Intensive versus less intensive blood pressure targets after mechanical thrombectomy in acute ischemic stroke: a systematic review and network meta-analysis.

Hemodynamic management, specifically blood pressure, is essential to reduce mortality and preserve functional capacity. However, the literature is uncertain about the best blood pressure target to be adopted after performing mechanical thrombectomy in patients with acute ischemic stroke. Randomized clinical trials that compared blood pressure goals after mechanical thrombectomy were searched in the following databases: MEDLINE/PubMed, Embase, Scopus, Biomedcentral, and Cochrane Library. The last search was on September 19, 2023. The results obtained were used to construct network meta-analyses. A total of 1556 participants were enrolled from 4 randomized controlled trials (OPTIMAL-BP, ENCHANTED2/MT, BP-TARGET, BEST-II). The last article was not included in the network meta-analysis because it did not have common blood pressure targets. The outcomes compared were: mRS (modified Rankin scale), eTICI/mTICI scale scores, symptomatic and any intracerebral hemorrhage, post-intervention NIHSS, and post-intervention infarct volume. The outcomes using the mRS scale showed that better outcomes were reached with less intensive blood pressure targets when comparing < 120 mmHg vs. ≤ 180 mmHg, OR: 0.71 (95% CI 0.54 - 0.94), in the outcome of mRS 0-1. And for the mRS 0-2 outcome with comparisons < 120 mmHg vs. ≤ 180 mmHg, with OR: 0.59 (95% CI 0.44 - 0.77) and < 140 mmHg vs. ≤ 180 mmHg, with OR: 0.61 (95% CI 0.41 - 0.89). In patients with large vessel occlusion treated with mechanical thrombectomy and who achieved good reperfusion, intensive blood pressure lowering is not effective and might be harmful respect to non intensive blood pressure control in recanalized patients.

Identification and expression of MarCE, a marine carboxylesterase with synthetic ester-degrading activity.

Carboxylic ester hydrolases with the capacity to degrade polyesters are currently highly sought after for their potential use in the biological degradation of PET and other chemically synthesized polymers. Here, we describe MarCE, a carboxylesterase family protein identified via genome mining of a Maribacter sp. isolate from the marine sponge Stelligera stuposa. Based on phylogenetic analysis, MarCE and its closest relatives belong to marine-associated genera from the Cytophaga-Flavobacterium-Bacteroides taxonomic group and appear evolutionarily distinct to any homologous carboxylesterases that have been studied to date in terms of structure or function. Molecular docking revealed putative binding of BHET, a short-chain PET derivative, onto the predicted MarCE three-dimensional structure. The synthetic ester-degrading activity of MarCE was subsequently confirmed by MarCE-mediated hydrolysis of 2 mM BHET substrate, indicated by the release of its breakdown products MHET and TPA, which were measured, respectively, as 1.28 and 0.12 mM following 2-h incubation at 30°C. The findings of this study provide further insight into marine carboxylic ester hydrolases, which have the potential to display unique functional plasticity resulting from their adaptation to complex and fluctuating marine environmentsw.

'Queer in Microbiology': a Microbiology Society members' endeavour for creating a safe and inclusive environment for LGBTQIA+ microbiologists.

The past decade has seen growing awareness of the challenges faced by LGBTQIA+ scientists, including discrimination in the workplace and the lack of representation. Initiatives such as 500 Queer Scientists, Pride in STEM and the Microbiology Society's LGBTQIA+ events have been instrumental in promoting inclusivity in science, technology, engineering, mathematics and medicine (STEMM). The Microbiology Society and its members have played a pivotal role in these efforts and summarized here are their initiatives towards safer and more inclusive scientific and research environments. Starting with a series of interviews and blog posts about the experiences of LGBTQIA+ microbiologists in research, the Society has promoted the organization of networking and social events and developed guidelines for creating more inclusive scientific conferences. These initiatives have not only improved the representation and visibility of LGBTQIA+ individuals in microbiology, but have also served as a blueprint for similar efforts in other scientific areas. Nevertheless, despite improvements in some areas, full inclusion of LGBTQIA+ scientists is still hindered by societal and institutional policies around the world. Here, we propose novel measures to support and empower LGBTQIA+ microbiological communities within learned societies.

