Assessment of cognitive functioning using the Mini Mental State Examination in men with alcohol and crack cocaine use disorder

Abstract Introduction Consumption of substances has been associated with cognitive impairment. The Mini Mental State Examination (MMSE) is an easy-to-apply screening tool used to assess cognitive functions. Objectives To evaluate the cognitive performance of individuals with alcohol (AUD) and/or crack cocaine use disorder (CUD) and polysubstance use using the MMSE and to investigate the impact of substance use profile and the moderation effect of educational level on MMSE performance. Methods Cross-sectional study with 508 adult male inpatients diagnosed with substance use disorders (245 with AUD, 85 with CUD, and 178 with polysubstance use). Cognitive performance was assessed using the MMSE scale (total and composite scores). Results Individuals with AUD had worse total MMSE scores and scored worse for all three MMSE components compared to individuals with polysubstance use (p < 0.001, oral/written language comprehension, p < 0.001, attention/memory, and p = 0.007, motor functions). MMSE scores were positively correlated with educational level (p < 0.017), but were not associated with age, recent drug use, or years of drug use. Educational level moderated the impact of substance use on MMSE performance, especially total score and composite language comprehension score. Individuals with a low educational level (≤ 8 years) had worse performance than those with a high educational level (≥ 9 years), mainly in individuals with AUD (p < 0.001). Discussion Individuals with a low educational level and alcohol use are more prone to present cognitive impairment than crack cocaine users, especially involving language aspects. Better-preserved cognitive function could impact treatment adherence and might guide the decision of therapeutic strategies.

The Endoscopic Anatomy of the External Acoustic Meatus and of the Middle Ear in Dry Temporal Bones: A Study Conducted Using Digital and Mobile Device Technology

Abstract Introduction The endoscopic anatomy of the middle ear (ME) and of the external acoustic meatus (EAM) has been described in cadavers, in fresh temporal bones, or in vivo using conventional video recording, but not in dry bones or using an alternative inspection and recording technique. Objective To study the anatomy of the ME and of the EAM in dry temporal bones using a smartphone-endoscope system. Methods The EAM and the ME were studied in dry temporal bones using an endoscopic transcanal approach with a telescope connected to a smartphone (M-scope mobile endoscope app and adaptador, GBEF Telefonia, São Paulo, SP, Brazil). Results Out of 50 specimens, 2 had exostosis of the EAM and 3 contained remains of the tympanic membrane. The anterior wall of the EAM was prominent in 10/48 specimens (20.8%). Ossicles were seen in 13/45 (28.8%), stapes at the oval window were seen in 12/45 (26.6%), and the incus was seen in 1/45 (2.2%) specimens. The facial canal was open and protruding in 15/45 (33.3%) and in 7/45 (15.5%) specimens, respectively. Of the 45 MEs evaluated, type A was predominant for finiculus (93.3%), subiculum (100%), and ponticulus (95.6%). The rest were type B. None was classified as type C. According to its position in relation to the round window, the fustis was classified into type A (68.9%) or B (31.1%). The pyramidal eminence, the bony portion of the Eustachian tube, the semicanal of the tensor tympani muscle, and the cochleariform process were visualized completely or partially in all cases. Conclusion The use of a smartphone-based endoscopic transcanal procedure in dry temporal bones allowed the evaluation of anatomical variations in the EAM and in the ME.

Inflammatory cytokines and alcohol use disorder: systematic review and meta-analysis

Objective: To assess differences in blood inflammatory cytokines between people with alcohol use disorder (AUD) and healthy controls (HC). Methods: Searches were performed from inception through April 14, 2021. Meta-analyses with random-effects models were used to calculate the standardized mean difference ([SMD], 95%CI), and potential sources of heterogeneity were explored trough meta-regressions and subgroup analysis. Results: The meta-analysis included 23 studies on the following 14 cytokines: tumor necrosis factor (TNF)-α, IL-1, IL-1RA, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-13, IL15, interferon (IFN)-γ and sCD14. There were significantly higher concentrations of IL-6 (n=462 AUD and 408 HC; SMD = 0.523; 95%CI 0.136-0.909; p = 0.008) in AUD than HC. No significant differences were found in the other 13 cytokines. Conclusion: We found that IL-6 levels were significantly higher in individuals with AUD than HC and that other cytokines were not altered. This can be explained by the small number of studies, their methodological heterogeneity, and confounding factors (active use, abstinence, quantity, and physical or psychiatric illnesses, for example). Despite a great deal of evidence about alcohol and inflammatory diseases, studies assessing the role of neuroimmune signaling in the development and severity of AUD are still lacking.

Correlation between the Severity of the Lumbar Degenerative Disease and Sagittal Spinopelvic Alignment / Correlação entre a gravidade da doença degenerativa lombar e o alinhamento espinopélvico

Abstract Objective To evaluate the impact of the severity of lumbar degenerative disease (LDD) on sagittal spinopelvic alignment. Methods In total, 130 patients (mean age: 57 years; 75% female) with LDD-associated low-back pain were prospectively included. The severity of the LDD was defined by the following findings on anteroposterior and lateral lumbar spine radiographs: osteophytosis; loss of of height of the intervertebral disc; terminal vertebral plate sclerosis; number of affected segments; deformities; and objective instability. The disease was classified as follows: grade 0-absence of signs of LDD in the lumbar spine; grade I - signs of LDD in up to two segments; grade II - three or more segments involved; grade III - association with scoliosis, spondylolisthesis, or laterolisthesis. Spinopelvic radiographic parameters, including pelvic incidence (PI), lumbar lordosis (LL), discrepancy between the PI and LL (PI-LL), pelvic tilt (PT), and sagittal vertical axis (SVA), were analyzed according to the LDD grades. Results The radiographic parameters differed according to the LDD grades; grade-III patients presented higher SVA (p= 0.001) and PT (p= 0.0005) values, denoting greater anterior inclination of the trunk and pelvic retroversion when compared to grade-0 andgrade-I subjects. In addition, grade-III patients had higher PI-LL values, which indicates loss of PI-related lordosis, than grade-I subjects (p= 0.04). Conclusion Patients with more severe LDD tend to present greater spinopelvic sagittal misalignment compared to patients with a milder disease.

