Resumo A escoliose idiopática do adolescente (EIA) é considerada a deformidade vertebral de maior gravidade e ocorrência, que acomete crianças e adolescentes ainda na fase de desenvolvimento neuropsicomotor, antes de atingirem a maturidade esquelética. Este estudo teve como objetivo avaliar a abordagem cirúrgica da EIA, considerando resultados associados à redução de curvatura patológica, função pulmonar e repercussões na qualidade de vida dos adolescentes submetidos a tal tratamento. Revisão Sistemática de literatura, com abordagem quanti-qualitativa dos dados coletados, cuja estruturação se deu conforme as orientações de Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) realizada nas bases de dados vinculadas à Medical Literature Analysis and Retrieval System Online (MEDLINE) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). A amostra total dos estudos foi de 638 adolescentes com EIA, com uma idade média de 14,93 anos ± 1,24. A correção média da curvatura patológica principal nos estudos foi de 55,06% ± 12,24. Em todos os estudos selecionados com fusão espinhal posterior para correção da EIA verificou-se redução significativa das curvaturas patológicas (> 49%), sendo que a reincidência de curvatura em nenhum dos estudos superou um ganho patológico superior a 5%. Quanto à função pulmonar, os estudos apontaram ganhos significativos de volume expiratório forçado em 1 segundo (VEF1) e capacidade vital forçada (CVF) em pacientes com EIA grave. Além disso, não foram relatados prejuízos de função pulmonar após intervenção cirúrgica para correção da EIA. (EIA ocorrência neuropsicomotor esquelética tratamento literatura quantiqualitativa quanti qualitativa coletados MetaAnalyses Meta Analyses PRISMA (PRISMA MEDLINE (MEDLINE LatinoAmericana Latino Americana LILACS. LILACS . (LILACS) 63 1493 14 93 14,9 124 24 1,24 5506 55 06 55,06 1224 12 12,24 verificouse verificou > ( 49%, 49 49% , 49%) 5 5% VEF1 VEF (VEF1 CVF (CVF grave disso (LILACS 6 149 9 14, 2 1,2 550 0 55,0 122 12,2 4 (VEF 1, 55, 12,

Abstract Adolescent idiopathic scoliosis is considered the most severe and common spinal deformity, affecting children and adolescents still in the neuropsychomotor development phase before they reach skeletal maturity. This study aimed to evaluate the surgical approach to adolescent idiopathic scoliosis (AIS), considering the results associated with the reduction of pathological curvature, pulmonary function, and repercussions on the quality of life of adolescents undergoing such treatment. Systematic literature review, with a quantitative and qualitative approach to the data collected, structured according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), carried out in the databases linked to the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Latin American and Caribbean Health Sciences Literature (LILACS). The total sample of the studies was 638 adolescents with AIS, with a mean age of 14.93 years ± 1.24. The mean correction of the main pathological curvature in the studies was 55.06% ± 12.24. In all of the selected studies using posterior spinal fusion to correct AIS, there was a significant reduction in pathological curvatures (> 49%), and the recurrence of curvature in none of the studies exceeded a pathological gain of more than 5%. As for lung function, the studies showed significant increases in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in patients with severe AIS, and no pulmonary function losses were reported after surgery to correct AIS. deformity maturity AIS , (AIS) treatment review collected MetaAnalyses Meta Analyses PRISMA, PRISMA (PRISMA) MEDLINE (MEDLINE LILACS. LILACS . (LILACS) 63 1493 14 93 14.9 124 24 1.24 5506 55 06 55.06 1224 12 12.24 > ( 49%, 49 49% 49%) 5 5% FEV1 FEV (FEV1 FVC (FVC (AIS (PRISMA (LILACS 6 149 9 14. 2 1.2 550 0 55.0 122 12.2 4 (FEV 1. 55. 12.

ABSTRACT Objective: To analyze the spatiotemporal epidemiological dynamics of meningitis in Brazil, between 2010 and 2019. Methods: Descriptive ecological study with cases and deaths due to meningitis in Brazil (2010-2019) in the National Notifiable Diseases Information System (Sistema de Informações de Agravos de Notificação – SINAN). The following analyses were performed: (I) frequency analyses of cases and deaths, prevalence rates, mortality, lethality, Fisher's exact test, and chi-square test; (II) Prais-Winstein regression; and (III) Global, Local Moran's index, and Kernel density. Results: 182,126 cases of meningitis were reported in Brazil, of which 16,866 (9.26%) resulted in death, with prevalence rates of 9.03/100,000 inhabitants, mortality of 0.84/100,000 inhabitants, and lethality of 9.26%. There was a noted trend of decreasing prevalence rates (−9.5%, 95% confidence interval — 95%CI −13.92; −4.96, p<0.01) and mortality (−11.74%, 95%CI −13.92; −9.48, p<0.01), while lethality remained stable (−2.08%, 95%CI −4.9; 0.8; p<0.1941). The majority of cases were viral meningitis (45.7%), among 1-9 years old (32.2%), while the highest proportion of deaths was due to bacterial meningitis (68%), among 40-59 years old (26.3%). In the Moran and Kernel maps of prevalence and mortality rates, municipalities in the South, Southeast, and the capital of Pernambuco in the Northeast stood out with high rates; as for lethality, the North, Northeast, and Southeast coastal areas were highlighted. Conclusion: A decrease in meningitis cases and deaths was found in this study; however, the lethality rate was higher in areas with lower prevalence, emphasizing the need to enhance actions for identifying, monitoring, and providing health care for cases, as well as expanding vaccination coverage.

