolfo Torres. Originalidad: el estudio ofrece una nueva perspectiva sobre la violencia inherente a los procesos de evangelización en la Sierra Nevada de Santa Marta, destacando la resistencia de las familias arhuacas frente a la intervención estatal y religiosa. La investigación de fuentes archivísticas inéditas proporciona una comprensión más profunda de las dinámicas de poder y violencia en este contexto. Conclusiones: los procesos de evangelización en la Sierra Nevada estuvieron marcados por una violencia sistemática, y que la lucha de las familias arhuacas por la autonomía y la educación de sus hijos refleja una resistencia significativa ante las imposiciones externas, subrayando la importancia de las fuentes archivísticas inéditas para reinterpretar estos eventos históricos.

The purpose of the article is devoted to the problem of researching the level of formation of communicative and organisational skills in the professional training of future foreign language teachers by tools of modern information technology (IT). Based on the analysis of the problem of professional training of foreign language teachers by means of modern IT, the state of development of methods for identifying communicative and organisational abilities of future foreign language teachers and features of the process of their training for foreign language communication activity by instruments of modern IT was clarified. According to the results of the analysis of the problem, it was noted that the majority of students who communicate in a foreign language have psychological difficulties and have communicative and organisational barriers due to their psychological characteristics. The selection of methodological tools for the study of professional training of future foreign language teachers by instruments of modern IT followed the described criteria and indicators of the formation of communicative and organisational skills.

Abstract Little is known about the pathobiology of SARS-CoV-2 infection in sub-Saharan Africa, where severe COVID-19 fatality rates are among the highest in the world and the immunological landscape is unique. In a prospective cohort study of 306 adults encompassing the entire clinical spectrum of SARS-CoV-2 infection in Uganda, we profile the peripheral blood proteome and transcriptome to characterize the immunopathology of COVID-19 across multiple phases of the pandemic. Beyond the prognostic importance of myeloid cell-driven immune activation and lymphopenia, we show that multifaceted impairment of host protein synthesis and redox imbalance define core biological signatures of severe COVID-19, with central roles for IL-7, IL-15, and lymphotoxin-α in COVID-19 respiratory failure. While prognostic signatures are generally consistent in SARS-CoV-2/HIV-coinfection, type I interferon responses uniquely scale with COVID-19 severity in persons living with HIV. Throughout the pandemic, COVID-19 severity peaked during phases dominated by A.23/A.23.1 and Delta B.1.617.2/AY variants. Independent of clinical severity, Delta phase COVID-19 is distinguished by exaggerated pro-inflammatory myeloid cell and inflammasome activation, NK and CD8+ T cell depletion, and impaired host protein synthesis. Combining these analyses with a contemporary Ugandan cohort of adults hospitalized with influenza and other severe acute respiratory infections, we show that activation of epidermal and platelet-derived growth factor pathways are distinct features of COVID-19, deepening translational understanding of mechanisms potentially underlying SARS-CoV-2-associated pulmonary fibrosis. Collectively, our findings provide biological rationale for use of broad and targeted immunotherapies for severe COVID-19 in sub-Saharan Africa, illustrate the relevance of local viral and host factors to SARS-CoV-2 immunopathology, and highlight underemphasized yet therapeutically exploitable immune pathways driving COVID-19 severity.

Background: Recent findings point to the key role of cathepsin S (CTSS) in the survival of malignant cells, as well as the significance of the anti-apoptotic properties of high-density lipoprotein (HDL) that contribute to enhanced cell survival. The purpose of this study is to analyse CTSS as a potential biomarker in lymphoma. Also, in order to better understand the role of CTSS in the origin and development of lymphoma, its association with cystatin C (Cys C), lipids, and inflammatory markers was analysed. Methods: The study included 90 subjects: 11 Hodgkin (HL) and 44 B-cell non-Hodgkin lymphoma (NHL) patients, as well as 35 healthy subjects. CTSS was determined using the Invitrogen ELISA kit (Thermo Fisher Scientific, Inc., Waltham, MA, USA). The non-denaturing 3%-31% polyacrylamide gradient gel electrophoresis method was used to separate plasma HDL particles. Results: The level of CTSS was significantly higher in NHL patients than in control subjects: 12.20 (9.75-14.57) vs 9.97 (8.44-10.99), P

