Abstract Currently, the market for organic products is in growing demand, and consumers seek to be in tune with the proposal of organic cultivation. The main reasons for this demand are related to the environment and health. Therefore, in the same proportion, there are studies in the literature addressing the subject. Thus, packaging has become an important vehicle for food, with the emergence of alternative materials to the use of conventional plastic. This study reports, within the profile of the consumer in the South and Southeast regions of Brazil, the probability of the consumer to purchasing organic packaging, as an alternative, for food products. For the present study, 328 questionnaires were used, consisting of 17 open and multiple-choice questions that addressed socioeconomic issues, consumption of organic and conventional foods, and the probability of using organic packaging. The profile of the consumer of organic products is predominantly women, with a postgraduate degree, between 31 and 40 years old and with a family income of 4 to 6 minimum wages. About organic packaging, there is a high probability that the consumer will purchase it with or without adding cost to the final value. Currently cultivation health Therefore proportion subject Thus plastic reports Brazil 32 used 1 multiplechoice multiple choice issues foods women degree 3 wages value

ABSTRACT Objective To compare two methods for defining and classifying the severity of pediatric acute respiratory distress syndrome: the Berlin classification, which uses the relationship between the partial pressure of oxygen and the fraction of inspired oxygen, and the classification of the Pediatric Acute Lung Injury Consensus Conference, which uses the oxygenation index. Methods This was a prospective study of patients aged 0 - 18 years with a diagnosis of acute respiratory distress syndrome who were invasively mechanically ventilated and provided one to three arterial blood gas samples, totaling 140 valid measurements. These measures were evaluated for correlation using the Spearman test and agreement using the kappa coefficient between the two classifications, initially using the general population of the study and then subdividing it into patients with and without bronchospasm and those with and without the use of neuromuscular blockers. The effect of these two factors (bronchospasm and neuromuscular blocking agent) separately and together on both classifications was also assessed using two-way analysis of variance. Results In the general population, who were 54 patients aged 0 - 18 years a strong negative correlation was found by Spearman’s test (ρ -0.91; p < 0.001), and strong agreement was found by the kappa coefficient (0.62; p < 0.001) in the comparison between Berlin and Pediatric Acute Lung Injury Consensus Conference. In the populations with and without bronchospasm and who did and did not use neuromuscular blockers, the correlation coefficients were similar to those of the general population, though among patients not using neuromuscular blockers, there was greater agreement between the classifications than for patients using neuromuscular blockers (kappa 0.67 versus 0.56, p < 0.001 for both). Neuromuscular blockers had a significant effect on the relationship between the partial pressure of oxygen and the fraction of inspired oxygen (analysis of variance; F: 12.9; p < 0.001) and the oxygenation index (analysis of variance; F: 8.3; p = 0.004). Conclusion There was a strong correlation and agreement between the two classifications in the general population and in the subgroups studied. Use of neuromuscular blockers had a significant effect on the severity of acute respiratory distress syndrome. Conference 1 samples 14 measurements agent twoway way variance 5 Spearmans s ρ 0.91 091 91 -0.91 0.001, 0001 , 001 0.62 062 62 (0.62 067 67 0.6 056 56 0.56 0.00 both. . both) F 12.9 129 12 9 8.3 83 8 3 0.004. 0004 0.004 004 0.004) studied 0.9 09 -0.9 000 00 06 6 (0.6 0. 05 0.5 0.0 12. 8. -0. (0. -0 (0 (

