Influence of Congenital Heart Defect Types over Cardiopulmonary Bypass, Aortic Cross-Clamping, and Intensive Care Unit Length of Stay and Their Association with Genetic Factors

Aim: Surgical correction of congenital heart defects (CHD) often requires interruption of blood flow through cardiopulmonary bypass (CPB) and aortic cross-clamping (ACC), for which duration(s) are considered to be prognostic factors, along with intensive care unit (ICU) length of stay (ICULOS). The aim of this study was to evaluate these surgical prognostic factors in pediatric patients with different types of CHD regarding their type of lesion and associated genetic factors. Study Design: Cross-sectional cohort study with 307 pediatric patients. Place and Duration of Study: Pediatric Intensive Care Unit (ICU) of Hospital da Criança Santo Antônio, in Porto Alegre/RS, Brazil, from 2006-2009 (3 years) Methodology: After inclusion criteria, we studied 266 pediatric patients admitted for the first time in a reference cardiac pediatric ICU from Southern Brazil following cardiac surgery. Intraoperative prognostic factors such as duration of CPB, ACC and ICULOS, in addition to dysmorphological and cytogenetic examinations were compiled and analyzed. P-values of <0.05 were considered significant. Results: CPB time was associated to four outflow tract defects (Tetralogy of Fallot [ToF], transposition of the great arteries [TGA], double outlet right ventricle, and truncus arteriosus [TA]), atrioventricular septal defect, and hypoplastic left heart syndrome (HLHS) (P < 0.001). ACC duration was associated with three outflow tract defects (ToF, TGA, and TA) and HLHS (P < 0.001). Moreover, CPB and ACC times showed an association with cyanotic and complex heart defects, as well as prolonged ICULOS (P < 0.001). There was no relationship between these prognostic factors and syndromic aspects or cytogenetic findings. Conclusions: CHD type has an impact over CPB and ACC duration and ICULOS, whereas genetic factors are not associated with those prognostic factors.

Face-based automatic pain assessment: challenges and perspectives in neonatal intensive care units

Abstract Objective: To describe the challenges and perspectives of the automation of pain assessment in the Neonatal Intensive Care Unit. Data sources: A search for scientific articles published in the last 10 years on automated neonatal pain assessment was conducted in the main Databases of the Health Area and Engineering Journal Portals, using the descriptors: Pain Measurement, Newborn, Artificial Intelligence, Computer Systems, Software, Automated Facial Recognition. Summary of findings: Fifteen articles were selected and allowed a broad reflection on first, the literature search did not return the various automatic methods that exist to date, and those that exist are not effective enough to replace the human eye; second, computational methods are not yet able to automatically detect pain on partially covered faces and need to be tested during the natural movement of the neonate and with different light intensities; third, for research to advance in this area, databases are needed with more neonatal facial images available for the study of computational methods. Conclusion: There is still a gap between computational methods developed for automated neonatal pain assessment and a practical application that can be used at the bedside in real-time, that is sensitive, specific, and with good accuracy. The studies reviewed described limitations that could be minimized with the development of a tool that identifies pain by analyzing only free facial regions, and the creation and feasibility of a synthetic database of neonatal facial images that is freely available to researchers.

Residência Médica e Reforma Psiquiátrica brasileira: convergências e conflitos na formação para o cuidado em saúde mental / Medical Residency and Brazilian Psychiatric Reform: Convergences and conflicts in the formation for Mental Health Care

Resumo O estudo tem por objetivo identificar em que medida e de que forma os princípios, diretrizes e métodos propostos pela Reforma Psiquiátrica Brasileira (RPB) estão presentes na formação dos psiquiatras em programas de Residência Médica. Trata-se de estudo qualitativo que investiga conteúdos e experiências promovidos durante a formação em programas de Residência Médica de Psiquiatria no Brasil. Foram entrevistados 16 sujeitos em quatro instituições públicas de formação, sendo dois programas centrados em hospitais-escola e outros dois em modelos integrados a serviços da Rede de Atenção Psicossocial. Os resultados do estudo permitem sustentar que, apesar de todos os programas remeterem a princípios da RPB em seus conteúdos teóricos, as oportunidades de prática dos modelos integrados dialogam mais diretamente com a experiência da RPB. Entre outros resultados relevantes, destacam-se: preocupação com o cuidado integral, não centrado apenas nos diagnósticos e sintomas, mas na singularidade e no andar a vida dos sujeitos; crítica à medicalização, seja na forma do uso abusivo de medicação, seja como interferência em demandas não especificamente médicas; importância de experiências interdisciplinares em equipes multiprofissionais e uma proposta da superação de uma cultura manicomial que vai além da institucionalidade dos serviços, mas que opera nos processos cotidianos de normalização social.

Abstract The study aims to identify to what extent and how the principles, guidelines and methods proposed by the Brazilian Psychiatric Reform (BPR) are present in the training of psychiatrists in medical residency programs. This is a qualitative study that investigates contents and experiences promoted during training in psychiatric medical residency programs in Brazil. A total of 16 subjects were interviewed in four public training institutions, two programs centered on school hospitals and two in models integrated with psychosocial care network services. The results of the study allow us to argue that, although all programs refer to BPR principles in their theoretical contents, the services integrated programs seems to promote a closer dialogue with the BPR experience. Among other relevant results, the following stand out: concern with comprehensive care, not focused only on diagnoses and symptoms, but on the singularity and ways of life of the subjects; criticism of medicalization, either in the form of abuse of medication, or as interference in non-specifically medical demands; relevance of interdisciplinary experiences in multidisciplinary teams and the aim to overcome a manicomial culture that goes beyond the institutionality of services, but that operates in the daily processes of social normalization.

