Resumo O objetivo desse estudo foi conhecer os fatores associados à experiência materna no parto hospitalar. A metodologia utilizada foi uma revisão integrativa da literatura utilizando as bases de dados eletrônicas Medline (PubMed) e Biblioteca Virtual em Saúde BVS, tendo sido usados os seguintes comandos de busca: (("pregnant women" OR "postpartum period") AND perception AND ("childbirth experience" OR "labor obstetric"), selecionando artigos publicados a partir de 2017. A pesquisa finalizou com 15 referências bibliográficas onde foi possível identificar três grupos de resultados que influenciam a experiência materna, sendo eles apoio, informação/preparação para o parto e intervenções. Os estudos apontaram que os três grupos de resultados são elementos que se complementam. A percepção da experiência materna no parto é influenciada pelas condições socioeconômicas da mulher, pela preparação educacional para o parto, pelo apoio familiar e assistência da equipe de saúde durante o processo, pela qualidade e quantidade de intervenções realizadas e pelo respeito à autonomia da mulher nas decisões terapêuticas.

Abstract The objective of this study was to determine the factors associated with the maternal experience of hospital birth. An integrative literature review was performed using the electronic databases Medline (PubMed) and Biblioteca Virtual em Saúde (BVS - Virtual Health Library). The following search terms were used: (("pregnant women" OR "postpartum period") AND perception AND ("childbirth experience " OR "labor obstetric"), only articles published from 2017 onwards were selected. After selection, 15 bibliographical references were selected, where it was possible to identify three distinct groups of results, which were support, information/preparation for childbirth, and interventions. Our results suggest that the three result groups complement each other. We concluded that the maternal perception of the childbirth experience is influenced by socioeconomic conditions of the woman, educational preparation for the birth, family support, health team support during the labor process, quality and quantity of the interventions performed and respect to the woman’s autonomy in the therapeutical decisions.

ABSTRACT The primates that inhabit the rainforest surrounding the city of Manaus (Amazonas, Brazil) have long been recognised as potentially important reservoirs of emerging and re-emerging infectious diseases (ERIDs). PCR amplification of filarial sequences from wild-caught Simulium oyapockense has been used to incriminate potentially important Amazon-region ERID bridge vectors by showing they had previously fed on non-human primates. The broader use of filarial parasite sequences for the incrimination of biting insects as potentially important zoonotic disease vectors is limited by a paucity of primate-derived filarial parasite reference sequences which can be matched to the PCR amplified sequences obtained from insect-vector vectors. Here we have used shotgun sequencing to obtain reference data from an adult Dipetalonema gracile parasite which was found infecting a wild pied tamarin (Saguinus bicolor) in a peripheral region of Manaus. We report the parasite´s complete mitochondrial genome (which is 13,647 base pairs in length), 894,846 base pairs of its Wolbachia genome and 6,426 base pairs of its ribosomal DNA locus (spanning from the start of its 18S subunit to the end of its 28S subunit). Despite being critically endangered, S. bicolor is commonly encountered around the periphery of Manaus and in urban forest fragments. The reported sequences may be a useful reference tool for identifying ERID bridge vectors and potentially provide some insights into the amount and the nature of contact between primate pathogen reservoirs and the residents of Manaus.