Resumo Objetivo Avaliar o impacto da graduação da doença degenerativa lombar (DDL) sobre o alinhamento sagital espinopélvico. Métodos Ao todo, 130 pacientes (dade média: 57 anos; 75% do sexo feminino) com dor lombar associada a DDL foram prospectivamente incluídos. A gravidade da DDL foi definida pelos seguintes achados nas radiografias anteroposterior e de perfil da coluna lombar: osteofitose; perda de altura do disco intervertebral; esclerose na placa vertebral terminal; número de segmentos afetados; deformidades; e instabilidade objetiva. Os pacientes foram graduados segundo a DDL da seguinte maneira: grau 0-ausência de sinais de DDL na coluna lombar; grau I - sinais de DDL em até dois segmentos; grau II - envolvimento em três ou mais segmentos; grau III - quando associada a escoliose, espondilolistese ou laterolistese. Parâmetros radiográficos espinopélvicos, como incidência pélvica (IP), lordose lombar (LL), discrepância entre a IP e a LL (IP-LL), versão pélvica (VP), e eixo vertical sagital (EVS) foram analisados de acordo com os graus de DDL. Resultados Houve diferença nos parâmetros radiográficos comparando-se os graus de DDL, com os pacientes de grau III apresentando maiores valores de EVS (p= 0,001) e VP (p= 0,0005), o que denota maior inclinação anterior do tronco e maior retroversão pélvica do que os pacientes de graus 0 e I. Pacientes de grau III também apresentaram maiores valores de IP-LL, o que denota perda da lordose relativa ao valor da IP, do que pacientes grau I (p= 0,04). Conclusão Pacientes com DDL mais grave demonstraram uma tendência a maior desalinhamento sagital espinopélvico comparados com pacientes com graus mais leves.

Study of the diameter of the oblique corridor in lateral decubitus and dorsal decubitus: radiological study / Estudo do diâmetro do corredor oblíquo em decúbito lateral e decúbito dorsal: estudo radiológico / Estudio del diámetro del corredor oblicuo en decúbito lateral y dorsal: estudio radiológico

ABSTRACT Introduction: Degenerative intervertebral disc disease and its impact on quality of life when associated with sagittal misalignmentis a current topic in the literature. The technique known as OLIF derives from the need to use anterior cage stop romote stabilization of the affected segment, indirect decompression, restoration of segmental lordosis, and sagittal balance. Methods: Single-center, non-randomized, comparative, observational study. The following variables were measured using magnetic resonance imaging of the lumbar spine in dorsal and lateral decubitus, establishing a comparison between the size of the OLIF corridor in the L3L4 and L4L5 segments, as well as a comparison of corridor size between the different positions. Results: There was no difference incorridor size in the comparison between decubitus. However, when the L3L4 and L4L5 levels were compared, there was a significant difference in the size of the corridor in both the lateral and dorsal positions. Conclusion: The present study did not show any difference between the size of the OLIF corridor in L3L4 and L4L5 in the different decubitus, suggesting that thee valuation of the corridor in convention al magnetic resonance images appearstobe safe andreflects the actual size when positio ned for performing the OLIF technique. Level of evidence III; Retrospective study.

RESUMO Introdução: A doença degenerativa do disco intervertebral e seu impacto sobre a qualidade de vida quando está associada a desalinhamento sagital é tema atual na literatura. A técnica conhecida como OLIF deriva da necessidade de uso de cages anteriores para promover estabilização do segmento afetado, descompressão indireta, restauração da lordose segmentar e equilíbrio sagital. Métodos: Estudo de centro único, não randomizado, comparativo, observacional. Foram medidas as seguintes variáveis por ressonância magnética de coluna lombar em decúbito dorsal e lateral, estabelecendo comparação entre o tamanho do corredor OLIF nos segmentos L3-L4 e L4-L5, assim como comparação entre o tamanho do corredor entre as diferentes posições. Resultados: Não houve diferença entre o tamanho do corredor na comparação entre os decúbitos. Entretanto, ao comparar os níveis L3-L4 e L4-L5 houve diferença significativa no tamanho do corredor, tanto na posição lateral quanto na posição dorsal. Conclusões: O presente estudo não demonstrou diferença detamanho do corredor OLIF em L3-L4 e L4-L5 em diferentes decúbitos, sugerindo que a avaliação do corredor em ressonância magnética convencional parece ser segura e reflete o tamanho real quando posicionado para execução da técnica OLIF. Nível de evidência III; Estudo retrospectivo.

RESUMEN Introducción: La enfermedad degenerativa del disco intervertebral y su impacto en lacalidad de vida cuando se asocia a una desalineación sagital es un tema actualenla literatura. La técnica conocida como OLIF deriva de la necesidad de utilizar cages anteriores para favorecer la estabilización del segmento afectado, la descompresión indirecta, la restauración de la lordosis segmentaria y el equilibrio sagital. Métodos: Estudio observacional comparativo unicéntrico, no aleatorizado. Se midieron las siguientes variables mediante resonancia magnética de la columna lumbar endecúbito dorsal y lateral, estableciendo la comparación entre el tamaño del corredor OLIF en los segmentos L3L4 y L4L5, así como la comparación entre el tamaño del corredor entre las diferentes posiciones. Resultados: No hubo diferencia entre el tamaño del corredor en la comparación entre decúbitos. Sin embargo, al comparar los niveles L3-L4 y L4-L5, hubo una diferencia significativa en el tamaño del corredor tanto en posición lateral como dorsal. Conclusiones: El presente estudio no mostró diferencias en el tamaño del corredor OLIF en L3-L4 y L4-L5, en diferentes posiciones de decúbito, lo que sugiere que la evaluación del corredor en la resonancia magnética convenciona lparece ser segura y refleja el tamaño real cuando se posiciona para realizar la técnica OLIF. Nivel de evidencia III; Estudio retrospectivo

COVID-19 and outpatient care: a nationwide household survey / COVID-19 e assistência ambulatorial: uma pesquisa domiciliar de abrangência nacional / COVID-19 y atención ambulatoria: una encuesta domiciliaria a escala nacional