The potential role of artificial intelligence in the clinical management of Hansen's disease (leprosy).

Missed and delayed diagnoses of Hansen's disease (HD) are making the battle against it even more complex, increasing its transmission and significantly impacting those affected and their families. This strains public health systems and raises the risk of lifelong impairments and disabilities. Worryingly, the three countries most affected by HD witnessed a growth in new cases in 2022, jeopardizing the World Health Organization's targets to interrupt transmission. Artificial intelligence (AI) can help address these challenges by offering the potential for rapid case detection, customized treatment, and solutions for accessibility challenges-especially in regions with a shortage of trained healthcare professionals. This perspective article explores how AI can significantly impact the clinical management of HD, focusing on therapeutic strategies. AI can help classify cases, ensure multidrug therapy compliance, monitor geographical treatment coverage, and detect adverse drug reactions and antimicrobial resistance. In addition, AI can assist in the early detection of nerve damage, which aids in disability prevention and planning rehabilitation. Incorporating AI into mental health counseling is also a promising contribution to combating the stigma associated with HD. By revolutionizing therapeutic approaches, AI offers a holistic solution to reduce the burden of HD and improve patient outcomes.

Superficial skin temperature recovery of distal limbs of thoroughbred racehorses after training in a racetrack in different seasons.

In the present study we aimed to investigate superficial skin temperature of racehorses' distal limbs after training in a racetrack. Male and female Thoroughbred racehorses were investigated in summer, after light training, and in the winter, after light and intense training. Horses were exercised (Exercise group, EG) under trainers' protocol while others were maintained inside their stalls (Control group, CG). Thermographic images were obtained from the front (fetlock, cannon, and carpus) and hindlimbs (fetlock, cannon, and tarsus), before exercise and 45, 60, 120 and 180 min after exercising. Images were analyzed using the Flir Tools® program. Temperatures of different moments of each group were compared using Anova for repeated measures and each moment of EG versus CG using Student t test. Horses of the CG maintained steady temperature in the winter, but in summer temperature increased at M45 until M180 (P < 0,01). EG increased temperatures after exercises that remained higher than M0 even at 180 min post-exercise (P < 0,0001), for most of the regions in winter and summer. EG temperatures were higher than CG at most of the time points after exercise. There was positive correlation between all regions' temperature and the atmospheric temperature for the CG during the summer (P = 0,003, r2 = 0,9622), observed for the front fetlock and carpal regions for the EG (P = 0.035, r2 = 0,8166). This pilot study demonstrates that, after race exercising under natural conditions skin temperature might take more than 180 min to return to basal values.

Models for predicting coffee yield from chemical characteristics of soil and leaves using machine learning.

BACKGROUND: Coffee farming constitutes a substantial economic resource, representing a source of income for several countries due to the high consumption of coffee worldwide. Precise management of coffee crops involves collecting crop attributes (characteristics of the soil and the plant), mapping, and applying inputs according to the plants' needs. This differentiated management is precision coffee growing and it stands out for its increased yield and sustainability. RESULTS: This research aimed to predict yield in coffee plantations by applying machine learning methodologies to soil and plant attributes. The data were obtained in a field of 54.6 ha during two consecutive seasons, applying varied fertilization rates in accordance with the recommendations of soil attribute maps. Leaf analysis maps also were monitored with the aim of establishing a correlation between input parameters and yield prediction. The machine-learning models obtained from these data predicted coffee yield efficiently. The best model demonstrated predictive fit results with a Pearson correlation of 0.86. Soil chemical attributes did not interfere with the prediction models, indicating that this analysis can be dispensed with when applying these models. CONCLUSION: These findings have important implications for optimizing coffee management and cultivation, providing valuable insights for producers and researchers interested in maximizing yield using precision agriculture. © 2024 Society of Chemical Industry.

