ABSTRACT The collapse of the Fundão Dam in Mariana, MG, in 2015 introduced the challenge of using Technosol, a soil type formed by deposition of iron mining waste along the Doce River banks, for agricultural purposes. This study aimed to determine the optimal water depth for enhancing production of tropical forage, Megathyrsus maximus cv. Mombasa, when grown on iron ore tailings. Additionally, it sought to establish a crop coefficient applicable to the edaphoclimatic conditions of Viçosa, MG, Brazil. The experiment was conducted throughout the summer, fall, and winter of 2022, employing 21 drainage lysimeters. A completely randomized experimental design was adopted, featuring six treatment groups (plants in Technosol receiving water depths ranging from 20 to 120% of the crop’s evapotranspiration, as derived from the control treatment), along with a control group (plants in Latosol with a depth of 100%), each with three repetitions. Our findings showed that irrigation must replace 40% of the crop evapotranspiration. Moreover, cultivating in Technosol resulted in a reduction of productive capacity by 37.39% during the summer/fall and fall seasons. For Mombasa grass grown in Oxisol, crop coefficients of 1.2 during the summer and 1.5 during the fall and winter are advised.

RESUMO O rompimento da Barragem do Fundão em Mariana, MG, ocorrida em 2015, trouxe o desafio de usar o Tecnossolo (tipo de solo) formado pela deposição do rejeito de mineração de ferro nas margens do Rio Doce para agricultura. O objetivo desta pesquisa foi obter a lâmina de água para otimizar a produção da forragem tropical Megathyrsus maximum cv. Mombaça, cultivada em rejeito de mineração de ferro e determinar seu coeficiente de cultura para as condições edafoclimáticas de Viçosa, MG. O experimento foi realizado durante as estações de verão, outono e inverno do ano de 2022, com a utilização de 21 lisímetros de drenagem. O experimento foi distribuído em delineamento inteiramente casualizado com 6 tratamentos (plantas em Tecnossolo com lâminas variando de 20 a 120% da evapotranspiração da cultura, obtida do tratamento-testemunha) e adição de uma testemunha (plantas em Latossolo com lâmina de 100%) com três repetições. Recomenda-se irrigação com reposição de 40% da evapotranspiração da cultura. O cultivo em Tecnossolo diminuiu a capacidade produtiva em 37,39% nos ciclos das estações do verão/outono e outono. Recomenda-se os coeficientes de cultura de 1,2 no verão e 1,5 no outono e no inverno, para o capim-Mombaça cultivado em um Latossolo.

Abstract A continuous increase in levels of atmospheric pollution and emission restrictions has forced scientists and engineers to adopt new strategies to improve and develop internal combustion engines. One strategy is based on the development of new simulation methodologies using computational fluid dynamic (CFD) techniques, proposed in the present article. In this study,the dynamic loop methodology with ANSYS Fluent code is proposed to perform the numerical simulation ofa four-stroke spark ignition engine. The complexity of the real case was first simplified with three-dimensional CAD geometry, which was then discretized in ANSYS Meshing, whereby a hybrid mesh was created using prismatic and tetrahedral elements. Simulations for in-cylinder analyses were performed in cold flow and employing common flow parameters, such as swirl and tumble. The mesh quality results were classified as good or excellent, being higher than 0.79 for orthogonal quality criteria and lower than 0.36 for skewness criteria. Turbulent effects were introduced concerning the opening and closing of the valves. It was found that the turbulence increases during the intake stroke up to 90°, and during the power stroke, wherein the of the piston bowl, had a great contributionthat can be seen from the swirl and tumble profile for the engine cycle. In the case of the turbulence intensity, a sharp increase was registered during the admission step up to 90°, at which point the turbulence intensity was 4.0. It canbe concluded that this is an innovative approach, capable of simulating the engine motion profile in cold flow.