We aimed to assess the proportion of the population in 133 Brazilian municipalities who - from March to August 2020 - had a health problem but failed to seek care or failed to attend to a health service for routine appointment or examination. We conducted a household survey from August 24-27 in 133 Brazilian cities by asking the subjects if, since the beginning of the COVID-19 pandemic in March 2020, they had suffered from a health problem but did not seek care or failed to attend to a routine or screening examination. Poisson regression was used for the analyses. We interviewed 33,250 subjects and 11.8% (95%CI: 11.4-12.1) reported that, since March 2020, they failed to seek care despite being ill, 17.3% (95%CI: 16.9-17.7) failed to attend to a routine or screening examination and 23.9% (95%CI: 23.4-24.4) reported one or both outcomes. Health service closure and fear of the COVID-19 infection were the main reasons for not seeking care. Women and the poorest were more likely to not look for a health service, despite having a health problem or a scheduled routine appointment. On the other hand, those subjects who self-identified as white were less likely to not look for a health service. The COVID-19 pandemic is more critical for the indigenous people and the poorest, and these people are also more likely to not seek care for other health conditions during the pandemic.

O estudo teve como objetivo avaliar a proporção da população de 133 cidades brasileiras que apresentou algum problema de saúde entre março e agosto de 2020, mas que deixou de procurar atendimento, ou que deixou de buscar um serviço de saúde para consultas ou exames de rotina. Foram realizadas entrevistas domiciliares entre 24 e 27 de agosto de 2020 em 133 áreas urbanas brasileiras. Perguntava-se aos indivíduos se, desde o início da pandemia de COVID-19 em março de 2020, haviam sofrido algum problema de saúde mais não haviam procurado atendimento, ou se haviam deixado de realizar consultas ou exames de rotina. A regressão de Poisson foi utilizada para as análises. Foram entrevistados 33.250 indivíduos, entre os quais 11,8% (IC95%: 11,4-12,1) relataram que desde março de 2020 haviam deixado de procurar atendimento apesar de estarem doentes, 17,3% (IC95%: 16,9-17,7) haviam deixado de comparecer a consultas de rotina ou triagem e 23,9% (IC95%: 23,4-24,4) relataram um ou ambos os desfechos. O fechamento dos serviços de saúde e o medo da infecção pelo SARS-CoV-2 foram os principais motivos para não buscar atendimento. As mulheres e os indivíduos com menor nível socioeconômico mostraram maior probabilidade de não procurarem serviços de saúde em caso de doença, ou de faltar a consultas de rotina previamente agendadas. Por outro lado, indivíduos que se identificavam como brancos eram menos propensos a deixar de procurar os serviços de saúde. A pandemia da COVID-19 está afetando mais duramente os indígenas e as pessoas com menor nível socioeconômico, que também são mais propensos a deixar de procurar atendimento para outras condições de saúde durante a pandemia.

Se realizó un estudio con el fin de evaluar la proporción de población en 133 ciudades brasileñas que -de marzo a agosto 2020- tuvieron un problema de salud, pero no consiguieron buscar cuidados, o presentarse en un servicio de salud para consultas de rutina o exámenes. Se llevó a cabo una encuesta domiciliaria entre el 24 y 27 de agosto en 133 áreas urbanas brasileñas. A los encuestados se les preguntó si, desde el principio de la pandemia de COVID-19 en marzo de 2020, habían sufrido algún problema de salud, pero no habían buscado asistencia, o no consiguieron presentarse a exámenes de rutina o de exploración. Se utilizó una regresión de Poisson para los análisis. Se entrevistó a 33.250 individuos, y un 11,8% (IC95%: 11,4-12,1) informaron que desde marzo de 2020 no consiguieron buscar asistencia, a pesar de estar enfermos, un 17,3% (IC95%: 16,9-17,7) no consiguieron presentarse a exámenes de rutina o visitas de exploración, y un 23,9% (IC95%: 23,4-24,4) informaron de uno o ambos resultados. El cierre de los servicios de salud y el miedo a contraer COVID-19 fueron las razones principales para no buscar cuidados. Las mujeres y aquellos que tenían un estatus socioeconómico bajo eran más propensos a no buscar asistencia sanitaria, tanto si tenían un problema médico, como para un chequeo rutinario o se saltaban una cita médica programada. Por otro lado, estas personas que se autoidentificaron como blancas eran menos propensas a no buscar asistencia sanitaria. La pandemia de COVID-19 está golpeando duramente a los indígenas y a quienes tienen un estatus socioeconómico bajo, y estas personas también son más propensas a no conseguir buscar asistencia sanitaria relacionada con otros problemas de salud durante la pandemia.

Uso de máscara durante a pandemia de COVID-19 no Brasil: resultados do estudo EPICOVID19-BR / Mask use during the COVID-19 pandemic in Brazil: results of the EPICOVID19-BR study / Uso de mascarillas durante la pandemia de COVID-19 en Brasil: resultados del estudio EPICOVID19-BR

A pandemia de COVID-19 já causou mais de 399 milhões de infecções e custou a vida de mais de cinco milhões de pessoas no mundo, até 3 de março de 2022. Para reduzir a taxa de infecção, uma série de medidas de prevenção indicadas pela Organização Mundial da Saúde (OMS) foram adotadas pelos países, entre elas, o uso de máscara. O objetivo deste estudo é descrever a utilização de máscara na população brasileira, através da análise de dados do EPICOVID19-BR, um estudo de base populacional realizado em 133 cidades do país, em quatro fases entre março e agosto de 2020. A proporção de indivíduos que preferiram usar máscara quando saíam de casa foi de 97,9% (IC95%: 97,8-98,0). O entrevistador não visualizou a máscara do entrevistado em 50% (IC95%: 49,9-51,1) dos casos no momento da entrevista, no entanto, entre a fase uma e quatro da pesquisa, observou-se uma diminuição de 4,4 pontos percentuais na proporção de entrevistados que não usaram máscara no momento da entrevista. A não visualização da máscara foi mais observada em mulheres, participantes com idade entre 10-19 e 20-29 anos, de cor de pele indígena, preta, e parda, entre as pessoas com Ensinos Fundamental e Médio e na Região Centro-oeste. O uso de máscara de tecido foi predominante 91,4% (IC95%: 91,2-91,5) com um aumento de 4,9 pontos percentuais entre as fases 1 e 4. Os resultados do estudo trazem informações importantes para reforçar as políticas de controle de COVID-19 no Brasil. O alto percentual de pessoas sem máscara na hora da entrevista sugere que ainda é importante reforçar o aspecto preventivo e de autocuidado, não fazendo do uso da máscara algo apenas ligado à obrigatoriedade.