RESUMO Objetivo: Analisar a dinâmica epidemiológica espaçotemporal das meningites no Brasil, entre os anos de 2010 e 2019. Métodos: Estudo ecológico descritivo com os casos e óbitos por meningites no Brasil (2010–2019) no Sistema de Informações de Agravos de Notificação. Realizaram-se (I) análises de frequências dos casos e óbitos, taxas de prevalência, mortalidade, letalidade, testes de exato de Fisher e qui-quadrado; (II) regressão de Prais-Winsten; e (III) índice de Moran global, local e densidade de Kernel. Resultados: Notificaram-se 182.126 casos de meningites no Brasil, dos quais 16.866 (9,26%) evoluíram para óbito, com taxas de prevalência de 9,03/100.000/habitantes, mortalidade de 0,84/100.000/habitantes e letalidade de 9,26%. Destaca-se a tendência de decrescimento das taxas de prevalência (−9,5%, intervalo de confiança de 95% — IC95% −13,92; −4,96, p<0,01) e mortalidade (−11,74%, IC95% −13,92; −9,48, p<01,01), enquanto a letalidade se manteve estacionária (−2,08%, IC95% −4,9; 0,8; p<0,1941). A maioria dos casos foi de meningites virais (45,7%), entre 1 e 9 anos (32,2%), enquanto a maior parcela dos óbitos foi por meningites bacterianas (68%), entre 40 e 59 anos (26,3%). Nos mapas de Moran e Kernel das taxas de prevalência e mortalidade, destacaram-se com altas taxas os municípios do sul, sudeste e a capital de Pernambuco, no nordeste; já na letalidade, evidenciaram-se o norte, o nordeste e o litoral do sudeste. Conclusão: Encontrou-se decréscimo dos casos e óbitos por meningites neste estudo, entretanto a taxa de letalidade foi maior em áreas com menor prevalência, reforçando a necessidade do aprimoramento das ações de identificação, vigilância e assistência em saúde dos casos, bem como da ampliação da cobertura vacinal.

RESUMO Objetivo: Analisar a dinâmica epidemiológica espaçotemporal das meningites no Brasil, entre os anos de 2010 e 2019. Métodos: Estudo ecológico descritivo com os casos e óbitos por meningites no Brasil (2010–2019) no Sistema de Informações de Agravos de Notificação. Realizaram-se (I) análises de frequências dos casos e óbitos, taxas de prevalência, mortalidade, letalidade, testes de exato de Fisher e qui-quadrado; (II) regressão de Prais-Winsten; e (III) índice de Moran global, local e densidade de Kernel. Resultados: Notificaram-se 182.126 casos de meningites no Brasil, dos quais 16.866 (9,26%) evoluíram para óbito, com taxas de prevalência de 9,03/100.000/habitantes, mortalidade de 0,84/100.000/habitantes e letalidade de 9,26%. Destaca-se a tendência de decrescimento das taxas de prevalência (−9,5%, intervalo de confiança de 95% — IC95% −13,92; −4,96, p<0,01) e mortalidade (−11,74%, IC95% −13,92; −9,48, p<01,01), enquanto a letalidade se manteve estacionária (−2,08%, IC95% −4,9; 0,8; p<0,1941). A maioria dos casos foi de meningites virais (45,7%), entre 1 e 9 anos (32,2%), enquanto a maior parcela dos óbitos foi por meningites bacterianas (68%), entre 40 e 59 anos (26,3%). Nos mapas de Moran e Kernel das taxas de prevalência e mortalidade, destacaram-se com altas taxas os municípios do sul, sudeste e a capital de Pernambuco, no nordeste; já na letalidade, evidenciaram-se o norte, o nordeste e o litoral do sudeste. Conclusão: Encontrou-se decréscimo dos casos e óbitos por meningites neste estudo, entretanto a taxa de letalidade foi maior em áreas com menor prevalência, reforçando a necessidade do aprimoramento das ações de identificação, vigilância e assistência em saúde dos casos, bem como da ampliação da cobertura vacinal. Objetivo 201 2019 Métodos 2010–2019 20102019 (2010–2019 Notificação Realizaramse Realizaram I (I quiquadrado qui quadrado qui-quadrado II (II PraisWinsten Prais Winsten Prais-Winsten III (III global Resultados Notificaramse Notificaram 182126 182 126 182.12 16866 16 866 16.86 9,26% 926 26 (9,26% óbito 903100000habitantes habitantes 03 100 000 9,03/100.000/habitantes 084100000habitantes 0 84 Destacase Destaca −9,5%, 95 5 (−9,5% IC95 IC −13,92 1392 13 92 496 4 96 −4,96 p<0,01 p001 p 01 −11,74%, 1174 11 74 (−11,74% 948 48 −9,48 p<01,01, p0101 p<01,01 , p<01,01) −2,08%, 208 2 08 (−2,08% −4,9 49 0,8 8 p<0,1941. p01941 p<0,1941 . 1941 p<0,1941) 45,7%, 457 45,7% 45 7 (45,7%) 32,2%, 322 32,2% 32 (32,2%) 68%, 68 68% (68%) 26,3%. 263 26,3% 3 (26,3%) destacaramse destacaram sul Pernambuco evidenciaramse evidenciaram norte Conclusão Encontrouse Encontrou estudo identificação vacinal 20 2010–201 2010201 (2010–201 18212 18 12 182.1 1686 86 16.8 9,26 (9,26 10 00 −9,5% (−9,5 IC9 −13,9 139 p<0,0 p00 −11,74% 117 (−11,74 94 −9,4 p010 p<01,0 −2,08% (−2,08 −4, 0, p0194 p<0,194 194 45,7 (45,7% 32,2 (32,2% 6 (68% 26,3 (26,3% 2010–20 201020 (2010–20 1821 182. 168 16. 9,2 (9,2 −9,5 (−9, −13, p<0, p0 −11,74 (−11,7 −9, p01 p<01, −2,08 (−2,0 −4 p019 p<0,19 19 45, (45,7 32, (32,2 (68 26, (26,3 2010–2 20102 (2010–2 9, (9, (−9 −13 p<0 −11,7 (−11, −9 p<01 −2,0 (−2, − p<0,1 (45, (32, (6 (26, 2010– (2010– (9 (− −1 p< −11, (−11 −2, (−2 (45 (32 ( (26 (2010 −11 (−1 −2 (4 (3 (2 (201 (20

