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Abstract Plasmodium vivax, a challenging species to eliminate, causes millions of malaria cases globally annually. Developing an effective vaccine is crucial in the fight against vivax malaria, but considering the limited number of studies focusing on the identification and development of P. vivax-specific vaccine candidates, exploring new antigens is an urgent need. The merozoite protein CyRPA is essential for P. falciparum growth and erythrocyte invasion and corresponds to a promising candidate antigen. In P. vivax, a single study with multiple vaccine candidates indicates PvCyRPA with strong association with protection, outperforming classic malaria vaccine candidates. However, little is known about the specific naturally acquired response in the Americas, as well as the antigen epitope mapping. For this reason, we aimed to investigate the cellular and humoral immune response elicited against PvCyRPA in Brazilian endemic areas to identify the existence of immunodominant regions and the potential of this protein as a single or even a multi-stage specific malaria vaccine candidate for P. vivax. The results demonstrated that PvCyRPA is naturally immunogenic in Brazilian Amazon individuals previously exposed to malaria, which presented anti-PvCyRPA cytophilic antibodies. Moreover, our data show that the protein also possesses important immunogenic regions with an overlap of B and T cell epitopes. These data reinforce the possibility of including PvCyRPA in vaccine formulations for P. vivax.

Abstract The 4T1 model is extensively employed in murine studies to elucidate the mechanisms underlying the carcinogenesis of triple-negative breast cancer. Molecular biology serves as a cornerstone in these investigations. However, accurate gene expression analyses necessitate data normalization employing housekeeping genes (HKGs) to avert spurious results. Here, we initially delve into the characteristics of the tumor evolution induced by 4T1 in mice, underscoring the imperative for additional tools for tumor monitoring and assessment methods for tracking the animals, thereby facilitating prospective studies employing this methodology. Subsequently, leveraging various software platforms, we assessed ten distinct HKGs (GAPDH, 18 S, ACTB, HPRT1, B2M, GUSB, PGK1, CCSER2, SYMPK, ANKRD17) not hitherto evaluated in the 4T1 breast cancer model, across tumors and diverse tissues afflicted by metastasis. Our principal findings underscore GAPDH as the optimal HKG for gene expression analyses in tumors, while HPRT1 emerged as the most stable in the liver and CCSER2 in the lung. These genes demonstrated consistent expression and minimal variation among experimental groups. Furthermore, employing these HKGs for normalization, we assessed TNF-α and VEGF expression in tissues and discerned significant disparities among groups. We posit that this constitutes the inaugural delineation of an ideal HKG for experiments utilizing the 4T1 model, particularly in vivo settings.

Abstract Desert dust is an important source of essential metals for marine primary productivity, especially in oligotrophic systems surrounded by deserts, such as the Red Sea. However, there are very few studies on the effects of dust on reef-building corals and none on the response of corals to heat stress. We therefore supplied dust to two coral species (Stylophora pistillata and Turbinaria reniformis) kept under control conditions (26 °C) or heat stress (32 °C). Since dust releases large amounts of iron (Fe) in seawater, among other metals, the direct effect of different forms of Fe enrichment on coral photosynthesis was also tested. First, our results show that the desert dust altered the coral metallome by increasing the content of metals that are important for coral physiology (e.g. lithium (up to 5-fold), manganese (up to 4-fold in S. pistillata), iron (up to 3-fold in S. pistillata), magnesium (up to 1.3-fold), molybdenum (up to 1.5-fold in S. pistillata)). Overall, metal enrichment improved the photosynthetic performance of corals, especially under thermal stress (e.g. Pgross (up to 2-fold), Pnet (up to 10-fold), chlorophyll (up to 1.5-fold), symbionts (up to 1.6-fold)). However, Fe exposure (ferric chloride or ferric citrate) did not directly improve photosynthesis, suggesting that it is the combination of metals released by the dust, the so-called “metal cocktail effect”, that has a positive impact on coral photophysiology. Dust also led to a decrease in Ni uptake (up to 1.4-fold in the symbionts), likely related to the nitrogen metabolism. Finally, we found that the isotopic signature of metals such as iron, zinc and copper is a good indicator of heat stress and dust exposure in corals. In conclusion, desert dust can increase coral resistance to bleaching by supplying corals with essential metals.

Background: Injuries resulting from surgical positioning are preventable, yet they remain prevalent, causing temporary or permanent harm, extending hospital stays, and increasing the risk of hospital-acquired infections. Identifying patients at risk for these injuries is critical. This study aimed to assess the risk of developing surgical positioning injuries in orthopedic surgeries within teaching hospitals. Methods: This cross-sectional study was conducted between February and July 2023 in two teaching hospitals in Brazil. It involved a convenience sample of 147 patients who underwent orthopedic surgery. The study used the Risk Assessment Scale for the Development of Injuries Due to Surgical Positioning. Data analysis was performed using SPSS software, version 21, with the Chi-squared test applied to assess significance at the 0.05 level. Results: Most participants were male (51.70%), with a mean (±SD) age of 54.52±20.34 years. Of the total sample, 85% were at low risk of developing injuries. Women were three times more likely to be at high risk (OR=3.39, 95% CI=1.24 to 9.24). The presence of comorbidities increased the likelihood of high risk approximately sixfold (OR=5.56, 95% CI=2.06 to 15.57). Spinal anesthesia increased the likelihood of high risk fourfold (OR=4.08, 95% CI=1.14 to 14.53). Conclusion: Identifying risk factors allows for a more targeted approach to preventing surgical positioning injuries. Incorporating this knowledge into the development of institutional protocols is essential for improving patient safety and outcomes.

Introduction This study aimed to systematically analyze and describe the main challenges of congenital heart diseases (CHDs) in the countries in the Amazon region. Methods The methodology followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist utilizing the Medline, Embase, Lilacs, and Google Scholar databases. The inclusion criteria were articles addressing any topic involving CHD in the Amazon region. Incomplete articles, book chapters, lectures, conference abstracts, and editorials were excluded. Results Nine studies were identified, 7 of which were published in the last decade and were of Colombian and Brazilian origin. The methodology of the studies was cross-sectional and ecological, evaluating the regional and epidemiological factors, challenges to diagnosis and treatment, multidisciplinary team challenges, and the impact of the COVID-19 pandemic. Studies carried out by surgeons demonstrate more existing data regarding the challenges of the health-care system. Conclusions There is growing interest in analyzing the situation of CHD in the region. However, only a few studies are available, mostly on ecological and cross-sectional analysis. These records show the lack of hospital infrastructure and multidisciplinary teams for the diagnosis and treatment of CHD in the Amazon region; we see an initiative by specialists from two countries (Colombia and Brazil) to demonstrate the difficulties by seeking international training programs and government aid to improve the health system situation.

