BACKGROUND The prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) has changed unevenly over time around the world. Although whole genome sequencing is the gold standard for virus characterisation, the discovery of alpha VOC causing spike gene target failure (SGTF) result, when tested using an reverse transcription real-time polymerase chain reaction (RT-qPCR) assay, has provided a simple tool for tracking the frequencies of variants. OBJECTIVES The aim of this study was to investigate if a multiplex RT-qPCR assay (BioM 4Plex VOC) could be used to detect SARS-CoV-2 and to perform a VOC screening test in a single reaction tube. Here, we present the multicentre study evaluating this assay. METHODS Twelve laboratories have participated in the multicentre study. The BioM 4Plex VOC was distributed to them with detailed instructions of how to perform the test. They were asked to test the BioM 4Plex VOC in parallel with their routine Commercial SARS-CoV-2 diagnostic assay. Additionally, they were requested to select SARS-CoV-2-positive samples with genome sequenced and lineage definition according to PANGO lineage classification. FINDINGS The BioM 4Plex VOC and commercial RT-PCR assay are equally effective in detecting SARS-CoV-2. Results revealed a specificity of 96.5-100% [95% confidence interval (CI)], a sensitivity of 99.8-100% (95% CI), and an accuracy of 99.8-100% (95% CI). A 99% concordance rate was found between results from the BioM 4Plex VOC and that from available genome sequencing data. MAIN CONCLUSIONS The BioM 4Plex VOC provides an effective solution to detect SARS-CoV-2 infections and screening for VOCs in a single reaction. It is a straightforward method to help us monitor the frequency and distribution of VOCs and develop strategies to better cope with the pandemics.

Abstract Aim: To characterize the goal-scoring patterns and investigate the goal process on match outcome during the Intercontinental Beach Soccer Cup Dubai 2019. Methods: A set of 35 goal-scoring patterns were grouped into nine macro-categories: Match-period, Court-zone, Set-play, Open-play, Touching by players before the goal, Offensive method, Goalkeeper-line, Number of passes before the goal, and Ball trajectory. Match outcome in regular time was considered the matches resulting in a loss (n=16), draw (n=8), or win (n=16). The offensive sequences that resulted in the goal were analyzed in all 20 matches during the competition (n=138 goals). Results: The most goals were scored in Open-play (69%), during the 2nd and 3rd periods (36% for each), near to goal (Zone 4; 50%), preceded by 1-touch (67%) and 0-pass (29%), using positional attack (46%), without goalkeeper-line (68%), and with high-ball trajectory (51%). In addition, won matches presented a higher number of goals in Zone 4, 1-touch, Counterattack, 4v4 goal-successful, Receiving pass, Sand-touch, and High-ball compared to draw and loss matches (p<0.001−0.03; Effect Size [ES]=1.24−2.58, large). Conclusion: In summary, winning teams scored their goals mainly in open-play situations and without a goalkeeper-line, using counterattacks to achieve zones near the opponent's goals, and implementing a direct offensive style. In addition, goals scored were usually preceded by 1-touch, both through high-ball and sand-touch ball trajectory. Coaches and practitioners may consider these goal processes to train prescription and deep understanding of the process to goal in elite Beach soccer.

BACKGROUND The coronaviruses (CoVs) called the attention of the world for causing outbreaks of severe acute respiratory syndrome (SARS-CoV), in Asia in 2002-03, and respiratory disease in the Middle East (MERS-CoV), in 2012. In December 2019, yet again a new coronavirus (SARS-CoV-2) first identified in Wuhan, China, was associated with a severe respiratory infection, known today as COVID-19. This new virus quickly spread throughout China and 30 additional countries. As result, the World Health Organization (WHO) elevated the status of the COVID-19 outbreak from emergency of international concern to pandemic on March 11, 2020. The impact of COVID-19 on public health and economy fueled a worldwide race to approve therapeutic and prophylactic agents, but so far, there are no specific antiviral drugs or vaccines available. In current scenario, the development of in vitro systems for viral mass production and for testing antiviral and vaccine candidates proves to be an urgent matter. OBJECTIVE The objective of this paper is study the biology of SARS-CoV-2 in Vero-E6 cells at the ultrastructural level. METHODS In this study, we documented, by transmission electron microscopy and real-time reverse transcription polymerase chain reaction (RT-PCR), the infection of Vero-E6 cells with SARS-CoV-2 samples isolated from Brazilian patients. FINDINGS The infected cells presented cytopathic effects and SARS-CoV-2 particles were observed attached to the cell surface and inside cytoplasmic vesicles. The entry of the virus into cells occurred through the endocytic pathway or by fusion of the viral envelope with the cell membrane. Assembled nucleocapsids were verified inside rough endoplasmic reticulum cisterns (RER). Viral maturation seemed to occur by budding of viral particles from the RER into smooth membrane vesicles. MAIN CONCLUSIONS Therefore, the susceptibility of Vero-E6 cells to SARS-CoV-2 infection and the viral pathway inside the cells were demonstrated by ultrastructural analysis.