Analysis of the efficacy of prophylactic tranexamic acid in preventing postpartum bleeding: systematic review with meta-analysis of randomized clinical trials

Abstract Background Postpartum Hemorrhage (PPH) is one of the main causes of maternal mortality, mainly in the poorest regions of the world, drawing attention to the need for strategies for preventing it. This study aims to evaluate the efficacy of prophylactic administration of Tranexamic Acid (TXA) in decreasing blood loss in pregnant women in delivery, preventing PPH. Methods Systematic review of randomized clinical trials. We searched for publications in PubMed, EMBASE and Cochrane Library databases, with the uniterms "postpartum, puerperal hemorrhage" and "tranexamic acid", published between January of 2004 and January of 2020. The eligibility criteria were trials published in English with pregnant women assessed during and after vaginal or cesarean delivery about the effect of prophylactic use of TXA on bleeding volume. The random-effects model was applied with the DerSimonian-Laird test and the Mean Difference (MD) was calculated for continuous variables together with each 95% CI. This systematic review was previously registered in the PROSPERO platform under the registration n° CRD42020187393. Results Of the 630 results, 16 trials were selected, including one with two different doses, performing a total of 6731 patients. The intervention group received a TXA dose that varied between 10 mg.kg−1 and 1g (no weight calculation). The TXA use was considered a protective factor for bleeding (MD: -131.07; 95% CI: -170.00 to -92.78; p= 0.000) and hemoglobin variation (MD: -0.417; 95% CI: -0.633 to -0.202; p= 0.000). In the subgroup analysis related to the cesarean pathway, the effect of TXA was even greater. Conclusion The prophylactic use of tranexamic acid is effective in reducing the post-partum bleeding volume. PROSPERO registration ID CRD42020187393.

Eating disorders are associated with adverse obstetric and perinatal outcomes: a systematic review

Objective: To systematically review the literature focusing on obstetric and perinatal outcomes in women with previous or current eating disorders (EDs) and on the consequences of maternal EDs for the offspring. Methods: The study was performed following the systematic review and meta-analysis (PRISMA) statement. PubMed, SciELO, and Cochrane databases were searched for non-interventional studies published in English or Portuguese from January 1980 to December 2020. Risk of bias was assessed using the Methods guide for effectiveness and comparative effectiveness reviews (American Agency for Healthcare Research and Quality). Results: The search yielded 441 records, and 30 articles were included. The psychiatric outcome associated with EDs in women was mainly perinatal depression. The most prevalent obstetric outcomes observed in women with EDs were vomiting, hyperemesis, bleeding, and anemia. Most studies found maternal anorexia nervosa and bulimia nervosa to be associated with low birth weight and slow fetal growth. Women with binge EDs delivered children with increased birth weight. Of the 30 studies included, methodological quality was good in seven, fair in eight, and poor in 15 studies. Conclusion: A considerable body of evidence was reviewed to assess obstetric and perinatal outcomes in EDs. Acute and lifetime EDs, especially if severe, correlated with poor perinatal, obstetric, and neonatal outcomes. Obstetricians and general practitioners should be vigilant and screen for EDs during pregnancy.

Fluidodinâmica Computacional na Avaliação do Risco Futuro de Aneurismas de Aorta Ascendente / Computational Fluid Dynamics to Assess the Future Risk of Ascending Aortic Aneurysms

Resumo Fundamentos Uma metodologia para identificação de pacientes portadores de aneurisma de aorta ascendente (AAAs) sob alto risco de remodelamento aórtico não está completamente definida. Objetivo Esta pesquisa objetiva caracterizar numericamente o fluxo sanguíneo aórtico, relacionando a distribuição do estresse mecânico resultante com o crescimento de AAAs. Métodos Estudo analítico, observacional, unicêntrico, em que um protocolo de fluidodinâmica computacional (CFD - Computacional Fluid Dynamics) foi aplicado a imagens de angiotomografia computadorizada (ATC) de aorta de pacientes portadores de AAAs. Duas ATC de aorta com pelo menos um ano de intervalo foram obtidas. Dados clínicos dos pacientes foram registrados e, a partir das imagens de ATC, foram gerados modelos tridimensionais. Foram realizados estudos do campo de velocidade e estruturas coerentes (vórtices) com o objetivo de relacioná-los ao crescimento ou não do aneurisma e, posteriormente, compará-los com os dados clínicos dos pacientes. O teste de Kolmogorov-Smirnov foi utilizado para avaliar a normalidade da amostra e o teste não-paramétrico Wilcoxon signed-rank foi aplicado para comparações de dados pareados entre os ângulos aórticos. A significância estatística foi fixada em 5%. Resultados Para o grupo que apresentou crescimento do aneurisma, a incidência do jato na parede aórtica gerou áreas de recirculação posterior ao jato, induzindo à formação de vórtices complexos, ocasionando um incremento na pressão média no endotélio aórtico. O grupo sem crescimento do aneurisma apresentou diminuição na pressão média. Conclusão Este estudo piloto mostrou que a CFD baseada em ATC pode, em um futuro próximo, ser uma ferramenta auxiliar na identificação dos padrões de fluxo associados ao processo de remodelamento de AAAs.

