Combination of Tele-Cardiology Tools for Cardiovascular Risk Stratification in Primary Care: Data from the PROVAR+ Study. / Combinação de Ferramentas de Telecardiologia para Estratificação de Risco Cardiovascular na Atenção Primária: Dados do Estudo PROVAR.

BACKGROUND: Tele-cardiology tools are valuable strategies to improve risk stratification. OBJECTIVE: We aimed to evaluate the accuracy of tele-electrocardiography (ECG) to predict abnormalities in screening echocardiography (echo) in primary care (PC). METHODS: In 17 months, 6 health providers at 16 PC units were trained on simplified handheld echo protocols. Tele-ECGs were recorded for final diagnosis by a cardiologist. Consented patients with major ECG abnormalities by the Minnesota code, and a 1:5 sample of normal individuals underwent clinical questionnaire and screening echo interpreted remotely. Major heart disease was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion, or wall-motion abnormalities. Association between major ECG and echo abnormalities was assessed by logistic regression as follows: 1) unadjusted model; 2) model 1 adjusted for age/sex; 3) model 2 plus risk factors (hypertension/diabetes); 4) model 3 plus history of cardiovascular disease (Chagas/rheumatic heart disease/ischemic heart disease/stroke/heart failure). P-values < 0.05 were considered significant. RESULTS: A total 1,411 patients underwent echo; 1,149 (81%) had major ECG abnormalities. Median age was 67 (IQR 60 to 74) years, and 51.4% were male. Major ECG abnormalities were associated with a 2.4-fold chance of major heart disease on echo in bivariate analysis (OR = 2.42 [95% CI 1.76 to 3.39]), and remained significant after adjustments in models (p < 0.001) 2 (OR = 2.57 [95% CI 1.84 to 3.65]), model 3 (OR = 2.52 [95% CI 1.80 to3.58]), and model 4 (OR = 2.23 [95%CI 1.59 to 3.19]). Age, male sex, heart failure, and ischemic heart disease were also independent predictors of major heart disease on echo. CONCLUSIONS: Tele-ECG abnormalities increased the likelihood of major heart disease on screening echo, even after adjustments for demographic and clinical variables.

FUNDAMENTO: As ferramentas de telecardiologia são estratégias valiosas para melhorar a estratificação de risco. OBJETIVO: Objetivamos avaliar a acurácia da tele-eletrocardiografia (ECG) para predizer anormalidades no ecocardiograma de rastreamento na atenção primária. MÉTODOS: Em 17 meses, 6 profissionais de saúde em 16 unidades de atenção primária foram treinados em protocolos simplificados de ecocardiografia portátil. Tele-ECGs foram registrados para diagnóstico final por um cardiologista. Pacientes consentidos com anormalidades maiores no ECG pelo código de Minnesota e uma amostra 1:5 de indivíduos normais foram submetidos a um questionário clínico e ecocardiograma de rastreamento interpretado remotamente. A doença cardíaca grave foi definida como doença valvular moderada/grave, disfunção/hipertrofia ventricular, derrame pericárdico ou anormalidade da motilidade. A associação entre alterações maiores do ECG e anormalidades ecocardiográficas foi avaliada por regressão logística da seguinte forma: 1) modelo não ajustado; 2) modelo 1 ajustado por idade/sexo; 3) modelo 2 mais fatores de risco (hipertensão/diabetes); 4) modelo 3 mais história de doença cardiovascular (Chagas/cardiopatia reumática/cardiopatia isquêmica/AVC/insuficiência cardíaca). Foram considerados significativos valores de p < 0,05. RESULTADOS: No total, 1.411 pacientes realizaram ecocardiograma, sendo 1.149 (81%) com anormalidades maiores no ECG. A idade mediana foi de 67 anos (intervalo interquartil de 60 a 74) e 51,4% eram do sexo masculino. As anormalidades maiores no ECG se associaram a uma chance 2,4 vezes maior de doença cardíaca grave no ecocardiograma de rastreamento na análise bivariada (OR = 2,42 [IC 95% 1,76 a 3,39]) e permaneceram significativas (p < 0,001) após ajustes no modelo 2 (OR = 2,57 [IC 95% 1,84 a 3,65]), modelo 3 (OR = 2,52 [IC 95% 1,80 a 3,58]) e modelo 4 (OR = 2,23 [IC 95% 1,59 a 3,19]). Idade, sexo masculino, insuficiência cardíaca e doença cardíaca isquêmica também foram preditores independentes de doença cardíaca grave no ecocardiograma. CONCLUSÕES: As anormalidades do tele-ECG aumentaram a probabilidade de doença cardíaca grave no ecocardiograma de rastreamento, mesmo após ajustes para variáveis demográficas e clínicas.

Agreement between Handheld and Standard Echocardiography for Diagnosis of Latent Rheumatic Heart Disease in Brazilian Schoolchildren from High-Prevalence Settings (Agreement between Screening and Standard Echo for RHD).