Coronavirus disease 2019 (COVID-19) surveillance, in Brazil, initiated shortly after its description, in China. Our aim was to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and additional pathogens in samples from the initial phase of the outbreak in Brazil, from late February to late March. From 707 samples analysed, 29 (4.1%) were SARS-CoV-2 positive. Fever and cough were their most prevalent symptoms. Co-detection of rhinovirus was observed in 2 (6.9%) cases. Additional pathogens were identified in 66.1% of the SARS-CoV-2 negative cases, mainly rhinovirus and influenza A(H1N1)pdm09. Thus, we emphasise the importance of differential diagnosis in COVID-19 suspected cases.

The influenza A(H3N2) virus has circulated worldwide for almost five decades and is the dominant subtype in most seasonal influenza epidemics, as occurred in the 2014 season in South America. In this study we evaluate five whole genome sequences of influenza A(H3N2) viruses detected in patients with mild illness collected from January-March 2014. To sequence the genomes, a new generation sequencing (NGS) protocol was performed using the Ion Torrent PGM platform. In addition to analysing the common genes, haemagglutinin, neuraminidase and matrix, our work also comprised internal genes. This was the first report of a whole genome analysis with Brazilian influenza A(H3N2) samples. Considerable amino acid variability was encountered in all gene segments, demonstrating the importance of studying the internal genes. NGS of whole genomes in this study will facilitate deeper virus characterisation, contributing to the improvement of influenza strain surveillance in Brazil.

After the World Health Organization officially declared the end of the first pandemic of the XXI century in August 2010, the influenza A(H1N1)pdm09 virus has been disseminated in the human population. In spite of its sustained circulation, very little on phylogenetic data or oseltamivir (OST) resistance is available for the virus in equatorial regions of South America. In order to shed more light on this topic, we analysed the haemagglutinin (HA) and neuraminidase (NA) genes of influenza A(H1N1)pdm09 positive samples collected during the pandemic period in the Pernambuco (PE), a northeastern Brazilian state. Complete HA sequences were compared and amino acid changes were related to clinical outcome. In addition, the H275Y substitution in NA, associated with OST resistance, was investigated by pyrosequencing. Samples from PE were grouped in phylogenetic clades 6 and 7, being clustered together with sequences from South and Southeast Brazil. The D222N/G HA gene mutation, associated with severity, was found in one deceased patient that was pregnant. Additionally, the HA mutation K308E, which appeared in Brazil in 2010 and was only detected worldwide the following year, was identified in samples from hospitalised cases. The resistance marker H275Y was not identified in samples tested. However, broader studies are needed to establish the real frequency of resistance in this Brazilian region.

During the influenza pandemic of 2009, the A(H1N1)pdm09, A/H3N2 seasonal and influenza B viruses were observed to be co-circulating with other respiratory viruses. To observe the epidemiological pattern of the influenza virus between May 2009-August 2011, 467 nasopharyngeal aspirates were collected from children less than five years of age in the city of Salvador. In addition, data on weather conditions were obtained. Indirect immunofluorescence, real-time transcription reverse polymerase chain reaction (RT-PCR), and sequencing assays were performed for influenza virus detection. Of all 467 samples, 34 (7%) specimens were positive for influenza A and of these, viral characterisation identified Flu A/H3N2 in 25/34 (74%) and A(H1N1)pdm09 in 9/34 (26%). Influenza B accounted for a small proportion (0.8%) and the other respiratory viruses for 27.2% (127/467). No deaths were registered and no pattern of seasonality or expected climatic conditions could be established. These observations are important for predicting the evolution of epidemics and in implementing future anti-pandemic measures.

