Acute physiological responses to "recovery intermittent hypoxia" in hiit / Respuestas agudas a la "hipoxia intermitente de recuperación" en el hiit / Respostas fisiológicas agudas à "hipóxia intermitente de recuperação" no hiit

ABSTRACT Introduction: Traditional intermittent hypoxia training improves sport performance after short periods of exposure, but acute exposure to intermittent hypoxia leads to decreased training intensity and technical quality. The solution to overcome these negative effects may be to perform efforts in normoxia and the intervals between efforts in hypoxia, maintaining the quality of training and the benefits of hypoxia. Objective: This study aimed to evaluate the acute physiological responses to hypoxia exposure during recovery between high intensity efforts. Materials and methods: Randomized, one-blind, placebo-controlled study. Sixteen men performed a graded exercise test to determine their maximal intensity and two sessions of high-intensity interval training. The training intervals could be in hypoxia (HRT), FIO2: 0.136 or normoxia (NRT), FIO2: 0.209. During the two-minute interval between the ten one-minute efforts, peripheral oxygen saturation (SpO2), heart rate (HR), blood lactate ([La]), blood glucose ([Glu]) were constantly measured. Results: There were differences in HR (TRN = 120 ± 14 bpm; TRH = 129 ± 13 bpm, p < 0.01) and SpO2 (TRN = 96.9 ± 1.0%; TRH = 86.2 ± 3.5%, p < 0.01). No differences in [La] and [Glu] TRN (4.4 ± 1.7 mmol.l-1; 3.9 ± 0.5 mmol.l-1) and TRH (5.2 ± 2.0 mmol.l-1; 4.0 ± 0.8 mmol.l-1, p = 0.17). Conclusion: The possibility of including hypoxia only in the recovery intervals as an additional stimulus to the training, without decreasing the quality of the training, was evidenced. Level of Evidence II; Randomized Clinical Trial of Minor Quality.

RESUMEN Introducción: El entrenamiento tradicional en hipoxia intermitente mejora el rendimiento deportivo tras cortos periodos de exposición, sin embargo, la exposición aguda a la hipoxia intermitente conduce a una disminución de la intensidad del entrenamiento y de la calidad técnica. La solución para superar estos efectos negativos puede ser realizar los esfuerzos en normoxia y los intervalos entre esfuerzos en hipoxia, manteniendo la calidad del entrenamiento y los beneficios de la hipoxia. Objetivo: Este estudio pretendía evaluar las respuestas fisiológicas agudas a la exposición a la hipoxia durante la recuperación entre esfuerzos de alta intensidad. Materiales y métodos: Estudio aleatorizado, a ciegas y controlado con placebo. Dieciséis hombres realizaron una prueba de ejercicio graduado para determinar su intensidad máxima y dos sesiones de entrenamiento por intervalos de alta intensidad. Los intervalos de entrenamiento podían ser en hipoxia (HRT), FIO2: 0,136 o normoxia (NRT), FIO2: 0,209. Durante el intervalo de dos minutos entre los diez esfuerzos de un minuto, se midieron constantemente la saturación periférica de oxígeno (SpO2), la frecuencia cardiaca (FC), el lactato en sangre ([La]) y la glucemia ([Glu]). Resultados: Hubo diferencias en la FC (TRN = 120 ± 14 lpm; TRH = 129 ± 13 lpm, p < 0,01) y la SpO2 (TRN = 96,9 ± 1,0%; TRH = 86,2 ± 3,5%, p < 0,01). No hubo diferencias en [La] y [Glu] TRN (4,4 ± 1,7 mmol.l-1; 3,9 ± 0,5 mmol.l-1) y TRH (5,2 ± 2,0 mmol.l-1; 4,0 ± 0,8 mmol.l-1, p = 0,17). Conclusión: Se evidenció la posibilidad de incluir hipoxia sólo en los intervalos de recuperación como estímulo adicional al entrenamiento sin disminuir la calidad del mismo. Nivel de Evidencia II; Ensayo Clínico Aleatorizado de Baja Calidad.

RESUMO Introdução: O treinamento de hipóxia intermitente tradicional melhora o desempenho esportivo após curtos períodos de exposição, porém a exposição aguda à hipóxia intermitente leva à diminuição da intensidade do treinamento e da qualidade técnica. A solução para superar esses efeitos negativos pode ser realizar esforços em normóxia e os intervalos entre os esforços em hipóxia, mantendo a qualidade do treinamento e os benefícios da hipóxia. Objetivo: Este estudo teve como objetivo avaliar as respostas fisiológicas agudas à exposição de hipóxia durante a recuperação entre esforços de alta intensidade. Materiais e métodos: Estudo aleatório e one-blinded, com efeito placebo controlado. Dezesseis homens realizaram um teste de exercício graduado para determinar sua intensidade máxima e duas sessões de treinamento intervalado de alta intensidade. Os intervalos de treinamento podem ser em hipóxia (TRH), FIO2: 0,136 ou normóxia (TRN), FIO2: 0,209. Durante os dois minutos de intervalo entre os dez esforços de um minuto, foram medidos constantemente a saturação periférica de oxigênio (SpO2), frequência cardíaca (FC), lactato sanguíneo ([La]), glicemia ([Glu]). Resultados: Houve diferenças na FC (TRN = 120 ± 14 bpm; TRH = 129 ± 13 bpm, p <0,01) e SpO2 (TRN = 96,9 ± 1,0%; TRH = 86,2 ± 3,5%, p <0,01). Sem diferenças em [La] e [Glu] TRN (4,4 ± 1,7 mmol.l-1; 3,9 ± 0,5 mmol.l-1) e TRH (5,2 ± 2,0 mmol.l-1; 4,0 ± 0,8 mmol.l-1, p = 0,17). Conclusão: Evidenciou-se a possibilidade de incluir a hipóxia apenas nos intervalos de recuperação como um estímulo adicional ao treinamento, sem diminuir a qualidade do treinamento. Nível de Evidência II; Estudo Clínico Randomizado de Menor Qualidade.

