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BACKGROUND: Prolonged fatigue effects may be a concern after futsal matches mainly because of the actions performed by futsal players (e.g., sprinting, jumping) that usually involve the stretch-shortening cycle (SSC). However, there no studies analyzed the prolonged effects of futsal-specific fatigue and how futsal players can recover from performance tasks. OBJECTIVE: To analyze the acute and prolonged effects of a protocol that simulates specific physical demands of futsal on countermovement-jump, sprint performance, muscle strength and muscle soreness. METHODS: Fifteen amateur futsal male athletes (18.3 ± 3.8 years) performed a futsal intermittent running protocol (FIRP) and were assessed for (moment production, sprint and jumping performance and muscle soreness) at pre, during half-time, immediately after, post 24 and 48 hours after the FIRP. Analysis of variance (repeated measures) was used to compare variable means over time. RESULTS: The main results indicated a decrement in the CMJ height (p= 0.03) and an increase of 10 m and 20 m sprint times (p= 0.01–p< 0.01, respectively) during half-time and the post FIRP. There was a decrement in eccentric peak moment of the knee extensors (p= 0.02) and flexors (p< 0.01) until 48h post protocol and a decrement in concentric peak moment of the flexors (p< 0.01) post protocol. Athletes reported muscle soreness in the hamstrings (p= 0.03) post and 24 h after the FIRP. CONCLUSION: FIRP induced acute effects in the jump and sprint performances only. On the other hand, the knee moment production capability (mainly eccentric) suffered acute and also prolonged effects of the FIRP accompanied by delayed muscle soreness in the hamstring muscles.

This report shows the experience of report of the elaboration and development of the first stage (classes 1 to 5) of the “Biosafety Course for Oral Health Teams in times of Covid-19”, by professors from the School of Public Health of the State of Bahia Professor Jorge Novis (ESPBA), an institution belonging to Superintendence of Human Resources of the Health Department of the State of Bahia. The experience stems from coping with the Covid-19 pandemic in the State of Bahia, Brazil, considering the forms of transmission of the disease through direct contact with people, through speech, coughing, sneezing and aerosols. Salivary glands are reservoirs of SARS-CoV-2, the virus responsible for the disease, and the dental environment has a high risk of spreading this microorganism. It was a self-instructional course using ESPBA's Moodle EAD-SUS platform, consisting of five video classes, covering the operational part and clinical practice on Biosafety in Covid-19 times. The course was offered by health regions, prioritizing the initial classes according to the epidemiological indicators of the number of cases. The number of enrolled students by health regions, the number of accesses and the number of content and course evaluations were estimated. The interest of professionals in the area in the theme of Biosafety was noted; however, structural and work overload issues may have compromised the performance of all stages of the course. The course obtained excellent evaluation by the students, showing the success of the educational action.

BACKGROUND: Repetitive stretch-shortening cycle exercises generate high rates of mechanical work and consequently induce substantial muscular fatigue related to delayed neuromuscular functions. OBJECTIVE: To investigate the neuromuscular impairment after high-intensity exercise protocols involving different gravity loads in stretch-shortening cycle – running (RUN) and vertical jumps (VJ). METHODS: Twenty-two healthy men, divided into two groups, VJ and RUN participated in this study. The individuals performed a training session involving six bouts of 30 s of VJ or RUN. The isokinetic PM (PM) of the knee extensors and flexor muscles, rate of perceived exertion and delayed onset muscle soreness (DOMS) were evaluated at pre, post, 24 h and 48 h post-training. RESULTS: The concentric and eccentric PM of the extensor in the RUN group was reduced until 24 h, while in the VJ a decrement was observed until 48 h. Following running, the PM of the flexors decreased until 48 h, while for VJ there was an eccentric PM decrement at 48 h. The DOMS increased at the anterior thigh and only after VJ training for 48 h. CONCLUSION: Acute and delayed neuromuscular impairment may be observed after both exercise regimens, but high-intensity training using vertical jumps seems to induce a more pronounced impairment than running.

This meta-analysis aimed to review complication rates following the treatment of an ankle fracture in diabetic patients and to early detect the subgroup of patients at potential risk in order to minimise this complication rate.A search of 3 databases was performed for studies published till March 2018. Twelve studies met the eligibility criteria for further statistical analysis. An odds ratio (OR) with a 95% confidence interval (95% CI) for each complication was calculated between the diabetic and non-diabetic groups.The overall complication risk after ankle fracture was twice as high in diabetes mellitus (DM) than non-diabetes mellitus (non-DM) patients (OR 1.9, 95%CI: 1.7-2.03). This risk was considerably higher with surgery versus non-surgical treatment (OD 3.7, 95%CI: 2.3-6.2). The risk of infection was 3 times higher in DM than in non-DM patients (OR 3.4, 95%CI: 2.9-9.8). The complication rate was even higher in patients with advanced DM (OR 8.4, 95%CI: 2.9-24.5).This meta-analysis provides evidence that diabetic patients are at a greater risk of complication after an ankle fracture.

Introduction: Dupilumab is a fully human monoclonal antibody that blocks interleukin-4 and interleukin-13, key drivers of type 2 helper T-cell (Th2)-mediated inflammatory response. It was the first biologic treatment approved for adult patients with inadequately-controlled moderate-to-severe atopic dermatitis (AD). Continuous collection of daily data practice is important in order to evaluate the real effectiveness and safety of dupilumab treatment. Methods: In this observational cohort study, we prospectively included all adult patients with moderate to severe AD treated with dupilumab in our portuguese dermatology center from July 2019 to April 2020. Baseline clinical data was initially collected and treatment effectiveness and safety were assessed after 16 weeks. Results: Twenty-five patients were included. All patients had been previously treated with systemic immunosuppressants. The estimated mean Eczema Area and Severity Index Score (EASI) decreased from 27.8 at baseline to 8.8 at week 16 (+/- 4 weeks). A ΔEASI 75 response was achieved by 58.3% of patients (ΔEASI 90 - 29.1%). Conjunctivitis was the main reported side-effect, affecting 20.8% of patients. Discussion: Our study showed a significant EASI reduction during the first 16-weeks of dupilumab treatment in adult patients with AD. Despite its overall safety, daily-practice data tend to report a higher risk of conjunctivitis than previously expected and we hence recommend that patients should be specifically informed about this possible side-effect.

Studies describing characteristics and outcomes of COVID-19 among people living with HIV are currently limited, lacking detailed evaluation of the interplay among demographics, HIV-related variables, and comorbidities on COVID-19 outcomes. This retrospective cohort study describes mortality rates overall and according to demographic characteristics and explores predictors of admission to intensive care unit and death among 255 persons living with HIV with severe acute respiratory syndrome and confirmed SARS-CoV-2 infection in the State of Sao Paulo, Brazil. We found that the overall mortality rate was 4.1/1,000 person-days, with a case-fatality of 34%. Higher rates occurred among older adults, Black/Mixed skin color/race patients, and those with lower schooling. In a multivariable analysis adjusted for age, sex, CD4 count, viral load and number of comorbidities, skin color/race, and schooling remained significantly associated with higher mortality. Although tenofovir use was more frequent among survivors in the univariable analysis, we failed to find a statistically significant association between tenofovir use and survival in the multivariable analysis. Our findings suggest that social vulnerabilities related to both HIV and COVID-19 significantly impact the risk of death, overtaking traditional risk factors such as age, sex, CD4 count, and comorbidities.

