Abstract Mortality caused by the COVID-19 pandemic has impacted indicators of Years of Potential Life Lost (YPLL) worldwide. This study aimed to estimate the YPLL due to mortality caused by COVID-19, according to sex, age group, and race/color in Brazil, from March 2020 to December 2021. Deaths caused by COVID-19 were characterized, in which the rates and ratios of standardized YPLL rates, the average number of years of potential life lost (ANYPLL), and the average age at death (AAD) were estimated and compared. Overall, 13,776,969.50 potential years of life were lost, which resulted in an average loss of 22.5 potential years not lived. A greater loss of potential years of life was identified in men (58.12%) and in the age groups from 0 to 59 years in the black (58.92%) and indigenous (63.35%) populations, while in the age groups of 60 years and over, a greater loss of YPLL was observed in the white (45.89%) and yellow (53.22%) populations. Women recorded the highest ADD, with the exception of indigenous women. White men (1.63), brown men (1.59), and black men (1.61) had the highest rates when compared to white women. Although COVID-19 has a greater impact on the elderly, it was the black and indigenous populations under the age of 60 who had the greatest loss of potential years of life.

Resumo A mortalidade provocada pela pandemia da COVID-19 tem produzido impactos aos indicadores de Anos Potenciais de Vida Perdidos (APVP) em nível mundial. Objetiva-se estimar os APVP devido à mortalidade por COVID-19, segundo sexo, faixa etária e raça/cor, no período de março de 2020 a dezembro de 2021, no Brasil. Foram caracterizadas as mortes por COVID-19, estimadas e comparadas as taxas e razão de taxas padronizadas de APVP, a média de anos potenciais de vida não vividos (APVNV) e a idade média do óbito (IMO). No geral, foram perdidos 13.776.969,50 anos potenciais de vida, o que determinou uma perda média de 22,5 anos potenciais não vividos. Houve maior perda de anos potenciais de vida nos homens (58,12%) e nas faixas etárias de 0 a 59 anos nas populações negra (58,92%) e indígena (63,35%), enquanto nas faixas etárias de 60 anos e mais foi observada maior perda de APVP nas populações branca (45,89%) e amarela (53,22%). As mulheres registraram as maiores IMO, com exceção das mulheres indígenas. Homens brancos (1,63), pardos (1,59) e pretos (1,61) tiveram as maiores taxas em comparação às mulheres brancas. Apesar da COVID-19 ter tido maior impacto em idosos, foram as populações negra e indígena na faixa de menos de 60 anos quem teve maior perda de anos potenciais de vida.

ABSTRACT Introduction: Previous research demonstrated benefits of late conversion to mTOR inhibitors against cutaneous squamous cell carcinomas (cSCC) in kidney transplant recipients (KTR), despite of poor tolerability. This study investigated whether stepwise conversion to sirolimus monotherapy without an attack dose modified the course of disease with improved tolerability. Methods: This prospective exploratory study included non-sensitized KTR with more than 12-months post-transplant, on continuous use of calcineurin inhibitors (CNI)-based therapy, and with poor-prognosis cSCC lesions. Incidence densities of high-risk cSCC over 3-years after conversion to sirolimus-monotherapy were compared to a non-randomized group with high-risk cSCC but unsuitable/not willing for conversion. Results: Forty-four patients were included (83% male, mean age 60 ± 9.7years, 62% with skin type II, mean time after transplantation 9 ± 5.7years). There were 25 patients converted to SRL and 19 individuals kept on CNI. There was a tendency of decreasing density of incidence of all cSCC in the SRL group and increasing in the CNI group (1.49 to 1.00 lesions/patient-year and 1.74 to 2.08 lesions/patient-year, p = 0.141). The density incidence of moderately differentiated decreased significantly in the SRL group while increasing significantly in the CNI group (0.31 to 0.11 lesions/patient-year and 0.25 to 0.62 lesions/patient-year, p = 0.001). In the SRL group, there were no sirolimus discontinuations, no acute rejection episodes, and no de novo DSA formation. Renal function remained stable. Conclusions: This study suggests that sirolimus monotherapy may be useful as adjuvant therapy of high-risk cSCC in kidney transplant recipients. The conversion strategy used was well tolerated and safe regarding key mid-term transplant outcomes.

