Visceral Leishmaniasis Associated with HIV Coinfection in Pará, Brazil.

Introduction: Human visceral leishmaniasis (VL) is a zoonosis of great importance to public health due to its epidemiological diversity, with emphasis on the possibility of aggravation by coinfection with the human immunodeficiency virus (HIV). Objective: The aim was to study the epidemiological characteristics of VL cases associated with HIV coinfection in Pará. Methods. Reported cases of VL from January 2006 to December 2016 were investigated. A descriptive epidemiological method related to age, gender, area of residence and coinfection with HIV was used. To calculate variance and test equity, the F-test (Fisher) was performed. To observe the influence of one aspect on another, the chi-square was used to verify if there was dependence or independence between the variables. Results: A total of 1171 cases of VL were reported during the study period. There was an annual mean of LV of 94.9, with a statistical difference (p<0.05) between age groups, with the highest number of cases being observed in children aged 1 to 4 years (27.16%). Males and the urban area had a higher number of cases. There were 57 cases of VL/HIV coinfection, with emphasis on the year 2013 and the municipality of Santarém, which had the highest number of cases. During the ten years studied, there was a correlation between coinfection VL/ HIV, with significant differences between patients with and without HIV who contracted VL (p<0.001). Conclusion: The data reveal the endemic nature of VL in the region, with a high percentage of infection in children living in urban areas. Although the studied region is not identified as a predominant area of HIV cases, this study showed a high annual average (10.3) of cases of VL/HIV coinfection being the first time that cases of VL/HIV coinfection were reported in the Mesoregion of the Lower Amazon and Southwest Pará.

Trabalho doméstico remunerado e resistência: interseccionando raça, gênero e classe / Paid domestic work and resistance: intersecting race, gender, and class / Trabajo doméstico remunerado y resistencia: intersección entre raza, género y clase

No Brasil, o trabalho doméstico remunerado é essencialmente feminino e emprega cerca de 5,9 milhões de mulheres, correspondendo a 16,8% da ocupação feminina. Desse contingente, 61 % são compostos por mulheres negras. As empregadas domésticas estiveram historicamente submetidas a uma série de aspectos excludentes, como baixa remuneração, contratações à margem da legalidade e discriminação de gênero e raça. Esta pesquisa objetivou compreender a resistência enquanto categoria fundamental para compreensão do trabalho doméstico. Ao falar sobre essa categoria, destacamos a subjetividade que constitui os fenômenos sociais, partindo de uma compreensão dialética e histórica do sujeito e da relação indivíduo-sociedade, inserida em uma historicidade. Os resultados encontrados, coletados por meio de documentos, notícias, reportagens, participações no sindicato da categoria e da realização de entrevistas com cinco domésticas apontam a existência de formas de resistência no campo do trabalho doméstico, compondo movimentos de oposição e reação ao modus operandi colonial e às hierarquias de gênero-raça-classe que formam a sociedade brasileira. A psicologia sócio-histórica foi escolhida como abordagem teórico-metodológica, pois possibilita compreender do homem como ser ativo, social e histórico. Ao investigar as formas de resistência presentes nesse tipo de trabalho, compreende-se a trabalhadora doméstica não como mera consequência da realidade social em que se insere, mas como sujeito ativo que constitui essa realidade e é simultaneamente constituído por ela. Com esta pesquisa, pretende-se contribuir com a crítica à ideologia dominante que subalterniza essas trabalhadoras e as relega à subcidadania, uma condição sem reconhecimento e direitos.(AU)

In Brazil, paid domestic work is essentially female and employs about 5.9 million women, corresponding to 16.8% of the female occupation. Of this contingent, 61% is made up of black women. Domestic workers have historically been subjected to a series of exclusionary aspects, such as low remuneration, hiring outside the legal system and gender and race discrimination. This research aimed to understand resistance as a fundamental category for understanding domestic work. When talking about this category, we highlight the subjectivity that constitutes social phenomena, starting from a dialectical and historical understanding of the subject and the individual-society relationship, inserted in a historicity. The results found, collected from documents, news, reports, participation in the category union and interviews with five domestic workers, point to the existence of forms of resistance in the field of domestic work, composing movements of opposition and reaction to the colonial modus operandi and the gender-race-class hierarchies that make up Brazilian society.Socio-historical psychology was chosen as a theoretical-methodological approach, since it provides an understanding of man as an active, social and historical being. When investigating the forms of resistance present in this type of work, the domestic worker is understood not as a mere consequence of the social reality in which she is inserted, but, as an active subject, who constitutes this reality and is simultaneously constituted by it. This research intends to contribute to the criticism of the dominant ideology that subordinates these workers and relegates them to a sub-citizenship, a condition without recognition and rights.(AU)