Introduction: The safety and effectiveness of natalizumab in patients with relapsing-remitting multiple sclerosis (RRMS) has been demonstrated in clinical trials. However, due to the limitations of these trials, it is important to know how the condition behaves under long-term clinical practice conditions. Objective: To determine the long-term effectiveness of natalizumab in patients with RRMS by means of annual evaluation of the “no evidence of disease activity” (NEDA) parameter, which includes number of relapses, disability (measured with the Expanded Disability Status Scale), and brain MRI parameters. Patients and methods: We performed a retrospective study of patients with RRMS from 3 centres who were treated with one or more doses of natalizumab. Each year, we evaluated NEDA status and safety based on the percentage of patients who discontinued treatment with natalizumab and experienced adverse reactions. Results: The study included 89 patients, most of whom received treatment for 2 to 4 years, with a follow-up period of up to 7 years. Natalizumab significantly reduces the radiological and clinical progression of the disease, as well as the annual rate of relapses. The NEDA parameter demonstrates the effectiveness of the drug, with values of 75.28% for year one and 66.67% for year 7. Twenty-five patients (28.1%) dropped out after a median of 4 years. Fourteen of these patients (56%) dropped out due to the appearance of anti–JC virus antibodies, either in isolation or associated with another cause. Four dropouts (16%) were due to treatment ineffectiveness, with one patient dying due to progressive multifocal leukoencephalopathy. Conclusions: Natalizumab is highly effective as measured by the NEDA long-term remission parameter. Resumen: Introducción: La efectividad y seguridad de natalizumab en pacientes con esclerosis múltiple remitente recurrente (EMRR) se demostró en ensayos clínicos. Sin embargo, por las limitaciones de estos, es importante saber cómo se comporta en condiciones de práctica clínica a largo plazo. Objetivo: Conocer la eficacia a largo plazo de natalizumab en pacientes con EMRR mediante la evaluación anual del NEDA (no evidence of disease activity), que incluye número de brotes, discapacidad medida con EDSS y parámetros de RM cerebral. Pacientes y métodos: Estudio retrospectivo y multicéntrico (n = 3) de pacientes con EMRR tratados con una o más dosis de natalizumab. Se evaluó el estado NEDA cada año y la seguridad a partir del porcentaje de pacientes que discontinuaron y que presentaron efectos adversos. Resultados: Incluimos 89 pacientes, la mayoría recibieron tratamiento durante 2 a 4 años, con una duración del seguimiento de hasta 7 años. Natalizumab reduce significativamente la progresión radiológica y clínica de la enfermedad, así como la tasa anual de brotes, demostrándose su eficacia con el parámetro NEDA, 75.28% al primer año y 66.67% al séptimo año. 25 pacientes (28.1%) han abandonado el estudio en una mediana de tiempo de 4 años. 14 pacientes (56%) fue por aparición de anticuerpos contra el virus JC, como causa única o asociada a otro motivo. 4 abandonos (16%) fueron por ineficacia, un paciente falleció a causa de LMP. Conclusiones: Natalizumab presenta una alta eficacia medida mediante el parámetro de remisión NEDA a largo plazo.

Purpose: The objective of this study was to evaluate a plyometric conditioning activity (3 sets of 5 countermovement jumps, [CA]) for twitch properties and voluntary knee extension. Methods: After a familiarization session, fourteen highly trained sprint athletes, 12 men (23.25 ± 7.17 years) and 2 women (23.0 ± 2.8 years) performed 2 experiments, each in a randomized order (crossover design). In one experiment, the time-course of twitch contractile properties was evaluated with and without the previous CA at 2, min intervals to 10 min of recovery. In the second session, maximal voluntary knee extension was evaluated at the same recovery intervals, for control and experimental condition in random order. Results: Mixed-model ANOVA with Bonferroni post-hoc revealed significant differences between pre-test and 2 min (p 0.05). No significant difference was observed for voluntary RTD following CA. Conclusion: The plyometric CA increased twitch peak torque and RTD consistent with PAP; however, there was no effect of CA on voluntary RTD of knee extension at any time after the plyometric CA. Even with PAP confirmed, we observed that the CA fails to improve isometric RTD of quadriceps femoris muscles. HighlightsA plyometric CA significantly increased twitch peak torque (at 2 and 4 min) and twitch rate of torque development (at 2 min) of quadriceps femoris muscles, indicating postactivation potentiation (PAP).No effect was observed for twitch contraction time and ½ relaxation time after the CA.No improvement was observed on voluntary rate of torque development evaluated at the same time intervals.

Neste trabalho, descrevem-se as mudanças no acesso à educação superior e no perfil do seu alunado, bem como a evolução do impacto redistributivo do investimento em educação superior pública, durante o período 2001-2015, com dados da Pesquisa Nacional por Amostra de Domicílios do Instituto Brasileiro de Geografia e Estatística (PNAD/ IBGE) e do Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira do Ministério da Educação (Inep/MEC). A expansão da educação superior caminhou rumo a uma maior democratização do acesso especialmente nas universidades públicas e no período 2005-2015. Como resultado, uma proporção maior do investimento do governo em educação superior pública passou a alcançar os estratos mais pobres da sociedade e, além disso, esse nível de educação vem deixando de contribuir para a concentração da renda.

To evaluate attenuation of the totally implantable vascular access device (TIVAD) and assess its clinical and dosimetric impact on radiotherapy (RT) of lymphoma patients.The first part of the study consisted of an in vitro approach by irradiating the TIVAD with different electron and photon energies. The attenuation data measured were compared with data calculated by our treatment planning system. All patients treated by radiotherapy for Hodgkin's lymphoma with their TIVAD in the target volume were then reviewed to assess the clinical outcome and dosimetric comparison using different plan metrics. All patients were treated by 3D conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy delivered by Helical Tomotherapy (HT).Nineteen patients treated for stage I-III HL were studied. Seven patients were treated exclusively on the side of TIVAD and 12 were treated bilaterally. Median prescription dose was 30Gy. No significant clinical or dosimetric differences were observed between the side of the TIVAD and the contralateral side in patients treated bilaterally. HT resulted in a significantly higher conformity index (P0.0022) and a significantly lower healthy tissue coverage (P=0.0008) than 3DCRT. The observed attenuation was 79% for 6 MeV, 59% for 9 MeV, and 46% for 12 MeV for electrons and 9% for 4 MV, 8% for 6 MV, 5% for 10 MV and 15 MV and 3% for 20 MV for X photons.TIVADs induce significant beam attenuation when using electrons, which can be overcome by using high-energy photons or by creating an exclusion zone in when HT is used.

Venolymphatic malformations are benign. Fetal MRI can more precisely demonstrate an infiltrative pattern of malformations than US. To evaluate perinatal outcomes and long-term follow-up of fetal venolymphatic malformations treated in different medical facilities using fetal MRI. This retrospective cohort study evaluated 20 pregnant women between 22 weeks and 37 weeks of gestation who were referred from different institutions. They presented with fetuses with various diagnoses of cystic masses on routine US. The cases were studied using MRI. We analyzed prenatal data, perinatal outcomes and long-term follow-up. We reviewed the MRI scans of 20 patients with venolymphatic malformation. Referral diagnosis was changed in 40% (8/20) of cases, with postnatal concordance of 100% (20/20). Moreover, 65% (13/20) presented with venolymphatic malformation in more than one body segment. The neck was affected in 70% (14/20) of fetuses, while the head and thorax were affected in 30% (6/20) and 45% (9/20), respectively. There were intrathoracic lesions in 35% (7/20), lesions in the abdomen in 30% (6/20), and lesions in the perineum and extremities in 10% (2/20) each. Tracheal displacement, neck deflection and anatomical displacement caused by tumoral compression were present in 15% (3/20) of cases. Moreover, 25% (5/20) of newborns required neonatal intensive care unit admission, and all presented with cervical or thoracic venolymphatic malformation. Furthermore, 50% (10/20) of cases presented with complete resolution after medical therapy. The intrathoracic and cervical residuals (35%, 7/20) were monitored and treated. MRI showed good correlation with postnatal examination of venolymphatic malformation, was useful in the differential diagnosis of fetal cysts on US, and presented a significant postnatal correlation with thoracic infiltration. The outcomes of prenatally diagnosed venolymphatic malformations are good despite the varying protocols among medical facilities.

In the face of new diseases, medicine needs to reinvent itself in order to contain and control epidemics, such as the one we have recently faced, COVID-19, a disease with a wide spectrum of clinical severity. A new moment has been established, since the application of well-known, effective and safe medications for other diseases, has shown high success rates in the treatment of COVID-19. Thereunto, studies with early intervention are needed, which can change the unfavorable outcome of patients. In this article, we report the successful experience using an oral strategy during the collapse of Belem (Para, Brazil) Health System. Two hundred and ten patients were diagnosed with respiratory failure due to COVID-19, with no option of hospital treatment due to lack of beds and resources. These patients were then started on therapeutic regimen consisting of 40 mg prednisolone, 40 mg enoxaparin and macrolides (500 mg clarithromycin, 500 mg axetylcefuroxime) associated and followed in outpatient facilities. Two hundred and eight patients had an excellent therapeutic response and there were only two fatalities. These results push research boundaries, valuing outpatient treatment with early use of prednisolone in the initial pulmonary phase, preventing severe COVID-19 pneumonitis. Adoption of the proposed treatment intends to reduce the need for hospitalization, as well as lethality, with social robust benefits and incalculable economic savings since involves the use of accessible, safe and not expensive medications.