Abstract Background A methodology to identify patients with ascending aortic aneurysm (AsAA) under high risk for aortic growth is not completely defined Objetive This research seeks to numerically characterize the aortic blood flow by relating the resulting mechanical stress distribution with AsAA growth. Methods Analytical, observational, single-center study in which a computational fluid dynamics (CFD) protocol was applied to aortic computed tomography angiogram (CTA) images of patients with AsAA. Two CTA exams taken at a minimum interval of one year were obtained. From the CTA-gathered images, three-dimensional models were built, and clinical data were registered. Study of velocity field and coherent structures (vortices) was performed aiming to relate them to the presence or absence of aneurysm growth, as well as comparing them to the patients' clinical data. The Kolmogorov-Smirnov test was used to evaluate the normality of the distribution, and the non-parametric Wilcoxon signed-rank test, for non-normal distribution, was used to compare the paired data of the aortic angles. Statistical significance was set at 5%. Results The incident jet in the aortic wall generated recirculation areas in the posterior region of the jet, inducing complex vortices formation in the group with aneurysm growth, leading to an average pressure increase in the ascending aortic wall between exams. In the group without aneurysm growth, the average pressure decreased. Conclusion This pilot study showed that CFD based on CTA may in the near future be a tool to help identify flow patterns associated with AsAA remodeling process.

The contribution of the BIOTA/FAPESP Program to the advancement of the knowledge on terrestrial invertebrates / A contribuição do Programa BIOTA/FAPESP para o avanço no conhecimento sobre os invertebrados terrestres

Abstract The variability of the organisms living in a given area constitute what is referred to as biodiversity, one of nature's fundamental properties, responsible for the balance and stability of ecosystems. The loss of biodiversity has been of great concern to scientists, especially because of the role played by human activities in this regard, able to lead to irreversible circumstances. The São Paulo Research Foundation (Fundação de Amparo à Pesquisa do Estado de São Paulo, FAPESP) plays a major role in supporting research efforts in the most diverse branches of science. In the late 1990´s, FAPESP launched a major program to promote research on biodiversity, named BIOTA/FAPESP. So far, this program has financed the conduction of 26 projects, involving research activities in most of Brazil, while focusing mainly the State of São Paulo. These projects have generated about 1140 publications in peer-reviewed journals of high standard, providing relevant information, including the original description of 1187 species and 76 genera, the complementary description of 350 species, as well as a number of inventory works, biological studies, etc. The program has also been instrumental in the establishment or adequacy of research facilities and training of new taxonomists. Most extensively studied groups of terrestrial invertebrates include Insecta of the orders Hymenoptera, Lepidoptera and Diptera, and Arachnida of the subclasses Araneae and Acari. Distinct projects have also contributed to the detection of organisms potentially useful as biological control agents and in the determination of maps of major interest for the establishment of public policies. In the future, priority groups for study should include the Annelida and the Nematoda, for the potential both have as beneficial organisms, or for the potential some Nematoda have as organisms harmful to plants and animals.

Resumo A variabilidade dos organismos em uma determinada área constitui o que se denomina biodiversidade, uma das propriedades fundamentais da natureza, responsável pelo equilíbrio e estabilidade dos ecossistemas. A perda da biodiversidade tem sido uma grande preocupação para os cientistas, principalmente pelo papel desempenhado pelas atividades humanas, com potencial para desencadear circunstâncias irreversíveis. A Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) desempenha um papel importante no apoio às pesquisas nos mais diversos ramos da ciência. No final da década de 1990, a FAPESP lançou um grande programa de fomento à pesquisa em biodiversidade, denominado BIOTA/FAPESP. Até o momento, este programa financiou a realização de 26 projetos, envolvendo atividades na maior parte do Brasil, embora tenham como foco principal o estado de São Paulo. Esses projetos geraram cerca de 1.140 publicações em periódicos de alto impacto, fornecendo informações relevantes que incluem a descrição original de 1.187 espécies e 76 gêneros e a descrição complementar de 350 espécies, além de diversos trabalhos de inventário, estudos biológicos etc. O programa também tem sido fundamental para o estabelecimento ou adequação de instalações de pesquisa científica e o treinamento de novos taxonomistas. Os grupos de invertebrados terrestres mais estudados incluem os Insecta das ordens Hymenoptera, Lepidoptera e Diptera, e os Arachnida das subclasses Araneae e Acari. Projetos distintos também têm contribuído para a detecção de organismos potencialmente úteis como agentes de controle biológico e na determinação de mapas de áreas preferenciais para o estabelecimento de políticas públicas. No futuro, os grupos prioritários de estudo devem incluir os Annelida e os Nematoda, pelo potencial que ambos têm como organismos benéficos, ou pelo potencial que alguns Nematoda têm como organismos prejudiciais a plantas e animais.