The II Brazilian Guidelines for the pharmacological treatment of patients hospitalized with COVID-19 Joint Guidelines of the Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia and Sociedade Brasileira de Reumatologia / II Diretrizes Brasileiras para o tratamento farmacológico de pacientes hospitalizados com COVID-19 Diretriz conjunta da Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia e Sociedade Brasileira de Reumatologia

ABSTRACT Objective: To update the recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: Experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Twenty-one recommendations were generated, including strong recommendations for the use of corticosteroids in patients using supplemental oxygen and conditional recommendations for the use of tocilizumab and baricitinib for patients on supplemental oxygen or on noninvasive ventilation and anticoagulants to prevent thromboembolism. Due to suspension of use authorization, it was not possible to make recommendations regarding the use of casirivimab + imdevimab. Strong recommendations against the use of azithromycin in patients without suspected bacterial infection, hydroxychloroquine, convalescent plasma, colchicine, and lopinavir + ritonavir and conditional recommendations against the use of ivermectin and remdesivir were made. Conclusion: New recommendations for the treatment of hospitalized patients with COVID-19 were generated, such as those for tocilizumab and baricitinib. Corticosteroids and prophylaxis for thromboembolism are still recommended, the latter with conditional recommendation. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and to promote resource economy.

RESUMO Objetivo: Atualizar as recomendações para embasar as decisões para o tratamento farmacológico de pacientes hospitalizados com COVID-19 no Brasil. Métodos: A elaboração desta diretriz foi feita por especialistas, incluindo representantes do Ministério da Saúde e metodologistas. O método utilizado para o desenvolvimento rápido de diretrizes baseou-se na adoção e/ou adaptação de diretrizes internacionais existentes (GRADE ADOLOPMENT) e contou com o apoio da plataforma e-COVID-19 RecMap. A qualidade das evidências e a elaboração das recomendações seguiram o método GRADE. Resultados: Chegaram-se a 21 recomendações, incluindo recomendações fortes quanto ao uso de corticosteroides em pacientes em uso de oxigênio suplementar e recomendações condicionais para o uso de tocilizumabe e baricitinibe, em pacientes com oxigênio suplementar ou ventilação não invasiva, e de anticoagulantes, para prevenção de tromboembolismo. Devido à suspensão da autorização de uso, não foi possível fazer recomendações para o tratamento com casirivimabe + imdevimabe. Foram feitas recomendações fortes contra o uso de azitromicina em pacientes sem suspeita de infecção bacteriana, hidroxicloroquina, plasma convalescente, colchicina e lopinavir + ritonavir, além de recomendações condicionais contra o uso de ivermectina e rendesivir. Conclusão: Foram criadas novas recomendações para o tratamento de pacientes hospitalizados com COVID-19, como as recomendações de tocilizumabe e baricitinibe. Ainda são recomendados corticosteroides e profilaxia contra tromboembolismo, esta em caráter condicional. Vários medicamentos foram considerados ineficazes e não devem ser usados, no intuito de proporcionar o melhor tratamento segundo os princípios da medicina baseada em evidências e promover a economia de recursos.

COVID-19 clinical manifestations in children and adolescents admitted to intensive care in the city of São Carlos, Brazil: a case series / Manifestações clínicas da COVID-19 em crianças e adolescentes admitidos para terapia intensiva na cidade de São Carlos: uma série de casos

INTRODUCTION: Children with COVID-19 may be asymptomatic or present a heterogeneous clinical presentation. The present case series aimed to report clinical manifestations of COVID-19 in children and adolescents admitted to pediatric intensive care units (PICU) in the city of São Carlos, Brazil, during 2020 and 2021. REPORTS: The subjects were six children aged 3 months to 13 years, with COVID-19. The data were collected from electronic charts. All cases were domestic contact with a COVID-19 case. Two cases had multisystem inflammatory syndrome (MIS-C) and one had jaundice and ascites. One case had a seizure. One case required invasive ventilation and two cases presented gastrointestinal symptoms. There were no deaths in the cases. The length of PICU stays varied from one to 16 days. CONCLUSION: In the six cases reported, COVID-19 clinical manifestations in children and adolescents who required intensive care in São Carlos revealed a heterogeneous presentation and no lethality. It is worth emphasizing that a history of contact with a symptomatic respiratory person should guide the suspicion of COVID-19 in children and indicate a proper follow-up, as COVID-19 may be severe in this population.