Resumo A verificação de mudanças morfológicas e fisiológicas sob diferentes condições luminosas em espécies frutíferas nativas em estágio juvenil é importante, uma vez que indicam o ambiente adequado para a formação de mudas com alto vigor. Objetivou-se verificar o crescimento e as alterações morfofisiológicas sob gradiente de sombreamento em mudas de feijoa (Acca sellowiana (O. Berg) Burret) para obter mudas de boa qualidade, adequadas para fomentar os plantios da espécie em pomares. As mudas foram cultivadas por vinte e um meses sob quatro tratamentos de sombreamento (0%, 30%, 50% e 80%). Foram avaliados parâmetros de crescimento, pigmentos fotossintéticos, trocas gasosas, fluorescência da clorofila e anatomia foliar. Mudas a pleno sol e 30% de sombra apresentaram maior crescimento em altura, diâmetro e acúmulo de massa seca, devido à maior taxa de fotossíntese. Como principais mecanismos de aclimatação sob 80% de sombra, as mudas desenvolveram maior área foliar, redução da espessura do limbo foliar e aumento do rendimento quântico do fotossistema II. Mesmo assim, a assimilação líquida de CO2 e a taxa de transporte de elétrons foram menores e, consequentemente, houve restrição ao crescimento e acúmulo de massa seca das mudas no maior nível de sombreamento. Portanto, para a obtenção de mudas de feijoa de maior qualidade, recomendamos que seja realizada a pleno sol ou até 30% de sombra, para maximizar o vigor das mudas em viveiros e, posteriormente, este ambiente de luz também pode ser utilizado em pomares para favorecer o crescimento e a produção de frutos.

Abstract Understanding morphological and physiological changes under different light conditions in native fruit species in juveniles’ stage is important, as it indicate the appropriate environment to achieve vigorous saplings. We aimed to verify growth and morphophysiological changes under shade gradient in feijoa (Acca sellowiana (O. Berg) Burret) to achieve good quality saplings adequate to improve cultivation in orchards. The saplings were grown for twenty-one-month under four shading treatments (0%, 30%, 50%, and 80%). Growth, photosynthetic pigments, gas exchanges, chlorophyll fluorescence, and leaf anatomy parameters were evaluated. Saplings under full sun and 30% shade had higher height and diameter growth and dry mass accumulation due to higher photosynthesis rate. As main acclimatization mechanisms in feijoa saplings under 80% shade were developed larger leaf area, reduced leaf blade thickness, and enhanced quantum yield of photosystem II. Even so, the net CO2 assimilation and the electron transport rate was lower and, consequently, there was a restriction on the growth and dry mass in saplings under deep shade. Therefore, to obtain higher quality feijoa saplings, we recommend that it be carried out in full sun or up to 30% shade, to maximize the sapling vigor in nurseries and, later, this light environment can also be used in orchards for favor growth and fruit production.

Resumo A leishmaniose visceral (LV) é uma doença de natureza infecciosa, predominante em países de zonas tropicais. A predição de ocorrência de doenças infecciosas através da modelagem epidemiológica tem se revelado uma importante ferramenta no entendimento de sua dinâmica de ocorrência. O objetivo deste estudo foi desenvolver um modelo de previsão da incidência da LV no Maranhão usando o modelo de Média Móvel Integrada Autocorrelacionada Sazonal (SARIMA). Foram coletados os dados mensais de casos de LV através do Sistema de Informação de Agravos de Notificação (SINAN) correspondentes ao período de 2001 a 2018. O método de Box-Jenkins foi aplicado para ajustar um modelo de predição SARIMA para incidência geral e por sexo (masculino e feminino) de LV para o período de janeiro de 2019 a dezembro de 2023. Durante o período de 216 meses dessa série temporal, foram registrados 10.431 casos de LV no Maranhão, com uma média de 579 casos por ano. Em relação à faixa etária, houve maior registro no público pediátrico (0 a 14 anos). Houve predominância do sexo masculino, com 6437 casos (61,71%). Os valores do teste de Box-Pierce para incidência geral, sexo masculino e feminino reforçados pelos resultados do teste Ljung-Box sugerem que as autocorrelações de resíduos apresentam um comportamento de ruído branco. Para incidência mensal geral e por sexo masculino e feminino, os modelos SARIMA (2,0,0) (2,0,0), (0,1,1) (0,1,1) e (0,1,1) (2, 0, 0) foram os que mais se ajustaram aos dados, respectivamente. O modelo SARIMA se mostrou uma ferramenta adequada de previsão e análise da tendência de incidência da LV no Maranhão. A determinação da variação temporal e sua predição são determinantes no norteamento de medidas de intervenção em saúde.