Introduction: Handheld echocardiography (echo) is the tool of choice for rheumatic heart disease (RHD) screening. We aimed to assess the agreement between screening and standard echo for latent RHD diagnosis in schoolchildren from an endemic setting. Methods: Over 14 months, 3 nonphysicians used handheld machines and the 2012 WHF Criteria to determine RHD prevalence in consented schoolchildren from Brazilian low-income public schools. Studies were interpreted by telemedicine by 3 experts (Brazil, US). RHD-positive children (borderline/definite) and those with congenital heart disease (CHD) were referred for standard echo, acquired and interpreted by a cardiologist. Agreement between screening and standard echo, by WHF subgroups, was assessed. Results: 1390 students were screened in 6 schools, with 110 (7.9%, 95% CI 6.5-9.5) being screen positive (14 ± 2 years, 72% women). Among 16 cases initially diagnosed as definite RHD, 11 (69%) were confirmed, 4 (25%) reclassified to borderline, and 1 to normal. Among 79 cases flagged as borderline RHD, 19 (24%) were confirmed, 50 (63%) reclassified to normal, 8 (10%) reclassified as definite RHD, and 2 had mild CHD. Considering the 4 diagnostic categories, kappa was 0.18. In patients with borderline RHD reclassified to non-RHD, the most frequent WHF criterion was B (isolated mitral regurgitation, 64%), followed by A (2 mitral valve morphological features, 31%). In 1 patient with definite RHD reclassified to normal, the WHF criterion was D (borderline RHD in aortic and mitral valves). After standard echo, RHD prevalence was 3.2% (95% CI 2.3-4.2). Conclusions: Although practical, RHD screening with handheld devices tends to overestimate prevalence.

Grazing-incidence synchrotron radiation diffraction studies on irradiated Ce-doped and pristine Y-stabilized ZrO2 at the Rossendorf beamline.

In this work, Ce-doped yttria-stabilized zirconia (YSZ) and pure YSZ phases were subjected to irradiation with 14 MeV Au ions. Irradiation studies were performed to simulate long-term structural and microstructural damage due to self-irradiation in YSZ phases hosting alpha-active radioactive species. It was found that both the Ce-doped YSZ and the YSZ phases had a reasonable tolerance to irradiation at high ion fluences and the bulk crystallinity was well preserved. Nevertheless, local microstrain increased in all compounds under study after irradiation, with the Ce-doped phases being less affected than pure YSZ. Doping with cerium ions increased the microstructural stability of YSZ phases through a possible reduction in the mobility of oxygen atoms, which limits the formation of structural defects. Doping of YSZ with tetravalent actinide elements is expected to have a similar effect. Thus, YSZ phases are promising for the safe long-term storage of radioactive elements. Using synchrotron radiation diffraction, measurements of the thin irradiated layers of the Ce-YSZ and YSZ samples were performed in grazing incidence (GI) mode. A corresponding module for measurements in GI mode was developed at the Rossendorf Beamline and relevant technical details for sample alignment and data collection are also presented.

Evidence of SARS-CoV-2 infection and co-infections in stray cats in Brazil.

The zoonotic virus SARS-CoV-2, which causes severe acute respiratory syndrome in humans (COVID-19), has been identified in cats. Notably, most positive cases were in cats that had close contact with infected humans, suggesting a role for humans in animal transmission routes. Previous studies have suggested that animals with immune depletion are more susceptible to SARS-CoV-2 infection. To date, there is limited evidence of SARS-CoV-2 infections in stray and free-range cats affected by other pathogens. In this study, we investigated infections caused by SARS-CoV-2, Leishmania spp., Toxoplasma gondii, Mycoplasma spp., Bartonella spp., Feline leukemia virus (FeLV), and Feline immunodeficiency virus (FIV) in stray cats from an urban park in Brazil during the COVID-19 pandemic. From February to September 2021, 78 mixed-breed cats were tested for SARS-CoV-2 and hemopathogens using molecular analysis at Américo Renné Giannetti Municipal Park, Belo Horizonte, Minas Gerais, Brazil. An enzyme-linked immunosorbent assay (ELISA) was used to detect IgG in T. gondii. None of the animals in this study showed any clinical signs of infections. The SARS-CoV-2 virus RNA was detected in 7.7 % of cats, and a whole virus genome sequence analysis revealed the SARS-CoV-2 Delta lineage (B.1.617.2). Phylogenetic analysis showed that SARS-CoV-2 isolated from cats was grouped into the sublineage AY.99.2, which matches the epidemiological scenario of COVID-19 in the urban area of our study. Leishmania infantum was detected and sequenced in 9 % of cats. The seroprevalence of T. gondii was 23.1 %. Hemotropic Mycoplasma spp. was detected in 7.7 % of the cats, with Mycoplasma haemofelis and Candidatus Mycoplasma haemominutum being the most common. Bartonella henselae and Bartonella clarridgeiae were detected in 38.5 % of the cats, FeLV was detected in 17,9 %, and none of the cats studied tested positive for FIV. This study reports, for the first time, the SARS-CoV-2 infection with whole-genome sequencing in stray cats in southeastern Brazil and co-infection with other pathogens, including Bartonella spp. and Feline leukemia virus. Our study observed no correlation between SARS-CoV-2 and the other detected pathogens. Our results emphasize the importance of monitoring SARS-CoV-2 in stray cats to characterize their epidemiological role in SARS-CoV-2 infection and reinforce the importance of zoonotic disease surveillance.