INTRODUÇÃO: Crianças com COVID-19 podem ser assintomáticas ou podem ter apresentação clínica heterogênea. O objetivo desta série de casos foi relatar as manifestações clínicas da COVID-19 em crianças e adolescentes internados em unidade de terapia intensiva pediátrica (UTIP) na cidade de São Carlos, Brasil, durante 2020 e 2021. RELATOS: Os casos foram seis crianças com idade entre 3 meses e 13 anos, com COVID-19. Os dados foram coletados do prontuário eletrônico. Todos os casos foram contactantes domiciliares de algum caso de COVID-19. Dois casos se apresentaram como síndrome multissistêmica inflamatória (MIS-C), sendo um destes com icterícia e ascite. Um caso manifestou convulsão. Um caso necessitou de ventilação mecânica invasiva e dois casos apresentaram sintomas gastrointestinais. Não foi observado óbito entre os casos e o tempo de permanência na UTIP variou de 0 a 16 dias. CONCLUSÃO: Nos seis casos relatados, a COVID-19 revelou manifestações clínicas variadas, com rápida resolução e não foi observado óbito. É importante enfatizar que a história de contato com uma pessoa sintomática respiratória deveria guiar a suspeita de COVID-19 em crianças e indicar acompanhamento, uma vez que esta doença pode ser grave nesta população.

Sex differences in smoking cessation: a retrospective cohort study in a psychosocial care unit in Brazil

Abstract Introduction Despite the results of epidemiological and psychometric studies reporting comparable levels of tobacco dependence among males and females, some clinical studies have detected disparities. Some smoking cessation studies based on clinical setting programs reported poorer outcomes among women than men. Methods This retrospective cohort study aimed to compare treatment success and retention between men and women on a smoking cessation program (n = 1,014) delivered at a CAPS-AD unit in Brazil. The psychological intervention lasted 6 weeks for each group of 15 patients. Each patient had to participate in weekly group cognitive-behavioral therapy (CBT) sessions and individual medical appointments during this period. These appointments were focused on the possibility of prescribing pharmacological treatment (i.e., nicotine replacement therapy, bupropion, or nortriptyline) as adjuvants to group therapy. Results The women had lower smoking severity at baseline, more clinical symptoms, and lower prevalence of alcohol and drug use disorders and were older than the men. Females had significantly higher levels of success (36.6% vs. 29.7%) and retention (51.6% vs. 41.4%) than males. Sensitivity analysis showed that female gender was significantly associated with both retention and success, among those without drug use disorders only. Conclusion Depending on the smoking cessation setting (i.e., low and middle-income countries and mental health and addiction care units), females can achieve similar and even higher quit rates than males. Previous drug use disorder was an important confounding variable in the gender outcomes analyses. Future studies should try to replicate these positive smoking cessation effects of CBT-based group therapy plus pharmacotherapy in women.

Desfechos clínicos e características da mecânica pulmonar entre a síndrome do desconforto respiratório agudo associada à COVID-19 e a não associada à COVID-19: uma análise de escore de propensão de dois importantes ensaios randomizados / Clinical outcomes and lung mechanics characteristics between COVID-19 and non-COVID-19-associated acute respiratory distress syndrome: a propensity score analysis of two major randomized trials

RESUMO Objetivo: Comparar a mecânica pulmonar e os desfechos entre a síndrome do desconforto respiratório agudo associada à COVID-19 e a síndrome do desconforto respiratório agudo não associada à COVID-19. Métodos: Combinamos dados de dois ensaios randomizados sobre a síndrome do desconforto respiratório agudo, um incluindo apenas pacientes com COVID-19 e o outro incluindo apenas pacientes sem COVID-19, para determinar se a síndrome do desconforto respiratório agudo associada à COVID-19 está associada à maior mortalidade aos 28 dias do que a síndrome do desconforto respiratório agudo não associada à COVID-19 e também examinar as diferenças na mecânica pulmonar entre esses dois tipos de síndrome do desconforto respiratório agudo. Resultados: Foram incluídos na análise principal 299 pacientes com síndrome do desconforto respiratório agudo associada à COVID-19 e 1.010 pacientes com síndrome do desconforto respiratório agudo não associada à COVID-19. Os resultados mostraram que os pacientes sem COVID-19 utilizaram pressão positiva expiratória final mais alta (12,5cmH2O; DP 3,2 versus 11,7cmH2O; DP 2,8; p < 0,001), foram ventilados com volumes correntes mais baixos (5,8mL/kg; DP 1,0 versus 6,5mL/kg; DP 1,2; p < 0,001) e apresentaram menor complacência respiratória estática ajustada para o peso ideal (0,5mL/cmH2O/kg; DP 0,3 versus 0,6mL/cmH2O/kg; DP 0,3; p = 0,01). Não houve diferença entre os grupos quanto à mortalidade aos 28 dias (52,3% versus 58,9%; p = 0,52) ou à duração da ventilação mecânica nos primeiros 28 dias entre os sobreviventes (13 [IQ 5 - 22] dias versus 12 [IQ 6 - 26] dias; p = 0,46). Conclusão: Esta análise mostrou que os pacientes com síndrome do desconforto respiratório agudo não associada à COVID-19 têm mecânica pulmonar diferente, mas desfechos semelhantes aos dos pacientes com síndrome do desconforto respiratório agudo associada à COVID-19. Após pareamento por escore de propensão, não houve diferença na mecânica pulmonar e nem nos desfechos entre os grupos.