By March 3, 2022, the COVID-19 pandemic has caused more than 399 million infections and claimed the lives of more than five million people worldwide. To reduce infection rates, a series of prevention measures indicated by the World Health Organization (WHO) were adopted by countries, including the use of masks. This study aims to describe mask use in Brazil via data analysis from the EPICOVID19-BR, a population-based study conducted in 133 cities in the country in four phases between March and August 2020. The proportion of individuals who reported wearing a mask when they left their homes was 97.9% (95%CI: 97.8-98.0). The interviewer did not see interviewees' mask in 50% (95%CI: 49.9-51.1) of the cases at the time of the interview. However, between phase one and four of the survey, we observed a 4.4% decrease in the proportion of interviewees who failed to wear masks at the time of the interview. Mask non-visualization was more prominent in women, participants aged 10-19 and 20-29 years of indigenous, black, and brown skin color, and those with elementary and high school education and in the Central-West Region. The use of cloth masks showed a 91.4% predominance (95%CI: 91.2-1.5) with a 4.9% increase between phases 1 and 4. The results of the study bring important information to reinforce COVID-19 control policies in Brazil. The high percentage of people who failed to wear masks at the time of the interview suggests that it is still important to reinforce prevention and self-care, rather than relating mask wear to a mandatory measure.

La pandemia del COVID-19 ha provocado más de 399 millones de infecciones y se ha cobrado la vida de más de cinco millones de personas en todo el mundo hasta el 3 de Marzo de 2022. Para reducir la tasa de contagios, los países adoptaron una serie de medidas de prevención indicadas por la Organización Mundial de la Salud (OMS), entre ellas el uso de mascarillas. El objetivo de este estudio es describir el uso de mascarillas en la población brasileña, utilizando el análisis de datos de EPICOVID19-BR, un estudio de base poblacional realizado en 133 ciudades del país, en cuatro fases entre marzo y agosto de 2020. La proporción de personas que informaron usar mascarillas al salir de casa fue del 97,9% (IC95%: 97,8-98,0). El entrevistador no vio la mascarilla del entrevistado en el 50% (IC95%: 49,9-51,1) de los casos al momento de la entrevista, sin embargo entre las fases uno y cuatro de la investigación se observó una disminución de 4,4 puntos porcentuales en la proporción de los encuestados que no llevaban mascarilla durante la entrevista. Se observó una mayor visualización de falta de uso de mascarillas en las mujeres, en participantes con edades entre 10-19 y 20-29 años, de color de piel indígena, negra y parda, entre personas con educación primaria y secundaria y en la Región Centro-oeste. Hubo un mayor predominio de uso de mascarillas de tela en el 91,4% (IC95%: 91,2-91,5) con un aumento de 4,9 puntos porcentuales entre las fases 1 y 4. Los resultados muestran la importancia de fortalecer las políticas de prevención del COVID-19 en Brasil. El alto porcentaje de personas sin mascarilla al momento de la entrevista sugiere que es importante reforzar la prevención y el autocuidado en general no solo relacionado a la obligatoriedad en el uso de mascarillas.

A Synthetic Analog of Resveratrol Inhibits the Proangiogenic Response of Liver Sinusoidal Cells during Hepatic Metastasis

We utilized Fas21, a resveratrol analog, to modulate the function of hepatic stellate cells (HSCs) and liver sinusoidal endothelial cells (LSECs) during the angiogenic phase of murine liver metastasis by B16 melanoma and 51b colorectal carcinoma. Preangiogenic micrometastases were treated with Fas21 (1 mg/kg/day) or vehicle during the development of intra-angiogenic tracts.Mice treated with Fas21 showed reduced liver tumor foci in both liver metastasis models. Micrometastases were classified immunohistochemically, as well as according to their position coordinates and connection to local microvasculature. The volume of liver occupied by sinusoidal-type foci, containing infiltrating angiogenic capillaries, decreased by ~50% in Fas21-treated mice compared to vehicle-treated ones in both tumor metastasis models. The volume of portal foci, containing peripheral neoangiogenesis within a discontinuous layer of myofibroblasts, was similar in all experimental groups in both tumor metastasis models, but displayed enhanced necrotic central areas devoid of angiogenesis following Fas21 treatment. As a result, sinusoidal tumors from mice treated with Fas21 showed a 50% reduction in desmin(+)/asma(+) HSCs and CD31(+) vessel density, and a 45% reduction in intrametastatic VEGF mRNA compared with sinusoidal tumors from vehicle-treated mice. Necrotic portal metastases increased 2-4-fold in treated mice. In vitro, Fas21 reduced VEGF secretion by HSCs and 51b cells dose-dependently. Additionally, HSCs migration in response to tumor soluble factors was dose-dependently diminished by Fas21, as was LSEC migration in response to HSCs and tumor soluble factors. Resveratrol analog Fas21 inhibits the proangiogenic response of HSCs and LSECs during the development of murine liver metastasis.

Population-level seropositivity trend for SARS-Cov-2 in Rio Grande do Sul, Brazil

ABSTRACT OBJECTIVE To describe the evolution of seropositivity in the State of Rio Grande do Sul, Brazil, through 10 consecutive surveys conducted between April 2020 and April 2021. METHODS Nine cities covering all regions of the State were studied, 500 households in each city. One resident in each household was randomly selected for testing. In survey rounds 1-8 we used the rapid WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech Co., Guangzhou, China). In rounds 9-10, we used a direct ELISA test that identifies IgG to the viral S protein (S-UFRJ). In terms of social distancing, individuals were asked three questions, from which we generated an exposure score using principal components analysis. RESULTS Antibody prevalence in early April 2020 was 0.07%, increasing to 10.0% in February 2021, and to 18.2% in April 2021. In round 10, self-reported whites showed the lowest seroprevalence (17.3%), while indigenous individuals presented the highest (44.4%). Seropositivity increased by 40% when comparing the most with the least exposed. CONCLUSIONS The proportion of the population already infected by SARS-Cov-2 in the state is still far from any perspective of herd immunity and the infection affects population groups in very different levels.