Combinação de Ferramentas de Telecardiologia para Estratificação de Risco Cardiovascular na Atenção Primária: Dados do Estudo PROVAR+ / Combination of Tele-Cardiology Tools for Cardiovascular Risk Stratification in Primary Care: Data from the PROVAR+ Study

Resumo Fundamento: As ferramentas de telecardiologia são estratégias valiosas para melhorar a estratificação de risco. Objetivo: Objetivamos avaliar a acurácia da tele-eletrocardiografia (ECG) para predizer anormalidades no ecocardiograma de rastreamento na atenção primária. Métodos: Em 17 meses, 6 profissionais de saúde em 16 unidades de atenção primária foram treinados em protocolos simplificados de ecocardiografia portátil. Tele-ECGs foram registrados para diagnóstico final por um cardiologista. Pacientes consentidos com anormalidades maiores no ECG pelo código de Minnesota e uma amostra 1:5 de indivíduos normais foram submetidos a um questionário clínico e ecocardiograma de rastreamento interpretado remotamente. A doença cardíaca grave foi definida como doença valvular moderada/grave, disfunção/hipertrofia ventricular, derrame pericárdico ou anormalidade da motilidade. A associação entre alterações maiores do ECG e anormalidades ecocardiográficas foi avaliada por regressão logística da seguinte forma: 1) modelo não ajustado; 2) modelo 1 ajustado por idade/sexo; 3) modelo 2 mais fatores de risco (hipertensão/diabetes); 4) modelo 3 mais história de doença cardiovascular (Chagas/cardiopatia reumática/cardiopatia isquêmica/AVC/insuficiência cardíaca). Foram considerados significativos valores de p < 0,05. Resultados: No total, 1.411 pacientes realizaram ecocardiograma, sendo 1.149 (81%) com anormalidades maiores no ECG. A idade mediana foi de 67 anos (intervalo interquartil de 60 a 74) e 51,4% eram do sexo masculino. As anormalidades maiores no ECG se associaram a uma chance 2,4 vezes maior de doença cardíaca grave no ecocardiograma de rastreamento na análise bivariada (OR = 2,42 [IC 95% 1,76 a 3,39]) e permaneceram significativas (p < 0,001) após ajustes no modelo 2 (OR = 2,57 [IC 95% 1,84 a 3,65]), modelo 3 (OR = 2,52 [IC 95% 1,80 a 3,58]) e modelo 4 (OR = 2,23 [IC 95% 1,59 a 3,19]). Idade, sexo masculino, insuficiência cardíaca e doença cardíaca isquêmica também foram preditores independentes de doença cardíaca grave no ecocardiograma. Conclusões: As anormalidades do tele-ECG aumentaram a probabilidade de doença cardíaca grave no ecocardiograma de rastreamento, mesmo após ajustes para variáveis demográficas e clínicas.

Abstract Background: Tele-cardiology tools are valuable strategies to improve risk stratification. Objective: We aimed to evaluate the accuracy of tele-electrocardiography (ECG) to predict abnormalities in screening echocardiography (echo) in primary care (PC). Methods: In 17 months, 6 health providers at 16 PC units were trained on simplified handheld echo protocols. Tele-ECGs were recorded for final diagnosis by a cardiologist. Consented patients with major ECG abnormalities by the Minnesota code, and a 1:5 sample of normal individuals underwent clinical questionnaire and screening echo interpreted remotely. Major heart disease was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion, or wall-motion abnormalities. Association between major ECG and echo abnormalities was assessed by logistic regression as follows: 1) unadjusted model; 2) model 1 adjusted for age/sex; 3) model 2 plus risk factors (hypertension/diabetes); 4) model 3 plus history of cardiovascular disease (Chagas/rheumatic heart disease/ischemic heart disease/stroke/heart failure). P-values < 0.05 were considered significant. Results: A total 1,411 patients underwent echo; 1,149 (81%) had major ECG abnormalities. Median age was 67 (IQR 60 to 74) years, and 51.4% were male. Major ECG abnormalities were associated with a 2.4-fold chance of major heart disease on echo in bivariate analysis (OR = 2.42 [95% CI 1.76 to 3.39]), and remained significant after adjustments in models (p < 0.001) 2 (OR = 2.57 [95% CI 1.84 to 3.65]), model 3 (OR = 2.52 [95% CI 1.80 to3.58]), and model 4 (OR = 2.23 [95%CI 1.59 to 3.19]). Age, male sex, heart failure, and ischemic heart disease were also independent predictors of major heart disease on echo. Conclusions: Tele-ECG abnormalities increased the likelihood of major heart disease on screening echo, even after adjustments for demographic and clinical variables.