ABSTRACT Objective: To analyze the spatiotemporal epidemiological dynamics of meningitis in Brazil, between 2010 and 2019. Methods: Descriptive ecological study with cases and deaths due to meningitis in Brazil (2010-2019) in the National Notifiable Diseases Information System (Sistema de Informações de Agravos de Notificação – SINAN). The following analyses were performed: (I) frequency analyses of cases and deaths, prevalence rates, mortality, lethality, Fisher's exact test, and chi-square test; (II) Prais-Winstein regression; and (III) Global, Local Moran's index, and Kernel density. Results: 182,126 cases of meningitis were reported in Brazil, of which 16,866 (9.26%) resulted in death, with prevalence rates of 9.03/100,000 inhabitants, mortality of 0.84/100,000 inhabitants, and lethality of 9.26%. There was a noted trend of decreasing prevalence rates (−9.5%, 95% confidence interval — 95%CI −13.92; −4.96, p<0.01) and mortality (−11.74%, 95%CI −13.92; −9.48, p<0.01), while lethality remained stable (−2.08%, 95%CI −4.9; 0.8; p<0.1941). The majority of cases were viral meningitis (45.7%), among 1-9 years old (32.2%), while the highest proportion of deaths was due to bacterial meningitis (68%), among 40-59 years old (26.3%). In the Moran and Kernel maps of prevalence and mortality rates, municipalities in the South, Southeast, and the capital of Pernambuco in the Northeast stood out with high rates; as for lethality, the North, Northeast, and Southeast coastal areas were highlighted. Conclusion: A decrease in meningitis cases and deaths was found in this study; however, the lethality rate was higher in areas with lower prevalence, emphasizing the need to enhance actions for identifying, monitoring, and providing health care for cases, as well as expanding vaccination coverage. Objective 201 2019 Methods 20102019 (2010-2019 Sistema SINAN. SINAN . SINAN) performed I (I Fishers Fisher s test chisquare chi square II (II PraisWinstein Prais Winstein regression III (III Global Morans index density Results 182126 182 126 182,12 16866 16 866 16,86 9.26% 926 9 26 (9.26% death 903100000 03 100 000 9.03/100,00 inhabitants 084100000 0 84 0.84/100,00 −9.5%, 95 5 (−9.5% 95CI CI −13.92 1392 13 92 496 4 96 −4.96 p<0.01 p001 p 01 −11.74%, 1174 11 74 (−11.74% 948 48 −9.48 p<0.01, , −2.08%, 208 2 08 (−2.08% −4.9 49 0.8 8 p<0.1941. p01941 p<0.1941 1941 p<0.1941) 45.7%, 457 45.7% 45 7 (45.7%) 19 1 1- 32.2%, 322 32.2% 32 (32.2%) 68%, 68 68% (68%) 4059 40 59 40-5 26.3%. 263 26.3% 3 (26.3%) South North highlighted Conclusion however identifying monitoring coverage 20 2010201 (2010-201 18212 18 12 182,1 1686 86 16,8 9.26 (9.26 90310000 10 00 9.03/100,0 08410000 0.84/100,0 −9.5% (−9.5 −13.9 139 p<0.0 p00 −11.74% 117 (−11.74 94 −9.4 −2.08% (−2.08 −4. 0. p0194 p<0.194 194 45.7 (45.7% 32.2 (32.2% 6 (68% 405 40- 26.3 (26.3% 201020 (2010-20 1821 182, 168 16, 9.2 (9.2 9031000 9.03/100, 0841000 0.84/100, −9.5 (−9. −13. p<0. p0 −11.74 (−11.7 −9. −2.08 (−2.0 −4 p019 p<0.19 45. (45.7 32. (32.2 (68 26. (26.3 20102 (2010-2 9. (9. 903100 9.03/100 084100 0.84/100 (−9 −13 p<0 −11.7 (−11. −9 −2.0 (−2. − p01 p<0.1 (45. (32. (6 (26. (2010- (9 90310 9.03/10 08410 0.84/10 (− −1 p< −11. (−11 −2. (−2 (45 (32 ( (26 (2010 9031 9.03/1 0841 0.84/1 −11 (−1 −2 (4 (3 (2 (201 903 9.03/ 084 0.84/ (20 90 9.03 0.84 9.0