Abstract Visceral leishmaniasis (VL) is an infectious disease predominant in countries located in the tropics. The prediction of occurrence of infectious diseases through epidemiologic modeling has revealed to be an important tool in the understanding of its occurrence dynamic. The objective of this study was to develop a forecasting model for the incidence of VL in Maranhão using the Seasonal Autoregressive Integrated Moving Average model (SARIMA). We collected monthly data regarding VL cases from the National Disease Notification System (SINAN) corresponding to the period between 2001 and 2018. The Box-Jenkins method was applied in order to adjust a SARIMA prediction model for VL general incidence and by sex (male or female) for the period between January 2019 and December 2013. For 216 months of this time series, 10,431 cases of VL were notified in Maranhão, with an average of 579 cases per year. With regard to age range, there was a higher incidence among the pediatric public (0 to 14 years of age). There was a predominance in male cases, 6437 (61.71%). The Box-Pierce test figures for overall, male and female genders supported by the results of the Ljung-Box test suggest that the autocorrelations of residual values act as white noise. Regarding monthly occurrences in general and by gender, the SARIMA models (2,0,0) (2,0,0), (0,1,1) (0,1,1) and (0,1,1) (2, 0, 0) were the ones that mostly adjusted to the data respectively. The model SARIMA has proven to be an adequate tool for predicting and analyzing the trends in VL incidence in Maranhão. The time variation determination and its prediction are decisive in providing guidance in health measure intervention.

Resumo O setor florestal brasileiro se destaca pela tecnologia, práticas de manejo florestal, responsabilidade social e ambiental e, principalmente, alta produtividade, mas pragas exóticas podem reduzir isto. O parasitoide Psyllaephagus bliteus (Riek, 1962) (Hymenoptera: Encyrtidae), percevejos predadores e fungos entomopatogênicos como Beauveria bassiana e Metarhizium anisopliae são inimigos naturais usados no controle biológico do psilídeo-de-concha do eucalipto Glycaspis brimblecombei (Moore, 1964) (Hemiptera: Aphalaridae), praga em plantios de eucalipto. A utilização de fungos entomopatogênicos contra pragas exóticas vem aumentando no setor florestal e a prospecção e identificação de isolados fúngicos é importante para o manejo integrado de pragas. O objetivo deste estudo foi o isolamento e identificação molecular de Cordyceps spp. e avaliar a patogenicidade dos isolados de Cordyceps javanica (LCBPF 11) e Cordyceps fumosorosea (LCBPF 12 e LCBPF 63), obtidos de adultos de Bemisia tabaci Gennadius (Hemiptera: Aleyrodidae), ao psilídeo-de-concha G. brimblecombei. Os fungos foram isolados de adultos de B. tabaci encontrados em culturas de soja e tomate e identificados molecularmente. Os conídios foram suspensos em solução com Tween 80 (0,1%) na concentração de 1,0 x 108 conídios/mL e pulverizados sobre dez ninfas de G. brimblecombei por folha de Eucalyptus cortada e colocada sobre gel hidrorretentor no interior de placas de Petri por repetição. O número de insetos mortos foi quantificado, diariamente, por sete dias e transferidos para câmaras úmidas. Cordyceps javanica (LCBPF 11) e C. fumosorosea (LCBPF 12 e LCBPF 63) foram identificados por análise molecular e todos os isolados foram patogênicos para os insetos. Isto indica serem importantes para o manejo de G. brimblecombei e confirma relatos de que, normalmente, fungos causam maiores mortalidades em insetos da mesma ordem daquela da qual foram isolados.