ABSTRACT Objective: To compare the lung mechanics and outcomes between COVID-19-associated acute respiratory distress syndrome and non-COVID-19-associated acute respiratory distress syndrome. Methods: We combined data from two randomized trials in acute respiratory distress syndrome, one including only COVID-19 patients and the other including only patients without COVID-19, to determine whether COVID-19-associated acute respiratory distress syndrome is associated with higher 28-day mortality than non-COVID-19 acute respiratory distress syndrome and to examine the differences in lung mechanics between these two types of acute respiratory distress syndrome. Results: A total of 299 patients with COVID-19-associated acute respiratory distress syndrome and 1,010 patients with non-COVID-19-associated acute respiratory distress syndrome were included in the main analysis. The results showed that non-COVID-19 patients used higher positive end-expiratory pressure (12.5cmH2O; SD 3.2 versus 11.7cmH2O SD 2.8; p < 0.001), were ventilated with lower tidal volumes (5.8mL/kg; SD 1.0 versus 6.5mL/kg; SD 1.2; p < 0.001) and had lower static respiratory compliance adjusted for ideal body weight (0.5mL/cmH2O/kg; SD 0.3 versus 0.6mL/cmH2O/kg; SD 0.3; p = 0.01). There was no difference between groups in 28-day mortality (52.3% versus 58.9%; p = 0.52) or mechanical ventilation duration in the first 28 days among survivors (13 [IQR 5 - 22] versus 12 [IQR 6 - 26], p = 0.46). Conclusion: This analysis showed that patients with non-COVID-19-associated acute respiratory distress syndrome have different lung mechanics but similar outcomes to COVID-19-associated acute respiratory distress syndrome patients. After propensity score matching, there was no difference in lung mechanics or outcomes between groups.

Falo, feijão e fuzil: uma leitura decolonial das questões de gênero, de raça e de classe nas narrativas do barebacking sex / Phallus, beans and rifle: a decolonial reading of gender, race and class issues in barebacking sex narratives / Falo, frijoles y rifle: una lectura decolonial de cuestiones de género, raza y clase en narrativas del barebacking sex

Barebacking sex é o engajamento intencional de homens que fazem sexo com homens na relação anal sem camisinha. Para além de abordagens moralistas, relacionadas à possibilidade de infecção pelo HIV, analisamos como narrativas barebacking classificam os corpos em desejáveis e indesejáveis, a partir da maneira como são apresentados em cartazes de divulgação de orgias brasileiras disponíveis para visualização na internet. Neste artigo, almejamos uma discussão interseccional sobre desejo sexual, gênero, raça e classe, partindo das imagens em circulação nos contextos brasileiros do bareback.

Barebacking sex is the intentional engagement of men who have sex with other men in anal intercourse without a condom. Beyond moralistic approaches, related to the possibility of HIV infection, we analyse how barebacking narratives classify bodies into the desirable and the undesirable, through the way they are shown in posters publicizing Brazilian orgies available for viewing on the internet. In this article, we aim to develop an intersectional discussion about sexual desire, gender, race and class, starting from the images circulating in Brazilian bareback contexts.

Barebacking sex es el compromiso intencional de hombres que tienen sexo con hombres en el coito anal sin condón. Además de los enfoques moralistas relacionados con la posibilidad de infección por el VIH, analizamos cómo las narrativas barebacking clasifican los cuerpos en deseables e indeseables, en función de la forma en que se presentan en carteles para la difusión de orgías brasileñas disponibles para su visualización en Internet. En este artículo,apuntamos a una discusión interseccional del deseo sexual, género, raza y clase, a partir de las imágenes en circulación en contextos de bareback brasileños.

Diretrizes Brasileiras para o tratamento farmacológico de pacientes hospitalizados com COVID-19: Diretriz conjunta da Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia e Sociedade Brasileira de Reumatologia / Brazilian Guidelines for the pharmacological treatment of patients hospitalized with COVID-19: Joint guideline of Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia, Sociedade Brasileira de Reumatologia