El trabajo doméstico remunerado en Brasil es predominantemente femenino y emplea casi 5,9 millones de mujeres, lo que corresponde al 16,8% de la ocupación femenina. El 61% de este grupo está compuesto por mujeres negras. Históricamente, las trabajadoras del hogar han sido sometidas a una serie de aspectos excluyentes, como la baja remuneración, la contratación fuera del sistema legal y la discriminación de género y raza. Esta investigación tuvo como objetivo comprender la resistencia como categoría fundamental para entender el trabajo doméstico. Al hablar de esta categoría, se destaca la subjetividad que constituye los fenómenos sociales a partir de una comprensión dialéctica e histórica del sujeto y la relación individuo-sociedad, insertada en una historicidad. Los datos recogidos de documentos, noticias, participación en la categoría unión y entrevistas con cinco sirvientas permitieron concluir que existen formas de resistencia en el ámbito del trabajo doméstico, que se componen de movimientos de oposición y reacción al modus operandi colonial y a jerarquías de género-raza-clase que conforman la sociedad brasileña. La psicología sociohistórica fue el enfoque teórico-metodológico utilizado, ya que proporciona una comprensión del ser humano como ser activo, social e histórico. El análisis de las formas de resistencia presentes en este tipo de trabajo permite identificar la trabajadora doméstica no como una mera consecuencia de la realidad social en la cual se inserta, sino como sujeto activo que constituye esta realidad y, a la vez, es constituido por ella. Se espera que esta investigación pueda contribuir a la crítica de la ideología dominante que subordina a estas trabajadoras, relegándolas a una subciudadanía, una condición sin reconocimiento y sin derechos.(AU)

Adressing Energy Demand and Climate Change through the Second Law of Thermodynamics and LCA towards a Rational Use of Energy in Brazilian Households.

This study focuses on a typical Brazilian household through the lens of sustainable development, regarding energy demand and GHG emissions. The analysis encompasses both the direct and indirect energy, exergy consumption, and GHG emissions (quantified by life cycle assessment) associated with the usual routine of a household. The household is modeled as a thermodynamic system to evaluate inputs (food, electricity, fuels for transportation) and outputs (solid and liquid residues). The hypothesis is that each input and output contains CO2,eq emissions and exergy derived from its physical-chemical characteristics or production chains. Each household appliance is modeled and tested as a function of external parameters. The contribution of several industries was obtained to the total GHG emissions and exergy flows entering and exiting the household (e.g., fuels for transportation, food, gas, electricity, wastewater treatment, solid waste). It was verified that urban transportation was the flow with the highest GHG and exergy intensity, ranging between 1.49 and 7.53 kgCO2,eq/day and achieving 94.7 MJ/day, almost five times higher than the calculated exergy demand due to electricity. The second largest flow in GHG emissions was food due to the characteristics of the production chains, ranging from 1.6 to 4.75 kgCO2,eq/day, depending on the adopted diet. On the other hand, the electricity presented low GHG emissions due to the main energy sources used to generate electricity, only 0.52 kgCO2,eq/day. Moreover, the chemical exergy of the solid waste was 9.7 MJ/day, and is not irrelevant compared to the other flows, representing an interesting improvement opportunity as it is entirely wasted in the baseline scenario.

[COVID-19 in Brazil: trends, challenges, and perspectives after 18 months of the pandemicCOVID-19 en Brasil: tendencias, desafíos y perspectivas después de 18 meses de pandemia]. / COVID-19 no Brasil: tendências, desafios e perspectivas após 18 meses de pandemia.

Objective: To analyze the incidence and mortality trends from COVID-19 in Brazil as well as in federation units and their capitals. Method: An ecological study was performed using COVID-19 incidence and mortality data covering the period from 25 February 2020 (first case recorded in Brazil) to 31 July 2021. Data were grouped by month for calculation of crude rates (by 100 000 population) and assessment of time trends in federation units and capitals. Significant changes in time trends were analyzed by joinpoint regression. Results: Two waves of new cases and deaths were identified. The highest incidence rates were recorded in the states of Amapá, Rio Grande do Norte, Rondônia, and Roraima. The states of Amazonas and Rondônia had the highest mortality rates. In general, incidence and mortality rates were worse in the second wave. In the first wave, the mean number of months until the onset of reduction in new cases was higher in capitals, whereas in the second wave the onset of reduction in new cases took longer in the federation units. The decline in mortality began earlier in capital cities in both waves. Conclusion: The regional differences detected underscore the notion that COVID-19 incidence and mortality are associated with political, geographic, cultural, social, and economic factors.

Objetivo: Analizar las tendencias de la incidencia de COVID-19 y la mortalidad por esta enfermedad en Brasil (unidades federativas y capitales). Método: Se realizó un estudio ecológico con datos sobre incidencia de COVID-19 y la mortalidad por esta enfermedad en el período comprendido entre el 25 de febrero del 2020 (fecha del primer caso notificado en Brasil) y el 31 de julio del 2021. Los datos se agruparon por mes para calcular las tasas brutas (por 100 000 habitantes) y evaluar las tendencias temporales observadas en las unidades federativas y sus capitales. Las modificaciones significativas en las tendencias temporales se analizaron con el método de regresión de punto de inflexión (joinpoint). Resultados: Se identificaron dos olas de casos nuevos y muertes. Las unidades federativas con las mayores tasas de incidencia fueron Amapá, Rio Grande do Norte, Rondônia y Roraima; Amazonas y Rondônia tuvieron las mayores tasas de mortalidad. En general, la incidencia y la mortalidad fueron peores en la segunda ola. En la primera ola, el promedio de meses transcurridos hasta que empezó a reducirse el número de casos nuevos fue mayor en las capitales, mientras que, en la segunda ola, fue mayor en los estados. En ambas olas, el número de muertes se redujo en menos tiempo en las capitales. Conclusión: La heterogeneidad regional detectada refuerza la idea de que la incidencia de la COVID-19 y la mortalidad por esta enfermedad guardan relación con factores políticos, geográficos, culturales, sociales y económicos.