CONTEXTO: Desde sua introdução, em 1991, o reparo endovascular do aneurisma da aorta abdominal infrarrenal tem se tornado uma alternativa atraente para o tratamento dessa doença. Avaliar nossos resultados iniciais quanto à segurança e eficácia dessa técnica nos levou à realização deste estudo. OBJETIVOS: Analisar a mortalidade perioperatória, a sobrevida tardia, as reoperações, as taxas de perviedade e o comportamento do saco aneurismático em pacientes com anatomia favorável para a realização do procedimento. MÉTODOS: Trata-se de um estudo longitudinal, observacional e retrospectivo realizado entre outubro de 2004 e janeiro de 2009 com 41 pacientes que foram submetidos à correção endovascular do aneurisma de aorta abdominal infrarrenal por apresentarem anatomia favorável para o procedimento. Foram analisados os achados dos exames diagnósticos, o tratamento e o seguimento em todos os pacientes. RESULTADOS: Foram implantadas, com sucesso, 31 (75,6%) próteses bifurcadas e 10 (24,5%) monoilíacas, de 5 diferentes marcas. O diâmetro médio dos aneurismas fusiformes era de 62 mm. A mortalidade perioperatória foi de 4,8% e a sobrevida tardia, 90,2%. Durante o acompanhamento médio de 30 meses, 2 (4,8%) pacientes necessitaram de reintervenção, um por migração da endoprótese e outro por vazamento tipo II. Dois (4,8%) pacientes apresentaram oclusão de ramo da prótese. Oito (19,5%) vazamentos foram diagnosticados e não houve nenhuma rotura dos aneurismas. CONCLUSÃO: Apesar do pequeno número de pacientes, os resultados observados parecem justificar a realização do procedimento endovascular nos pacientes com anatomia favorável.

BACKGROUND: Since its introduction in 1991, endovascular repair of infrarenal aortic aneurysms has become an attractive option to treat this disease. The evaluation of our initial results about safety and efficacy of this technique has led us to carry out this study. OBJECTIVES: To analyze perioperative mortality, late survival, reoperations, patency rates and the aneurysmal sac behavior in patients with favorable anatomy for this procedure. METHODS: A longitudinal, observational and retrospective study was conducted from October 2004 to January 2009, involving 41 patients with favorable anatomy for endovascular repair of infrarenal aortic aneurysm. The findings of diagnostic exams, the treatment and follow-up results were analyzed. RESULTS: Thirty-one (75.6%) bifurcated and 10 (24.5%) mono-iliac prosthesis of five different brands were successfully implanted. The average diameter of the fusiform aneurysms was 62 mm. Perioperative mortality rate was 4.8% and late survival was 90.2%. During the mean follow-up period of 30 months, two (4.8%) patients needed re-intervention, one for migration of the endoprosthesis and the other for type II endoleak. Two (4.8%) patients presented occlusion of an endograft branch. Eight (19.5%) endoleaks were diagnosed and there was no aneurysm rupture. CONCLUSION: Despite the small number of patients, the results seem to justify the performance of endovascular therapy in patients with favorable anatomy.

Background: Patellar resurfacing in total knee arthroplasty (TKA) remains controversial. We aimed to identify differences in the clinical outcomes of TKA according to whether or not patellar resurfacing had been performed. Methods: 100 knees (16 bilateral) in 84 patients were enrolled in a prospective clinical trial using a posterior stabilized knee replacement (50 resurfaced versus 50 non-resurfaced). Surgeries were performed by only one experienced surgeon. Patients were blindly assessed with the Knee Society Score. Results: 10 patients were lost to follow-up. The mean Knee Society clinical score improved from 56 points to 95 in the resurfaced group and 53 to 86 in the non resurfaced group (p < 0.05). At the time of the latest follow-up, there was a significantly higher incidence of anterior knee pain in the knees that had not been resurfaced: 17 (34%) vs. 5 (10%). Of the 17 patients without patellar resurfacing 16 had a non anatomic trochlear component. 75% of patients who had a bilateral knee replacement preferred the resurfaced side. Conclusions: Patients who underwent patellar resurfacing had better clinical results in terms of functional score and anterior knee pain. It seems likely that postoperative anterior knee pain relates to the component design. We recommend patellar resurfacing at the time of total knee replacement when technically possible.

Introducción: La indicación de implantar el componente patelar (ICP) en el reemplazo total de rodilla (RTR) es controvertida El objetivo del presente trabajo consistió en analizar prospectivamente dos grupos de pacientes con RTR: uno con ICP y otro sin él. Materiales y métodos: En el período comprendido entre mayo de 1990 y noviembre de 2001 se practicaron 100 RTR, sistematizando dos grupos de 50 casos cada uno: a) con ICP y b) sin ICP Se establecieron criterios de selección de los pacientes. Se emplearon dos variedades de implante: a) con tróclea "anatómica" y b) con tróclea "universal". El período de seguimiento fue mayor de 6 ańos. Se aplicó el puntaje de la Knee Society. Se elaboró una encuesta de satisfacción comparativa aplicable a los pacientes operados bilaterales. Resultados: Se registraron resultados estadísticamente significativos más favorables (mejor puntaje de la Knee Society, menor incidencia de dolor en la cara anterior de la rodilla y encuesta de satisfacción positiva) en los pacientes en quienes se implantó el CP. Estos mejores resultados fueron apreciados globalmente y resultaron independientes del diseńo protésico empleado. Conclusiones: Se documentó que el diseńo protésico con tróclea "anatómica" ofreció menor riesgo de problemas patelofemorales en los casos en los cuales el componente patelar no se implantó.