Há diversas terapias sendo utilizadas ou propostas para a COVID-19, muitas carecendo de apropriada avaliação de efetividade e segurança. O propósito deste documento é elaborar recomendações para subsidiar decisões sobre o tratamento farmacológico de pacientes hospitalizados com COVID-19 no Brasil. Métodos: Um grupo de 27 membros, formado por especialistas, representantes do Ministério da Saúde e metodologistas, integra essa diretriz. Foi utilizado o método de elaboração de diretrizes rápidas, tomando por base a adoção e/ou a adaptação de recomendações a partir de diretrizes internacionais existentes (GRADE ADOLOPMENT), apoiadas pela plataforma e-COVID-19 RecMap. A qualidade das evidências e a elaboração das recomendações seguiram o método GRADE. Resultados: Foram geradas 16 recomendações. Entre elas, estão recomendações fortes para o uso de corticosteroides em pacientes em uso de oxigênio suplementar, para o uso de anticoagulantes em doses de profilaxia para tromboembolismo e para não uso de antibacterianos nos pacientes sem suspeita de infecção bacteriana. Não foi possível fazer uma recomendação quanto à utilização do tocilizumabe em pacientes hospitalizados com COVID-19 em uso de oxigênio, pelas incertezas na disponibilidade e de acesso ao medicamento. Foi feita recomendação para não usar azitromicina, casirivimabe + imdevimabe, cloroquina, colchicina, hidroxicloroquina, ivermectina, lopinavir/ ritonavir, plasma convalescente e rendesivir. Conclusão: Até o momento, poucas terapias se provaram efetivas no tratamento do paciente hospitalizado com COVID-19, sendo recomendados apenas corticosteroides e profilaxia para tromboembolismo. Diversos medicamentos foram considerados ineficazes, devendo ser descartados, de forma a oferecer o melhor tratamento pelos princípios da medicina baseada em evidências e promover economia de recursos não eficazes.

Several therapies are being used or proposed for COVID-19, and many lack appropriate evaluations of their effectiveness and safety. The purpose of this document is to develop recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: A group of 27 experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Sixteen recommendations were generated. They include strong recommendations for the use of corticosteroids in patients using supplemental oxygen, the use of anticoagulants at prophylactic doses to prevent thromboembolism and the nonuse of antibiotics in patients without suspected bacterial infection. It was not possible to make a recommendation regarding the use of tocilizumab in patients hospitalized with COVID-19 using oxygen due to uncertainties regarding the availability of and access to the drug. Strong recommendations against the use of hydroxychloroquine, convalescent plasma, colchicine, lopinavir + ritonavir and antibiotics in patients without suspected bacterial infection and also conditional recommendations against the use of casirivimab + imdevimab, ivermectin and rendesivir were made. Conclusion: To date, few therapies have proven effective in the treatment of hospitalized patients with COVID-19, and only corticosteroids and prophylaxis for thromboembolism are recommended. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and promote economical resource use.

Orchidists' profile, management and perception of the main pests in orchid cultivation

This study investigated the profile of orchidists, their cultivation practices, and their knowledge about pests in orchid cultivation in the state of Bahia. There were applied 74 questionnaires to producers (amateurs and commercials) in 23 municipalities. The data were submitted to univariate statistics using the chi-square test, the Mann­Whitney U-test and the Kruskal­Wallis H-test. The survey shows that orchid cultivation is mostly practiced by women (67.6%) and those with higher education (48.7%). Most respondents were amateurs (87.8%). Insects (39.9%) and diseases (32.5%) were the main organisms associated with phytosanitary problems. The presence of insects was reported to occur mainly in the leaves (47%), mainly mealybugs (46.3%). Correspondence was significant between commercial and amateur groups according to the pairwise Mann­Whitney U-test(1) = 370.04 and p < 0.01. The Kruskal­Wallis H-test(27) = 924.78 and p < 0.01 discriminated categories between the groups. Despite the growing interest in orchid cultivation in the state of Bahia, most orchidists are amateurs. The study warns about the risk of pest dispersion between crops since exchanging plants and purchasing specimens in open markets are common practices.

Brazilian guidelines for the treatment of outpatients with suspected or confirmed COVID-19. A joint guideline of the Brazilian Association of Emergency Medicine (ABRAMEDE), Brazilian Medical Association (AMB), Brazilian Society of Angiology and Vascular Surgery (SBACV), Brazilian Society of Geriatrics and Gerontology (SBGG), Brazilian Society of Infectious Diseases (SBI), Brazilian Society of Family and Community Medicine (SBFMC), and Brazilian Thoracic Society (SBPT)

ABSTRACT Background Several therapies have been used or proposed for the treatment of COVID-19, although their effectiveness and safety have not been properly evaluated. The purpose of this document is to provide recommendations to support decisions about the drug treatment of outpatients with COVID-19 in Brazil. Methods A panel consisting of experts from different clinical fields, representatives of the Brazilian Ministry of Health, and methodologists (37 members in total) was responsible for preparing these guidelines. A rapid guideline development method was used, based on the adoption and/or adaptation of recommendations from existing international guidelines combined with additional structured searches for primary studies and new recommendations whenever necessary (GRADE-ADOLOPMENT). The rating of quality of evidence and the drafting of recommendations followed the GRADE method. Results Ten technologies were evaluated, and 10 recommendations were prepared. Recommendations were made against the use of anticoagulants, azithromycin, budesonide, colchicine, corticosteroids, hydroxychloroquine/chloroquine alone or combined with azithromycin, ivermectin, nitazoxanide, and convalescent plasma. It was not possible to make a recommendation regarding the use of monoclonal antibodies in outpatients, as their benefit is uncertain and their cost is high, with limitations of availability and implementation. Conclusion To date, few therapies have demonstrated effectiveness in the treatment of outpatients with COVID-19. Recommendations are restricted to what should not be used, in order to provide the best treatment according to the principles of evidence-based medicine and to promote resource savings by aboiding ineffective treatments.