COVID-19 no Brasil: tendências, desafios e perspectivas após 18 meses de pandemia

[RESUMO]. Objetivo. Analisar as tendências de incidência e mortalidade por COVID-19 no Brasil, nas unidades da fede- ração e nas capitais. Método. Realizou-se um estudo ecológico com dados de incidência e de mortalidade por COVID-19 referen- tes ao período de 25 de fevereiro de 2020 (primeiro caso notificado no Brasil) a 31 de julho de 2021. Os dados foram agrupados por mês para cálculo das taxas brutas (por 100 000 habitantes) e avaliação das tendências temporais das unidades da federação e de suas capitais. As modificações significativas nas tendências tem- porais foram analisadas pelo método de regressão por joinpoint. Resultados. Foram identificadas duas ondas de novos casos e óbitos. As unidades da federação com as maiores taxas de incidência foram Amapá, Rio Grande do Norte, Rondônia e Roraima; Amazonas e Rondônia tiveram as maiores taxas de mortalidade. Em geral, as taxas de incidência e mortalidade foram piores na segunda onda. Na primeira onda, a média de meses até o início de uma redução de casos novos foi maior nas capitais, enquanto na segunda onda, o início da redução demorou mais nos estados. Quanto aos óbitos, as capitais necessitaram de menos tempo para apresentar redução tanto na primeira quanto na segunda onda. Conclusão. A heterogeneidade regional detectada reforça a ideia de que a incidência e a mortalidade por COVID-19 estão associadas a fatores políticos, geográficos, culturais, sociais e econômicos.

[ABSTRACT]. Objective. To analyze the incidence and mortality trends from COVID-19 in Brazil as well as in federation units and their capitals. Method. An ecological study was performed using COVID-19 incidence and mortality data covering the period from 25 February 2020 (first case recorded in Brazil) to 31 July 2021. Data were grouped by month for calculation of crude rates (by 100 000 population) and assessment of time trends in federation units and capitals. Significant changes in time trends were analyzed by joinpoint regression. Results. Two waves of new cases and deaths were identified. The highest incidence rates were recorded in the states of Amapá, Rio Grande do Norte, Rondônia, and Roraima. The states of Amazonas and Rondônia had the highest mortality rates. In general, incidence and mortality rates were worse in the second wave. In the first wave, the mean number of months until the onset of reduction in new cases was higher in capitals, whe- reas in the second wave the onset of reduction in new cases took longer in the federation units. The decline in mortality began earlier in capital cities in both waves. Conclusion. The regional differences detected underscore the notion that COVID-19 incidence and mortality are associated with political, geographic, cultural, social, and economic factors.

[RESUMEN]. Objetivo. Analizar las tendencias de la incidencia de COVID-19 y la mortalidad por esta enfermedad en Brasil (unidades federativas y capitales). Método. Se realizó un estudio ecológico con datos sobre incidencia de COVID-19 y la mortalidad por esta enfermedad en el período comprendido entre el 25 de febrero del 2020 (fecha del primer caso notificado en Brasil) y el 31 de julio del 2021. Los datos se agruparon por mes para calcular las tasas brutas (por 100 000 habitantes) y evaluar las tendencias temporales observadas en las unidades federativas y sus capitales. Las modificaciones significativas en las tendencias temporales se analizaron con el método de regresión de punto de inflexión (joinpoint). Resultados. Se identificaron dos olas de casos nuevos y muertes. Las unidades federativas con las mayores tasas de incidencia fueron Amapá, Rio Grande do Norte, Rondônia y Roraima; Amazonas y Rondônia tuvieron las mayores tasas de mortalidad. En general, la incidencia y la mortalidad fueron peores en la segunda ola. En la primera ola, el promedio de meses transcurridos hasta que empezó a reducirse el número de casos nuevos fue mayor en las capitales, mientras que, en la segunda ola, fue mayor en los estados. En ambas olas, el número de muertes se redujo en menos tiempo en las capitales. Conclusión. La heterogeneidad regional detectada refuerza la idea de que la incidencia de la COVID-19 y la mortalidad por esta enfermedad guardan relación con factores políticos, geográficos, culturales, sociales y económicos.

Decoding the radiomic and proteomic phenotype of epicardial adipose tissue associated with adverse left atrial remodelling and post-operative atrial fibrillation in aortic stenosis.