Abstract Background The Brazilian Policy for Comprehensive Care for People with Rare Diseases was implemented in 2014; however, national epidemiological data on rare diseases (RDs) are scarce and mainly focused on specific disorders. To address this gap, University Hospitals, Reference Services for Neonatal Screening, and Reference Services for Rare Diseases, all of which are public health institutions, established the Brazilian Rare Diseases Network (RARAS) in 2020. The objective of this study was to perform a comprehensive nationwide epidemiological investigation of individuals with RDs in Brazil. This retrospective survey collected data from patients receiving care in 34 healthcare facilities affiliated with RARAS in 2018 and 2019. Results The survey included 12,530 participants with a median age of 15.0 years, with women representing 50.5% of the cohort. Classification according to skin color demonstrated that 5044 (47.4%) participants were admixed. Most had a confirmed diagnosis (63.2%), with a predominance of phenylketonuria (PKU), cystic fibrosis (CF), and acromegaly. Common clinical manifestations included global developmental delay and seizures. The average duration of the diagnostic odyssey was 5.4 years (± 7.9 years). Among the confirmed diagnoses, 52.2% were etiological (biochemical: 42.5%; molecular: 30.9%), while 47.8% were clinical. Prenatal diagnoses accounted for 1.2%. Familial recurrence and consanguinity rates were 21.6% and 6.4%, respectively. Mainstay treatments included drug therapy (55.0%) and rehabilitation (15.6%). The Public Health System funded most diagnoses (84.2%) and treatments (86.7%). Hospitalizations were reported in 44.5% of cases, and the mortality rate was 1.5%, primarily due to motor neuron disease and CF. Conclusion This study marks a pioneering national-level data collection effort for rare diseases in Brazil, offering novel insights to advance the understanding, management, and resource allocation for RDs. It unveils an average diagnostic odyssey of 5.4 years and a higher prevalence of PKU and CF, possibly associated with the specialized services network, which included newborn screening services.

Objetivo. Identificar e sintetizar evidências sobre efetividade e custo-efetividade da metodologia Aedes com Wolbachia para redução dos casos de arboviroses. Método. Revisão sistemática rápida, com busca realizada em fevereiro de 2022 em cinco portais de busca e bases de dados bibliográficas online. As etapas de seleção foram conduzidas por dois revisores, com resolução de conflitos por um terceiro. A extração dos dados foi feita por um revisor e conferida posteriormente por outro. Os critérios de inclusão foram estudos com descrição de custo-efetividade e efetividade da metodologia Aedes com Wolbachia, a partir de intervenções em campo, publicados nos idiomas português, inglês e espanhol, sem restrição de data de publicação. Resultados. Foram incluídos quatro estudos, sendo um ensaio randomizado em cluster, dois quase- experimental e um antes-depois, publicados entre 2019 e 2021 em quatro países. Os estudos encontrados tiveram resultados efetivos em alguns dos desfechos avaliados, como na diminuição da incidência de casos de dengue, Zika e chikungunya. Apesar de não terem sido identificados estudos experimentais abordando custo-efetividade da estratégia Aedes com Wolbachia, alguns estudos de modelagem demonstraram um potencial custo-benefício desta estratégia. Conclusão. Considerando os resultados apresentados, conclui-se que a Wolbachia apresenta potencial para ser uma estratégia economicamente efetiva e que leva à redução da incidência de casos de dengue, Zika e chikungunya. Apesar disso, não é possível, todavia, recomendar a estratégia como política pública, pois ainda são necessários mais estudos de grande porte e de alta qualidade metodológica para subsidiar a tomada de decisão política.

Abstract Gastric Cancer (GC) is the fifth most common cancer worldwide. Early stages of GC began being detected, giving rise to a new concern, Quality of Life. This study aimed to systematically assess the effects of different GC reconstruction techniques on postoperative type 2 diabetes mellitus (T2DM), hypertension (HBP), and body mass index (BMI) reduction rate and to provide an overview of recent research on oncometabolic surgery (OS). We performed a systematic review and meta-analysis by searching three databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a meta-analysis of risk ratios and mean differences to estimate the impact of duodenal bypass, Roux-en-Y reconstruction, and residual stomach on T2DM, HBP, and BMI reduction rate. Heterogeneity was assessed using the I 2 statistics. At the end of the follow-up, the duodenal bypass group compared to Billroth I had a significantly higher postoperative remission of T2DM and HBP, with a relative risk (RR) of 1.43 (95% confidence interval (95% CI) [1.27; 1.62]) and 1.3 (95% CI [1.00; 1.69]), respectively. Compared with the Billroth II group, Roux-en-Y reconstruction had significantly greater T2DM remission after gastrectomy (RR = 1.19; 95% CI [1.08; 1.31]), while HBP showed no significant differences. Regarding the improvement of HBP, total gastrectomy was significantly superior to subtotal gastrectomy (95% CI [1.01; 2.64]). A trend towards Roux-en-Y Esophagojejunostomy as the best option for T2DM remission was observed (95% CI [0.98; 2.77]; p = 0.06). Gastrectomy with Roux-en-Y reconstruction appears to be the most effective treatment for T2DM remission. Further research is needed to assess the impact of OS on metabolic diseases.

Abstract Cardiac rhythms are related to heart electrical activity, being the essential aspect of the cardiovascular physiology. Usually, these rhythms are represented by electrocardiograms (ECGs) that are useful to detect cardiac pathologies. Essentially, the heart activity starts in the sinoatrial node (SA) node, the natural pacemaker, propagating to the atrioventricular node (AV), and finally reaching the His-Purkinje complex (HP). This paper investigates the control of cardiac rhythms in order to induce normal rhythms from pathological responses. A mathematical model that presents close agreement with experimental measurements is employed to represent the heart functioning. The adopted model comprises a network of three nonlinear oscillators that represent each one of the cardiac nodes, connected by delayed couplings. The pathological behavior is induced by an external stimulus in the SA node. An adaptive controller is proposed acting in the SA node considering an strategy based on the signal obtained by the natural pacemaker and its regularization. The incorporation of adaptive compensation in a Lyapunov-based control scheme allows the compensation for the unknown dynamics. The controller ability to deal with interpatient variability is evaluated by assuming that the heart model is not available to the controller design, being used only in the simulator to assess the control performance. Results show that the adaptive term can reduce the control effort by around 3% while reducing the tracking error by 20%, when compared to the conventional feedback approach. Additionally, the controller can avoid abnormal rhythms, turning the ECG closer to the expected normal behavior and preventing critical cardiac responses. Therefore, this work demonstrates that an adaptive controller can be used to regulate the ECG signal without prior information about the system and disregarding inter- and intrapatient variability.

Abstract Objective We developed an in-house bioinformatics pipeline to improve the detection of respiratory pathogens in metagenomic sequencing data. This pipeline addresses the need for short-time analysis, high accuracy, scalability, and reproducibility in a high-performance computing environment. Results We evaluated our pipeline using ninety synthetic metagenomes designed to simulate nasopharyngeal swab samples. The pipeline successfully identified 177 out of 204 respiratory pathogens present in the compositions, with an average processing time of approximately 4 min per sample (processing 1 million paired-end reads of 150 base pairs). For the estimation of all the 470 taxa included in the compositions, the pipeline demonstrated high accuracy, identifying 420 and achieving a correlation of 0.9 between their actual and predicted relative abundances. Among the identified taxa, 27 were significantly underestimated or overestimated, including only three clinically relevant pathogens. We also validated the pipeline by applying it to a clinical dataset from a study on metagenomic pathogen characterization in patients with acute respiratory infections and successfully identified all pathogens responsible for the diagnosed infections. These findings underscore the pipeline’s effectiveness in pathogen detection and highlight its potential utility in respiratory pathogen surveillance.