RESUMO Objetivo Comparar dois métodos para definição e classificação de gravidade na síndrome do desconforto respiratório agudo pediátrica: a classificação de Berlim, que utiliza a relação entre pressão parcial de oxigênio e fração inspirada de oxigênio e a classificação do Pediatric Acute Lung Injury Consensus Conference, que utiliza o índice de oxigenação. Métodos Estudo prospectivo com pacientes de 0 - 18 anos com diagnóstico de síndrome do desconforto respiratório agudo e ventilados mecanicamente de forma invasiva, que forneceram de uma a três amostras de gasometria arterial, totalizando 140 medidas válidas. Essas medidas foram avaliadas quanto à correlação pelo teste de Spearman e à concordância pelo coeficiente kappa entre as duas classificações, inicialmente usando a população geral do estudo e, depois, subdividindo-a em pacientes com e sem broncoespasmo e com e sem o uso do bloqueador neuromuscular. Também foi verificado o efeito desses dois fatores (broncoespasmo e bloqueador neuromuscular) de forma separada e conjunta sobre ambas as classificações por meio da análise de variância para dois fatores. Resultados Na população geral, composta de 54 pacientes com idades de 0 - 18 anos, foi encontrada forte correlação negativa pelo teste de Spearman (ρ -0,91; p < 0,001) e forte concordância pelo coeficiente kappa (0,62; p < 0,001) na comparação entre Berlim e Pediatric Acute Lung Injury Consensus Conference. Nas populações com e sem broncoespasmo e com e sem o uso do bloqueador neuromuscular, os coeficientes de correlação mantiveram valores semelhantes aos da população geral. Entretanto, para os pacientes sem uso do bloqueador neuromuscular, houve maior concordância entre as classificações em relação aos pacientes com uso do bloqueador neuromuscular (kappa 0,67 versus 0,56 com p < 0,001 em ambos). Acrescenta-se ainda o efeito significativo do uso do bloqueador neuromuscular sobre a relação entre pressão parcial de oxigênio e fração inspirada de oxigênio (análise de variância; F: 12,9; p < 0,001) e o índice de oxigenação (análise de variância; F: 8,3; p = 0,004). Conclusão Houve forte correlação e concordância entre as duas classificações na população geral e nos subgrupos estudados, entretanto, há efeito significativo do uso do bloqueador neuromuscular sobre as classificações de gravidade da síndrome do desconforto respiratório agudo. pediátrica Conference 1 invasiva arterial 14 válidas depois subdividindoa subdividindo 5 ρ 0,91 091 91 -0,91 0001 001 0,62 062 62 (0,62 Entretanto 067 67 0,6 056 56 0,5 0,00 ambos. ambos . ambos) Acrescentase Acrescenta se F 12,9 129 12 9 8,3 83 8 3 0,004. 0004 0,004 004 0,004) estudados entretanto 0,9 09 -0,9 000 00 06 6 (0,6 0, 05 0,0 12, 8, -0, (0, -0 (0 (

ABSTRACT Background: Microscopic colitis (MC) is a chronic inflammatory bowel disease causing non-bloody diarrhea, and several cases are undiagnosed as a hidden cause of chronic diarrhea. Objective: We aimed to report the symptoms, delay diagnosis and the treatment of MC in a case series. Methods: All patients were treated at a Gastroenterology reference office from May 2022 to June 2023. Personal history including preexisting disorders, use of medications and smoking habits were collected. The delay between the onset of symptoms and the correct diagnosis was informed. All patients consented to use budesonide MMX (Corament®) off label. Results: During the study period, six Caucasoid patients were diagnosed with MC, five females and one male, between the ages of 65 and 74. All patients had comorbities and were taking multiple prescription drugs. Laboratory findings showed negative serology for celiac disease for all patients, normal levels of albumin and vitamin B12. The delay between the symptoms and the MC diagnosis varied from 2 months to 6 years. All patients had a previous diagnosis of irritable bowel syndrome. All patients were in complete clinical remission during the treatment and referred no side effects of the drug. Conclusion: Older females using high-risk medications are suggestive of MC. Preventing delay in the diagnosis of MC is crucial to improvement in patients´ quality of life. Budesonide MMX appears to be effective, safe and well-tolerated. Background (MC nonbloody non bloody diarrhea Objective series Methods 202 2023 disorders collected informed Corament® Corament (Corament® label Results period male 74 drugs B12 B years syndrome drug Conclusion highrisk high risk life effective welltolerated. welltolerated well tolerated. tolerated well-tolerated 20 (Corament 7 B1