Abstract The Brazilian forestry sector stands out for its technology, forestry management practices, social and environmental responsibility and, mainly, for its high productivity and exotic pests can reduce it. The red gum lerp psyllid Glycaspis brimblecombei (Moore, 1964) (Hemiptera: Aphalaridae) is an important pest in Eucalyptus plantations. The parasitoid Psyllaephagus bliteus (Riek, 1962) (Hymenoptera: Encyrtidae), predatory bugs and entomopathogenic fungi such as Beauveria bassiana and Metarhizium anisopliae are the natural enemies and used in the biological control of the red gum lerp psyllid. The use of entomopathogenic fungi against exotic pests is increasing in the forestry sector and the prospecting and identification of fungus isolates is important for integrated pest management. The objective of this work was the isolation and molecular identification of Cordyceps spp. And to evaluate the pathogenicity of isolates, obtained from Bemisia tabaci (Gennadius, 1889) (Hemiptera: Aleyrodidae) adults, against to the red gum lerp psyllid G. brimblecombei. The fungi were isolated from B. tabaci adults found in soybean and tomato crops and molecularly identified. The conidia obtained were suspended in solution with Tween 80 (0.1%) at a concentration of 1.0 × 108 conidia/mL and sprayed on ten G. brimblecombei nymphs per Eucalyptus leaf cut and placed on a hydroretentive gel inside per Petri dishes as a replication. The number of dead insects was quantified, daily, for seven days, and transferred to humid chambers. Cordyceps javanica (LCBPF 11) and C. fumosorosea (LCBPF 12 and LCBPF 63) were identified with a molecular analysis and all isolates were pathogenic to the insects and indicates that they could be used to manage G. brimblecombei and adds to reports that, normally, fungi cause greater mortality on insects of the same order as that from which they were isolated.

Resumo Os microRNAs (miRNAs) são reconhecidos como biomarcadores do diabetes mellitus tipo 2 (DM2), úteis para a compreensão do metabolismo da doença, e possuem grande potencial como alvos terapêuticos. O aumento da expressão de BDNF e IGF1 está altamente envolvido nos benefícios as vias de insulina e glicose, porém, são regulados negativamente em condições de resistência à insulina, enquanto seu aumento de expressão está correlacionado com a melhora do metabolismo da glicose e da insulina. Estudos sugerem a regulação desses genes por microRNA em vários contextos diferentes, proporcionando uma nova abordagem de investigação para compreender o metabolismo do DM2 e revelar potenciais alvos terapêuticos. No presente estudo, investigamos em diferentes modelos animais (humanos, ratos e camundongos) miRNAs que têm como alvo BDNF e IGF1 em tecido muscular esquelético com condições fisiológicas de DM2. As análises foram realizadas utilizando ferramentas de bioinformática e bancos de dados para predição de miRNA, homologia molecular, validação experimental de interações, expressão na condição fisiológica estudada e interação em rede. Os resultados mostraram três candidatos a miRNAs para IGF1 (miR-29a, miR-29b e miR-29c) e um para BDNF (miR-206). As avaliações experimentais e a busca pela expressão no músculo esquelético de indivíduos com DM2 confirmaram a interação prevista entre miRNA-mRNA para miR-29b e miR-206 através de modelos humanos, ratos e camundongos. Essa interação foi reafirmada em múltiplas análises de rede. Em conclusão, nossos resultados mostram a relação de regulação entre miR-29b e miR-206 com os genes investigados, em diversos tecidos, sugerindo um padrão de inibição. Contudo, esses dados mostram um grande número de possíveis processos fisiológicos de interação para perspectivas biotecnológicas.