Impact of COVID-19 on education, health and lifestyle behaviour of Brazilian urology residents

ABSTRACT Objectives: To evaluate the impact of COVID-19 on clinical and surgical practice, educational activities, health and lifestyle behavior of Brazilian urology residents. Materials and Methods: A web-based survey was sent to 468 Brazilian urology residents from postgraduate years (PGY) 3 to 5 to collect data on clinical practice and training after 4 months of COVID-19. We also assessed health-related and behavior changes, rate of infection by SARS-CoV-2, deployment to the front line of COVID-19, residents' concerns, and access to personal protective equipment (PPE). Results: Massive reductions in elective and emergency patient consultations, diagnostic procedures and surgeries were reported across the country, affecting PGY 3 to 5 alike. Most in-person educational activities were abolished. The median damage to the urological training expected for 2020 was 6.0 [3.4 - 7.7], on a scale from 0 to 10, with senior residents estimating a greater damage (P< 0.001). Educational interventions developed included online case-based discussions, subspeciality conferences and lectures, and grand rounds. Most senior residents favored extending residency to compensate for training loss and most younger residents favored no additional training (p< 0.001). Modifications in health and lifestyle included weight gain (43.8%), reduced physical activity (68.6%), increased alcoholic intake (44.9%) and cigarette consumption (53.6%), worsening of sexual life (25.2%) and feelings of sadness or depression (48,2%). Almost half were summoned to work on the COVID-19 front-line and 24.4% had COVID-19. Most residents had inadequate training to deal with COVID-19 patients and most reported a shortage of PPE. Residents' concerns included the risk of contaminating family members, being away from residency program, developing severe COVID-19 and overloading colleagues. Conclusions: COVID-19 had a massive impact in Brazilian urology residents´ training, health and lifestyle behavior, which may reflect what happened in other medical specialties. Studies should confirm these findings to help developing strategies to mitigate residents' losses.

Correlação entre o sistema sanguíneo ABO e portadores de gastrite / Correlation between the ABO blood group system and gastritis

RESUMO: Introdução: A infecção pelo Helicobacter pylori (HP) e fatores ambientais são importantes fatores de risco para gastrite. Estudos apontam correlação entre o sistema ABO e doenças gastrointestinais. Objetivos: caracterizar o perfil sociodemográfico de portadores de gastrite e HP e sua correlação com o sistema do grupo sanguíneo ABO. Materiais e métodos: Estudo prospectivo e descritivo, realizado em Aracaju, Sergipe, Brasil, de abril/2018 a maio/2019. Amostra constituída por 133 pacientes que realizaram endoscopia digestiva alta, análise histopatológi-ca e tipagem sanguínea. Foram diagnosticados com gastrite 93 pacientes. Utilizou-se questionário sociodemográ-fico e clínico. Os dados foram analisados pelo RCore Team 2019 e submetidos a análises descritivas e inferenciais. Nível de significância 5%. Resultados: Idade média 53,7 anos (DP 17,4) sendo 48 (51,6%) do sexo masculino (p=0,018), 56 (65,9%) pardos, 45 (52,9%) casados e 33 (35,5%) tinham empregos fixos. Dos portadores de gastrite, 59 (63,4%) eram do tipo sanguíneo O. Dentre os tipos de gastrite, 31(33,4%) eram enantematosa leve e 16 (51,6%) desses eram do tipo O. Houve prevalência do tipo O em todos os graus de atividade inflamatória. Foi detectado H. pylori em 29 (31,2%) pacientes, sendo o fenótipo O mais prevalente nos graus moderado e severo da infecção. Conclusão: Os homens foram mais acometidos de gastrite, independente do tipo segundo a classificação de Sydney. O fenótipo sanguíneo O foi mais prevalente nos portadores de gastrite, naqueles que apresentaram atividade inflamatória à histologia e em portadores de H. pylori grau moderado e severo. (AU)

ABSTRACT: Introduction: Helicobacter pylori (HP) infection and environmental factors are important risk factors for gastritis. Studies show a correlation between the ABO system and gastrointestinal diseases. Aims: To characterize the sociodemographic profile of patients with gastritis and HP and its correlation with the ABO blood group system. Materials and methods: Prospective and descriptive study, carried out in Aracaju, Sergipe, Brazil, from April / 2018 to May / 2019. Samples were collected from 133 patients who underwent upper digestive endoscopy, histo-pathological analysis, and blood typing. Out of which, 93 patients were diagnosed with gastritis. A sociodemographic and clinical questionnaire was also used. Data analyzed by RCore Team 2019 and submitted to descriptive and inferential analyzes. Results: Average age 53.7 (SD 17.4) with 48 (51.6%) being male (p = 0.018), 56 (65.9%) brown, 45 (52.9%) married and 33 (35.5%) pursuing permanent jobs. Fifty-nine patients (63.4%) out of those with gastritis were blood type O. Among the types of gastritis, 31 (33.4%) were mild enanthematous and 16 (51.6%) of these were type O. There was a prevalence type O in all degrees of inflammatory activity. H. pylori were detected in 29 (31.2%) patients; the most prevalent phenotype being the moderate and severe degrees of infection. Conclusion: Men were mostly affected by gastritis, regardless of the type according to the Sydney classification. The blood phenotype O was more prevalent in patients with gastritis, in those who had inflammatory activity at histology and in patients with moderate, and severe H.pylori. (AU)