Atitudes diante da morte e espiritualidade em estudantes de Medicina: um ensaio educacional / Attitudes towards death and spirituality in Medical students: an educational trial

RESUMO Introdução: Apesar de ser parte essencial do cuidado, os profissionais de saúde não recebem, durante a formação, o preparo adequado para que possam lidar com os sentimentos consequentes da morte de um paciente, o que pode gerar impactos negativos no bem-estar deles. Por conta disso, é imprescindível realizar uma reflexão sobre essa temática. Objetivo: Este estudo teve como objetivo analisar as atitudes dos estudantes de Medicina acerca do processo de morte e o índice de espiritualidade antes e depois da vivência do módulo "Saúde do Idoso, Envelhecimento e Terminalidade da Vida", dirigido aos alunos do oitavo período da Faculdade Pernambucana de Saúde, em 2021. Método: Realizou-se um ensaio educacional, do tipo antes e depois, analítico, baseado na abordagem da morte e do processo de morrer por meio do referido módulo. Os participantes responderam a um questionário contendo as variáveis de interesse e instrumentos validados (Perfil de atitudes frente à morte - Revisado (DAP-R) e Spirituality Self Rating Scale - SSRS). Para análise estatística, adotou-se o teste do qui-quadrado, considerando o valor de p < 0,05. Resultado: Não houve mudança significativa da atitude diante da morte antes e depois do módulo (p = 0,236), destacando-se predominância de atitudes negativas (p = 0,775), em especial evitamento da morte, nos dois momentos do estudo. Entre os estudantes com espiritualidade alta, atitudes negativas também foram mais prevalentes, sem diferença significativa nos períodos pré e pós-módulo. Conclusão: A ausência de mudanças de atitude corrobora a hipótese de que a atual abordagem acerca dessa temática não é suficiente para que os estudantes desenvolvam atitudes adaptativas necessárias para lidar com a morte no âmbito profissional.

ABSTRACT Introduction: Despite being an essential part of medical care, professionals do not receive adequate preparation during their training to best face all the feelings resulting from the loss of a patient, generating negative impacts on the well being of these professionals, and justifying the need to reflect on the approach to this theme. Objective: The present study analyzed the attitudes of medical students regarding the process of death and spirituality before and after the completion of the module "Health of the Elderly, Aging, and Terminality of Life", for medical students of the 8th period at the Faculdade Pernambucana de Saúde, in 2021. Method: This is a clinical educational trial, of the analytical before-and-after type, focused on the approach to death and the dying process through the mentioned module. The participants answered a questionnaire containing the variables of interest and validated instruments (Death Attitude Profile Revised and Spirituality Self Rating Scale). For statistical analysis the chi-square test was used, considering a value of p<0.05. Result: There was no significant change in attitude towards death before and after the module (p=0.236), with a predominance of negative attitudes (p=0.775), especially avoidance of death, in both moments of the study. Among students with high spirituality, negative attitudes were also more prevalent, with no significant difference between the two moments of the survey. Conclusion: The lack of changes in attitude corroborates the hypothesis that the current approach to this topic is not sufficient for students to develop the adaptive attitudes necessary to deal with death in the professional environment.

The relationship between the clinical severity of chronic venous insufficiency and the calf muscle pump: A cross-sectional study.

PURPOSE: To investigate the connection between the clinical severity of chronic venous insufficiency (CVI) and the biomechanics of the calf muscle pump (CMP). MATERIAL AND METHODS: Through a cross-sectional observational study, we analyzed women on the age range between 30 and 80 years with chronic venous insufficiency, stratified according to the clinical classification. Ninety-nine women were assessed and classified into groups with different levels of severity: C1 (n = 22); C2 (n = 22); C3 (n = 22); C4 (n = 22); C5 (n = 8); C6 (n = 3). The main purpose was to investigate the strength of the calf muscle pump through total work (TW) and peak torque (PT), and the range of motion (ROM) of the ankle joint. For a secondary analysis, the fatigue index was assessed. All results were run through the Humac®/NORMT isokinetic dynamometer to obtain the data. RESULTS: Our findings pointed out that as the clinical severity of CVI increases, there is a reduction on the PT, the TW, the maximum active ROM and the ROM at 120°/sec. As severity increased, there was a reduction of 24Nm in the TW at 30°/sec.and a reduction of 3Nm in the PT at 30°/sec. OUTCOMES: When increased, clinical severity of CVI may trigger downgrading in the strength of the CMP and the ROM in the ankle. These findings are of relevance to the clinician, since through these findings, individuals with venous insufficiency may be treated more precisely for each classification.

Self-rated health of Brazilian women of childbearing age: a cross-sectional study.

OBJECTIVE: To investigate sociodemographic factors, non-communicable diseases and conditions, and behavioral risk factors associated with negative self-rated health among Brazilian women of childbearing age. METHOD: Cross-sectional study with 26,071 Brazilian women of reproductive age. Estimated prevalence of self-rated health according to sociodemographic characteristics, non-communicable diseases and conditions, and behavioral risk factors. Poisson regression was used to estimate adjusted and unadjusted prevalence ratios. RESULTS: Occurrence of two or more of the diseases and conditions presented a prevalence of negative self-rated health almost three times higher than none. There was a positive association between negative self-rated health and older age groups, lower education, black or brown skin color/race, living in the north and northeast regions, physical inactivity, being a smoker, and presence of one or more of the diseases and conditions. CONCLUSION: There are differences in self-rated health, reflecting social inequalities.

Molecular detection and characterization of SARS-CoV-2 in cats and dogs of positive owners during the first COVID-19 wave in Brazil.