RESUMO Introdução: Pesquisas anteriores demonstraram benefícios da conversão tardia para inibidores de mTOR contra carcinomas espinocelulares cutâneos (CECs) em receptores de transplante renal (RTR), apesar da baixa tolerabilidade. Este estudo investigou se a conversão gradual para monoterapia com sirolimo sem dose de ataque modificou o curso da doença com melhor tolerabilidade. Métodos: Esse estudo prospectivo exploratório incluiu RTR não sensibilizados com mais de 12 meses pós-transplante, uso contínuo de terapia imunossupressora baseado em inibidor de calcineurina (CNI) associado a micofenolato de sódio ou azatioprina, com lesões de CECs de mau prognóstico. Comparou-se densidades de incidência de CECs de alto risco durante 3 anos após conversão para monoterapia com sirolimo à um grupo não randomizado com CECs classificados conforme os mesmos critérios de gravidade do grupo sirolimo, mas inadequado/não disposto à conversão. Resultados: Foram incluídos 44 pacientes (83% homens, idade média 60 ± 9,7 anos, 62% com fototipo de pele II, tempo médio pós-transplante 9 ± 5,7 anos). 25 pacientes foram convertidos para SRL e 19 indivíduos mantidos em CNI. Foi observado tendência de diminuição da densidade de incidência de todos CECs no grupo SRL e de aumento no grupo CNI (1,49 a 1,00 lesões/paciente-ano; 1,74 a 2,08 lesões/paciente-ano; p = 0,141). A densidade de incidência de lesões moderadamente diferenciadas diminuiu significativamente no grupo SRL enquanto aumentou significativamente no grupo CNI (0,31 a 0,11 lesões/paciente-ano; 0,25 a 0,62 lesões/paciente-ano; p = 0,001). No grupo SRL não houve descontinuação do sirolimo, nenhum episódio de rejeição aguda e nenhuma formação de DSA de novo. Função renal permaneceu estável. Conclusões: Esse estudo sugere que a monoterapia com sirolimo pode ser útil como terapia adjuvante de CECs de alto risco em RTR. A estratégia de conversão usada foi bem tolerada e segura em relação aos principais desfechos do transplante a médio prazo.

Abstract Introduction: cystic fibrosis is a disease that causes inflammation, oxidative stress and metabolic changes that lead to nutrient deficiency, such as vitamin D deficiency. On the other hand, it is suggested that vitamin D has anti-inflammatory and antioxidant actions. Objective: to evaluate the prevalence of hypovitaminosis D and the association between serum 25 hydroxyvitamin D levels with markers of oxidative stress and inflammation in patients with cystic fibrosis. Method: a cross-sectional study was carried out with 48 patients with cystic fibrosis including children, adolescents and adults in the northeast region of Brazil. Blood collection was performed for analysis of 25-hydroxyvitamin D, calcium, parathyroid hormone, inflammatory process (C-reactive protein [CRP] and alpha-1-acid glycoprotein-A1 [A1GPA]) and oxidative stress (malondialdehyde (MDA) and total antioxidant capacity [CAOT]). The statistical analysis was performed using the "Statistical Package for the Social Sciences", adopting a significance level of p < 0.05. Results: vitamin D insufficiency/deficiency was found in 64.6 % of patients. After multiple linear regression analysis, MDA showed an inverse association with blood values of 25-hydroxyvitamin D (p < 0.05) conditioned by the presence of inflammatory process markers. When only oxidative stress was evaluated, this association disappeared. Conclusion: in conclusion, there was a high prevalence of hypovitaminosis D, with 25(OH)D levels associated with greater oxidative stress when combined with inflammatory markers. Improved vitamin D levels may be an alternative to reduce the damage caused by excess oxidative stress and inflammation in CF patients.