RESUMO Contexto: A colite microscópica (CM) é uma doença inflamatória intestinal crônica que causa diarreia não sanguinolenta, e vários casos não são diagnosticados como uma causa oculta de diarreia crônica. Objetivo: Esse estudo visou relatar os sintomas, qual o atraso diagnóstico e o tratamento da CM em uma série de casos. Métodos: Todos os pacientes foram atendidos em um consultório de referência em Gastroenterologia no período de maio de 2022 a junho de 2023. Foram coletados antecedentes pessoais, incluindo distúrbios preexistentes, uso de medicamentos e tabagismo. Foi buscado o período entre o início dos sintomas e o diagnóstico correto. Todos os pacientes consentiram em usar budesonida MMX (Corament®) off label. Resultados: Durante o período do estudo, seis pacientes caucasóides foram diagnosticados com CM, cinco mulheres e um homem, com idades entre 65 e 74 anos. Todos os pacientes apresentavam comorbidades e faziam uso de vários medicamentos prescritos. Os achados laboratoriais mostraram sorologia negativa para doença celíaca em todos os pacientes, níveis normais de albumina e vitamina B12. O atraso entre os sintomas e o diagnóstico de CM variou de 2 meses a 6 anos. Todos os pacientes tinham diagnóstico prévio de síndrome do intestino irritável. Todos os pacientes apresentaram remissão clínica completa durante o tratamento e não referiram efeitos colaterais da droga. Conclusão: As mulheres mais velhas que usam medicamentos de alto risco são sugestivas de CM. Evitar o atraso no diagnóstico de CM é fundamental para melhorar a qualidade de vida dos pacientes. A budesonida MMX foi eficaz, segura e bem tolerada. Contexto (CM sanguinolenta Objetivo Métodos 202 2023 pessoais preexistentes tabagismo correto Corament® Corament (Corament® label Resultados homem 7 anos prescritos B12 B irritável droga Conclusão eficaz tolerada 20 (Corament B1

ABSTRACT Purpose: To evaluate the saccadic movements of patients with visual field loss due to primary open-angle glaucoma. Methods: Thirteen patients with good visual acuity (0.2 logMAR or better) (seven patients with primary open-angle glaucoma 65 ± 13 years) and six controls (51 ± 6 years) yielded a comprehensive ophthalmological examination, including Humphrey Visual Field tests (SITA-Standard 24-2), and performed a monocular, exploratory digital visual search task that quantifies the duration for finding the number “4” on a random array of digits distributed on the screen. After individual adjustments of the angle and distance positioning, the screen was spatially matched with the 24-2 visual field, and divided into five areas for analysis. During the task, saccades were simultaneously recorded in the same eye with a video-based eye tracker. Results: The patients with primary open-angle glaucoma showed a significantly higher number of saccades/screen (median ± interquartile range, 59.00 ± 29.00 vs. 32.50 ± 19.75 saccades (p=0.027) and visual search time per screen (38.50 ± 60.14 vs. 23.75 ± 8.90 seconds (p=0.035) than the controls did. Although the univariate analysis indicated a significant correlation with visual field mean deviation (coefficient=26.19 (p=0.02), only the visual search time/screen was significantly associated with the number of saccades/screen in the multivariate regression model (coefficient=0.55 (p<0.001). Overall, no significant correlation was observed between the sectorial number of saccades and the sensitivity of the five visual field areas. Conclusions: The patients with primary open-angle glaucoma show impaired search performance and showed a higher number of saccades needed to find stimuli when performing the exploratory visual task. Purpose openangle open Methods 0.2 02 0 2 (0. better seven 1 years 51 (5 examination SITAStandard SITA Standard 242, 242 24 , 24-2) monocular 4 “4 positioning 24- videobased video based tracker Results saccadesscreen median range 5900 59 00 59.0 2900 29 29.0 vs 3250 32 50 32.5 1975 19 75 19.7 p=0.027 p0027 p 027 (p=0.027 38.50 3850 38 (38.5 6014 60 14 60.1 2375 23 23.7 890 8 90 8.9 p=0.035 p0035 035 (p=0.035 did coefficient=26.19 coefficient2619 coefficient 26 (coefficient=26.1 p=0.02, p002 p=0.02 (p=0.02) timescreen coefficient=0.55 coefficient055 55 (coefficient=0.5 p<0.001. p0001 p<0.001 . 001 (p<0.001) Overall Conclusions 0. (0 5 ( “ 590 59. 290 29. 325 3 32. 197 7 19. (p=0.02 38.5 385 (38. 601 60. 237 23. 89 9 8. p=0.03 p003 03 (p=0.03 coefficient=26.1 coefficient261 (coefficient=26. p00 p=0.0 coefficient=0.5 coefficient05 (coefficient=0. p000 p<0.00 (p<0.001 (p=0.0 38. (38 coefficient=26. coefficient26 (coefficient=26 p0 p=0. coefficient=0. coefficient0 (coefficient=0 p<0.0 (p<0.00 (p=0. (3 coefficient=26 coefficient2 (coefficient=2 p=0 coefficient=0 (coefficient= p<0. (p<0.0 (p=0 coefficient=2 p= coefficient= (coefficient p<0 (p<0. (p= p< (p<0 (p (p<