N-Acetylcysteine Alters Disease Progression and Increases Janus Kinase Mutation Frequency in a Mouse Model of Precursor B-Cell Acute Lymphoblastic Leukemia.

B-cell acute lymphoblastic leukemia (B-ALL) is the most prevalent type of cancer in young children and is associated with high levels of reactive oxygen species (ROS). The antioxidant N-acetylcysteine (NAC) was tested for its ability to alter disease progression in a mouse model of B-ALL. Mb1-CreΔPB mice have deletions in genes encoding PU.1 and Spi-B in B cells and develop B-ALL at 100% incidence. Treatment of Mb1-CreΔPB mice with NAC in drinking water significantly reduced the frequency of CD19+ pre-B-ALL cells infiltrating the thymus at 11 weeks of age. However, treatment with NAC did not reduce leukemia progression or increase survival by a median 16 weeks of age. NAC significantly altered gene expression in leukemias in treated mice. Mice treated with NAC had increased frequencies of activating mutations in genes encoding Janus kinases 1 and 3. In particular, frequencies of Jak3 R653H mutations were increased in mice treated with NAC compared with control drinking water. NAC opposed oxidization of PTEN protein ROS in cultured leukemia cells. These results show that NAC alters leukemia progression in this mouse model, ultimately selecting for leukemias with high Jak3 R653H mutation frequencies. SIGNIFICANCE STATEMENT: In a mouse model of precursor B-cell acute lymphoblastic leukemia associated with high levels of reactive oxygen species, treatment with N-acetylcysteine did not delay disease progression but instead selected for leukemic clones with activating R653H mutations in Janus kinase 3.

COVID-19 death risk predictors in Brazil using survival tree analysis: a retrospective cohort from 2020 to 2022.

PURPOSE: This study analyses the survival of hospitalized patients with Severe Acute Respiratory Syndrome (SARS) due to COVID-19 and identifies the risk groups for death due to COVID-19 from the identification of potential interactions between its predictors. METHODS: This was a retrospective longitudinal study with data from 1,756,917 patients reported in the Influenza Epidemiological Surveillance Information System from 26 February 2020 to 31 December 2022. In this study, all adult and older (≥ 20 years) patients were hospitalized with SARS due to COVID-19, with death as the outcome. Survival tree analysis was used to identify potential interactions between the predictors. A model was built for each year of study. RESULTS: Hospital lethalitywas 33.2%. The worst survival curve was observed among those who underwent invasive mechanical ventilation and were aged 80 years or older in the three years of the pandemic. Black and brown race/color were predictors of deaths in the years 2020 and 2021 when there was greater demand from the health system due to the greater number of cases. CONCLUSION: By applying survival tree analysis we identified several numbers of homogeneous subgroups with different risks for mortality from COVID-19. These findings show the effects of wide inequalities of access by the population, requiring effective policies for the reduction and adequate management of the disease.

Selection of forage grasses for cultivation under water-limited conditions using Manhattan distance and TOPSIS.

Extreme weather events, such as severe droughts, pose a threat to the sustainability of beef cattle by limiting the growth and development of forage plants and reducing the available pasture for animals. Thus, the search for forage species that are more tolerant and adapted to soil water deficit conditions is an important strategy to improve food supply. In this study, we propose utilizing the mathematical concept of the Manhattan distance to assess the variations in the morphological variables of tropical forage grasses under water-limited conditions. This study aimed to select genotypes of tropical forage grasses under different water stress levels (moderate or severe) at this distance and the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS). Nine varieties from five species were examined. Forage grasses were grown in 12-L pots under three soil irrigation regimes [100% pot capacity-PC (well-irrigated control), 60% PC (moderate drought stress), and 25% PC (severe drought stress)] with four replicates. Drought stress treatments were applied for 25 days during the forage grass tillering and stalk elongation phases. After exposure to drought stress, the growth and morphological traits of forage plants were evaluated. The results show that the use of the Manhattan distance combined with TOPSIS helps in the genotypic selection of more stable tropical forage grass varieties when comparing plants exposed to moderate and severe drought conditions in relation to the nonstressful environment (control). The 'ADR 300', 'Pojuca', 'Marandu', and 'Xaraés' varieties show greater stability when grown in a greenhouse and subjected to water stress environments. The selected forage varieties can be used as parents in plant breeding programs, allowing us to obtain new drought-resistant genotypes.