RESUMO Os primatas que habitam a floresta tropical ao redor da cidade de Manaus (Amazonas, Brasil) há muito são reconhecidos como reservatórios potencialmente importantes de doenças infecciosas emergentes e reemergentes. Sequências de DNA de parasitas filariais detectadas por PCR em amostras de Simulium oyapockense foram usadas para demonstrar que eles haviam se alimentado anteriormente de primatas não humanos e, dessa maneira, incriminar vetores-ponte da região amazônica. O uso mais amplo de detecção de parasitas filariais para a incriminação de vetores-ponte é limitado por uma escassez de sequências referência de parasitas filarias obtidas de hospedeiros. Aqui nós usamos o sequenciamento tipo shotgun para obter dados de referência de um parasita adulto Dipetalonema gracile encontrado infectando um sauim-de-coleira, Saguinus bicolor no entorno de Manaus. Relatamos o genoma mitocondrial completo do parasita (que tem 13.647 pares de bases de comprimento), 894.846 pares de bases de seu genoma de Wolbachia e 6.426 pares de bases de seu locus de DNA ribossômico (desde o início de sua subunidade 18S até o final de sua subunidade 28S). Apesar de criticamente ameaçado, S. bicolor é comumente encontrado no entorno de Manaus e em fragmentos florestais urbanos. As sequências relatadas podem ser uma ferramenta de referência útil para identificar vetores ponte e potencialmente fornecer algumas informações sobre o contato entre reservatórios de patógenos de primatas e os moradores de Manaus.

ABSTRACT: This study evaluated forage-free diets supplemented with sodium bicarbonate (SB) based on ground flint corn on intake, apparent nutrient digestibility, ruminal parameters, and N balance. Four rumen-cannulatedDorper × Santa Inês lambs, with a body weight of 43.4 ± 0.85 kg (mean ± standard deviation) were used. The experimental design was a 4×4 Latin square. Each experimental period lasted 21 days. Experimental diets were: positive control, a diet without SB containing 400 g/kg DM of soybean hulls (CONT), and three diets based on ground flint corn, containing 10 (10SB), 20 (20SB) or 30 (30SB) g/kg DM of SB. Intake of neutral and acid detergent fiber was greater for CONT (P < 0.01) when compared to SB. Intake and apparent nutrient digestibility of dry and organic matter, ether extract, and crude protein did not differ. Intake (P = 0.01) and digestibility (P < 0.01) of non-fiber carbohydrates were greater for SB diets and neutral detergent fiber digestibility was greater (P = 0.03) for CONT. The total digestible nutrients and metabolizable energy were greater for SB (P = 0.04). Rumen concentrations of acetate (P < 0.01), isobutyrate (P < 0.01), butyrate (P < 0.01), isovalerate (P < 0.01), and total short-chain fatty acids (P < 0.01) were greater for CONT. Ruminal pH showed a quadratic (P = 0.05) response to SB levels, with greater values for 20SB. Sodium bicarbonate was efficient in increasing ruminal pH at the level of 20 g/kg DM without interfering with the intake and apparent nutrient digestibility characteristics.

RESUMO: O presente estudo avaliou a suplementação de bicarbonato de sódio (BS) em dietas sem forragem à base de milho moído sobre o consumo e a digestibilidade aparente dos nutrientes, os parâmetros ruminais e o balanço de N. Foram utilizados quatro cordeiros Dorper × Santa Inês, com um peso corporal inicial de 43,4 ± 0,85 kg (média ± desvio padrão). O delineamento experimental foi quadrado latino 4×4. Cada período experimental durou 21 dias. As dietas experimentais foram: controle positivo, sem BS, contendo 400 g/kg de MS de casca de soja (CONT) e três dietas à base de milho moído, sem casca de soja, contendo 10 (10BS), 20 (20BS) ou 30 (30BS) g/kg de MS de BS. O consumo de fibra em detergente neutro e ácido foi maior (P < 0,01)para o CONT quando comparado com BS. O consumo e a digestibilidade aparente da matéria seca, matéria orgânica, extrato etéreo e proteína bruta não diferiram entre os tratamentos. O consumo (P = 0,01) e digestibilidade (P < 0,01) dos carboidratos não fibrosos foram superiores para as dietas contendo BS e a digestibilidade da fibra em detergente neutro foi maior para o CONT. Os teores de nutrientes digestivos totais e energia metabolizável foram superiores para as dietas contendo BS (P = 0,04). A concentração ruminal de acetato (P < 0,01), isobutirato (P < 0,01), butirato (P < 0,01), isovalerato (P < 0,01) e ácidos graxos totais de cadeia curta (P < 0,01) foram mais elevadas para o CONT. O pHruminal apresentou resposta quadrática (P = 0,05) em relação aos níveis de BS, sendo observado maior pH para os animais alimentados com a dieta 20BS. O BS foi eficiente em aumentar o pHruminal no teor de 20 g/kg MS sem interferir no consumo e na digestibilidade aparente dos nutrientes. Portanto, 20 g/kg de MS é a dose indicada de BS em dietas sem forragem para terminação de cordeiros em confinamento.