Qualidade de vida em idosos integrantes de um centro de convivência / Quality of life in elderly attend of a social center / Calidad de vida en ancianos atendidos de un centro social

Objetivo: analisar a qualidade de vida de idosos integrantes de um centro de convivência mediante a aplicação das escalas World Health Organization Quality of Life (WHOQOL) -bref e WHOQOL-OLD. Método: trata-se de um estudo descritivo e inferencial, de abordagem quantitativa, com 58 idosos de um centro de convivência com atendimento pela equipe multiprofissional. Para a obtenção dos dados foram utilizados dados sociodemográficos e as escalas WHOQOL-bref e WHOQOL-OLD. Resultados:a maior média obtida nos instrumentos foi WHOQOL-bref domínio "meio ambiente" (26,9%) e WHOQOL-OLD domínio "participação social" (15,5%). A variável idade apresentou correlação significante com o domínio morte e morrer do WHOQOL-OLD e o domínio relações sociais do WHOQOL-bref. Conclusão: idosos que são acompanhados no centro de convivência apresentaram boa percepção da qualidade de vida. Demonstrando a importância de capacitar equipes para melhor atenção no cuidado e manejo gerontológico

Objective: to analyze the quality of life of elderly members of a community center through the application of the World Health Organization Quality of Life (WHOQOL) -bref and WHOQOL-OLD scales. Method: this is a descriptive and inferential study, with a quantitative approach, with 58 elderly people from a social center for care by the multidisciplinary team. To obtain the data, a sociodemographic data collection instrument was used, the WHOQOL-bref and WHOQOL-OLD scales. Results: the highest average obtained in the instruments was the WHOQOL-bref "environment" domain (26.9%) and WHOQOL-OLD "social participation" domain (15.5%). The variable age was significantly correlated with the domain of death and dying of the WHOQOL-OLD and the social relationships domain of the WHOQOL-bref. Conclusion: elderly people who are followed up at the community center showed a good perception of quality of life. Demonstrating the importance of training teams for better attention to care and gerontological management

Objetivo: analizar la calidad de vida de ancianos de un centro social mediante aplicación de las escalas World Health Organization Quality of Life (WHOQOL) -bref y WHOQOL-OLD. Método: estudio descriptivo e inferencial, con abordaje cuantitativo, con 58 ancianos de un centro social con la atención del equipo multidisciplinario. Para obtención de los datos se utilizó datos sociodemográficos las escalas WHOQOL-bref y WHOQOL-OLD. Resultados: la media más alta obtenida en los instrumentos fue el dominio "medio ambiente" del WHOQOL-bref (26,9%) y el dominio "participación social" del WHOQOL-OLD (15,5%). La variable edad se correlacionó significativamente con el dominio de muerte y morir del WHOQOL-OLD y el dominio de relaciones sociales del WHOQOL-bref. Conclusiones: los ancianos que son seguidos en el centro social mostraron una buena percepción de calidad de vida. Demostrar la importancia de formar equipos para una mejor atención en el cuidado y manejo geriátrico

Ambulation capacity, age, immunosuppression, and mechanical ventilation are risk factors of in-hospital death in severe COVID-19: a cohort study

Abstract Importance: Despite ambulation capacity being associated with a decreased level of physical activity and survival may be influenced by the functional capacity, studies have not addressed the association between ambulation capacity and death in patients hospitalized by COVID-19. Objective: To verify the functional, clinical, and sociodemographic risk factors associated with in-hospital death in individuals with severe COVID-19. Methods: It is a cohort retrospective study performed at a large tertiary hospital. Patients 18 years of age or more, of both sexes, hospitalized due to severe COVID-19 were included. Cases with dubious medical records and/or missing essential data were excluded. Patients were classified according to their ambulation capacity before the COVID-19 infection. Information regarding sociodemographic characteristics, in-hospital death, total hospital stays, Intensive Care Unit (ICU) stays, and the necessity of Mechanical Ventilation (MV) were collected from medical records and registered in a RedCap database. Multiple logistic regression analysis was used to identify possible factors associated with the in-hospital death rate. Results: Data from 1110 participants were included in the statistical analysis. The median age of the patients was 57 (46‒66) years, 58.42% (n = 590) were male, and 61.73% (n = 602) were brown or black. The case fatality rate during hospitalization was 36.0% (n = 363). In-hospital death was associated with ambulation capacity; dependent ambulators (OR = 2.3; CI 95% = 1.2-4.4) and non-functional ambulation (OR = 1.9; CI 95% = 1.1-3.3), age [older adults (OR = 3.0; CI 95% = 1.9‒4.), ICU stays (OR = 1.4; CI 95% = 1.2‒1.4), immunosuppression (OR = 5.5 CI 95% = 2.3‒13.5) and mechanical ventilation (OR = 27.5; CI 95% = 12.0-62.9). Conclusion and relevance: Decreased ambulation capacity, age, length of ICU stay, immunosuppression, and mechanical ventilation was associated with a high risk of in-hospital death due to COVID-19.