IKZF3/Aiolos H195Y mutation identified in a mouse model of B cell leukemia results in altered DNA binding and altered STAT5-dependent gene expression.

Precursor B cell acute lymphoblastic leukemia (Pre-B-ALL) arises from developing B cells and frequently involves mutations in genes encoding transcription factors. In this study, we investigated the function of mutations in the transcription factor IKZF3 (Aiolos), R137* and H195Y, discovered in a mouse model of pre-B-ALL. R137* IKZF3 mutation resulted in a truncated protein, while electrophoretic mobility shift assay showed that H195Y IKZF3 mutation resulted in a protein with altered DNA binding. 38B9 pre-B cell lines were generated expressing WT and H195Y IKZF3 proteins. Anti-IKZF3 ChIP-seq showed that H195Y IKZF3 interacted with a larger number of sites that were different than WT IKZF3. Treatment with interleukin-7 induced changes in gene expression in 38B9 cells expressing WT IKZF3, but did not induce any changes in gene expression in cells expressing H195Y IKZF3. Anti-STAT5 ChIP-seq showed that expression of H195Y IKZF3 resulted in redistribution of STAT5 binding sites in the genome. H195Y IKZF3 binding sites overlapped with a subset of STAT5 binding sites, including in the promoter of the Cish gene. These findings suggest that H195Y mutation of IKZF3 results in altered DNA binding specificity and altered binding of STAT5 to target genes.

Polyphenols, Antioxidants, and Wound Healing of Lecythis pisonis Seed Coats.

To better use the Lecythis pisonis Cambess. biomass, this study investigates whether Sapucaia seed coats present wound healing properties. We analyzed the antibacterial, antioxidant, and wound healing-promoting potentials, plus cytotoxicity and stimulation of vascular endothelial growth factor-A. The chemical composition was analyzed by positive ion mode electrospray ionization Fourier transform ion cyclotron resonance mass spectrometry. A total of 19 compounds were identified, such as proanthocyanidin A1, procyanidins A1, B2, and C1, epigallocatechin, and kaempferol (p-coumaroyl) glycoside. Potent antioxidant strength/index was verified for 2,2-diphenyl-1-picrylhydrazyl radical (IC50 = 0.99 µg/mL) and ferric reducing antioxidant power (IC50 = 1.09 µg/mL). The extract did not present cytotoxicity and promoted significant cell migration and/or proliferation of fibroblasts (p < 0.05). Vascular endothelial growth factor-A was stimulated dose-dependently at 6 µg/mL (167.13 ± 8.30 pg/mL), 12.5 µg/mL (210.3 ± 14.2 pg/mL), and 25 µg/mL (411.6 ± 29.4 pg/mL). Platelet-derived growth factor (PDGF) (0.002 µg/mL) was stimulated at 215.98 pg/mL. Staphylococcus aureus was susceptible to the extract, with a minimum inhibitory concentration of 31.25 µg/mL. The identified compounds benefit the antioxidant activity, promoting hemostasis for the wound healing process, indicating that this extract has the potential for use in dermatological cosmetics.

Prevalence of Perceived Barriers to Physical Activity Among Pre- and Post-Metabolic and Bariatric Surgery Patients: A Cross-Sectional Study.