ABSTRACT School dropout has significant consequences for individuals and society, including increased crime, reduced productivity, and limited economic innovation. Identifying students at risk of dropping out is crucial. This paper aims to develop a logistic regression-based tool for predicting dropout in the state’s public schools of Espírito Santo, Brazil. We utilized students’ information, such as grades, school attendance, socioeconomic data, and others, provided by Espírito Santo State Education Secretariat and the National Institute of Educational Studies and Research Anísio Teixeira. Various regularization methods were employed. We compared three model specifications for students in the first year of high school in Espírito Santo using data from 2019 to 2022. The results indicated that the models could identify at-risk students satisfactorily, highlighting the effective use of available data by educational departments to identify potential dropouts. This tool can aid educators in creating targeted interventions to minimize dropout rates. society crime productivity innovation crucial regressionbased regression based states state s Brazil information grades attendance others Teixeira employed 201 2022 atrisk satisfactorily dropouts rates 20 202 2

Introduction: Burnout syndrome in the professional context is a condition caused by long-term stress in the workplace. In the face of the COVID-19 pandemic it has been observed that healthcare workers have experienced psychological health issues. Objective: This study aims to analyze different professional categories and sectors, identifying the main risk factors and coping mechanisms adopted by healthcare professionals associated with Burnout syndrome. Method: A literature search was conducted, and an electronic form was administered to healthcare professionals who provided direct medical care to COVID-19 diagnosed and hospitalized patients in the city of Curitiba, Brazil, from March 2020 to November 2021. The questionnaire included personal and professional information, as well as specific conditions experienced during the pandemic, coping strategies, and the application of the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) to assess the prevalence of Burnout syndrome. Results: The sample consisted of 89 healthcare professionals, and a prevalence of 48.31% for Burnout syndrome was identified. No statistically significant results were found when analyzing different professional categories and sectors. However, changing sectors during the pandemic was statistically significant (p=0.0245), as well as seeking emotional/psychiatric/psychological support (p=0.0004), and the importance of using mediation during the pandemic (p=0.0027). Conclusions: Changing sectors during the pandemic was identified as the only risk factor in this study. The main coping mechanisms adopted by healthcare professionals during the COVID-19 pandemic to address Burnout syndrome included seeking emotional, psychological, and psychiatric support, as well as an increased use of psychotropic medication.

Introdução: A síndrome de Burnout no ambiente profissional é uma condição causada por estresse de longo prazo no local de trabalho e que diante da pandemia causada pela COVID-19, foram evidenciados agravos à saúde psíquica do trabalhador da saúde. Objetivo: Analisar as diferentes categorias e setores de atuação profissional, elencando os principais fatores de risco e as principais formas de enfrentamento adotadas pelos profissionais de saúde associados à síndrome de Burnout. Método: Foi realizada busca bibliográfica e aplicação de formulário eletrônico, aos profissionais de saúde que prestaram assistência médica direta a pacientes internados e hospitalizados com COVID-19 no município de CuritibaPR entre o período de março de 2020 a novembro de 2021; contendo comandos com informações pessoais,profissionais e relacionados com as condições específicas vivenciadas durante a pandemia/ medidas de enfrentamento e aplicação do teste Maslach Burnout Inventory – Human Services Survey (MBI-HSS) para análise da prevalência do Síndrome de Burnout. Resultados: A amostra foi composta por 89 profissionais de saúde. Evidenciou-se uma prevalência de 48,31% de Síndrome de Burnout. Não foram encontrados resultados estatisticamente ao analisar diferentes categorias profissionais e setores de atuação. A mudança de setor durante a pandemia foi estatisticamente significativa (p=0,0245), assim como a busca por apoio emocional/psiquiátrico/psicológico (p=0,0004) e seguro acerca do uso de mediação durante a pandemia (p= 0,0027). Conclusões:A mudança de setor durante uma pandemia foi considerada o único fator de risco encontrado no estudo. As principais formas de enfrentamento ao Síndrome de Burnout adotadas pelos profissionais de saúde durante a pandemia de COVID-19 foram a busca por apoio emocional, psicológico, psiquiátrico e aumento do uso de medicação psicotrópica