Abstract The increase in the construction of mega dams in tropical basins is considered a threat to freshwater fish diversity. Although difficult to detect in conventional monitoring programs, rheophilic species and those reliant on shallow habitats comprise a large proportion of fish diversity in tropical basins and are among the most sensitive species to hydropower impacts. We used Baited Remote Underwater Video (BRUV), an innovative, non-invasive sampling technique, to record the impacts caused by Belo Monte, the third largest hydropower project in the world, on fishes inhabiting fast waters in the Xingu River. BRUV were set in a river stretch of ~ 240 km for 7 years, 2 before and 5 after the Belo Monte operation. We explored the spatial and temporal variation in fish diversity (α, β, and γ) and abundance (MaxN) using generalized additive models. We also investigated the variation of environmental variables and tested how much information we gained by including them in the diversity and abundance models. Belo Monte altered the flow regime, water characteristics, and fishery yield in the Xingu, resulting in changes in the fish community structure. Temporally, we observed sharp declines in α diversity and abundance, far exceeding those from a previous study conducted with more conventional sampling methods (i.e., catch-based) in the region. γ-diversity was also significantly reduced, but we observed a non-expected increase in β diversity over time. The latter may be associated with a reduction in river connectivity and an increase in environmental heterogeneity among river sectors. Unexpected signs of recovery in diversity metrics were observed in the last years of monitoring, which may be associated with the maintenance of flow levels higher than those previously planned. These results showed that BRUV can be a useful and sensitive tool to monitor the impacts of dams and other enterprises on fish fauna from clear-water rivers. Moreover, this study enhances our comprehension of the temporal variations in freshwater fish diversity metrics and discusses the prevalent assumption that a linear continuum in fish-structure damage associated with dam impoundments may exhibit temporal non-linearity.

Abstract SARS-CoV-2 caused the pandemic situation experienced since the beginning of 2020, and many countries faced the rapid spread and severe form of the disease. Mechanisms of interaction between the virus and the host were observed during acute phase, but few data are available when related to immunity dynamics in convalescents. We conducted a longitudinal study, with 51 healthy donors and 62 COVID-19 convalescent patients, which these had a 2-month follow-up after symptoms recovery. Venous blood sample was obtained from all participants to measure blood count, subpopulations of monocytes, lymphocytes, natural killer cells and dendritic cells. Serum was used to measure cytokines, chemokines, growth factors, anti-N IgG and anti-S IgG/IgM antibodies. Statistic was performed by Kruskal–Wallis test, and linear regression with days post symptoms and antibody titers. All analysis had confidence interval of 95%. Less than 35% of convalescents were anti-S IgM+, while more than 80% were IgG+ in D30. Anti-N IgG decreased along time, with loss of seroreactivity of 13%. Eosinophil count played a distinct role on both antibodies during all study, and the convalescence was orchestrated by higher neutrophil-to-lymphocyte ratio and IL-15, but initial stages were marked by increase in myeloid DCs, B1 lymphocytes, inflammatory and patrolling monocytes, G-CSF and IL-2. Later convalescence seemed to change to cytotoxicity mediated by T lymphocytes, plasmacytoid DCs, VEGF, IL-9 and CXCL10. Anti-S IgG antibodies showed the longest perseverance and may be a better option for diagnosis. The inflammatory pattern is yet present on initial stage of convalescence, but quickly shifts to a reparative dynamic. Meanwhile eosinophils seem to play a role on anti-N levels in convalescence, although may not be the major causative agent. We must highlight the importance of immunological markers on acute clinical outcomes, but their comprehension to potentialize adaptive system must be explored to improve immunizations and further preventive policies.

Abstract To verify if data obtained in the prehospital evaluation of patients with severe acute respiratory syndrome (SARS) during the initial response to the COVID-19 pandemic is associated with clinical outcomes: mechanical ventilation, hospital discharge, and death. This is a retrospective analysis involving secondary data from the Emergency Medical Service (EMS) records and the Health Surveillance Information System of patients assisted by the EMS in Manaus, from January to June 2020, the period of the first peak of COVID-19 cases. The combination of the two databases yielded a total of 1.190 patients, who received a first EMS response and were later admitted to hospital with SARS and had data on clinical outcomes of interest available. Patients were predominantly male (754, 63.4%), with a median age of 66 (IQR: 54.0–78.0) years. SARS illness before medical assistance was associated to need for invasive mechanical ventilation (IMV, p

Abstract Background Given the health and social needs generated by the COVID-19 pandemic, the Telehealth Network of Minas Gerais, Brazil, implemented a teleconsultation and telemonitoring program to assist patients with suspected or confirmed COVID-19, the TeleCOVID-MG program. The telemonitoring service was conducted by medical students, under the supervision of a physician. The main goal of this study was to analyze the experience of the students while collaborating on the aforementioned telemonitoring program. Methods A questionnaire with 27 questions was developed to address the participation of the students in the telehealth program. The questionnaire included questions about the student’s profile, the system usability, and the satisfaction in participating in such a telehealth program. The questionnaire was generated on Google Forms® platform and sent via email to each student who was part of the telemonitoring team. Results Sixty students were included in the analysis (median age 25 years-old [interquartile range 24–26], 70% women). Of those, 61.6% collaborated on the telehealth program for more than 6 months, 65.1% performed more than 100 telemonitoring calls, 95.2% reported difficulties in contacting the patient through phone calls; 60.3% believe some patients might have felt insecure about being approached by medical students and not by graduate professionals; and 39.6% reported eventual system instabilities. The main strengths reported by the students were related to the system usability and to the self-perception of the quality of healthcare delivered to the patients. Even though 68.3% of the students mentioned technical difficulties, 96.6% reported that they were promptly solved. Finally, 98.3% believed that the program was useful and would recommend it to an acquaintance. Conclusion This study reports a successful experience of undergraduate medical students in a COVID-19 telemonitoring program. Overall, the medical students were satisfied with their participation, especially considering the continuity of clinical practice remotely during a period of classes suspension during the COVID-19 pandemic and their important role in the assistance of patients from low-income regions, which has minimized the health system burden in an emergency context.

ABSTRACT Objective To characterize the use of private services in infant vaccination and assess vaccination coverage according to the service used. Methods : This was a national vaccination survey conducted in 2020 that estimated the use of private vaccination services and vaccination coverage among infants residing in state capitals and 12 inland municipalities. Results : Of the 37,801 participants, 25.1% (95%CI 23.2;27.2) used private services at least once, with higher proportions in capitals, larger cities and in the South and Southeast regions. Socioeconomic and demographic differences were identified among families, based on the service used. The coverage for the set of vaccines administered up to 24 months was 60.3% (95%CI 58.6;62.0) in the public service and 59.5% (95%CI 55.9;63.0) in private services, and up-to-date vaccines, 10.3% (95%CI 9.1;11.6) and 9.4% (95%CI 7.4;11.8), respectively. Conclusion The use of private services was frequent, with low coverage for the set of vaccines, regardless of the type of service used, especially for up-to-date vaccines.

ABSTRACT Objective To estimate vaccination coverage, identify barriers and hesitancy to vaccinating children up to 24 months, born between 2017-2018, living in the urban area of Rio Branco, Acre, Brazil. Methods Population survey carried out from 2020 to 2021, which assessed sociodemographic characteristics and vaccination status among children. Results Among 451 included children, vaccination coverage was below 80%. Meningococcal C vaccine had the lowest coverage for administered doses (76.3%; 95%CI 70.5;81.3) and doses on time (27.4%; 95%CI 23.1;32.1). The statements “vaccines cause serious adverse reactions” (26.4%; 95%CI 18.1;36.8) and “you don’t need vaccination for diseases that no longer exist” (22%; 95%CI 15.7;29.8) were the most frequent regarding vaccination hesitancy. Lack of vaccines was the main barrier to care (86.6%; 95%CI 71.8;94.3). Conclusion Vaccination coverage in children born in 2017-2018 was below the target recommended for the full schedule of administered doses, both valid and timely administered.