Abstract The management of drainage and urban rainwater management in Brazil and in the world faces numerous challenges in order to be sustainable. When dealing with sustainability, it is important to relate the aspects: of social, environmental and economic, known as the sustainability tripod. Compensatory urban drainage techniques, through infiltration or detention and increasing the evapotranspiration rate, have the potential to reduce: the amount of rainwater runoff; flow peaks; vulnerability of urban areas to flooding; contamination of water courses. It is important that, even with all these benefits, such technologies are associated with such aspects. In this context, this systematic review article (SR) was developed, which aimed to identify trends in the use of sustainable drainage technologies adopted in Brazil and in the world, relating them to aspects of sustainability. For that, a systematic review (SR) was carried out in which the following were identified: trends in the adoption of technologies for sustainable drainage in the world and in Brazil; and the terms used and related to technologies for sustainable drainage. It was also observed, both in Brazil and in the world, that the approach to the theme begins with the technological aspect involving the implementation, life cycle and maintenance of sustainable technologies and, in sequence, the environmental, economic and social aspects unfold in this order, but which are not done in an integral way. It was possible to characterize an important knowledge gap. tripod techniques rate reduce runoff peaks flooding courses benefits context SR (SR developed identified observed implementation sequence way gap

BACKGROUND The Amazon Region hosts invaluable and unique biodiversity as well as mineral resources. Consequently, large illegal and artisanal gold mining areas exist in indigenous territories. Mercury has been used in gold mining, and some has been released into the environment and atmosphere, primarily affecting indigenous people such as the Yanomami. In addition, other heavy metals have been associated with gold mining and other metal-dispersing activities in the region. OBJECTIVE Investigate the gut microbiome of two semi-isolated groups from the Amazon, focusing on metal resistance. METHODS Metagenomic data from the Yanomami and Tunapuco gut microbiome were assembled into contigs, and their putative proteins were searched against a database of metal resistance proteins. FINDINGS Proteins associated with mercury resistance were exclusive in the Yanomami, while proteins associated with silver resistance were exclusive in the Tunapuco. Both groups share 77 non-redundant metal resistance (MR) proteins, mostly associated with multi-MR and operons with potential resistance to arsenic, nickel, zinc, copper, copper/silver, and cobalt/nickel. Although both groups harbour operons related to copper resistance, only the Tunapuco group had the pco operon. CONCLUSION The Yanomami and Tunapuco gut microbiome shows that these people have been exposed directly or indirectly to distinct scenarios concerning heavy metals.

BACKGROUND Pandrug-resistant (PDR) Klebsiella pneumoniae has been reported sporadically in many countries and remains rare in Brazil. OBJECTIVES This study unravelled the genetic determinants involved with the PDR background of a clinical ST11 K. pneumoniae recovered in the Brazilian Amazon Region, where K. pneumoniae genomic and epidemiological information is scarce. METHODS Kp196 was submitted to the antimicrobial susceptibility test by the disk-diffusion method and minimum inhibitory concentration (MIC) determination. The whole genome sequencing was obtained and the sequence type was determined by core genome multilocus sequence typing (cgMLST). Its intrinsic and acquired resistome was assessed by Comprehensive Antibiotic Resistance Database (CARD) and comparison with wild-type genes. FINDINGS The analyses revealed that Kp196 belonged to the pandemic ST11 and presented the PDR phenotype. Its acquired resistome was composed of a huge set of clinically relevant resistance determinants, including bla CTX-M-15 and bla NDM-1, all found in the vicinity of mobile platforms. Considering its intrinsic resistome, the multidrug resistance, especially to colistin, tigecycline and fluoroquinolones, was multifactorial and attributed to modifications (indels, missense mutations, and gene disruption) in several housekeeping genes (arnT/phoQ/mgrB/ramR/acrB/gyrA/parC/ompK35-36-37). The Kp196 intrinsic resistome was also observed in a ST11 environmental strain, although harbouring distinct acquired resistomes. CONCLUSIONS An accumulation of different resistance mechanisms regarding the intrinsic resistome accounts for a more stable resistome, strongly contributing to the Kp196 PDR phenotype.