Resumen Introducción: la fibrosis quística es una enfermedad que cursa con inflamación, estrés oxidativo y cambios metabólicos que conducen a deficiencia de nutrientes como la vitamina D. Por otro lado, se sugiere que la vitamina D tiene acción antiinflamatoria y antioxidante. Objetivo: evaluar la prevalencia de hipovitaminosis D y la asociación entre los niveles séricos de 25 hidroxivitamina D con los marcadores de estrés oxidativo e inflamación en pacientes con fibrosis quística. Método: estudio transversal realizado con 48 pacientes con fibrosis quística, niños, adolescentes y adultos, de la región nordeste de Brasil. Se realizó una extracción de sangre para el análisis de 25-hidroxivitamina D, calcio, hormona paratiroidea, proceso inflamatorio (proteína C-reactiva [PCR] y alfa-1-glucoproteína ácida-A1 [A1GPA]) y estrés oxidativo (malondialdehído [MDA] y capacidad antioxidante total [CAOT]). El análisis estadístico se realizó utilizando el "Paquete Estadístico para las Ciencias Sociales", adoptando un nivel de significancia de p < 0,05. Resultados: se encontró insuficiencia/deficiencia de vitamina D en el 64,6 % de los pacientes. Después de un análisis de regresión lineal múltiple, la MDA mostró una asociación inversa con los valores sanguíneos de 25-hidroxivitamina D (p < 0,05) condicionado a la presencia de marcadores de proceso inflamatorio; cuando solo se evalúa el estrés oxidativo, esta asociación desaparece. Conclusión: en conclusión, hubo una alta prevalencia de hipovitaminosis D, con niveles de 25(OH)D asociados a mayor estrés oxidativo cuando se combina con marcadores inflamatorios. La mejora de los niveles de vitamina D puede ser una alternativa para reducir el daño causado por el exceso de estrés oxidativo y la inflamación en pacientes con FQ.

Abstract Objective: This article aims to review the literature regarding the use of technologies to promote mental health for pregnant women. We seek to: understand the strategies that pregnant women use for mental health care. Also, we investigate the existence of scientific evidence that validates such practices. Methods: This study follows the PRISMA guidelines for systematic reviews. We analyze 27 studies published between 2012 and 2019. We include publications in Portuguese, English, and Spanish. Results: The results revealed several different possibilities to use technology, including the use of text messages and mobile applications on smartphones. Mobile applications are the most commonly used approaches (22.5%). Regarding the strategies used, cognitive-behavioral approaches, including mood checks, relaxation exercises, and psychoeducation comprised 44.12% of the content. Conclusion: There is a need for further investigation and research and development efforts in this field to better understand the possibilities of intervention in mental health in the digital age.

Resumo Objetivo: Este artigo objetiva revisar a literatura quanto ao uso das tecnologias como promotoras de saúde mental de gestantes. Desta forma, compreender quais são as estratégias utilizadas no cuidado da saúde mental dessas mulheres, assim como verificar se há evidências científicas que justifiquem a implementação dessas práticas. Métodos: Este estudo segue o protocolo PRISMA para revisões sistemáticas de 27 estudos publicados em 2012-2019, incluindo publicações em português, inglês e espanhol. Resultados: Os resultados revelaram diferentes possibilidades de utilização da tecnologia, sendo o uso de mensagens de texto e de aplicativos em smartphones mais os utilizados (22,5%). No que se refere às ferramentas utilizadas, estratégias cognitivo-comportamentais, tais como verificação do humor, exercícios de relaxamento e psicoeducação compreenderam 44,12% do conteúdo. Conclusão: Verifica-se a necessidade de mais investimentos nessa área para que se possa compreender as possibilidades de intervenção em saúde mental na era digital.