Background and Objectives: This study presents a retrospective analysis of 26 autopsy cases from a single centre, primarily focusing on forensic cases, with a majority of male individuals. Materials and Methods: We systematically analysed autopsy reports and cardiac tissue slides using haematoxylin-eosin stain and immunohistochemistry for CD3, CD163, and IL-6. The histological assessment evaluated key variables such as inflammation severity, necrosis, and background changes using a standardised grading system. Quantitative analysis of immunohistochemical markers was performed, calculating the percentage of positively stained cells within the inflammatory infiltrate. Results: The average age was 51.6 years, slightly skewed towards older males. The fatalities varied widely, with sudden death and drug abuse being the most common conditions linked to myocarditis findings on histological examination. A strong correlation was found between the severity of inflammation (measured by size within a myocardium section) and the scoring system based on the number of inflammatory foci per section (p ≤ 0.001). Most cases showed mild to minimal fibrosis, with some exhibiting moderate to severe fibrosis, arteriosclerosis, and myocyte hypertrophy. The presence of protein CD3 in the inflammatory infiltrate revealed a moderate inverse correlation between the CD3 values and the severity of inflammation and necrosis, and a strong inverse correlation with neutrophil levels. CD3 levels were higher in sudden death cases and lower in cases with numerous inflammatory foci, highlighting the discreet nature of lymphocytic myocarditis. Macrophage presence, assessed using CD163, showed a moderate inverse correlation with neutrophil levels and significant differences between sudden death and non-sudden death cases. Macrophage-rich inflammation was observed in cases with pneumonia/bronchopneumonia-associated lesions. IL-6 expression showed a moderate direct correlation with inflammation severity (p = 0.028), severity of necrosis (p = 0.005), and the number of inflammatory foci per section (p = 0.047). A moderate inverse correlation was found between CD3 and IL-6 expression (p = 0.005). Conclusions: These findings highlight the need for a unique immunohistochemical approach in forensic cases of myocarditis, differing from guidelines for endomyocardial biopsies due to diverse inflammatory cells. The study suggests exploring inflammatory chemokines within myocarditis foci for their significance in clinical scenarios. Specifically, IL-6, a crucial pro-inflammatory interleukin, correlated significantly with the severity of inflammation and necrosis (p < 0.05). This study provides novel and valuable insights into the histopathological and immunological markers of myocarditis in autopsy cases.

Background: Neutrophilic myocarditis often stems from bacterial or fungal infections, and it is typically detectable through blood cultures or analyses of the primary infection site. However, research specifically addressing the morphological features of acute myocarditis in complex sepsis cases is scarce, with existing studies primarily dating back to the pre-antibiotic era. Methods: This study constitutes a retrospective and descriptive analysis encompassing 22 forensic cases. We collected data from forensic reports emphasising clinical details, disease history, gross observations, and histopathological findings. Results: The results show that using positive-air-pressure ventilation could be related to cardiac inflammation (45.45%, 10/22). Despite large-spectrum antibiotic therapy, the blood samples were positive for Staphylococcus aureus (MRSA strain), Klebsiella pneumoniae (ESBL strain), Acinetobacter baumannii, and Pseudomonas aeruginosa. Colonies developed in the myocardium of 36% of the patients (8/22), where 4 of them had septic emboli. Fungal myocarditis accompanied bacterial infections (2/8) and were unsuspected clinically. Background changes, such as interstitial fibrosis and arteriosclerosis, were associated with a greater degree of inflammation and septic embolism. Conclusion: Neutrophilic myocarditis in patients with emerging sepsis is linked to fatal virulent infections, where bacteria and/or fungi contaminate and impair the myocardium syncytium. Prolonged hospitalisation and positive-air-pressure ventilation may be a risk factor for this condition and needs further research.