BACKGROUND The parasite Giardia duodenalis infects a wide range of vertebrate hosts, including domestic and wild animals as well as humans. Giardia is genotyped into eight assemblages (A-H). Zoonotic assemblages A and B have already been identified in humans and wild and domestic animals (non-human primates and cats) from Brazilian Amazon and in the world. Due to its zoonotic/zooanthroponotic nature, surveillance initiatives and the definition of Giardia assemblages are important in order to characterise the epidemiological scenario and to implement further control measures. OBJECTIVES Determine assemblages of G. duodenalis in sloths from the Brazilian Amazon Region. METHODS Faecal parasitological examination of sloths from Amazonas State. Polymerase chain reaction (PCR) targeting the beta giardin (BG), and genes from multilocus sequence typing (MLST) scheme, amplicon sequencing and phylogenetic analysis. FINDINGS Here, we identified, by microscopy, Giardia in two northern sloths (Bradypus tridactylus). These two samples were submitted to molecular assays and it was revealed that both were infected by G. duodenalis assemblage A. Phylogenetic analysis showed that they belong to assemblage A within sequences from humans and wild and domestic animals. CONCLUSION Therefore, besides showing, by the first time, the current presence of this parasite in sloths, our findings reveals that this wild animal species would be part of the zoonotic/zooanthroponotic scenario of this parasite in the Brazilian Amazon.

Resumo Introdução: O tabagismo traduz-se em elevada morbi-mortalidade. Deixar de fumar tem benefícios em qualquer idade. O objetivo desta revisão é determinar o nível de evidência da prescrição de citisiniclina (citisina) no tratamento farmacológico da cessação tabágica (CT). Metodologia: Realizou-se a 9 de dezembro de 2021 uma pesquisa bibliográfica nas bases de dados de estudos publicados nos últimos 10 anos, em inglês e português, utilizando os termos MeSH: “cytisine” e “smoking cessation”. Para estratificar o nível de evidência e a força de recomendação, foi utilizada a escala SORT da American Academy of Family Physicians. Resultados: Foram encontrados 153 artigos, tendo sido selecionados 14 artigos: 2 meta-análises, 7 revisões sistemáticas e 5 ensaios clínicos controlados randomizados. Conclusão: Concluiu-se que a citisiniclina apresenta efeitos benéficos na CT, com efeitos secundários ligeiros, pelo que evidência atual permite recomendar a citisiniclina na terapêutica farmacológica da CT (nível de evidência 1, grau de recomendação A).

Abstract Introduction: Smoking results in high morbidity and mortality. Quitting smoking has benefits at any age. The objective of this review is to determine the level of evidence of prescribing cytisine in the pharmacological treatment of smoking cessation (SC). Methodology: On 9 December 2021, a bibliographic search was conducted in data bases of studies published in the last 10 years, in English and Portuguese, using the terms MeSH “cytisine” and “smoking cessation”. To stratify the level of evidence and the strength of recommendation, the SORT scale of the American Academy of Family Physicians was used. Results: We found 153 articles: 14 articles were selected, including 2 meta-analysis, 7 systematic reviews and 5 randomized controlled clinical trials. Conclusion: We conclude that cytisine has beneficial effects on SC, with mild side effects. The current evidence allows recommending cytisine in the pharmacological therapy of SC (level of evidence 1, strength of recommendation A).