A dissecção espontânea isolada do tronco celíaco sem a dissecção concomitante da aorta é uma condição rara, pouco descrita na literatura. O objetivo do presente trabalho é descrever um caso dessa entidade clínica em um paciente masculino, 74 anos, assintomático, cujo diagnóstico foi feito por ultrassonografia e confirmado com angiotomografia computadorizada. O paciente tem sido acompanhado com sucesso mediante observação clínica por um período de 25 meses.

The isolated spontaneous dissection of the celiac artery without the concomitant dissection of the aorta is a rare condition seldomly described in the literature. The objective of the present study is to describe a case of this clinical entity in a 74-year-old, male patient, who was asymptomatic, and whose diagnosis was established by means of ultrasound and confirmed using computed angiotomography. The patient has been successfully followed up by means of clinical management for a period of 25 months.

CONTEXTO: Pacientes tratados por revascularização arterial (enxertos e angioplastias) nos membros inferiores acometidos por doença arterial oclusiva periférica foram seguidos por até 2 anos pós-tratamento usando ultrassom vascular (análise espectral segmentar, AES). OBJETIVO: Demonstrar que a AES pode ser utilizada no seguimento dos pacientes tratados por doença arterial oclusiva periférica. MÉTODOS: As medidas de AES realizadas foram: velocidade sistólica de pico, índice de pulsatilidade e forma da onda de velocidade de fluxo. Essas foram comparadas em cada paciente no pré e pós-tratamento (com intervalos de 3 meses) para diagnóstico de perviedade. RESULTADOS: Medidas realizadas no pós-operatório nas artérias imediatamente distais aos segmentos tratados mostraram aumento consistente de velocidade sistólica de pico e índice de pulsatilidade com mudanças na forma da onda de velocidade de fluxo de unifásica para bi ou trifásica. A velocidade sistólica de pico e o índice de pulsatilidade aumentaram respectivamente em 92,26 e 98,2% (tratamentos no segmento aorto-ilíaco), em 112,83 e 62,39% (tratamentos no segmento fêmoro-poplíteo) e em 149,08 e 28,8% (tratamentos no segmento poplíteo-tibial). Tais mudanças nos padrões de velocidade de fluxo ocorreram em todos os pacientes e permaneceram quase inalteradas enquanto os tratamentos estivessem pérvios. Quando ocorria falência nos tratamentos (oclusões ou estenoses hemodinamicamente significantes), os parâmetros caíam a níveis similares aos de antes do tratamento. Se a falência do tratamento era corrigida por nova revascularização (enxerto ou angioplastia), os parâmetros de AES voltavam a se comportar como após o tratamento inicial. CONCLUSÃO: A AES pode ser usada no seguimento dos pacientes com revascularização dos membros devido a doença arterial oclusiva periférica, demonstrando tanto a perviedade quanto a falência do tratamento.

BACKGROUND: Patients treated for peripheral arterial occlusive disease with lower limb revascularization (angioplasty or grafts) were followed up for a 2-year period after treatment with vascular ultrasound (segmental spectrum analysis, SSA). OBJECTIVE: To demonstrate that SSA can be used in the follow-up of patients treated for peripheral arterial occlusive disease. METHODS: The following SSA measurements were performed: peak systolic velocity (PSV), pulsatility index (PI), and flow velocity waveform (FVW). These measurements were performed and compared for each patient during the pre- and post-treatment periods (with 3-month intervals) for diagnosis of vascular patency. RESULTS: Measurements performed postoperatively in the arteries immediately distal to the treated segments showed a significant increase in PSV and PI, with a change of the FVW from a monophasic to a biphasic or triphasic configuration. PSV and PI increased, respectively, 92.26 and 98.2% (intervention in the aortoiliac segment), 112.83 and 62.39% (intervention in the femoral-popliteal segment), and 149.08 and 28.8% (in the popliteal-tibial segment). Such changes in flow velocity patterns occurred in all patients and remained almost unaltered during the period of patient follow up. When treatment failed (hemodynamically significant occlusion or stenosis), parameters fell to levels similar to those observed prior to treatment. If treatment failure was corrected by new revascularization (angioplasty or grafts), SSA parameters returned to patterns observed after initial treatment. CONCLUSION: SSA can be used in the follow-up of patients with lower limb revascularization due to peripheral arterial occlusive disease, demonstrating treatment patency and failure.