To the Editor, Transcatheter aortic valve implantation (TAVI) has become a safe and minimally invasive alternative to surgical aortic valve replacement, and its indications have expanded to include younger and lower surgical risk patients.1 The development of advanced atrioventricular conduction disorders (AVCD) requiring permanent pacemaker implantation has been reported in 2.3% to 36% of patients, and is one of the major concerns associated with this technique, leading to higher mortality rates.2 Specifically, late-onset AVCD can have fatal consequences. Its highly variable temporal definition hampers the identification of predictive factors. However, the appearance of complete left bundle branch block and baseline atrial fibrillation has been suggested.3,4 We conducted a study to assess whether electrocardiographic (ECG) changes can be predictors of late-onset AVCD requiring permanent pacemaker implantation within the first month after discharge following TAVI. This was a retrospective, observational, and cohort study of consecutive patients treated with TAVI from 2011 through 2022 at a tertiary referral center. We studied sociodemographic variables, atrial fibrillation, prior pacemaker implantation, baseline ECG abnormalities and within 24 hours after implantation, the need for pacemaker implantation during admission and after discharge, survival, and the length of stay. The diagnosis of late-onset AVCD and the indication for pacemaker implantation occurred...

Sr. Editor: El implante percutáneo de válvula aórtica (TAVI) se ha consagrado como una alternativa segura y mínimamente invasiva frente a la sustitución valvular quirúrgica, y su indicación se ha expandido para abarcar pacientes más jóvenes y con menor riesgo quirúrgico1. El desarrollo de trastornos de la conducción auriculoventricular (TCAV) avanzados con necesidad de implante de marcapasos definitivo se produce en el 2,3 al 36% de los pacientes; es una de las mayores preocupaciones asociadas a esta técnica y acarrea mayor mortalidad2. Específicamente, los TCAV que aparecen de forma tardía pueden tener consecuencias fatales. No obstante, la heterogeneidad en su definición temporal dificulta la identificación de factores predictores, pero se han sugerido la aparición de bloqueo completo de rama izquierda de haz de His y la fibrilación auricular basal3,4. Realizamos un estudio para evaluar si existen alteraciones electrocardiográficas (ECG) que puedan actuar como predictores de TCAV tardíos que requieran implante de marcapasos definitivo en el primer mes tras el alta hospitalaria después de un TAVI. Se trata de un estudio observacional retrospectivo de tipo cohorte en el que se incluyen pacientes sucesivos sometidos a TAVI entre los años 2011 y 2022 en un hospital de tercer nivel. Se analizaron variables sociodemográficas, fibrilación...

Abstract Infrasound may be used to detect the approach of hazardous volcanic mudflows, known as lahars, tens of minutes before their flow fronts arrive. We have analyzed signals from more than 20 secondary lahars caused by precipitation events at Fuego Volcano during Guatemala’s rainy season in May through October of 2022. We are able to quantify the capabilities of infrasound monitoring through comparison with seismic data, time lapse camera imagery, and high-resolution video of a well-recorded event on August 17. We determine that infrasound sensors, deployed adjacent to the lahar path and in small-aperture (10 s of meters) arrays, are particularly sensitive to remote detection of lahars, including small-sized events, at distances of at least 5 km. At Fuego Volcano these detections could be used to provide timely alerts of up to 30 min before lahars arrive at a downstream monitoring site, such as in the frequently impacted Ceniza drainage. We propose that continuous infrasound monitoring, from locations adjacent to a drainage, may complement seismic monitoring and serve as a valuable tool to help identify approaching hazards. On the other hand, infrasound arrays located a kilometer or more from the lahar path can be effectively used to track a lahar’s progression.