A percepção do usuário de um Centro de Atenção Psicossocial sobre a assistência em saúde mental / The perception of Psychosocial Care Center users about the assistance in mental health

RESUMO:Introdução: Os Centros de Atenção Psicossocial (CAPS) são serviços especializados na assistência de indivíduos com transtornos mentais graves e persistentes e têm como finalidade trabalhar o processo de reabilitação psicos-social. Objetivo: conhecer a percepção dos usuários de um CAPS sobre a assistência em saúde mental. Método:Trata-se de um estudo descritivo, exploratório, com abordagem qualitativa, realizado com oito usuários de um CAPS de Maceió-AL, no mês de fevereiro de 2017, por meio de entrevista para coleta de material e análise de conteúdo para discussão dos resultados. Resultados: A partir das falas dos sujeitos, surgiram as categorias "O CAPS na visão do usuário" e "Desafios e possibilidades para melhoria no CAPS". Conclusão: O estudo aponta para uma importância significativa desses serviços na saúde mental dos usuários e reconhecimento da necessidade do inves-timento em políticas públicas para melhoria da qualidade da assistência. (AU)

ABSTRACT: Introduction: The psychosocial care centers (CAPS in Brazilian Portuguese) are specialized services that assist people with severe and persistent mental disorders and it has the purpose of developing the process of psychosocial rehabilitation. Objective: to identify the perception of users of CAPS about the assistance in mental health. Method: it is a descriptive and exploratory study, with a qualitative approach, performed with 08 users of CAPS in Maceió-AL, Brazil, in February 2017, through interviews to collect material and content analysis to discuss the results. Results: From the subjects' statements, such categories have emerged "CAPS from the user's perspective" and "Challenges and possibilities to improve CAPS". Conclusion: The research points to the considerable importance of these services to the users and to the acknowledgment of the need to invest in public policies to improve the assistance quality.

Effect of dietary inclusion of guanidinoacetic acid on broiler performance / Efecto de la inclusión dietética del ácido guanidinoacético en el desempeño de pollos de engorde / Efeito da inclusão dietética do ácido guanidinoacético no desempenho de frangos de corte

Abstract Background: Creatine and its precursor, guanidinoacetic acid (GAA), decrease protein degradation, avoiding amino acid offset to gluconeogenesis. Objective: To evaluate the inclusion of GAA in the pre-initial diet (1 to 7 days) on performance, digestibility, and blood parameters of broilers from one to 21 days of age. Methods: 252 male broiler chickens aged one day were distributed in a completely randomized design with seven replicates and 12 animals per experimental unit. Treatments consisted of a basal diet, and the basal added with 0.10 and 0.20% GAA. Results: From days 1 to 7, a tendency on improved feed conversion (FC) was observed for broilers receiving 0.20% GAA (p<0.10). Between 7 and 14 days, FC improved, as well as a tendency was observed on improved weight gain in animals fed 0.20% GAA. Animals that received 0.20% GAA showed higher blood concentrations of creatine kinase. Blood creatine and blood glucose did not differ between treatments at day six. The assimilation coefficient of crude protein increased during days 3 to 7 for animals receiving 0.20% GAA. On the period between 17 and 21 days, no difference was observed between treatments. Intestinal weight and length did not show significant differences. Conclusion: Dietary inclusion of 0.20% GAA during the pre-initial stage could improve weight gain and feed conversion of broilers between 1 and 14 days of age.

Resumen Antecedentes: La creatina suministra energía y el ácido guanidinoacético (GAA) es su precursor y actúa como sustrato energético, reduciendo la degradación proteica y evitando el desvío de aminoácidos para gluconeogénesis. Objetivo: Evaluar el GAA en la dieta de pre-iniciación (1 a 7 dias) sobre el desempeño, la digestibilidad y los parámetros sanguíneos de pollos entre 1 y 21 dias de edad. Métodos: Se utilizaron 252 pollitos de engorde machos de un día de edad, distribuidos en un diseño completamente al azar, con siete repeticiones y 12 aves por unidad experimental. Los tratamientos consistieron en: ración basal y ración basal adicionada con 0,10 y 0,20% de GAA. Resultados: En el período de 1 a 7 días se observó una tendencia de mejora de la conversión alimenticia (FC) en las aves que recibieron 0,20% de GAA (p<0,10). De 7 a 14 días hubo mejoría en FC y tendencia de mejora en ganancia de peso de los animales que recibieron 0,20% de GAA. Los animales que recibieron 0,20% de GAA presentaron mayor concentración sanguínea de creatina quinasa. La creatinina y la glucosa sanguínea a los seis días no difirieron entre los tratamientos. El coeficiente de metabolización de la proteína bruta aumentó en el período de 3 a 7 días en los animales que recibieron 0,20% de GAA. Para el período de 17 a 21 días no hubo diferencia entre los tratamientos. Para peso y longitud del intestino no se presentaron diferencias significativas. Conclusión: El GAA a un nivel de 0,20% en la dieta pre- inicial podria mejorar la ganancia de peso, y la conversión alimenticia en el período de 1 a 14 días de edad en pollos de engorde.