Chagas disease (CD), caused by Trypanosoma cruzi, is a life-threatening neglected anthropozoonosis primarily transmitted by triatomine bugs. Affecting an estimated 5.7 million people globally, CD has significant morbidity and mortality, particularly in Latin America. The Oxente Chagas Bahia Project aims to screen approximately 30,000 individuals, validate a rapid diagnostic test in a real-world setting, and provide crucial data on its diagnostic performance and cost-effectiveness. Additionally, a biobank will be established to support further research on disease biomarkers and treatment cure rates. By enhancing access to timely diagnosis and treatment, the project will evaluate a strategy to reduce the CD burden. CD, , (CD) cruzi lifethreatening life threatening bugs 57 5 7 5. globally mortality America 30000 30 000 30,00 individuals realworld real world setting costeffectiveness. costeffectiveness cost effectiveness. effectiveness cost-effectiveness Additionally rates burden (CD 3000 3 00 30,0 300 0 30,

RESUMO Antecedentes O tempo de reação é afetado em diferentes condições neurológicas, mas não foi muito investigado considerando todos os tipos de comprometimento cognitivo leve (CCL). Objetivo Este estudo investigou a acurácia diagnóstica do CompCog, uma bateria computadorizada de rastreio cognitivo focada em medidas de tempo de reação. Métodos Uma amostra de 52 idosos passou por uma avaliação neuropsicológica, incluindo o CompCog, e uma consulta médica para serem classificados como grupo controle ou serem diagnósticos com CCL. A acurácia do teste para distinguir entre os dois grupos foi calculada. Resultados Os resultados das análises de acurácia diagnóstica mostraram AUC das curvas ROC tão altas quanto 0,915 (CI 0,837-0,993). O subteste com maior sensibilidade e especificidade - subteste de tempo de reação de escolha - apresentou sensibilidade de 91,7% e especificidade de 89,3%. O modelo final de regressão logística classificou corretamente 92,3% dos indivíduos, com especificidade de 92,9% e sensibilidade de 91,7%, e incluiu apenas 4 variáveis de diferentes subtestes. Conclusões Em resumo, o estudo mostrou que o tempo de reação avaliado pelo CompCog é uma boa medida de rastreio para diferenciar entre envelhecimento normal e CCL. Medidas de tempo de reação em milissegundos se mostraram melhores que o número de respostas corretas. O teste pode fazer parte de testes clínicos de rotina para atingir o objetivo de rastrear o CCL, indicar outros procedimentos para investigação e diagnóstico e planejar intervenções.

ABSTRACT Background Reaction time is affected under different neurological conditions but has not been much investigated considering all types of mild cognitive impairment (MCI). Objective This study investigated the diagnostic accuracy of CompCog, a computerized cognitive screening battery focusing on reaction time measurements. Methods A sample of 52 older adults underwent neuropsychological assessments, including CompCog, and medical appointments, to be classified as a control group or be diagnosed with MCI. The accuracy of CompCog for distinguishing between the two groups was calculated. Results The results from diagnostic accuracy analyses showed that the AUCs of ROC curves were as high as 0.915 (CI 0.837-0.993). The subtest with the highest sensitivity and specificity (choice reaction time subtest) had 91.7% sensitivity and 89.3% specificity. The logistic regression final model correctly classified 92.3% of individuals, with 92.9% specificity and 91.7% sensitivity, and included only four variables from different subtests. Conclusions In summary, the study showed that reaction time assessed through CompCog is a good screening measure to differentiate between normal aging and MCI. Reaction time measurements in milliseconds were more accurate than correct answers. This test can form part of routine clinical tests to achieve the objectives of screening for MCI, indicating further procedures for investigation and diagnosis and planning interventions.