COVID-19 and social distancing among children and adolescents in Brazil

ABSTRACT OBJECTIVE To estimate the prevalence of SARS-CoV-2 antibodies and the adherence to measures of social distancing in children and adolescents studied in three national surveys conducted in Brazil between May-June 2020. METHODS Three national serological surveys were conducted in 133 sentinel cities located in all 27 Federative Units. Multistage probability sampling was used to select 250 individuals per city. The total sample size in age ranges 0-9 and 10-19 years old are of 4,263 and 8,024 individuals, respectively. Information on children or adolescents was gathered with a data collection app, and a rapid point-of-case test for SARS-CoV-2 was conducted on a finger prick blood sample. RESULTS The adjusted prevalence of antibodies was 2.9% (2.2-3.6) among children 0-9 years, 2.2% (1.8-2.6) among adolescents 10-19 years, and 3.0% (2.7-3.3) among adults 20+years. Prevalence of antibodies was higher among poor children and adolescents compared to those of rich families. Adherence to social distancing measures was seen in 72.4% (71.9-73.8) of families with children, 60.8% (59.6-61.9) for adolescents, and 57.4% (56.9-57.8) for adults. For not leaving the house except for essential matters the proportions were 81.7% (80.5-82.9), 70.6% (69.6-61.9), and 65.1% (64.7-65.5), respectively. Among children and adolescents, social distancing was strongly associated with socioeconomic status, being much higher in the better-off families. CONCLUSIONS The prevalence of antibodies against SARS-CoV-2 showed comparable levels among children, adolescents, and adults. Adherence to social distancing measures was more prevalent in children, followed by adolescents. There were important socioeconomic differences in the adherence to social distancing among children and adolescents.

Time-dependent decay of detectable antibodies against SARS-CoV-2: A comparison of ELISA with two batches of a lateral-flow test

ABSTRACT Background: Large-scale epidemiological studies of seroprevalence of antibodies against SARS-CoV-2 often rely on point-of-care tests that provide immediate results to participants. Yet, little is known on how long rapid tests remain positive after the COVID-19 episode, or how much variability exists across different brands and even among batches of the same test. Methods: In November 2020, we assessed the sensitivity of three tests applied to 133 individuals with a previous positive PCR result between April and October. All subjects provided finger prick blood samples for two batches (A and B) of the Wondfo lateral-flow IgG/IgM test, and dried blood spot samples for the S-UFRJ ELISA test. Results: Overall sensitivity levels were 92.5% (95% CI 86.6-96.3), 63.2% (95% CI 54.4-71.4) and 33.8% (95% CI 25.9-42.5) for the S-UFRJ test, Wondfo A and Wondfo B tests, respectively. There was no evidence of a decline in the positivity of S-UFRJ with time since the diagnosis, but the two Wondfo batches showed sharp reductions to as low as 41.9% and 19.4%, respectively, for subjects with a positive PCR in June or earlier. Positive results for batch B of the rapid test were 35% to 54% lower than for batch A at any given month of diagnosis. Interpretation: Whereas the ELISA test showed high sensitivity and stability of results over the five months of the study, both batches of the rapid test showed substantial declines, with one of the batches consistently showing lower sensitivity levels than the other. ELISA tests based on dried-blood spots are an inexpensive alternative to rapid lateral-flow tests in large-scale epidemiological studies.

O enfrentamento da COVID-19 nos países da Comunidade dos Países de Língua Portuguesa (CPLP) / Coping with COVID-19 in the countries of the Community of Portuguese Speaking Countries (CPLP)

A presente publicação, a quinta da série LEIASS (Linha Editorial Internacional de Apoio aos Sistemas de Saúde), do Conass e do Instituto de Higiene e Medicina Tropical da Universidade Nova de Lisboa, reúne artigos oriundos de vários dos Estados-Membros da Comunidade de Países de Língua Portuguesa (CPLP). O intuito foi o de registrar como esses países enfrentaram a chamada primeira onda da Covid-19, na singularidade de seus respectivos contextos. Registra-se aqui um agradecimento muito especial aos doutores Mário Fresta, Helga Freitas e Tânia Lourenço (Angola); Magda Robalo, Plácido Cardoso, Jamila Bathy, Joana Cortez e Rachel Schwartz (Guiné-Bissau); Mohsin Sidat e Ilesh Jani (Moçambique); António Pedro Costa Delgado, Artur Jorge Correia, Maria da Luz Lima Mendonça, Francisca Suassuna Freyre Monteiro (Cabo Verde); Jorge Simões, André Biscaia, João Paulo Magalhães, António Pereira, Gonçalo Figueiredo Augusto, Inês Fronteira e Manuel Clarote Lapão (Portugal); Fernando Passos Cupertino de Barros, Jurandi Frutuoso Silva e Nereu Henrique Mansano (Brasil) que aceitaram de muito bom grado o convite para contribuir para o propósito deste volume dedicado especialmente a documentar a atuação dos diferentes países diante da emergência internacional de saúde pública provocada pela pandemia da covid-19. Infelizmente, a despeito dos esforços dos editores, não foi possível obter o contributo de São Tomé e Príncipe, da Guiné Equatorial e de Timor Leste. Para além do registro das estratégias adotadas, das dificuldades enfrentadas e das perspectivas de uma pandemia ainda em curso, os textos servem, também, para evidenciar, como em um instantâneo, a imagem da situação transcorrida desde o final do mês de fevereiro até o mês de setembro de 2020, data em que findou a coleta dos artigos. De tudo isso, espera-se que lições tenham sido aprendidas para que, tanto agora como no futuro, em situações de similar gravidade, possam servir aos nossos sistemas de saúde como alavancas capazes de garantir as respostas adequadas e eficazes na proteção de toda a população.