ABSTRACT Objective To analyze full vaccination coverage in live births in 2017 and 2018 in the capitals of the Midwest region of Brazil, according to social strata. Methods Population-based household survey with cluster sampling. Full coverage in children at 12 and 24 months of age and sociodemographic factors were analyzed. Results 5,715 children were analyzed. Full coverage at 12 months of age was 67.9% (95%CI 65.4;70.4), while at 24 months it was 48.2% (95%CI 45.3;51.1). Pneumococcal vaccine had the highest vaccination coverage (91.3%), while the second dose of rotavirus vaccine had the lowest (74.2%). In Campo Grande, no vaccine reached coverage above 90%, with BCG (82.9%) and hepatitis B (82.1%) standing out. Campo Grande and Brasília had the worst vaccination coverage in the high social stratum (24 months of age). Conclusion Vaccination coverage in the Midwest was below 80%, falling short of the recommended target and associated with socioeconomic factors.

ABSTRACT Objective To estimate vaccination coverage and analyze sociodemographic factors associated with non-vaccination in children born in 2017 and 2018 in the state capitals of Northeast Brazil. Methods A household survey using cluster sampling was conducted from 2020-2022 to estimate vaccination coverage and hesitancy. Factors associated with non-vaccination were analyzed using logistic regression to calculate Odds Ratios (OR) and their Confidence Intervals (95%CI). Results Natal was the capital with the lowest vaccination coverage, below 75.0% for most immunizers. Teresina had rates equal to or greater than 90.0% for all vaccines. Among those interviewed, 99.1% (95%CI 98.9;99.3) believe that vaccines are important for health; 95.4% (95%CI 95.0;95.8) trust immunobiologicals and 79.6% (95%CI% 78.8;80.3) are not afraid of reactions. Belonging to the highest socioeconomic stratum (adjusted OR: 1.34 – 95%CI 1.20;1.50) was as a factor associated with non-vaccination. Conclusion Low coverage highlights the need for a better understanding of regional specificities and social inequalities.

BackgroundType 2 diabetes (T2D) is preceded by prediabetes, and these conditions place a great burden on patients and society. These conditions are significantly associated with poor glycemic control, which is improved by resistance exercise. It has been suggested that resistance exercise should be performed with a high degree of effort to improve glucose metabolism, but this is associated with negative psychological responses that might lead to lower long-term adherence. ObjectiveThis study aimed to investigate the effect of the degree of effort during a resistance exercise session on glycemic control and psychological responses in individuals living with prediabetes or T2D. MethodsThis study will be a crossover, 3-arm, randomized controlled trial. A total of 15 participants living with prediabetes or T2D will be thoroughly familiarized with 7 resistance exercises; afterward, they will perform 3 randomized experimental sessions, each lasting approximately 48 hours each, separated by at least 4 washout days. In 2 of these sessions, supervised resistance exercise will be performed, but the sessions will differ in the degree of effort in each set (high vs low) and will be equalized in terms of total weight lifted and session duration. For this, proximity to failure will be manipulated by changing the number of sets per exercise, the number of repetitions per set, and the resting interval between sets and exercises. Participants will also complete a sedentary (control) session, where they will not perform any exercise. In response to each session, psychological responses will be assessed (exertion, affect, enjoyment, self-efficacy, and discomfort). Glycemic control will be assessed by a continuous glucose monitoring device every 5 minutes, throughout the approximately 48 hours of each experimental session. Food and drink will be individually prescribed by a registered dietitian nutritionist and provided to participants, in order to control for the confounding effect of energy intake and diet composition. Physical activity levels will be assessed by accelerometry. Randomization will be done using the opaque, sequentially numbered envelopes technique. Participants and researchers will be blinded for continuous glucose monitoring and accelerometry data, and data will be analyzed by a blinded statistician. ResultsThis study has been funded, and data collection is expected to take place between June 2024 and May 2025. Final manuscript submission should happen by August 2025. ConclusionsThe results of this project might encourage individuals living with prediabetes and T2D to engage in resistance exercise while better informing exercise specialists on how to best incorporate resistance exercise in their client’s or patient’s routine. Trial RegistrationClinicalTrials.gov NCT06208189; https://clinicaltrials.gov/study/NCT06208189 International Registered Report Identifier (IRRID)PRR1-10.2196/63598

ABSTRACT Major liver resections require extensive margins. Occasionally, insufficient parenchyma is available after surgery to maintain liver function. In such cases, vascular embolization in the affected lobe is necessary to induce contralateral lobe hypertrophy. We present a case of embolization of the right portal and hepatic veins prior to intrahepatic cholangiocarcinoma resection. Embolization was performed because of insufficient residual parenchyma on imaging studies. The patient recovered well with no signs of liver failure, and remains in remission at 3 years postoperatively. Knowledge of the use of this technique in association with surgical resection can reduce postoperative complications and allow the removal of larger tumors than those previously considered borderline.

Resumo: Este estudo teve como objetivo analisar a associação entre o desenvolvimento de ações intersetoriais entre escola/serviços de saúde da atenção primária à saúde (APS) e o reconhecimento de uma fonte usual do cuidado de APS entre adolescentes brasileiros. Trata-se de um estudo transversal, a partir da Pesquisa Nacional de Saúde do Escolar de 2015, realizado com 97.903 adolescentes, com amostragem complexa. A associação entre ações intersetoriais entre serviços de APS e escolas e o reconhecimento da fonte usual do cuidado da APS foram estimadas por meio da razão de prevalência (RP), com uso do modelo de regressão logística, sendo considerado o fator de ponderação amostral, por meio do Stata 14.0 Dos adolescentes analisados, 72,8% estudavam em escolas que desenvolviam ações intersetoriais com os serviços de APS. Entre esses, observou-se associação entre o reconhecimento da fonte usual do cuidado da APS e ações intersetoriais (RP = 1,11; IC95%: 1,08-1,14). Quando analisado para ações do Programa Saúde na Escola (RP = 1,40; IC95%: 1,37-1,43) e o desenvolvimento de ações entre a escola e os serviços de APS (RP = 1,08; IC95%: 1,05-1,12). Os resultados mostram que existe uma associação positiva entre o reconhecimento dos serviços de APS como uma fonte usual do cuidado e as ações intersetoriais. Entretanto, existem desafios na articulação entre os setores de saúde e educação, na perspectiva de uma prática que se configura como intersetorial, para a implementação das ações de prevenção e de promoção da saúde ao adolescente na escola. Envolvem, ainda, maior conhecimento sobre a percepção dos adolescentes sobre a qualidade do serviço ofertado pelas unidades de saúde.

ABSTRACT Objective To estimate vaccination coverage in children born between 2017-2018, living in urban areas of state capitals, the Federal District and 12 inland municipalities in Brazil, and to identify associated factors. Methods This was a household survey conducted between 2020-2022, among children up to 24 months old. Vaccination coverage was estimated according to family, maternal and child characteristics. Results Among the 37,801 children in the sample, complete coverage (doses administered) was 60.1% (95%CI 58.6;61.6) and 6.1% (95%CI 5.4;7.0) had not received any vaccines. Coverage was lower among children of mothers with lower level of education (OR = 0.70; 95%CI 0.54;0.90) and in those who experienced delays in receiving any vaccine by 6 months old (OR = 0.28; 95%CI 0.24;0.32). Conclusion Vaccination coverage is below the expected levels. Effective communication strategies are needed to reinforce the importance of routine vaccination, prevent delays and abandonment of the vaccination schedule, in order to recover the high coverage levels achieved in past decades.