Background and Objectives: Rehabilitation is a part of the comprehensive treatment of multiple sclerosis (MS). If present, psychological reactive states limit the results of the rehabilitation. The objectives were to determine the impact of psychological reactive states in these patients on the functionality obtained by rehabilitation and QoL, and to determine the connection between the objective and subjective evaluation. Materials and Methods: Based on the Hospital anxiety and depression scale, the patients were divided into a group with anxious and/or depressive reactive state and a group without the reactive state. The values of functional scores—the Berg Balance Scale (BBS) and the Expanded Disability Status Scale (EDSS), as well as the parameters of the QoL-Physical health Component Score (PCS) and the Mental health Component Score (MCS)—were determined at the beginning and at the end of the rehabilitation. Results: There was a statistically significant difference between the BBS, EDSS, PCS, and MCS groups at the beginning and the end of the rehabilitation in both groups. A statistically significant difference at the beginning and the end of the rehabilitation between the groups was found only in PCS and MCS. A highly statistically significant correlation between EDSS and PCS, and EDSS and MCS, was found only in the group without the reactive state. Conclusions: Although rehabilitation leads to an objective improvement of functionality in patients with MS, the presence of the anxious and/or depressive reactive state limits the results of rehabilitation and leads to discrepancies in the aforementioned objective assessment and the patient’s subjective experience through the evaluation of their QoL.

Abstract Cognitive interviews can provide validity evidence for instruments based on item response processes; however, use of focus groups still prevails in Brazilian literature. Moreover, semantic analysis has only been considered when searching for validity evidence based on test content. This paper presents a proposal for qualitative data analysis based on cognitive interviewing, thus providing researchers with a protocol that enables best practices in carrying out this technique, and consolidating it in the Brazilian literature as an option to search for validity evidence based on item response processes. To conclude, we present some criticisms regarding current procedures for validity evidence based on test content and discuss some possibilities.

AbstractThe correlation between entrepreneurship education and entrepreneurial intention is neither clear nor conclusive. While some studies show a positive correlation between entrepreneurship education and entrepreneurship, others confirm contradictory results. To contribute to the understanding of the relationship between entrepreneurship education and entrepreneurial intention and to contribute to the literature on this topic in Latin America, this research aimed to determine the influence of entrepreneurship education on the entrepreneurial intention of students from five Latin American universities. The type of research is quantitative, cross-sectional, and explanatory. To carry out the study, a questionnaire was applied to 1213 students from five universities in Colombia, Ecuador, Mexico, and Peru. The sample size was determined with a probabilistic design, and the sample was collected randomly by convenience. The Chi-square test showed a p-value of 0.056 higher than 0.05. Therefore, the null hypothesis indicating that entrepreneurship education is independent of entrepreneurial intention was accepted. Practical and theoretical implications emerge from these findings. While acknowledging the importance of entrepreneurship education, it becomes apparent that supplementary mechanisms enhancing entrepreneurial intentions are essential. The absence of a definitive consensus on the connection between entrepreneurial education and intent emphasizes the need for further exploration.

Newer research points to alterations in the plasma redox status and the HDL subclass distributions in cancer. We aimed to assess the redox status and the HDL subclass distributions, lipids, and inflammatory markers in lymphoma patients in order to determine whether they were correlated with changes in FDG-PET/CT scans. At the beginning of this study, redox status, HDL subclasses, lipids, and inflammation biomarkers were determined in 58 patients with lymphoma (Hodgkin lymphoma, n=11 and non-Hodgkin lymphoma, n=47), and these same measurements were reassessed during their ensuing treatment (in 25 patients). Initially, the total oxidation status (TOS), the prooxidant–antioxidant balance (PAB), the OS index (OSI), the total protein sulfhydryl groups (SH-groups), and the advanced oxidation protein products (AOPP) were significantly higher in lymphoma patients as compared to healthy subjects, but the total antioxidant status (TAS) was significantly reduced. The PAB had a strong correlation with the CRP and interleukin-6 (rho=0.726, p