Resumo Antecedentes: A creatina é uma substância que fornece energia e o ácido guanidinoacético (GAA) é seu precursor atuando como substrato energético, menor degradação proteica evitando o desvio de aminoácidos para gliconeogênese. Objetivo: Avaliar o GAA em dietas pré-iniciais sobre o desempenho, a digestibilidade e parâmetros sanguíneos. Métodos: Foram utilizados 252 pintos de corte machos de um a 21 dias de idade distribuído sem delineamento inteiramente casualizado, sete repetições e 12 aves por unidade experimental. Os tratamentos consistiram: ração basal e rações com 0,10 e 0,20% de GAA. Resultados: No período de 1 a 7 dias foi observada tendência de melhora da conversão alimentar (FC) (p<0,10) quando as aves receberam 0,20% de GAA. No período de 7 a 14 dias houve melhora na FC e tendência de melhora do ganho de peso dos animais que receberam 0,20% de GAA. Animais que receberam 0,20% de GAA apresentaram concentração sanguínea da enzima creatina quinase maior. A creatinina sanguínea aos seis dias e glicose sanguínea não diferiram entre os tratamentos. O coeficiente de metabolização da proteína bruta foi aumentado no período de 3 a 7 dias para animais que receberam 0,20% de GAA, para o período de 17 a 21 dias não houve diferença entre os tratamentos. Peso e comprimento do intestino não apresentaram diferenças significativas. Conclusão: O GAA em nível de 0,20% na dieta pré-inicial melhoram o ganho de peso, e a conversão alimentar no período de 1 a 14 dias de idade em frangos.

Influence of treatment access on survival of metastatic renal cell carcinoma in brazilian cancer center

ABSTRACT Background: Tyrosine kinase inhibitors (TKI) and immunotherapy improved survival in metastatic renal cell carcinoma (mRCC). Disparities in treatment access are present in healthcare systems globally. The aim of this study was to analyze survival outcomes of mRCC patients treated with first-line TKIs in the public (PHS) and private (PrS) health system in a Brazilian Cancer Center. Materials and Methods: Records from all mRCC patients treated with first-line TKIs from 2007-2018 were reviewed retrospectively. Categorial variables were compared by Fisher's exact test. Survival was estimated by Kaplan-Maier method and survival curves were compared using the log-rank test. Prognostic factors were adjusted by Cox regression model. Results: Of the 171 eligible patients, 37 (21.6%) were PHS patients and 134 (78.4%) were PrS patients. There were no difference in age, gender, or sites of metastasis. PHS patients had worse performance status (ECOG ≥2, 35.1% vs. 13.5%, p=0.007), poorer risk score (IMDC poor risk, 32.4% vs. 16.4%, p=0.09), and less nephrectomies (73% vs. 92.5%, p=0.003) than PrS patients. Median lines of therapy was one for PHS versus two for PrS patients (p=0.03). Median overall survival (OS) was 16.5 versus 26.5 months (p=0.002) and progression-free survival (PFS), 8.4 versus 11 months (p=0.01) for PHS and PrS patients, respectively. After adjusting for known prognostic factors on multivariate analysis, PHS patients still had a higher risk of death (HR: 1.61, 95% CI: 1.01-2.56, p=0.047). Conclusion: Patients with mRCC treated via the PHS had worse overall survival, possibly due to poorer prognosis at presentation and less drug access.

Healthcare professionals in COVID-19: safety, fear, and intention to leave / Profissionais de saúde na COVID-19: segurança, medo e intenção de se afastar / Profesionales de la salud en COVID-19: seguridad, miedo e intención de alejarse

The objective was to verify the fear of COVID-19 mediating role between the perception of safety at work and the intention of professionals on the frontline of COVID-19 to distance themselves from work. For this intent, 227 professionals (Mage = 33.01; SD = 7.67), mostly female (67.8%), answered the Safety Climate Scale in Hospital Work, the Intentional Behavior to Take a Leave of Absence Scale adapted to the COVID-19 context, the Fear of COVID-19 Scale, and a sociodemographic questionnaire. The safety perception in places of fight against the COVID-19 minimizes the fear of infection, consequently reducing health professionals' intention to take leaves of absence when in hospitals in the pandemic. Thus, ensuring the professionals' safety in their workplace is a protective factor of fear, so it may collaborate for the development of relevant strategies that minimize the intention to take a leave of absence.

O objetivo deste trabalho foi verificar o papel mediador do medo da COVID-19 na relação entre a percepção de segurança no trabalho e a intenção de profissionais atuantes no combate da COVID-19 de se afastarem do serviço. Para tanto, 227 profissionais (Midade = 33,01; DP = 7,67), maioria do gênero feminino (67,8%), responderam à Escala de Clima de Segurança no Trabalho Hospitalar, à Escala de Intenção Comportamental de Afastamento dos Serviços, adaptadas para o contexto da COVID-19, a Fear of COVID-19 Scale e a um questionário sociodemográfico. A percepção de segurança nos locais de combate à COVID-19 minimiza o medo da infecção, consequentemente diminuindo a intenção dos profissionais atuantes em hospitais na pandemia de se afastarem do serviço. Assim, assegurar segurança dos profissionais no local de trabalho é um fator protetivo do medo, que pode então colaborar para o desenvolvimento de estratégias pertinentes que minimizem a intenção de afastamento do trabalho.