Abstract microRNAs (miRNAs) are recognized as diabetes mellitus type 2 (T2DM) biomarkers useful for disease metabolism comprehension and have great potential as therapeutics targets. BDNF and IGF1 increased expression are highly involved in the benefits of insulin and glucose paths, however, they are down-regulated in insulin resistance conditions, while their expression increase is correlated to the improvement of glucose and insulin metabolism. Studies suggest the microRNA regulation of these genes in several different contexts, providing a novel investigation approach for comprehending T2DM metabolism and revealing potential therapeutic targets. In the present study, we investigate in different animal models (human, rat, and mouse) miRNAs that target BDNF and IGF1 in skeletal muscle tissue with T2DM physiological conditions. Bioinformatics tools and databases were used to miRNA prediction, molecular homology, experimental validation of interactions, expression in the studied physiological condition, and network interaction. The findings showed three miRNAs candidates for IGF1(miR-29a, miR-29b, and miR-29c) and one for BDNF (miR-206). The experimental evaluations and the search for the expression in skeletal muscle from T2DM subjects confirmed the predicted interaction between miRNA-mRNA for miR-29b and miR-206 through human, rat, and mouse models. This interaction was reaffirmed in multiple network analyses. In conclusion, our results show the regulation relationship between miR-29b and miR-206 with the investigated genes, in several tissues, suggesting an inhibition pattern. Nevertheless, these data show a large number of possible interaction physiological processes, for future biotechnological prospects.

Resumo A adubação orgânica é uma opção mais barata e de grande eficácia em relação à rentabilidade e consequente melhoria da estrutura física, química e biológica do solo. Desta forma, o objetivo deste trabalho foi avaliar diferentes tipos de adubação: orgânica (cama de frango), mineral e via foliar sobre parâmetros de produtividade de alface cultivada em diferentes tipos de plantio. Os tratamentos consistiram na utilização de dois sistemas de plantio (P1 - Linha e P2 - Quincôncio) e adubações minerais e orgânicas (A1 - adubação mineral; A2 - adubação mineral + adubação foliar; A3 - adubação orgânica com cama de aviário e A4 - adubação orgânica + mineral). As unidades experimentais foram compostas por 36 e 52 plantas, respectivamente, para os tratamentos em linha e em quincôncio, sendo avaliadas todas as plantas centrais da unidade experimental. Foram observados a altura do coração, massa fresca e número de folhas. Os tratamentos mineral e mineral + foliar não diferenciaram entre si, tanto em linha quanto em quincôncio. O tratamento que se destacou em relação às variáveis analisadas foi aquele baseado na adubação orgânica e sistema de plantio em quincôncio, refletindo em maior número de pés de alface e melhor aproveitamento da área.

Abstract Organic fertilization is a cheaper and highly effective option for profitability and consequent improvement of the soil's physical, chemical, and biological structure. Thus, the objective of this work was to evaluate different types of fertilization: organic (poultry shed litter), mineral, and leaf path on yield parameters of lettuce grown in various types of planting. The treatments consisted of using two planting systems (P1 - Line and P2 - quincunxes) and mineral and organic fertilizers (A1 - mineral fertilization; A2 - mineral fertilization + leaf fertilization; A3 - organic fertilization with poultry shed litter and A4 - fertilization organic + mineral). The experimental units consisted of 36 and 52 plants, respectively, for treatments P1 and P2, and all central plants of the experimental unit were evaluated. Heart height, fresh mass, and leaf number were observed. The mineral and mineral + leaf treatments did not differentiate, either in line or in quincunxes. The treatment that stood out about the analyzed variables was the organic fertilization and quincunxes planting system, reflecting a more significant number of lettuce plants and better use of the area.