Priorities in testis cancer care during Covid-19 Pandemic

ABSTRACT Introduction: There is little information on how to prioritize testis cancer (TC) patients' care during COVID-19 pandemic in order to relieve its pressure on the health care systems. Objective: To describe the recommendations for diagnosis, treatment and follow-up of patients with TC amidst COVID- 19 pandemic. Material and Methods: Pubmed search and review of the main urological association guidelines on TC. Results: The biology of TC requires immediate care of patients during diagnosis, initial surgical therapy and management of recurrent disease. Active surveillance is the first choice of management and should be offered to all compliant clinical stage I TC patients provided they understand the need to self-isolate. Active surveillance may also help decrease the demand for intensive care unit beds, ventilators, personal protective equipment, and other critical hospital and human resources by minimizing surgeries without compromising patient outcomes. Complications of therapy and symptomatic patients represent medical emergencies and should be treated immediately. Telemedicine may be useful during follow-up periods. Conclusions: Most stages of testis cancer require urgent care; however, all recommendations must be adapted to local health care priorities considering that most of these patients are at low risk of severe COVID-19 infection.

Adaptation of the frailty index for brazilian portuguese in adult spine deformity surgery / Adaptação para o português do Brasil do índice de fragilidade em cirurgia de deformidade da coluna vertebral do adulto / Adaptación para portugués de Brasil del índice de fragilidad en cirugía de deformidad de la columna vertebral del adulto

ABSTRACT Objectives To adapt the adult spinal deformity frailty index (ASD-FI), which was presented as an instrument for stratification of risk of surgical complications, for application in the Brazilian population. Methods This is a consensus-building study, following the Delphi method, in which a team of six Brazilian spine surgery specialists worked alongside the International Spine Study Group (ISSG), the group responsible for preparing the original version of the ASD-FI, in order to adapt the index for the Brazilian population. The variables to be included in the new version, as well as the translation of the terminology into Portuguese, were evaluated and a consensus was considered to have been reached when all (100%) of the Brazilian experts were in agreement. Results A version of the ASD-FI was created, composed of 42 variables, with the inclusion of two new variables that were not included in the original version. The new version was then back translated into English and approved by the ISSG members, resulting in the adapted version of the ASD-FI for the Brazilian population. Conclusion This study presents an adapted version of the adult spinal deformity frailty index for the Brazilian population, for the purpose of risk stratification in the surgical treatment of these complex deformities. Level of evidence II; Study of adaptation of a valid score.

RESUMO Objetivos Adaptar o Índice de Fragilidade para Deformidade da Coluna Vertebral do Adulto (IF-DCVA), apresentado como instrumento para estratificação de risco para complicações cirúrgicas, para aplicação na população brasileira. Métodos Trata-se de um estudo de criação de consenso, seguindo o método Delphi, em que uma equipe de seis especialistas brasileiros em cirurgia da coluna trabalhou em conjunto com o International Spine Study Group (ISSG), grupo responsável pelo desenvolvimento da versão original do IF-DCVA, a fim de adaptar o índice para a população brasileira. As variáveis a serem incluídas na nova versão, assim como a tradução da terminologia para o português foram avaliadas e foi considerado consenso quando todos (100%) os especialistas brasileiros chegaram a um acordo. Resultados Uma versão do IF-DCVA foi criada, composta por 42 variáveis, com a inclusão de duas novas variáveis que não faziam parte da versão original. A nova versão foi, então, retrotraduzida para o inglês e aprovada pelos membros do ISSG, resultando na versão adaptada do IF-DCVA para a população brasileira. Conclusões O presente estudo apresenta uma versão adaptada do Índice de Fragilidade para Deformidade da Coluna Vertebral do Adulto para a população brasileira com o objetivo de avaliar a estratificação de risco no tratamento cirúrgico dessas deformidades complexas. Nível de evidência II; Estudo de adaptação de um escore válido.

RESUMEN Objetivos Adaptar el Índice de Fragilidad para Deformidad de la Columna Vertebral del Adulto (IF-DCVA), presentado como instrumento para estratificación de riesgo para complicaciones quirúrgicas, para aplicación en la población brasileña. Métodos Se trata de un estudio de creación de consenso, siguiendo el método Delphi, en el que un equipo de seis especialistas brasileños en cirugía de columna trabajó junto con el International Spine Study Group (ISSG), grupo responsable por el desarrollo de la versión original de IF-DCVA, a fin de adaptar el índice para la población brasileña. Las variables a ser incluidas en la nueva versión, así como la traducción de la terminología para el portugués de Brasil fueron evaluadas y se consideró consenso cuando todos (100%) los especialistas brasileños llegaron a un acuerdo. Resultados Fue creada una versión del IF-DCVA, compuesta por 42 variables, con la inclusión de dos nuevas variables que no formaban parte de la versión original. La nueva versión fue entonces retrotraducida al inglés y aprobada por los miembros del ISSG, lo que resultó en la versión adaptada del IF-DCVA para la población brasileña. Conclusiones El presente estudio presenta una versión adaptada para la población brasileña del Índice de Fragilidad para la Deformidad de la Columna Vertebral del Adulto, con el objetivo de evaluar la estratificación de riesgo en el tratamiento quirúrgico de esas deformidades complejas. Nivel de evidencia II; Estudio de adaptación de una escala válida.

Spinopelvic variability according to the roussouly classificaton curve type / Variabilidade espinopélvica de acordo com o tipo de curva da classificação de roussouly / Variabilidad espinopélvica de acuerdo con el tipo de curva de la clasificación de roussouly

ABSTRACT Objective To evaluate the variability of spinopelvic sagittal parameters and the distribution of lordosis in the lumbar spine in a sample of patients. Methods This is a cross-sectional study considering full-spine radiographs of a patient sample. The patients were classified according to the Roussouly classification and both radiographic spinopelvic alignment parameters and the lordosis measurement of each lumbar spinal segment were considered. The radiographic parameters were correlated with the Roussouly classification type. Results Ninety patients were included in the study. There was significant correlation between pelvic incidence (PI) and lumbar lordosis (LL) (R=0.89; p<0.0001). The values of PI were significantly higher in Roussouly types 3 and 4 than in types 1 and 2 (p<0.001), as were the values of LL L1-S1(p<0.001). Considering the total sample, 67% of LL L1-S1 was located between L4-S1, but with variations by the Roussouly classification curve types. Conclusion This study demonstrated a high correlation between the values of PI and LL, as well as the importance of the distal lumbar segment (L4-S1) in the overall value of LL L1-S1, which was even higher in patients with a lower PI value (Roussouly types 1 and 2). Level of evidence II; Retrospective analysis of a prospective database (Cohort); Diagnostic study.