El objetivo del presente trabajo fue verificar el papel mediador del miedo de la COVID-19 en la relación entre percepción de seguridad en el trabajo y la intención de apartarse de los servicios de profesionales actuantes en el combate el COVID-19. Por lo tanto, 227profesionales (Medad = 33.01 años; DE= 7.67), la mayoría mujeres (67.8%), respondieran la Escala de Clima de Seguridad en el Trabajo Hospitalario, la Escala de Intención Comportamental de Alejarse de los Servicios, adaptadas para el contexto de la COVID-19, Fear of COVID-19 Scale y cuestionario sociodemográfico. La percepción de seguridad en los lugares de combate al COVID-19 minimiza el miedo a la enfermedad, reduciendo en consecuencia la intención de alejarse de los profesionales de los hospitales durante la pandemia. Así, velar por la seguridad de los profesionales en el trabajo es un factor protector del miedo, por lo que es posible colaborar en el desarrollo de estrategias relevantes que minimicen la intención de alejarse del trabajo.

Drivers of damselfishes distribution patterns in the southwestern Atlantic: tropical and subtropical reefs compared

Damselfishes are known keystone species of reef environments, however large-scale distribution patterns are poorly studied in the southwestern Atlantic. We evaluated main drivers of distribution of three conspicuous damselfishes, along tropical and subtropical coastal systems, in Brazil. Abundances were assessed against wave exposure, depth (within 1-7 m in tropical and 1-11 m in subtropical reefs) and benthic cover. Despite differences between systems, exposure and depth consistently explained damselfishes distribution. Stegastes fuscus, the larger damselfish species of the genus in the southwestern Atlantic, was dominant in both systems, inhabiting preferably shallow and sheltered reefs. Conversely, Stegastes variabilis occupied shallow habitats with higher exposure. Stegastes pictus was absent from tropical reefs sampled, inhabiting depths >7 m, in subtropical reefs. Species were weakly associated with benthic features, which poorly predicted changes in abundances. Regardless, S. fuscus showed association with articulated calcareous algae, and S. variabilis juveniles associated with erect macroalgae. Despite occurring in very distinctive reef systems, Brazilian damsels habitat requirements are consistent in both tropical and subtropical reefs. While highly persistent species, long term monitoring will inform us how they respond to pervasive global changes and human impacts along Brazilian reefs.(AU)

Os peixes donzela são espécies-chave em ambientes recifais, contudo seus padrões de distribuição em grande escala são pouco conhecidos no sudoeste do Atlântico. Avaliamos os principais descritores de distribuição para três espécies comuns em sistemas recifais tropicais e costões rochosos subtropicais costeiros no Brasil, em resposta a diferentes regimes de exposição a ondas, profundidade e cobertura bentônica. Apesar das grandes diferenças entre estes sistemas, a exposição das ondas e a profundidade consistentemente explicaram sua distribuição. Stegastes fuscus é numericamente dominante, sendo a maior espécie do gênero no Atlântico sudoeste, dominando recifes rasos e menos hidrodinâmicos, enquanto S. variabilis foi mais abundante em habitats com maior hidrodinamismo. Stegastes pictus foi ausente nos recifes rasos tropicais amostrados e, nos recifes rochosos subtropicais, foi mais abundante em profundidades acima de 7 m. Características do substrato influenciaram pouco a densidade, porem S. fuscus apresentou associação a algas calcárias articuladas, enquanto juvenis de S. variabilis se associaram a macroalgas eretas. Peixes donzelas são generalistas e persistentes, ocorrendo em ambientes distintos, e mesmo assim, regulados de forma especifica e consistente ao longo da costa. O monitoramento a longo prazo nos informará como elas responderão às constantes mudanças globais e impactos antrópicos nos recifes brasileiros.(AU)

Mortality Following Hip Fracture Surgery During COVID-19 Pandemic Compared to Pre-COVID-19 Period: A Case Matched Cohort Series

@#Introduction: This study aims to report on clinical outcomes and 30-day mortality of patients with neck of femur fracture during COVID-19 pandemic and compare the outcomes in a cohort during the same period prior to the pandemic. Materials and methods: The study included 66 patients with hip fracture over the age of 60 years, presented between 1st March and 15th May 2020 and matched with the patients with hip fractures (75 patients) managed during the corresponding period in 2019 as control. Data was collected on demographics, comorbidities, COVID-19 status, procedures and mortality and complications. Results: Thirty-day mortality following hip surgery was 13.6% during COVID-19 pandemic with all the mortalities in patients with ASA Grade 3 and 4. Mortality was considerably high for intracapsular fracture (20%) but highest in cemented hemiarthroplasty (20%). One third of the hip fractures operated in COVID-19 designated theatre died within 30 days of surgery. Thirty-day mortality rate for COVID-19 positive hip fracture patients were 55.5%. There has been higher 30-day mortality for hip surgeries during COVID-19 pandemic with positive correlation between patient’s COVID-19 test status and 30-day mortality following hip surgeries. Conclusion: There is strong association between 30-day mortality and the designated theatre (Clean/COVID) where the patients were operated on with higher mortality for intracapsular neck of femur fractures with significant mortality associated with cemented hemiarthroplasty particularly among symptomatic or COVID-19 positive patients. Therefore, adoption of a multidisciplinary approach is recommended to optimally balance the risk-benefit ratio for planning of management of hip fractures while considering patient’s peri-operative outcomes.