INTRODUÇÃO: A apneia do sono ocorre devido ao colabamento das vias aéreas superiores e possui importante associação a doenças cardiovasculares. METODOLOGIA: Trata-se de uma revisão literária realizada por meio de pesquisa na base de dados PubMed, tendo como descritores "sleep apnea syndromes" e "cardiovascular diseases" e publicações nos idiomas inglês e português com disponibilização do texto completo. RESULTADOS: Os estudos ocorreram entre os anos de 2016 e 2020, sendo 2019 o ano de maior índice. Todos os trabalhos são estudos de revisão e dentre os 24 artigos selecionados, 7 foram fundamentais para execução desta pesquisa e destacaram-se como principais referenciais teóricos. DISCUSSÃO: A apneia do sono é uma condição que provoca alterações na fisiologia respiratória, e isso pode acarretar em consequências cardiovasculares. Indivíduos com apneia do sono estão predispostos a diversas afecções cardiovasculares como: hipertensão arterial sistêmica, fibrilação atrial, morte súbita, doença coronariana e consequentemente insuficiência cardíaca, e isso pode ser explicado por diversos mecanismos. CONCLUSÃO: Os estudos mostraram que existe uma intensa correlação entre a apneia do sono e patologias cardiovasculares, que é explicada por alguns eventos que ocorrem no nosso corpo e geram um processo de remodelação da atividade elétrica do coração e também uma remodelação estrutural.

The aim of this study was to determine the prevalence, magnitude, and methods of rapid weight loss (RWL) in visually impaired (VI) judo athletes, and compare these aspects between males and females. Thirty VI judo athletes (20 men and 10 women) completed a validated questionnaire to assess information about the magnitude and methods of RWL. Simple frequency was used to describe the influence and methods in all athletes and according to sex. Moreover, the t test was used to compare the variables between the sexes with the significance level set at p

In recent years, the emergence of antibiotic resistant pathogens made increasingly difficult to establish appropriate empiric antimicrobial therapy protocols for acute diabetic foot infection (DFI) treatment. Early recognition of the population at-risk for multidrug-resistant (MDR) bacterial infection is of paramount importance in order to decrease large-spectrum antibiotic overuse. This study used retrospective cohort study in a multidisciplinary tertiary diabetic foot unit. Patients with severe DFI were included and divided according to their infection resistance profile (susceptible vs MDR bacteria). Data regarding their comorbidities and length of hospital stay were collected. The primary endpoint was to determine the risk factors for MDR infections and to evaluate if these were associated with an increased length of stay (LOS). A total of 112 microbial isolates were included. Predominance of Gram-positive bacteria was observed and 22.3% of isolated bacteria were MDR. Previous hospitalisation was associated with a higher likelihood of MDR infection. MDR bacterial infection was also associated with an increased LOS (P = .0296). Our study showed a high incidence of MDR bacteria in patients with a DFI, especially in those who had a recent hospitalisation. MDR infections were associated with a prolonged LOS and represent a global public health issue for which emergent measures are needed. info:eu-repo/semantics/publishedVersion

Introduction: Basal cell carcinomas are mostly treated surgically, mostly by surgery with postoperative histopathologic margin evaluation (“conventional surgery”), but large long-term data regarding recurrence by completeness of excisions is limited. Methods: Retrospective cohort study of basal cell carcinomas treated by conventional surgery at different medical specialties in a large tertiary centre, between 2008 and 2014. Survival analysis with a Cox proportional-hazards was performed, stratified by completeness of excision (complete excision/incomplete excision) and adjusted to several potentially confounding covariates. Results: A total of 2876 basal cell carcinomas were identified, of which 2306 (2100 primary, 206 recurrent) were considered eligible for analysis. During the 5-years of follow-up, there were 80 (4%) recurrences among 1980 complete excisions (16/1000 cases-year) and 83 (23.9%) recurrences among 348 incomplete excisions (100/1000 cases-year). Survival analysis was performed with multivariable adjustment. In the final adjusted model, we identified an association between relapse and re-intervention on recurrent tumors [adjusted Hazard Ratio (HR) 2.20 (95% Confidence interval (IC), 1.26-3.84), p=0.006], a wrong preoperative clinical diagnosis/surgery devoid of preoperative biopsy [adjusted HR 2.75 (95% CI, 1.68-4.5), p

Serous cystadenofibroma of the ovary is a cystic neoplasm containing fibrous component, and lining of high, cylindrical, and ciliated epithelial cells surrounded by clear serous fluid, with smooth or papillary surface and abundant vessels. Serous cystadenofibroma in the present case report was an incidental discovery observed during an abdominal and pelvic cavity review performed in a 39-week elective cesarean section applied to in a 32-year-old patient who presented uneventful pregnancy. The importance of conducting inventories of these cavities during cesarean sections to identify asymptomatic adnexal masses unseen in prenatal ultrasonography is clear.

Current practices in structural engineering demand ever-increasing knowledge and expertise concerning stability of structures from professionals in this field. This paper implements standardized procedures for geometrically nonlinear analysis of steel and reinforced concrete structures, with the objective of comparing methodologies with one another and with a geometrically exact finite element analysis performed with Ansys 14.0. The following methods are presented in this research: Load Amplification Method, from NBR 8800:2008; the γ z coefficient method, from NBR 6118:2014; the P-Delta iterative method and the α c r coefficient method, prescribed in EN 1993-1-1:2005. A bibliographic review focused on standardized approximate methods and models for consideration of material and geometric nonlinearities is presented. Numerical examples are included, from which information is gathered to ensure a valid comparison between methodologies. In summary, the presented methods show a good correlation of results when applied within their respective recommended applicability limits, of which, Eurocode 3 seems to present the major applicability range. The treated approximate methods show to be more suitable for regular framed structures subjected to regular load distributions.

Sustainably managed wild fisheries support food and nutritional security, livelihoods, and cultures (1). Harmful fisheries subsidies—government payments that incentivize overcapacity and lead to overfishing—undermine these benefits yet are increasing globally (2). World Trade Organization (WTO) members have a unique opportunity at their ministerial meeting in November to reach an agreement that eliminates harmful subsidies (3). We—a group of scientists spanning 46 countries and 6 continents—urge the WTO to make this commitment...

In complex organizational choices with consequences spread all over the organization, good management practice recommends the auscultation of the points of view of people from different operational areas, to inform a final decision-making body. In large corporations such an internal participatory process may easily involve a large number of people, however time and scheduling constraints are not compatible with gathering them together in presential meetings to reach an alignment around key decision objectives. One of these cases was the selection of a new Enterprise Management System (EMS) for GALP ENERGIA (a Portuguese energy company). The aim of this paper is to report on how a socio-technical process was designed and took place under the “Collaborative Value Modelling” framework, combining technical elements of the MACBETH multicriteria evaluation method with two social settings: firstly, Web-Delphi to elicit individual qualitative judgements from a large number of collaborators from the different departments of GALP ENERGIA; followed by a Decision Conference where a small steering committee used the knowledge collected in the Delphi to inform the construction of a quantitative model to compare the EMS alternatives proposed by information technology companies. To detail our rationale, we focus on the qualitative swing-weighting questioning MACBETH mode, implemented in the Welphi information technology platform in which GALP collaborators provided individual weighting judgements, and then in the decision conferencing for final weighting of criteria by the steering committee. The main contribution of this paper is on detailing how, through the “Collaborative Value Modeling” framework, it is possible to promote “dialogue” among a large group of participants in a corporate setting, therefore promoting alignment and increasing model acceptance within the company.

Background: Polypharmacy paves the way for non-adherence, adverse drug reactions, negative health outcomes, increased use of healthcare services and rising costs. Since it is most prevalent in the older adults, there is an urgent need for introducing effective strategies to prevent and manage the problem in this age group.Purpose: To perform a scoping review critically analysing the available literature referring to the issue of polypharmacy management in the older adults and provide narrative summary.Data sources: Articles published between January 2010–March 2018 indexed in CINHAL, EMBASE and PubMed addressing polypharmacy management in the older adults.Results: Our search identified 49 papers. Among the identified interventions, the most often recommended ones involved various types of drug reviews based on either implicit or explicit criteria. Implicit criteria-based approaches are used infrequently due to their subjectivity, and limited implementability. Most of the publications advocate the use of explicit criteria, such as e.g. STOPP/START, Beers and Medication Appropriateness Index (MAI). However, their applicability is also limited due to long lists of potentially inappropriate medications covered. To overcome this obstacle, such instruments are often embedded in computerised clinical decision support systems.Conclusion: Multiple approaches towards polypharmacy management are advised in current literature. They vary in terms of their complexity, applicability and usability, and no “gold standard” is identifiable. For practical reasons, explicit criteria-based drug reviews seem to be advisable. Having in mind that in general, polypharmacy management in the older adults is underused, both individual stakeholders, as well as policymakers should strengthen their efforts to promote these activities more strongly.