RESUMO Objetivo Avaliar a variabilidade dos parâmetros sagitais espinopélvicos em uma amostra de pacientes, assim como a distribuição de lordose no segmento lombar da coluna vertebral. Métodos Trata-se de um estudo transversal, considerando radiografias da coluna total de uma amostra de pacientes. Os pacientes foram avaliados de acordo com a classificação de Roussouly e foram considerados os parâmetros radiográficos do alinhamento sagital espinopélvico, além da medida da lordose de cada segmento da coluna lombar. Os parâmetros radiográficos foram correlacionados com o tipo da classificação de Roussouly. Resultados Noventa pacientes foram incluídos no estudo. Houve correlação significativa entre a incidência pélvica (IP) e a lordose lombar (LL) L1-S1 (R=0,89; p<0,0001). O valor da IP foi significativamente maior nos tipos 3 e 4 de Roussouly do que nos tipos 1 e 2 (p<0,001), assim como o valor da LL L1-S1 (p<0,001). Considerando o total da amostra, 67% da LL L1-S1 estava localizada entre L4-S1, porém com variação conforme o tipo de curva pela classificação de Roussouly. Conclusões O presente estudo demonstrou grande correlação entre os valores da IP e da LL, assim como a importância do segmento lombar distal (L4-S1) no valor global da LL L1-S1, ainda maior nos pacientes com menor valor de IP (tipos 1 e 2 de Roussouly). Nível de evidência II; Análise retrospectiva de banco de dados prospectivo (coorte); Estudo diagnóstico.

RESUMEN Objetivo Evaluar la variabilidad de los parámetros sagitales espinopélvicos en una muestra de pacientes, así como la distribución de lordosis en el segmento lumbar de la columna vertebral. Métodos Se trata de un estudio transversal, considerando radiografías de la columna total de una muestra de pacientes. Los pacientes fueron evaluados de acuerdo con la clasificación de Roussouly y fueron considerados los parámetros radiográficos de la alineación sagital espinopélvica, además de la medida de la lordosis de cada segmento de la columna lumbar. Los parámetros radiográficos fueron correlacionados con el tipo de la clasificación de Roussouly. Resultados Fueron incluidos 90 pacientes en el estudio. Hubo correlación significativa entre la incidencia pélvica (IP) y la lordosis lumbar (LL) L1-S1 (R=0,89; p <0,0001).). El valor de la IP fue significativamente mayor en los tipos 3 y 4 de Roussouly que en los tipos 1 y 2 (p <0,001), así como el valor de la LL L1-S1 (p <0,001). Considerando el total de la muestra, 67% de la LL L1-S1 estaba localizada entre L4-S1, aunque con variación conforme al tipo de curva por la clasificación de Roussouly. Conclusiones El presente estudio demostró gran correlación entre los valores de la IP y de la LL, así como la importancia del segmento lumbar distal (L4-S1) en el valor global de la LL L1-S1, aún mayor en los pacientes con menor valor de IP (tipos 1 y 2 de Roussouly). Nivel de evidencia II; Análisis retrospectivo de banco de datos prospectivo (cohorte), Estudio diagnóstico.

Evolução da prevalência de infecção por COVID-19 no Rio Grande do Sul, Brasil: inquéritos sorológicos seriados / Trends in the prevalence of COVID-19 infection in Rio Grande do Sul, Brazil: repeated serological surveys

Resumo A COVID-19 é uma doença produzida pelo vírus SARS-CoV-2. Esse vírus se espalhou rapidamente pelo mundo, o que levou a Organização Mundial da Saúde a classificar a COVID-19 como uma emergência de saúde internacional e, posteriormente, a declará-la uma pandemia. O número de casos confirmados, no dia 11 de abril de 2020, já passa de 1.700.000, porém esses dados não refletem a real prevalência de COVID-19 na população, visto que, em muitos países, os testes são quase que exclusivamente realizados em pessoas com sintomas, especialmente os mais graves. Para definir políticas de enfrentamento, é essencial dispor de dados sobre a prevalência real de infecção na população. Este estudo tem por objetivos avaliar a proporção de indivíduos já infectados pelo SARS-CoV-2 no Rio Grande do Sul, Brasil, analisar a velocidade de expansão da infecção e estimar o percentual de infectados com e sem sintomas. Serão realizados quatro inquéritos sorológicos repetidos a cada 15 dias, com amostragem probabilística de nove cidades sentinela, em todas as sub-regiões do Estado. As entrevistas e testes ocorrerão no âmbito domiciliar. Serão utilizados testes rápidos para detecção de anticorpos, validados previamente ao início da coleta de dados.

Abstract COVID-19, the disease produced by the virus SARS-CoV-2, has spread quickly throughout the world, leading the World Health Organization to first classify it as an international health emergency and, subsequently, declaring it pandemic. The number of confirmed cases, as April 11, surpassed 1,700,000, but this figure does not reflect the prevalence of COVID-19 in the population as, in many countries, tests are almost exclusively performed in people with symptoms, particularly severe cases. To properly assess the magnitude of the problem and to contribute to the design of evidence-based policies for fighting COVID-19, one must accurately estimate the population prevalence of infection. Our study is aimed at estimating the prevalence of infected individuals in the state of Rio Grande do Sul, Brazil, to document how fast the infection spreads, and to estimate the proportion of infected persons who present or presented symptoms, as well as the proportion of asymptomatic infections. Four repeated serological surveys will be conducted in probability samples of nine sentinel cities every two weeks. Tests will be performed in 4,500 participants in each survey, totaling18,000 interviews. Interviews and tests will be conducted at the participants' household. A rapid test for the detection of antibodies will be used; the test was validated prior to the beginning of the fieldwork.