RESUMEN Objetivo: Identificar y mapear la evidencia científica existente en el ámbito de las intervenciones no farmacológicas implementadas por enfermeras, con el objetivo de proporcionar el control del dolor a la persona en situación paliativa. Método: Protocolo de scoping review, según la metodología de Instituto Joanna Briggs. En la estrategia de investigación e identificación de estudios, se utilizarán las bases de datos electrónicas CINAHL Complete (vía EBSCOhost), MEDLINE (vía Pubmed), Registro Cochrane Central de Ensayos Controlados, Base de Datos Cochrane de Revisiones Sistemáticas, Scielo, JBI Library of Systematic Reviews. Scopus. A su vez, la búsqueda de estudios inéditos incluirá el Repositorio Científico de Acceso Abierto de Portugal (RCAAP) y OpenGrey. La estrategia de búsqueda incluirá todos los artículos publicados en portugués, español e inglés en los últimos 5 años. Resultados: Los resultados se presentarán en formato narrativo, mediante tablas, de acuerdo con el objetivo, enfoque y pregunta de revisión. El mapeo de las intervenciones no farmacológicas, en el ámbito del control del dolor, contribuirá para la difusión de la evidencia disponible. Conclusión: Se espera que la presente revisión contribuya para el análisis crítico de las intervenciones no farmacológicas en esta área, dado el potencial impacto de estas en el control del dolor y en la cualidad de los cuidados prestados.

RESUMO Objetivo: Identificar e mapear a evidência científica existente no âmbito das intervenções não farmacológicas implementadas por enfermeiros, com o objetivo de proporcionar controlo da dor, da pessoa em situação paliativa. Metodologia: Protocolo de Scoping review com base na metodologia proposta pelo Joanna Briggs Institute. Na pesquisa e identificação dos estudos, serão usadas as bases de dados eletrónicas MEDLINE (via Pubmed), CINAHL Complete (via EBSCOhost), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scielo, JBI Library of Systematic Reviews, Scopus. Adicionalmente, a pesquisa de estudos não publicados incluirá o Repositório Científico de Acesso Aberto de Portugal (RCAAP) e o OpenGrey. A estratégia de pesquisa abrangerá todos os artigos publicados em português, espanhol e inglês, nos últimos 5 anos. Resultados: Os resultados serão apresentados em formato narrativo, recorrendo a tabelas, de acordo com o objetivo, foco e questão de revisão. O mapeamento das intervenções não farmacológicas implementadas por enfermeiros, no âmbito do controlo da dor, irá contribuir para a disseminação da evidência disponível. Conclusão: Espera-se que a presente scoping review contribua para a análise crítica das intervenções não farmacológicas implementadas pelos enfermeiros neste âmbito, dado o potencial impacte destas no controlo da dor e na qualidade dos cuidados prestados.

ABSTRACT Aim: To identify and map the existing scientific evidence within the scope of non-pharmacological interventions implemented by nurses with the objective of providing pain relief to the people in a palliative situation. Method: This study followed the scoping review protocol based on the Joanna Briggs Institute methodology. In regard to the research strategy and identification of studies, the following electronic databases were consulted: MEDLINE (via Pubmed), CINAHL Complete (via EBSCOhost), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scielo, JBI Library of Systematic Reviews, and Scopus. In addition, the search for unpublished studies included the Scientific Repository for Open Access of Portugal (RCAAP) and OpenGrey. The research strategy included all the articles published in Portuguese, Spanish and English in the last 5 years. Results: Following the main objective, focus and research question, the results will be presented in a narrative format, using tables. The mapping of the non-pharmacological interventions implemented by nurses focused on pain relief will contribute to the dissemination of the available evidence. Conclusion: It is expected that the present scoping review will contribute to the critical analysis of non-pharmacological interventions implemented by nurses in this area given the potential impact of these on pain relief and the quality of care provided.