ABSTRACT Objetive: This study aims to analyze the learning curves in performing the arthroscopic Latarjet surgery. Methods: This was an observational, retrospective, single-center study. All cases of arthroscopic Latarjet performed in this institution from 2016 to 2021 were included. The data analyzed were surgical time (of the chief surgeon alone and the group of surgeons), complications, and time until the return to sports activities. Technical observations about the learning process were also reported. Results: In total, 50 consecutive cases were included (93% retention of the initial sample identified at the institution). The decrease in surgical time was presented logarithmically and showed a decrease in time both for the individualized analysis of the senior surgeon (r = −0.67, p < 0.001) and for the surgical group (r = −0.476, p < 0.001). Mean operating time (and standard deviation) dropped from 235 minutes (73) in the first 10 cases to 156 minutes (34) for the subsequent cases (p < 0.001). In the first 20 cases, five intercurrences were recorded and three reoperations were performed, whereas subsequent cases presented only one intercurrence requiring surgical intervention (p = 0.032). The median time to return to sport was nine months for the first 20 cases versus six months for subsequent cases (p = 0.001). Conclusion: The learning curve for the arthroscopic Latarjet procedure showed a progressive decrease in operative time, complications, and time to return to sports activities. This suggests that the surgeon developed the necessary skills and confidence to reach a plateau of expertise to perform the surgical procedure. Level of evidence IV, Observational retrospective.

ABSTRACT Objective To analyze vaccination coverage according to social strata in children up to 24 months old, living in the municipality of Londrina (PR), Brazil. Methods This was a population-based survey conducted between 2021 and 2022, in which vaccination coverage and sociodemographic aspects of mothers and families were evaluated using Pearson’s chi-square test. Results In a sample of 456 children, complete vaccination coverage varied according to social strata, being 36.0% (95%CI 26.8;57.8); in stratum A; 59.5% (95%CI 26.1;86); in stratum B; 66.2% (95%CI 51.7;78.1); in stratum C; and 70.0% (95%CI 56.1;81.0) in stratum D. Conclusion The analysis of vaccination coverage indicated that social stratum A is at highest risk for vaccine-preventable diseases.

ABSTRACT Objective To estimate hepatitis A vaccination coverage in 24-month-old children and identify factors associated with non-vaccination. Methods This was a survey involving a sample stratified by socioeconomic strata in capital cities (2020-2022), with coverage estimates and 95% confidence intervals (95%CI), the factor analysis was performed using the prevalence ratio (PR) by means of Poisson regression. Results Among 31,001 children, hepatitis A coverage was 88.1% (95%CI 86.8;89.2). Regarding socioeconomic strata (A/B), the variable immigrant parents/guardians was associated with non-vaccination (PR = 1.91; 95%CI 1.09;3.37); in strata C/D, children of Asian race/skin color (PR = 4.69; 95%CI 2.30;9.57), fourth-born child or later (PR = 1.68; 95%CI 1.06;2 .66), not attending daycare/nursery (PR = 1.67; 95%CI 1.24;2.24) and mother with paid work (PR = 1.42; 95%CI 1.16;1.74) were associated with non-vaccination. Conclusion Hepatitis A coverage was below the target (95%), suggesting that specificities of social strata should be taken into consideration.

ABSTRACT Objective To analyze the reliability of records held on the National Immunization Program Information System (SI-PNI) in a subsample of children included in the national vaccination coverage survey in Brazilian state capitals and Federal District in 2020. Methods This was a study of agreement between data recorded on vaccination cards (doses and dates) and on the SI-PNI for 4050 children with full coverage at 24 months. Results Data on 3587 children were held on the SI-PNI, with losses of 11% (95%CI: 10;12). Total agreement between doses and dates in the two sources was 86% (95%CI: 86;87), however taking each dose and vaccine individually, variation was greater, with 32% of data in only one source. Conclusion Part of the information was not recorded, but the discrepancy can be considered small. Nonetheless, underrecording of doses and children can compromise vaccination coverage estimates, altering the numerator and denominator data.

ABSTRACT Objective To evaluate vaccination coverage and delay in vaccine dose administration in infants in six municipalities in the Southern region of Brazil. Methodology National Vaccination Coverage Survey 2020, with infants born alive in 2017 and 2018, carried out from September 2020 to March 2022. Coverage of doses administered, doses administered on time and delay in dose administration were evaluated. Results For 4681 infants analyzed, coverage for vaccines recommended up to 24 months was 68.0% (95%CI 63.9;71.8%) for doses administered and 3.9% (95%CI 2.7%;5.7%) for doses administered on time. Delay time for the majority of late vaccinations was ≤ 3 months. For some boosters, 25% of vaccine administration was delayed by ≥ 6 months. Conclusion In addition to tracking vaccine defaulters, strategies are needed to encourage compliance with the vaccination schedule at the recommended ages.

A expansão do acesso à internet ganhou força nos últimos anos, inclusive em áreas não urbanas. Esse acesso vem sendo incorporado ao cotidiano e ocupando espaços em contextos que anteriormente eram reservados para atividades mais coletivas ou de integração com o espaço onde se vive. Embora mudanças no cotidiano após a inclusão tecnológica sejam esperadas, o fato de o celular concentrar múltiplas funções rompe a ideia de utilização de um dispositivo para um fim específico, impactando, dessa forma, as rotinas pessoais, comunitárias e profissionais de seus usuários. Dessa forma, o presente trabalho tem como objetivo apresentar uma análise a partir da teoria bioecológica de Urie Bronfenbrenner sobre as percepções dos moradores de duas comunidades rurais, destacando a influência do uso ou da presença do telefone celular e da internet. Participaram da pesquisa 24 pessoas (22 usuários de telefone e 2 não) escolhidas através da metodologia de amostragem Snowball. O trabalho aponta diferenças nos resultados de inserções tecnológicas anteriores, como antenas rurais e orelhões, no cotidiano das pessoas, ao passo que demonstra o caráter ambíguo sobre o papel desses recursos que, ao mesmo tempo que facilitam o cotidiano e aproximam as pessoas, prejudicam as relações e deixam seus usuários vulneráveis a adoecimentos causados pelo uso abusivo dos equipamentos.

Abstract The increasing water contamination by toxic heavy metals, particularly hexavalent chromium, has become a significant environmental concern. This study explores the pyrolysis of termite-processed biomass, specifically Pinus elliottii particleboard and its termite droppings (TDs), to produce biochar and its application for chromium (VI) adsorption. Termite droppings, rich in lignin, and particleboard, rich in cellulose, were pyrolyzed at various temperatures to assess the effect of biomass composition on biochar properties. The study found that lignin-rich termite droppings produced biochar with higher fixed carbon content and specific surface area than cellulose-rich particleboard biochar. FTIR and Raman spectroscopy revealed significant molecular structure changes during pyrolysis, which influenced the adsorption capabilities of the biochar. Adsorption experiments demonstrated that TD biochar exhibited significantly higher chromium (VI) adsorption capacity, attributed to its distinct chemical composition and enhanced surface properties due to higher lignin content. These findings underscore the crucial role of lignin in producing efficient biochar for heavy metal adsorption, highlighting the practical applicability of termite-processed biomass in water purification technologies.