AIMS: Epicardial adipose tissue (EAT) volume and attenuation on computed tomography (CT) have been associated with atrial fibrillation. Beyond these conventional CT measures, radiomics allows extraction of high-dimensional data and deep quantitative adipose tissue phenotyping, which may capture its underlying biology. We aimed to explore the EAT proteomic and CT-radiomic signatures associated with impaired left atrial (LA) remodelling and post-operative atrial fibrillation (POAF). METHODS AND RESULTS: We prospectively included 132 patients with severe aortic stenosis with no prior atrial fibrillation referred for aortic valve replacement. Pre-operative non-contrast CT images were obtained for extraction of EAT volume and other radiomic features describing EAT texture. The LA function was assessed by 2D-speckle-tracking echocardiography peak atrial longitudinal strain and peak atrial contraction strain. The EAT biopsies were performed during surgery for proteomic analysis by sequential windowed acquisition of all theoretical fragment ion mass spectra (SWATH-MS). The POAF incidence was monitored from surgery until discharge. Impaired LA function and incident POAF were associated with EAT up-regulation of inflammatory and thrombotic proteins, and down-regulation of cardioprotective proteins with anti-inflammatory and anti-lipotoxic properties. The EAT volume was independently associated with LA enlargement, impaired function, and POAF risk. On CT images, EAT texture of patients with POAF was heterogeneous and exhibited higher maximum grey-level values than sinus rhythm patients, which correlated with up-regulation of inflammatory and down-regulation of lipid droplet-formation EAT proteins. The CT radiomics of EAT provided an area under the curve of 0.80 (95% confidence interval: 0.68-0.92) for discrimination between patients with POAF and sinus rhythm. CONCLUSION: Pre-operative CT-radiomic profile of EAT detected adverse EAT proteomics and identified patients at risk of developing POAF.

Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial.

BACKGROUND: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to evaluate the impact of the use of LPA and Xpert. METHODS: Patients with DR-TB were eligible if their drug susceptibility testing results were available to the treating physician at the time of consultation. The standard reference MGITTM 960 was compared with Xpert (arm 1) and LPA (arm 2). Effectiveness was considered as the start of the appropriate TB regimen that matched drug susceptibility testing (DST) and the proportions of culture conversion and favorable treatment outcomes after 6 months. RESULTS: A higher rate of empirical treatment was observed with MGIT alone than with the Xpert assay (97.0% vs. 45.0%) and LPA (98.2% vs. 67.5%). Patients started appropriate TB treatment more quickly than those in the MGIT group (median 15.0 vs. 40.5 days; p<0.01) in arm 1. Compared to the MGIT group, culture conversion after 6 months was higher for Xpert in arm 1 (90.9% vs. 79.3%, p=0.39) and LPA in arm 2 (80.0% vs. 83.0%, p=0.81). CONCLUSIONS: In the Xpert arm, there was a significant reduction in days to the start of appropriate anti-TB treatment and a trend towards greater culture conversion in the sixth month.

The alien octocoral Carijoa riisei is a biogenic substrate multiplier in artificial Brazilian shipwrecks.

Despite the obvious negative effects caused by invasive species, some recent studies have shown that the impacts at local scale are diverse and not necessarily negative. Arborescent benthic organisms such as octocorals form three-dimensional structures capable of increasing the amount of substrate available and providing shelter for epibiont species. We investigated the role of the alien octocoral Carijoa riisei on the diversity of benthic communities in three shipwrecks on the north-eastern coast of Brazil. We expected that (a) the fauna associated with the octocoral are richer and more diverse compared to the adjacent; (b) some species are exclusively associated with C. riisei; (c) the species that are present both in the areas with and without C. riisei have a greater abundance when associated with the octocoral. For this, we compared the macrobenthic communities associated with C. riisei to those found in adjacent areas where the octocoral was absent. Our study showed that the communities associated with the octocoral were 1.5 times richer and 10 times more abundant than adjacent communities, with 29 exclusive taxa. The dominant taxa were the amphipods Ericthonius brasiliensis and Podocerus brasiliensis and polychaetes of the family Syllidae. These taxa were present in areas with presence and absence of C. riisei, but their abundance was significantly greater where the octocoral was present. Our results reinforce the idea that Carijoa riisei acts as an ecosystem engineer in coastal reefs, creating new habitats and increasing diversity at a local scale, even though it is an alien species.

Intersubjetividad e Inter claridad en la guardería: jugar y constitución psíquica del bebé / Intersubjetividade e interludicidade na creche: brincar e constituição psíquica do bebê / Intersubjectivity and interplay in nursery school: playing and the baby's psychic constitution

RESUMO O artigo aborda a intersubjetividade, com destaque para um de seus indicadores, a interludicidade, a fim de pensar a importância das construções lúdicas entre o adulto e a pequena criança no desenvolvimento psíquico. O esquete escolhido para análise foi extraído de diários construídos a partir de observações-intervenções em uma turma de berçário, a fim de investigar a potência da interação lúdica na dupla: adulto e bebê. A permanência dos bebês na creche faz com que os profissionais acompanhem muitas aquisições no desenvolvimento do bebê. Dessa forma, os resultados apontam que a presença do adulto na cena do brincar possibilita novas experimentações ao bebê, as quais podem ser suporte para o seu desenvolvimento psíquico.

RESUMEN En el artículo se aborda la intersubjetividad, con hincapié para uno de sus indicadores, la Inter claridade, con la finalidad de pensar la importancia de las construcciones lúdicas entre el adulto y el pequeño niño, en el desarrollo psíquico. La encuesta elegida para análisis se extrae de diarios construidos a partir de observaciones-intervenciones en un grupo de guardería, con la finalidad de investigar la potencia de la interacción lúdica en la pareja: adulto y bebé. La permanencia de los bebés en la guardería hace con que los profesionales acompañen muchas adquisiciones en el desarrollo del bebé. De esta manera, los resultados apuntan que la presencia del adulto en la escena del jugar posibilita nuevas experimentaciones al bebé, las cuales pueden ser soporte en su desarrollo psíquico.