Abstract This study aimed to formulate a milk protein concentrate (MPC) and evaluate the effect of this MPC supplementation on body composition, lipid profile, and product acceptability in resistance training (RT) practitioners. The physical, chemical and sensory properties were then analyzed. To evaluate the effect of the MPC supplementation on resistance training practitioners, 30 males were divided into two groups: a control group and an intervention group. Then the participants in the intervention group were supplemented with 500 mL of the MPC (250 mL pre-RT and 250 mL post-RT). Body composition (weight, height, and skinfolds) and biochemical markers (cholesterol and triglycerides) were measured at baseline and at 30, 60, and 90 days after treatment. Body composition results showed that the MPC supplementation during a RT program significantly (p < 0.05) reduced body fat percentage and fat mass, and increased lean mass in RT practitioners. Characterization of the MPC revealed low fat (3.32 ± 0.08%) and carbohydrates (4.58 ± 0.59%), and high protein (18.51 ± 0.51%) concentrations. Additionally, the product showed satisfactory acceptability index (> 71%). Thus, the MPC supplementation contributed to reduction of fat percentage, fat mass, and increase of lean mass in RT practitioners, without lipid profile alterations.

Resumo: Estudos apontam que, mesmo no Ensino Fundamental I, os conteúdos de Geociências estão presentes em disciplinas como Ciências e Geografia, embora, muitas vezes, não sejam reconhecidos como geocientíficos, resultando em um ensino descontextualizado. Reconhecendo a importância desse objeto, o objetivo deste estudo foi, a partir da verificação dos conteúdos de Geociências abordados no Ensino Fundamental I em uma escola pública, propor um tema estruturante a partir do contexto geológico do município. Para tal, foram compiladas informações de pesquisas que investigaram os conteúdos de Geociências em livros de Ciências e Geografia usados no município e, como resultado, observou-se que esses conteúdos representam 16,44% nesse ciclo do ensino, sendo mais expressivos a partir do 3º ano do ensino fundamental I. A paisagem foi identificada como passível de articulação com os demais assuntos geocientíficos. Assim, conforme o contexto estudado, propõe-se utilizar a paisagem dunar como possibilidade integradora de conteúdos de Geociências.

Abstract: Studies show that even in the first years of elementary school (EFI), the contents of Geosciences are present in subjects like Science and Geography, although they are often not recognized as geoscientific, which results in decontextualized teaching. By recognizing the importance of this object, the purpose of this study was - based on the verification of the contents of Geosciences covered in EFI in a public school - to propose a structuring theme based on the geological context of the municipality. To do that, this study compiled information from studies that investigated the contents of Geosciences in Science and Geography books in the municipal school system and, as a result, it was observed that these contents represent 16.44% in this teaching cycle and are more expressive from the 3rd year on. The local landscape was found to be suitable for promoting articulation with other geoscientific subjects. In the studied context, the dune landscape is proposed as a likely articulator of Geosciences contents.

Abstract Background Eugenol shows both antibacterial and antiparasitic activities, suggesting that it might be evaluated as an option for the treatment of praziquantel-resistant schistosome. Methods The in vitro activities of three eugenol derivatives (FB1, FB4 and FB9) on adult worms from Schistosoma mansoni were examined by fluorescence and scanning electron microscopy to analyze effects on the excretory system and integument damage, respectively. Biochemical tests with verapamil (a calcium channel antagonist) and ouabain (a Na+/K+-ATPase pump inhibitor) were used to characterize eugenol derivative interactions with calcium channels and the Na+/K+-ATPase, while in silico analysis identified potential Na+/K+-ATPase binding sites. Results The compounds showed effective doses (ED50) of 0.324 mM (FB1), 0.167 mM (FB4), and 0.340 mM (FB9). In addition, FB4 (0.322 mM), which showed the lowest ED50, ED90 and ED100 (p < 0.05), caused the most damage to the excretory system and integument, according to both fluorescence and scanning electron microscopy analysis. The death of adult worms was delayed by ouabain treatment plus FB1 (192 versus 72 hours) and FB9 (192 versus 168 hours), but the response to FB4 was the same in the presence or absence of ouabain. Besides, no changes were noted when all of the eugenol derivatives were combined with verapamil. Moreover, FB1 and FB9 inhibited Na+/K+-ATPase activity according to in silico analysis but FB4 did not show a time-dependent relationship and may act on targets other than the parasite Na+/K+-ATPase. Conclusion Eugenol derivatives, mainly FB4 when compared to FB1 and FB9, seem to act more effectively on the integument of adult S. mansoni worms.