Abstract Background Literature is scarce on echocardiographic characteristics of COVID-19 patients admitted to the intensive care unit (ICU). Objectives To describe echocardiographic characteristics of ICU COVID-19 patients and associate them with clinical signals/symptoms, laboratory findings and outcomes. Methods Patients with RT-PCR-confirmed COVID-19, admitted to the ICU, who underwent echocardiography were included. Clinical characteristics associated with an abnormal echocardiogram (systolic ventricular dysfunction of any degree — left and/or right ventricle — and/or high filling pressures and/or moderate to severe pericardial effusion) were analyzed. Groups were compared using the Student’s t-test, chi-square, and logistic regression. A p < 0.05 was considered statistically significant. Results A total of 140 patients met inclusion criteria, and 74 (52.9%) had an abnormal echocardiogram. A low number of left and right ventricular systolic dysfunction was observed, and 35% of the population had a normal diastolic function. In the univariate analysis, characteristics associated with abnormal echocardiogram were age, chronic kidney disease, elevated troponin, previous heart failure, and simplified acute physiology score 3 (SAPS 3). In the regression model, troponin and SAPS3 score were independent markers of abnormal echocardiogram. An abnormal echocardiogram was associated with a higher prevalence of in-hospital death (RR 2.10; 95% CI 1.04-4.24) and orotracheal intubation (RR 2.3; 95% CI 1.14-4.78). Conclusions COVID-19 has little effect on ventricular function, but it is common to find increased filling pressures. Elevated serum troponin level and SAPS3 score were the independent markers of an abnormal echocardiogram. In addition, the prevalence of in-hospital death and need for mechanical ventilation were higher in patients with abnormal echocardiogram.

ABSTRACT Vulnerable populations, such as migrants and refugees, have an increased risk of tuberculosis disease, especially in the first years after arrival in the host country. The presence of migrants and refugees in Brazil exponentially grew over the period between 2011 and 2020, and approximately 1.3 million migrants from the Global South were estimated to be residing in Brazil, most of whom from Venezuela and Haiti. Tuberculosis control programs for migrants can be divided into pre- and post-migration screening strategies. Pre-migration screening aims to identify cases of tuberculosis infection (TBI) and can be carried out in the country of origin (pre-entry) or in the destination country (at entry). Pre-migration screening can also detect migrants at an increased risk of developing tuberculosis in the future. High-risk migrants are then followed up in post-migration screening. In Brazil, migrants are considered a priority group for the active search for tuberculosis cases. However, there is no recommendation or plan regarding screening for TBI in migrants and refugees. Ensuring prevention, diagnosis, and treatment for TBI and tuberculosis disease in migrant populations is an important aspect of tuberculosis control and elimination. In this review article, we address epidemiological aspects and access to health care for migrants in Brazil. In addition, the migration medical screening for tuberculosis was reviewed.

RESUMO Populações vulneráveis, como imigrantes e refugiados, apresentam maior risco de tuberculose doença, especialmente nos primeiros anos após a chegada ao país de acolhimento. A presença de imigrantes e refugiados no Brasil cresceu exponencialmente no período entre 2011 e 2020, sendo estimado que aproximadamente 1,3 milhão de imigrantes do Sul Global residiam no Brasil, a maioria proveniente da Venezuela e do Haiti. Os programas de controle da tuberculose para imigrantes podem ser divididos em estratégias de triagem pré- e pós-migração. A triagem pré-migração visa identificar casos de tuberculose infecção (TBI) e pode ser realizada no país de origem (pré-entrada) ou no país de destino (no momento da entrada). A triagem pré-migração também pode detectar imigrantes com maior risco de desenvolver tuberculose no futuro. Os imigrantes de alto risco são então acompanhados na triagem pós-migração. No Brasil, os imigrantes são considerados um grupo prioritário para a busca ativa de casos de tuberculose. No entanto, não há recomendação ou plano sobre triagem para TBI em imigrantes e refugiados. Garantir a prevenção, o diagnóstico e o tratamento da TBI e da tuberculose doença em populações imigrantes é um aspecto importante do controle e eliminação da tuberculose. Neste artigo de revisão, abordamos aspectos epidemiológicos e acesso à saúde para imigrantes no Brasil. Além disso, revisou-se a triagem médica de imigrantes para tuberculose.