ABSTRACT The article addresses intersubjectivity, highlighting one of its indicators, interplay, in order to reflect about the importance of playful constructions between adults and small children in psychic development. The skit chosen for analysis was extracted from diaries constructed from observations-interventions in a nursery class, in order to investigate the potency of playful interaction in the pair: adult and baby. The permanence of babies in nursery school makes professionals monitor many acquisitions in the baby's development. In this way, the results indicate that the presence of the adult in the play scene allows new experiments for the baby, which can be a support in their psychic development.

COVID-19 no Brasil: tendências, desafios e perspectivas após 18 meses de pandemia / COVID-19 in Brazil: trends, challenges, and perspectives after 18 months of the pandemic / COVID-19 en Brasil: tendencias, desafíos y perspectivas después de 18 meses de pandemia

RESUMO Objetivo. Analisar as tendências de incidência e mortalidade por COVID-19 no Brasil, nas unidades da federação e nas capitais. Método. Realizou-se um estudo ecológico com dados de incidência e de mortalidade por COVID-19 referentes ao período de 25 de fevereiro de 2020 (primeiro caso notificado no Brasil) a 31 de julho de 2021. Os dados foram agrupados por mês para cálculo das taxas brutas (por 100 000 habitantes) e avaliação das tendências temporais das unidades da federação e de suas capitais. As modificações significativas nas tendências temporais foram analisadas pelo método de regressão por joinpoint. Resultados. Foram identificadas duas ondas de novos casos e óbitos. As unidades da federação com as maiores taxas de incidência foram Amapá, Rio Grande do Norte, Rondônia e Roraima; Amazonas e Rondônia tiveram as maiores taxas de mortalidade. Em geral, as taxas de incidência e mortalidade foram piores na segunda onda. Na primeira onda, a média de meses até o início de uma redução de casos novos foi maior nas capitais, enquanto na segunda onda, o início da redução demorou mais nos estados. Quanto aos óbitos, as capitais necessitaram de menos tempo para apresentar redução tanto na primeira quanto na segunda onda. Conclusão. A heterogeneidade regional detectada reforça a ideia de que a incidência e a mortalidade por COVID-19 estão associadas a fatores políticos, geográficos, culturais, sociais e econômicos.

ABSTRACT Objective. To analyze the incidence and mortality trends from COVID-19 in Brazil as well as in federation units and their capitals. Method. An ecological study was performed using COVID-19 incidence and mortality data covering the period from 25 February 2020 (first case recorded in Brazil) to 31 July 2021. Data were grouped by month for calculation of crude rates (by 100 000 population) and assessment of time trends in federation units and capitals. Significant changes in time trends were analyzed by joinpoint regression. Results. Two waves of new cases and deaths were identified. The highest incidence rates were recorded in the states of Amapá, Rio Grande do Norte, Rondônia, and Roraima. The states of Amazonas and Rondônia had the highest mortality rates. In general, incidence and mortality rates were worse in the second wave. In the first wave, the mean number of months until the onset of reduction in new cases was higher in capitals, whereas in the second wave the onset of reduction in new cases took longer in the federation units. The decline in mortality began earlier in capital cities in both waves. Conclusion. The regional differences detected underscore the notion that COVID-19 incidence and mortality are associated with political, geographic, cultural, social, and economic factors.

RESUMEN Objetivo. Analizar las tendencias de la incidencia de COVID-19 y la mortalidad por esta enfermedad en Brasil (unidades federativas y capitales). Método. Se realizó un estudio ecológico con datos sobre incidencia de COVID-19 y la mortalidad por esta enfermedad en el período comprendido entre el 25 de febrero del 2020 (fecha del primer caso notificado en Brasil) y el 31 de julio del 2021. Los datos se agruparon por mes para calcular las tasas brutas (por 100 000 habitantes) y evaluar las tendencias temporales observadas en las unidades federativas y sus capitales. Las modificaciones significativas en las tendencias temporales se analizaron con el método de regresión de punto de inflexión (joinpoint). Resultados. Se identificaron dos olas de casos nuevos y muertes. Las unidades federativas con las mayores tasas de incidencia fueron Amapá, Rio Grande do Norte, Rondônia y Roraima; Amazonas y Rondônia tuvieron las mayores tasas de mortalidad. En general, la incidencia y la mortalidad fueron peores en la segunda ola. En la primera ola, el promedio de meses transcurridos hasta que empezó a reducirse el número de casos nuevos fue mayor en las capitales, mientras que, en la segunda ola, fue mayor en los estados. En ambas olas, el número de muertes se redujo en menos tiempo en las capitales. Conclusión. La heterogeneidad regional detectada refuerza la idea de que la incidencia de la COVID-19 y la mortalidad por esta enfermedad guardan relación con factores políticos, geográficos, culturales, sociales y económicos.

Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial

ABSTRACT Background: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to evaluate the impact of the use of LPA and Xpert. Methods: Patients with DR-TB were eligible if their drug susceptibility testing results were available to the treating physician at the time of consultation. The standard reference MGITTM 960 was compared with Xpert (arm 1) and LPA (arm 2). Effectiveness was considered as the start of the appropriate TB regimen that matched drug susceptibility testing (DST) and the proportions of culture conversion and favorable treatment outcomes after 6 months. Results: A higher rate of empirical treatment was observed with MGIT alone than with the Xpert assay (97.0% vs. 45.0%) and LPA (98.2% vs. 67.5%). Patients started appropriate TB treatment more quickly than those in the MGIT group (median 15.0 vs. 40.5 days; p<0.01) in arm 1. Compared to the MGIT group, culture conversion after 6 months was higher for Xpert in arm 1 (90.9% vs. 79.3%, p=0.39) and LPA in arm 2 (80.0% vs. 83.0%, p=0.81). Conclusions: In the Xpert arm, there was a significant reduction in days to the start of appropriate anti-TB treatment and a trend towards greater culture conversion in the sixth month.

A Pliocene-Pleistocene continental biota from Venezuela.

The Pliocene-Pleistocene transition in the Neotropics is poorly understood despite the major climatic changes that occurred at the onset of the Quaternary. The San Gregorio Formation, the younger unit of the Urumaco Sequence, preserves a fauna that documents this critical transition. We report stingrays, freshwater bony fishes, amphibians, crocodiles, lizards, snakes, aquatic and terrestrial turtles, and mammals. A total of 49 taxa are reported from the Vergel Member (late Pliocene) and nine taxa from the Cocuiza Member (Early Pleistocene), with 28 and 18 taxa reported for the first time in the Urumaco sequence and Venezuela, respectively. Our findings include the first fossil record of the freshwater fishes Megaleporinus, Schizodon, Amblydoras, Scorpiodoras, and the pipesnake Anilius scytale, all from Pliocene strata. The late Pliocene and Early Pleistocene ages proposed here for the Vergel and Cocuiza members, respectively, are supported by their stratigraphic position, palynology, nannoplankton, and 86Sr/88Sr dating. Mammals from the Vergel Member are associated with the first major pulse of the Great American Biotic Interchange. In contrast to the dry conditions prevailing today, the San Gregorio Formation documents mixed open grassland/forest areas surrounding permanent freshwater systems, following the isolation of the northern South American basin from western Amazonia. These findings support the hypothesis that range contraction of many taxa to their current distribution in northern South America occurred rapidly during at least the last 1.5 million years.

Effectiveness of the Mat Pilates on the postural control, plantar pressure and plantar arch of school children: A randomized clinical trial.

OBJECTIVE: To evaluate the effectiveness of Mat Pilates on postural control, plantar pressure and plantar arch (ALM) in schoolchildren. DESIGN AND SETTING: The study was a randomized clinical trial, developed at the Early Childhood Education Institute, Londrina-PR. The participants were randomly assigned to groups: Pilates Group (PG) and Control Group (CG). Patients in the CG did not perform extra physical activity (Interventions). PARTICIPANTS: 43 children (eight to 12 years), no prior knowledge of the Pilates method, and no exercise training in the last six months. INTERVENTION: The exercise program was based on the Mat Pilates method, twice weekly, 50 min each, 28 sessions. OUTCOME MEASURES: Static balance (force platform), dynamic balance (the Reach Test), ALM (plantigraphy) and plantar pressure (baropodometry). The assessors were blinded to the allocation of participants. RESULTS: Three children were excluded before randomization and 40 were randomized (PG n: 20; CG n:20).12 children were excluded during the protocol (PG n:7; CG n:5) and included in the intention to treat analysis. No significant difference between groups was observed for static and dynamic balance and ALM measures. There was a significant difference in the following outcomes for the PG: the plantar pressure on the right hemibody forefoot between pre-test 38.70 ± 14.38 and post-test 42.65 ± 15.63 (ES = 0.66; SRM = 0.50). The plantar pressure on the right hemibody rearfoot between pre-test 61.10 ± 14.18 and post-test 56.85 ± 19.39 (ES = 0.68; SRM = 0.53). No adverse or harmful events were reported in any group. CONCLUSION: There were no differences in static and dynamic postural control and ALM between PG and CG. However, children GP showed improvement in some results of plantar pressure in relation CG. CLINICAL TRIAL REGISTRATION NUMBER: Brazilian Registry of Clinical Trials (REBEC) (N_ RBR-8t5p7d).

Extinction at the end-Cretaceous and the origin of modern Neotropical rainforests.

The end-Cretaceous event was catastrophic for terrestrial communities worldwide, yet its long-lasting effect on tropical forests remains largely unknown. We quantified plant extinction and ecological change in tropical forests resulting from the end-Cretaceous event using fossil pollen (>50,000 occurrences) and leaves (>6000 specimens) from localities in Colombia. Late Cretaceous (Maastrichtian) rainforests were characterized by an open canopy and diverse plant-insect interactions. Plant diversity declined by 45% at the Cretaceous-Paleogene boundary and did not recover for ~6 million years. Paleocene forests resembled modern Neotropical rainforests, with a closed canopy and multistratal structure dominated by angiosperms. The end-Cretaceous event triggered a long interval of low plant diversity in the Neotropics and the evolutionary assembly of today's most diverse terrestrial ecosystem.

Prevalence, multimodality imaging characterization, and mid-term prognosis of quadricuspid aortic valves: an analysis of eight cases, based on 160 004 exams performed during 12 years in a tertiary care hospital.