IntroductionAs a result of the coronavirus disease 2019 (COVID-19) pandemic the year 2020 brought major changes on the delivery of health care and face to face physician patient communication was significantly reduced and the practice of remote telehealth care using computer technology is assuming a standard of care, particularly, with COVID-19 patients with attempts to reduce viral spread.ObjectiveTo describe the clinical practice experience using telemedicine towards COVID-19 and the respective clinical outcomes.MethodsWe performed a pilot open-label non-randomized, controlled clinical trial. The patients were divided into four groups, according severity of symptoms: (1) asymptomatic, (2) mild symptoms, (3) moderate symptoms and (4) severe symptoms, and were followed up for five days, counted from the beginning of the symptoms. A drug intervention was performed in group 3, for which the protocol followed as suggested by the International Pulmonology Society’s consensus for adults with moderate symptoms: first day (attack phase) hydroxychloroquine sulfate 400 mg 12/12h; second to fifth day (maintenance phase) 200 mg (half pill) 12/12h. The medication was associated with azithromycin 500mg once a day for five days. For children with moderate symptoms were used: hydroxychloroquine sulfate 6.5 mg/kg/dose every 12 hours in the first day and 3.25 mg/kg/dose every 12 hours from day 2 to 5. The therapeutic response was telemonitored. Group 4 patients were directly oriented to seek hospital care. During the use of the drugs, the patients were telemonitored daily.ResultsOne hundred eighty-seven patients were seen with mean age of 37,6 years (±15,6). The most frequent symptom was cough (57,6%), followed by malaise (60,3%), fever (41,1%), headache (56,0%), muscle pain (51,1%). Of all the patients that sought telemedicine service in our center, 23% were asymptomatic despite contact with people with probable diagnostic of COVID-19; 29,4% reported mild symptoms, 43,9% moderate symptoms, and 3,7% severe symptoms. It was possible to observe in patients treated their symptoms of COVID-19 (group 3) with hydroxychloroquine and azithromycin for five days, presented statistically better improvement of the symptoms when compared to those that did not follow the protocol (p = 0.039). Three patients were hospitalized and discharged after recovery.ConclusionsOur study showed that patients with COVID-19 who had delivery of health care through telemedicine initiated in early stages of the disease presented satisfactory clinical response, reducing the need of face-to-face consultations and hospitalizations. Our results indicate that the use of telemedicine with diagnosis and drug treatment protocols is a safe and effective strategy to reduce overload of health services and the exposure of healthcare providers and the general population to infected patients in a pandemic situation.Trial registrationRBR-658khmHuman Research Ethics Committee number: 30246520.0.0000.0069

Introduction Although percutaneous coronary intervention (PCI) for ostial or midshaft lesions in left main (LM) disease has shown similar results as compared with coronary artery bypass grafting (CABG), distal LM bifurcations are associated with an increase in procedural complexity and higher rates of target lesion revascularization. Several studies have investigated the optimal stenting strategy in patients with coronary bifurcation lesions and showed no benefit for systematic two-stent approach in comparison with provisional stenting. This is reflected in the current guidelines that recommend provisional stenting of the side branch as the preferred approach for most bifurcation lesions. However, there is still debate about the optimal strategy according to lesion location. Objectives This analysis aimed to compare the clinical outcomes of LM bifurcation PCI using a provisional strategy versus a two-stent strategy. Methods Retrospective, observational study including patients submitted to LM bifurcation (Medina 1,1,1) PCI between January 2010 and December 2019. Data was collected from the emergency department and hospitalization registries. Patients were divided according to the stenting approach. We made a global analysis including baseline clinical and angiographic data. The primary endpoint was target lesion failure (TLF), defined as the composite of myocardial infarction, cardiac death, and target lesion revascularization (TLR). Secondary endpoints included the individual components. Results A total of 106 patients were included (median age 74 [66–82], 79 (74.5%) males), 57 (53.8%) submitted to provisional stenting and 49 (46.2%) to a two-stent technique. Baseline characteristics were well matched (table 1). The mean SYNTAX score was 29.6±10.0 and LM stenosis grade was ≥70% in all lesions. Median follow-up was 26.6 [12.0–48.6] months. No differences were found regarding the primary endpoint (TLF in provisional stenting was 21.7% vs 21.4%, HR 2.432; 95% confidence interval, 0.472–12.450; p=0.233.). Although target lesion revascularization within the LM complex was numerically higher in the two-stent group (10.2% vs. 3.5%, p=0.245), the opposite was found in cardiac death (provisional group 10.5% vs. 4.3%, p=0.289). Conclusions Besides being a “simpler” technique, provisional stenting had no significant differences in outcomes compared to two-stent techniques. Without further evidence, revascularization strategies should primarily rely on operator expertise. Funding Acknowledgement Type of funding sources: None.

Highlights • During COVID-19 lockdown, the number of radiotherapy treatments had to be reduced. • Given number of delayed treatments, the post-crisis period should be anticipated. • Data visualization software allowed to predict when peak activity would happen.

Background:Since 2009, the use of IMRT for the treatment of breast cancer with lymph node involvement has been considerably growing at our institution. Helical Tomotherapy (HT) was chosen as main technique using field width of 2.5 cm (HT_FW_2.5). Alternatively HT using field width of 5 cm (HT_FW_5), Volumetric Modulated Arc Therapy (VMAT), or Proton Therapy with Pencil Beam Scanning (PT-PBS) were used to reduce treatment duration or optimize organs at risk (OAR) sparing. Purpose: the aim of this study is to compare the 4 modalities of treatment available at our site. Patients and methods: We studied 10 patients treated for breast cancer with lymph node involvement. The prescribed dose was 51.8 Gy to breast with simultaneous integrated boost till 63 Gy, 50.4 Gy to the lymph nodes in 28 fractions for all studied patients. The CTV (clinical target volume) were delineated using ESTRO Guidelines. Dosimetric plan used in routine clinical practice was done using HT_FW_2.5. Clinical plan approved was compared to the plan using the 3 others IMRT techniques. Dosimetric parameters were noted down. For Planning Target Volume (PTV) coverage, dosimetric goals were D95% ≥ 95% and D2% ≤ 107% of the prescribed dose. Regarding OAR, mean dose were noted for heart, contralateral/ipsilateral lung and contralateral breast. Maximum dose in the spinal cord was also recorded. Dosimetric score was made to evaluate plan quality. For both PTV score (PTVs) and OAR score (OARs), 1 was the best and 4 the worst achievable score. Results:HT_FW_5 and VMAT plans ensure an equivalent or even better PTV coverage than the initial clinically approved plan (PTVs = 2.3 and 2.0 VS 2.5) but at the cost of a deterioration of OAR sparing (OARs = 3.3 and 3.2 VS 2.3). PT_PBS plans show that an excellent PTV coverage can be maintained with significantly lower doses to OAR (PTVs = 2.0; OARs = 1.1) Conclusion:HT_FW_5 and VMAT plans allow significantly reducing treatment duration and can be good alternative to HT_FW_2.5 for specified population which has already a good OAR sparing and needs to reduce treatment duration. HT_FW_2.5 could be chosen for patient with higher risk of side effect. In addition PT_PBS treatment should be considered in the near future as it showed great potential benefit to lower the risk of side effects without deteriorating PTV coverage. Dosimetric Scores of different IMRT techniquesHT_FW_2,5HT_FW_5VMATPT_PBSD95% (Gy)PTV Breast49.449.950.149.7PTV Tumor Bed60.160.160.361.1PTV Lymph Nodes47.748.148.548.3PTV Score2.52.32.02.0Dmean (Gy)Heart7.28.47.31.0Contralateral Lung4.35.16.40.4Ipsilateral Lung13.513.714.59.3Contralateral Breast3.53.64.30.0OAR Score2.33.33.21.1 Citation Format: Wassim El Amine, Laurent Bartolucci, Camille Adrien, Marie Lejars, Alain Fourquet, Marion Vaillant, Magalie Robilliard, Emilie Costa, Alejandro Mazal, Farid Goudjil, Youlia Kirova. Intensity modulated radiotherapy (IMRT) for breast and lymph node irradiation [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-12-32.