Abstract Cyclodextrins (CDs) have the ability to encapsulate numerous molecules and have applicability in several industrial areas, however, their cost has made their use difficult. To seek alternatives that may enable the use of DCs, the present study evaluated the efficiency of the ultrafiltration process in a continuous system to produce CDs from the enzyme cyclomaltodextrin glucanotransferase (CGTase) from recombinant Bacillus subtilis WB800. The possibility of using the crude enzyme as an alternative means of producing CDs was also evaluated. All strategies evaluated in this research proved to be promising for the production of CDs, with the production of β-CD being the most efficient (average of 15 mmol/L) using crude recombinant enzyme and a temperature of 50 °C. Therefore, the results obtained can contribute to the reduction of stages and costs of production of CDs, favoring their industrial application.

ABSTRACT Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as Nonalcoholic fatty liver disease (NAFLD), is one of the most common hepatic diseases in individuals with overweight or obesity. In this context, a panel of experts from three medical societies was organized to develop an evidence-based guideline on the screening, diagnosis, treatment, and follow-up of MASLD. Material and methods: A MEDLINE search was performed to identify randomized clinical trials, meta-analyses, cohort studies, observational studies, and other relevant studies on NAFLD. In the absence of studies on a certain topic or when the quality of the study was not adequate, the opinion of experts was adopted. Classes of Recommendation and Levels of Evidence were determined using prespecified criteria. Results: Based on the literature review, 48 specific recommendations were elaborated, including 11 on screening and diagnosis, 9 on follow-up, 14 on nonpharmacologic treatment, and 14 on pharmacologic and surgical treatment. Conclusions: A literature search allowed the development of evidence-based guidelines on the screening, diagnosis, treatment, and follow-up of MASLD in individuals with overweight or obesity.

Abstract Fifteen polar extracts from leaf, seed, pod, stem, flower and root of Crotalaria spectabilis were prepared using aqueous systems, based on the principles of green chemistry, and showed different protease inhibitor (PI) activities on trypsin, papain, pepsin and the extracellular L. amazonensis serine protease (LSPIII). The most pronounced inhibitory effect on LSPIII was observed in leaf (CS-P), root, stem, flower (CS-FPVPP) and pod (CS-VA) extracts. Crotalaria extracts exhibited low cytotoxicity on macrophages; however, they decreased the viability of L. amazonensis promastigotes and amastigotes, as observed in leaf (CS-AE, CS-P, CS-T and CS-PVPP), seed (CS-ST), flower and root (CS-RA) extracts. CS-P was chosen to study PI and secondary metabolites and a 10-12 kDa protein, analyzed by mass spectrometry, was identified as a serine PI homologous with papaya latex serine PI. Glycosylated flavonoids, such as quercetins, vitexin and tricin were the major secondary metabolites of CS-P. The presence of PIs in C. spectabilis is a new finding, especially in other organs than seeds since PIs have been reported only in seed legumes. Besides, this is the first report of antileishmanial activity of C. spectabilis extracts and the identification of serine polypeptide PI and glycosylated flavonoids from leaf.

ABSTRACT The objective of this work was to produce and characterize biochar from sugarcane straw, as well as to investigate possible phytotoxic effects on the germination of cotton, maize, and soybean. To this end, the biochar was produced in a double-drum oven and characterized by different techniques. The germination trials were conducted in vitro, with biochar doses varying between 0 and 100 t/ha. The biochar was obtained with a yield of 40%, pH equal to 9.10, electrical conductivity of 2.22 dS/m and specific surface area of 20.3 m2/g. The elemental analysis showed H/C and O/C atomic ratios of 0.41 and 0.21, respectively. The FTIR showed the presence of C=C groups, while SEM/EDS showed a honeycomb porous structure and nutrients such as Mg, K and Ca. The germination test classified the biochar as a phytonutrient for corn and showed no phytotoxicity for soybeans. On the other hand, for cotton, the highest doses (50 and 100 t/ha) caused phytotoxicity. The results of this work meet the global demands for green techniques. Biochar made from sugarcane straw is a promising technology to improve the infertility of poor soils and manage carbon sequestration.