Background: The pandemic of severe acute respiratory syndrome by coronavirus 2 (SARS-CoV-2) is a multi-system disease caused by a diffuse systemic process involving a complex interaction of the inflammatory, immunological and coagulative cascades. This study aims to identify the most effective biomarkers to predict poor outcome in intensive care unit (ICU) patients with severe COVID-19 disease. Methods: A single-centre retrospective observational study enrolled 69 deceased and 20 recovered patients treated in the ICU of the General Hospital Gradiska in the period from March 1, 2021. until April 1, 2022. We evaluated the leukocytes (WBC), lymphocytes (LYM), neutrophils (NEU), platelets (PLT), haemoglobin, neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). In addition, we evaluated the IL-6, ferritin, CRP, D-dimer, magnesium, bilirubin and lactate dehydrogenase. Results: Between deceased and recovered patients on admission to the ICU, there was a significant difference between the following parameters: WBC x109/L 11.50 (8.86-14.75) vs. 9.40 (5.90-11.90), p =0.026; NEU x109/L 10.15 (7.81-12.74) vs. 8.60 (4.80-10.30) p=0.022; NLR 15.01 (10.60-24.33) vs. 9.45 (5.10-14.90) p=0.02; SII 3712 (2240-6543) vs. 1949 (993-3720) p=0.003. The magnesium level increased significantly over time in the patients who died, while the haemoglobin level and platelet count decreased. ROC analysis showed the following AUC values: WBC 0.774; NEU 0.781; NLR 0.786; SII 0.776; D-dimer 0.741, and bilirubin 0.713. Conclusion: In this retrospective study WBC, NEU, NLR, SII, D-dimer, and bilirubin determined at hospital admission had a high value in predicting death among patients with severe COVID-19.

Essa pesquisa objetiva apresentar as inteligências múltiplas que foram utilizadas por alunos da Educação Básica para desenvolver uma pesquisa centrada em seu interesse na aplicação da Dicumba, uma metodologia de ensino que parte do pressuposto de que o aluno motivado pela curiosidade e pelo interesse escolhe um assunto que emerge do seu contexto de vida para estudar. A pesquisa foi realizada traçando-se um perfil relacional entre a Dicumba e as inteligências múltiplas. A Dicumba foi aplicada com alunos da Educação Básica de três escolas públicas de Curitiba, por professores participantes do subprojeto Pibid/Química; logo, do ponto de vista metodológico, a pesquisa apresenta tipologia explicativa quanto aos objetivos, documental quanto aos procedimentos e quali-quantitativa quanto a abordagem dos dados analisados. Os trabalhos produzidos pelos alunos a partir da Dicumba foram analisados tendo como elementos estruturantes as inteligências múltiplas, permitindo estabelecer relações entre as inteligências e a Dicumba. Nesse campo, a partir do teste de normalidade dos dados a 95% (nível de significância (α) de 5%), fez-se a análise dos dados por meio do teste não-paramétrico Kruskal-Wallis de amostras independentes para averiguar a função de distribuição dos grupos diante das inteligências. Os resultados indicam quais inteligências são mais mobilizadas em cada pesquisa que o aluno desenvolve e destacam a necessidade, a importância e a influência do papel docente no desenvolvimento da Dicumba, visto que o professor é responsável por promover a conexão entre o científico e o contexto do aluno, estimulando-o a desenvolver autonomia e organização. O incentivo docente ao uso de diferentes formas de apresentação de trabalhos também foi identificado como fator influenciador da quantidade de inteligências que podem ser mobilizadas nos estudantes. Palavras-chave: Metodologia Dicumba; múltiplas inteligências; ensino de Química; educação básica.

On 20th September 2022, Uganda declared the 7th outbreak of Ebola virus disease (EVD) caused by the Sudan Ebola strain following the confirmation of a case admitted at Mubende Regional Referral Hospital. Upon confirmation, the Government of Uganda immediately activated the national incident management system to initiate response activities. Additionally, a multi‑country emergency stakeholder meeting was held in Kampala; convening Ministers of Health from neighbouring Member States to undertake cross‑border preparedness and response actions. The outbreak spanned 69 days and recorded 164 cases (142 confirmed, 22 probable), 87 recoveries and 77 deaths (case fatality ratio of 47%). Nine out of 136 districts were affected with transmission taking place in 5 districts but spilling over in 4 districts without secondary transmission. As part of the response, the Government galvanised robust community mobilisation and initiated assessment of medical counter measures including therapeutics, new diagnostics and vaccines. This paper highlights the response actions that contributed to the containment of this outbreak in addition to the challenges faced with a special focus on key recommendations for better control of future outbreaks.