OBJECTIVE: This study aims to describe and compare the prevalence of perceived barriers to physical activity (PBPA) in pre- and post-metabolic and bariatric surgery (MBS) patients and assess the association of these barriers with their physical activity levels. METHODS: A cross-sectional study included pre-operative (n = 63) and post-operative (n = 119) groups. Sociodemographic characteristics, leisure-time physical activity levels, and PBPA data were collected. Descriptive statistics, chi-square, and Fisher's exact tests, and binomial logistic regression analyses were used for comparisons and associations. RESULTS: Compared to the pre-operative group, the post-operative group had a lower prevalence of barriers in the physical domain (p = 0.036) and the behavioral domain (p = 0.004). However, there were no significant differences in the environmental (p = 0.531) or social (p = 0.597) domains. Pre-MBS patients were more likely to be physically inactive when perceiving barriers in the environmental (p = 0.048) and behavioral (p = 0.048) domains. In contrast, post-surgical patients were more likely to be physically inactive when perceiving barriers in the environmental (p = 0.027), social (p = 0.020), and behavioral (p = 0.037) domains. CONCLUSION: The results show that individuals who underwent metabolic and bariatric surgery have a lower prevalence of behavioral and physical PBPA compared to those awaiting the procedure. The perception of barriers to physical activity in the environmental and behavioral domains increases the likelihood of physical inactivity in both pre- and post-MBS patients, while in the social domain, it was only associated with physical activity in post-MBS patients.

Antimicrobial resistance and biotechnological potential of plastic-associated bacteria isolated from an urban estuary.

Plastics have quickly become one of the major pollutants in aquatic environments worldwide and solving the plastic pollution crisis is considered a central goal of modern society. In this study, 10 different plastic samples, including high- and low-density polyethylene and polypropylene, were collected from a deeply polluted urban estuary in Brazil. By employing different isolation and analysis approaches to investigate plastic-associated bacteria, a predominance of potentially pathogenic bacteria such as Acinetobacter, Aeromonas, and Vibrio was observed throughout all plastic samples. Bacteria typically found in the aquatic environment harboured clinically relevant genes encoding resistance to carbapenems (blaKPC ) and colistin (such as mcr-3 and mcr-4), along with genetic determinants associated with potentially active gene mobilization. Whole genome sequencing and annotation of three plastic-associated Vibrio strains further demonstrated the carriage of mobile genetic elements and antimicrobial resistance and virulence genes. On the other hand, bacteria isolated from the same samples were also able to produce esterases, lipases, and bioemulsifiers, thus highlighting that the plastisphere could also be of special interest from a biotechnological perspective.

Utilizing intramammary Melaleuca alternifolia as an organic internal sealant for dry-off therapy in Murrah buffaloes.

The effects of intramammary dry cow therapy based on the administration of 5% Melaleuca alternifolia tea tree essential oil (TTO) as an internal teat sealant to Murrah cows were evaluated. A longitudinal prospective and retrospective negative control study was performed using 12 buffaloes from a total of 20 Murrah buffaloes on an organic farm, with the cow used as a control for herself. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) for treatments with pure oil (TTO) and medication containing 5% TTO (O5) were determined. The buffaloes were clinically examined, and the teats were evaluated using thermography and ultrasound. Udder health was monitored during the first 100 days in milk (DIM) using milk somatic cell count (SCC) and California mastitis test (CMT). Laboratory tests against standard strains Staphylococcus aureus ATCC®25,923™, Escherichia coli ATCC®25,922™, and wild bacterial strains showed maximum MIC values of 50 µL/mL for the TTO and O5 treatments. One wild-type S. aureus strain showed no MBC. No adverse effects were observed after the intramammary application of TTO. The CMT and SCC values were similar (P > 0.05) for all observations. The medication containing 5% TTO was effective in vitro and compatible with the intramammary tissue in vivo of Murrah buffaloes. TTO was safe, not inducing inflammatory processes or other modifications of the teat detectable by thermography or ultrasound. It was able to protect buffaloes during the dry period under field conditions, demonstrating potential use as a teat sealant for organic farms.

Building a queer- and trans-inclusive microbiology conference.