AIMS: Quadricuspid aortic valve (QAV) is a rare abnormality, which may cause aortic regurgitation (AR) requiring surgical intervention in some patients. The characteristics associated with aortic valve functional degeneration in patients with QAV are still unknown. The aim of this study is to describe QAV prevalence, characterize the disease by multimodality imaging, evaluate predictors of severe AR, and assess mid-term prognosis. METHODS AND RESULTS: Retrospective search in imaging exams database of one tertiary centre, for patients diagnosed with QAV between January 2007 and September 2019. QAV was characterized by cardiac computed tomography, transthoracic/transoesophageal echocardiography, and cardiac magnetic resonance. A total of 160 004 exams were reviewed and eight patients with QAV were identified (50% men, mean age 53.5 ± 10.7 years). The prevalence of QAV was 0.005%. During a median follow-up of 52 months (interquartile range 16-88), there were no deaths. Seven patients (88%) had pure AR (three severe, one moderate, and three mild) and one patient (12%) had moderate AR and moderate aortic stenosis. Three patients (38%) with severe AR underwent valve surgery (two replacements and one repair). Analysis of predictors of severe AR was not statistically significant. CONCLUSION: QAV is a rare congenital cardiac defect, with a prevalence of 0.005% in our study. Its predominant functional abnormality was regurgitation and about one-third of the patients required aortic valve surgery. Multimodality imaging may play a pivotal role in assessing patients with QAV with significant valve dysfunction or associated congenital heart disease and improve their treatment strategy.

A Complexidade da intervenção social segundo gênero e escolaridade do doente renal crónico / The complexity of social intervention according to gender and education of chronic kidney disease patients

A elevada prevalência da doença renal crónica e a relevância social do seu tratamento exigem um aprofundamento do conhecimento sobre a população doente, tendo em conta a sua complexidade holística. O estudo pretendeu analisar os níveis de complexidade no processo de intervenção social com pessoas com doença renal crónica numa perspetiva de gênero e de escolaridade. A amostra integrou 584 doentes com idades compreendidas entre os 19 e os 93 anos, maioritariamente do sexo masculino, casados e com o 1.º ciclo ensino básico. Os participantes, com diagnóstico de doença renal crónica, foram avaliados através de um protocolo que inclui um questionário sociodemográfico e a Matriz de Complexidade Associada ao Processo de Intervenção Social com Doentes Renais Crónicos (MCAPIS_DRC). Encontrou-se uma associação estatisticamente significativa entre os três níveis de complexidade avaliados e as variáveis sexo (p = 0,002, phi = 0,146) e escolaridade (p > 0,001, phi = 0,277). Verificou-se, igualmente, uma interação entre a escolaridade e o índice de complexidade consoante o sexo (F(5, 572) = 6,647 p = < 0,001, ƞp2 = 0,113). As mulheres apresentaram maiores pontuações no índice e as pessoas com maiores níveis de escolaridade pontuam menos no índice. A evidência permite ter uma abordagem diferenciadora na avaliação e intervenção social, priorizando grupos e situações problema.

The high prevalence of chronic kidney disease and the social relevance of its treatment require a deeper knowledge concerning this sick population, taking into account its overall complexity. The study aimed to analyze the levels of complexity in the social intervention process with people with chronic kidney disease from a gender and educational perspective. The sample included 584 patients aged between 19 and 93 years, mostly male, married and with the 1st cycle of primary education completed. Participants, diagnosed with chronic kidney disease, were assessed using a protocol that includes a sociodemographic questionnaire and The Matrix of Complexity Associated with the Process of Social Intervention with Chronic Kidney Disease Patients (MCAPIS_DRC). A statistically significant association was found between the three levels of complexity assessed and the variables gender (p=0.002, phi=0.146) and education (p>0.001, phi=0.277). There was also an interaction between education and the complexity index according to sex (F (5, 572) =6.647 p=<0.001, ƞp2=0.113). Women had higher scores on the index and people with higher levels of education scored less on the index. The evidence allows for a different approach in the assessment and social intervention if this condition, prioritizing problematic groups and situations.

Construção e validação de um material educativo como estratégia de promoção da alimentação adequada e saudável na Atenção Básica / Construction and validation of an educational material as a strategy to promote proper and healthy food in Primary Care

Introdução: Os materiais educativos e didáticos distribuídos na Atenção Básica constituem importantes estratégias de promoção da saúde e de Educação Alimentar e Nutricional. Objetivo: Apresentar o processo de construção e validação de um material educativo sobre a alimentação de crianças menores de dois anos, dirigido aos profissionais de saúde. Método: Realizou-se estudo quantitativo com delineamento estruturado em duas etapas: construção e validação do material educativo. O processo de construção do material educativo se deu a partir da revisão da literatura e das atividades práticas desenvolvidas com mães e profissionais de saúde das unidades de saúde no município de Macaé-RJ. Na validação, o material educativo foi encaminhado por e-mail aos especialistas e, da mesma forma, após ajustes, enviado aos juízes. Calcularam-se as médias aritméticas, tendo como ponto de corte a nota ≥7 de cada item para verificar a importância/adequação atribuída e os desvios-padrão, tendo como ponto de corte o valor <3 para estimar o grau de consenso entre os especialistas e juízes. Resultados: O miniguia apresenta três módulos temáticos: Aleitamento materno, Alimentação Complementar partes 1 e 2. Na validação pelos especialistas, a média(±DP) foi 8,5(±1,2), sendo o material considerado importante/adequado e consensuado por todos; pelos juízes, a média(±DP) foi 9,9(±0,3), sendo considerado importante/adequado e consensuado por todos. Conclusão: O miniguia foi considerado "importante/adequado" e consensuado pelos avaliadores. (AU)