O Cartoon Test é um instrumento que analisa a percepção de crianças e adolescentes acerca do significado de bullying por meio de cenas de interação entre pares no ambiente escolar. Este estudo qualitativo exploratório constitui a segunda etapa de validação do instrumento no Brasil, com os objetivos de verificar se os participantes compreendem as imagens e legendas dos cartoons e que palavras são utilizadas para descrever os comportamentos inadequados. Foram realizados oito grupos focais, com 52 alunos, com idades de oito e 14 anos, de duas cidades do Rio Grande do Sul. Os instrumentos utilizados foram: Questionário sociodemográfico, Folha de registro do pesquisador e Cartoon Test. Realizou-se análise de conteúdo para tratamento dos dados. Os resultados indicaram que o instrumento foi compreendido pelos participantes e o termo bullying foi o mais utilizado para descrever situações agressivas. Para as crianças, sugere-se a redução no número de cartoons, visando evitar a exaustão.

Objective: Evaluate the association between breastfeeding, exclusive breastfeeding at six months and the introduction of complementary feeding during the pre-pandemic and the COVID-19 pandemic periods. Methods: Cohort study conducted with puerperal women and their newborns in the immediate postpartum period at a reference maternity hospital in Southern Brazil between 2018-2020. The COVID-19 pandemic period and the need to work outside the home during restricted circulation were the factors of exposure. The outcome evaluated was the weaning in the first six months (breastfeeding and exclusive breastfeeding) and the introduction of complementary feeding before the sixth month of life. Results: 547 puerperal women and their newborns were included. During the COVID-19 pandemic, there was a higher risk to weaning of exclusive breastfeeding up until six months (RR 1.16; 95%CI 1.03-1.31) and introducing complementary feeding early (RR 1.40; 95%CI 1.01-1.96). The need to work outside the home during the COVID-19 pandemic increased the risk of not breastfeeding exclusively at the sixth month (RR 1.27; 95%CI 1.08-1.49). Conclusions: The difficulties of the pandemic did reflect negatively on breastfeeding and complementary feeding practices. The pandemic was a risk factor for the early weaning of exclusive breastfeeding and the introduction of complementary feeding. However, not having to work outside the home during the pandemic period was a protective factor for exclusive breastfeeding at six months.

Abstract Background Chronic obstructive pulmonary disease (COPD) is projected to become the third cause of mortality worldwide. COPD shares several pathophysiological mechanisms with cardiovascular disease, especially atherosclerosis. However, no definite answers are available on the prognostic role of COPD in the setting of ST elevation myocardial infarction (STEMI), especially during COVID-19 pandemic, among patients undergoing primary angioplasty, that is therefore the aim of the current study. Methods In the ISACS-STEMI COVID-19 registry we included retrospectively patients with STEMI treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 from 109 high-volume primary PCI centers in 4 continents. Results A total of 15,686 patients were included in this analysis. Of them, 810 (5.2%) subjects had a COPD diagnosis. They were more often elderly and with a more pronounced cardiovascular risk profile. No preminent procedural dissimilarities were noticed except for a lower proportion of dual antiplatelet therapy at discharge among COPD patients (98.9% vs. 98.1%, P = 0.038). With regards to short-term fatal outcomes, both in-hospital and 30-days mortality occurred more frequently among COPD patients, similarly in pre-COVID-19 and COVID-19 era. However, after adjustment for main baseline differences, COPD did not result as independent predictor for in-hospital death (adjusted OR [95% CI] = 0.913[0.658–1.266], P = 0.585) nor for 30-days mortality (adjusted OR [95% CI] = 0.850 [0.620–1.164], P = 0.310). No significant differences were detected in terms of SARS-CoV-2 positivity between the two groups. Conclusion This is one of the largest studies investigating characteristics and outcome of COPD patients with STEMI undergoing primary angioplasty, especially during COVID pandemic. COPD was associated with significantly higher rates of in-hospital and 30-days mortality. However, this association disappeared after adjustment for baseline characteristics. Furthermore, COPD did not significantly affect SARS-CoV-2 positivity. Trial registration number: NCT 04412655 (2nd June 2020).