Abstract Inborn errors of metabolism are rare disorders with few therapeutic options for their treatments, which can make patients suffer with complications. Therefore, compounded drugs might be a promising option given that they have the ability of meeting the patient’s specific needs, (i) identification of the main drugs described in the literature; (ii) proposal of compounding systems and (iii) calculation of the budgetary addition for the inclusion of these drugs into the Brazilian Unified Health System. The research conducted a literature review and used management data as well as data obtained from official Federal District government websites. The study identified 31 drugs for the treatment of inborn errors of metabolism. Fifty eight percent (58%) (18) of the medicines had their current demand identified, which are currently unmet by the local Health System. The estimated budget for the production of compounded drugs was of R$363,16.98 per year for approximately 300 patients. This estimated cost represents a budgetary addition of only 0.17% from the total of expenditures planned for drug acquirement. There is a therapeutic gap for inborn errors of metabolism and compounding pharmacies show potential in ensuring access to medicine therapy with a low-cost investment. treatments complications Therefore patient s needs i (i ii (ii iii (iii System websites 3 58% 58 (58% 18 (18 R3631698 R 363 16 98 R$363,16.9 30 017 0 17 0.17 acquirement lowcost low investment 5 (58 1 (1 R363169 36 9 R$363,16. 01 0.1 (5 ( R36316 R$363,16 0. R3631 R$363,1 R363 R$363, R36 R$363 R3 R$36 R$3 R$

Abstract Pitaya is a rich source of bioactive compounds, such as polyphenols and betalains. Moreover, these compounds has been associated with reduced risk of type 2 diabetes mellitus. The aim of this study is to evaluate the effect of this fruit on glycemia and oxidative stress in aloxan-induced diabetic mice. Thus, considering that In the in vivo assays, the mice were divided into 5 groups (n = 6): (a) healthy group treated with water; (b) diabetic mice treated with metformin at 200 mg/kg body weight diluted in water; (c) untreated diabetic mice; (d) diabetic mice treated with pitaya at 200 mg/kg and (e) diabetic mice treated with pitaya at 400 mg/kg of body weight diluted in water. The results shows that pitaya was able significantly to reduce blood glucose (p < 0.05) (200 mg/kg); significantly reduce cholesterol (200 and 400 mg/kg) and significantly increase HDL-c (400 mg/kg) levels. In the oxidative stress experiment, Malondialdehyde levels in the liver were significantly reduced (p < 0.05) in the groups treated with pitaya, when compared to the other groups, suggesting lower lipid peroxidation. The consumption of pitaya reduced the blood glucose and cholesterol and increase the HDL, in addition, the lipid peroxidation - which is common in diabetic patients, was reduced. betalains Moreover mellitus aloxaninduced aloxan induced Thus assays n 6 6) (a water b (b 20 mgkg mg kg c (c d (d e (e 40 p 0.05 005 0 05 (20 HDLc HDL (40 experiment addition patients 4 0.0 00 (2 (4 0. (

Resumo Objetivos: analisar uma década do comportamento espaço-temporal da coqueluche no Brasil e as suas características epidemiológicas. Métodos: estudo ecológico de série temporal dos casos e óbitos por coqueluche do Sistema de Informação de Agravos de Notificação no Brasil (2010-2019). Utilizou-se o método de análise linear generalizada de Prais-Winsten e a análise de Kernel. Resultados: notificaram-se 32.849 casos, desses 466 (1,42%) evoluíram para óbito, com prevalência de 1,63/100.000 habitantes e coeficiente de mortalidade de 0,023/100.000 habitantes. Na análise temporal, evidenciou-se o comportamento cíclico da coqueluche com variações de tendência no período em 2014. A maioria dos casos ocorreu em menores de 1 ano (60,16%, p<0,01), sexo feminino (55,28%, p=0,066) e brancos (48,42%, p=0,14). A maior parcela dos óbitos foi em crianças <1 ano (98,07, p<0,01), sexo feminino (56,01%, p=0,066) e brancos (43,78%, p=0,14). No Kernel da prevalência, destacaram-se as regiões Sul, Sudeste e Nordeste com alta densidade; enquanto para mortalidade, sobressaíram-se Sudeste e Nordeste. Conclusão: observou-se o comportamento cíclico da coqueluche, com tendência de decréscimo nos últimos anos e a concentração de casos no público infantil. O que reforça a importância de fortalecer o processo de imunização da população.

Abstract Objectives: to analyze a decade of spatio-temporal behavior of pertussis in Brazil and its epidemiological characteristics. Methods: ecological time series study of pertussis cases and deaths from the Notifable Diseases Information System in Brazil (2010-2019). The method of generalized linear analysis of Prais-Winsten and the Kernel analysis were used. Results: 32,849 cases were reported, of which 466 (1.42%) evolved to death, with a prevalence of 1.63/100,000 inhabitants and a mortality rate of 0.023/100,000 inhabitants. In the temporal analysis, the cyclical behavior of pertussis was evidenced, with trend variations in the period in 2014. Most cases occurred in children under 1 year of age (60.16%, p<0.01), sex female (55.28%, p=0.066) and white (48.42%, p=0.14). The largest share of deaths was in children aged <1 year (98.07, p<0.01), females (56.01%, p=0.066) and whites (43.78%, p=0.14). In the Kernel of prevalence, the South, Southeast and Northeast regions stood out with high density; while for mortality, the Southeast and Northeast stood out. Conclusions: the cyclical behavior of pertussis was observed, with a decreasing trend in recent years and the concentration of cases in children. This reinforces the importance of strengthening the population’s immunization process.