Resumo A pandemia COVID-19 obrigou a uma rápida adaptação dos serviços de saúde para que se pudesse manter a resposta e qualidade dos cuidados. De forma a garantir a acessibilidade dos utentes aos cuidados de saúde primários e minimizar as consequências do distanciamento social, oferecendo alternativas à consulta presencial, a nossa Unidade de Saúde Familiar (USF) criou a linha de apoio ao utente. Os profissionais da USF adquiriram de forma autónoma seis telemóveis e criaram seis linhas diferentes: duas linhas para apoio médico geral, duas linhas para assuntos relacionados com a COVID-19, uma linha de apoio de enfermagem e uma linha de apoio do secretariado clínico. Foi criada uma base de dados para registo de contactos médicos e de enfermagem. Esta base de dados permitiu ainda a referenciação direta a apoio de psicologia. Avaliou-se um período de seis meses (entre 16 de março e 16 de setembro de 2020). Foram registadas 7.535 chamadas: 5.281 nas linhas de apoio médico geral e 230 nas linhas médicas relacionadas com a COVID-19. Foram feitas 51 referenciações para apoio psicológico. As restrições que obrigaram a medidas extraordinárias serão levantadas e esta experiência pode fornecer bases para o futuro, nomeadamente como diversificar a acessibilidade de uma unidade de saúde familiar, salientando a necessidade de investimento nessa área. No contexto atual, a telemedicina tem-se revelado uma alternativa adequada para o atendimento e orientação dos utentes.

Abstract The COVID-19 pandemic forced a quick adaptation of the health services so that the response and quality of care could be maintained. In order to guarantee the accessibility of users to primary health care and minimize the consequences of social distancing, offering alternatives to face-to-face consultation, our family health unit created a support line for the patients. The health professionals of this primary health care facility purchased six mobile phones and created six different helplines: two lines for general medical support, two lines for matters related to COVID-19, a nursing support line, and a support line for clinical secretaries. A database was created to record all telephone contacts. This database also allowed direct referral to psychological support. The record of the clinical secretaries’ line was discontinued. A six-month period was evaluated (between March 16 and September 16, 2020). 7,535 calls were registered: 5,281 to the general medical support lines, 230 to the medical lines related to COVID-19, and 2,024 to the nursing support lines. Fifty-one referrals were made for psychological support. The restrictions that forced extraordinary measures will be lifted one day and this experience may provide some knowledge for the future, regarding how to diversify the accessibility of a primary health care facility and highlight the need for investment in this area. In the current pandemic situation, telemedicine has proven to be an adequate alternative for the care and guidance of users.

Abstract Objective: There is limited scientific evidence on the cetuximab exposure- response relationship and no concentration threshold has been associated with optimal disease control. The aims were to assess, in a real-life setting, the relationship between steady state cetuximab concentrations (Ctrough, SS) and disease control. Method: A prospective observational study in patients with metastatic colorectal cancer or head and neck cancer treated with cetuximab. Steady state trough concentrations were compared with the results of radiological assessment of response (progression or clinical benefit). Generalized estimating equations analysis was performed. To test the association between steady state concentrations and overall survival and progression-free survival, Cox proportional hazard models were developed. An optimal cut-off point was searched using the area under the receiver operating characteristic curve. Results: A total of 30 steady state cetuximab concentrations from 16 patients were analysed. Median Ctrough, SS was 26.86 mg/L and there was marked inter- and intraindividual variability (standard deviation 32.4 mg/L and 16.9 mg/L, respectively). A positive association was found between cetuximab Ctrough, SS and clinical benefit (odds ratio 1.24, 95% confidence interval: 0.95-1.63, . = 0.113), although without reaching statistical significance. The area under the receiver operating characteristic curve (. = 30) had moderate discrimination power (0.71; 95% confidence interval 0.49‑0.93), and the empirical optimal cutoff point was 19.12 mg/L. However, no association was observed between cetuximab Ctrough, SS and survival in metastatic colorectal cancer or neck cancer patients. Conclusions: We cannot confirm a relationship between cetuximab Ctrough, SS and disease control despite a positive association. This study was conducted with a small sample, which reduces the power analysis. Further controlled randomised studies with a sufficient number of patients are needed.