Resumo Em uma escala global o Sorghum bicolor (L.) é uma das culturas mais importantes, ocupando o quinto lugar entre todos os cereais. É cultivada na África, Ásia, Oceania e Américas, onde serve como fonte de alimento e ração para humanos e animais, respectivamente. No entanto, a produção é limitada por vários fatores, incluindo pragas e doenças. Entre as pragas que atacam o sorgo, Schizaphis graminum (Rondani), comumente chamado de pulgão verde dos cereais, é a praga mais destrutiva do sorgo. O dano de S. graminum ao sorgo é agravado pelo déficit hídrico que favorece sua ocorrência. Informações limitadas sobre a distribuição espacial da praga e seus inimigos naturais impedem o desenvolvimento de estratégias de manejo ecologicamente corretas. Portanto, o objetivo desta pesquisa foi determinar a distribuição espaço-temporal de S. graminum e seu inimigo natural Coccinella septempunctata (L.) durante a fase vegetativa e reprodutiva da cultura por meio de análise geoestatística. A distribuição espaço-temporal de S. graminum foi influenciada pelo estágio de desenvolvimento do sorgo, paisagem circundante e presença de seu principal predador C. septempunctata. Além disso, a abundância de C. septempunctata foi influenciada pela densidade de S. graminum. Os resultados deste estudo são necessários para o desenvolvimento de estratégias sustentáveis de manejo de pragas contra S. graminum.

Abstract At the global level, Sorghum bicolor (L.), is one of the most important crops, which ranks fifth among all cereals. It is cultivated in Africa, Asia, Oceania and the Americas, where it serves as a source of food and feed for humans and animals, respectively. However, production is constrained by several factors including pests and diseases. Among the pests that are known to attack Sorghum, Schizaphis graminum (Rondani), commonly called the green cereal aphid, is the most destructive pest of sorghum. S. graminum damage to sorghum is worsen by water deficit which favors its occurrence. Limited information on the spatial distribution of the pest and its natural enemies impedes the development of ecologically friendly management strategies. Therefore, the objective of this research was to determine the spatiotemporal distribution of S. graminum and its natural enemy Coccinella septempunctata (L.) during the vegetative and reproductive stage of the crop using geostatistical analysis. The spatiotemporal distribution of S. graminum was influenced by Sorghum development stage, surrounding landscape, and presence of its main predator C. septempunctata. Moreover, the abundance of C. septempunctata was influenced by the density of S. graminum. The findings from this study are required for developing sustainable pest management strategies against S. graminum.

Abstract Analytical and computational calibrations and subsequent parametric analyses were performed on the four UHPFRC beams under flexure to estimate their actual shear strength. The computational models were calibrated using different values for the CDP parameters, and a finite element mesh sensitivity study was conducted. These models predicted the experimental behavior satisfactorily, and the analytical model was also able to find the beams’ failure loads and proved to be a simple tool to estimate their behavior. The parametric analysis showed that the current beams did not require stirrups once the UHPFRC had high shear strength, and the maximum shear capacity was accurately determined.

Health literacy (HL) is defined as a cognitive and social skill that determines the motivation and ability of individuals to understand and use information to promote and maintain proper health. Inadequate HL has been associated with worse outcomes in diabetes control, poor self-care, and higher hospitalization rates for some chronic diseases. We hypothesized that HL influences the prevalence of diabetic retinopathy (DR) among individuals with type 2 diabetes mellitus (T2DM) and that inadequate glycemic control would mediate this association. This was a cross-sectional study carried out with 288 participants of the “Brazilian Diabetes Study” cohort. Inclusion criteria were people diagnosed with T2DM aged between 40 and 70 years and ability to read and write. In the adequate HL group, DR was found in 16.5% of participants and in the inadequate HL group, it was found in 32.8% (P=0.0081). Individuals with inadequate HL had a higher risk of having DR, and this association was still statistically significant after adjusting for HbA1c, low-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure. In conclusion, HL is related to DR without the mediation of classical clinical variables.