Abstract Lychnophorinae comprises 19 genera and 117 species. Its representatives are found mostly in the rocky grasslands (“campos rupestres”) of Minas Gerais, Bahia, and Goiás States, Brazil. This study presents a palynological investigation of 10 species belonging to the genus Piptolepis, endemic to the rocky grasslands of the Espinhaço Mountains, in Minas Gerais State. The plant material used in this investigation was obtained from specimens deposited in Brazilian herbaria. Pollen grains were processed by the acetolysis method, measured, described, and photomicrographed in light microscopy and scanning electron microscopy. Morphological observations revealed Piptolepis pollen to be large, prolate spheroidal in most species, 3-colporate, ectoapertures long, sexine subechinolophate or sublophate. Endoapertures vary from almost circular, lalongate or lalongate, with a median constriction observed only in three species. Three types of spines were identified: prostrate and disorganized, elongated and narrow, and conical, erect, apex acute in the other species. This first palynological study of Piptolepis species allowed the separation of representatives of the genus using pollen keys. The most significant characters were pollen shape, ornamentation, endoaperture, and presence of median constriction in the endoaperture. The findings presented here do not support the infrageneric classification of Piptolepis, as pollen characters were not unique to any section.

Resumo Tradicionalmente, as águas subterrâneas têm sido consideradas protegidas pelo subsolo. No entanto, o descarte de poluentes estáveis em zonas de infiltração favorável pode gerar contaminação do recurso hídrico, colocando em risco a saúde da população. Para solucionar a crescente contaminação de aquíferos por atividades antrópicas, a avaliação de vulnerabilidade é um dos requisitos fundamentais para gerar diretrizes, estratégias e políticas de prevenção e minimização da contaminação de águas subterrâneas. O presente estudo tem como objetivo avaliar a vulnerabilidade à poluição antropogênica nos aquíferos da Região Metropolitana de Natal. Nesta pesquisa foi utilizado o método GODS (Grau de confinamento, Ocorrência de substrato litológico, Distância da superfície do terreno ao nível da água subterrânea e tipo de Solo), que propõe um cálculo da vulnerabilidade por meio da multiplicação de quatro parâmetros geológicos e hidrológicos, os quais são: grau de confinamento hidráulico, ocorrência do substrato subjacente, distância ao nível da água subterrânea e tipo de solo. Foram usadas ferramentas de um Sistema de Informações Geográficas - SIG. Os resultados mostram que a maior parte do território está em um nível de vulnerabilidade baixo com 39,75%, em nível médio com 24,26%, seguido de um nível de vulnerabilidade extrema com 14,7%, 10,68% com nível alto e 10,61% insignificante. A pesquisa contribuiu para evidenciar como as características intrínsecas do aquífero Dunas-Barreiras da Região Metropolitana de Natal, permitem o transporte de poluentes até o lençol freático em algumas áreas como na zona costeira e nas porções mais baixas das bacias hidrográficas.,

Abstract Traditionally, groundwater has been considered protected by the subsurface. However, the disposal of stable pollutants in favorable infiltration zones can generate contamination of the hydric resource, jeopardizing the health of the population. To tackle the increasing contamination of aquifers by anthropic activities, vulnerability assessment is one of the fundamental requirements to generate guidelines, strategies, and policies to prevent and minimize groundwater contamination. The present study aims to evaluate the vulnerability to anthropogenic pollution in aquifers of the Metropolitan Region of Natal (MRN). In this research, the GODS (Groundwater hydraulic confinement, Overlaying strata, Deph to groundwater and Soil type) method was used, proposing a vulnerability calculation through the multiplication of four geological and hydrological parameters, which are: degree of hydraulic confinement, the occurrence of the underlying substratum, distance to the groundwater level, and type of soil. Tools from a Geographic Information System (GIS) were used. The results show that most of the territory is in a low vulnerability level with 39.75%, in moderate level with 24.26%, followed by very high vulnerability level with 14.7%, 10.68% with high level, and 10.61% insignificant level. The research contributed to highlighting how the intrinsic characteristics of the Dunas-Barreiras aquifer in the Metropolitan Region of Natal, allow the transport of pollutants to the water table in some areas such as in the coastal zone and in the lower portions of the river basins.