Pink Resin as an Alternative for Restoration of Cervical Lesions Associated with Gingival Recession: a Case Report / Resina de Gengiva como Alternativa para Restaurações de Lesões Cervicais Associadas a Recessão Gengival: Relato de Caso

Abstract Gingival recession occurs when the gingival margin is located apically to the cementoenamel junction, causing root exposure. This work aims to report a clinical case of restorative treatment of multiple non-carious cervical lesions (NCCL´s) with gingival-colored resin, as an alternative approach of restorative procedure in cervical defects associated with gingival recession in the aesthetic area. A patient attended a ClinicalSchool complaining several NCCL´s in addition to Miller's class I gingival vestibular recession in the elements: 13, 21, 22 and 23. Dentin hypersensitivity was absent, however, aesthetic appearance bothered the patient. Presence of occlusal interferences, acid feeding and inadequate brushing habits were observed as important etiological factors for NCCL´s and gingival recessions. Periodontal surgery would be the treatment of choice, however, the patient needed orthodontic intervention first to promote dental alignment and correct distribution of the occlusal load. In order to decrease the progression of the lesions during the orthodontic treatment the NCCL´s associated with gingival recession were restored with gingival-colored resin. Two colors of pink composite resin (color G3 and G5) were incrementally inserted, promoting a correct emergence profile, taking the resin to the lower cavity limit avoiding aggression to the periodontal tissue. Clinical follow-up of 22 months was favorable due to the appearance of restorations and satisfactory periodontal health. Gingival resin can be assigned to improve the aesthetic effect of the restoration at a low cost and time-saving. (AU)

Resumo A recessão gengival ocorre quando a margem gengival está localizada apicalmente à junção cemento-esmalte, causando exposição radicular. Este trabalho tem como objetivo relatar um caso clínico de tratamento restaurador de múltiplas lesões cervicais não cariosas (LCNC´s) com resina de cor gengival, como uma forma alternativa de procedimento restaurador em defeitos cervicais associados a recessão gengival em área estética. Uma paciente buscou atendimento odontológico em um centro especializado por apresentar várias lesões do tipo LCNC, além de recessão gengival vestibular classe I de Miller nos elementos: 13, 21, 22 e 23 que não apresentavam sensibilidade, porém eram lesões que a incomodava quanto ao fator estético. Foram observados importantes fatores etiológicos para as LCNC's e recessões gengivais, como a oclusão desarmônica, alimentação ácida e hábitos de escovação inadequados. A cirurgia periodontal seria o tratamento de primeira escolha, contudo havia a necessidade de intervenção ortodôntica primeiramente para promover alinhamento dentário e correta distribuição das forças oclusais. Com o intuito de diminuir a progressão das lesões durante o tratamento ortodôntico optou-se por restaurar as LCNC´s associadas à recessão gengival com resina composta caracterizada para gengiva. Foram utilizadas 2 cores de resina rosa (G3 e G5) de forma incremental, até o limite inferior da cavidade, promovendo um correto perfil de emergência e evitando agressão aos tecidos periodontais. Acompanhamento clínico de 22 meses mostrou um aspecto favorável das restaurações assim como boa saúde periodontal. Dessa forma, a resina do tipo gengival pode ser indicada para melhorar o efeito estético da restauração a um baixo custo e rapidez no procedimento. (AU)

Efficiency of two digestion methods in determining the presence of metals (Cd, Cu, Cr, Pb and Zn) in geopropolis produced by Melipona scutellaris / Eficacia de dos métodos de digestión para determinar metales (Cd, Cu, Cr, Pb y Zn) en geopropóleos producidos por Melipona scutellaris / Eficiência de dois métodos de digestão para determinar metais (Cd, Cu, Cr, Pb e Zn) na geoprópolis produzida por Melipona scutellaris

Abstract This study evaluates the efficiency of acid extraction and total digestion to determine the presence of metals in geopropolis produced by the stingless bee Melipona scutellaris. Geopropolis samples were collected at five meliponaries in the city and in the metropolitan region of Salvador, Bahia State, Brazil. The sample treatment methods comprised acid extraction and total digestion. The Inductively Coupled Plasma Optical Emission Spectrometry (ICP OES) technique was used to quantify Cd, Cu, Cr, Pb, and Zn. Geopropolis samples submitted to both digestion methods showed statistical differences. For both methods, Cr and Zn showed the highest concentrations, while those of Cd were the lowest. The Cr concentration for determination by total digestion was 37.53 mg/kg, while for acid extraction it was 32.90 mg/kg. For Zn, the concentration was 17.65 mg/kg and 8.85 mg/kg for total digestion and acid extraction, respectively. The total digestion method showed the highest concentrations of the metals evaluated; however, acid extraction (USEPA 3050b) is a more straightforward procedure for metal evaluation in geopropolis samples and presented values that support the use of geopropolis as a bioindicator. The acid extraction method USEPA 3050b, in combination with detection using ICP OES, showed efficiency in analyses carried out to determine metals in geopropolis.