Resumo Introdução O carcinoma epidermoide de laringe é o segundo mais prevalente entre os tumores de cabeça e pescoço e o tratamento dos pacientes com doença em estádio I ou II pode ser feito com cirurgia ou radioterapia. Estudos populacionais nacionais que descrevem os resultados terapêuticos e compararam essas modalidades são poucos frequentes, mas podem ser muito importantes para orientar diretrizes de tratamento. Objetivo Avaliar os resultados de sobrevida dos pacientes com carcinoma epidermoide de laringe em estádios clínicos I ou II de acordo com as principais modalidades terapêuticas usadas. Método Estudo transversal de base populacional com a base de dados da Fundação Oncocentro de São Paulo de janeiro de 2000 a março de 2019. Os critérios de inclusão foram pacientes com carcinoma epidermoide de laringe em estádios clínicos cT1-2N0. Para compensar pela alocação não randômica dos pacientes e pelo desequilíbrio entre variáveis confundidoras entre os grupos, usamos a metodologia do escore de propensão. Resultados Preencheram os critérios de inclusão 3.786 pacientes. Em relação ao estádio cT, houve 2.171 pacientes (57,3%) com tumores cT1. Os pacientes do sistema único de saúde (SUS) apresentaram um maior tempo entre o diagnóstico e o tratamento (p < 0,001). A análise por escore de propensão mostrou que os pacientes submetidos a cirurgia apresentaram uma tendência de melhor sobrevida doença específica (p = 0,012). Comparando-se radioterapia isolada versus combinação com radioquimioterapia, o tratamento isolado demonstrou tendência a melhor taxa de sobrevida (p< 0,001). Conclusão A análise por escore de propensão identificou melhores resultados de sobrevida doença específica em pacientes com carcinoma epidermoide de laringe estádios clínicos I e II tratados por cirurgia quando comparados a radioterapia.

Abstract Introduction Laryngeal squamous cell carcinoma is the second most prevalent malignancy among head and neck tumors, and the treatment of patients with stage I or II disease can be performed with surgery or radiation therapy. National population studies describing therapeutic results comparing these modalities are unusual, but they can be very important to direct treatment guidelines. Objective To evaluate the survival results of patients with laryngeal squamous cell carcinoma at clinical stages I or II, according to the main therapeutic modalities used. Methods Cross-sectional, population-based study using the database of Fundação Oncocentro de São Paulo from January 2000 to March 2019. Inclusion criteria were patients with laryngeal squamous cell carcinoma in clinical stages cT1-2N0. To compensate for the non-random allocation of patients and the imbalance between confounding variables between groups, we used the propensity score methodology. Results A total of 3786 patients met the inclusion criteria. Regarding the cT stage, there were 2171 patients (57.3%) with cT1 tumors. Patients in the public health system had a longer time between diagnosis and treatment (p< 0.001). The analysis by propensity score showed that patients treated with surgery had a tendency towards better disease-specific survival (p = 0.012). Comparing radiotherapy alone versus its combination with radiochemotherapy, radiotherapy alone showed a tendency towards a better survival rate (p< 0.001). Conclusion Analysis by propensity score identified better results for disease-specific survival in patients with laryngeal squamous cell carcinoma at clinical stages I and II treated by surgery when compared to radiotherapy.

Resumo Neste presente estudo, objetivou-se avaliar as alterações induzidas pela infecção natural de Schistosoma mansoni nas concentrações de glicose do sangue periférico de roedores Holochilus sciureus, reservatório silvestre do parasito. A dosagem da concentração de glicose foi realizada no plasma de amostras de sangue por meio de teste enzimático colorimétrico. Parâmetros biológicos e carga parasitária de S. mansoni também foram verificados em cada roedor e correlacionados com as concentrações de glicose. Um total de 76 H. sciureus foram capturados, dentre os quais 20 (26%) estavam infectados por S. mansoni (n=13 machos e n=7 fêmeas). Apesar da carga parasitária ter sido semelhante entre os sexos, as concentrações de glicose no sangue foram menores em machos naturalmente infectados e quase inalteradas em fêmeas. Além disso, os dados histopatológicos mostraram uma maior reação inflamatória granulomatosa hepática em roedores machos, quando comparados com as fêmeas. Adicionalmente, também foi confirmado que o peso e o comprimento total dos animas analisados não interferiram nos valores de glicose. Portanto, a infecção natural por S. mansoni em H. sciureus pode induzir menos impacto na homeostase glicêmica em fêmeas, o que pode ajudar a melhor entender o papel desses roedores como reservatórios de S. mansoni.

