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Background: The city of Manaus, Brazil, has seen two collapses of the health system due to the COVID-19 pandemic. We report anti-SARS-CoV-2 nucleocapsid IgG antibody seroconversion rates and associated risk factors in Manaus residents before the second wave of the epidemic in Brazil. Methods: A convenience sample of adult (aged ≥18 years) residents of Manaus was recruited through online and university website advertising into the DETECTCoV-19 study cohort. The current analysis of seroconversion included a subgroup of DETECTCoV-19 participants who had at least two serum sample collections separated by at least 4 weeks between Aug 19 and Oct 2, 2020 (visit 1), and Oct 19 and Nov 27, 2020 (visit 2). Those who reported (or had no data on) having a COVID-19 diagnosis before visit 1, and who were positive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at visit 1 were excluded. Using an in-house ELISA, the reactivity index (RI; calculated as the optical density ratio of the sample to the negative control) for serum anti-SARS-CoV-2 nucleocapsid IgG antibodies was measured at both visits. We calculated the incidence of seroconversion (defined as RI values ≤1·5 at visit 1 and ≥1·5 at visit 2, and a ratio >2 between the visit 2 and visit 1 RI values) during the study period, as well as incidence rate ratios (IRRs) through cluster-corrected and adjusted Poisson regression models to analyse associations between seroconversion and variables related to sociodemographic characteristics, health access, comorbidities, COVID-19 exposure, protective behaviours, and symptoms. Findings: 2496 DETECTCoV-19 cohort participants returned for a follow-up visit between Oct 19 and Nov 27, 2020, of whom 204 reported having COVID-19 before the first visit and 24 had no data regarding previous disease status. 559 participants were seropositive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at baseline. Of the remaining 1709 participants who were seronegative at baseline, 71 did not meet the criteria for seroconversion and were excluded from the analyses. Among the remaining 1638 participants who were seronegative at baseline, 214 showed seroconversion at visit 2. The seroconversion incidence was 13·06% (95% CI 11·52–14·79) overall and 6·78% (5·61–8·10) for symptomatic seroconversion, over a median follow-up period of 57 days (IQR 54–61). 48·1% of seroconversion events were estimated to be asymptomatic. The sample had higher proportions of affluent and higher-educated people than those reported for the Manaus city population. In the fully adjusted and corrected model, risk factors for seroconversion before visit 2 were having a COVID-19 case in the household (IRR 1·49 [95% CI 1·21–1·83]), not wearing a mask during contact with a person with COVID-19 (1·25 [1·09–1·45]), relaxation of physical distancing (1·31 [1·05–1·64]), and having flu-like symptoms (1·79 [1·23–2·59]) or a COVID-19 diagnosis (3·57 [2·27–5·63]) between the first and second visits, whereas working remotely was associated with lower incidence (0·74 [0·56–0·97]). Interpretation: An intense infection transmission period preceded the second wave of COVID-19 in Manaus. Several modifiable behaviours increased the risk of seroconversion, including non-compliance with non-pharmaceutical interventions measures such as not wearing a mask during contact, relaxation of protective measures, and non-remote working. Increased testing in high-transmission areas is needed to provide timely information about ongoing transmission and aid appropriate implementation of transmission mitigation measures. Funding: Ministry of Education, Brazil; Fundação de Amparo à Pesquisa do Estado do Amazonas; Pan American Health Organization (PAHO)/WHO. World Health Organization Revisión por pares

Background: Twice city of Manaus located in the Brazilian rainforest, has experienced a health system collapse due to the SARS-CoV-2 pandemic. However, little is known about which groups among the general population have been more affected. In this report, we present the overall prevalence of SARS-CoV-2 infection and associated factors from the DETECTCoV-19 cohort. Methods: A convenience sampling strategy via online advertising recruited 3046 adults. Sociodemographic characteristics, COVID-19-related symptoms, COVID-19 testing, self-medication and prescribed medications were recorded. Serum anti-SARS-CoV-2 nucleocapsid IgG antibodies were measured with an in-house ELISA. Prevalence ratios (PR) were obtained using cluster-corrected and adjusted Poisson’s regression models. Findings: A crude positivity rate among asymptomatic and symptomatic individuals, was estimated at 29·10%, with a maximum seroprevalence of 41·53% corrected by test characteristics and an antibody decay rate of 27%. Regression models demonstrated a strong association towards marginalized low-income and vulnerable residents with limited health access. Presence of a COVID-19 case (PR 1·39, 1·24-1·57) or death (PR 2·14, 1·74-2·62) in a household increased greatly the risk of other household members acquiring infection. SARS-CoV-2 seroprevalence was higher among those who self-medicated to prevent infection (PR 1·36, 1·27-1·46). Interpretation: High SARS-CoV-2 seropositivity reveals a much burdensome scenario than estimations based on confirmed COVID-19 cases in Manaus. Overall, prevalence of SARS-CoV-2 antibody response demonstrated a disproportionate social and economic disparity among the study participants. The syndemic nature of COVID-19 in the Amazon region needs differential policies and urgent solutions to control the pandemic. Funding: Research was funded by Ministry of Education (MEC), Brazil. BBS, IVPF, ROS, ARCB and WBSS received scholarship from CAPES. DSSS, TBNM, MFF and NOC received scholarship from FAPEAM Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: The research ethics committee of Federal University of Amazonas (UFAM) approved this study (CAAE:34906920·4·0000·5020) in accordance with Brazilian law