RESUMO O objetivo deste trabalho foi produzir e caracterizar o biocarvão a partir da palha de cana-de-açúcar, bem como investigar possíveis efeitos fitotóxicos às germinações de algodão, milho e soja. Para tanto, o biocarvão foi produzido em forno de duplo tambor e caracterizado por diferentes técnicas. Os ensaios de germinação foram conduzidos in vitro, com doses de biocarvão variando entre 0 e 100 t/ha. O biocarvão foi obtido com rendimento de 40%, pH igual a 9,10, condutividade elétrica de 2,22 dS/m e área superficial específica de 20,3 m2/g. A análise elementar mostrou razões atômicas H/C e O/C de 0,41 e 0,21, respectivamente. A FTIR mostrou a presença de grupos C=C, enquanto a MEV/EDS mostrou estrutura porosa tipo favo de mel e nutrientes, como o Mg, K e Ca. O ensaio de germinação classificou o biocarvão como fitoestimulante para o milho e mostrou ausência de fitotoxicidade para soja. Por outro lado, para o algodão, as doses mais elevadas (50 e 100 t/ha) causaram fitotoxicidade. Os resultados deste trabalho vêm ao encontro das demandas globais por técnicas verdes. O biocarvão feito da palha de cana-de-açúcar é uma tecnologia promissora para melhorar a infertilidade de solos pobres e gerir o sequestro de carbono.

ABSTRACT Historically, all efforts against tuberculosis were focused on rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, more and more evidence has been found on the dramatic consequences of the condition defined as post-tuberculosis lung disease (PTLD). Approximately one third of patients surviving pulmonary tuberculosis face considerable ongoing morbidities, including respiratory impairment, psychosocial challenges, and reduced health-related quality of life after treatment completion. Given the important global and local burden of tuberculosis, as well as the estimated burden of PTLD, the development of a consensus document by a Brazilian scientific society-Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)-was considered urgent for the prevention and management of this condition in order to allocate resources to and within tuberculosis services appropriately and serve as a guide for health care professionals. A team of eleven pulmonologists and one methodologist was created by the SBPT to review the current evidence on PTLD and develop recommendations adapted to the Brazilian context. The expert panel selected the topics on the basis of current evidence and international guidelines. During the first phase, three panel members drafted the recommendations, which were divided into three sections: definition and prevalence of PTLD, assessment of PTLD, and management of PTLD. In the second phase, all panel members reviewed, discussed, and revised the recommendations until a consensus was reached. The document was formally approved by the SBPT in a special session organized during the 2023 SBPT Annual Conference.

RESUMO Historicamente, todos os esforços contra a tuberculose concentraram-se no diagnóstico rápido e no tratamento efetivo para quebrar a cadeia de transmissão do Mycobacterium tuberculosis. No entanto, nos últimos anos, têm sido encontradas mais e mais evidências sobre as dramáticas consequências da condição definida como doença pulmonar pós-tuberculose (DPPT). Aproximadamente um terço dos pacientes que sobrevivem à tuberculose pulmonar enfrenta morbidades consideráveis e persistentes, incluindo comprometimento respiratório, desafios psicossociais e redução da qualidade de vida relacionada à saúde após o término do tratamento. Diante da importante carga global e local da tuberculose, bem como da carga estimada da DPPT, considerou-se urgente o desenvolvimento de um documento de consenso por uma sociedade científica brasileira - a Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) - para a prevenção e manejo dessa condição, a fim de alocar recursos de forma adequada para e nos serviços de tuberculose e servir de guia para os profissionais de saúde. Uma equipe de onze pneumologistas e um metodologista foi criada pela SBPT para revisar as evidências atuais sobre a DPPT e desenvolver recomendações adaptadas ao contexto brasileiro. O painel de especialistas selecionou os temas com base nas evidências atuais e diretrizes internacionais. Durante a primeira fase, três membros do painel redigiram as recomendações, que foram divididas em três seções: definição e prevalência de DPPT, avaliação da DPPT e manejo da DPPT. Na segunda fase, todos os membros do painel analisaram, discutiram e revisaram as recomendações até chegar a um consenso. O documento foi aprovado formalmente pela SBPT em sessão especial organizada durante o Congresso Anual da SBPT de 2023.