Abstract L1CAM-positive extracellular vesicles (L1EV) are an emerging biomarker that may better reflect ongoing neuronal damage than other blood-based biomarkers. The physiological roles and regulation of L1EVs and their small RNA cargoes following stroke is unknown. We sought to characterize L1EV small RNAs following stroke and assess L1EV RNA signatures for diagnosing stroke using weighted gene co-expression network analysis and random forest (RF) machine learning algorithms. Interestingly, small RNA sequencing of plasma L1EVs from patients with stroke and control patients (n = 28) identified micro(mi)RNAs known to be enriched in the brain. Weighted gene co-expression network analysis (WGCNA) revealed small RNA transcript modules correlated to diagnosis, initial NIH stroke scale, and age. L1EV RNA signatures associated with the diagnosis of AIS were derived from WGCNA and RF classification. These small RNA signatures demonstrated a high degree of accuracy in the diagnosis of AIS with an area under the curve (AUC) of the signatures ranging from 0.833 to 0.932. Further work is necessary to understand the role of small RNA L1EV cargoes in the response to brain injury, however, this study supports the utility of L1EV small RNA signatures as a biomarker of stroke.

We detected Mayaro virus (MAYV) in 3.4% (28/822) of febrile patients tested during 2018–2021 from Roraima State, Brazil. We also isolated MAYV strains and confirmed that these cases were caused by genotype D. Improved surveillance is needed to better determine the burden of MAYV in the Amazon Region.

Abstract Several studies have documented the significant impact of methodological choices in microbiome analyses. The myriad of methodological options available complicate the replication of results and generally limit the comparability of findings between independent studies that use differing techniques and measurement pipelines. Here we describe the Mosaic Standards Challenge (MSC), an international interlaboratory study designed to assess the impact of methodological variables on the results. The MSC did not prescribe methods but rather asked participating labs to analyze 7 shared reference samples (5 × human stool samples and 2 × mock communities) using their standard laboratory methods. To capture the array of methodological variables, each participating lab completed a metadata reporting sheet that included 100 different questions regarding the details of their protocol. The goal of this study was to survey the methodological landscape for microbiome metagenomic sequencing (MGS) analyses and the impact of methodological decisions on metagenomic sequencing results. A total of 44 labs participated in the MSC by submitting results (16S or WGS) along with accompanying metadata; thirty 16S rRNA gene amplicon datasets and 14 WGS datasets were collected. The inclusion of two types of reference materials (human stool and mock communities) enabled analysis of both MGS measurement variability between different protocols using the biologically-relevant stool samples, and MGS bias with respect to ground truth values using the DNA mixtures. Owing to the compositional nature of MGS measurements, analyses were conducted on the ratio of Firmicutes: Bacteroidetes allowing us to directly apply common statistical methods. The resulting analysis demonstrated that protocol choices have significant effects, including both bias of the MGS measurement associated with a particular methodological choices, as well as effects on measurement robustness as observed through the spread of results between labs making similar methodological choices. In the analysis of the DNA mock communities, MGS measurement bias was observed even when there was general consensus among the participating laboratories. This study was the result of a collaborative effort that included academic, commercial, and government labs. In addition to highlighting the impact of different methodological decisions on MGS result comparability, this work also provides insights for consideration in future microbiome measurement study design.

Resumo: Este estudo objetivou mensurar o acesso aos medicamentos para o tratamento da hipertensão arterial sistêmica e diabetes mellitus tipo 2 no Brasil segundo a via de obtenção, bem como analisar os fatores associados a esse acesso, de acordo com os dados da Pesquisa Nacional de Saúde (PNS) de 2019. Foram analisados dados socioeconômicos e relacionados ao uso de medicamentos de pessoas de 15 anos ou mais, em relação ao acesso via Programa Farmácia Popular do Brasil (PFPB) e via serviço público. A maior parte dos brasileiros que participaram da PNS referiu fazer uso do medicamento para controle da hipertensão, nos últimos 15 dias (91,5%), assim como a maior parte referiu fazer uso de medicamento oral para diabetes (95,2%) e/ou uso da insulina (70%).Os medicamentos orais para hipertensão arterial sistêmica e diabetes mellitus tipo 2 foram obtidos majoritariamente via PFPB, sendo respectivamente (45,2% e 53,6%), e os fatores que mais influenciaram negativamente esse acesso foram maior faixa etária, menor renda, menor escolaridade, não ter plano de saúde e referir uma autoavaliação de saúde muito ruim. O acesso à insulina, por sua vez, se deu com maior frequência via serviço público de saúde (69,7%), e os fatores que mais influenciaram negativamente esse acesso foram raça preta/parda, menor renda, não ter plano de saúde e referir uma autoavaliação de saúde muito ruim. De forma geral, foi evidenciada a importância do PFPB como política de ampliação de acesso a medicamentos essenciais no Brasil, considerando a gratuidade dos anti-hipertensivos e antidiabéticos.

ABSTRACT Objectives Individuals with congenital isolated growth hormone deficiency (IGHD) in Northeastern Brazil have a normal lifespan with a prolonged healthspan. We hypothesize that their increased healthspan is accompanied by a reduced cognitive decline during aging. We have recently shown that these individuals have a similar total cognitive function and better attention and executive function than controls. These data were obtained using a Portuguese version of the Literacy Independent Cognitive Assessment (LICA) instrument, whose translation to facilitate cognitive research in Portuguese-speaking countries is described here. Subjects and methods In the first stage, a psychologist and a psychiatrist translated the LICA instrument from English into Portuguese, and an English teacher proofread the translation. The second stage included its synthesis and cultural adaptation, carried out by Brazilian authors, and changes in some words and images. The third stage involved an evaluation round with two referees (independent psychologists). The fourth stage involved a back translation of the instrument, which demonstrated > 95% agreement with the original version. The fifth stage included a study to verify the understanding of the questionnaire by responders. In the sixth stage, an endocrinologist and a psychiatrist approved the final Portuguese version of the instrument, which was then administered to 15 individuals with IGHD and 15 controls older than 50 years. Results The LICA instrument was applied 59 times (5 times in the pilot study, 24 in the variability studies, and 30 in the experimental step). The interobserver and intraobserver variabilities were 99% and 96%, respectively. Cronbach’s alpha was 0.76, indicating good reliability. The mean (± standard deviation) duration of the application was 39 ± 8.6 and 48.5 ± 5.8 minutes in literate and illiterate individuals, respectively. Conclusion The Portuguese version of the LICA instrument was valuable for the cognitive assessment of individuals with Itabaianinha syndrome.

N/a.

Objective To evaluate the admission brain computed tomography (CT) scan findings in patients with traumatic brain injury (TBI) in a low- and middle-income country (LMIC) to predict long-term neurological outcomes.