Despite previous reports of SARS-CoV-2 infection in dogs and cats worldwide, the type of swab sample used for its detection through RT-qPCR needs to be better compared and described. Accordingly, as part of a multicenter study in Brazil, the aim of the present study was to assess which rectal or oropharyngeal swabs would be more appropriate for detecting SARS-CoV-2 in cats and dogs, through viral load comparison. Pets of owners diagnosed with COVID-19 in the last 7 days were eligible. A total of 148 animals from four of the five Brazilian geographical regions were analyzed, among which 10/48 cats (20.83%) and 11/100 dogs (11.00%) were positive. The results suggested that oropharyngeal swabs should be considered for SARS-CoV-2 detection, particularly in cats, due to the higher cDNA viral load. Also, the genomic results showed similarities between SARS-CoV-2 animal variants and human variants that were circulating at the time of sampling, thus corroborating the existence of zooanthroponotic transmission. In conclusion, the present study highlighted the importance of SARS-CoV-2 monitoring among cats and dogs, as virus modification may indicate the possibility of mutations in animals and spillover back to owners. Thus, positive individuals should always self-isolate from their pets during COVID-19, to prevent trans-species transmission and mutation.

Microwave-Assisted Digestion of Polyurethane Foam as an Alternative to Elution: Solid Phase Extraction of Cd(II) and Pb(II) for Their Determination in Swimming Pool Waters.

In this work, a separation/preconcentration method is proposed for the determination of Cd(II) and Pb(II) in swimming pool waters, using ammonium pyrrolidine dithiocarbamate (APDC) as a complexing agent and unloaded polyurethane foam (PUF) as a sorbent. The proposed method was optimized, and the defined optimal conditions were a pH of 7, 30 min of shaking time, 400 mg of PUF, and 0.5% (m/v) of the APDC solution. The release of Cd(II) and Pb(II) from the solid phase was achieved through the total digestion of PUF using a microwave-assisted acid approach with a 10.5 mol·L-1 HNO3 solution. The methodology was applied to four samples of swimming pool water for the determination of Cd(II) and Pb(II) using graphite furnace atomic absorption spectrometry (GF AAS). The limits of detection and quantification obtained were 0.02 and 0.06 µg·L-1 for Cd(II) and 0.5 e 1.8 µg·L-1 for Pb(II), respectively. We analyzed four samples of swimming pool waters, finding Cd concentrations between 0.22 and 1.37 µg·L-1. On the other hand, only one sample presented Pb concentration above the limit of quantification (11.4 µg·L-1). Recovery tests were performed by spiking the samples with known concentrations of the analytes, and recovery percentages between 82% and 105% were obtained.

Toxicity of copper and zinc alone and in combination in Caenorhabditis elegans model of Huntington's disease and protective effects of rutin.

Copper (Cu) and Zinc (Zn) are required in small concentrations for metabolic functions, but are also toxic. There is a great concern about soil pollution by heavy metals, which may exposure the population to these toxicants, either by inhalation of dust or exposure to toxicants through ingestion of food derived from contaminated soils. In addition, the toxicity of metals in combination is questionable, as soil quality guidelines only assess them separately. It is well known that metal accumulation is often found in the pathologically affected regions of many neurodegenerative diseases, including Huntington's disease (HD). HD is caused by an autosomal dominantly inherited CAG trinucleotide repeat expansion in the huntingtin (HTT) gene. This results in the formation of a mutant huntingtin (mHTT) protein with an abnormally long polyglutamine (polyQ) repeat. The pathology of HD results in loss of neuronal cells, motor changes, and dementia. Rutin is a flavonoid found in various food sources, and previous studies indicate it has protective effects in HD models and acts as a metal chelator. However, further studies are needed to unravel its effects on metal dyshomeostasis and to discern the underlying mechanisms. In the present study, we investigated the toxic effects of long-term exposure to copper, zinc, and their mixture, and the relationship with the progression of neurotoxicity and neurodegeneration in a C. elegans-based HD model. Furthermore, we investigated the effects of rutin post metal exposure. Overall, we demonstrate that chronic exposure to the metals and their mixture altered body parameters, locomotion, and developmental delay, in addition to increasing polyQ protein aggregates in muscles and neurons causing neurodegeneration. We also propose that rutin has protective effects acting through mechanisms involving antioxidant and chelating properties. Altogether, our data provides new indications about the higher toxicity of metals in combination, the chelating potential of rutin in the C. elegans model of HD and possible strategies for future treatments of neurodegenerative diseases caused by the aggregation of proteins related to metals.

The Omicron Lineages BA.1 and BA.2 (Betacoronavirus SARS-CoV-2) Have Repeatedly Entered Brazil through a Single Dispersal Hub.

Brazil currently ranks second in absolute deaths by COVID-19, even though most of its population has completed the vaccination protocol. With the introduction of Omicron in late 2021, the number of COVID-19 cases soared once again in the country. We investigated in this work how lineages BA.1 and BA.2 entered and spread in the country by sequencing 2173 new SARS-CoV-2 genomes collected between October 2021 and April 2022 and analyzing them in addition to more than 18,000 publicly available sequences with phylodynamic methods. We registered that Omicron was present in Brazil as early as 16 November 2021 and by January 2022 was already more than 99% of samples. More importantly, we detected that Omicron has been mostly imported through the state of São Paulo, which in turn dispersed the lineages to other states and regions of Brazil. This knowledge can be used to implement more efficient non-pharmaceutical interventions against the introduction of new SARS-CoV variants focused on surveillance of airports and ground transportation.

Epidemiological Surveillance Reveals the Rise and Establishment of the Omicron SARS-CoV-2 Variant in Brazil.