Objetivo: Verificar atraves da busca de artigos cientificos os possiveis efeitos da Terapia por espelho na funcao do membro superior em criancas com diagnostico de Paralisia Cerebral hemiplegica. Metodologia: Nos meses de junho e julho de 2020 foi realizada uma busca de estudos, dos ultimos 5 anos, nas bases de dados PEDRO e BVS . A variavel selecionada foi funcao e os criterios de inclusao foram ensaios controlados aleatorizados e criancas com diagnostico clinico de Paralisia Cerebral hemiplegica e os criterios de exclusao foram estudos cientificos que nao tivessem relacao com o tema da pesquisa. Resultados: A estrategica de busca resultou em 215 artigos, que apos o processo de selecao, procedeu em 3 ensaios controlados aleatorizados com um tamanho de amostra total agrupada em 70 participantes. Conclusao: Apos a leitura e verificacao dos artigos selecionados pode-se concluir que a Terapia por espelho demonstrou-se eficaz na sensibilidade tatil, percepcao, forca de preensao e destreza para o membro superior de criancas com diagnostico clinico de Paralisia Cerebral hemiplegica.

Introducao: A Insuficiencia Cardiaca Cronica (ICC) e uma sindrome complexa que compromete multiplos sistemas, ocasionando como principais sintomas a dispneia e a intolerância progressiva ao esforco fisico. Dessa forma, a indicacao de reabilitacao cardiovascular para ICC inclui exercicios aerobicos regulares para aumentar a capacidade funcional, reduzir sintomas e melhorar a qualidade de vida. Objetivo: Verificar atraves das bases de dados cientificas os efeitos da reabilitacao cardiaca na capacidade funcional de pacientes idosos com Insuficiencia Cardiaca Cronica. Metodologia: Nos mes de maio a agosto de 2020 foi realizada uma busca de estudos, dos ultimos 5 anos, nas bases de dados Pubmed e Scielo. Os criterios de inclusao foram artigos que relacionavam o treinamento aerobico e a capacidade funcional em pacientes idosos com insuficiencia cardiaca cronica, ensaios clinicos randomizados e os criterios de exclusao foram estudos cientificos com mais de 5 anos que nao tivessem relacao com o tema da pesquisa. Resultados: A estrategia de busca resultou em 360 artigos, que apos o processo de selecao, procedeu em 3 ensaios controlados aleatorizados com um tamanho de amostra total agrupada em 97 participantes. Conclusao: Apos a leitura e verificacao dos artigos selecionados pode-se concluir que a pratica de exercicio fisico continuo traz beneficios sobre a capacidade funcional e aumento do volume de oxigenio nos pacientes idosos e que a reabilitacao cardiaca e fundamental para aumento da qualidade de vida.

To evaluate the prevalence of extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae fecal carriers at admission in a Portuguese hospital and to determine the epidemiology and antimicrobial resistance patterns of ESBL-producing isolates. During a 2-month period, rectal swabs were collected at hospital admission from 151 at-risk patients. In addition, 48 rectal swabs were obtained from weekly screenings of 37 patients hospitalized for > 48 h. All ESBL/carbapenemase-producing isolates were tested for antimicrobial susceptibility and characterized by PFGE and MLST. The prevalence of ESBL producers at hospital admission was 17% and 24% among at-risk patients hospitalized for > 48 h, while the prevalence of carbapenemase producers was 3% in both cases. Most of the isolates were Escherichia coli (54%) and Klebsiella pneumoniae (41%). The most common ESBL identified was CTX-M-15 (n = 17/34; 50%), followed by CTX-M-27 (n = 10; 29%), CTX-M-33 (n = 4; 12%), SHV-12 (n = 2), and CTX-M-55 (n = 1). The 20 E. coli isolates were distributed into 16 PFGE types and nine sequence types (ST), with 60% of the isolates belonging to ST131. The 15 K. pneumoniae were grouped into 12 PFGE types and nine STs, with three STs (ST17, ST449, ST147) corresponding to 60% of the isolates. A high proportion of isolates showed resistance to ciprofloxacin (86%), trimethoprim-sulfamethoxazole (68%), tobramycin (57%), and gentamicin (43%). All isolates remained susceptible to fosfomycin. A high prevalence of ESBL-producing Enterobacteriaceae was found at hospital admission among at-risk patients and > 50% of the isolates showed resistance to first-line antibiotics for the treatment of lower urinary tract infections, leaving fosfomycin as an alternative.

With an increasingly aging population, it is of extreme importance to exclude potentially reversible dementias, such as hyperparathyroidism with hypercalcemia, in the differential diagnosis of a rapidly progressive dementia. According to literature, this entity is undervalued and it is highly relevant to be aware of it.

The genus Fusarium is ubiquitous in the environment and has been emerging as an opportunistic human pathogen. We report the case of a 65-year-old man with a history of neuroischemic, otherwise unamenable to revascularization, diabetic foot, who was admitted due to an infected deep foot ulcer. Despite conventional antibiotic and wound care treatment, no improvement was initially observed. A reappraisal of the diagnosis, with microbiological and histological analyses, documented infection of the foot ulcer with Fusarium oxysporum. Clinical improvement was noted under prolonged oral voriconazole therapy. The present case broadens the differential diagnosis of diabetic foot infection. Subcutaneous fusariosis should be considered in recalcitrant infected diabetic ulcers, as early diagnosis and management may help prevent amputation and life-threatening disease.

The diagnosis of visceral leishmaniasis (VL) presents problems due to the toxicity and/or high cost of drugs. In addition, no vaccine exists to protect against human disease. In this study, the antigenicity and immunogenicity of amastin protein were evaluated in L. infantum–infected dogs and humans. For the diagnosis, besides the recombinant protein, 1 linear B-cell epitope was synthetized and evaluated in serological assays. Results showed high sensitivity and specificity values to detect the disease when both antigens were employed against a canine and human serological panel. By contrast, when using rA2 and a soluble Leishmania antigenic preparation, sensitivity and specificity values proved to be lower. A preliminary immunogenicity study showed that the amastin protein induced high IFN-γ and low IL-10 production in stimulated PBMC derived from treated VL patients and healthy subjects, thus suggesting a potential use of this protein as an immunogen to protect against human disease.

Marine Protected Areas (MPAs) are conservation tools intended to protect biodiversity, promote healthy and resilient marine ecosystems, and provide societal benefits. Despite codification of MPAs in international agreements, MPA effectiveness is currently undermined by confusion about the many MPA types and consequent wildly differing outcomes. We present a clarifying science-driven framework—The MPA Guide—to aid design and evaluation. The guide categorizes MPAs by stage of establishment and level of protection, specifies the resulting direct and indirect outcomes for biodiversity and human well-being, and describes the key conditions necessary for positive outcomes. Use of this MPA Guide by scientists, managers, policy-makers, and communities can improve effective design, implementation, assessment, and tracking of existing and future MPAs to achieve conservation goals by using scientifically grounded practices.

In the face of new diseases, medicine needs to reinvent itself in order to contain and control epidemics, such as the one we have recently faced, COVID-19, a disease with a wide spectrum of clinical severity. A new moment has been established, since the application of well known, effective and safe medications for other diseases, has shown high success rates in the treatment of COVID-19. Thereunto, studies with early intervention are needed, which can change the unfavorable outcome of patients. In this article, we report the successful experience using an oral strategy during the collapse of Belém do Pará Health System, Brazil. Two hundred and ten patients were diagnosed with respiratory failure due to COVID-19, with no option of hospital treatment due to lack of beds and resources. These patients were then started on therapeutic regimen consisting of prednisolone, enoxaparin and macrolides associated and followed in outpatient facilities. Two hundred and eight patients had excellent therapeutic response and there were only two fatalities. These results push research boundaries, valuing outpatient treatment with early use of prednisolone in the initial pulmonary phase, preventing severe COVID-19 pneumonitis. Adoption of the proposed treatment intends to reduce the need for hospitalization, as well as lethality, with social robust benefits and incalculable economic savings since involves the use of accessible, safe and not expensive medications.