Abstract The present study aimed to evaluate the changes in peripheral blood glucose concentrations induced by Schistosoma mansoni infection in Holochilus sciureus rodents, a wild reservoir of the parasite. Glucose concentration was measured in the plasma of blood samples using a colorimetric enzymatic test. Biological parameters and S. mansoni burden in each rodent were also verified and correlated with glucose concentrations. A total of 76 H. sciureus were captured, out of which 20 (26%) were infected with S. mansoni (n=13 males and n=7 females). Although the parasite burden was comparable between the sexes, blood glucose concentration was lower in infected males and almost unchanged in females. Furthermore, histopathological data revealed that male rodents had a greater hepatic granulomatous inflammatory reaction than females. In addition, we also confirmed that the weight and total length of the analyzed animals had no effect on glucose levels. Therefore, natural infection with S. mansoni in H. sciureus may have a lower impact on glycemic homeostasis in females, which will help us understand the role of these rodents as reservoirs of S. mansoni.

Abstract Introduction Postoperative neck hematoma (PNH) is an uncommon but potentially-lethal complication of thyroid surgery. Objective To identify the risk factors for postthyroidectomy hematoma requiring reoperation, the timing, the source of the bleeding, the related respiratory distress requiring tracheotomy, and the late outcomes. Methods We retrospectively analyzed the records of 5,900 consecutive patients submitted to surgery for thyroid diseases at a single institution. Results In total, PNH occurred in 62 (1.1%) patients. Most cases of bleeding occurred within the first 6 hours after thyroidectomy, but 12.5% of the hematomas were observed after 24 hours. Obvious bleeding points were detected in 58.1% of the patients during the reoperation, with inferior thyroid artery branches and superior thyroid vessels being the most frequent bleeding sources. Only two patients required urgent tracheostomy. There were no hematoma-related deaths. Permanent hypoparathyroidism and recurrent laryngeal nerve injury are more frequent following reoperation for PNH. The factors significantly associated with PNH were: older age, concurrent lymph node dissection, and chronic lymphocytic thyroiditis. Gender, previous neck irradiation, presentation at diagnosis (symptomatic or incidental), substernal goiter, thyroidectomy for hyperthyroidism, prior thyroid surgery, malignant histology, the extent of the surgery (total versus non-total thyroidectomy), the use of energy-based vessel sealing devices, the use of the hemostatic agent Surgicel, and the placement of a surgical drain were not significantly associated with PNH. Conclusion Hematoma after thyroid surgery is an uncommon complication, but it is related to significant postoperative morbidity. A better understanding of the risk factors and of the time until hematoma formation can help target high-risk patients for preventive measures and closer postoperative observation.

ABSTRACT Background: The aim of this study was to address the first cases of TOETVA done in Brazil, by TOETVA-Bra study group, regarding safety and complications. Materials and Methods: Series of the first 93 TOETVAs cases in Brazil. All authors except LPK, AJG JOR and RPT received TOETVA training including cadaveric hands-on in Thailand or United States (Johns Hopkins Medicine) during 2017. After they came back to Brazil and started doing their first TOETVA cases in the cities of Rio de Janeiro, Sao Paulo and Chapecó they agreed to collaborate and gather data using an online spreadsheet. All patients were submitted to the technique described by Anuwong. Results: A total of 93 patients underwent TOETVA. Most patients (58.1%) were submitted to total thyroidectomy and 59.1% had benign disease. Two patients (2.2%) needed conversion to open surgery. Five patients (9.3%) developed transient hypoparathyroidism and there were 3 (2.0%) temporary recurrent laryngeal nerve palsy. There was one (0.7%) permanent unilateral palsy. Twenty patients had some sort of complication, 16.1% were minor and 5.4% were major. A total of 73 patients (78.5%) had an uneventful recovery. Conclusion: The technique is reproducible with a low complication rate. While further studies are needed to confirm equivalency, early efforts suggest that TOETVA is not inferior to traditional open thyroidectomy in appropriately selected patients.

Resumo Mesmo no período em que a pandemia de Covid-19 encontrava-se em crescimento no Nordeste do Brasil, iniciou-se a adoção de medidas de flexibilização do distanciamento social. O objetivo do estudo é o de avaliar a pertinência das propostas de flexibilização, tomando-se em conta a situação da pandemia em cada local e o momento em que foram adotadas. Tendo como referência as diretrizes da OMS, foram construídos e analisados indicadores operacionais para cada diretriz, no contexto da região Nordeste. Para análise do comportamento da epidemia, conforme indicadores selecionados, foram usadas técnicas de Joinpoint Trend Analysis, mapas de calor, razão de taxas e comparação da tendência temporal entre capitais e interior dos estados. O pico do crescimento semanal ocorreu em maio-julho/2020 (semanas epidemiológicas 19 a 31). Na maioria das capitais não se observou tendência decrescente simultânea do número de casos e óbitos nos 14 dias prévios à flexibilização. Em todos os estados o quantitativo de testes realizados foi insuficiente. Na semana epidemiológica 24 os percentuais estaduais de ocupação de leitos de UTI/Covid-19 foram próximos ou superiores 70%. A situação epidemiológica das nove capitais dos estados do Nordeste, no momento em que a decisão de flexibilização foi tomada, mostra que nenhuma delas atendia aos critérios e parâmetros recomendados pela OMS.