Microbiology conferences can be powerful places to build collaborations and exchange ideas, but for queer and transgender (trans) scientists, they can also become sources of alienation and isolation. Many conference organizers would like to create welcoming and inclusive events but feel ill-equipped to make this vision a reality, and a historical lack of representation of queer and trans folks in microbiology means we rarely occupy these key leadership roles ourselves. Looking more broadly, queer and trans scientists are systematically marginalized across scientific fields, leading to disparities in career outcomes, professional networks, and opportunities, as well as the loss of unique scientific perspectives at all levels. For queer and trans folks with multiple, intersecting, marginalized identities, these barriers often become even more severe. Here, we draw from our experiences as early-career microbiologists to provide concrete, practical advice to help conference organizers across research communities design inclusive, safe, and welcoming conferences, where queer and trans scientists can flourish.

Factors associated with the quality of death certification in Brazilian municipalities: A data-driven non-linear model.

Studies evaluating the local quality of death certification in Brazil focused on completeness of death reporting or inappropriate coding of causes of death, with few investigating missing data. We aimed to use missing and unexpected values in core topics to assess the quality of death certification in Brazilian municipalities, to evaluate its correlation with the percentage of garbage codes, and to employ a data-driven approach with non-linear models to investigate the association of the socioeconomic and health infrastructure context with quality of death statistics among municipalities. This retrospective study used data from the Mortality Information System (2010-2017), and municipal data regarding healthcare infrastructure, socioeconomic characteristics, and death rates. Quality of death certification was assessed by missing or unexpected values in the following core topics: dates of occurrence, registration, and birth, place of occurrence, certifier, sex, and marital status. Models were fit to classify municipalities according to the quality of death certification (poor quality defined as death records with missing or unexpected values in core topics ≥ 80%). Municipalities with poor quality of death certification (43.9%) presented larger populations, lower death rates, lower socioeconomic index, healthcare infrastructure with fewer beds and physicians, and higher proportion of public healthcare facilities. The correlation coefficients between quality of death certification assessed by missing or unexpected values and the proportion of garbage codes were weak (0.11-0.49), but stronger for municipalities with lower socioeconomic scores. The model that best fitted the data was the random forest classifier (ROC AUC = 0.76; precision-recall AUC = 0.78). This innovative way of assessing the quality of death certification could help quality improvement initiatives to include the correctness of essential fields, in addition to garbage coding or completeness of records, especially in municipalities with lower socioeconomic status where garbage coding and the correctness of core topics appear to be related issues.

What happened to health labour markets during COVID-19? Insights from the analysis of cross-sectional survey data on the perceptions of medical doctors in Brazil.

OBJECTIVES: To examine physicians' perceptions of changing employment opportunities in Brazil, and gain an insight into labour markets in low/middle-income countries (LMICs) during the pandemic. STUDY DESIGN: Descriptive and inferential analysis of a quantitative dataset from a representative cross-sectional survey of physicians of two Brazilian states. SETTINGS: São Paulo and Maranhão states in Brazil. PARTICIPANTS: Representative sample of 1183 physicians. OUTCOME MEASURES: We estimated prevalence and 95% CIs for physicians' perceptions of changes in demand and supply of doctors, as well as changes in prices of medical services for facilities of practice in the two states, stratified by public, private and dual-practice physicians. RESULTS: Most doctors reported increased job opportunities in the public sector (54.9%, 95% CI 52.0% to 57.7%), particularly in Maranhão state (65.0%, 95% CI 60.9% to 68.9%). For the private sector, increased opportunities were reported only in large private hospitals (46.7%, 95% CI 43.9% to 49.6%) but not in smaller clinics. We recorded perceptions of slight increases in availability of doctors in Maranhão, particularly in the public sector (51.4%, 95% CI 43.2% to 59.5%). Younger doctors recounted increased vacancies in the public sector (64%, 95% CI 58.1% to 68.1%), older doctors only in walk-in clinics in Maranhão (47.5%, 95% CI 39.9% to 55.1%). Those working directly with patients with COVID-19 saw opportunities in public hospitals (65%, 95% CI 62.3% to 68.4%) and in large private ones (55%, 95% CI 51.8% to 59.1%). CONCLUSIONS: Our findings hint that health labour markets in LMICs may not necessarily shrink during epidemics, and that impacts will depend on the balance of public and private services in national health systems.