Funding Acknowledgements Type of funding sources: None. Background Patients with anaemia are at increased risk of composite cardiovascular (CV) events and all-cause mortality. However, anaemia poses a challenge to doctors when in the context of an acute coronary syndrome (ACS) and the urge to offer intervention treatment and therefore antiplatelet therapy. Purpose To study the prognostic impact of anaemia in a population with ACS. Methods 436 ACS patients admitted to a single coronary care with anaemia (male gender, haemoglobin [Hb] Results Sixty-four percent of the patients were male, with a mean age 75 ± 10 years old. The majority (47%) was admitted with non-ST elevation myocardial infarction. Most of them had previous history of hypertension (87%), dyslipidaemia (63%) and chronic kidney disease (58%), while a minority had a diagnosis of diabetes mellitus (46%). Most of the patients remained in Killip-Kimbal class I throughout hospital-stay. Coronary angiography was not conducted in 15% of the patients. Thirty-six percent of the patients were conservatively treated (not submitted to percutaneous coronary intervention or coronary artery bypass graft). At discharge, 1% of the patients had no antiplatelet or anticoagulation therapy prescribed; 7% had simple antiplatelet therapy; 1% only had anticoagulation therapy; 67% had double antiplatelet therapy; 1% had double therapy (anticoagulation plus a single antiplatelet agent) and 5% had triple therapy (anticoagulation plus two antiplatelets agents); missing data about therapy at discharge in 18% of the patients. 224 patients met the primary outcome. In univariate analysis, nor antiplatelet neither anticoagulation strategies were related to the outcome (P = 0.59; P = 0.73, respectively). In a multivariable model adjusted for age, Hb level, glomerular filtration rate, heart failure diagnosis, left ventricular function (3 categories), maximum troponin I and treatment option (conservative vs revascularization), Hb level remains an important prognosis predictor (HR 0.86, 95% CI 0.77-0.97, per each g/dL increase). In this model, besides from Hb level, only age (HR 1.04, 95% CI 1.02-1.05) and moderate to severely impaired LV function (HR 1.91, 95% CI 1.38-2.63) remained associated with the outcome. Conclusion The outcome attributed to anaemia patients seems to be independent of treatment strategies and it is related to the Hb level itself. This reinforces the need to explore reversible causes of anaemia, as small increases in Hb level may have a major impact on the prognosis of these patients.

With over 117 million COVID-19–positive cases declared and the death count approaching 3 million, we would expect that the highly digitalized health systems of high-income countries would have collected, processed, and analyzed large quantities of clinical data from patients with COVID-19. Those data should have served to answer important clinical questions such as: what are the risk factors for becoming infected? What are good clinical variables to predict prognosis? What kinds of patients are more likely to survive mechanical ventilation? Are there clinical subphenotypes of the disease? All these, and many more, are crucial questions to improve our clinical strategies against the epidemic and save as many lives as possible. One might assume that in the era of big data and machine learning, there would be an army of scientists crunching petabytes of clinical data to answer these questions. However, nothing could be further from the truth. Our health systems have proven to be completely unprepared to generate, in a timely manner, a flow of clinical data that could feed these analyses. Despite gigabytes of data being generated every day, the vast quantity is locked in secure hospital data servers and is not being made available for analysis. Routinely collected clinical data are, by and large, regarded as a tool to inform decisions about individual patients, and not as a key resource to answer clinical questions through statistical analysis. The initiatives to extract COVID-19 clinical data are often promoted by private groups of individuals and not by health systems, and are uncoordinated and inefficient. The consequence is that we have more clinical data on COVID-19 than on any other epidemic in history, but we have failed to analyze this information quickly enough to make a difference. In this viewpoint, we expose this situation and suggest concrete ideas that health systems could implement to dynamically analyze their routine clinical data, becoming learning health systems and reversing the current situation.

Background/objective: The severity and outcome of COVID-19 are determined by the level of overstimulation of the immune response, age, and comorbidities in the patients infected by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Lymphopenia is the most consistent finding that characterizes the hemogram in COVID-19 patients. We evaluated the hemogram and compared the lymphocyte count (LC),neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) at diagnosis in COVID-19 patients hospitalized at the Clinical Hospital of the State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil. Methods: In this retrospective study, we reviewed the medical notes of 320 adult hospitalized patients with PCR-confirmed COVID-19 at the Clinical Hospital of UNICAMP, Campinas, from March 2020 to March 2021. The hemogram (performed using automated counter-XN 9000™, Sysmex, Japan) at COVID-19 diagnosis was analyzed, and NLR and PLR were calculated. The primary outcomes were discharge (n = 257 patients who recovered from the disease and were discharged from the hospital), and death (n = 63 those who died during treatment). Statistical analyses were performed using SPSS (version 22). Unpaired data of deceased and discharged COVID-19 patients were compared using Mann-Whitney tests. All results were significant if p < 0.05 or except otherwise stated. Results: Compared to the 257 discharged patients, the 63 deceased patients were older 56.0 vs 64.7 ys respectively, p = 0.000), the males are more in each group and the duration of hospitalization was not different (18.6 vs 19.7 days respectively, p = 0.12). The leukocyte (8.89 ± 4.50 vs 10.37 ± 7.03, p = 0.289) and platelet counts (227.00 ± 91.15 vs 197.79 ± 97.47, p = 0.119) were not significantly different in the two groups, the hematocrit was higher in the discharged than in the deceased patients (38.84 ± 6.86 vs 35.89 ± 8.57, p = 0.021). The LC was lower in the deceased (0.81 ± 0.59 × 103 vs 1.09 ± 0.80x103/μL, p = 0.002), and negatively correlated with the age of the patients(r = -0.145, p=0.009 at a significant level of 0.01). The deceased group had a higher NLR (17.52 ± 19.20 vs 10.06 ± 12.31, p < 0.001) and PLR (366.32 ± 275.03 vs 319.23 ± 331.54, p = 0.047) higher than the discharged group, and both parameters were strongly correlated (r = 0.734, p < 0.001 significant level of 0.01). One hundred and thirty-eight (53.7%) of the discharged patients and 45 (71.4%) of the deceased had LC of < 1.0 × 103/μL. The LC is associated with the disease outcome (χ2 = 6.498, df = 1, p = 0.011), and the odds for a deceased to have a lymphopenia is 1.9 times that for the discharged patients [OR = 1.87 (95% CI = 1.135-3.085). Discussion: Though lymphopenia is consistent in COVID-19, the cause is unclear. Acute recruitment of lymphocytes to the site of infection (mainly the lung) may explain this, thus the lymphopenia may worsen and the LRs will be elevated with the increasing severity of COVID-19. The negative correlation of LC with age and higher odds of lymphopenia in the deceased patients suggest that LC and the LRs at diagnosis could be easily accessible and useful predictors of severity and mortality in these patients. Conclusion: Our study supports that lymphopenia is negatively associated with mortality in COVID-19 patients and that the deceased patients have elevated NLR and PLR at diagnosis. These parameters are easily derived from the hemogram and could be utilized as affordable and accessible predictors of outcomes in patients with COVID-19.

Background While public health strategies to contain the current coronavirus disease 2019 (COVID-19) pandemic are primarily focused on social distancing and isolation, emerging evidence suggest that in some regions social isolation failed to lead to further decrease in the number of COVID-19 deaths in the long run. This apparent paradox was particularly observed in the northern region of Brazil, in the state of Amazonas. We hypothesized that the emergence of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mutations, leading to more transmissible and pathogenic variants, could explain the lack of further reductions in COVID-19 new cases and related deaths in some regions. Our objective is to determine if social isolation is associated with the emergence of new SARS-CoV-2 variants, particularly the P.1 lineage and E484K mutants, in Brazil and in the state of Amazonas. Materials and methods We assessed the prevailing SARS-CoV-2 genomes present in Brazil available on the GISAID (Global Initiative on Sharing All Influenza Data) database collected between June 1, 2020, and January 31, 2021. Data regarding demographics, lineage, and prevalence of P.1 lineage and E484K mutations were obtained. Social isolation was measured using the Social Isolation Index (SII), which quantifies the percentage of individuals that stayed within a distance of 450 meters from their homes on a given day, between February 1, 2020, and January 24, 2021. The number of daily COVID-19 deaths was obtained from the Brazilian Ministry of Health (OpenDataSUS, 2021) between March 12, 2020, and January 10, 2021. SII was correlated with the prevalence P.1 lineage and E484K mutations in the eight following weeks. All univariate associations were estimated using the Spearman Correlation Index. 3D surfaces were employed to reflect the relationship between time, social isolation, and prevalence of genomic variants simultaneously. Results A total of 773 and 77 samples were obtained in Brazil and in the Amazonas state, respectively. In the state of Amazonas, SII on a given week was positively, significantly, and moderately or strongly (r > 0.6) correlated with the prevalence of both P.1 lineage and other E484K variants in the six following weeks after the SII on a given week. Conversely, in overall Brazil, correlations between SII and P.1 lineage and E484K variants were weaker and shorter, or negative, respectively. When SII was below 40%, P.1 lineage or E484K variants were not detected in the following weeks. When SII was above 40%, apparently exponential positive correlations between SII and prevalence of both P.1 lineage and E484K variants were observed. Conclusion The results of this study indicate that SII above 40% is associated with the emergence of SARS-CoV-2 E484K variants and P.1 lineage in the state of Amazonas, which was not observed in overall Brazil.