Association between dietary pattern and metabolic disorders in children and adolescents with urolithiasis / Associação entre o padrão alimentar e distúrbios metabólicos em crianças e adolescentes com urolitíase

Abstract Objective: To describe the dietary patterns and occurrence of metabolic disorders in children and adolescents with urolithiasis treatment at a referral hospital in southern Brazil in order to learn the features of urolithiasis in this population to better develop preventive actions. Methods: Descriptive study conducted between 2016 and 2017 in a tertiary care referral hospital. Fourty patients aged 2-19 years old with urolithiasis proven by imaging were included. Clinical and dietary data were obtained through interviews and medical records. For statistical analyses, the chi-squared test was performed. Results: 40 individuals were analyzed. Mean age at diagnosis was 7.2 ± 4 years. 25% were overweight or obese. 95% had metabolic disorders, hypocitraturia being the predominant type. Protein intake was adequate in all participants and carbohydrate intake, in 70% of them; 37.5% had lipid intake above recommended and 65% had low fiber intake. The mean daily sodium intake was 2.64 g (±1.74), with 55% of participants ingesting more than the recommended amount. A total of 52.5% had low potassium intake, with a mean of 4.79 g/day (±2.49). Calcium intake was adequate in 27.5%. No significant differences were identified in relation to mean daily consumption among participants with or without the various metabolic disorders. Conclusion: Pediatric urolithiasis is often accompanied by metabolic disorders; therefore, metabolic evaluation should be part of the diagnostic process and subsequent analysis of these patients' dietary patterns, helping to optimize treatment and prevent recurrences and complications.

Resumo Objetivo: Descrever o padrão alimentar e a ocorrência de distúrbios metabólicos em crianças e adolescentes portadoras de urolitíase acompanhadas em hospital de referências no sul do Brasil a fim de conhecer as particularidades da urolitíase nessa população para melhor desenvolver ações de prevenção. Métodos: Estudo observacional descritivo realizado entre 2016 e 2017 em centro de referência em atenção terciária. Foram selecionados 40 pacientes de dois a 19 anos com urolitíase comprovada por exame de imagem. Dados clínicos e alimentares foram obtidos através de prontuário e entrevista. Para análise estatística, utilizou-se o teste qui-quadrado. Resultados: Foram analisados 40 indivíduos, 55% masculinos. Idade média ao diagnóstico 7,2 ± 4 anos; 25% tinham sobrepeso ou obesidade; 95% tinham distúrbios metabólicos, predominou a hipocitratúria. O consumo proteico e de carboidratos foi adequado em 100% e 70% dos participantes, respectivamente, 37,5% apresentaram ingestão de lipídeos acima do recomendado e 65% apresentaram ingestão de fibras alimentares abaixo do recomendado. O consumo diário médio de sódio foi de 2,64 g (± 1,74), com 55% acima do recomendado; 52,5% apresentaram baixa ingestão de potássio com média de 4,79 g/dia (± 2,49). O consumo de cálcio foi adequado em 27,5%. Não foram identificadas diferenças significativas em relação ao consumo médio diário dos nutrientes entre os participantes com ou sem os diversos distúrbios metabólicos. Conclusões: A urolitíase pediátrica é frequentemente acompanhada de distúrbios metabólicos, o que confirma a necessidade de avaliação metabólica adequada ao diagnóstico e análise do padrão alimentar a fim de identificar erros alimentares, aprimorar o tratamento desses distúrbios e prevenir recorrências e complicações.

Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists

ABSTRACT Objectives To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020. Materials and Methods A 39-question, web-based survey was sent to all urologist members of the Brazilian Society of Urology. We assessed socio-demographic, professional, health and behavior parameters. The primary goal was to evaluate changes in urologists' clinical practice and income after two months of COVID-19. We also looked at geographical differences based on the incidence rates of COVID-19 in different states. Results Among 766 urologists who completed the survey, a reduction ≥ 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of ≥ 50% was reported by 54.3%. Measures to reduce costs were implemented by most. Video consultations were performed by 38.7%. Modifications in health and lifestyle included weight gain (32.9%), reduced physical activity (60.0%), increased alcoholic intake (39.9%) and reduced sexual activity (34.9%). Finally, 13.5% of Brazilian urologists were infected with SARS-CoV-2 and about one third required hospitalization. Urologists from the highest COVID-19 incidence states were at a higher risk to have a reduction of patient visits and non-essential surgeries (OR=2.95, 95% CI 1.86 - 4.75; p< 0.0001) and of being infected with SARS-CoV-2 (OR=4.36 95%CI 1.74-10.54, p=0.012). Conclusions COVID-19 produced massive disturbances in Brazilian urologists' practice, with major reductions in patient visits and surgical procedures. Distressing consequences were also observed on physicians' income, health and personal lives. These findings are probably applicable to other medical specialties.