Abstract Objective To evaluate levels of pain, range of motion, hip isometric peak torque, and functional task performance in patients 6 months after total hip arthroplasty (THA) and to compare them to asymptomatic control participants (CG). Methods We recruited participants with unilateral THA due to hip osteoarthritis (OA) within a median of 6 months who had not developed postoperative complications. We assessed the pain levels, hip range of motion, peak isometric torque, self-reported assessment (Harris Hip Score) and objectively measured function (Timed Up & Go Test [TUG]) of the patients. The THA group was compared with a group of asymptomatic participants ≥50 years old recruited in the community. Comparisons are presented as mean differences (MDs) and 95% confidence intervals (CIs). Results A total of 23 participants were included in each group. Pain levels were low in the THA group (1.48 [1.60]), and 91.3% of the patients reported to be satisfied with the surgical procedure. Participants in the THA group reported significantly lower objectively measured (THA 12.2 [10.0–21.6]; CG 9.0 [6.7–12.2]) and self-reported function (THA 78.5 [43.8–93.9]; CG 100.0 [95.8–100.0]) compared with CG. The THA group also had significantly reduced range of motion for flexion (p< 0.001), internal (p< 0.001) and external rotation (p= 0.003) movements and reduced peak torque for flexion (p< 0.001), extension (p< 0.001), abduction (p< 0.001) and adduction (p= 0.024) movements compared with participants of the CG. Conclusions Despite reporting overall low pain scores and satisfaction with the surgery, the patients present with functional limitations, limited range of motion, and reduced muscle strength 6 months after THA. Evidence Level 3b

Resumo Objetivo Avaliar os níveis de intensidade da dor, amplitude de movimento, pico de torque isométrico do quadril e desempenho da tarefa funcional em pacientes 6 meses após a artroplastia total do quadril (ATQ), e comparar estes valores com os de participantes assintomáticos do grupo controle (GC). Métodos Recrutamos participantes com ATQ unilateral devida a osteoartrite (OA) do quadril, dentro de uma mediana de tempo de 6 meses, que não tinham desenvolvido complicações pós-operatórias. Os participantes foram avaliados quanto à intensidade da dor, à amplitude de movimento do quadril, ao pico de torque isométrico, à autoavaliação (questionário de avaliação do quadril Harris Hip Score [HHS, na sigla em inglês) e à função medida objetivamente por meio do teste Timed Up and Go (TUG, na sigla em inglês). O grupo ATQ foi comparado com um grupo de participantes assintomáticos com idade ≥ 50 anos recrutados na comunidade. As comparações são apresentadas como diferenças médias (DMs) e intervalos de confiança (ICs) de 95%. Resultados Cada grupo contou com 23 participantes. A intensidade da dor foi baixa no grupo ATQ (1,48 [1,60]), sendo que 91,3% dos pacientes relataram estar satisfeitos com o procedimento cirúrgico. Os participantes do grupo ATQ relataram uma função medida objetivamente significativamente menor (ATQ 12,2 [10,0-21,6]; GC 9,0 [6,7-12,2]) e a função autoavaliação (ATQ 78,5 [43,8-93,9]; GC 100,0 [95,8-100,0]), em comparação com o GC. O grupo ATQ também teve reduzida de forma significativa a amplitude de movimento para flexão (p< 0,001), os movimentos internos (p< 0,001) e de rotação externa (p= 0,003). O grupo ATQ também apresentou pico de torque reduzido para flexão (p< 0,001), extensão (p <0,001), movimentos de abdução (p< 0,001) e adução (p = 0,024) em comparação com os participantes do GC. Conclusões Apesar de informarem escores gerais de dor de baixa intensidade e satisfação com a cirurgia, os pacientes apresentaram limitações funcionais, amplitude de movimento limitada e redução da força muscular após 6 meses do procedimento cirúrgico de ATQ. Nível de Evidência3B.