Resumen Objetivo: Evaluar, en condiciones de vida real, la relación entre las concentraciones valle en estado estacionario de cetuximab y el control de la enfermedad, así como buscar la relación entre estas concentraciones y la supervivencia. Además, estudiar si existe una concentración límite que se pueda asociar con la probabilidad de beneficio clínico. Método: Estudio observacional prospectivo llevado a cabo en pacientes con cáncer colorrectal metastásico o cáncer de cabeza y cuello en tratamiento con cetuximab. Se realizó un análisis de regresión de ecuaciones de estimación generalizadas para evaluar la asociación entre la concentración valle en estado estacionario de cetuximab y la respuesta al tratamiento (progresión o beneficio clínico). Mediante modelos de riesgos proporcionales de Cox, se evaluó la asociación entre la mediana de concentraciones valle en estado estacionario de cetuximab en cada paciente o la última medida con la supervivencia global y la supervivencia libre de progresión, en cada una de las patologías. Asimismo, se buscó un punto de corte óptimo a través del área bajo la curva de características operativas del receptor. Resultados: Se analizaron 30 muestras de 16 pacientes. La concentración valle en estado estacionario mediana fue 26,86 mg/l y se encontró una gran variabilidad inter e intraindividual (desviación estándar de 32,4 y 16,9 mg/l, respectivamente). Se observó una asociación positiva entre la concentración valle en estado estacionario y el beneficio clínico (odds ratio 1,24; intervalo de confianza del 95%: 0,95-1,63; p = 0,113), aunque no alcanzó significación estadística debido a la baja potencia. El área bajo la curva de características operativas del receptor de las concentraciones (n = 30) tuvo una moderada capacidad discriminatoria (área bajo la curva de características operativas del receptor 0,710; intervalo de confianza del 95%: 0,49-0,93) y el punto de corte estimado fue de 19,12 mg/l. Sin embargo, no se observó relación entre la supervivencia y las concentraciones valle en estado estacionario en ninguna de las patologías. Conclusiones: No se ha podido confirmar una relación entre exposición a cetuximab y eficacia, a pesar de encontrar una tendencia positiva en el control de la enfermedad con el aumento de la concentración valle en estado estacionario. El nivel de evidencia se vio reducido por la pequeña muestra de pacientes en cada grupo, por lo que se necesitan estudios aleatorizados y controlados, con un número suficiente de pacientes, para evaluar adecuadamente esta relación.

Abstract Overview and Aims: Maternal mortality has significantly decreased in past decades, especially in developed countries, where maternal morbidity became a main topic of research. Admission to an Intensive Care Unit (ICU) is considered an objective marker of severe maternal morbidity (SMM). Better knowledge of these patients is vital to achieve further maternal health improvements. This study aims to review obstetric ICU admissions. Study Design, Population and Methods: Retrospective transversal analysis of all obstetric ICU admissions between 2010 and 2019, in a tertiary care centre. Results: Thirty-eight women required obstetric ICU admission (1,59 for 1000 deliveries, 1,07% of all ICU admissions). Mean maternal age was 32 years, 57,9% were nulliparous, 34,2% were non-caucasian and 21,1% did not live in Portugal. Caesarean section was the main mode of delivery (86,8%), with 52,6% prematurity rate. The majority of ICU admissions were postpartum (97,4%), and median length of ICU stay was 3 days. Major obstetric haemorrhage (MOH) (44,7%) and hypertensive disorders (21,1%) were the most common diagnostics. The main interventions required were blood transfusion (57,9%) and mechanical ventilation (52,9%). No maternal deaths were recorded. Postpartum hysterectomy was performed in 5 patients (29,4% of MOH cases). Conclusions: Maternal morbidity and mortality analysis is vital, regarding maternal health care improvement. Few obstetric patients required ICU admission, with good outcomes. MOH and hypertensive disorders are the main causes for obstetric ICU admission. An increased number of non-caucasian and non-resident women can have some impact on ICU admission trends. Nonetheless, critically ill patients can be successfully managed with a multidisciplinary approach.