Resume Introduccion Las ataxias (AT) y paraparesias espasticas hereditarias (PEH) son sindromes neurodegenerativos raros. Nos proponemos conocer la prevalencia de las AT y PEH en Espana en 2019. Pacientes y metodos Estudio transversal, multicentrico, descriptivo y retrospectivo de los pacientes con AT y PEH, desde marzo de 2018 a diciembre de 2019 en toda Espana. Resultados Se obtuvo informacion de 1.809 pacientes procedentes de 11 Comunidades Autonomas, de 47 neurologos o genetistas. Edad media: 53,64 anos ± 20,51 desviacion estandar (DE); 920 varones (50,8%), 889 mujeres (49,2%). En 920 pacientes (47,6%) no se conoce el defecto genetico. Por patologias, 1.371 pacientes (70,9%) diagnosticados de AT, 562 diagnosticados de PEH (29,1%). La prevalencia estimada de AT es 5,48/100.000 habitantes, y la de PEH es 2,24 casos/100.000 habitantes. La AT dominante mas frecuente es la SCA3. La AT recesiva mas frecuente es la ataxia de Friedreich (FRDA). La PEH dominante mas frecuente es la SPG4, y la PEH recesiva mas frecuente es la SPG7. Conclusiones La prevalencia estimada de AT y PEH en nuestra serie es de 7,73 casos/100.000 habitantes. Estas frecuencias son similares a las del resto del mundo. En el 47,6% no se ha conseguido un diagnostico genetico. A pesar de las limitaciones, este estudio puede contribuir a estimar los recursos, visibilizar estas enfermedades, detectar las mutaciones mas frecuentes para hacer los screenings por comunidades, y favorecer los ensayos clinicos.

Introduction A major barrier for successful therapeutic approaches for COVID-19 is the inability to diagnose COVID-19 during the viral replication stage, when drugs with potential antiviral activity could demonstrate efficacy and preclude progression to more severe stages. Reasons that hamper an earlier diagnosis of COVID-19 include the unspecific and mild symptoms during the first stage, the delay in the diagnosis and specific management caused by the requirement of a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2 for the diagnosis of COVID-19, and the insufficient sensitivity of the RT-PCR-SARS-CoV-2, converse to what is recommended for a screening test during an outbreak. More sensitive and earlier diagnostic tools for COVID-19 should be unraveled as a key strategy for a breakthrough change in the disease course and response to specific therapies, particularly those that target the blockage of viral shedding. We aimed to create an accurate, sensitive, easy-to-perform, and intuitive clinical scoring for the diagnosis of COVID-19 without the need for an RT-PCR-SARS-CoV-2 (termed The AndroCoV Clinical Scoring for COVID-19 Diagnosis), resulting from a 1,757 population cohort, to eventually encourage the management of patients with a high pre-clinical likelihood of presenting COVID-19, independent of an RT-PCR-SARS-COV-2 test, to avoid delays and loss of appropriate timing for potential therapies. Methods This is a post-hoc analysis of clinical data prospectively collected of the Pre-AndroCoV and AndroCov Trials, which resulted in scorings for the clinical diagnosis of COVID-19 based on the likelihood of presenting with actual COVID-19 according to the number of symptoms, presence of anosmia, and known positive household contact. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and accuracy were calculated for subjects screened in two different periods and both periods together, for females, males, and both, in a total of nine different scenarios, according to combinations of one, two, or three or more symptoms or the presence of anosmia in subjects without known positive household contacts, and no symptoms, one, two, or three or more symptoms, or presence of anosmia or ageusia in subjects with known positive household contacts. Scorings that yielded the highest pre-test probability, sensitivity, and accuracy were selected. Results Of the 1,757 patients screened, 1,284 were diagnosed with COVID-19. The scoring that required: (1) two or more symptoms, or anosmia or ageusia alone, for subjects without known contact; or (2) one or more symptoms, including anosmia or ageusia alone, when with known positive contacts presented the highest accuracy (80.4%) among all combinations attempted, and higher sensitivity (85.7%) than RT-PCR-SARS-CoV-2 commercially available kit tests. Conclusion The AndroCoV clinical scoring for COVID-19 diagnosis was demonstrated to be a feasible, easy, costless, and sensitive diagnostic tool for the clinical diagnosis of COVID-19. Because the clinical diagnosis of COVID-19 avoids delays in specific treatments, particularly for high-risk populations, prevents false-negative diagnosis, and reduces diagnostic costs, this diagnostic tool should be considered as an option for COVID-19 diagnosis, at least while SARS-CoV-2 is the prevailing circulating virus and vaccination rate is below the required for herd immunity.

The ROC curve is a statistical tool used broadly to help professionals from several fields of study gauge the ability of a binary classifier. Recent theoretical advancements have allowed the ROC curve to better examine existing confounding variables in its analysis allowing greater calibration for markers and classifiers.

Objective: The study aimed to validate the estimates of adult smokers determined by Vigitel for small areas, defined by the Health Vulnerability Index (IVS). Methods: The database of the Health Survey of the Metropolitan Region of Belo Horizonte (RMBH) carried out in 2010 and the data from Vigitel in the period from 2010 to 2013 were used to obtain estimates of adult smokers by IVS. With Vigitel, the estimate of smokers by IVS was obtained by the indirect estimation method in small areas. The prevalence of adult smokers was compared, considering RMBH as the gold standard. The t test was used to evaluate the difference between the means and the Pearson correlation, with a significance level of 5%. Results: When stratifying by IVS in the household survey, the prevalence of adult smokers ranged from 13.39% (95%CI 11.88 – 14.91) for residents in a low-risk area to 22.9% (95%CI 12.33 – 33.48) among residents in a very high-risk area. With Vigitel, according to IVS, the prevalence of adult smokers ranged from 11.98% (95%CI 10.75 – 13.21) for residents in the low-risk area to 22.31% (95%CI 18.25 – 26.1) in very high-risk areas. The prevalence was similar between the two surveys, showing good Pearson correlation (r = 0.93). Conclusion: The study points out that the estimates of smokers were similar in both surveys, showing the external validity of Vigitel. There was a gradient in prevalence, with progressive increase, identifying a higher proportion of smokers in high-risk areas. RESUMO: Objetivo: Validar as estimativas de adultos fumantes produzidas pelo Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por inquérito telefônico (Vigitel) para pequenas áreas, definidas pelo Índice de Vulnerabilidade à Saúde (IVS). Métodos: A base de dados do Inquérito de Saúde da Região Metropolitana de Belo Horizonte (RMBH), realizado em 2010, e os dados do Vigitel Belo Horizonte, no período de 2010 a 2013, foram utilizados para obter as estimativas de adultos fumantes por IVS, mediante uso do método indireto de estimação em pequenas áreas. As prevalências de adultos fumantes foram comparadas, considerando-se o Inquérito de Saúde da RMBH como padrão-ouro. Foi utilizado o Teste de hipótese para diferença entre as médias e a correlação de Pearson, sendo considerado o nível de significância de 5%. Resultados: Ao estratificar por IVS no inquérito domiciliar, a prevalência de adultos fumantes variou de 13,39% (intervalo de confiança de 95% — IC95% 11,88 – 14,91), para residentes em área de baixo risco, a 22,9% (IC95% 12,33 – 33,48), entre residentes em área de muito alto risco. No Vigitel, segundo IVS, a prevalência de adultos fumantes variou de 11,98% (IC95% 10,75 – 13,21), para residentes em área de baixo risco, a 22,31% (IC95% 18,25 – 26,1), para residentes nas áreas de muito alto risco. As prevalências foram semelhantes entre os dois inquéritos, mostrando boa correlação de Pearson (r = 0,93). Conclusão: O estudo aponta que as estimativas de fumantes foram semelhantes em ambos os inquéritos, mostrando validade externa do Vigitel. Ocorreu gradiente nas prevalências, com aumento progressivo, identificando-se proporção mais elevada de fumantes em áreas de risco elevado.