Abstract: This study aimed to estimate the prevalence and identify social factors and preventive strategies associated with the coronavirus disease 2019 (COVID-19) in socio and economically vulnerable people (recyclable waste pikers, immigrants/refugees, and homeless people) in Goiânia, Goiás State, Central-Western Brazil. A cross-sectional study was conducted from July 2020 to October 2020. COVID-19 positivity was defined as a positive total anti-SARS-COV-2 antibody test and/or RNA test for SARS-COV-2. Univariable and multiple regression analyses were performed to identify the variables associated with COVID-19. Of the 594 participants, 47.3% were recyclable waste pickers, 29.6% were immigrants/refugees, and 23.1% were homeless people. The positivity for SARS-CoV-2 RNA was 14.1%, whereas for anti-SARS-CoV-2 a total of 30.8% were positive, and 39.4% were positive for at least one COVID-19 marker. Among the 541 individuals, being immigrants/refugees, not wearing a surgical mask, and having three or more people sleeping in the same room were associated with SARS-CoV-2 infection, while using TV news as the main source of information about the pandemic was a protective predictor of COVID-19. This study revealed ethnic and socioeconomic inequalities in the prevalence of COVID-19 among impoverished people in Brazil. Additionally, a high prevalence of COVID-19 was detected in all three groups. Developing new strategies to combat and prevent communicable diseases affecting this population is essential for mitigating future and ongoing pandemics.

Objetivos: Relatar caso de Síndrome de Desmielinização Osmótica (SDO) em paciente internado no Hospital Universitário Walter Cantídio (HUWC). Metodologia: Foi pesquisado na base de dados do aplicativo de gestão para Hospitais Universitários do HUWC paciente internado por SDO durante o período de agosto/2020 à outubro/2020. Após aprovação pelo Comitê de Ética em Pesquisa (CEP) do HUWC, foi realizado o relato do caso com base no prontuário, de forma retrospectiva e descritiva. Resultados: Paciente de 61 anos, portadora de doença renal crônica secundária a glomerulopatia membranosa, em uso de hidroclorotiazida e indapamida, diagnosticada com hiponatremia (sódio 104 mEq) sintomática. Realizada reposição com cloreto de sódio 3%. Apresentou elevação de 04, 15 e 27 mEq/L nas primeiras 24, 48 e 72 horas, respectivamente, resultando em sintomas neurológicos. Neuroimagem evidenciou mielinólise pontina e extrapontina. Após múltiplas intercorrências resultantes de infecções bacterianas, suporte clínico e reabilitação, evoluiu com melhora dos sintomas neurológicos, obtendo alta hospitalar. Conclusões: Faz-se necessário monitoramento do ionograma durante a terapêutica com tiazídicos em pacientes com doenças renais. Este caso demonstra que, mesmo seguindo diretrizes de reposição de sódio, o resultado pode ser imprevisível. Também evidencia a evolução variável da SDO, desde a recuperação dos sintomas até o óbito.

Abstract: The Brazilian Unified National Health System (SUS) has incorporated newborn screening for cystic fibrosis since 2001. The protocol involves two samples of immunoreactive trypsinogen (IRT1/IRT2). This study aims to analyze fixed and floating values at the first and second IRT (IRT1/IRT2) cutoff points and assess the accuracy of the IRT/IRT methodology in a population from Northeastern Brazil. Descriptive, individual-level data from the newborn screening reference service data system (2013-2017) were used in this observational population study. The sensitivity, specificity, and positive predictive values (PPV) for the protocol were calculated. The best cutoff point was determined using the Youden’s index. The previous year’s cut-off values for the IRT1 and IRT2 99.4-, 99.5-, 99.6-, and 99.7-percentiles were utilized for the floating cutoff. During the studied period, 840,832 newborns underwent screening for cystic fibrosis, obtaining 49 cystic fibrosis diagnoses: 39 by newborn screening (79.6%) and 10 (20.4%) by clinical suspicion (false negative). The sensitivity, specificity, and PPV of the protocol totaled 79.6%, 99.9%, and 6.1%, respectively. No proposed cutoff for IRT1 performed better than the current one. IRT2 performed similarly to the current protocol at a cutoff point of 90ng/mL, showing the appropriate sensitivity and specificity while reducing the frequency of false positives. The protocol to screen newborns for cystic fibrosis had low sensitivity, a predictive positive value, and a high number of false positives and negatives. A floating cut point for IRT1 or IRT2 seems to constitute no viable option. However, changing the IRT2 cut point from 70ng/mL to 90ng/mL seems to have advantages and should undergo consideration.

ABSTRACT Objective To describe vaccination coverage and hesitation for the basic children’s schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil. Methods Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy. Results Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy. Conclusion Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities.

ABSTRACT Objective To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. Methods Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. Results 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. Conclusion There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil.

Cetacean morbillivirus is an etiologic agent associated with strandings of live and dead cetacean species occurring sporadically or as epizootics worldwide. We report 2 cases of cetacean morbillivirus in humpback whales (Megaptera novaeangliae) in Brazil and describe the anatomopathological, immunohistochemical, and molecular characterization findings in the specimens.

Abstract Usher Syndrome classification takes into account the absence of vestibular function but its correlation with genotype is not well characterized. We intend to investigate whether video Head Impulse Test (vHIT) is useful in screening and to differentiate Usher Syndrome types. 29 Usher patients (USH) with a genetically confirmed diagnosis and 30 healthy controls were studied with vHIT and dizziness handicap inventory questionnaire (DHI). Statistical significant differences between USH1, USH2 and controls were found in the vestibulo-ocular-reflex (VOR) gain of all SCCs, with USH1 patients consistently presenting smaller gains. VOR gain of the right lateral SCC could discriminate controls from USH1, and USH2 from USH1 with an overall diagnostic accuracy of 90%. USH1 DHI correlated with VOR (ρ = − 0,971, p = 0.001). Occurrence rate of covert and overt lateral semicircular canals refixation saccades (RS) was significantly different between groups, being higher in USH1 patients (p

Abstract Although some studies have shown neuroimaging and neuropsychological alterations in post-COVID-19 patients, fewer combined neuroimaging and neuropsychology evaluations of individuals who presented a mild acute infection. Here we investigated cognitive dysfunction and brain changes in a group of mildly infected individuals. We conducted a cross-sectional study of 97 consecutive subjects (median age of 41 years) without current or history of psychiatric symptoms (including anxiety and depression) after a mild infection, with a median of 79 days (and mean of 97 days) after diagnosis of COVID-19. We performed semi-structured interviews, neurological examinations, 3T-MRI scans, and neuropsychological assessments. For MRI analyses, we included a group of non-infected 77 controls. The MRI study included white matter (WM) investigation with diffusion tensor images (DTI) and functional connectivity with resting-state functional MRI (RS-fMRI). The patients reported memory loss (36%), fatigue (31%) and headache (29%). The quantitative analyses confirmed symptoms of fatigue (83% of participants), excessive somnolence (35%), impaired phonemic verbal fluency (21%), impaired verbal categorical fluency (13%) and impaired logical memory immediate recall (16%). The WM analyses with DTI revealed higher axial diffusivity values in post-infected patients compared to controls. Compared to controls, there were no significant differences in the functional connectivity of the posterior cingulum cortex. There were no significant correlations between neuropsychological scores and neuroimaging features (including DTI and RS-fMRI). Our results suggest persistent cognitive impairment and subtle white matter abnormalities in individuals mildly infected without anxiety or depression symptoms. The longitudinal analyses will clarify whether these alterations are temporary or permanent.