RESUMO CONTEXTO: A pandemia da COVID-19 tem alterado o funcionamento de serviços de endoscopia digestiva pelo mundo. OBJETIVO: O presente estudo tem por objetivo medir o número de exames endoscópicos de urgência/emergência realizados em um hospital público brasileiro, comparando-o ao mesmo período do ano anterior, além de avaliar os fatores de risco dos pacientes com COVID-19 que realizaram exame endoscópico por hemorragia digestiva alta (HDA). MÉTODOS: Estudo retrospectivo, transversal, observacional e unicêntrico. Foram avaliados todos os exames endoscópicos de urgência/emergência realizados em pacientes acima de 18 anos, nos períodos de março a agosto dos anos de 2019 e 2020. Os pacientes com COVID-19 incluídos foram diagnosticados por RT-PCR, acima de 18 anos, com informações completas em prontuário. As variáveis avaliadas foram: tipo de exame endoscópico, idade, sexo, comorbidades, tempo de internação, d-dímero, necessidade de UTI e ventilação mecânica durante a internação. A comparação dos grupos em relação a variáveis quantitativas foi feita através do teste t de Student para amostras independentes ou o teste não-paramétrico de Mann-Whitney. As variáveis categóricas foram avaliadas pelo teste exato de Fisher. Valores de P<0,05 indicaram significância estatística. RESULTADOS: Observaram-se 130 exames endoscópicos de urgência/emergência no período avaliado em 2020, e 97 em 2019. No período do estudo foram internados 631 pacientes por COVID-19, dos quais 16 realizaram exame endoscópico de urgência/emergência, sendo 1,6% por HDA. Dentre as variáveis analisadas, necessidade de UTI e/ou ventilação mecânica durante o internamento foram estatisticamente significativos como risco para desenvolvimento de HDA. CONCLUSÃO: O presente estudo mostra que para a realidade local houve incremento de exames endoscópicos de urgência/emergência durante a pandemia. Dentre os pacientes internados com o novo coronavírus, há maior risco de HDA naqueles que necessitam de UTI e/ou ventilação mecânica.

ABSTRACT BACKGROUND: The COVID-19 pandemic has changed digestive endoscopy services around the world. OBJECTIVE: This study aimed to measure the number of urgent/emergency endoscopic procedures performed in a Brazilian hospital, comparing it to the same period in the previous year, and to identify risk factors in COVID-19 patients undergoing endoscopic procedures for upper gastrointestinal bleeding (UGIB). METHODS: This was a retrospective, cross-sectional, observational, single-center study. The study evaluated urgent/emergency endoscopic procedures performed on adult patients from March to August in 2019 and 2020. The COVID-19 patients included were diagnosed using RT-PCR, aged over 18 years with complete medical record information. The variables evaluated were age, sex, comorbidities, length of stay, D-dimer, need for intensive care unit (ICU) and mechanical ventilation. Student’s t-test for independent samples or the non-parametric Mann-Whitney test was used to compare quantitative variables. Categorical variables were analyzed using Fisher’s exact test. A P-value <0.05 indicated statistical significance. RESULTS: A total of 130 urgent/emergency endoscopic procedures were performed in 2020 and 97 in 2019. During the study period, 631 patients were hospitalized due to COVID-19, of whom 16 underwent urgent/emergency endoscopic procedures, 10 (1.6%) due to UGIB. Of the variables analyzed, the need for ICU and/or mechanical ventilation during hospitalization was statistically significant as a risk factor for UGIB. CONCLUSION: This study showed increased urgent/emergency endoscopic procedures during the pandemic at the study site. Among the patients hospitalized with the novel coronavirus, there is a higher risk for UGIB in those needing ICU and/or mechanical ventilation.

ABSTRACT Sexually transmitted infections (STIs) represent a global health problem with variable prevalence depending on the geographical region and the type of population. Human papillomavirus (HPV) encompasses widespread virus types related to cervical carcinogenesis. The present study investigated the molecular prevalence of HPV and seven other important STIs in asymptomatic women working or studying at a Brazilian university. A secondary aim was to assess cytological abnormalities associated with HPV and other STIs coinfections. We recruited 210 women from a Brazilian university. HPV was detected using a single-round polymerase chain reaction (sPCR) followed by a viral genotyping by restriction fragment length polymorphism (RFLP-PCR). The presence of seven STIs: Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, Trichomonas vaginalis, Mycoplasma genitalium, herpes simplex virus (HSV)-1 and HSV-2 was detected by multiplex PCR (M-PCR). Furthermore, cytological findings and epidemiological characteristics were evaluated.The mean age of the participants was 27.1 years old. HPV prevalence was 33.8%, and HPV16 was the most frequently detected papillomavirus genotype. Moreover, multiple HPV infections were common (42.2%). We detected at least one STI agent in 11.4% of the tested women, most frequently C. trachomatis (6.7%). Among HPV-positive women, 14.1% were coinfected with other STI agents. Cytological abnormalities were observed in 9.5% of smears, and HPV-DNA, high-risk HPV (HR-HPV), HPV16 and HPV multiple infections were associated with abnormal cytological findings. There was a high prevalence of HPV, and C. trachomatis was the most prevalent STI agent, with low rates of cytological abnormalities. These findings highlight the need of timely STI diagnosis in young asymptomatic women and of a public policy design for STI prevention.