The introduction of SARS-CoV-2 variants of concern (VOCs) in Brazil has been associated with major impacts on the epidemiological and public health scenario. In this study, 291,571 samples were investigated for SARS-CoV-2 variants from August 2021 to March 2022 (the highest peak of positive cases) in four geographical regions of Brazil. To identify the frequency, introduction, and dispersion of SARS-CoV-2 variants in 12 Brazilian capitals, VOCs defining spike mutations were identified in 35,735 samples through genotyping and viral genome sequencing. Omicron VOC was detected in late November 2021 and replaced the Delta VOC in approximately 3.5 weeks. We estimated viral load differences between SARS-CoV-2 Delta and Omicron through the evaluation of the RT-qPCR cycle threshold (Ct) score in 77,262 samples. The analysis demonstrated that the Omicron VOC has a lower viral load in infected patients than the Delta VOC. Analyses of clinical outcomes in 17,586 patients across the country indicated that individuals infected with Omicron were less likely to need ventilatory support. The results of our study reinforce the importance of surveillance programs at the national level and showed the introduction and faster dispersion of Omicron over Delta VOC in Brazil without increasing the numbers of severe cases of COVID-19.

Conhecimento dos profissionais de saúde sobre precauções específicas / Knowledge of health professionals about specific precautions / Conocimiento de profesionales de la salud sobre precauciones específicas

Objetivo: apresentar um diagnóstico situacional sobre o conhecimento dos profissionais de saúde sobre precauções específicas. Métodos: estudo transversal, realizado em um hospital filantrópico mineiro, com 127 profissionais de saúde de nível superior. Para a coleta de dados, utilizou-se o instrumento "Conhecimento dos profissionais de saúde sobre Precauções Específicas" com 29 questões de múltipla escolha, distribuídas em cinco eixos temáticos. Para a análise dos dados, foram executados procedimentos descritivos e diferentes testes estatísticos. Resultados: a média geral de acertos das questões foi 64,7%. O eixo temático "Acomodação e estrutura" apresentou mediana de acertos (43,6%) significativamente menor (p<0,001) que os demais eixos. O eixo "Cadeia epidemiológica de transmissão de microrganismos" apresentou mediana de 60% e os eixos "Cuidado com ambiente" e "Comunicação" tiveram mediana de 66,7%. A maior mediana de acertos ocorreu no eixo "Equipamento de proteção individual (80%)". Conclusão: a assertividade foi baixa em todos os eixos temáticos, o que pode comprometer a qualidade e a segurança da assistência prestada. Assim, verifica-se a necessidade de promover ações educativas com estratégias inovadoras, sensibilizando estes profissionais quanto à adesão dessas medidas de precaução. (AU)

Objective: to present a situational diagnosis about the knowledge of health professionals about specific precautions. Methods: cross-sectional study, conducted in a philanthropic hospital in Minas Gerais, with 127 health professionals of higher education. For data collection, was used the instrument "Knowledge of health professionals on Specific Precautions" with 29 multiple choice questions, distributed in five thematic axes. Descriptive procedures and different statistical tests were performed for the analysis of the data. Results: the overall average number of correct answers was 64.7%. The thematic axis "Accommodation and structure" presented a significantly lower median number of correct answers (p<0.001) than the other axes. The axis "Epidemiological chain of transmission of microorganisms" presented a median of 60% and the axes "Environment Care" and "Communication" had a median of 66.7%. The highest median of correct answers occurred in the axis "Personal protective equipment (80%)". Conclusion: assertiveness was low in all thematic axes, which can compromise the quality and safety of the care provided. Thus, there is a need to promote educational actions with innovative strategies, sensitizing these professionals about the adoption of these precautionary measures. (AU)

Objectivo: presentar un diagnóstico situacional sobre el conocimiento de los profesionales de la salud sobre precauciones específicas. Métodos: estudio transversal realizado en un hospital filantrópico de Minas Gerais, con 127 profesionales de la salud de nivel superior. Para la recopilación de datos, se utilizó el instrumento "Conocimiento de los profesionales de la salud sobre Precauciones Específicas", con 29 preguntas objetivas de múltiple elección, distribuidas en cinco ejes temáticos. Para el análisis de los datos, se realizaron procedimientos descriptivos y diferentes pruebas estadísticas. Resultados: la media general de respuestas correctas fue del 64,7%. El eje temático "Acomodación y estructura" mostró una mediana de respuestas correctas (43,6%) significativamente menor (p<0,001) que los otros ejes. El eje "Cadena epidemiológica de transmisión de microorganismos" tuvo una mediana del 60% y los ejes "Cuidado del medio ambiente" y "Comunicación" tuvieron una mediana del 66,7%. La mediana más alta de respuestas correctas se dio en el eje "Equipo de protección personal (80%)". Conclusión: el asertividad fue baja en todos los ejes temáticos, lo que puede comprometer la calidad y la seguridad de la atención prestada. Así, se comprueba la necesidad de promover acciones educativas con estrategias innovadoras, sensibilizando a estos profesionales en cuanto a la aplicación de las medidas de precaución. (AU)

Reasons for disagreement between screening and standard echocardiography in primary care: data from the PROVAR + study : Disagreement between screening and standard echo.