Objetivos: Analisar a utilização do tubo T de Montgomery para o tratamento de lesões esofágicas cervicais tardias em um hospital terciário. Metodologia: Estudo observacional descritivo e retrospectivo de pacientes atendidos no serviço de Cirurgia Torácica do Hospital Português Beneficente do Amazonas no período de janeiro de 2008 a dezembro de 2020 por meio de análise de prontuários. Submetido e aprovado pelo Comitê de Ética em Pesquisa pelo CAEE: 34100920.0.0000.5020 e parecer de nº 4.131.284. Foram incluídos todos os pacientes tratados através da utilização de tubo T de Montgomery visando a correção de lesões cervicais tardias. Aqueles sem dados suficientes nos prontuários foram excluídos do estudo. Resultado: Foram estudados cinco pacientes com lesões esofágicas cervicais tardias tratados com a utilização do tubo T de Montgomery. Havia três (60%) pacientes do sexo feminino e dois (40%) do sexo masculino, com uma idade média de 44 anos. Os principais sintomas apresentados foram cervicalgia e disfagia. Em todos os casos, devido à contaminação e ao comprometimento do tecido, foi realizada cervicotomia com rafia de esôfago e colocação do Tubo de Montgomery culminando com o fechamento completo das fístulas. Conclusão: o prognóstico das lesões cervicais de esôfago depende do tempo de diagnóstico e da intervenção precoce. Quando o tratamento é feito tardiamente e na vigência de infecção, o tubo T de Montgomery se apresenta como uma alternativa obtentora de bons resultados.

Objetivo: Descrever o perfil epidemiológico e características do trabalho de profissionais atuantes em UTI de pacientes com COVID-19, seus principais meios de atualização frente à pandemia e fatores de estresse a que são submetidos. Métodos: Trata-se de estudo transversal, envolvendo profissionais atuantes em UTI-COVID-19, aprovado pelo Comitê de Ética em Pesquisa e realizado em agosto de 2020, com dados coletados por meio da plataforma Google Forms. Resultados: Foram avaliados 63 profissionais, 41,3% técnicos de enfermagem e 27% enfermeiros; 52% com menos de 40 anos e com média de 13 anos de atuação profissional. A Internet foi utilizada por 96,8% dos avaliados para sanar dúvidas profissionais. A carga horária diária de 77,7% dos profissionais foi de 12 horas e a realização de curativos e banhos no leito foram consideradas as atividades mais demoradas e cansativas; 46% dos profissionais foram acometidos por COVID-19. Conclusão: Profissionais atuantes em UTI COVID eram, majoritariamente, da área da enfermagem e com menos de 40 anos. A alta taxa de infecção por COVID na equipe, demora e cansaço na realização de determinadas atividades e o regime de trabalho podem ser considerados fatores estressores na equipe. A Internet se mostrou o principal meio de atualização utilizado.

There is a high prevalence of leprosy in the Amazon region of Brazil. We have developed a distance education course in leprosy for training staff of the Family Health Teams (FHTs). The course was made available through a web portal. Tele-educational resources were mediated by professors and coordinators, and included the use of theoretical content available through the web, discussion lists, Internet chat, activity diaries, 3-D video animations (Virtual Human on Leprosy), classes in video streaming and case simulation. Sixty-five FHT staff members were enrolled. All of them completed the course and 47 participants received a certificate at the end of the course. At the end of the course, 48 course-evaluation questionnaires were answered. A total of 47 participants (98%) considered the course as excellent. The results demonstrate the feasibility of an interactive, tele-education model as an educational resource for staff in isolated regions. Improvements in diagnostic skills should increase diagnostic suspicion of leprosy and may contribute to early detection.