Introduction: Educational and didactic materials available at the Primary Care units are important strategies to promote health and food and nutrition education. Objective: To present the construction and validation process of an educational material about feeding of children under the age of two years, designed to healthcare professionals. Method: a quantitative study was carried out with a design structured in two stages: construction and validation of the educational material. The construction process was based on a literature review and practical activities developed with mothers and health professionals in primary care units in the city of Macaé- RJ. For validation, the educational material was sent by e-mail to specialists and, likewise, after adjustments, to a panel of judges. Arithmetic means were calculated, having the score ≥7 as the cutoff point of each item to verify the assigned importance/adequacy and standard deviations. The cutoff value of <3 was set to estimate the degree of consensus among specialists and judges. Results: The miniguide has three thematic modules: Breastfeeding, Complementary Feeding ­ Parts 1 and 2. In the validation by specialists, the mean value(±SD) was 8.5(±1.2), and they all consensually considered the material important/appropriate; by judges, the mean value(±SD) was 9.9(±0.3), being consensually considered important/appropriate. Conclusion: All evaluators in consensus agreed that the miniguide was "important/appropriate". (AU)

Influence of EPICardial adipose tissue in HEART diseases (EPICHEART) study: Protocol for a translational study in coronary atherosclerosis.

INTRODUCTION: Accumulation of epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD) and increased risk of coronary events in asymptomatic subjects and low-risk patients, suggesting that EAT promotes atherosclerosis in its early stage. Recent studies have shown that the presence of CAD affects the properties of adjacent EAT, leading to dynamic changes in the molecular players involved in the interplay between EAT and the coronary arteries over the history of the disease. The role of EAT in late-stage CAD has not been investigated. OBJECTIVES: In a comparative analysis with mediastinal and subcutaneous adipose tissue, we aim to investigate whether the volume of EAT assessed by computed tomography and its proteome assessed by SWATH-MS mass spectrometry are associated with late stages of CAD in an elderly cohort of severe aortic stenosis patients. METHODS: The EPICHEART study (NCT03280433) is a prospective study enrolling patients with severe degenerative aortic stenosis referred for elective aortic valve replacement, whose protocol includes preoperative clinical, nutritional, echocardiographic, cardiac computed tomography and invasive coronary angiographic assessments. During cardiac surgery, samples of EAT and mediastinal and subcutaneous thoracic adipose tissue are collected for proteomics analysis by SWATH-MS. In addition, pericardial fluid and peripheral and coronary sinus blood samples are collected to identify circulating and local adipose tissue-derived biomarkers of CAD. CONCLUSION: We designed a translational study to explore the association of EAT quantity and quality with advanced CAD. We expect to identify new biochemical factors and biomarkers in the crosstalk between EAT and the coronary arteries that are involved in the pathogenesis of late coronary atherosclerosis, especially coronary calcification, which might be translated into new therapeutic targets and imaging tools by biomedical engineering.

Effect of Pilates Matwork exercises on posterior chain flexibility and trunk mobility in school children: A randomized clinical trial.

OBJECTIVE: To investigate the effects of an exercise program, based on the Pilates Matwork method, on posterior chain flexibility and trunk mobility in healthy school age children. DESIGN AND SETTING: The study was a parallel-group randomized clinical trial. The participants were randomly assigned to groups: Pilates Group (PG) and Control Group (CG). The program was developed at the Early Childhood Education Institute, Londrina-PR. PARTICIPANTS: 43 children with age between eight to 12 years, no prior knowledge of the Pilates method, and no exercise training in the last six months. INTERVENTION: Four months of twice a week 50 min Pilates Matwork exercises were administered. OUTCOME MEASURES: Flexibility and mobility, assessed using the sit-and-reach test, fingertip-to-floor test and photogrammetry. The assessors were blinded to the allocation of participants. RESULTS: Three children were excluded before randomization and 40 were randomized (PG n = 20; CG n = 20).12 children were excluded during the protocol (PG n = 7; CG n = 5) and included in the intention to treat analysis. No significant difference between groups was observed for flexibility measures. There was a significant difference in the following outcomes for the PG: distance reached in the sit-and-reach test between pre-test (median 14.25[11.25-28.38]) and post-test (median 20.25[12.00-29.63]) (ES = 0.29, SRM = 0.73); Posterior angle of the knee in the fingertip-to-floor test between pre-test (median 191.60[187.20-191.60]) and post-test (median 189.00[185.90-191.50]) (ES = 0.56, SRM = 0.54). CONCLUSION: There were no differences in posterior chain flexibility and trunk mobility between school age children who underwent Pilates Matwork exercises and the control. However, children who participated in the exercise program showed improvement in some results of flexibility. CLINICAL TRIAL REGISTRATION NUMBER: Brazilian Registry of Clinical Trials (REBEC) (N° RBR-8t5p7d).