We aimed to evaluate the reasons for disagreement between screening echocardiography (echo), acquired by nonexperts, and standard echo in the Brazilian primary care (PC). Over 20 months, 22 PC workers were trained on simplified handheld (GE VSCAN) echo protocols. Screening groups, consisting of patients aged 17-20, 35-40 and 60-65 years, and patients referred for clinical indications underwent focused echo. Studies were remotelyinterpreted in US and Brazil, and those diagnosed with major or severe HD were referred for standard echoperformed by an expert. Major HD was defined as moderate to severe valve disease, ventriculardysfunction/hypertrophy, pericardial effusion or wall-motion abnormalities. A random sample of exams wasselected for evaluation of variables accounting for disagreement. A sample of 768 patients was analyzed, 651(85%) in the referred group. Quality issues were reported in 5.8%, and the random Kappa for major HD between screening and standard echo was 0.51. The most frequent reasons for disagreement were: overestimation of mitral regurgitation (MR) (17.9%, N=138), left ventricular (LV) dysfunction (15.7%, N=121), aortic regurgitation (AR) (15.2%, N=117), LV hypertrophy (13.5%, N=104) and tricuspid regurgitation (12.7%, N=98). Misdiagnosis of mitral and aortic morphological abnormalities was observed in 12.4% and 3.0%, and underestimation of AR and MR occurred in 4.6% and 11.1%. Among 257 patients with suspected mild/moderate MR, 129 were reclassified to normal. In conclusion, although screening echo with task-shifting in PC is a promising tool in low-income areas, estimation of valve regurgitation and LV function and size account for considerable disagreement with standard exams.

Exogenous Adenosine Modulates Behaviors and Stress Response in Caenorhabditis elegans.

Adenosine, a purine nucleoside with neuromodulatory actions, is part of the purinergic signaling system (PSS). Caenorhabditis elegans is a free-living nematode found in soil, used in biological research for its advantages as an alternative experimental model. Since there is a lack of evidence of adenosine's direct actions and the PSS's participation in this animal, such an investigation is necessary. In this research, we aimed to test the effects of acute and chronic adenosine at 1, 5, and 10 mM on nematode's behaviors, morphology, survival after stress conditions, and on pathways related to the response to oxidative stress (DAF-16/FOXO and SKN-1) and genes products downstream these pathways (SOD-3, HSP-16.2, and GCS-1). Acute or chronic adenosine did not alter the worms' morphology analyzed by the worms' length, width, and area, nor interfered with reproductive behavior. On the other hand, acute and chronic adenosine modulated the defecation rate, pharyngeal pumping rate, and locomotion, in addition, to interacting with stress response pathways in C. elegans. Adenosine interfered in the speed and mobility of the worms analyzed. In addition, both acute and chronic adenosine presented modulatory effects on oxidative stress response signaling. Acute adenosine prevented the heat-induced-increase of DAF-16 activation and SOD-3 levels, while chronic adenosine per se induced DAF-16 activation and prevented heat-induced-increase of HSP-16.2 and SKN-1 levels. Together, these results indicate that exogenous adenosine has physiological and biochemical effects on C. elegans and describes possible purinergic signaling in worms.

Pediatricians' perceptions of gender issues that influence the choice of medical specialty.

Introduction: The medical field has witnessed a growing expansion of the female workforce. Despite a greater appreciation and trust in women in pediatric spaces, gender violence remains a significant concern on the health agenda. Objectives: This study aimed to investigate how pediatricians perceive gender experiences in daily work, discussing its effects on professional practice. Methods: The study adopted a descriptive, exploratory, and qualitative approach and was conducted in a university hospital with 14 pediatricians from the urgency and emergency service. Virtual semi-structured interviews were conducted to explore sociodemographic data, training, and professional background. The narratives obtained were subjected to Content Analysis, resulting in the construction of five categories: choice by specialty; maternity; place of reception; violence; and the male doctor. Results: It was observed that pediatricians build their professional routine based on conservative values of patriarchal and sexist anchorage. Conclusions: The set of narratives emphasize the importance of confronting gender inequality within the scope of medical training.

Introdução: A medicina vem apresentando uma crescente expansão da mão de obra feminina. Apesar de maior valorização e confiança em mulheres nos espaços pediátricos, as violências de gênero fazem parte da agenda de saúde. Objetivos: Investigar como os pediatras percebem as vivências de gênero no cotidiano do trabalho, discutindo os seus efeitos na prática profissional. Métodos: Tratou-se de um estudo descritivo, exploratório e qualitativo, realizado em um hospital universitário com 14 pediatras do serviço de urgência e emergência. As entrevistas semiestruturadas foram realizadas virtualmente, investigando dados sociodemográficos e percursos formativo e profissional. As narrativas foram analisadas pelo método de análise de conteúdo. Foram formadas cinco categorias: escolha pela especialidade; maternidade; lugar de acolhimento; violências; e o médico homem. Resultados: Observou-se que pediatras constroem seu cotidiano profissional a partir de valores conservadores de ancoramento patriarcal e machista. Conclusões: O conjunto das narrativas coloca a importância do enfrentamento da desigualdade de gênero no âmbito da formação médica.