Os autores descrevem a técnica que utilizaram para a realização da colecistectomia agulhascópica no Núcleo de Hospital de Aeronáutica de Manaus, de setembro de 1997 a maio de 1999, e os resultados iniciais obtidos em 83 pacientes (11 do sexo masculino e 72 do feminino, com idades variando de 17 a 87 anos) portadores de doenças da vesícula biliar. Empregaram, além de um equipamento completo de videolaparoscopia, um equipamento acessório composto de um monitor de vídeo, uma microcâmera, com seu processador de imagens, e uma fonte de luz, tudo para o laparoscópio de 1,7 mm MiniSite®. A operação foi realizada principalmente sob monitoramento videolaparoscópico de 10 mm pelo portal umbilical e por meio de três portais de 2 mm (epigástrico, hipocôndrio direito e flanco direito). Utilizou-se o videolaparoscópio de 2 mm pelo portal epigástrico quando se procedeu às ligaduras císticas, ocasião em que o laparoscópio de 10 mm umbilical era substituído pelo aplicador de clipes de 10 mm. Da mesma forma, a vesícula foi retirada da cavidade abdominal pelo portal umbilical sob monitoramento videolaparoscópico de 1,7 mm epigástrico. A maioria dos casos operados (89,2%) não apresentava espessamento da parede vesicular. O tempo cirúrgico médio do procedimento foi de 92 ± 21 min e o de internação foi de 16 h. A principal intercorrência operatória foi a perfuração da vesícula biliar (41%), atribuída à curva de aprendizado no método por que passa a equipe. Vômitos foram a principal complicação pós-operatória (51,8%), não tendo havido infecção de ferida operatória. Oitenta e dois por cento dos casos puderam ser terminados pelo método agulhascópico puro, enquanto em 6% e 3,6%, respectivamente, houve necessidade de trocar um dos portais de 2 mm por um de 5 ou de 10 mm e de converter o procedimento para videolaparoscopia usual. Em 6% dos casos, por problemas de imagem com o microlaparoscópio, realizou-se o procedimento agulhascópico com a assistência de um portal suprapúbico de 10 mm. Dois casos (2,4%) tiveram que ser convertidos para laparotomia convencional, um por problemas operacionais com o equipamento e outro por dificuldades técnicas transoperatórias. Os autores concluem ser o procedimento agulhascópico factível, demandar uma nova curva de aprendizado por parte da equipe e ser demorado em virtude das características de seus instrumental e equipamento. The authors describe the technique they employed to perform needlescopic cholecystectomies in the Núcleo de Hospital de Aeronáutica de Manaus, from September 1997 to May 1999. A complete videolaparoscopic set of equipment was used in the procedure in association to an extra videocapture set for the microlaparoscope (video monitor, microcamera and light source). The procedure is mainly performed with the needlescopic instruments (MiniSite®) inserted in the epigastric, upper right abdominal quadrant and right flanc 2mm trocar sleeves, introduced through the anterior abdominal wall with 10 mm umbilical videolaparoscopic guidance. The microlaparoscope was employed through the epigastric port to monitor the 10 mm clip applier, inserted through the umbilical port to ligate the cistic elements. Likewise, it was employed to monitor gallbladder removal from the abdominal cavity through the umbilical wound. The 2 mm skin wounds were closed with sterile surgical tape. A total of 83 patients (11 males, 72 females), ranging from 17 to 87 years of age, with gallbladder diseases were operated. There was no patient selection in the study but most of the cases (89.2%) did not present inspissated gallbladder walls. The mean operative time was 92 ± 21 min and the average time of hospitalization was 16 h. The main peroperative incident observed was gallbladder puncture with bile leakage to the abdominal cavity (41%), which was considered due to the surgical team’s learning curve in the method. Vomits were the main postoperative complication (51.8%) and there was no instance of wound infection. The complete method of needlescopic cholecystectomy was employed in 82% of the patients; in 6% of the patients, a 5 or 10 mm portal had to be put in place of one of the 2 mm to deal with thick walled gallbladders or to correct image problems encountered with the 2 mm laparoscope; in another 6% of the patients, an extra 10 mm suprapubic portal was employed to receive the 10 mm laparoscope when the umbilical portal was used with 5 and 10 mm instruments (in these cases the 2 mm laparoscope was not available due to fiberoptic deterioration). In 3.6 % of the surgeries, the needlescopic method had to be converted to the usual videolaparoscopic one (with two 5 mm and two 10 mm portals). Two operations had to be converted to conventional cholecystectomies (one due to equipment failure and the other due to a solid block of inflammatory adhesions to the hepatic hilar structures). The authors conclude that needlescopic cholecystectomies are feasible, demand the surgical team to go through a new learning curve period and are responsible for a longer operative time due to peculiarities of the instruments and equipment involved.