Abstract Even in the period when the Covid-19 pandemic was on the rise in the Northeast of Brazil, the relaxation of social distancing measures was introduced. The scope of the study is to assess, in the light of the epidemiological-sanitary situation in the region, the suitability of relaxation of social distancing measures. Based on the WHO guidelines for relaxation of social distancing, operational indicators were created and analyzed for each guideline in the context of the Northeast. To analyze the behavior of the epidemic, according to selected indicators, Joinpoint trend analysis techniques, heat maps, rate ratios and time trends between capitals and the state interior were compared. The weekly growth peak of the epidemic occurred in May-July 2020 (epidemiological weeks 19 to 31). In most capitals, there was no simultaneous downward trend in the number of cases and deaths in the 14 days prior to flexibilization. In all states the number of tests performed was insufficient. In epidemiological week 24, the state percentages of ICU/Covid-19 bed occupancy were close to or above 70%. The epidemiological situation of the nine Northeastern state capitals analyzed here did not meet criteria and parameters recommended by the World Health Organization for the relaxation of social distancing measures.

BACKGROUND The high demand for adequate material for the gold standard reverse transcription real-time polymerase chain reaction (RT-qPCR)-based diagnosis imposed by the Coronavirus disease 2019 (COVID-19) pandemic, combined with the inherent contamination risks for healthcare workers during nasopharyngeal swab (NP) sample collection and the discomfort it causes patients, brought the need to identify alternative specimens suitable for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). OBJECTIVES The aim of this work was to compare saliva and gingival fluid swabs to NP swabs as specimens for RT-qPCR-based SARS-CoV-2 diagnosis. METHODS We compared gingival fluid swabs (n = 158) and saliva (n = 207) to the rayon-tipped NP swabs obtained from mild-symptomatic and asymptomatic subjects as specimens for RT-qPCR for SARS-CoV-2 detection. FINDINGS When compared to NP swabs, gingival fluid swabs had a concordance rate of 15.4% among positive samples, zero among inconclusive, and 100% among negative ones. For saliva samples, the concordance rate was 67.6% among positive samples, 42.9% among inconclusive, and 96.8% among negative ones. However, the concordance rate between saliva and NP swabs was higher (96.9%) within samples with lower cycle threshold (Ct) values (Ct > 10 ≤ 25). MAIN CONCLUSIONS Our data suggests that whereas gingival fluid swabs are not substitutes for NP swabs, saliva might be considered whenever NP swabs are not available or recommended.

Resumo Mesmo no período em que a pandemia de Covid-19 encontrava-se em crescimento no Nordeste do Brasil, iniciou-se a adoção de medidas de flexibilização do distanciamento social. O objetivo do estudo é o de avaliar a pertinência das propostas de flexibilização, tomando-se em conta a situação da pandemia em cada local e o momento em que foram adotadas. Tendo como referência as diretrizes da OMS, foram construídos e analisados indicadores operacionais para cada diretriz, no contexto da região Nordeste. Para análise do comportamento da epidemia, conforme indicadores selecionados, foram usadas técnicas de Joinpoint Trend Analysis, mapas de calor, razão de taxas e comparação da tendência temporal entre capitais e interior dos estados. O pico do crescimento semanal ocorreu em maio-julho/2020 (semanas epidemiológicas 19 a 31). Na maioria das capitais não se observou tendência decrescente simultânea do número de casos e óbitos nos 14 dias prévios à flexibilização. Em todos os estados o quantitativo de testes realizados foi insuficiente. Na semana epidemiológica 24 os percentuais estaduais de ocupação de leitos de UTI/Covid-19 foram próximos ou superiores 70%. A situação epidemiológica das nove capitais dos estados do Nordeste, no momento em que a decisão de flexibilização foi tomada, mostra que nenhuma delas atendia aos critérios e parâmetros recomendados pela OMS.

Abstract Even in the period when the Covid-19 pandemic was on the rise in the Northeast of Brazil, the relaxation of social distancing measures was introduced. The scope of the study is to assess, in the light of the epidemiological-sanitary situation in the region, the suitability of relaxation of social distancing measures. Based on the WHO guidelines for relaxation of social distancing, operational indicators were created and analyzed for each guideline in the context of the Northeast. To analyze the behavior of the epidemic, according to selected indicators, Joinpoint trend analysis techniques, heat maps, rate ratios and time trends between capitals and the state interior were compared. The weekly growth peak of the epidemic occurred in May-July 2020 (epidemiological weeks 19 to 31). In most capitals, there was no simultaneous downward trend in the number of cases and deaths in the 14 days prior to flexibilization. In all states the number of tests performed was insufficient. In epidemiological week 24, the state percentages of ICU/Covid-19 bed occupancy were close to or above 70%. The epidemiological situation of the nine Northeastern state capitals analyzed here did not meet criteria and parameters recommended by the World Health Organization for the relaxation of social distancing measures.