Self-rated health of Brazilian women of childbearing age: a cross-sectional study / Autoevaluación de la salud de mujeres brasileñas en edad fértil: estudio transversal / Autoavaliação de saúde das mulheres brasileiras em idade reprodutiva: estudo transversal

ABSTRACT Objective: To investigate sociodemographic factors, non-communicable diseases and conditions, and behavioral risk factors associated with negative self-rated health among Brazilian women of childbearing age. Method: Cross-sectional study with 26,071 Brazilian women of reproductive age. Estimated prevalence of self-rated health according to sociodemographic characteristics, non-communicable diseases and conditions, and behavioral risk factors. Poisson regression was used to estimate adjusted and unadjusted prevalence ratios. Results: Occurrence of two or more of the diseases and conditions presented a prevalence of negative self-rated health almost three times higher than none. There was a positive association between negative self-rated health and older age groups, lower education, black or brown skin color/race, living in the north and northeast regions, physical inactivity, being a smoker, and presence of one or more of the diseases and conditions. Conclusion: There are differences in self-rated health, reflecting social inequalities.

RESUMEN Objetivo: Investigar factores sociodemográficos, enfermedades y condiciones no transmisibles y factores de riesgo conductuales asociados con la autoevaluación negativa de la salud entre mujeres brasileñas en edad fértil. Método: Estudio transversal con 26.071 mujeres brasileñas en edad reproductiva. Prevalencia estimada de salud autovalorada según características sociodemográficas, enfermedades y trastornos no transmisibles y factores de riesgo conductuales. Se utilizó la regresión de Poisson para estimar las tasas de prevalencia ajustadas y no ajustadas. Resultados: La aparición de dos o más de las enfermedades y agravios mostró una prevalencia de autoevaluación negativa de la salud casi tres veces mayor que ninguna. Hubo una asociación positiva entre la autoevaluación negativa de la salud y los grupos de mayor edad, menor educación, color de piel/raza negra o morena, vivir en las regiones norte y noreste, inactividad física, ser fumador y la presencia de una o más de las enfermedades y condiciones. Conclusión: Existen diferencias en la autoevaluación de la salud, lo que refleja desigualdades sociales.

RESUMO Objetivo: Investigar fatores sociodemográficos, doenças e agravos não transmissíveis e fatores de risco comportamentais associados à autoavaliação de saúde negativa das mulheres brasileiras em idade reprodutiva. Método: Estudo transversal com 26.071 mulheres brasileiras em idade reprodutiva. Estimadas prevalências da autoavaliação de saúde segundo características sociodemográficas, doenças e agravos não transmissíveis e fatores de risco comportamentais. Utilizou-se regressão de Poisson para estimar as razões de prevalência ajustadas e não ajustadas. Resultados: Ocorrência de duas ou mais das doenças e agravos apresentou prevalência de autoavaliação de saúde negativa quase três vezes maior do que nenhuma. Houve associação positiva entre autoavaliação de saúde negativa e maiores faixas etárias, menor escolaridade, cor da pele/raça preta ou parda, viver nas regiões norte e nordeste, inatividade física, ser fumante e presença de uma ou mais das doenças e agravos. Conclusão: Existem diferenças na autoavaliação de saúde, refletindo em iniquidades sociais.

Effects of complex decongestive therapy and aquatic physiotherapy on markers of the inflammatory process in individuals with lymphedema.

BACKGROUND: Chronic lymphedema is a progressive and inflammatory disease caused by impaired lymphatic transport. PURPOSE: This study evaluates the effects of complex decongestive therapy (CDT) and aquatic physiotherapy on markers of the inflammatory process and lower limb volumes in individuals with lymphedema. METHODS: A randomized controlled clinical trial was carried out with three groups: patients with lymphedema submitted to CDT, patients with lymphedema submitted to aquatic physiotherapy, and control group of individuals without lymphedema. The evaluation was performed through blood count, CRP measurements, C3, C4 complement, measurement of serum levels of cytokines interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), interleukins 4 (IL-4), 6 (IL-6), and 10 (IL-10), and the volume of a lower limb using the volume formula of a truncated cone. The study was registered with the Brazilian Clinical Trials Registry (RBR-4tpkszn). RESULTS: Our work showed a reduction in the TNF-α levels of patients in the CDT group (p = .028). Significant differences were found between the control group and the CDT group for IL-10 (p = .049) and Monocytes (p = .039). No significant reduction in limb volume was found. CONCLUSION: Our results show that CDT was able to significantly reduce the inflammatory marker TNF-α in patients with lymphedema, suggesting an anti-inflammatory effect of the therapy.

SARS-CoV-2 Omicron BA.1, BA.2, and XAG identification during routine surveillance on a university campus in Belo Horizonte, Brazil, 2022.

We report SARS-CoV-2 genomic surveillance results between Belo Horizonte, Brazil's third and fourth case waves. Samples were obtained through a routine university monitoring COVID-19 program from the 9th to the 22nd epidemiological weeks (March and June 2022). We identified ten samples from the BA.1 clade (BA.1, BA.1.1, and BA.1.14.1 lineages) and 45 samples from the BA.2 clade (BA.2, BA.2.56, BA.2.9, BA.2.62, BA.2.23, BA.2.81, and BA.2.10). We observed progressive replacement of the BA.1 by the BA.2 clade. Furthermore, two XAG recombinants were found in the 22nd week. Diversification of the omicron variant seems to have contributed to the resurgence of cases in Belo Horizonte, similarly to what has been reported in South Africa.