[COVID-19 mortality in metropolitan areas vs. other regions of Brazil, 2020 to 2021Mortalidad por COVID-19 en las regiones metropolitanas y en el interior de Brasil, 2020-2021]. / Mortalidade por covid-19 no interior e em regiões metropolitanas do Brasil, 2020 a 2021.

Objective: To compare hospital mortality rates (HMR) due to severe acute respiratory syndrome (SARS) associated with COVID-19 recorded in metropolitan areas and other regions (interior) of Brazil in 2020 and 2021. Method: This ecological study used public data available on OpenDataSUS. The information was accessed in May 2022. The following variables were considered: age, sex, hospitalization, presence of a risk factor, ICU stay, use of ventilatory support, and final classification in the individual registration form of SARS cases due to COVID-19. Cases and deaths were stratified into five age groups (0-19 years, 20-39 years, 40-59 years, 60-79 years, and ≥80 years) and by place of residence (metropolitan area or interior). The HMR had as numerator the absolute number of deaths by SARS associated with covid-19; and, as a denominator, the absolute number of cases of SARS due to covid-19 according to the year of occurrence, area of residence, age bracket, sex, hospitalization, presence of a risk factor, ICU admission, and use of ventilatory support. Results: There was a significant increase in HMR due to SARS associated with COVID-19 in 2021 in all age groups, except 0-19 years and ≥80 years, as well as among individuals admitted to an ICU and who used invasive ventilatory support, both in metropolitan areas as well as in the interior. Conclusions: There was a worsening of the epidemiological scenario in 2021 with an increase in HMR. However, no differences were identified between the metropolitan regions and the interior of the country.

Objetivo: Comparar las tasas de mortalidad hospitalaria por el síndrome respiratorio agudo grave relacionado con la COVID-19 registradas en las regiones metropolitanas y el interior de Brasil en el período 2020-2021. Método: Se realizó un estudio ecológico con datos públicos disponibles en el sistema OpenDataSUS. La información se consultó en mayo del 2022. Se tomaron en cuenta las siguientes variables: edad, sexo, hospitalización, presencia de factores de riesgo, ingreso en la unidad de cuidados intensivos, uso de apoyo ventilatorio y clasificación final en la hoja de registro individual de casos del síndrome respiratorio agudo grave por COVID-19. Los casos y las defunciones se estratificaron en cinco grupos etarios (0-19 años, 20-39 años, 40-59 años, 60-79 años y ≥80 años) y por ubicación del municipio de residencia (región metropolitana o interior). El numerador de la tasa de mortalidad hospitalaria fue el número absoluto de defunciones por el síndrome respiratorio agudo grave relacionado con la COVID-19, y el denominador, el número absoluto de casos del mismo síndrome relacionado con la COVID-19 según el año de aparición, la residencia en una región metropolitana o en el interior, el grupo etario, el sexo, la hospitalización, la presencia de factores de riesgo, el ingreso en la unidad de cuidados intensivos y el uso de apoyo ventilatorio. Resultados: Se comprobó un aumento significativo de la tasa de mortalidad hospitalaria por el síndrome respiratorio agudo grave relacionado con la COVID-19 en el 2021 en todos los grupos etarios, excepto en los grupos de 0-19 años y ≥80 años, así como entre las personas internadas en la unidad de cuidados intensivos que recibieron apoyo respiratorio invasivo, tanto en las regiones metropolitanas como en el interior. Conclusiones: La situación epidemiológica empeoró en el 2021 con el aumento de la tasa de mortalidad hospitalaria, pero no se observaron diferencias entre las regiones metropolitanas y el interior del país.