Environmental structure affects taxonomic diversity but not functional structure of understory birds in the southwestern Brazilian Amazon

Changes in environmental characteristics can affect habitat use by birds, impacting the number of individuals, number of species, and changing species composition and functional structure of assemblages. Metrics that evaluate the functional structure of biological assemblages constitute a complementary tool to the traditional taxonomic approach, because they quantify the differences between species by means of functional traits. We assessed the effect of environmental characteristics on the taxonomic diversity (species richness, species composition and number of individuals) and functional structure (functional richness, functional evenness, Rao's functional diversity, and community-weighted mean traits) of bird assemblages in northern Mato Grosso state, in the southwestern Brazilian Amazon. We sampled birds in 32 plots. At each plot birds were captured using mist nets, and eight environmental variables were measured: canopy openness, leaf litter, elevation, number of trees in three classes of DBH, soil clay content, and distance to nearest stream. To evaluate functional structure, we measured seven morphological traits from individuals of each bird species. Habitat variables had a significant effect on taxonomic diversity. However, the general functional structure was not affected. Elevation and distance to nearest stream were the main variables driving changes in taxonomic diversity and had a minor effect on functional richness. The other metrics of functional structure were not significantly affected by the set of environmental variables. Our results suggest that the sampled bird assemblages exhibit some functional tolerance (redundancy) to small-scale environmental variation, implying certain resilience to ecosystem modification. (AU)

Grading scale of lumbar degenerative disease in full spine x-ray / Escala de graduação da doença degenerativa lombar em exames de radiografia panorâmica da coluna vertebral / Escala de graduación de la enfermedad degenerativa lumbar en exámenes de radiografía panorámica de la columna vertebral

ABSTRACT Objective: To present a new lumbar degenerative disease grading scale considering full spine radiography and to evaluate its inter- and intraobserver reproducibility. Methods: A total of 132 full spine radiographies in the anterior and lateral views were analyzed. The cases were independently graded by two examiners. The radiographic parameters observed were osteophytosis, loss of disc height, sclerosis and subchondral cysts, number of affected segments, deformities, and signs of instability. The grading scale was proposed as follows: Degree zero corresponded to the absence of signs of degenerative disease in the lumbar spine; Grade I - presence of signs of degenerative disease up to two segments; Grade II - involvement of three or more segments; Grade III - associated deformity or signs of instability. The intra- and interobserver reproducibility was determined by the Kappa coefficient (κ) in general and according to the age group. Results: Kappa coefficient obtained for interobserver and intraobserver analysis showed excellent overall correlation (0.855 and 0.902, respectively). When analyzed according to age, results obtained in intraobserver correlation remained excellent (κ >0.8) in all age groups. The interobserver correlation remained excellent, except in the age range of 40-59 years (κ = 0.773), although maintaining a substantial reproducibility. Conclusion: The grading scale of lumbar degenerative disease observed in full spine x-rays showed excellent inter- and intraobserver reproducibility. Level of Evidence I; Diagnostic study.

RESUMO Objetivo: Apresentar uma nova escala de graduação da doença degenerativa lombar observada em exames de radiografia panorâmica da coluna vertebral e avaliar sua reprodutibilidade inter e intraobservador. Métodos: Foram avaliados 132 exames de radiografia total da coluna vertebral (panorâmica) nas incidências frente e perfil. Os casos foram graduados de maneira independente por dois examinadores. Os parâmetros radiográficos observados foram osteofitose, perda da altura discal, esclerose e cistos subcondrais, número de segmentos acometidos, deformidades e sinais de instabilidade. A escala de graduação foi proposta da seguinte maneira: Grau zero como ausência de sinais de doença degenerativa na coluna lombar; Grau I apresentando sinais de doença degenerativa até 2 segmentos; Grau II apresentando acometimento de três segmentos ou mais; Grau III quando associado com deformidade ou instabilidade. A reprodutibilidade intra e interobservador foi determinada pelo coeficiente Kappa (κ) de forma geral e conforme a faixa etária. Resultados: O Coeficiente Kappa obtido para a análise interobservador e intraobservador, mostrou excelente correlação geral (0,855 e 0,902, respectivamente). Quando analisados conforme a faixa etária, os resultados obtidos na correlação intraobservador mantiveram-se como excelente (κ > 0,8) em todas as faixas etárias. Na correlação interobservador, os resultados mantiveram-se excelentes, exceto na faixa etária de 40-59 anos (κ = 0,773), mas mantendo uma reprodutibilidade substancial. Conclusão: A escala de graduação da doença degenerativa lombar observada em exames de radiografia total (panorâmica) da coluna vertebral apresentou excelente reprodutibilidade tanto inter quanto intraobservador. Nível de Evidência I; Estudo diagnóstico.

RESUMEN Objetivo: Presentar una escala de graduación de la enfermedad degenerativa lumbar en radiografías panorámicas de columna vertebral y evaluar su reproducibilidad inter e intraobservador. Métodos: Se evaluaron 132 radiografías panorámicas anteriores y laterales de columna vertebral. Los casos fueron graduados de manera independiente por dos examinadores. Los parámetros radiográficos observados fueron osteofitosis, pérdida de la altura discal, esclerosis y quistes subcondrales, número de segmentos afectados, deformidades y signos de inestabilidad. La escala de graduación que se propuso fue la siguiente: Grado cero - ausencia de signos de enfermedad degenerativa en la columna lumbar; Grado I - signos de enfermedad degenerativa hasta 2 segmentos; Grado II - compromiso de tres segmentos o más; Grado II I - deformidad asociada o signos de inestabilidad. La reproducibilidad intra e inter-observador fue determinada por el coeficiente Kappa (κ) de forma general y conforme al grupo de edad. Resultados: El coeficiente Kappa obtenido en los análisis interobservador e intraobservador mostró excelente correlación general (0,855 y 0,902, respectivamente). Cuando se analizaron según el grupo de edad, los resultados de la correlación intraobservadores se mantuve excelente (κ > 0,8) en todas las edades. En la correlación interobservadores, los resultados se mantuvieron excelentes, excepto en el edad de 40-59 años (κ = 0,773), pero manteniendo reproducibilidad sustancial. Conclusión: La escala de graduación de la enfermedad degenerativa lumbar observada en exámenes de radiografía total (panorámica) de la columna vertebral presentó excelente reproducibilidad tanto inter como intraobservador. Nivel de evidencia I; Estudio diagnóstico.