Transformations involving structurally complex molecules, natural products and representative molecules are extremely important to obtain key reaction intermediates, in addition to accessing molecules with bioactive properties. The development of cyanation methodologies in those molecules becomes important, because nitriles are versatile and important building blocks in organic synthesis. They can be converted into other organic functions, including amines, alcohols, α-amino acids and various carbonyl compounds and can therefore become relevant synthetic intermediates. Recent studies show new and intriguing asymmetric cyanation protocols or reagents as those that use electrophilic cyanide source, metal- and oxidant-free or avoid the use of toxic cyanide reagents. Photoredox catalysis emerges as a relevant approach from the point of view of green and sustainable chemistry; usually provides access to the versatile skeleton of α-aminonitriles that among their various modes of reactivity and provide access to reactive iminium ion. Thus, this perspective aims to highlight these impressive advances as well as to show their main advantages and applications.

Resumo Fundamento Alguns estudos demonstraram uma maior prevalência de óbitos em portadores de fatores de risco cardiovascular (FRC) durante internação por COVID-19. Objetivos Avaliar o impacto do alto risco cardiovascular em pacientes internados em terapia intensiva por COVID-19 Métodos Estudo retrospectivo com pacientes admitidos em terapia intensiva, com diagnóstico confirmado de COVID-19 por RT-PCR e com pelo menos uma dosagem de troponina durante a internação. Os critérios para definição de paciente de alto risco cardiovascular (ARC) foram: histórico de doença cardiovascular estabelecida (infarto, AVC ou doença arterial periférica), diabetes, doença renal crônica com clearance < 60ml/min ou presença de 3 FRC (hipertensão, tabagismo, dislipidemia ou idade > 65 anos). O desfecho primário deste estudo é mortalidade hospitalar por todas as causas. P<0,05 foi considerado significativo. Resultados Foram incluídos 236 pacientes, média de idade= 61,14±16,2 anos, com 63,1% homens, 55,5% hipertensos e 33,1% diabéticos. Um total de 47,4% dos pacientes apresentavam ARC. Observou-se um aumento significativo da mortalidade conforme aumento do número de fatores de risco (0 FRC: 5,9%; 1 FRC: 17,5%; 2 FRC: 32,2% e ≥3 FRC: 41,2%; p=0,001). Na regressão logística ajustada para gravidade (escore SAPS3), o grupo de alto risco cardiovascular e troponina elevada apresentou maior ocorrência de mortalidade hospitalar (OR 40,38; IC95% 11,78-138,39). Pacientes sem alto risco cardiovascular, mas com troponina elevada, também exibiram associação significativa com o desfecho primário (OR 16,7; IC95% 4,45-62,74). Conclusão Em pacientes internados em terapia intensiva por COVID-19, a presença de alto risco cardiovascular afeta a mortalidade hospitalar somente em pacientes que apresentaram elevação de troponina.

Abstract Background Some studies have shown a higher prevalence of deaths in patients with cardiovascular risk factors (CRF) during hospitalization for COVID-19. Objectives To assess the impact of high cardiovascular risk in patients hospitalized in intensive care for COVID-19 Methods Retrospective study with patients admitted to an intensive care unit, with a diagnosis of COVID-19 confirmed by RT-PCR, and with at least one troponin measurement during hospitalization. The criteria for defining high cardiovascular risk (HCR) patients were: history of established cardiovascular disease (myocardial infarction, stroke, or peripheral arterial disease), diabetes, chronic kidney disease with clearance < 60ml/min, or presence of 3 CRFs (hypertension, smoking, dyslipidemia, or age > 65 years). The primary outcome of this study is all-cause in-hospital mortality. P<0.05 was considered significant. Results This study included 236 patients, mean age = 61.14±16.2 years, with 63.1% men, 55.5% hypertensive, and 33.1% diabetic; 47.4% of the patients also presented HCR. A significant increase in mortality was observed as the number of risk factors increased (0 FRC: 5.9%; 1 FRC: 17.5%; 2 FRC: 32.2% and ≥3 FRC: 41.2%; p=0.001). In the logistic regression adjusted for severity (SAPS3 score), the HCR and myocardial injury group had a higher occurrence of in-hospital mortality (OR 40.38; 95% CI 11.78-138.39). Patients without HCR but with myocardial injury also exhibited a significant association with the primary outcome (OR 16.7; 95% CI 4.45-62.74). Conclusion In patients hospitalized in intensive care for COVID-19, HCR impacts in-hospital mortality only in patients with myocardial injury.