Resumen El objetivo de este artículo fue evaluar la eficacia da extracción ácida y de la digestión total para determinación de metales absorbidos en geopropóleos producidos por Melipona scutellaris. Se colectaron muestras de geopropóleos en cinco meliponarios localizadas en la región metropolitana del Salvador, estado de Bahia, Brasil. Se utilizaron como métodos de tratamiento para muestras, la extracción ácida y la digestión total. Para determinar los metales Cd, Cu, Cr, Pb y Zn se utilizó Espectroscopia de Emisión Óptica con Plasma Acoplado Inductivamente (ICP OES). Se encontraron diferencias estadísticas en la concentración de metales hallados en las muestras de geopropóleos sometidas a los diferentes métodos de digestión. Para ambos métodos de digestión, las mayores concentraciones de metal fueron observadas para Cr y Zn. Entre los metales evaluados Cd presentó la menor concentración. La concentración de Cr para la determinación por digestión total fue de 37,53 mg/kg y para la extracción ácida fue de 32,90 mg/ kg. Para el Zn, la concentración fue de 17,65 mg/kg y 8,85 mg/kg para la digestión total y la extracción ácida, respectivamente. El método de digestión total mostró los mayores valores para concentraciones de los metales evaluados. Entretanto, la extracción ácida, USEPA 3050b, es un procedimiento más simple para la evaluación de metales en muestras de geopropóleos y también mostró valores que pueden satisfacer la necesidad de su uso en evaluaciones de colmenas como bio-indicador. El método de extracción ácida USEPA 3050b en combinación con la detección a través de ICP OES se mostró eficiente para el análisis de metales en geopropóleos.

Resumo O objetivo deste estudo foi avaliar a eficiência da extração ácida e da digestão total para determinação de metais adsorvidos na geoprópolis produzida por Melipona scutellaris. Foram coletadas amostras de geoprópolis em cinco meliponários, situados em Salvador, Estado da Bahia e região metropolitana. Foram utilizados como métodos de tratamento das amostras a extração ácida e a digestão total. Para determinação dos metais Cd, Cu, Cr, Pb e Zn utilizou-se a Espectrometria de Emissão Óptica com Plasma Indutivamente Acoplado (ICP OES). Houve diferença estatística na concentração de metais encontrados nas amostras de geoprópolis submetidas aos diferentes métodos de digestão. Para ambos os métodos de digestão as maiores concentrações de metais foi observada para o Cr e Zn. Dentre os metais avaliados o Cd apresentou a menor concentração. A concentração de Cr para determinação por digestão total foi de 37,53 mg/kg e para extração ácida de 32,90 mg/ kg. Para o Zn, a concentração foi de 17,65 mg/kg e 8,85 mg/kg para digestão total e extração ácida, respectivamente. O método de digestão total apresentou os maiores valores para concentrações dos metais avaliados. No entanto, a extração ácida, USEPA 3050b, é um procedimento mais simples para a avaliação dos metais em amostras de geoprópolis e também apresentou valores que podem satisfazer a necessidade de utilização na avaliação deste produto da colmeia como bioindicador. O método de extração ácida USEPA 3050b em combinação com a detecção por ICP OES mostrou eficiência para análise de metais em geoprópolis.

First case of extracorporeal membrane oxygenation in cardiorespiratory arrest in an emergency room in Brasil: a possible reality?

SUMMARY The extracorporeal membrane oxygenation (ECMO) is a procedure that has been used for a long time in reference centers worldwide. Its fundamental precept is to serve as a bridge to a definitive treatment in patients with severe, but potentially reversible, clinical conditions. Despite this, its use in cardiopulmonary arrest (ECPR) is still a matter of debate, especially when indicated in the emergency department. There is not yet a sufficient level of evidence to support its routine use. In Brasil, the procedure stopped being considered an experimental technique by the Federal Council of Medicine only in 2017. The objective of the present case is to share the pioneering spirit of a Brazilian reference center with ECPR in the emergency room and to discuss the future challenges of the ECMO technique.

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

Use and misuse of biomarkers and the role of D-dimer and C-reactive protein in the management of COVID-19: A post-hoc analysis of a prospective cohort study

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19. METHODS: Data were extracted from electronic patient records and laboratory databases. Crude and adjusted associations for age, sex, number of comorbidities, Sequential Organ Failure Assessment score at admission, and D-dimer or CRP logistic regression models were used to evaluate associations. RESULTS: Between March and June 2020, COVID-19 was documented in 3,254 inpatients. The D-dimer level ≥4,000 ng/mL fibrinogen equivalent unit (FEU) mortality odds ratio (OR) was 4.48 (adjusted OR: 1.97). The CRP level ≥220 mg/dL OR for death was 7.73 (adjusted OR: 3.93). The D-dimer level ≥4,000 ng/mL FEU VTE OR was 3.96 (adjusted OR: 3.26). The CRP level ≥220 mg/dL OR for VTE was 2.71 (adjusted OR: 1.92). All these analyses were statistically significant (p<0.001). Stratified hospital costs demonstrated a dose-response pattern. Adjusted D-dimer and CRP levels were associated with higher mortality and doubled hospital costs. In the first week, elevated D-dimer levels predicted VTE occurrence and systemic inflammatory harm, while CRP was a hospital mortality predictor. CONCLUSION: D-dimer and CRP levels were associated with higher hospital mortality and a higher incidence of VTE. D-dimer was more strongly associated with VTE, although its discriminative ability was poor, while CRP was a stronger predictor of hospital mortality. Their use outside the usual indications should not be modified and should be discouraged.

Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital

OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.