RESUMO CONTEXTO: A papilectomia endoscópica tem sido a opção terapêutica menos invasiva no tratamento de tumores precoces que acometem a papila duodenal maior. OBJETIVO: Avaliar pacientes com tumores ampulares precoces submetidos a papilectomia endoscópica com finalidade curativa, com relação ao sucesso técnico (avaliação histopatológica da margem tumoral) e sua segurança (taxa de eventos adversos [EAs]). MÉTODOS: Foram avaliados retrospectivamente dados demográficos, exame histopatológico e evolução clínica pré e pós-procedimento de pacientes consecutivos submetidos a papilectomia endoscópica. Os desfechos avaliados foram o sucesso técnico (avaliação histopatológica de tumor residual) e taxa de EAs. RESULTADOS: Um total de 21 prontuários de pacientes com predominância feminina (13 casos, 61,9%) foi incluído no estudo. O diagnóstico tumoral foi incidental em 8 (38%) casos. A taxa de margem de ressecção negativa foi 72% (15 casos); três destas lesões confirmaram displasia de alto grau (DAG) no espécime ressecado e seis casos de neoplasia invasora. Houve recorrência tumoral em dois casos e a mediana de seguimento foi de 12 meses, com 23% de taxa de perda de seguimento (cinco casos). Seis (28,5%) pacientes apresentaram EAs, todos precoces (hemorragia e pancreatite aguda); nenhum destes necessitou de intervenção cirúrgica e não houve mortalidade. CONCLUSÃO: A papilectomia endoscópica permitiu sucesso técnico, com a completa remoção de lesões neoplásicas ampulares na maioria dos casos com taxa de EAs aceitáveis. A taxa de recorrência tumoral deve ser cuidadosamente avaliada em estudos futuros. Houve um aumento recente do número de procedimentos realizados. Também houve baixa correlação entre o diagnóstico histológico pré e pós-procedimento para a presença de adenocarcinoma invasor e adenoma com DAG, com predomínio de lesões adenomatosas superficiais.

ABSTRACT BACKGROUND: Endoscopic papillectomy has been conceived as a less invasive therapeutic option for treatment of early neoplastic lesions located at the major duodenal papilla. OBJECTIVE: Evaluating patients with early ampullary lesions who underwent curative intent endoscopic papillectomy related to technical success (histopathological tumor margin assessment) and safety (adverse event rate). METHODS: A retrospective study including consecutive patients who underwent curative intent endoscopic papillectomy for demographic, histopathological and pre-/post-procedural clinical assessment. Endpoints were technical success (histopathological residual tumor assessment) and adverse events rates. RESULTS: A total of 21 medical records patients with a female predominance (13 cases, 61.9%) were included. The tumor was incidental in 8 (38%) cases. Negative residual tumor resection margin rate was 72% (15 cases); three of these cases confirmed high-grade dysplasia in the resected specimen, and six cases were invasive neoplasia. Tumoral recurrence was seen in two cases, and median follow-up time was 12 months, with a 23% loss rate (five patients). Six (28.5%) patients had adverse events, all of them early (bleeding and pancreatitis); none of them required surgical intervention and there was no mortality. CONCLUSION: Endoscopic papillectomy allowed for technical successful procedure with complete removal of ampullary neoplastic lesions in the majority of cases with acceptable adverse event rates. Recurrence rate should be carefully assessed in further studies. There was a recent increase in the number of procedures. There was also a low correlation between pre- and post-histopathological assessment regarding the presence of invasive carcinoma and adenoma with high grade dysplasia, with a predominance of superficial neoplastic adenomatous lesions.