Abstract The Council of the European Communities in 1991, through the Directive 91/676/EEC of 12 December 1991, recognized the importance of protecting areas of high susceptibility to water pollution, caused or induced by nitrates (NO3 -) of agricultural origin. One of these areas is the Nitrate Vulnerable Zone (NVZ) of Esposende-Vila do Conde, created in 1997 by Ordinance No. 1037/1997 of October 1, at the date designated as the free aquifer of Esposende and Vila do Conde, included in the list of Vulnerable Zones present in Ordinance 164/2010, of March 16. This article aims to disseminate the results of the monitoring of farms in the NVZ of Esposende-Vila do Conde, in a work carried out over a period of twelve years (three quarters) and based on Geographic Information Systems for the analysis of groundwater pollution caused by nitrates of agricultural origin. Through the use of the geostatistical interpolation technique IDW (Inverse Distance Weighting), and using the data obtained from 1,517 expeditious analyzes to the groundwater of farms and carried out between 2008 and 2019, it was possible to determine a decrease in the surface with high levels of contamination by nitrates (> 100 mg NO3-/ L) which decreased from 1,261 ha in the 2008-2011 quadrennium to 666 ha in the 2016-2019 quadrennium.

Resumo O Conselho das Comunidades Europeias em 1991, através da Diretiva 91/676/CEE de 12 de dezembro de 1991, reconheceu a importância de proteger as áreas de elevada suscetibilidade para a poluição das águas subterrâneas, causada ou induzida por nitratos (NO3 -) de origem agrícola. Uma dessas áreas é a Zona Vulnerável a Nitratos (ZVN) de Esposende -Vila do Conde, criada em 1997 pela Portaria nº 1037/1997 de 1 de outubro, à data designada por Aquífero livre entre Esposende e Vila do Conde e que consta da lista de Zonas Vulneráveis a Nitratos presente na Portaria n.º 164/2010, de 16 de março. Este artigo teve como objetivo difundir os resultados da monitorização das explorações agrícolas inseridas na ZVN de Esposende -Vila do Conde no que respeita à análise da poluição das águas subterrâneas por nitratos, num trabalho realizada ao longo de doze anos (três quadriénios, de 2008 a 2019) e suportada no Sistema de Informação Geográfica. Recorrendo à técnica de interpolação geoestatística IDW (Inverse Distance Weighting), e com base em resultados de 1.517 análises expeditas de água subterrânea realizadas entre 2008 e 2019, foi possível determinar uma diminuição da superfície com elevados níveis de contaminação por nitratos (> 100 mg NO3 -/ L) que diminuiu de 1.261 ha no quadriénio de 2008-2011 para 666 ha no quadriénio de 2016-2019.

BACKGROUND Mycolicibacterium fortuitum is an opportunistic pathogen associated with human and animal infection worldwide. Studies concerning this species are mainly represented by case reports, some of them addressing drug susceptibility with a focus on a specific geographic region, so there is a gap in relation to the global epidemiological scenario. OBJECTIVES We aimed determine the global epidemiological scenario of M. fortuitum and analyse its traits associated with pathogenicity. METHODS Based on publicly available genomes of M. fortuitum and a genome from Brazil (this study), we performed a genomic epidemiology analysis and in silico and in vitro characterisation of the resistome and virulome of this species. FINDINGS Three main clusters were defined, one including isolates from the environment, human and animal infections recovered over nearly a century. An apparent intrinsic resistome comprises mechanisms associated with macrolides, beta-lactams, aminoglycosides and antitubercular drugs such as rifampin. Besides, the virulome presented Type VII secretion systems (T7SS), including ESX-1, ESX-3, ESX-4 and ESX-4-bis, some of which play a role on the virulence of Mycobacteriaceae species. MAIN CONCLUSIONS Here, M. fortuitum was revealed as a reservoir of an expressive intrinsic resistome, as well as a virulome that may contribute to its success as a global opportunist pathogen.