The primary treatment for chronic myeloid leukemia (CML) involves first- and second-generation tyrosine kinase inhibitors (TKIs), such as imatinib, nilotinib, bosutinib, and dasatinib. However, these medications are ineffective against mutations in the kinase domain of the ABL1 protein, particularly in the protein with the T315I mutation. To address this, ponatinib (PNT), a third-generation inhibitor, was developed. Despite its efficacy in treating the BCR-ABL1T315I mutation, the use of PNT was briefly suspended in 2013 due to serious adverse effects but was subsequently reintroduced to the market. During the drug discovery and development process, it is rare to consolidate all information into a single article, as is the case with ponatinib. This review aims to compile and chronologically organize the research on the discovery of ponatinib using medicinal chemistry tools and computational methods. It includes in silico calculations, such as the octanol/water partition coefficient (cLogP) via SwissAdme, and 2D maps of intermolecular interactions through molecular docking. This approach enhances understanding for both specialists and those interested in medicinal chemistry and pharmacology, while also contextualizing future directions for further optimizations of ponatinib, facilitating the development of new analogs of this crucial inhibitor for the treatment of CML and Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL).

Introduction Obesity has become a worldwide public health problem and is directly linked to loss of quality of life, complications and comorbidities. One of them is chronic pain, especially in the knees, which increases significantly and proportionally with weight gain. In patients with severe obesity, with indication for bariatric surgery, the presence of chronic pain disables and often prevents their participation in a pre-surgical rehabilitation programme. As an analgesic therapy, photobiomodulation (PBM) has been studied with safety, efficacy, well-tolerated used and low costs. Thus, this study aims to evaluate the use of PBM for the treatment of chronic knee pain in obese patients undergoing a pre-surgical rehabilitation programme for bariatric surgery.Methods and analyses This is a double-blinded, randomised, placebo-controlled clinical, superiority, trial protocol. The PBM will be applied in bilateral knees and lumbar paraspinal points levels referring to the roots of innervation of the knee. The outcomes evaluated will be pain intensity, functionality, quality of life and clinical signs of neurological sensitization of chronic knee pain pathways.Ethics and dissemination This protocol has already been approved by the Comitê de Ética em Pesquisa do Hospital das Clínicas da Universidade Federal de Goiás/EBSERH—Ethics Committee and it is following SPIRIT guidelines. The results will be statistically analysed and subsequently published in peer-reviewed journals.Trial registration number Clinical Trials Platform (https://clinicaltrials.gov/) with the number NCT05816798.

A tuberculose é uma doença infecciosa transmitida pela bactéria Mycobacterium tuberculosis, que acomete principalmente os pulmões. O estudo relata a experiência de estudantes de medicina na elaboração e execução de ações para prevenção e controle da tuberculose em parceria com o Programa Saúde na Escola. Essa vivência possibilitou aos estudantes a compreensão dos problemas ocasionados pelo aumento dos casos de tuberculose na comunidade, sendo imprescindível a realização de ações de educação em saúde com medidas de prevenção e controle dessa patologia. Dessa forma, os estudantes perceberam a importância da articulação entre equipes de saúde e escolas do território de abrangência das Unidades Básicas de Saúde, a fim de fortalecer o enfrentamento das vulnerabilidades sociais.

Introduction: Currently, the physical and functional consequences on individuals who have recovered from the severe form of the Covid-19 and are experiencing traumatic stress remain unknown. Objective: To assess post-traumatic stress disorder (PTSD) in individuals post-hospital discharge following COVID-19 and investigate its relationship with sociodemographic variables, quality of life, muscle strength and functional capacity. Methods: A cross-sectional study was conducted, including individuals of both genders aged between 31 and 79 years, who had recovered from COVID-19 and required hospitalization. Participants underwent evaluations for PTSD, physical activity level, mobility and balance (Timed Up and Go test – TUG), the distance covered in the 6-minute walk test (6MWT) and quality of life (Short Form-36 Health Srvey -SF-36). Results: Out of 153 eligible individuals, 60 successfully completed the assessments. The age range was 31 to 77 years, and 63.3% were female. PTSD was identified in 48.3%, with 38.7% exhibiting partial symptoms. Furthermore, 65.5% of individuals with PTSD were obese, and 62.1% were hypertensive. This group demonstrated a higher degree of sedentary behavior (p=0.009), increased frequency of intensive care unit hospitalization, and a greater number of days hospitalized, respectively (p

A gastroenterite aguda (GEA) continua a ser uma das patologias mais frequentes em idade pediátrica, sendo que a rehidratação oral permanece a pedra angular do seu tratamento. O racecadotril é um fármaco antidiarreico utilizado no tratamento da diarreia aguda em crianças, dado que reduz a secreção de água e eletrólitos pelo aparelho digestivo. Apesar de poder ser considerado no tratamento da GEA, não é claro se é realmente eficaz. O objetivo deste trabalho é, através de uma revisão bibliográfica, avaliar se existe evidência que suporte o seu uso no tratamento da diarreia aguda em idade pediátrica. Foi realizada uma pesquisa de artigos publicados nos últimos 10 anos, na língua portuguesa ou inglesa, nas bases de dados MEDLINE; NICE; Cochrane Library; BMJ; CPG Infobase - Clinical Practice Guidelines; Bandolier. As palavras-chave utilizadas foram “Racecadotril”, “Child”, “Child, Preschool”, “Diarrhea” e “Gastroenteritis”. A seleção dos artigos foi feita em duplicado pelas autoras que, perante dúvidas, discutiram conjuntamente a sua inclusão/exclusão. Para a atribuição dos níveis de evidência e forças de recomendação, foi usada a escala Strenght of Recommendation Taxonomy. Obtiveram-se um total de 443 artigos, tendo, no final, sido incluídos oito artigos: três meta-análises, duas revisões, duas guidelines e uma opinião de peritos. Os estudos incluídos nesta revisão demonstraram uma redução no número e volume de dejeções, na duração da diarreia e no tempo de cura. Conclui-se que o racecadotril parece ser eficaz no tratamento da diarreia aguda e pode ser considerado em conjunto com a solução de rehidratação oral (SORT B).

A gastroenterite aguda (GEA) continua a ser uma das patologias mais frequentes em idade pediátrica, sendo que a rehidratação oral permanece a pedra angular do seu tratamento. O racecadotril é um fármaco antidiarreico utilizado no tratamento da diarreia aguda em crianças, dado que reduz a secreção de água e eletrólitos pelo aparelho digestivo. Apesar de poder ser considerado no tratamento da GEA, não é claro se é realmente eficaz. O objetivo deste trabalho é, através de uma revisão bibliográfica, avaliar se existe evidência que suporte o seu uso no tratamento da diarreia aguda em idade pediátrica. Foi realizada uma pesquisa de artigos publicados nos últimos 10 anos, na língua portuguesa ou inglesa, nas bases de dados MEDLINE; NICE; Cochrane Library; BMJ; CPG Infobase - Clinical Practice Guidelines; Bandolier. As palavras-chave utilizadas foram “Racecadotril”, “Child”, “Child, Preschool”, “Diarrhea” e “Gastroenteritis”. A seleção dos artigos foi feita em duplicado pelas autoras que, perante dúvidas, discutiram conjuntamente a sua inclusão/exclusão. Para a atribuição dos níveis de evidência e forças de recomendação, foi usada a escala Strenght of Recommendation Taxonomy. Obtiveram-se um total de 443 artigos, tendo, no final, sido incluídos oito artigos: três meta-análises, duas revisões, duas guidelines e uma opinião de peritos. Os estudos incluídos nesta revisão demonstraram uma redução no número e volume de dejeções, na duração da diarreia e no tempo de cura. Conclui-se que o racecadotril parece ser eficaz no tratamento da diarreia aguda e pode ser considerado em conjunto com a solução de rehidratação oral (SORT B).