Abstract Tityus serrulatus scorpion is responsible for a significant number of envenomings in Brazil, ranging from mild to severe, and in some cases, leading to fatalities. While supportive care is the primary treatment modality, moderate and severe cases require antivenom administration despite potential limitations and adverse effects. The remarkable proliferation of T. serrulatus scorpions, attributed to their biology and asexual reproduction, contributes to a high incidence of envenomation. T. serrulatus scorpion venom predominantly consists of short proteins acting as neurotoxins (α and β), that primarily target ion channels. Nevertheless, high molecular weight compounds, including metalloproteases, serine proteases, phospholipases, and hyaluronidases, are also present in the venom. These compounds play a crucial role in envenomation, influencing the severity of symptoms and the spread of venom. This review endeavors to comprehensively understand the T. serrulatus scorpion venom by elucidating the primary high molecular weight compounds and exploring their potential contributions to envenomation. Understanding these compounds' mechanisms of action can aid in developing more effective treatments and prevention strategies, ultimately mitigating the impact of scorpion envenomation on public health in Brazil.

Screener, a board game supplemented with online resources, was introduced and distributed by the Brazilian Society of Pharmacology and Experimental Therapeutics to postgraduate programs as an instructional tool for the process of drug discovery and development (DDD). In this study, we provided a comprehensive analysis of five critical aspects for evaluating the quality of educational games, namely: 1) description of the intervention; 2) underlying pedagogical theory; 3) identification of local educational gaps; 4) impact on diverse stakeholders; and 5) elucidation of iterative quality enhancement processes. We also present qualitative and quantitative assessments of the effectiveness of this game in 11 postgraduate courses. We employed the MEEGA+ online survey, comprising thirty-three close-ended unipolar items with 5-point Likert-type response scales, to assess student perceptions of the quality and utility of Screener. Based on 115 responses, the results indicated a highly positive outlook among students. In addition, we performed a preliminary evaluation of learning outcomes in two courses involving 28 students. Pre- and post-quizzes were applied, each consisting of 20 True/False questions directly aligned with the game's content. The analysis revealed significant improvement in students' performance following engagement with the game, with scores rising from 8.4 to 13.3 (P<0.0001, paired t-test) and 9.7 to 12.7 (P<0.0001, paired t-test). These findings underscore the utility of Screener as an enjoyable and effective tool for facilitating a positive learning experience in the DDD process. Notably, the game can also reduce the educational disparities across different regions of our continental country.

Abstract Objective To analyze access to surgical care for congenital heart diseases in public specialized centers in the state of São Paulo before and during the COVID-19 pandemic and availability of surgical care in specialized hospitals, to identify bottlenecks in the care path for neonatal cardiac surgery. Methods This study included 1,437 children, under one year old, with congenital heart disease and formal referral to heart surgery between February 1, 2019, and February 28, 2021. Quantitative data analysis was performed using t-tests or the Mann-Whitney test. Results Approximately 30 % of children with urgent congenital heart disease could not access recommended care, mainly those needing complex surgeries (categories RACHS 4 to 6). The main diagnoses of neonates accessing care were patency of the ductus arteriosus (10.5 %) and coarctation of the aorta (10.1 %). Referral time for children in RACHS 1 to 3 was 4 days (median), while for those in categories 4 to 6, it was 7 days (p< 0.001). Longer referral time (20 days) was associated with court orders. During the pandemic, referral time decreased to 3 days, compared to 5 days (median) in the pre-pandemic period (p< 0.001). Conclusion The emergency surgical treatment supply for congenital heart diseases is insufficient compared to the current demand. Future research should evaluate if access to care in publicly funded hospitals could be improved by better access to prenatal care for pregnant women, increased diagnostic and therapeutic capacity in pediatric cardiology, and financial incentives for complex cardiac surgeries.