As manifestações clínicas da síndrome do desfiladeiro torácico são predominantemente neurológicas, sendo as complicações arteriais raras, mas potencialmente graves. Entre elas, devemos citar os aneurismas com complicações embólicas e a trombose. Os autores relatam o caso de uma mulher de 37 anos com costela cervical bilateral que apresentou embolia no membro superior direito originada de um aneurisma pós-estenótico da artéria subclávia direita, além de apresentar ectasia da subclávia esquerda também por compressão.

The clinical manifestations of thoracic outlet syndrome are mainly neurological. Although arterial complications are rare, they are potentially severe. Among these are aneurysms associated with embolism and thrombosis. The authors report a case of a 37 year-old woman with bilateral cervical rib that developed embolism in the right upper limb from a poststenotic right subclavian artery aneurysm and dilatation of the left subclavian artery, both due to compression.

CONTEXTO: Dos aneurismas periféricos, o da artéria poplítea é o mais freqüente, correspondendo a 70 a 80% dos casos. O tratamento cirúrgico convencional consta de exclusão do aneurisma e interposição de enxerto em ponte ou de ressecção parcial ou total do aneurisma e reconstrução arterial com enxerto em continuidade. O tratamento endovascular surgiu como uma alternativa ao reparo convencional. OBJETIVO: Avaliar o uso de endoprótese para o tratamento endovascular do aneurisma de artéria poplítea. METODOLOGIA: Num total de 17 pacientes, todos do sexo masculino, 11 foram tratados por técnica endovascular, utilizando-se próteses Hemobahn e Viabahn. RESULTADOS: Um paciente apresentou pseudo-aneurisma no pós-operatório imediato. Dentre as complicações tardias, um paciente apresentou endoleak distal da prótese após 7 meses, e houve oclusão da endoprótese em outro. Os nove pacientes restantes apresentaram controle de eco-Doppler satisfatório aos 20 meses, resultando em uma perviedade primária de 90% em um período médio de 27 meses de seguimento. CONCLUSÃO: O tratamento endovascular para aneurisma de artéria poplítea é factível e apresenta algumas vantagens em relação ao tratamento aberto, como menor tempo de internação e de recuperação.

BACKGROUND: The most commonly occurring aneurysms in the periphery are those involving the popliteal artery. They comprise 70-80% of all such aneurysms. Conventional aneurysm repair consists of either opening the aneurysm sac and interposing a bypass graft or aneurysm ligation combined with bypass grafting. Endovascular treatment is an alternative to conventional repair. OBJECTIVE: To evaluate use of stent graft in the endovascular treatment of popliteal artery aneurysms. METHODS: We analyzed 17 male patients; of these, 11 were treated with endovascular stent graft, using Hemobahn and Viabahn stent grafts. RESULTS: One patient had pseudoaneurysm in the immediate postoperative period. Among late complications, one patient had distal endoleak after 7 months, and there was stent graft occlusion in another patient. The remaining nine patients had satisfactory Doppler ultrasonography control at 20 months, which resulted in a primary patency of 90% over mean follow-up time of 27 months. CONCLUSION: Endovascular repair of a popliteal artery aneurysm is feasible and has some advantages compared with the open treatment, such as shorter hospital stay and recovery.

O objetivo deste artigo é analisar como a crise de meia-idade afeta os indivíduos e as organizações. Para realizar esta análise, partimos da interpretação realizada por Carl Gustav Jung sobre a meia-idade e o processo de individuação. Neste sentido, abordamos os principais conceitos junguianos associados ao fenômeno, enfatizando os arquétipos sombra, anima, animus e self. Em seguida, utilizamos estes conceitos e arquétipos para avaliar como os dilemas da crise de meia-idade e o conflito entre as dimensões masculinas e femininas dos indivíduos afetam a dinâmica organizacional.

This article tries to analyze the effect of middle age crisis in the individuals and the organizations. In this direction, we based on interpretation of Carl Gustav Jung about the middle age and the individuation process. In this sense, we analyze the Jung´s concepts related to phenomenon emphasizes the shadow, anima, animus and self archetypes. After, we utilize this concepts and archetypes to evaluate as the middle age crisis dilemmas and the conflict between masculine and feminine dimensions of individuals affects the organizational dynamics.

Este artigo trata dos conceitos de participação conflitual, participação funcional, participação administrativa, co-gestão e autogestão, discutindo a noção e o papel da educação participativa na construção de uma nova sociedade.