Introduction: Testosterone is the main hormone that regulates male reproductive functions, directly participating in spermatogenesis and increasing sexual activity. The blood measurement of this hormone is essential for the diagnosis of neuroendocrine disorders, such as hypogonadism. However, there is lack of standardization regarding patient preparation for the hormone collection in clinical laboratories. Objective: Evaluate the effect of pre-analytical variables, including fasting, circadian and seasonal variation on testosterone levels in healthy young males. Material and methods: Forty-two volunteers were selected for the study, in the city of Barbacena, Minas Gerais. Four blood samples were collected from each of the participants, three in the winter: the first one in the morning after fasting; the second in the afternoon, without fasting; the third, in the next day morning, without fasting; and the last one taken in the summer, in the morning, after fasting. Results: The analyses showed that there was a significant decrease in total testosterone levels when there was no fasting for eight hours prior to collection and in the afternoon compared to the morning, both with p < 0.001. There was no significant difference in the results obtained in winter and summer. Conclusion: It is recommended that clinical laboratories standardize the collection of total testosterone by performing the test in the morning and after an eight-hour fast, in order to reduce variability and ensure reliability in the results. RESUMEN Introducción: La testosterona es la principal hormona reguladora de funciones reproductoras masculinas, participando directamente en la espermatogénesis y en el aumento de la actividad sexual. La medición sanguínea de esa hormona es fundamental en el diagnóstico de trastornos neuroendocrinos, como el hipogonadismo. Sin embargo, hay poca estandarización en la preparación adecuada del paciente para la recolección de la hormona en laboratorios clínicos. Objetivo: Evaluar el efecto de variables preanalíticas, incluyendo ayuno, variación circadiana y estacional en las mediciones de testosterona en hombres jóvenes sanos. Material y métodos: Se eligieron 42 voluntarios para el estudio, en la ciudad de Barbacena, Minas Gerais. Se tomaron cuatro muestras de sangre de cada uno de los participantes, de las cuales tres en invierno: la primera, matutina, en ayunas; la segunda, vespertina, sin ayunas; la tercera, el dia siguiente, matutina, sin ayunas; el última se recolectó en verano, por la mañana, en ayunas. Resultados: Los análisis demostraron que hubo reducción significativa en los niveles de testosterona total cuando no se realizó el ayuno de ocho horas antes de la recolección y en el período vespertino en comparación al matutino, ambos con valor de p < 0,001. No hubo diferencia significativa en los resultados obtenidos en invierno y en verano. Conclusión: Se recomienda que los laboratórios clínicos estandarizen la recolección de testosterona total con la realización de la prueba en el período matutino y en ayuno de ocho horas, para reducir la variación y garantizar la confiabilidad de los resultados. RESUMO Introdução: A testosterona é o principal hormônio regulador das funções reprodutivas masculinas, participando diretamente da espermatogênese e do aumento da atividade sexual. A dosagem sanguínea desse hormônio é fundamental no diagnóstico de distúrbios neuroendócrinos, como o hipogonadismo. Entretanto, há pouca padronização no preparo adequado do paciente para a coleta do hormônio em laboratórios clínicos. Objetivo: Avaliar o efeito de variáveis pré-analíticas, incluindo realização de jejum, variação circadiana e sazonal nas dosagens de testosterona em jovens saudáveis do sexo masculino. Material e métodos: Foram selecionados 42 voluntários para o estudo, na cidade de Barbacena, Minas Gerais. Quatro amostras de sangue de cada um dos participantes foram coletadas, sendo três no inverno: a primeira de manhã, em jejum; a segunda à tarde, sem jejum; a terceira no dia seguinte, de manhã, sem jejum. A última foi coletada no verão, na parte da manhã, em jejum. Resultados: As análises demonstraram que houve diminuição significativa dos níveis de testosterona total quando não foi realizado jejum de 8 horas antes da coleta e no período da tarde em comparação ao período da manhã, ambos com valor de p < 0,001. Não houve diferença significativa nos resultados obtidos no inverno e no verão. Conclusão: Recomendamos que os laboratórios clínicos padronizem a coleta de testosterona total com a realização do exame no período da manhã e em jejum de 8 horas, a fim de reduzir a variabilidade e garantir a confiabilidade nos resultados.

Aims: To evaluate how common radiation therapy techniques perform in the setting of the new European Society for Radiotherapy and Oncology-Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) delineation recommendations for immediate breast reconstruction (IBR). Materials and methods: Seven Danish radiation therapy centres and six international European centres participated in this project. Two breast cancer cases (one left-sided and one right-sided) with a retropectoral implant were chosen for radiation therapy planning using deep-inspiration breath-hold. Target volumes were delineated according to ESTRO-ACROP delineation recommendations. The centres were asked to plan the cases using any radiation therapy technique according to the Danish Breast Cancer Group plan objectives. Results: In total, 35 treatment plans were collected. Half of the submitted plans, for both the left-sided and the right-sided case, used the field-in-field (FiF) technique (nine for each), a quarter used volumetric arc radiation therapy (VMAT; five for right-sided, four for left-sided) and the remaining quarter was a mix of inverse intensity-modulated radiation therapy (IMRT), helicoidal therapy and hybrid (combined open fields and VMAT) techniques. Mean clinical target volume doses were in the range 99-102% of the prescribed dose. The median FiF mean heart dose (MHD) for right-sided radiation therapy was 1 Gy (range 0.8-3.7) and 5.2 Gy for left-sided radiation therapy (range 2.2-6.5). For right-sided radiation therapy, the median VMAT MHD was 3.42 Gy, for IMRT was 2.3 Gy and for helicoidal therapy was 5.1 Gy. For left-sided radiation therapy, the median VMAT MHD was 6.3 Gy, for IMRT was 7.8 Gy and for helicoidal therapy was 7.3 Gy. Conclusions: Different radiation therapy techniques could be used to plan radiation therapy in the setting of IBR. FiF provided good coverage with acceptable organ at risk doses. The best dose distribution results as a trade-off between the objectives of target volume coverage and high-dose organ at risk inclusion. The radiation therapy technique affects the interplay between these objectives. (C) 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

This study aims to problematize public policies for evaluation, regulation, and supervision of Brazilian Higher Education, by relating them to Goals 12, 13 and 14 of the PNE related to the National Higher Education Evaluation System (Sinaes), Law no. 10,861 from 2004. It is a theoretical and documentary study, based on Dourado (2017 and 2018); Barreyro and Rothen (2006 and 2011); Dias Sobrinho (2010); Amaral (2016 and 2019) and others, in addition to normative texts about Sinaes. The study revealed that the evaluation of Higher Education has been going through processes of flexibility and (de)regulation based on changes that intensify the (de)formation of Sinaes, and marked by tensions, disputes, and clashes since the PNE Law 13,005 of 2014. El objetivo de este estudio es problematizar las políticas públicas de evaluación, regulación y supervisión de la Educación Superior brasileña, relacionándolas con los Objetivos 12, 13 y 14 del PNE relacionados con el Sistema Nacional de Evaluación de la Educación Superior (Sinaes), Ley n. 10.861 de 2004. Es un estudio teórico y documental, basado en Dourado (2017 y 2018); Barreyro y Rothen (2006 y 2011); Dias Sobrinho (2010); Amaral (2016 y 2019) y otros, además de textos normativos sobre el Sinaes. El estudio reveló que la evaluación de la Educación Superior ha pasado por procesos de flexibilidad y (des)regulación basados en cambios que intensifican la (de)formación de Sinaes, marcados por tensiones, disputas y enfrentamientos desde la Ley 13.005 de 2014 del PNE. O objetivo deste estudo é problematizar as políticas públicas para avaliação, regulação e supervisão da Educação Superior brasileira, ao relacioná-las às Metas 12, 13 e 14 do PNE relativas ao Sistema Nacional de Avaliação da Educação Superior (Sinaes), Lei n. 10.861 de 2004. É um estudo teórico e documental, ancorado em Dourado (2017 e 2018); Barreyro e Rothen (2006 e 2011); Dias Sobrinho (2010); Amaral (2016 e 2019) e outros, além de textos normativos sobre o Sinaes. O estudo revelou que a avaliação da Educação superior vem passando por processos de flexibilização e (des)regulamentação a partir de mudanças que intensificam a (de)formação do Sinaes, marcadas por tensões, disputas e embates desde a Lei 13.005 de 2014 do PNE.